The second episode of Channel 4’s interactive program giving viewers the option to choose which patients should hypothetically have their treatment funded on the NHS was aired on Sunday night.
For those who haven’t seen it before, the program overlays a live Twitter feed using the hash tag #NHS2BILLION so that people’s views regarding each prospective patient can be seen on screen. The show’s name is derived from the fact that the NHS budget is approximately £2 billion per week.
Featured patients included a 19 year old called David, who suffered a leg amputation after complications arose during an operation to treat his congenital heart condition. David has a prosthetic leg which cost the NHS £3,500. The leg often gives way and after a day of lots of walking, David is often confined to a wheelchair for the following few days to rest due to the pain of having spent so long standing up on the prosthetic leg. David wants a bionic leg with a microchip which would make his life much easier, but costs £70,000.
In the case of David, there were many people taking to Twitter to argue that as David had done nothing wrong and it was not his fault that he had lost a leg; he should be given the bionic leg that he wants.
There seemed to be an equal number of Twitterati arguing that David had received enough already from the NHS in terms of his surgery and his current leg, and that he should be satisfied with what he already has. This concept of whether people are “deserving” of treatment and whether they are to blame for their own ill health appears to have increasingly infiltrated the public consciousness in recent years, with arguments about smokers and the obese draining NHS finances appearing in the media on a regular basis.
The Principles of the NHS
When the NHS was launched by the then Minister of Health, Aneurin Bevan, on July 5th 1948, it was based on three core principles: that it meet the needs of everyone, that it be free at the point of delivery, and that it be based on clinical need, not ability to pay.
The concept of not contributing to one’s own demise did not feature and it seems that this is a more recent concern that has grown out of the ever increasing demand placed on the NHS as population numbers and life expectancy increase. The popularity of this view with the general public was even more evident when the show told the story of Pete, a 43 year old heroin addict living in Brighton. Perhaps predictably, many people tweeted that he did not “deserve” his £15,000 per year rehab program to be funded by the NHS.
In terms of raising debate on important issues facing the NHS, the story of Amanda, who suffered from a rare kidney disease and had spent the last six and a half years on dialysis, was perhaps the most eye opening for many. A new life saving drug had been developed which could save Amanda’s life, however it cost £340,000 per person, per year.
The reaction to this on Twitter showed that many people were shocked and outraged that a drug could be so expensive. The show then featured the National Institute for Health and Care Excellence (NICE) debating whether the drug should be available on the NHS and questioning the pharmaceutical company why it was so expensive. By the end of the program, the drug had been approved by NICE and a committee member commented that for many of the vulnerable people suffering with this disease it was the only option they had.
Whilst there are likely to be many who comment that pitching patients against each other in this way is not helpful and that thankfully, those taking to Twitter do not make decisions about the real life NHS budget, it is surely a positive that the scale of the problem, and the extent to which clinical decisions are influenced by cost, has been brought home to such a large number of people. There is no easy answer to the problems facing the NHS, and this was made very clear.
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