Friday, December 29, 2006


To whom is the NHS accountable? It is not accountable to local people, it is not accountable to MPs and certainly there is no accounability with local government. It now appears that the NHS is not accountable to ministers either.

Perhaps I am missing something but shouldn't an organisation that has £90 billion of tax payer's money be accountable to somebody?

Sunday, December 17, 2006

Legal challenge to ISTC

Interesting development in the murky private world of Hewitt and Co. A legal challenge to ISTC has started in Bristol, thought to be the first legal challenge against these.

Bristol Evening Post

Saturday, December 16, 2006

Obesity - is a Staple Diet Needed?

The news that NICE has recomended surgical intervention for extreme cases of childhood obesity shows the complete failure of government policy in stemming the obesity epidemic and it represents the increasing medicalisation of life with medical and surgical interventions being used to correct a failure of social policy.

The government has clearly failed to address the causes of obesity. Suggestions that people should go to the gym in their lunch hour or giving them free passes to gyms are simply sticking plaster ideas - what is needed is reengineering of the way we get around. Exercise has to be useful in order for it to be engaged in over a long period, yet transport policies encourage car use and discourage walking and cycling.

The government's failure to address the fast food culture is the other side of the obesity failure. While recent improvements in school food were welcome, they fail to address the widening cultural and health divide that requires are rethink of the way we supply food.

Thursday, December 7, 2006

Cooperative Health and Social Enterprise

Social enterprise, mutual health, cooperative health - all flavours of health care with a socially responsible theme, usually a health care service owned by its workers providing care for local people.

Pre-NHS there were many disparate healthcare services paid for out of, often, locally arrange social insurance or worker insurance - for example a community might fund a GP with a set amount each week charged to individuals.

I have been thinking a lot about these over the past few weeks as there is a great feeling that the model of health care is a useful one - but three things worry me: accountability, ownership and accessibility.

Accountability: This applies equally to the big boys, the private / corporate sector / foundation trusts etc. To whom are they accountable and how are they held to account? What happens when things go wrong (as they inevitably will from time to time)? Is professional liability enough?

Ownership: Most recent models talk of worker ownership and profits rather that ownership by a community and the mutual interest of a community. The organisation should be there to serve the community as its primary goal, rather than its owners.

Accessibility: Pre-NHS accessibility was often assured by community ownership, i.e. if you were part of the community and had paid your duty then you had access. The NHS is a nation wide version of this. If the organisation is funded through the NHS, then there is an assumption of universal access. If the organisation is not paid for by the community as a whole then universal access is unlikely.

I think there can be a role for mutual / cooperative health care in stable communities, but that ownership should be with the community, accountability should be to the community and the whole community should have access. But then we already have this don't we?


Wednesday, December 6, 2006

Foxtrot and tango

This is akin to driving to the gym... prescriptions for dance classes. I can't get my head around people that drive to the gym for a workout.. why don't the choose a gym a couple of miles away and run there an back (without going in) and save themselves pounds? I'm told it helps with motivation...

Anyway dance classes??? This was tried a few years ago with gym classes on prescription and is a prime example of a sticking plaster public health measure. If someone urgently needs support and motivation to lose weight then this should be available. If we want the popoulation as a whole to slim down, we have to address the way people want to live their lives.

Getting more people to walk and cycle will do a lot more good than a few people learning the quick step. That said, dancing is excellent fun and recommended to all (just not on prescription).


Saturday, December 2, 2006

Private costs revealed

The document published this week by the House of Commons Health Select Committee makes for fascinating reading, even though it will take you a few weeks to wade through the detail.

Snippets so far....

1. NHS spending on private healthcare companies (NHS expenditure on the purchase of healthcare from non-NHS bodies) has increased from £1.1 billion in 1997/98 to £3.7 billion in 2004/05 (page 99). This figure will far higher this year as with the exponential rise in ISTCs over the past 2 years. Surrey and Sussex Strategic Health Authority topped the table for spending the most on private healthcare companies (£238 million) and Leistershire spent the least (only £69 million).

2. The 'Wave 1' ISTCs (the first set of private treatment centres to be set up to provide NHS funded operations) cost 11% more than if the care has been provided by the NHS (p101).

3. Page 54 sets out the payments made each year to PFI companies as the 'unitary charge'. This charge includes the cost of the lease of the hospital plus any services that PFI company provides, e.g. cleaning / portering etc. Norfolk and Norwich are at the top with £43m being paid each year to their PFI company.

More to follow!


Saturday, November 25, 2006

Herceptin funding

As we all remember, there was no increase in funding to accompany the use of the latest 'wonder' drug Herceptin. Yesterday's reports on the BBC website talks about how Herceptin is draining money from other types of care - hardly surprising if there was no extra cash!

