Matthew Norman: Can we still believe in the NHS?


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The Independent Online

The British have only one national religion, Nigel Lawson famously observed, and it is the NHS. The former Chancellor was bang on the money back in the 1980s, and today most of us still worship the great monolith. For all that, one sniffs a rise in heretical questioning, and even agnosticism. No sooner have the angels of geriatric nursing been stripped of their wings than the local priests, our general practitioners, come under attack. Complaints about GPs summarily removing patients from their lists have risen in the past year, and ombudsman Ann Abraham is rightly displeased that a growing number of family doctors now operate a zero-tolerance policy better suited to one of those publicity-crazed sheriffs who is beloved of rural Alabama voters.

The rules which dictate that GPs observe a careful process before sacking a patient are increasingly ignored, we are told. Indeed, some doctors are now as queenily intolerant of perceived disobedience from those they are paid to look after as cabin crew who demand an emergency landing to remove a passenger for looking at them funnily after a two-hour wait for the complimentary peanuts.

As always with the NHS, its vastness makes it very hard to gauge the scale of a problem from the statistics alone, and the figures here are tiny. But invariably we judge its state of health not from waiting-list times or cancer-survival rates, but from personal experience and anecdotal evidence... anecdotes such as that of the terminally ill woman peremptorily struck off, along with the daughter who changed a battery in a nausea-alleviating device without waiting for the district nurse.

Every trade has its fools and nutters, and you cannot judge a profession by the pathological idiocy of the odd individual. And yet there is that osmotic sense that GPs are ever more vulnerable to the inflammatory disease known in Harley Street (forgive the technicality; there are excellent medical dictionaries online) as uptheirownarseitis: that too many have forgotten, if they ever knew it, that theirs is a service industry.

I trust no physician will take umbrage if we describe the GP as a glorified plumber with shorter hours, much better pay and a less cumbersome toolbox. No offence is intended, because to this urban Jew the simplest precepts of plumbing are as awe-inspiring as those of car mechanics or deckchair assemblage. The challenges facing the GP are, in fact, less opaque. All correctly hypochondriacal Jews regard themselves as doctors who never bothered with the petit bourgeois requirement of formal training, and I am a consultant diagnostician of the first water.

Writing as such, I have enormous sympathy for the humble GP. He or she is obliged to spend most of a draining 45-hour week dealing with athlete's foot, housemaid's knee and minor infections of the upper respiratory tract; and is at grave peril not only of the alcoholism and drug addiction that plague the business, but of repetitive strain injury from scrawling "amoxicillin" on a prescription pad to nudge the cold-sufferer out after five minutes, even though the antibiotics won't foreshorten the sniffling by so much as five seconds. Also writing as such, I have even more sympathy for any GP who has to deal with the likes of me. I wouldn't wish myself – armed to the teeth with internet-published research papers and results of double-blind clinical trials – on Dr Shipman, Dr Mengele or even Dr Fox (and his faithful sidekick, Nurse Werritty).

Yet that sympathy is tempered by the suspicion that the startling improvement in GPs' pay and conditions under New Labour is alienating them – or more of them; one hears as often of brilliant and empathetic GPs as of cocky, clueless ones – from those who effectively pay their salaries.

A century ago, in his coruscating foreword to The Doctor's Dilemma, George Bernard Shaw regretted the typical physician's poverty. Today, the British GP is much the most lavishly rewarded in the Western world, with £100,000 per annum below the average. Many make twice that, and some thrice, despite no longer being obliged to work outside office hours, so that the nocturnally stricken are left to the untender mercies of often inadequate locums.

In return for such reimbursement, we ask no more than a fairly prompt appointment with a competent doctor, and that the receptionist not be styled after a Chinatown waiter trained to insult punters to ensure the table is freed up as quickly as possible. Much too often, anecdotes insist, even these modest expectations are unmet. Over-indulgent treatment by government has a knack of divorcing public servants (even if most GPs are technically self-employed) from the public they allegedly serve, as students of modern policing may agree.

The reputations of every once-cherished British institution have bombed in recent decades, and like the BBC the NHS has been latterly weakened by the perceptions of bloated budgets and insular arrogance. The Beeb has reacted well to the criticisms, and the British Medical Association would do well not to dismiss Ms Abraham with the usual high-handed disdain.

I wouldn't describe the health service as the opiate of the masses (you try asking your GP for liquid diamorphine), but it is a religion, and like all religions relies on the sustenance of faith. Peremptorily excommunicating the dying is a shocking betrayal of that faith, and should be no more tolerated than priestly interference with choirboys.