NHS2 in the year 2053 – a sideways look at the future

The Hub headquarters, glass clad and monolithic, glistened from its dominant position at the north end of the campus. I stared up at it, but was soon drawn back to the shabby, warehouse-like building to my right which appeared to have received little attention since the winter of ’45, the year I had worked in it as an intensive care doctor. We called it the ‘Lung’ back then.

A new influenza strain had swept through the country, the largest epidemic since 1918/19, and most of those infected developed respiratory failure. Because there was a national shortage of ventilators we relied on five powerful, central bellows A to pump oxygen via filtered tubes into fifty intubated patients at a time. It was hell. Two trainee doctors and eight nurses looked after each fifty patient cohort. It was one of the reasons I packed it all in. Each morning as I walked in, and each night as I walked back to the magnatram terminal, I saw the lighted windows of the other unit, where patients slept, artificially, to the sound of their own machine.

Six months later I gave up medicine to become a social historian. And that’s why I had returned, to the North Eastern Health Hub – to conduct research for my new book. The Hub had grown while its competitors in the region had closed down…or, more accurately, had been absorbed. The medical staff moved across, local managers evaporated, the bricks and mortar were flattened. The magnatram was jammed with patients arriving for their appointments. The Hub was massive now – a hospital town.

As the lift approached the executive floor I began to get nervous. Professor Sam Laszlo, or his PA, had put aside forty-five minutes. In that time I had to discover all I could about how his company had come to dominate the UK health market. I knew he would be coy about some things…but I hoped that pride would feed his honesty.

He smiled openly, his tall silhouette framed and blurred in window of bright blue sky behind him.

“Hello! Thank you for coming today. I’m sorry we don’t have much time…”

“Any insights would be gratefully received…it’s a bit of a coup to get to meet you.”

“ I understand you worked here once.”

“Yes. Intensive care. In the Lung.”

“The Lung?”

“Down there.” I pointed over his shoulder, for the roof was visible below us.

“Ah. Of course. I apologise. It’s got a quite different use now.”

“It looks pretty neglected to me.”

“Not on the inside. Not at all. It houses the fibreoptic data spine, and the refrigeration units to keep the hardware cool. Since the UniRecB scandal we have had to keep all patient data on-site. A pain, but there you go. Anyway, tell me, remind me, what is title of your book? You sent it to me but I don’t have it with me.”

“‘Two Tears: The Long Dying of NHS1’. But I might change it. That’s ‘tears’ with an E and an A.”

“Two Tears! Ingenious! But why not ‘In Pursuit Of Excellence: How NHS2 Put The Patient Back In Charge?”

“I err…come from a rather socialist background. I’m cynical about the changes…”

“But it was New Labour who let us in. You won’t remember personally of course, but after Cameron won a large majority for the Old Conservatives in ’15, on a welfare-immigration ticket, ably assisted by the nascent economic recovery, New Labour begged David Miliband to come back from the States. He shook them up, rode the economic recovery and promised a happier life free of austerity…and they won in 2020. Small majority mind you. The new health secretary, Burnham, was held by a few to the promise he had made in 2012 to repeal the Health and Social Care Act, but it was too late [1]. The benefits had become clear. It was the quality you see. New Labour didn’t even have to discuss health in their manifesto, there was no hunger for change anymore. People were happy.”

“The healthy majority were happy.”

“No, patients were happy. Qualified Providers came in, staffed their establishments properly, asked their patients about the experience, changed what they didn’t like, dealt with complaints promptly, sacked doctors and nurses in the lowest 5% on their real-time bedside compassion scores…how could Burnham dismantle it? Private companies were soon providing 25% of secondary care, it was growing at several percentage points per year. Trusts all over the country had budgeted for huge increases in income from privately ensured patients [2]. It was done.”

“But by that time there was evidence of inaccessibility…”

No-one was excluded. Remember, the state was still funding healthcare – and increasing it –  as it does now, no-one had to pay anything to get treatment…”

“Isn’t that disingenuous? State funding fell in proportion to national health needs estimates, provision became second class. This was described in the Scott review in 2024. There were already identifiable, statistically significant survival differences between NHS and privately insured patients…”

“In a few conditions only.”

“Cancer…”

“But cancer is no longer an issue, not in the era of vectorgen therapy. By 2022 that technology was already coming through. Successive governments saw that and planned strategically to account for a reduction in demand. A poor example…for your book. Don’t hang your thesis on cancer. The story isn’t in mortality, it’s in quality of life. Private companies were soon demonstrating a greater focus of quality of life…”

“…because those companies concentrated on the non life-threatening conditions. The routine, relatively safe stuff…non-urgent surgery for healthy people. That’s how you get great Patient Reported Outcome Measures.”

