Friday, 30 November 2012

The NHS's Structural Deficit

Today's Telegraph has a fascinating and deeply depressing little article on the latest outbreak of hooping cough that has now taken 13 little lives. Those deaths are saddening of themselves, but what affected me more was an overwhelming sense that they were avoidable but for a structural deficit within the NHS.

What do I mean? The NHS's aproach to diseases like hooping cough is simple: immunisation. Think about it for a moment. We now routinely immunise out children against hooping cough (that's the P in DTP and stands for pertussis), dyptheria and tetanus, measles, mumps and rubella, meningitus of various alhpabetical types, HPV and tuberculosis. Many of these are given together in cocktails. Several involve boosters. And if, as a parent, you decide not to agree to any of these innoculations, for whatever sensible and cogent reasons, boy, do you get harassed by the local arm of the NHS.

Now many will say this is right. That disease control is all about building up a herd immunity. But is it that simple? Let's take another look at the hooping cough outbreak. Apparently current vaccination levels are high and health experts (whatever they are) say that the outbreak is not due to parents shunning the jab. Even so the NHS is urging women in their third trimester to get vaccinated. Why? Could it be because it's just another way for the NHS to keep tabs on us; to fill out forms, tick boxes, achieve the trigger levels for payment schemes, control our lives?

Hold that thought for a moment and look at the reasons that are being given for the current outbreak. 'Whooping cough cases tend to come in waves as immunity against the disease provided by vaccination wanes over time and allows small outbreaks to occur' the Telegraph reports.  The article then goes onto describe the symptoms in both babies and older children and adults. And that's when it hit me. You see, in older children and adults the disease presents as a prolonged cough, just like the one that was sweeping around Sussex, for example, this summer. My daughter had it. Several of her friends had it. And when they went to the doctors they were all given the same story. Yes, it's a nasty cough, it lasts about 8 weeks and it will go away on its own. At no point did the GP mention hooping cough, or warn them to keep away from babies.

And when you think about it this is typical. One part of the NHS is massively pushing immunisations against a disease that kills babies while the other part of the NHS fails to spot (or doesn't bother to mention) it in older children. And the funny thing is that it's not two parts of the NHS, because the GPs who aren't bothered about hooping cough in older children are the same people who are pushing the vaccines. But then again, there aren't any boxes to be ticked, forms to be filled, payments to be won when someone comes along with a cough, are there?

So is there a structural failure here? I'd say so. And it's deeply disturbing when it leads to the death of so many tiny lives.

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