Moral Dissonance

We invest in cancer care because it’s the right thing to do, and because an added qualy year of life is worth £30,000.

But we’ll only invest in dementia care if we can prove savings as a result, regardless of quality of life.

This is Moral Dissonance.

Cancer.

14 days to see a specialist.

31 days to diagnosis.

62 days to treatment.

Near enough anyway, and admirable.

When I was told I had what looked like kidney cancer I wanted to know quickly.

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They said it was highly likely to be slow growing and non-aggressive, and they would recommend monitoring it rather than going through the trauma of nephrectomy.

But I wanted it out. At 64 and with other diseases I didn’t want to risk having a serious operation later when I would be less well than now.

And it turned out to be aggressive.

Oops.

If I have colon cancer they’ll treat it within 62 days. Why?

If I gave breast cancer they’ll treat it within 62 days. Why?

Is it because they’re calculating savings in future years that will be greater than the now cost of treatment?

Is it a good financial return on investment?

If drugs are involved, I’ll get them if the cost is less than the predicted qualys I might live for. My life is worth around £30,000 a year apparently.

Basically, I’ll get treated for cancer because people “up there” have decided that it is morally and financially right to pay for me to live longer.

Oh and because there’s loads of sexy research and jobs and companies and money to be made in cancer treatment.

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If I have dementia…and I do…I will get a diagnosis eventually, as long as I am lucky enough to see a GP who can see the point in diagnosis. And a memory service that has short waiting times…which I do.

I spoke to someone last week who’s wife waited eight months for a memory service appointment!

If I have Alzheimers dementia…and I have…I will probably be given a drug to counteract the effects in the early to middle stages of disease. Won’t stop it…but it does often speed up your brain cells.

If I have vascular dementia…and I have…I will continue on my statin and hypertension drugs, because these should slow down development of the disease. But not reverse it.

Now I may live…and I’m not sure whether to add “hopefully” here…for ten years or more with the disease developing and knocking out my brain.

“They” can’t yet cure me, or indeed significantly stop the disease.

What would my qualys look like?

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Well they’re not qualys are they. Because they’re not extra years of life.

They’re better years of life.

Living as I choose, as well as I can, continuing my life as it is, meeting people, socialising, travelling to meetings, walking the dog, watching birds…

What’s that worth?

Is it £30,000 a year?

What would it cost to help me do this?

£30,000 a year?

No. Nothing like.

As my disease develops I’ll need some help.

Some transport.

Perhaps an hour a week with a “companion” to help me and my carer navigate the nefarious and unhelpful systems.

A reminder pill dispenser and a white board. And a large orientation clock.

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Then maybe some remote technology so someone can monitor my whereabouts, my falls…

Is that £30,000 a year?

Nope.

Is it the right thing to do?

Yep.

Keep me independent and happy as long as you can.

Keep me out of hospital.

Keep my carer fit and happy too.

All for, what, a tenth of a qualy?

 

But what do commissioners want as justification to spend on dementia care?

For every extra pound they spend on dementia care they’ve got to see £1.01 in reduced costs elsewhere.

It’s got to pay for itself.

By that standard I’d still have my cancerous kidney inside me.

In fact we could save the NHS billions.

Don’t treat cancer. Prescribe pain relief instead.

The public would go for that wouldn’t they?

If we humans think we can do something, we want to it. It’s what humans do.

If think we can cure cancer we’ll try. And frankly we’ll spend a fortune doing it.

Breast cancer, with metastatic secondary five years later? Adds five years average. Cost around £175,000. We do that don’t we? Of course. Five extra years of reasonable quality life. Continuing to do what you choose.

Well, we may not yet be able to cure dementia, or even arrest it, but let’s for goodness sake sound a small amount enabling 800,000 people today in the U.K. living with dementia to continue to live their lives as they choose, and to enjoy their lives as long as humanly possible.

It’s not all about return on investment, is it?

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Spending money to treat cancer gives qualys. It extends life years. We spend it.

Spending money to improve life with dementia does not extend life years. It improves life quality. We don’t spend it.

Which is better?

Which is far less expensive?

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