David versus the NHS

I know we revere the NHS, and defend it against all slights and spending cuts. And yes, I revere it.  But I have to admit that I spend more time than I should irritated with its little blind spots, by the little humiliations it distributes – but most of all by its boneheaded stupidy about chronic health problems.

These are not marginal. Chronic ill-health – asthma, diabetes, drepression, back pain, you know the kind of thing – takes up 80 per cent of NHS time and a similar proportion of NHS resources.

I feel particularly strongly about this because I suffer from chronic eczema, some times more than others – sometimes very badly. I will do anything if I think it might help, make any journey, go to almost any expense (if I have the money). But the NHS has an instutional blindness about this. They would prefer to carry on quietly treating my symptoms, and maintaining me on my various ointments for the rest of my life.  At huge expense.

There may be imaginative and forward-thinking dermatologists out there in the NHS somewhere, but most of those I have met are uncomfortable with anything more challenging than this.  That's what they do: treat the skin.  The idea that eczema might involve other parts of the body seems to irritate them.

Why should I not go along with this? Well two reasons, apart from the expense that the NHS is put to on my behalf.

First, because if I keep using the powerful steroids for the rest of my life, then I am in serious danger of osteoporosis.  For some reason this is never discussed (that is not my department, says Werner von Braun).

Second, if I shift onto the more effective Protopic, then I know there is a greater risk of me contracting cancer. In fact, the tubes carry warnings to this effect in the USA and Australia. Again, for some reason, this is never mentioned in the UK.

So, now the scene is set.  Fast forward to this year.  I've been asked to be referred, not to another dermatologist, but to the Royal London Hospital for Integrated Health.  They have a very successful eczema clinic which uses various different complementary medicines.  Not traditional, I know, but they are part of the University College Hospital and therfore part of the NHS, and quite rightly.

But no, Croydon PCT has finally come back and said no.  It took me some time to discover the details.

This was a decision by the NHS South West London Regional Exceptions Panel.  For some reason, the more we hear about devolving decision-making, the more distant it gets.

Would they give me the details of why?  No, I had to get their letter from my GP.  This is all it said:

"The Panel's opinion is that this child should first be referred to Croydon Integrated Dermatology Service for their specialist opinion."
Note the care they have taken to ascertain my age (53).

Can I appeal?  No, but my GP can - and eventually will - ask them to reconsider on 'clinical' grounds.

Can I be present?  No, I can't (though apparently I can write a letter).

So have a glance with me at my rights under the NHS constitution (and I quote from the NHS website):

•The right to choose which hospital to go to if your GP refers you to see a specialist.
•The right to be involved in decisions about your healthcare and to be given the information you need to do this.

Do these guarantees sound as hollow to you as they do to me?

I haven't decided what to do yet.  I am reasonably confident that, if I decide to press on, then I will eventually get my way.  But I am extremely pushy and articulate.  It is a pity you have to be pushy and articulate to be treated with thought, individuality and imagination.
But, more important, how is the NHS ever going to be sustainable for future generations if they don't work with those patients who are determined to tackle their chronic health issues.  Because I'm absolutely sure of this: resolutely treating symptoms is the quickest way to backruptcy.