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!