Should big pharma face criminal charges for deaths?

From the BBC today: "Almost 3,000 people have died in the past three years after suffering serious side-effects or allergies to their medicines, say official figures."

Apparently there are about 13000 more who have suffered reactions to drugs and countless others whose reactions have not been reported. Taking different medicines at the same time is even more dodgy. Polypharmacy is common, especially with older people, and the chance of drugs interacting with each other is very high.

What to do though??? Arthritis, atrial fibrilation, COPD together could put you on a cocktail of at least half a dozen regular medicines that would not just be keeping pain at bay but are keeping you alive. The answer is firstly to stay healthy, then keep it simple and finally do what works for you.

An alternative solution, which might be more interesting... if drug companies were faced criminal charges for each death I am sure that their drugs would be far safer! This would also eat into their obscene profits. If 3000 people died from eating Heinz tomato soup I feel certain that Mr Heinz would be in the dock, so why not Mr Pfizer or Mr Glaxo?

Lib Dems' Nick Clegg plans radical departure?

This is the headline in the Torygraph - apparently the Lib Dems have a radical plan for health care provision, they are going to bring the private sector in to help with long waits.

So all we need to identify is which part of this concept is radical and distinguishes them from Labour (pushing as much to their corporate friends as they can) and the Tories (weren't quite brave enough to privatise health care but would do now).

The mushy grey centre of politics is not where radical progressive parties are. Perhaps not putting taxpayers money that should go to patient care into corporate shareholders pockets would have been radical.

Hospital 'fines' for patient harm

What madness is this? "Hospitals should be fined if they harm patients, the government's chief medical officer has proposed."

So a hospital is struggling to control infections, get its procedures and care right and so on - so what can be done to help them? The most important thing not to do is take away money (i.e. staff) from them. They need support, guidance and help, not hindrance, penalties and fines.

Perhaps a hospital failing on its infection targets should get rid of a few nurses and cut back on cleaning? This is in effect what the government is suggesting. If anyone thinks this is a good idea please let me know...

Stuart

Kingston Hospital - privatisation

The piece below is from the Wimbledon Guardian.

Yet again we are subjected to the lie that privatisation is more efficient that the public sector. This is utter rubbish - time and time again we see that the private sector is less efficient. At a international level, just look at the US to see what an absolute travesty the private sector brings to health care. They spend almost twice as much as the UK as a proportion of GDP but don't provide care for 40 million people. Cuba spends less than the UK's GDP proportion but has 5 times more doctors per head than us and has a fantastic health care record...

Stuart

Hospital chief: privatization is the best way forward. Kingston Hospital's £1.6m plan for a private company to run its elective care is the only way to combat falling numbers of patients, according to the hospital's chief executive Carole Heatly. She said that turning to the private sector was the best way for the hospital to increase the quantity of its elective care - a necessary safeguard against losing its training status. If the 10-year deal is brokered, a private company will take control of the hospital's new surgical centre, day unit and eye unit. It would also be put in charge of the hospital's small private ward, Coombe Wing, which it might be able to extend, with profits shared between the hospital and the private company. The exact split of profits has not yet been finalised but Ms Heatly said the hospital's share would be re-invested in the NHS. It is also hoped that the company would expand the hospital's catchment area, making the most of the patient's power to choose a hospital, by marketing its services to GPs and potential patients. Staff would remain employed by the NHS for at least two years but they would be seconded to the private company, who would manage them. Ms Heatly said that, after two years, staff may be able to choose to be employed by the private company and that in similar set ups across the country, many staff had chosen this option. Nora Pearce, hospital midwife and Unison representative, said: "The hospital has always said its most valuable asset is the staff. Now what are they doing? Selling their most valuable commodity."

Health and the War Machine

This is an email from Joseph Healy, point out succintly what I'm sure many of us are very aware of. We are still spending less than our neighbours on health care (as a proportion of GDP) and yet we put phenomenal amounts into 'defence'. When was the last time we we invaded or attacked? Probably when Labour started selling off the NHS and let the private sector in...

Stuart

This article is very much in line with what I have been saying as a prospective Euro candidate in London. For anyone who does not see the link between foreign policy and the backward health and social care, not to mention transport modernisation etc, the writing is on the wall.

http://www.communitycare.co.uk/blogs/social-work-blog/2007/11/britains-colonial-mentality-is.html


Defence spending should be cut to the bone and the frummery of Empire, such as Trident etc, axed. The imperial posturing will cost the deaths of many pensioners, patients etc. When a local Labour councillor tried to get a campaign going on extending the tube system to Camberwell, I supported
him in the letters page of the local paper, but suggested that he got Gordon Brown, then the Chancellor, to divert some of the Iraq millions into the scheme.

