TOUGH decisions must be made about how much is spent on care towards the end of life if health services are to remain affordable in years to come, a leading Scottish doctor has warned.
Professor Ian Frazer – the Glasgow-born inventor of the vaccine to prevent cervical cancer – said intensive treatment of people approaching the end of life meant fewer resources were available to care for those with a better chance of recovery.
The researcher, now based in Australia, said society needed to decide where money was best spent, even if that meant making harsh choices about who receives treatment.
Later this month, Prof Frazer will highlight these issues in a speech at the Royal Society of Edinburgh. He will also return to the city in July to pick up an honorary degree from Edinburgh University, where he did his medical training.
Prof Frazer came to worldwide prominence after his work developing a vaccine to protect against the human papilloma virus, which can cause cervical cancer.
But as work continues to find new vaccines and treatments for diseases like cancer, concerns have been raised about how the NHS and other health services will cope with the rising costs.
Scotland has already faced harsh criticism over funding decisions on cancer treatments, which have left some patients forced to pick up the costs themselves, travel to England for care or go without the drugs.
Speaking to The Scotsman ahead of his visit, Prof Frazer said health services could save a huge amount of money if people took simple precautions: not smoking, keeping alcohol intake moderate, exercising regularly and keeping out of the sun.
But he said society also had to make “some tough decisions” about end-of-life care if services were to remain affordable.
“The figure widely quoted is that 50 per cent of all of your healthcare costs occur in the last six months of your life,” he said.
“Most of the reason for that is because we are increasingly using intensive care to look after complex problems in the elderly. We do that because it’s easier.
“If you’re faced with a decision, do you treat the patient or do you say to the relatives, ‘your parent has a problem that is not likely to get better, how intensive should we be about the treatment programme?’ … it’s much easier just to be intensive about the treatment than to have that discussion.”
Prof Frazer added: “We have to be realistic and say if you spend the resources on treating an 85-year-old with pneumonia, then you won’t be able to treat a 35-year-old who’s had a car crash. It is as simple as that.
“The 35-year-old is likely to recover and have a normal lifespan afterwards. The 85-year-old is much less likely to recover.
“It’s a very harsh business, because it comes down to rationing of healthcare. But we’ve always rationed healthcare at some level and what we’re really doing is now saying maybe we have to set some rules.”
Prof Frazer said spending was set to increase to unaffordable levels with the population ageing over the next 20 years.
Greg McCracken, policy officer at Age Scotland, said Prof Frazer was right to highlight the “vital role” of prevention.
“However, an individual’s life should be valued irrespective of whether they are young or old and we should not seek to prioritise care towards one deserving group at the expense of another, equally deserving, group.”
A Scottish Government spokeswoman said: “If people in Scotland need treatment, including palliative or end-of-life care from our NHS, they will get it – regardless of age or condition.”