CENTRE POINT
Girl B or not girl B, public money for health cannot be supplied on demand
SIMON JENKINS
Ionce fondly imagined that the obsession of the British tabloids with 'human interest' stories was the guarantee of the welfare state. No hard-luck case would ever want for column inches. No minister could afford to 'cut or close' because that meant to starve and kill. The nation's hospitals and orphanages, its hospices and charities were safe under the vigilant eye of Fleet Street. The old sub said, 'Make 'em cry!' and nothing makes 'em cry like a sick child.
Last week's saga of girl B has changed my mind. I have seldom seen such outra- geous tear-jerking. But it tore asunder any benign link there might be between the media and a sane National Health Service. `Sentenced to Death' screamed the Daily Mail. 'Let Her Die' was the Star's version of the judges' ruling. 'Let the Sun Save Her: Cancer Girl's Lifeline after Court's Snub' shouted the Sun. Even the Independent on Sunday sneered that the 'New NHS-Speak has no Word for Compassion' while the Financial Times said that 'The Cost of Right to Life Proves Too High for NHS'. The message was clear. What might seem to the NHS a painful weighing of clinical and resource priorities was to the press blissfully simple. A 10-year-old girl was going to die because of the deliberate cal- lousness of health administrators and lawyers. Only the gentlemen of the press stood between her and death.
I defy anyone to read the testimony entered into the High Court last Friday by Cambridgeshire health authority and not agree with it. True, it was informed by hos- pital consultants, written by health bureau- crats and spoken by lawyers. True, it had to set a difficult decision about one patient in a wider context, because the patient's father had taken the health authority to court. True, the system was defending itself against one despairing man with whose plight it was impossible not to sympathise. All that was true.
What was depressing was how mindlessly the media fell into the trap set by this stereotype. The health authority could not be right. Bureaucrats never are. The system must be at fault. It always is. The family must have their money from the taxpayer. It did not matter how much. Doctors, judges, civil servants are all out to do down the little man. Who cares about the rights and wrongs of the case itself? A girl is dying. Make 'em cry.
I cannot imagine a more delicate deci- sion than one over the expensive, experi- mental treatment of a near hopeless case. Girl B had been sick since the age of five with the cancer known as non-Hodgkin's lymphoma. A bout of drastic treatment had been tried, which had the effect of inducing acute myeloid leukaemia. This was treated in turn with chemotherapy and bone-mar- row transplant. This failed and the illness had returned. Every doctor dealing with the case, not just at Addenbrooke's in Cambridge but at the Royal Marsden, the British Medical Association and' the child cancer charities agreed that another bout of 'aggressive' treatment had a minimal chance of success. They put this at 2.25 per cent, though I gather that no truly compa- rable case has survived a second dose of this treatment. It would be extremely unpleasant and make the child's remaining weeks or months of life miserable. They could not recommend it, whatever it cost.
The health authority perhaps made a public relations mistake in ever mentioning the word resources in connection with a specific patient. Its lawyer, Nigel Pitt, declared that it had reached its decision, `bearing in mind medical circumstances, suffering of the patient and all the other calls on local resources. If the health authority was to spend all its money on treatment which doctors have advised was extremely unlikely to succeed and then had no money left to treat hundreds of other patients, what would the public have to say about that?' This perfectly reasonable argu- ment failed to sway Mr Justice Laws in the High Court last Friday. He implied that medical decisions should disregard money altogether. The Cambridgeshire authority had 'assaulted' the child's 'right to life'. He then, in a near incomprehensible judgment, announced that this was not a medical deci- sion after all but a 'human' one. The Court of Appeal overturned him within six hours.
Thus is public health deratiocinated. Nobody ever supposed that the NHS could provide an unlimited range of treatment on demand. It does not do so for cosmetic surgery, or normally for experimental medicine. What it provides is the judgment of the best consultants on whether a partic- ular treatment is likely to be effective. The Cambridgeshire health authority was crys- tal-clear on girl B: if the doctors had rec- ommended the treatment it would have paid for it. What it could not do was buy treatment not recommended by doctors purely because a patient demanded it and had found a private clinic willing to admin- ister it. Nobody is stopping the treatment, only the public funding of it.
I cannot see what is wrong in this. If pub- lic money for health is to be supplied on demand we are all in the madhouse. Some concept of equity must rule. Hand NHS priorities over to Fleet Street front pages, eccentric judges and, come contingency fees, ambulance-chasing lawyers and the result is easy to predict. There will be no money for such unglamorous objects of our attention as the elderly, the mentally ill and preventive medicine.
At least the tabloid press put its money where its mouth was. Having damned the system, the Sun and the Mirror offered to pay for private treatment for girl B in return for her story. Their ballyhoo pro- duced a private donor. Insofar as that is what the parent and the girl really want, it is welcome. But the result? Another family is suing Northumberland health authority because it has refused to buy an experimen- tal drug for their son. There is no limit to this. If journalists and lawyers drive the NHS to medicine's far horizons, every case will be decided by money and politics. Then the weakest really will go to the wall.
Simon Jenkins writes for the Times.
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