Your visit to A&E in 2020

Man- Ooooowww! Help me!
Nurse- I’m with you now, sir. Welcome to the Serco quick response care service, how can we aid you today?
Man- Ooowww! Is this not A&E
Nurse- Well yes sir, but following a listening exercise with our customers Serco rebranded the department- they felt “Accident and Emergency” sounded too downbeat. So we are now “quick response care service”. How can we aid you today.
Man- I fell off a ladder and I think I broke my leg. I had to get a taxi in because the ambulance service said it was not resource friendly to provide transport for just a broken leg!
Nurse- yes, then Serco direct transport aid service will say that nowadays sir.
Man- I didn’t realise that I had to be cost effective to get an ambulance!
Nurse- well in order for us to meet our contractual targets, Serco has to be shown to be providing a value for money service. But what can you expect, people want a health care service that is free at the point of access and then complain when we provide that! Anyway, enough of this chit chat, I have two minutes to triage you,mane we have already used one of those minutes, so chop chop, how can we aid you today?
Man- as I say, I think that I’ve broken my leg.
Nurse- think you have or know you have?
Man- well how should I know?
Nurse- oh that’s a shame, if you knew it was broken we could have put you on the fast track treatment pathway, but if you need a diagnosis that will slow things down. We estimate your wait will be four hours.
Man- Four hours?! But I’m in agony, AND there’s nobody else here.
Nurse- well no sir, but you have been triaged as a level five emergency which we aim to reposed to within four hours. If we start treating you now, and a level 1 emergency comes in hen we might miss a target there.
Man- but I don’t want to wait four hours!
Nurse- I know,mist frustrating; if you had broken a hand as well that would move you quite sharply up the list. Some people pop to the bathroom and break their hand in order to move up the list. We can provide the equipment to do that in a safe way, for a reasonable price if you like?
Man- I’m not breaking my own hand!
Nurse- well do you have anything else that will move you up he list?
Man- I’ve got depression;
Nurse- Oh that’s good.
Man- so I get moved up he list?
Nurse- Ah, no. That treatment is not supplied by Serco, but we do however get £50 for every successful referral so I’ll write it down.
man- But it doesn’t move me up the list?
Nurse- No but did you not hear me, we get fifty quid!
Man- Why should I care about that?
Nurse- Well that fifty and other peoples fifties add up and that money gets invested back in to the service
Man- Where?
Nurse- Well… Doctors bonuses, but I’m sure you want your doctor to be happy, right? By the way while we’re talking about referrals, do you think you might have cancer?
Man- Is this really the time for this?
Nurse- Oh I’m sorry sir do you have a pressing engagement to get to? A pressing appointment for sitting and waiting in agony to get to?
Man- No
Nurse- Precisely sir, so do you think you might have cancer?
Man- I don’t see why I would?
Nurse- Hmm, well has anyone in your family ever had a heart condition?
Man- Well my dad died of a heart attack…
Nurse- Perfect! Checking for congenital heart failure could get us £120!
Man- Oh, I can’t be bothered with this. I’m just going to go home and take my chances.
Nurse- That will lead to a fifty pound fine, sir, for engaging services without using them.
Man- Fine, put the bill in the post.
Nurse- We will, sir, and we would kindly ask for you to fill in and send back our Customer satisfaction survey, which we will send out with the bill. Have a good day now, sir.


Considering the Medical Innovation Bill especially in relation to the TTIP

The Medical Innovation Bill also dubbed the ‘Saatchi Bill’, as it has been sponsored by Lord Saatchi, is currently at the Committee stage in the House of Lords on its journey to being enacted.

The goal of this bill is to allow doctors (a person listed as a medical practitioner) to “depart from the existing range of accepted treatments for a condition”. This means, for instance, that instead of a doctor having to say to a patient they have run out of curative options and all medical support from here will be purely palliative, they are able to say that the standard treatment options have run out, but with your permission we would like to try options that have not been fully accepted in this country but may save your life. This bill would give people hope that they can have their lives extended in ways that are not possible under current legislation. I have no doubt that this is a good thing; on the face of it, it seems to be a morally commendable step. It seems to be saying ‘we value life more than legislation’ and ‘it is better to have tried and lost than to have never tried at all’; something that I am sure a lot of patients and their families would empathise with.

But, I can’t help feeling a small knot in my stomach. I have no doubt that this Bill is being put forward with the best of intentions, but I wonder whether it could also be used to serve other more capitalist agendas.

The government, in the face of loud, but generally ignored, opposition is forcing through the ‘Transatlantic Trade and Investment Partnership’ (TTIP) with as little public discussion as possible. The goal of TTIP is generally to decrease the barriers of trade between the EU and the US. On the face of it this does not seem too insidious a deal, but there has been large criticism of this partnership, particularly around the idea that corporations would be able to sue countries on the grounds that they are trying to enact legislation that negatively impacts their trade in the country.

This is not the main point here though. The Food and Drugs Agency (FDA) in the US is agency that controls which medications are allowed to be sold and which cannot be. The FDA is regularly criticised for being pushed in to making decisions by money, and the power of large pharmaceutical companies. US legislation means that only research that shows a pharmaceutical company’s medications look positive need to be published, allowing the companies to sweep a lot of undesirable information under the carpet.

Now, here is where a potential problem lies, the Medical Innovation Bill enables medications and treatments to be used that are not currently considered best, and only, practice in this country; TTIP allows easier trade with the UK, which may lead to US pharmaceutical companies more easily selling their wares in the UK; and the fast and loose ways of the FDA means that medications may creep in to use that really shouldn’t be. For me, this is potentially a huge concern which should be taken seriously; we are talking about a person’s life here.

The Medical Innovation Bill discusses the importance of doctors acting responsibly, but what does this mean? Are we going to see a situation where ‘drug reps’ are able to sell their wares to doctors and be the providers of the information? Keeping up to date of all of the medications that are NICE (National Institute of Health and Care Excellence) recommended and are in the BNF (British National Formulary) is a monumental task. To then ask doctors to be aware of innovative treatments and medications seems to me a nigh impossible task. If doctors were to sit down and critically appraise the evidence base for all of these treatments they would never see a patient, so how then are they to glean the correct information? Are they going to be open to be trusting incorrect information of people who do not fully understand the complex medical situations they are involving themselves in?

If a drug rep was to approach a doctor and say ‘this medication could save your patients life’ what is that doctor to do? But they don’t know how effective this medication is, what potential side effects there are (as don’t forget, these may not have been included in the published research but swept out of sight), and whether this drug rep really knows what they are talking about. Suddenly responsible decisions are looking very difficult to make.

Will TTIP enable pharmaceutical corporations to sell in the UK? This and other areas need to be looked at hard before the Medical Innovation Bill is put through. Another angle; is the privatisation of core NHS services going to create different drivers for services which again could be exploited with the Medical Innovation Bill?

I am certainly not saying that a Medical Innovation Bill should be enacted, but every single aspect of this Bill should be looked at, and all the potential implications of it explored. A Bill which can be exploited for capitalist gains could quickly lose all of its desired moral integrity and become something very different from what its creators dreamed it would be.