Why have Germany, France, Italy and most continental countries got better health services? Answers on a postcard to the Ministry of Defence.

Joseph Healy

Buffers

This is news from the BBC: "A clampdown on spending within the NHS has turned a massive deficit into an even bigger surplus in just two years.

As much as £1.8bn, about 2% of the budget, will be left unspent this year, the Department of Health says - prompting charges of "boom and bust"."

Apart from the disgrace that these cuts have been too high and patients suffer rather that funds getting spent as they were intended, this underspend also demonstrates the madness of the NHS market economy.

With purchasers (PCTs) and providers (hospitals etc) paying and receiving funding on the basis of volume of work, there is no certainty around budgets. They therefore have to aim greatly on the side of caution when planning expenditure - or face losing their jobs. It looks like they have acheived a margin / buffer of 2%, which is great if you are a business, but bad if you are one of the patients queuing in an ambulance for a bed in Norwich last night.
The NHS's rationale is to provide care, not to make surpluses, get involved in market economies and not to put patients at risk through bizarre, outdated and damaging practices such as the health care market. We only have to look at the pinnacle of healthcare waste - the US system - to see what the market can do for healthcare.

Tescopoly to take over GP services

This is from : Pulse "GP practices are to be forcibly converted into franchises and offered up to high-street retailers to run under ambitious plans welcomed by senior NHS managers as a blueprint for the future."

Fortunately, there has been a small U turn for other areas being privatised: "The government is rowing back on its use of the private sector for NHS care by scrapping a series of projects. Six clinics in the pipeline and another already up-and-running will fold at a cost of millions of pounds as they do not provide good value, ministers said." from the BBC.

What is clear is there is a complete lack of strategy. Alan Johnson seems to be trying to quieten the noise, from those opposed to privatisation while trying to get some new corporate friends on board. The thought of Tescos running GP surgeries is obscene. Tescos will have have same effect on primary care as it has had on small independent shops - devastating.

Stuart

Chan Wheeler - fraud allegation

I don't read The Mail much, but this caught my eye: NHS boss 'benefited from Sting-lie fraud' in US role.

"A highly paid American recruited to commercialise the NHS is facing allegations that he benefited from fraud during his previous job with a US health insurance giant.

"A US judge likened the allegations against NHS Commercial Director Chan Wheeler to the plot of the film The Sting, in which two conmen win huge sums betting on horse races after the results are known.

"The judge said Mr Wheeler and his co-directors in UnitedHealth were accused of doing the same by awarding themselves millions of dollars worth of shares in the firm deliberately dated to a time when the US stock market was at an all-time low after the September 11 attacks in 2001."

More United Health problems again, this time with one of their executives entering the NHS to extract more taxerpayer's money to turn into shareholder profits. I have blogged before on Simon Stevens and won't go on about him again, but do remember him as the Downing St advisor on health who now heads up United Health Europe...

Stuart

Told you so...

Organic produce IS better for you (and better for the environment / people living where the crops are growing / kinder to the animals etc.) according to Newcastle University. It has always been a no-brainer for me, things are alway better the closer to working with nature that you get. This is from the BBC:

"Researchers grew fruit, vegetables and reared cattle on adjacent organic and non-organic sites across Europe, including a 725-acre farm attached to Newcastle University.
"They found levels of antioxidants in milk from organic cattle were between 50% and 80% higher than normal milk.
"Organic wheat, tomatoes, potatoes, cabbage, onions and lettuce had between 20% and 40% more nutrients."

I expect there will be backlash and organic deniers funded by the agrochemical co.s and the oil industry against this, it will be interesting to see what they come up with.

Stu

NHS Demo 3rd Nov

This is the quote from Unison, the union that still provides massive funds to Labour:

"Help us campaign to defend the NHS and to celebrate its founding principles. Join us on the march and rally in central London on Saturday 3 November and send a strong message to the government that big business and the profit motive have no place in our health service."

Of course the health lead, Karen Jennings is going to be a Labour candidate too.

However, do try to get to the rally. The Greens will be there - the NHS is too important to be messed with in the way Labour are.

Letter to the Telegraph

Sent this to the Telegraph some time back in response to this piece, sadly it was not published.