“How can you say that? What are we most famous for?”

“Hegemony.”

“We are dominant now, I agree. But clinically?”

“The HEPMatrix, I guess.”

“Yes! We poured resources into a group of patients with high mortality, very little hope, that no-one had tried to help before, and we changed the game. What happens now when alcoholics or Hepatitis QC patients decompensate? They are plugged into the HEPMatrix until they recover. It’s revolutionised the care of liver failure. My predecessor in this office was awarded the Nobel prize. I won’t accept this overwhelming negativity. We do benefit society…we make money yes, but we re-invest…”

“You have to re-invest, to create new markets. The HEPMatrix did that. It opened up a massive market, and the state had no choice but to pay you to provide the machines.”

“The HEPMatrix would never have come about without private investment. You must understand that. We ran research programmes from the outset. It’s altruistic, clearly.”

“Are drug companies truly altruistic? No. It’s their business. Health is your business. You wouldn’t invest in research unless, on balance, you made money out of it.”

“The two are intertwined. Healthcare has never come for free, somebody pays. Just as we pay for food, water, energy, CO2 removal…you grew up regarding clean air and a stable climate as basic human rights, but twenty-five years ago, when you were what – three or four years old? – we were all taxed for those electrolised graphene spongestacks you see on the horizon. Every industrialised country in the world did the same after the Mumbai Olympics were washed out and the European drought of 2026/27. Health does not come for free. Someone must make money out of it, but as long as that money is made ethically, and used well, what’s the problem? My shareholders are not evil men and women. They work. They too will get sick someday.”

“And none of them will go state.”

“It’s so lacking in objectivity, your line of questioning…”

“I have a responsibility to dig. In the time we have I’ve got to stress my sources a little bit…do you mind? I want to know about the separation. What precipitated the overt separation of state and private funded health streams? It’s not something you find written about much.”

“It’s convoluted. When the double-prion phenomenon began to reveal itself in the huge wave of pre-senile dementia, it became clear that disease progression could be halted if the diagnosis could be made within six months of disease onset and a course of three, 72 hour extra-corporeal cerebrospinal fluid fractionations. General practitioners were urged to screen their patients, and this led to a massive increase in referrals to neurology clinics around the country…”

“ …and the true two-speed nature of New Health Streaming (NHS2) was revealed.”

“Quite. It had been going on for years of course, that’s what the Streaming structure was all about…but the double-prion epidemic, Marshall’s diseaseD, showed up its…vulnerabilities.”

“You mean only those who were insured got seen and treated in time.”

“Only a condition with such a short window of therapeutic opportunity could have done it.”

“How thoughtless of it.”

“It could not have been planned for.”

“But it happened. New diseases occur all the time. Whatever system we have needs to be able to handle them, equitably.”

“NHS2 was doing just that, both streams were audited and proven to work within clinically acceptable timescales. Until then there were no real inequalities…”

“…until the McCartney report smashed that illusion. She showed, five years later, that among the uninsured permanent dementia was eight times as prevalent than among the insured. Because they didn’t get seen in time. Two streams…”

“New Health Streaming was developed democratically, in the oldest parliament in the world. The populace agreed, in principle, that those in work, and therefore insured, should be seen sooner, as their health was more important to the community. You think that’s evil…the voting public did not. How else do you think the Cameron government, the government that facilitated and welcomed the arrival of Any Qualified Providers, how else do you think they got voted in again in 2015? They had a mandate by then, and New Labour did not reverse it.”

“I don’t believe the populace always reach the right decision.”

“Ahh! So perhaps a Communist regime, ruled by wise oligarchs who know what is best for their people, would suit you better! That went well in the mid 20th!”

It was going a bit wrong by now. I glanced at my watch and saw that time was running out. The professor looked down at the glass surface of his desk. I watched his eye track a new message, but I could not read the words from where I sat.

“How interesting!” he exclaimed, looking up sharply, “I know more about than you realise. You do have an agenda after all. Care to tell me about it, or shall I tell you what I know?”

“What do you know?”

“Your mother succumbed to complications following the removal of her colon…an operation she asked to have after receiving the result of a LifeSpan assessment. You’ve been politically active since your late teens. Demonstrations, i-pamphlets…and then you worked here. In the ‘Lung’. If I had known all that I wouldn’t have…”

“Seen me?”

“I don’t know. How old were you when she died?”

“Seven.”

