What the Sophie Roberts case really says about the NHS

Jul 4, 2012
Michael Bywater

British doctors said two major surgeries and extended chemotherapy were enough. Were they right?

WHEN I heard yesterday that Bob Diamond had resigned, I thought of Sophie Roberts, a pretty toddler from Hampshire who has hepatoblastoma and is dying from it.

Two teams of British surgeons said they didn't want to operate any more. So Sophie's parents – as I would, as you would – launched an appeal last month. Within two weeks they had raised around a quarter of a million pounds to send her to Sloan-Kettering Memorial Hospital in New York, where they would operate.

A quarter of a million. That's one-eightieth of Bob Diamond's eff-off money. I wonder how much he'll give.

And a more difficult question: how much, ethically, should he give? For money and compassion may be intrinsically at war.

Little Sophie has had two major surgeries and extended chemotherapy. Now her liver and lungs have turned against her again.

Did the two surgical teams decline to operate because of meanness of purse or of spirit? I doubt it. More probably, they decided: enough.

If you want to understand how doctors are taught to think – how so many, how most of them do think – read the Oxford Handbook of Clinical Medicine. It's oddly and deeply moving.

Now in its eighth edition, it still bulges in the pockets or on the iPhone of every scared house doctor on his or her first night on the ward, giving comfort and reassurance. Not just about what to do or how to do it, but about human compassion.

Here's a doctor who has a pen-torch reserved for checking the pupil reflex of the dead: how many now-uninhabited eyes has its beam shone into?

Here are the ideals of practice, which "like stars are hard to reach – but they serve for navigation in the night".

And here's one, on the doctor's enemy, and, often, the patient's friend, death, explaining that it is not the job of medicine to preserve life at all costs, but to try to ensure that the inevitable deaths happen in the right order.

A dead child is the wrong order. It is against all our hopes. And perhaps when the British surgeons said No to Sophie, they knew there could be little hope and she should be spared further excruciation. She is only two.

Perhaps the ethos of American medicine, driven from the start by financial and business considerations, is different. Perhaps American doctors have a competitive, market-style sensibility: Just Do It.

Perhaps the greatest thing about our NHS is that it has removed the daily thought of money from the necessary consideration of what's best for the patient.

We're moving away from it, slowly, into a Bob Diamond ethos. God help us.

But there is an answer. A friend of mine, a doctrinal free-market devotee, told me on Sunday how shocked he was to discover that online traders offered a different price depending on their assessment of the client's ability to pay. It's not means-testing; it's means-knowing, and the information collected from you every time you hit the web provides that knowledge.

There's no reason the social services or the NHS can't use that. SW1 postcode, American Express Centurion card, £40,000 a year spent at your wine-merchants and you fly first class? You can pay £10,000 for your bypass without even noticing it. Cumbernauld sink estate, Switch card, no job: free. We'll look after you. Just like on the aeroplane, you've no idea what the chap in the next bed or seat is paying.

The market is increasingly about demographics. We have the information and the technology to use it, not to increase profit, but to fund compassion. What's stopping us?

Oxford Handbook of Clinical Medicine by Murray Longmore, Ian Wilkinson et al. OUP. ISBN 978-0199232178

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