Sir, Karol Sikora's approach to health care fills me with dread, treating cancer patients like customers in a pizza parlour is hardly what patients need or want. As for suggesting that the NHS is hopelessly inefficient - he is so far from the truth as to be laughable. The NHS has been the envy of the world's health care systems for decades, despite below average funding levels and continuous reform. How anyone can claim the NHS is inefficient when it is an organisation that can cope with high levels of change and a consistent lack of money yet still be a high performer internationally is beyond me.

Sikora's approach to cancer care would simply line his pockets and give us olives with our chemo.

Stuart Jeffery
Health spokesperson for the Green Party

Obesity, climate change and alcohol

So Alan Johnson reckons that obesity is as big a threat as climate change. True, it will have a massive impact on the health of people in this country, meaning that children could die before their parents, with the first time that life expectancy has fallen in the last 200 years. But is it a bigger threat than climate change?

The straight forward answer is of course not, but the solutions to both have a lot in common. Localisation of food, eating fresh, in-season produce, reducing meat consumption, using the car less, cycling and walking more will reduce our impact on the environment as well as the impact on ourselves and our families. The thing to do is consume less!

Obesity may hit the UK more quickly than climate change, but its effects are confined to the West and are moderately easy to reverse. Climate change threatens the lives of billions and will be almost impossible to reverse in any real sense

While I am on the subject of consuming less, the Guardian has reported a massive rise in alcohol abuse over the past 5 years.

"The figures reveal the number of people who have had to be admitted as emergency cases to hospital as a direct result of their own or someone else's drinking."

"The number of men admitted nationwide has risen from 714 per 100,000 in 2001-02 to 909 per 100,000 in 2005-06, a rise of 27.3 per cent, while, over the same period, the number of women has gone up from 396 per 100,000 to 510 per 100,000, a jump of 28.9 per cent."

In a society which is beholden to consumption, the problems of excess seem to be becoming very obvious.

C Diff

I have deferred blogging about the C Diff scandal at Maidstone and Tunbridge Wells NHS Trust, partly because it was a massive story, covered by everyone, partly because it was so shocking, partly because I think there was little that I could add, and partly because it is my local trust and I know quite a few people there.

It is difficult to estimate the shock of the tragedy and certainly there is a lot of anger among people in Maidstone (and across much of West Kent). My heart goes out to all those who have suffered and died.

The focus on targets and finances that has been at the forefront of blame, seems likely enough. Clearly the NHS had a rough ride during that period with money. Star ratings were everything.

We must put people at the heart of care, but what happens when the money runs out? What happens when we are pushed to meet targets at the expense of care? People suffer...

Other countries manage to find more cash for their health services, the UK still lags behind in investment in health care. But the British electorate doesn't want to pay more taxes. Look how the inheritance tax bung from the Tories swung the polls. Of course most people don't have to pay more tax for us to have a better society. Sure, lets tax the rich more and the poor less - you can't do it the other way round, but lets stop building more roads / airports / nuclear power / arms / armies and stop fighting illegal wars before we say there's not enough money around to look after sick and vulnerable people properly.

Stuart

DARZI REVIEW: MORE PRIVATISATION MEANS A WORSE SERVICE

The Green Party today responded to the interim Darzi Review. Supposed 
to set the NHS's priorities for the next 60 years, with key themes 
being access, quality and safety, the review was commissioned just 
three months ago.

"This review recommends yet more privatisation of the NHS, the last 
thing we need. (1)

"Giving people easier access to GP's is an admirable goal, but using 
private companies to provide that service is a disastrous idea.

"The NHS is already operating at a loss, hiring profit driven 
businesses to provide services will only make that worse."

"The challenges of delivering a world class health service over the 
next decade mean we must take private corporations out of the the 
picture  - the Green Party believe the NHS should be publicly funded, 
publicly owned, and publicly accountable."

ENDS

Notes for Editors:

(1)  Page 5 of the Executive summary states: "New resources should be 
invested to bring new GP practices –  whether they are organised on 
the  traditional independent contractor  model or by new private 
providers"

Assisted dying in the news

Media coverage on the Green Party policy to support assisted dying was excellent. This is from the Guardian:

"The Green party today called for assisted suicide to be legalised, despite fears it could cost the party votes.

"The party took the decision earlier today - the second day of its conference, taking place in Liverpool - amid warnings that it would be unpopular among voters with strong religious views.

"The policy sets out a framework of safeguards for individuals wishing to end their life and healthcare professionals involved in the process."

Voluntary Euthanasia

The Green Party has come out in support of a sensible framework for voluntary euthanasia. We have been working on this policy for a long time and it is great to see it enter as party policy.

