Lord Darzi: The fundamental flaw
On the Hardtalk show recommended by the Witch Doctor, Lord Darzi was given a grilling. It was not much of a grilling. Dr Grumble could have done a much better job. And when some of the answers did not hold water the noble Lord was let off the hook.
The hapless interviewer did ask an interesting question in which he essentially referred to the problem of there being more chronically ill and more people living longer and then said that he did not see how Lord Darzi was going to be able to cope with that.
Lord Darzi's answer was immediate and confident. He said that he was going to focus more on prevention. It is a crackers answer, of course. It is prevention of disease that has caused more people to live longer so that bits of them wear away or they develop chronic disease. Even if you can prevent or ameliorate some of these chronic illnesses you will then live even longer and develop something else. Unless you die young as we used to you are unlikely to die quickly after previously having been rather well. You are more likely to die slowly after going inexorably downhill with chronic debility of one sort or another. It is mad to think otherwise. Dr Grumble does not really think Lord Darzi believes the nonsense he spouted. But Lord Darzi would know that you can get away with this stock answer because it has been in use ever since the beginning of the NHS. The idea was always that you spend to eradicate disease. It is nonsense really.
It's laudable that the government promotes prevention by encouraging people to stop smoking and lead healthy lives but if you live long enough you will still get some disease or other that will kill you. Come to think of it if you don't live long enough something will have killed you anyway. We all die. You can't stop it. And the more you are successful in postponing death the more the population is going to suffer from the many degenerative and other diseases that can afflict the elderly.
The interviewer was right. Lord Darzi's answer was somewhat disengenuous. But you can't blame him for not having an answer to an insoluble problem.
2 comments:
Here's a cut a paste job from:
BMJ 1996;313:1268-1269 (16 November)
From it you can see that the Darzi argument goes back a long time. Probably it was more believable in the days of Bevan.
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The dream of Beveridge and Bevan was that a national health service would eventually put itself out of business by eradicating widespread diseases. But the dream has been destroyed by unimaginable advances in technology. This technology, and what it makes possible, is increasingly beyond the reach of civil health services. Instead of turning the heat on doctors and other staff to work better and faster, the government should dare to explain that no government can afford to pay for all of modern medicine. The NHS you have today is actually the best you can get for the money.
I looked at the programme after the recommendation by the Witch Doctor. It was very apparent from Lard Darzi constantly needing to drink water (at least I guess that was what was in the glass) that he was exceedingly nervous about being asked a difficult question, and he didn't seem particularly confident with his answers. He seemed to find it very difficult to deal with the comments that had been submitted to DNUK in relation to a question submitted by the BBC to that site. I was also somewhat concerned when he said that he did as much surgery now that he is a Junior Minister of Health as he did before he took the appointment.
I'm afraid that I was just as disappointed with Lord Darzi in this interview as I was when I read his review when it was published.
He should stick to what he is good at, and stop trying to mess around with the NHS in a manner that will only ever satisfy his political masters. His efforts so far have certainly not impressed me.
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