Abstract
By some accounts, the politics of the NHS dominated the UK’s election in December 2019. All parties promised more for the NHS, although many of the claims were contestable. They rowed over the prospects for the NHS in a post-apocalyptic post-Brexit world. Would the NHS be sold to Donald Trump? Would it become a private wolf in a sheep’s public clothing? Who was to blame for the soaring demand, lengthening waiting times and worsening understaffing? As in any political contest, politicians were quick to dodge blame but even quicker to exaggerate the brilliance of their ideas. Anybody concerned with the uncomfortable fit of a four- or five-year government cycle and the longer-term planning and implementation required to see success from health improvement strategies needed to look the other way as the election campaign descended beyond fake news to a bewildering haze of cheap point scoring.
At moments like these, you might wish for an independent NHS, one free of politicians and political footballs. This isn’t a new idea but, as good as the thought of an independent NHS seems, the practicalities seem impossible to navigate. In which case we should commend Salil Patel’s attempt to persuade us that the NHS should be independent like the judiciary. 1 Like a man who has just watched Lin Manuel Miranda’s Hamilton at London’s Victoria Palace, Patel begins with a reference to the Federalist Papers that shaped the constitution of the United States. An argument that begins in 1788 ends in 2020 with Patel arguing that judges of health are essential. These are, he says, ‘lifelong advocates with careers that do not ebb and flow with the latest electoral result.’
In a complete editorial coincidence, this issue is touched in many places by the United States. Robert Bartholomew debunks the Havana Syndrome, a mysterious sound-induced illness reported by US embassy staff in Cuba. 2 The late great statistician, Doug Altman, tells the story of Donald Mainland, a doctor from Edinburgh who became a professor of medical statistics at New York University. 3 Mainland was an anatomist, educator, thinker, medical statistician, trialist and rheumatologist. His influence on clinical research is clearly underappreciated. But we return to fundamentals with Alberto Friedmann’s Podium piece that explains why the current US healthcare system is unconstitutional, illegal and failing the founding doctrines. 4 Life, liberty and the pursuit of happiness have never had it so bad.
Politicians, you have been warned.