Synopsis:
There is increasing discussion on end of life care and this amendment seeks to establish a Green Party position in this highly emotive area. The amendment has been constructed from examples of end of life policies across the EU and seeks to establish a safe and fair framework for people to have an assisted death.

Motion:
The Green Party recognises that medical decisions taken towards the end of a person's life should never be undertaken lightly. We believe that when the quality of life is poor (e.g. due to severe dementia) life prolonging treatments such as influenza vaccines and antibiotics should not be given routinely without consideration of the whole situation including the wishes of the patient and relatives.

Many medical interventions provided at the end of a person's life will both relieve suffering and hasten death. We recognise that this can cause concern amount health professionals and the public and will introduce clear guidance to protect all parties.

Assisted death presents moral and legal concerns to health care professionals and the public. We believe that people have a right to an assisted death within the following framework:

* The appointment of an independent advocate must be made when either diagnosis of terminal illness is made or the person receiving care expresses the desire to end their life
* Counselling must always be offered to every patient considering an assisted death
* Alternatives, such as palliative care must be discussed with the patient
* The patient's ability to make the decision must be established by joint assessment of two independent doctors, one of whom should ordinarily be the patient's GP, unless impractical in the circumstances, in which case it may be the patient's medical consultant, one of which must be a psychiatrist and a third independent registered health or social care professional who has undertaken approved training in this area and who has no prior knowledge of the patient.
* This decision must take into account evidence provided by the independent advocate.
* Treatable illnesses that may impinge of the decision making ability, e.g. depression, must be treated and excluded from the rationale for requesting an assisted death
* The patient has the right to appoint individuals either during or prior to the process who will have access to their medical and other records and whom they wish to be involved in discussions
* The patient's informed consent must be clearly documented, full discussion of the outcomes of both the illness and the assisted death must also be provided in a language and form understandable to the patient
* The patient's close family should be involved in all discussions
* There should normally be a waiting period of at least 7 days, set by local policy, for the patient to reflect on their decision.
* Patients could orally revoke the request at any point
* Healthcare professionals can refuse to be party to any stage of assisted deaths for their own moral reasons
* Assisted death will be notifiable

We will introduce legislation based on this framework to ensure the protection of all parties.

Diesel fumes

From the Independent today:
"The World Health Organisation estimates that air pollution causes 800,000 premature deaths worldwide and a recent US study suggested long-term exposure to traffic fumes increases the risk of death from heart disease and stroke by 76 per cent."

Diesel fumes

From the Independent today:
"The World Health Organisation estimates that air pollution causes 800,000 premature deaths worldwide and a recent US study suggested long-term exposure to traffic fumes increases the risk of death from heart disease and stroke by 76 per cent."

Peak oil, health care and emotional issues

There are 1.3 million people employed in health care in the UK[1] and 5% of all traffic journeys [2] are connected with health care. Medical technologies increase in complexity year on year and with complexity comes increasing centralisation requiring longer journeys for treatment. Small units are no longer considered 'safe' as complex procedures require greater throughputs of patients to ensure clinicians remain practiced.

'Choice' and the health care market means that patients can choose a health care provider that doesn't have to be local, meaning even longer patient journeys. Medical technologies and medicines are founded on the princple of unlimited energy, developing new medicines is energy intensive and complex machines use increasing amounts of power to run and develop.

The new economics foundation / NHS Confederation report, Taking the Temperature [2], talked about the NHS's role in climate change with "energy use in NHS healthcare facilities costs £400 million annually and results in a net emission of around 1 million tonnes of carbon". There were other useful analyses such as the energy wasted from PCs being left on each year being enough to fly 26,000 people from London to New York and back, and that recycling 40% of its waste would save equivalent energy to driving a car 550 times round the equator.

The energy embodiment in health care consumables has not been properly assessed, but consider the plastic syringes, disposable bedpans, dressings, gloves and so on. Then multiply what you see on one ward by 20 to get to a hospital sized amount and then by 200 to get to the UK size and then add in 10000 GP surgeries and the amounts of consumables, all being produced with large amounts of energy derived from oil, are staggering.

The solutions to reducing CO2 emissions and preparing for peak oil are broadly the same. They focus upon system redesign to reduce the need for use of carbon based energy. This system redesign is multifaceted and, sadly, can be highly contentious escpecially as it clashes head on with clinician and public desire for a Rolls Royce service rather than the 'Honda' version described by Dan Bednarz[3]. The Honda model focuses upon good public health and not on increasing technological advances and could be paralleled to the Intermediate Technology concept developed by Schumacher[4].

