A lot of discussion about healthcare for VIPs at the moment. By 'VIP' I mean anyone unusual who we consider, or are asked to consider, treating 'differently'. Many ICU docs have been asked to comment publicly this week. 1/8

Occasionally we have a patient who is famous (eg film star) or in the public consciousness (eg victim of terrorism). They might be very wealthy or simply well known in our circle eg a senior manager of our hospital. 2/8

Regardless of the reason, we may choose to, or be asked to give this person special treatment. The 'best' of this or that. We may give more individual care to the patient thinking this better, or more than we usually provide. Certainly it is different. 3/8

In some countries, that may make sense but in the NHS this defies our culture. We set out to deliver the same great care to every patient in every hospital, whoever and wherever they are. 4/8

NHS care is very standardised. While observers from other countries often question the best of NHS care, they rarely compare us to the weakest parts of their own healthcare systems. 5/8

This raises the question of how good that 'individualised' care is for the VIP patient. If we strive to deliver the same great care for every patient across the whole system. Anything different to that is surely worse not better? 6/8

...are those clever therapies unavailable or unconsidered for the majority of NHS patients because they are really good, or is it because they arent really good? Suddenly that special care doesnt seem so clever. 7/8

Whilst we must always treat patients as the individuals they are, when choosing specialist medical therapies we should always have a clear evidence base for their care. Not because this is better but because this is our best. 8/8