“That was what, early 30’s, we had just published the PicassoE paper. A little earlier and perhaps she wouldn’t have given Lifespan as much credence.”

“Well she did. It gave her an 89% lifetime bowel cancer risk, with a high chance it would be biologically aggressive and unamenable to early detection, curative surgery or vectorgen therapy. It’s understandable, what she did.”

“Our analysis of Picasso’s DNA gave him a 79% chance of a similar disease. And he lived to a good age. Tragic.”

“But your company owned LifeSpan.”

“We sold it after the first cohort of adverse prophylactic procedures.”

“Five years later. After thousands of unnecessary procedures.”

“Not all were unnecessary. Many people were saved. That’s a fact. Once again, your Manichean view is proved to be naïve. It’s all about balance. Society, which includes this company, wavers across the correct path, to the left and to the right, as it develops new technologies and discovers how to apply them, but the correct path can only be charted in retrospect. Don’t blame the innovators.”

Click

The tape recorder in my jacket pocket had run out.

“Tape! How quaint. Of course, your G-glasses would have been taken off you downstairs. The screener would never detect a tape recorder. But you should have just asked, the audio file would have been in your cloud before you opened the door to leave. It still can be. I’m not embarrassed.”

“Is that it then?”

“I think so. Don’t you? I hope it been useful.”

Notes

A – The bellows were steeped in irony. The Hub had brought them in a few years before the influenza epidemic  hit to manage the Guillaine-Barre outbreak of ‘42, itself caused by a faulty influenza vaccine. The chief executive in charge of the manufacturing company who signed off the use of cheap porcine substrates (leading to xenomyelinic cross-talk) is still in punitive re-profiling on the North Sea hulk-network.

B – The ill-fated attempt to provide a unified system with which to access the medical records of all patients, nationwide, had a promising start. UniRec rolled out in 2024 and received positive reviews from primary and secondary care. Patients too were able to access their medical details from home and on their smart devices. However the financial regulator, while investigating the stellar performance of a private insurance provider, Longevity+, in the financial year 2027/8 discovered that the confidential medical details of over 80% of their applicants had been accessed. All those rejected for insurance cover had early indicators, in their bio-informatics, of chronic disease susceptibility. After this scandal UniRec was dismantled and all physical and wireless connections between regional databanks were severed or firewalled.

C- Hepatitis Q was discovered in 2038. It was identified, retrospectively, in archived biological material as far back as 1987. Although blood borne, the virus did not appear to have been passed to blood transfusion recipients, probably due to its exquisite sensitivity to citrate, an additive used in packed red cell storage. In any case, since 2032 red cells have not been used for transfusion, the advent of Self-Terminating Oxygen Delivery Nanobots (STODNs) having made this practise obsolete. The Hep Q epidemic of the late 30’s and early 40’s was caused by a single infected narcotics developer who isolated and then mass produced a novel hallucinogen from his own bile.

D – The currently accepted explanation is that a new, equine prion (proper nomenclature PrPeq/valupak/2012) was acquired through contamination of processed meat and ready-made meals in 2012/3 (and probably for several years prior to this). This interacted with the highly prevalent but latent ‘new variant Creutzfeldt-Jakob’ (nvCJD) prion. nvCJD was related to Bovine Spongiform Encephalopathy (BSE) which entered the human food chain in the final decade of the 20th century. Cows, natural herbivores, had been fed meat and bone meal derived from  sheep infected with Scrapie, and calves which received protein supplements to accelerate growth.

E – Picasso’s DNA was extracted from a bone fragment, retrieved with the permission of his estate from his grave in Vauvenargues, Eurorealm Subzone 26 (formerly Provence-Alpes-Côte d’Azur, France). LifeSpan were criticised not only for driving people to unnecessary surgery on healthy organs, but for a number of suicides (2,347, proven association) that occurred in the weeks prior to a ‘likely date of death (natural causes only)’ that was provided, at extra charge and without guarantee, to their clients.

References

[1] Speech to Royal College of Midwives’s annual conference in Brighton, 16th November 2011

http://www.guardian.co.uk/society/2011/nov/17/labour-repeal-nhs-bill

[2] Freedom of Information requests in 2013 revealed that Trust (NHS1 terminology) planned to increase income from private patients by up to 200% or more in the first years following the Health and Social Care Act/Any Qualified Provider agreement.

http://www.guardian.co.uk/society/2013/apr/06/nhs-hospitals-increase-private-patients

Apologies and acknowledgments: Isaac Asimov, Philip K Dick, David Mitchell, Arthur C Clarke, and all serious health commentators out there.

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