Peak oil, with its outcome of rapid price increases, will result in our current cost of health care (about 9% of GDP in the UK) rising rapidly in line with oil. When these rises are placed alongside the predictions made by Derek Wanless[5] who forecast spiralling costs of health care unless public health was improved rapidly, then we have a pretty daunting future in the UK. Unless improvements in public health are made then the attempts to reduce oil dependency in the NHS will be wiped out.

The challenge is for people to understand that reducing energy use in the NHS and improving public health can go hand in hand - less illness reduces the need for health care and therefore reduces early deaths. The difficulty will be with people protesting that the lack Rolls Royce care will mean that some individuals will die. This stark reality can be offset by a rational discussion on lives saved through better public health, but does that help when there is a sick child involved?

The public perception and media focus on a sick child that could be denied treatment through the adoption of a Honda service is extremely powerful. Currently in the UK there is a stream of media attention on cases of rare childhood diseases that the NHS can't treat. These may spawn campaigns to fund the child to fly to other countries for experimental treatments, with scorn being poured on the NHS for not being good enough. Again, the rational argument says that these rare diseases will be rarer with better public health, less reliance on plastics, less pollution and so on, but it is certain that they will still occur. If they occur to a close family member, especially a child, I suspect we would all react in the same way - no one wants to be told that there is nothing that can be done.

We therefore have a dicotomy effectively driven by emotion, a chasm that is widened by media pressure and therefore likely to spill into a political arena. Politics and healthcare are poor bed fellows in the UK, and much must be done to address this. All the time politicians are made to bow to emotional pressure and health care nimbyism, there will be no progress. We can have localised services, but they will not be as high tech as centralised ones. This is the stark choice we face and this arguement is occuring now, without the drivers of climate change or peak oil. Across the UK there are protests about the closure of A&E services and reconfiguration changes that are, it is claimed, led by the need for high enough catchment areas to ensure safety. If people want to have local services then they may need to accept that there is a reduction in clinical safety.

With any system of health care people will die - death is a natural as taxes! Grief is the proper response to death, not anger, media furore or political intervention, but it is anger and media furore that will be the hurdles to overcome when moving to the Honda system of health care. Explaining that vast numbers of people are living longer with less morbidity as a result of lower obesity levels should be a good counter argument to the inability of a system to provide high tech health care to a minority, but it can be derailed by media furore - after all what would sell more papers, a sick child 'denied' tretament or a headline about millions living longer and more healthily? Michael Ben-Eli [6] talks of various domains that are required to understand sustainability and heading his list is the spiritual domain, identifying the attitude and understanding for right conduct. This suggests that we need to grow as individuals as well as a society to be able to deal with the realities of life.

It has been said that we should look to Cuba for a first rate example of how health care can survive peak oil. According to Megan Quinn, Cuba went through its own peak oil crisis in the 1990's when the Soviet Union collapsed and it was maintenance of free health care that helped Cuba survive[7]. Cuba's health care system is provided at around 7% of GDP, yet has a doctor to person ratio of about one to 170, compared to one to 500 in England[8]. Cuban health care provides a focus on health improvement with general practitioners based close to people and having a close relationship to to their patients. Cuba has a phenomenonly low infant mortality rate that puts many richer nations to shame, including the US (infant mortality is a good indicator of a nation's general health). Through Cuba's early peak oil crisis the country has localised food and reduced dependancy on cars, and their diet is low in meat and physical activity is high. Increased activity and reduced meat intake are a good response to peak oil and an extremely good way of keeping healthy.

Peak oil could be disasterous for health care in the UK, and no doubt the media will spin post-peak oil health care in that light whatever is done. The UK needs a managed transition to a Cubaesque model of health care, rather than rapidly escalating costs followed by a collapse. A managed transition towards Intermediate Technology for health care, a switch to localism of food production, and move away from jumping in cars to go round the corner! Managing these changes in the face of media driven hysteria will be the biggest challenge of all.


