Understanding the Health Bill

Catching some of Sir Paul Nurse’s programme on climate change scepticism, and the wider issue of communicating scientific knowledge and research to the public, I started thinking about the issues raised by this week’s publication of the Government’s Health and Social Care Bill. Sir Paul, speaking to individuals opposing the “consensus” view on climate change, HIV / AIDS, and GM foods, began to think about the responsibility falling upon the scientific community to better communicate its ideas, research papers, and the complexity of scientific knowledge and discovery. By considering scientific coverage in blogs, newspapers, and public opinion, Sir Paul seemed to suggest that the need for a simple narrative ran counter to the considered, hypothetical and provisional conclusions drawn in scientific papers.

Of course mentioned, but never really examined by the programme, was the Andrew Wakefield case, which has received so much coverage in the BMJ this week. The Times journalist Brian Deer has been exposing the ethical and scientific concerns at the heart of Wakefield’s research paper, published in The Lancet in 1998. Wakefield’s case is perhaps analogous to Sir Paul’s argument; that a robust piece of scientific research is no match for a strong narrative (or scare story) in the public opinion.

So how does this bring us onto the Health Bill? In its proposals to abolish Primary Care Trusts (PCTs) and Strategic Health Authorities, the legislation would introduce consortia of GPs as the commissioning bodies for the £80bn NHS budget. This means that family doctors will be tasked with making the decisions on which treatments are financially viable for their patients, rather than this being based on a judgement by the advisors at NICE (who recommend maximum-price treatments, based on the number of quality adjusted life years they would provide) and the accountants at the PCTs. Resource allocation will become much more personal; if a GP has to decide whether or not to provide expensive medication to a long-standing and well-liked patient, the dilemma will be that much more complex than for a PCT bureaucrat (this is not to condone or condemn either approach). Similarly, if a patient is denied treatment due to cost issues, they will know that the decision has been made by their GP, with all sorts of potential issues for doctor-patient relationships (as pointed out by the Royal College of GPs).

These are real, complex issues; could it be that it is about better communication between doctors, or politicians, and patients, or the public, to see the necessity of certain treatments being denied? Can a seriously ill patient relinquish the hope of treatment due to resource issues? And will this be any easier to stomach when decision-making is being conducted in your local surgery? Sir Paul seemed confident about the potential of science to overcome these pitfalls. It will be interesting to see how the changes to healthcare are communicated to – and understood by – the public.

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