The focus on the debate surrounding the NHS has centred on the efficiency of the use of funds as well as the ‘lack’ of funds. The problem however is much wider and complex than this very simple dichotomy. Firstly, let us put things in perspective; in what system do you put in £50 and expect to receive £115 billion? 18% of the taxpayer’s money is channelled to the NHS. For the average person that is less than £50 per month. This may seem steep if you are in your twenties and property hunting or in pocket living. But for those of us who are closer to receiving a letter from the queen, it is no doubt the bargain of the century.

Nevertheless, when one is paying for a service, certain expectations are required to be met. Usually, these expectations are proportional to the amount one pays for the service or product. Thus when the United Kingdom adopts one of the highest tax rates in Europe, the population naturally expects a flawless service. The second factor in determining expectations is the reputation of the company or person providing it. Applying these criteria, the only conclusion one can arrive to is that the NHS has become a victim of its own success.

The NHS was launched in 1948 and was born out of the ideal that healthcare should be available to all, regardless of wealth, class, and social status. It is free at the point of service to 64.1 million people in the UK. In 2014, the commonwealth fund declared that the NHS was the best healthcare system when compared to Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, and our cousins across the Atlantic, the US. This declaration was based on it’s of efficiency, effective care, safe care, coordinated care, patient-centred care and fiscal situation.

However this should not disguise that there is a very real problem with the NHS. However it is not solely to do with fiscal management or lack of funds. With the aging population, it will cost incrementally more per patient per annum but the population has only increased in age by one year from last year. Yet despite this, the NHS expenditure has spiralled out of proportion. Why? The reason is simple; patient expectations have sky rocketed.

Patients now google symptoms on their smart phones on the way to their appointments. They arrive with more ‘knowledge’ than the doctors and nurses who have been performing their medical duties for years, and insist that they have illnesses that do not have any basis in the doctor’s diagnosis.

As the patient arrives in the surgery, having just closed internet explorer, google chrome, safari, or whatever other internet browser they were researching their symptoms on, they begin to describe their symptoms and their preliminary conclusions. As the doctor provides a diagnosis and appropriate treatment, the patient expresses dismay and a sense of unhappiness that his condition is not that described in his google searches. Surely the doctor is wrong and a specialist is required. Such is their right and so they insist on it.

So, the doctor refers him to a neurologist, despite knowing that the end result will be the same. This clogs up the referral system and slows down genuine patients who are in need of an expert opinion. But just like when one pays for any service, the patient feels aggrieved when their expectations are not met and hence they fight their corner to secure a referral. I would do the same thing. This is not only evident in the community, but in hospital medicine as well.

Despite being qualified to make a decision, whether that qualified person is a nurse or a doctor, they succumb to the demands of the patient and issue that golden referral letter to another healthcare professional and pass on the responsibility for making a decision. This is for a number of reasons and is most evident in the already struggling Emergency departments.

The elevated expectation levels have led to record numbers of legal claims against healthcare professionals which has subsequently led to a rise within the NHS of a practice called ‘Defensive medicine. ‘Defensive medicine’ is defined as the practice of recommending a diagnostic test or treatment that is not necessarily the best option for the patient, but an option that mainly serves to protect the physician from the patient who is always a potential plaintiff. The litigation against medical professionals has begun to spiral out of control and hence healthcare professionals have begun to shy away from making any decision and rather delay the decision by over-investigating and referring it to someone else, leading to an increased backlog in seeing patients, extended waiting times, unnecessary costs of the investigation or referral and delayed referral appointments as the system becomes overloaded with unnecessary referrals.

So what is the solution?

Many have suggested implementing a nominal extra fee when accessing the NHS, but this will only increase expectations and lead to more complaints from patients seeking ‘value for money’. Inevitably, some responsibility should be attributed to the medical professional to use the resources available more efficiently and appropriately. However as much as one can blame the patient’s high expectations, as I sit down and place myself in the patient’s shoes, I would definitely request that extra scan from a specialist to be safe.

On the legal front, removing no win no fee claims against healthcare professionals may break the trend of ‘defensive medicine’. However there is no doubt that the increased liability of doctors has pushed the boundaries of excellence within the NHS and has provided that impetus to continue improving and establishing itself as the leading healthcare provider worldwide.

Striking a balance between the effects of the demands and the need to constantly improve is no doubt difficult. However it is difficult to imagine such improvement taking place without such heavy demands on such a fundamental sector such as healthcare.