Its use in Norwich will take £1.9 million from other areas of cancer care - either 75 people could receive Herceptin or 355 could get post surgery care or 200 other chemotherapy.

So what is the answer? It's two fold...

1. Big pharma make huge profits, recouping the cost of research in the price of the new medicines. Many of the new medicines are little better than the ones they replace, yet cost more and make big profits. Prices for medicines should be set by the state, and research into new medicines should be directed by the state (or even done by the state). No-one should profit from health care - the only people to benefit from health care should be patients.

2. Government must learn that if it doesn't fund health care properly then things go wrong! Rosie Winterton's suggestion that "PCTs should always be planning ahead and we would expect them to consider the implications of introducing all drugs on the horizon" is sheer stupidity in this context. With the best planning in the world, expecting more and more health care to be funded from a finite budget is simply not possible.

On the second point there are parallels with most governments economic policies: they want continued growth and consumption in a finite world. Again this is frankly stupid and impossible.


Thursday, November 23, 2006

Health Tescopolism

"It’s like your local newsagents being taken over by Tesco" - John Lister in the Camden New Journal. GP surgeries have been predominantly run as small businesses by GP in the NHS, they are paid by the NHS, but are tecnically contractors, not employees. This is far from ideal, but is a result of the deals struck during the creation of the NHS and politicians have not had the will to change it.

The independent contractor status of GPs sadly leaves the door wide open for the private sector to take over surgeries, as is happening in Camden at the moment - as well as in most places across the country. The march of supermarkets on our village stores and corner shops has come to health care.

Clearly not wanted, needed or necessary, big private corporations are driven primarily by profit not by public duty and yet the Labour government is bringing them in faster than it is imaginable.


Monday, November 20, 2006

More advertising...

Despite government denial of a health care market, the Department of Health is to release a code of conduct on the use of advertising by individual hospitals to attract patients.

Just what the NHS doesn't need is more conflict and competition. The health care market eats away at the very fabric of our NHS and this market must be stopped if we are to have a health care service that puts people first. If cash strapped hospitals are forced to advertise to keep their incomes, and therefore to stay open, we have surely hit rock bottom in the marketised world of NHS Inc.

The use of demand and supply economics focuses services towards demands rather than needs. Advertising will increase demands for cures, moving health care away from care and health improvement. It will increase costs and push the growing NHS deficits higher. Advertising is an immoral, wasteful and inequitable addition to an already perverse health care market.

Health care should be about care and health, not profits and loss. Health care is not a commodity that should be bought and sold.

Wednesday, November 15, 2006

Queen's speech

Well it was good to see that climate change made it into the Queen's speech, but extremely sad that there are no yearly targets and the that th 2050 target is too little too late. Security was the other big head line. More oppression heading our way, more fear to be instilled and therefore more control by government.

But this is a health blog... There was little mention of health in the Queen's speech, a new mental health bill and the continuation of NHS reforms. "Controversial laws allowing people with untreatable personality disorders to be detained, even if they have not committed a crime, are to be revived." - the BBC reports. As I mentioned in the first paragraph: "More oppression heading our way, more fear to be instilled and therefore more control by government.".

Perhaps the Queen's speech could have been:

"My Prime Minister will continue to sell of the family silver with the continuation of PFI. His corporate cronies still regard this as a lucrative area and they feel they need to be richer still. This government will push ahead with the health care market ensuring further inequity.

"Finally, my government will lock up people they don't like under the guise of a new mental health bill. They may try to get them first on one of the terror / security bills, but the mental health bill will be a useful fall back."

Tuesday, November 14, 2006

Training bites the dust

The Junior Doctor's Committee at the BMA has written to Patsy about the way that the Department of Health is raiding training budgets to cover the deficits, the Health Service Journal has announced.

"While we give due regard to the financial constraints upon the NHS, patients will receive a lower standard of care if doctors do not have access to the training this budget funds." says the letter.

This happened last year of course with the underspends by SHA's reducing the overall deficit by £524 million - these saving were largely from training budgets.

This form of saving is another example of short-termism, why consider the future need when a quick fix is needed. The lack of preparation for future needs embodies the government's approach in most areas of policy, so why should the NHS be different?


Thursday, November 9, 2006

Roller coaster rides

The NHS is slipping into the red, the yearly roller coaster of NHS finances is staring its downward run. £93m deficit, which will be covered by raiding training budgets yet again. The annual financial cycle of the NHS means that Trusts have to tighten belts for the last half right in the middle of the winter months when demand for health care peaks!