References:
1. http://www.ic.nhs.uk/statistics-and-data-collections/workforce/nhs-staff-numbers/nhs-staff-1996--2006
2. Taking the Temperature (2007) new economics foundation & NHS Confederation http://www.neweconomics.org/gen/z_sys_publicationdetail.aspx?pid=240
3. Bednarz D (2007) http://www.orionmagazine.org/index.php/articles/article/31/
4. E F Schumacher (1973) Small is Beautiful
5. Wanless D (2002) http://www.hm-treasury.gov.uk/consultations_and_legislation/wanless/consult_wanless_final.cfm
6. Ben-Eli M (2007) Resurgence http://www.resurgence.org/2007/beneli244.htm
7. Quinn M (2006) The Power of Community: How Cuba Survived Peak Oil http://globalpublicmedia.com/articles/657
8. Hansard (2002) http://www.publications.parliament.uk/pa/cm200203/cmhansrd/vo021204/text/21204w26.htm

Sicko

Frustratingly, Sicko, the latest Michael Moore film, this time on the state of US healthcare hasn't got a release date here in the UK. Drawing the parallels emerging between US and UK systems would be interesting, especially in the context of Moore's work.

Bednarz and Crawford have published their take on Sicko here. Below is an excerpt. This link with our environment and with peak oil needs more exploration. Greens generally understand the context of health with environment, as do public health clinicians, but we need to explore a second aspect of interaction, that of health care and environment.

From Bednarz and Crawford:
"In bare-bones, Moore wants to exclude insurance and pharmaceutical companies; he wants money out of the temple of medicine.

" Fine, and imperative; but we have some questions. First, as urgent and humane as it is to make medical care a right regardless of one’s of financial status, will this solve our healthcare problems? Second, how sustainable is the new medical system Moore envisions? Third, how do we overcome the behemoth structure now in place to institute genuine reform?

"We depart from Moore and the vast majority of reform proposals we've seen by locating health care in its ecological context, and assert that all three questions have an ecological answer. Since this will sound odd to many, let us repeat this in slightly different language: the economy, of which medicine is a subsystem, exists within and is wholly dependent upon the natural environment (also known as the ecology or the biosphere, among other designations). The ecology is not ancillary or subservient to the market economy; ultimately, it supplies the energy and resources necessary for human economic activity. "

Continued privatisation of the NHS

This week's Health Service Journal makes depressing reading. Despite rumours that the Brown government was getting cold feet about private involvement in the NHS, things seem to be continuing at a pace. This is a selection of the headlines this week:

Established GPs prepare to feel the heat of big business
GP tendering could herald new era of competition for practices
GPs urged to refer directly to the private sector
Acute trust to privatise all elective ops

4 out of 11 headlines from the first five pages of the journal are on privatising services...

So much for Brown's socialist principles.

Stuart

Dentistry and Peak Oil

Interesting piece from Energy Bulletin on the readiness of UK dentistry for peak oil! The British Dental Association published a document called "Dental Futures – forward to 2020" which failed to mention the words: energy, oil, sustainability or carbon.

"Dentistry in the UK and around the world has a long way to go before it can even start a discussion about dental care in a post peak oil world."

NHS Support Federation Speech

This is a transcript of a speech that I gave at the House of Commons's Grand Committee Room on 24/7/07. This was part of a panel discussion with Frank Dobson, Norman Lamb and Neal Watson...

Thank you for giving me the opportunity to set out the Green perspective of what would be in this 'new prescription for the NHS'. I suspect that you may be asking what the Greens have to say on health care and I hope that I can show you that we have a very clear vision that sets us apart from others, and that we have a deep commitment to the NHS and its principles.

For example, we have been campaigning alongside the Keep Our NHS Public campaign for the past year or so, with many of our members joining local KONP groups, knocking on doors and organising petitions. It is worth remembering that we are the only main party that is fundamentally opposed to private sector involvement in health care.

In defining this new prescription for the NHS and where health care should go over the next 20 years, there are a number of key areas.

Firstly, I think the top priority that we must address is accountability. We currently have a health care system that spends £90 billion of taxpayers money, a system that accounts for about 9% of our GDP, results is 5% of vehicle journeys and therefore 5% of all vehicle pollution [1], yet it is under the dictatorial control of just one person, the secretary of state.

We all know that staff, patients, the public, local councillors, MPs and even ministers, don't get listened to. Last year we had Hazel Blears, John Reid and Jacqui Smith that were among 13 ministers protesting at cuts, including a health minister, Ivan Lewis [2]. We, not only have no accountability to local people for their services, but this lack of accountability exists at every level. We have also witnessed the decline of the Community Health Councils into Patients' fora, and now further decline into something called 'LINKS'. There is only one good solution to freeing the NHS of centralist dictates and for providing true accountability to and involvement with local people and that is to have the NHS accountable to local government.

