The painful truth about health screening

 

The editor of Health Insurance Daily, David Sawers, gives his take on the conflict between NHS and private screening companies, drawing on personal experience.

“Well, if you don’t mind me saying,” she smiled, with a soft Northern Irish brogue. “You’re not a young man any more.”

Not quite the words I was hoping for, but as I was just turning 40 I suppose the locum at my South London GP surgery had a point.

“I could do a couple of tests now,” she continued. “But you’ll be getting a letter about the 40-65 year old NHS Health Check in the next few days, so you should probably go along to that.”

Scooping my wounded ego up off the floor, I thanked her and left, assuring her that I would, indeed, be back for my Health Check when the letter (when it will be just email or text instead of letters?) arrived in due course.

“Oh, and by the way. Happy birthday when it comes,” she smiled as I closed the door.

Ouch.

Given that I was fortunate enough, though, to have had access to private health screening through my work, it wasn’t an issue (leaving ego aside). But I was curious to find out what the NHS Health MOT was like and so I waited for the letter.

In the meantime, I looked up “NHS Health Check” on the NHS website.

“An NHS Health Check takes about 20-30 minutes,” it said. “The health professional – often a nurse or healthcare assistant – will ask you some simple questions about your lifestyle and family history, measure your height and weight, and take your blood pressure and do a blood test – often using a small finger prick test.”

Ah, that sounds painless, I thought.

“Based on this, they will be able to give you an idea of your chances of getting heart disease, stroke, kidney disease and diabetes.”

Oh.

In that case – and given the fact that I was now officially “not a young man anymore” – when the letter came, I made the appointment, as promised.

After all, the website told me that the health conditions picked up by the NHS Health Check are, “when added together”, the biggest cause of preventable deaths in the UK, with around seven million people affected by them. In any case, more cows kill humans in the UK every year than sharks do globally, I remembered. Statistics count.

Apparently, in its first five years, the NHS Health Check is estimated to have prevented 2,500 heart attacks or strokes.

“This is the result of people receiving treatment after their Health Check,” the website said.

As it turns out, my Health Check uncovered nothing. A clean bill of health. Well, kind of.

And so, when I returned to the same GP practice to ask for a prescription for some antibiotics, I mentioned it during my appointment with my longstanding (not locum) GP.

“I don’t want to take up too much of your time, I said proudly. “But I went for my over-40 NHS Health Check. A clean bill of health.”

“I’ll be the judge of that,” he groaned. “In any case, why did you waste everyone’s time doing one of those?”

Confused by this new take on the good cop/bad cop (her good/him bad – or the other way around?) routine, I explained that the locum suggested I go.

“Those checks aren’t really meant for you,” he sighed. “They’re meant for smokers and people with weight problems and folk that sit around drinking all day. Except they’re the ones that usually never take the up the offer of a check-up.”

Concerned that he – a good GP – might have me down as one of the “worried well”, I muttered my thanks for the prescription and went on my way.

The episode – a common one, it seems – sprang to mind last month when a conference of NHS GPs called on private providers of health screening to stump up for follow-up doctors’ appointments after non-NHS health checks take place.

The annual conference (held in Belfast by a strange coincidence) of local medical committees (LMCs) passed a motion arguing that private screening providers should be ordered to pay for follow-up appointments with patients to discuss abnormal results and should not “offload responsibility” to the NHS.

NHS family doctors should be “empowered” to invoice private screening providers directly for their time if, as NHS GPs, they provide follow-up appointments to patients who had undergone privately-funded scans.

The conference also voted on a separate stem of the motion saying it believed that health screening should not take place in the NHS without the approval of the UK National Screening Committee.

Ciaran Kelly of North and North East Lincolnshire LMC, who proposed the motion, said that screening tests should – and  must – satisfy a strict set of criteria before they can be recommended for use in the NHS.

“Private companies don’t care about these strict criteria,” he argued. “They are in it for the money, pure and simple. Should they find something untoward [in the private scan], then the patient is immediately forwarded on to the NHS to pick up the pieces, including explaining tests that were not ordered by their GP and should never have been organised in the first place.

“They want to offload that responsibility as quickly as possible to us.”

Kelly added that, in some cases, private screening exposed patients to “unacceptable risk.” He cited examples such as full body CT scans with radiation risk, “poorly-evidenced” screening tests for cancer and food allergies, and “pseudo-genetic” screening tests.

He said that surely this is the “antithesis” of what “properly-done” health screening should achieve.

“It just represents another example of private medicine skimming the cream and leaving the dishwater for the already stretched primary care services.”

He went on: “I send letters to hospital consultants all the time saying, ‘If you want this test doing, you should order it and follow it up.’ I don’t see why we should give private industry a free pass.”

And so, once again, emerges the inevitable conflict inherent in the existence of a monolithic state provider of healthcare.

As usual, this year huge amounts of taxpayers’ money have been spent on raising awareness about a whole range of NHS-funded health screens – especially (and rightly so) cervical cancer. Early detection, the mantra goes, is essential in order to improve health and save lives (and reduce the financial burden on the health service).

Sure, there are some private health screens on the market that are at best dubious in efficacy and at worst just plain bogus. But increased regulation should always be a last resort in any market. Trying to penalise the providers – and recipients – of meaningful, clinically-accountable screening further is self-defeating and, potentially, driven by the type of self-interest that its proponents seem to oppose.

As Ansar Hayat of Wakefield LMC told the conference, he was opposed to the prohibition of health screening from taking place in the NHS without the regulatory approval of the UK National Screening Committee. Screening not approved by the committee was already available on the NHS, he said, and could provide benefit.

“We should let the patients do what they want to do,” he said.

He’s right. The majority of private health screening providers continue to encourage healthy living, pick up health conditions early on – and save lives (and save the health service money in the long run). Discouraging private health screening is short-sighted – and potentially harmful.

Private providers shouldn’t be penalised for providing a service that people want.

Patients should be able to do what they want to do – whether they happen to be young men any more or not.

 

 

David Sawers is the editor of Health Insurance Daily. You can see the original article here.

 
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