Medicine

Could the future of pandemic planning lie in our past? A century ago, there were hundreds of so-called 'fever hospitals' dotted across Britain. These small institutions were built for diseases of a bygone age – smallpox, scarlet fever and typhus – but were designed for precisely the same problems we face today.  They contained isolation wards, separate accommodation for different infections, laboratories, operating theatres and convalescent wards with activities for recovering patients. Given the current problems of the Covid-19 outbreak, we need to re-establish these medical relics.

Coronavirus is revealing many good things about our society: the number of people willing to volunteer to help tackle the outbreak and help the isolated, the number of former doctors and nurses keen to return to the front line, and the number of businesses that have switched to making equipment and protective clothing for those healthcare workers. But it has also revealed our ignorance about many matters that are still important outside of a pandemic. Today's example comes, inevitably, from our general reluctance to think about what old age and end-of-life care look like.

From the moment when Boris Johnson announced that the country was moving from containment to ‘delay’ in handling coronavirus, the world’s biggest healthcare organisation has been on a war footing. What doctors like me have witnessed over the past days and weeks has been nothing short of extraordinary. Trusts in the NHS declared a ‘major incident’ on the evening of the announcement, and emergency plans swung into action within hours. By the time I came into work the next morning, managers, who had been up all night, had already started to implement profound changes to the way in which the hospital and services were run, and this continued over the following days. It was replicated in every hospital across the country.

Some medical experts claim that Lyme disease is worse than cancer. It’s not a competition, but I do know one thing: at least if you’ve got the Big C you get sympathy, understanding and prompt treatment. With Lyme you’re pretty much on your own. This isn’t a plea for public sympathy. I’ve had Lyme for God knows how long — decades possibly — and though it has disrupted my health and my life in myriad weird, torturous and sometimes hideous ways, I still consider myself one of the fortunate ones. First, it hasn’t killed me; second, I’ve had some state-of-the-art stem cell treatment which with luck will eventually cure me. But it’s definitely not a condition I’d recommend.

Something interesting is happening in the House of Lords. Baroness O’Loan’s Conscientious Objection (Medical Activities) Bill, now at the committee stage, has put on the agenda an issue which well-deserves to be there. Its point is simple: all healthcare professionals should have a legal right to opt out of certain procedures which they find objectionable. It specifies three areas: abortion provision, withdrawal of life-saving treatment, and actions relating to certain reproductive technologies. This is not particularly radical; the 1967 Abortion Act already explicitly protects conscientious objection. Indeed, it could even be asked why this should, in a country with a tradition of liberty like ours, even be up for debate.

In George Bernard Shaw’s play The Doctor’s Dilemma, written early last century, the knife-happy surgeon invents a nut-shaped abdominal organ, the ‘nuciform sac’. It is situated near the appendix, ‘full of decaying matter’, and requires removal, assuming the patient can afford the fee. The surgeon, Cutler Walpole, has the line: ‘The operation ought to be compulsory.’ Bernard Shaw labours the point that removal of the nuciform sac equals 500 guineas, and not removing it equals nought guineas. He then suggests, wickedly, that we want our surgeons to be mortal, ‘quite as honest as most of us’, not God-like.

All along Harley Street, charlatans and medical experts have set up side by side with no obvious way to tell them apart. The same wide steps lead up to the same glossy front doors, all with prestigious brass knobs. Each separate house is itself a layered stack of quacks and docs: radiology one floor above absence healing, flower therapy down the corridor from paediatric ENT. The magnificent Harley Street address confers a blessing on every dubious therapy. Perhaps it has a placebo effect all of its own. I know the street quacks well, or used to. My mother had a horror of antibiotics and would pack us off to Harley Street’s alternative therapists. I remember a mournful young Russian who was said to have treated astronauts.

For technology manufacturers, healthcare is already big business, and, with an ageing population increasingly comfortable with technologies that would’ve been unthinkable even a decade ago, the opportunities to innovate are only going to increase. The Future Health Index, a global report commissioned by Philips, supports the fact that it is not just the UK’s younger generation that are embracing these technologies. However are these products – from popular or trendy FitBits to state-of-the-art imaging equipment – really going to revolutionise the country’s medical care? And will the NHS require a head to toe change of ethos to accommodate them?

And so, as it must, the pilgrimage to find a local GP surgery begins. This is a great British tradition, and I have been honoured in my lifetime to have taken part in many and varied official registerings at different NHS surgeries. Having been ceremoniously relieved of my first GP in London, and invited to find another one because they had redrawn the boundaries, last year I was on the road again after they closed the second one down. I found myself at a surgery on a sink estate where the first language — and indeed the second, third and fourth languages — appeared not to be British and where I was asked if I would like a female chaperone because of all the religious objections I was likely to have.