You probably remember that awkward moment when the Millennium Bridge across the Thames got a touch of the wobbles. Its architects (with or without the input of any associated structural engineers) had not bargained for the risk that lots of people might want to walk across the bridge at the same time, let alone in unison. Riverdance it wasn’t – but it could so easily have been (in another sense) if they hadn’t closed the bridge while a rethink took place. And then there’s that ‘strange but true’ story about the earth being knocked out of its orbit if everyone on the planet jumped up and down at the same moment in time. Same principle, no doubt, although I am tempted to wonder whether it depends upon where everyone is on the surface of the planet at the time they do it. On the law of averages, the short answer is probably ‘China’. Would the same principle apply, you might ask, if enough people shook their heads and took in a sharp intake of breath at the same moment? Obviously not – because I can’t have been alone in doing precisely that when I first read the story about Linda O’Boyle, a former healthcare professional herself, and married to a former NHS manager, who died after being denied NHS cancer care by Southend University Hospital NHS Foundation Trust. This was because she had elected to pay privately for a drug that would double her chance of survival and/or prolong her life. Group action A group action is currently being taken on behalf of six patients in this kind of situation and it could end up with a Judicial Review which would test the legality of the policy. NHS managers point out that the cost of the drugs themselves (drugs like Avastin, Sutent etc) are only one part of the overall cost of care and reatment for these patients. The drug needs to be administered in a hospital bed which has to be paid for, and administered by NHS staff whose salaries need to be met, and provided alongside other tests, investigations and treatments that can cost £100,000 or more a year once everything is added up. For the majority of NHS Trusts, and for the Department of Health, it is a non-negotiable philosophical principle. Indeed, Alan Johnson, the Secretary of State for Health, stood on the floor of the House and stated that it was ‘a founding principle of the NHS’ that ‘someone is either a private patient or an NHS patient’. But reading the details of the cases, and the impact on real people, with real emotions, it all seemed so unfair, and the arguments so obvious. I then read the persuasive counter-argument about how unfair and sensitive it would be on an NHS ward, if one patient was receiving a drug (albeit at their own expense) that doubled their prospects of survival, while the patient in the next door bed was being denied that drug. How difficult would it be for the nurses and others who were administering the treatment, caring for the patients and answering their questions? Clearly, the argument is not quite as straightforward as it seems at first sight. Principles Eminent Senior Counsel have gone on the record as saying that while it might be a ‘founding principle’ or a philosophical tenet at the NHS that you can’t mix NHS and private care, it is certainly not the law, and should not be quoted or treated as such. It was a founding principle of the NHS that it would be free to all at the point of delivery, but that was before dental and prescription charges (and other charges) changed all that. And how ‘safe’ is the ‘no mixing of NHS and private’ rule, in the face of all the Private Finance initiatives (PFIs) that have built so many hospitals and other facilities around the country, the specific regulatory provision to mix NHS and private dentistry, and the Health Minister Ben Bradshaw’s recent announcement that private sector senior managers will soon be employed as consultants by the NHS to turn around failing NHS hospitals, because of the added skills and competencies that they might bring to the challenge? One senses, however, that the government is alarmingly out of step with public opinion, and with a significant amount (but not all) of opinion within the medical and nursing professions. A recent ICM poll found that more than a fifth of those sampled would be willing to pay £10,000 or more to ‘top-up’ their NHS care if they were faced with a life-threatening condition. Just under a quarter would pay up to £15,000. Significantly, perhaps, those in their 20s and 30s were more likely to favour the ability to top-up NHS care, while those in retirement and/or on fixed incomes were more likely to believe that everything should be funded by the state. The difficulty with the government is that in clinging so trenchantly to one of its most precious principles (the elimination of any inequalities in healthcare), it finds itself abandoning another (patient choice) – unless of course ‘die sooner, or die later’ is an example of choice. Tipping point But if 93% of people (accepting for a moment the ICM poll, which for the record was commissioned by the ‘Doctors for Reform’ Lobby Group) really do think that they should be free to use their after-tax income to purchase private healthcare for themselves, without foregoing their right to receive NHS treatment in return for the taxes and National Insurance contributions that they have already paid, then we must be getting close to a tipping point. And if all those people jumped up and down in anger and frustration when the government would rather see people die than sacrifice a ‘founding principle’, would it be sufficient to deflect the Earth from its orbit? Probably not, but the strength of protests following the 10p tax rate debacle did prove enough to deflect the government from its intended course, and humble pie was definitely on the dinner menu in Ward 10. And to be honest, there is a lot of jumping up and down left to come in this latest production of a Whitehall farce. Fuel protests, the dire plight of the British Agricultural Industries at a time when food prices to the consumer are sky high, the credit crunch… anyone for a wobble?