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Book review: Who should we treat?

Christopher Newdick. Who should we treat? Rights, Rationing, and Resources in the NHS. Oxford University Press 2005. ISBN 0-19-926418-X. 270 pp. £29.95.

Faced with a bleak Bank Holiday weekend, there's nothing that bestirs the blood better than to settle down to read a book about the UK National Health Service written by a lawyer from a legal point of view. Imagine, a glass of ginger beer, some sherbet lemons, and you're set. Or maybe you'd just prefer to go hang gliding.

Well, the exciting choice may just be the book. Unlikely, yes, but Newdick's approach mixes a bit of fun with information and stimulus. For instance, where would you start to try and understand the NHS, assuming you had just arrived from Mars? Not any old government waffle, or party political broadcast, or tabloid hype. No, being from Mars and very logical, you would ask for a copy of the law that set up the NHS and it's governance.

Perhaps that is where trouble starts. The NHS is organised principally under an act of Parliament of 1977, but has been in a state of almost permanent revolution since 1980. Each subsequent act has made changes to the 1977 act, or some other act; new acts change previous acts, and newer acts change those, with the consequence that there is no single piece of paper that tells you what it is like now. So our friend form Mars would do well to have several pairs of arms, a large pair of scissors, and plenty of time to cut and paste.

There is no single place for ordinary mortals to get the single piece of paper saying how the NHS should be run, and for all practical purposes the rights and duties arising in connection with the NHS are inaccessible. Only when you know how the system should run, how it does run, and some of the ethical principles of how resources should be allocated, can you begin to consider thinking about whom to treat.

In the book there's tons of interesting stuff about making difficult decisions, written in a fairly racy style with lots of references to appropriate sources, be the Hansard, the DoH, NICE, or legal cases that can so affect how society works. And there are examples, especially highlighting the problem of variation, and how different conclusions may be reached, and actions taken, depending on where you start from and the particular circumstances you are in. Some nice evidence, especially the effect of NICE approval for herceptin around the country. While the percentage of eligible cancer patients receiving herceptin pre-NICE was almost always below 20%, 12-18 month afterwards in varied between 90% and below 10%, in a pretty linear way - making for an interesting take on the postcode lottery that NICE was supposed to end.

If you want to work in the NHS and are not retiring too soon, or you want to cause trouble, or sell to the NHS, or even if you have an intellectual need to have a challenge, this is the book for you. Stock up on the ginger beer and pray for a wet bank holiday.

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