Of course, if people want to have no say in health care, if people want to have no accountability, if people want the NHS to do its own thing, then we should opt for the arms length quango that seems to be flavour of the month. But if we want to have a real voice in our local health care services then we need to have direct accountability to local people through local government.

But shouldn't the NHS be led by clinicians? Well, we need clinicians to develop new approaches to health care and to develop new healthcare technology. We need clinicians to advise on the best and safest way to provide services. But just because something is deemed to be clinically right, it may not be what local people want or need and we must not forget that the NHS is there to serve them.

Accountability has been reduced further by the purchaser / provider split, the internal market, that the NHS operates. When you subcontract work you reduce your responsibility, it gives you the ability to say, “it wasn't me but I'll get on to them”. But with this reduction in responsibility come less accountability. The NHS tries hard to mitigate this problem with its various service reviews, but sub contracting any service, be it cleaning, independent sector treatments or foundation trust hospitals, brings problems when trying to hold them to account.

I am also sure that we are all well aware of the intensely destructive and expensive nature of the NHS market. We now have Payment by results and practice based commissioning, where 'money follows the patient' and every visit is costed and paid for, but health care is not a object to be bought and sold. In a civilized society health care should be a right not a commodity. 'From each according to his ability, to each according to his needs' - not according his, or his PCT's, ability to pay.


So, what are the alternatives to the internal market? We have already had a far superior model to the purchaser / provider split. Directly funded and managed health care was provided at a fraction of today's costs and at the same time the NHS was seen as the best in the world. Sure, wages were too low and health care technology wasn't as advanced, but we have seen a 50% increase in funding since then much of which is wasted on administering our flawed Americanised model.

We hear from the big corporate proponents of marketisation that markets deliver new ideas and advances in health care. I say that is rubbish - it is clinicians that come up with new ideas and advances and they do this for their patients and because they have a natural desire to improve care. UK clinicians are pushing the frontiers of health care because they feel it is the right thing to do, they don't do it to get a bigger market share. New methods of health care need to be driven by NHS staff as does the weeding out of outdated and unsafe practice. Clinicians need to drive clinical change.

But staff, patients and the public are missing this relentless march towards the US model. Let us not forget, the US model leaves millions with no access to health care yet costs twice as much as much as the UK! So why on earth are we trying to emulate it?

The NHS was founded upon a universal service for all based on clinical need, not ability to pay. It was founded as a health service to be funded by taxation. Rather than continuing in the current direction towards the US model, we must recapture the core values that the NHS was built upon.

Were you aware that the government recently consulted on changing its core principles for the NHS? Previously it had set out 10 principles in the NHS plan, one of which said: “Public funds for healthcare will be devoted solely to NHS patients.”. The new principles, proposed of course by Labour, leave this line out... and how could they leave it in while millions of pounds are going to private companies' shareholders?

We do need to re-examine the core values and ensure that they are fit for the 21st century. For example there is nothing in them which talks of timeliness of access to health care [3]. According to the current set of principles patients could wait years for treatment without going against the values of the NHS. There is also nothing in them about providing services to local people and communities. Putting values at the heart of health care, values at the forefront of any changes, must be paramount. Perhaps we ought to use core values as the key measures of performance rather than some of the weird targets currently in place.

Funding is another of the central themes of health care debates. Currently about one fifth of public spending is on health care - around £90 billion, or about a grand and a half for every citizen. But people don't know what the cost of health care is. On the one hand we have protests against spending cuts, on the other we have complaints about taxation.

It is time to reconcile these. We need to be honest and open about just how much health care costs and the best way to do this is to have an NHS Tax that people can see and relate to. Obviously this would not increase the overall tax burden but would simply re-badge part of our current direct taxes. The implications of this are wide reaching there would be an increased sense of ownership of the service as well as the acknowledgment of just how much health care costs.

Ok, so what does a green health service look like, what is our prescription for a new NHS? I've talked of accountability, principles, values and funding but what model of health care do we think NHS needs?


The principle of localisation not centralisation is one that flows through green philosophy. The arrival of climate change, and the pending arrival of peak oil, serve to increase the importance of making health care as local as possible. We do applaud Labour's polyclinic ideas - these have been Green Party policy for years. Community health centres with a wide range of health care functions serving communities are an excellent model. Cuba adopted the polyclinic model 30 years ago and now has one of the best health care services in the world.

It should be up to local people to decide the set up of health care services for their area, but as a general model / principle we support a four tier system of community services, GPs, polyclinics and hospitals. Polyclinics need to be underpinned by GPs, and polyclinics, in turn, need to support district hospitals.

