Can the NHS learn from the rise and fall of ancient empires?

The genetics of biology, quantum of physics and crux of consciousness are being unravelled by the eternal struggle against falsehoods we fancied calling Science. Such struggle does not exist naturally in the realm of politics. Truth-seekers battle against tides of misguided exaggeration and misplaced misguidance. British healthcare is in the throes of such misguidance. Consecutive governments nip and tuck at budgets, create taskforces and oversee new commissions while inevitably promising the public a loosely defined better NHS. Excellence, by its very nature, is contagious. The same is true for ignorance.

When asked about the great cities of the past, public consensus would list the grandiosity of ancient Rome or London, bohemian Paris or revolutionary New York. Nevertheless, long before these western metropolises came to the fore, truly ancient cities were found in the Confucian swath of land we now call China.¹ How, in a few centuries, did western empires – specifically Europe and North America – spring from nothingness to become the world’s superpowers? Niall Ferguson, an economic history professor at Harvard, argues that six factors alone are responsible for this tectonic switch from east to west.² The scientific revolution, modern medicine, consumerism, capitalistic competition, the right to property and an unbridled work ethic are the cogs responsible for the creation of empires.

Could these factors be adjusted for healthcare?

Modern medicine and scientific revolution are the obvious starting point. In the next few decades, genome mapping will become ubiquitous and with it comes the allure of truly personalised medicine. In addition, our technological revolution will infiltrate medicine to a greater degree with artificial intelligence now passing the Turing test with regularity.³ A recent Nature paper has outlined how artificial intelligence, in the form of deep convolutional neural networks, outperformed experienced dermatologists in the diagnosis of skin cancer.⁴ Soon, such remarkably plastic technology will become as commonplace as the current use of teleradiology. This ceaseless striving to innovate is integral to meeting increasing demands.

Capitalistic competition and consumerism are controversial when spoken in the same breath as healthcare. One of the marvels of the NHS is the freeness of use. This, I believe, is essential. However, it is hard to argue against the introduction of a capitalistic society in the UK ultimately creating a kingdom wealthy enough to sustain a universal healthcare system.⁵ Taking this a step further, could capitalism within healthcare itself be beneficial? Injecting market-based competition into healthcare systems has been shown to occasionally benefit non-paying NHS patients. A gamma knife radiosurgery service used to treat brain tumours, previously only available privately, was made available to NHS patients via a trade deal.⁶ Additional private services, used in conjunction with the NHS, have been shown to reduce waiting times and provide more options for patients. However, profiteering from care is not an axiom to build a health system around. It is essential there is a societal paradigm shift which shies away from doing so.

Right to property was historically meant in its literal form. The physician John Locke wrote that ‘life, liberty and property’ are essential human rights.⁷ Immigrants to a newly discovered America were subsequently entitled to land. With land came the right to vote.⁸ This established the formation of a strong middle class – paramount to a functioning society. In healthcare, the right to property can be applied as a metaphor for the right to a hypothetical stake. The NHS is funded through nationwide taxation. Subsequently, each citizen feels a personal entitlement to the system – this inevitably makes for a political discourse far more vitriolic than contemporaneous issues. Such entitlement should translate to remote involvement, allowing the public to kindle an affinity to a system with which they have a lifelong connection. The publicising of local trust, and national, medical milestones (novel treatments, clinical trials, retirements, etc.) connects the public to a faceless system to which fragments of their lives are inextricably entwined.

The final factor of the six is an unbridled work ethic. Regardless of your position on the NHS, constructing any argument on 1.7 million employees working harder is foolishly misguided. This system has been stretched enough evidence suggests.⁹ However, the focus of work can be adjusted – from needless bureaucracy to pioneering innovation, succumbing to the beauty of our permanently oscillating nature of wisdom.

Giving death dominion over one’s personal financial circumstance is morally indefensible. Universal healthcare may well be the root of modern civilisation. An aggregation of the people support those unable to support themselves in an act of enforced altruism and hope. The elixir of change is rationalised hope. Such hope is woven into the fabric of the NHS with doctors, nurses and scientists striving to improve. This same fervour needs to be duplicated by the government. As a result, we may find that a more accessible, compassionate, technologically primed system becomes the norm.

Declarations

Competing Interests

None declared

Funding

None declared

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Not applicable

Guarantor

SP.

Contributorship

Sole authorship.

Acknowledgements

None

Provenance

Not commissioned; editorial review.