Ignoring the discussion about why the NHS is in the red for a moment - what would be the effect of the financial year running October to September instead of April to March? The yearly deficits might not change much, but at least the two roller costers (finance and need) would be synchronised. Belt tightening in the summer would be easier and less damaging (there is a smaller peak in the summer though).

The financial year is arbitary anyway, a result of the calender changes in the 18th century that saw the new year move to 1st Jan, and the reluctance of the City to change their reporting to match (9 months figures would be lower than 12 months figures - bad for profit).


Tuesday, November 7, 2006

Nature 'can help people keep fit', alcohol doesn't

This story from the BBC about research by Natural England that spending more time in the countryside and in contact with nature keeps you fit and well is hardly big news to anyone with a green bone in their body (of even green fingers). What it is, is a welcome reminder of the need to connect with nature, a need that many forget, and it is of course, fundementally important to remember that we are part of nature not distinct from it.

Elsewhere we see that deaths due to alcohol have doubled in the past 15 years. It will be interesting to see what effect the opening times changes last year had. Back in April, the Guardian reported that there had been a large increase in A&E attendances in the past 5 years connected with alcohol.

So to help stay well we need to drink less and reconnect with nature, hardly ground breaking news, but clearly there is something about our society that is moving these health behaviours in the wrong direction.


p.s. sorry for the lack of blogs over the last week - I blogged off for a while.

Wednesday, November 1, 2006

Public health directors

Ruth Hussey's article for the Health Service Journal this week talks about the forthcomming appointments of Directors of Public Health by PCTs and how they are likely to be joint appointments with local authorities. This is a great step... I have be banging on about how public health is far more in tune with local government agenda than that of health care.

Ruth Hussey talks about the lifestyle issues of obesity and alcohol. These are clearly key issues that need addressing and governments local and national are better placed to do this than the NHS in its current form. It must be remembered, however, that a model of primary care that is close to its patients and understands them, can be very useful in reducing health problems.

When looking at health and health behaviours as a whole, encouraging kids to walk to school, people to walk and cycle to work, the eating of real food and reducing the stress in day to day life through a good work / life balance, and reducing the poverty gap will do far more good than hospital staff telling people to lose weight!


Saturday, September 30, 2006

Is saving lives just a marketing ploy?

A couple of days ago I said: "School nursing levels are extremely low, yet they play a key role in improving health but hospitals are high profile and save lives."

This question of saving lives has bugged my for years - what does it mean? It certainly doesn't mean saving lives as mortality is as certain as taxes. I vividly remember the first time that I used a defibrilator. I was on a night shift, in charge of the ward and a patient has been admitted an hour or so before with a heart attack. The patient went into ventricular fibriliation (her heart stopped beating) all of a sudden and I was there is a few moments with the defib and shocked her heart which then restarted. A few minutes later the crash team arrived and wanted to know what the fuss was about as my patient was sitting up asking for the loo!

The woman died about a year later. So did I save her life? No. Did I prolong her existance on this earthly plane? Yes. Did she enjoy her extra year? I hope so!

I spent quite some time getting cross every time I heard about a new treatment that would save lives - the whole emotive life / death thing hits people hard. How can we exist without this wonder pill? It almost seems like a marketing ploy.

Of course we should think about promoting good health and look after ourselves and others, these will help prevent early death / chronic disease. We should not kid ourselves that we can save lives - we must be honest with people.

Thursday, September 28, 2006

"24 hours to sell the NHS"

Email letter to the BBC's Today programme yesterday

Dear Sarah, James and Today,

It was great to learn the news that the Labour conference voted against privatisation of the NHS yesterday, however my money is on government and ministers ignoring their party once again. I find the concept that Labour ministers can ignore their party utterly incomprehensible and this must be an appalling affront to these Labour members. This is all especially timely given the NHS Logistics strike against being privatised, and last week at the Green Party's conference we passed a motion in support of the NHS Logistics strike.

Clearly, most of the Labour Party want the same as the Greens in respect of the NHS as it has been Green Party policy for some time to oppose both privatisation and marketisation of the NHS. Fortunately these Labour members will have a home in the Green Party (who are the only major party opposing privatisation) once they have been disaffected by Blair and co.

The privatisation of the NHS is rampant under this government, perhaps we miss heard Blair when he said "24 hours to save the NHS" and he actually said "24 hours to sell the NHS".

Stuart Jeffery
Health spokesperson for the Green Party

Excert from the Green Party Manifesto for a Sustainable Society:

H104 Healthcare is not a commodity to be bought or sold. The National Health Service must provide healthcare, free at the point of need, funded through taxation. It must be a public service funded by, run by and accountable to local and national government and devoid of all privatisation, whether privatised administration, healthcare provision, support services or capital ownership. The NHS is concerned with healthcare provision and should not be subject to market forces either internal or external.