David Blackburn

Jeremy Hunt’s tough talk on the NHS doesn’t address the toughest question of all: what is the purpose of modern medicine?

Jeremy Hunt’s tough talk on the NHS doesn’t address the toughest question of all: what is the purpose of modern medicine?
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Jeremy Hunt’s quiet demeanour is deceptive. The Health Secretary has a bit of what my late grandfather called ‘iron in the soul’ – a measure of self-confidence, calculation and the determination not to let the bastards get you down. ‘Iron in the soul’ came in handy during the Burma campaign in the Second World War. And I imagine that it’s vital if one is to prosper as Secretary of State for Health.

Hunt was sent to the Department of Health last year in order to clean up the political mess left by Andrew Lansley. Hunt’s tenure has been beset by scandals beyond his or his predecessor's control – from Mid Staffs to A&E, with numerous others in between (about which Jane Kelly wrote so vividly in the Spectator a few weeks ago). This has changed the terms of the NHS debate. It used to be that the ‘nasty Tories’ posed an existential threat to the NHS. Now the threat is more general, and more real. A YouGov poll quoted in the Sunday Times finds that 38 per cent of respondents believe that Britain can longer afford a health system that is free at the point of use.

The old religion has grown weaker, so Hunt – who believes in preserving the NHS – is launching a counter-reformation. He tells Isabel Oakeshott of the Sunday Times that he will sacrifice ‘every drop of [his] blood’ to ensure that the 11 hospitals on ‘special measures’ show significant improvement over the next 12 months, and he is prepared for more hospitals (perhaps as many as 20) to require similar attention in the immediate future. He has other targets: the return of the traditional family doctor and a 7 day NHS (to take pressure off A&E and improve out of hours care), tackling inefficiency, and make the NHS paperless by 2018. And, as Isabel Hardman reported in the Telegraph a few days ago, Hunt wants clinical and managerial elites to operate across the health service as the ‘superheads’ do for Education Secretary Michael Gove.

These are ambitious pledges – and it’s worth noting that the Tories' decision to protect the NHS budget has had the unintended consequence of giving them political cover at this very tricky moment. Andy Burnham, Hunt’s shadow, will have to work much harder to rebuild his shattered credibility than shout the simple refrain: ‘Tories cuts are killing the NHS’. Then again, Burnham and Labour are not Hunt’s foremost enemies in this fight; that dubious honour rests with the medical unions, which are intent on maintaining the status quo as far as possible. Transparency is Mr Hunt’s best weapon: each new scandal strengthens his argument for change. Hunt is busy trying to split the medical unions’ strength; for example, he told Isabel Oakeshott: ‘I think most consultants, their hearts are in the right place.’ Plainly, Hunt is not afraid of turning this policy battle into a moral fight.

Yet, for all those words, Hunt says nothing about the elephant on the operating table: what is the purpose of modern medicine, on which ever greater sums of public and private money is spent? The grandfather mentioned above died after a short illness in January 1991 aged 78; nowadays, he would have been kept alive in some discomfort and for little purpose for many more months. Men like him lived for golf and conviviality, not morphine and daytime TV. I can’t say whether I or anyone else would chose death over life in such circumstances; but how dispiriting to think that the last thing over which you imagine to have control - one’s will, one’s iron in the soul – is actually tethered by a public servant, empowered (perhaps against his will) by the choices of others.

A.N. Wilson charts similar territory while reviewing Raymond Tallis’ Reflections of a Metaphysical Flaneur and Other Essays in the latest issue of the Spectator. Here is Wilson in full flow:

‘…the book also contains excellent essays on medical ethics. The final essay in the book is an impassioned plea for ‘The Right to an Assisted Death’. ‘I believe it is not those who support assisted dying but those who oppose it who have a moral case to answer.’ He quotes, at length, the daughter of Dr Ann McPherson, whose protracted death from cancer — despite palliative care — makes painful reading. Her mother, a supporter of assisted dying, became tolerant of morphine and endured three weeks of torture. ‘There was no Mum; just a wounded animal who needed drips changed.’ ‘It is an honour to care for someone you love, but it no longer felt honourable to try to care for someone who wants to be dead.’ I find that the margins of this essay in my book are already black with ticks and many a sentence is underlined.

Tallis has no difficulty in exposing the sheer nonsense talked by religious groups which, for example, support the idea of a just war while nonetheless believing that it is sinful to ‘take’ a life which is the gift of God, in the case of terminal illness. I should like this lucid essay to be compulsory reading for every imam, rabbi, priest or minister of the Christian gospel before they are ordained. The sheer illogicality of the Catholic Church’s ‘Care not Killing’ is precisely exposed by Tallis, who shows the muddled (and often dishonest) way in which Christian churches conflate euthanasia, assisted dying and assisted suicide. He points out that it is still against the law for medical practitioners even to give advice to terminal patients who wish to be helped to die.’

Would the NHS’ mounting difficulties be eased by a simple change in the law? I’m not endorsing any position here (there are clearly economic, practical and moral imperatives on both sides); I’m just asking the question.

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