The start of the NHS. Source: Pelham Medical Group
There is no doubt that NHS is a success story and envy of the world, and we can learn and convey about primary and secondary care — but social care and public health need improvement. Repeated reforms and poor resources be they financial or human have led to healthcare professionals struggling to meet ever rising demands and expectations. With Covid-19 putting pressure on the NHS, is it any wonder that mantra from the government is to save the NHS.
In recent times repeated studies have shown that the morale among NHS staff has been low which in turn has contributed to totally unacceptable levels of burnout and common mental disorders with high rates of alcohol and drug use among healthcare professionals. Disproportionate numbers of deaths of BAME doctors and nursing staff following exposure to Covid-19 adds another dimension.
Societal changes, social media, changing patient expectations mean that stakeholders need to get together to explore what the Medicine’s Social contract is: when patients demand treatments as their right, which is fair and expected, they also need to recognise their responsibilities. The Social Contract is implicit and exists between medicine and patients and public, between medicine and government, and finally between government and public including patients.
Once the Covid-19 pandemic is over, it is a critical time to explore with the stakeholders how such a contract can be reviewed and renewed by clearly exploring each group’s expectations of the others; how healthcare is funded and how it is designed, developed and delivered and then utilised. Right to free healthcare must come with responsibilities be they personal, familial or community based. Employers and regulators have a responsibility and a financial stake in ensuring that doctors are trained appropriately and keep up-to-date with advances in knowledge, new technologies and learning new skills.
The government needs to revitalize the social contract with doctors by ensuring that they are listened to when informing the government policy, which is often made without any scientific evidence as is apparent in managing the Covid-19 pandemic. Doctors lack time with their patients which means the contract between them is also at risk especially in the face of changing public expectations, and that too when patients want to be a key part of the decision making process.
There are three key inter-locking components in this social contract and each group has its own imperatives and expectations from each other. These three groups are: the government, represented by the employers, regulators and health care managers; patients, their families, their informal carers and the public; and finally the medical profession and its professional bodies as well as formal carers.
This tri-partite contract is implicit but it needs periodic discussion and re-evaluation from time to time especially as society, societal expectations and more have changed over the past few decades.
Social contract between medicine and society is of critical importance for a number of reasons. Doctors need to know what is expected of them by the patients and the government who are acting on behalf of the population. Patients need to know their responsibilities as well as their rights. And the government needs to be honest in helping identify what is needed to deliver what services.
The role of the doctor in social contract: The key role of the doctor is to improve the health of individuals, extend life and improve the health of the community through a number of resources which need appropriate and adequate funding. If Covid-19 has shown us something it is that the tripartite relationship is the key to managing pandemics. The idea of doctors as healers has been lost possibly (hopefully temporarily) due to rapid advancements of science and technological innovations in medicine but also an increase in professional regulation and poor managerialism.
The social determinants of health have as great an impact on health and healthcare as medical interventions do. Thus, doctors need to advocate more and speak on behalf of their patients. They need respect and suitable renumeration and acknowledgement.