There is, however, a very real and worrying trend that needs urgent and sensible debate. The increasing centralisation of specialist health care is not a sustainable model. A 'network' approach to specialist services is fine, but the notion that we should only provide high tech health care services on a regional basis needs to be balanced by damage it does to local services, and of course the environment, as well as the difficulties it causes for vulnerable people having to travel great distances.

The argument that a service is not safe unless it is provided centrally can be taken to extreme lengths. At what point will we decide to have just the one full A&E service in the country? It would be very high tech, well staffed and probably tick all the governance boxes, but it would be of no use to most people.

It should be for local people to decide what level of risk that they want to have in their health care services and if people want a local A&E that doesn't see enough people to tick every clinical governance box then so be it - whose risk is it to take? We urgently need a sensible debate on how we can best serve local people.

Finally, I was asked to comment on what I think GB should do in his first 100 days... I'd like to suggest that he starts to buy back the hospitals that he has spent the last 10 years selling off through PFI.

---------------------------------------------------------------------------------------------

References

1. http://www.neweconomics.org/gen/nhsclimatechange220607.aspx Report by the NHS Confederation
2. http://politics.guardian.co.uk/publicservices/story/0,,1989410,00.html
3. NHS Plan 2000

Taking the temperature: towards an NHS response to global warming

Interesting report from the New Economic Foundation (NEF) and the NHS Confederation on some of the steps that the NHS needs to consider to reduce its impact on climate change.

http://www.neweconomics.org/gen/uploads/raqgyx45jjgxnfn5gs3tu15522062007190400.pdf

It doesn't go nearly far enough though. It does talk about green transport plans, using renewables, recycling more which are all great, but I think it misses the fundemental shift in think that is required.

For example, with 5% of all traffic being related to health care, simply putting in park and ride schemes is hardly likely to make a dent. The report does mention the closer to home strategy and suggests that it will reduce travelling. Frustratingly, there has been no study to see if this is true or not (or no study that I am aware of). Certainly patients recouperating in a local community hospital close to their relatives will be benficial (although this would need to be measured against potentially poorer energy efficiency of the smaller hospital). But what about intensive support at home? Plenty of staff driving round all day visiting patient to help them stay at home. Good for patient care, but is it good for the environment? We desparately need answers to these questions.

The report also doesn't enter the debate about increasing specialisation and centralisation of services and how they increase travel. We need a sensible debate about what we want and how far away we want it!

Stuart

Peak Oil Health Network

This is from Paul Roth:

"While blogging is part of the Web 2.0 revolution, it only gives the illusion of true interactivity. Why? Sure the content is dynamic, and readers can interact with the author and (to a limited extent) other readers by leaving comments at the end of a post. But there is no true reader to reader interaction: While there is a GROUP led by the blog author, there is no COMMUNITY.
"And to face and overcome the challenges posed by peak oil, climate change and other looming calamities, we need more than such a group. We do need a true community (or NETWORK) of like-minded individuals willing to share information, ideas, problems and solutions. And through the magic of modern technology, we can achieve this vision."

Paul has set up http://www.peakoilhealthnet.com as the answer to this. Please visit and join this network.

Stuart

Health and Peak Oil Articles

I have been working through Energy Bulletin and below is a selection of pieces from their site mostly written by Paul Roth and Dan Bednarz.
Precautionary Principle and Peak Oil: http://www.energybulletin.net/15535.html

Public Health in a post petroleum world: http://www.energybulletin.net/12158.html

The challenges of healthcare relocalisation: http://www.energybulletin.net/18882.html

Why we need a healthcare Hirsh report: http://www.energybulletin.net/20373.html

Peak oil and healthcare relocalisation: http://www.energybulletin.net/21217.html

How local healthcare authorities can prepare for peak oil: http://www.energybulletin.net/22428.html

Peak oil and healthcare: http://www.energybulletin.net/24270.html

Predicting global health trends: why peak oil matters: http://www.energybulletin.net/24397.html

The ethical challenges of healthcare and peak oil: http://www.energybulletin.net/25007.html

Energy: healthcare's preconditional crisis: http://www.energybulletin.net/26177.html

Energy, climate and the future of health: http://www.energybulletin.net/31485.html

Medicine After Oil - DANIEL BEDNARZ

Great article here by Daniel Bednarz who discusses the reliance of health care on oil. He states that the US model of health care, where the affluent Americans go for a 'Ferrari' model of health care and are in worse health than the UK 'Honda' model.

He seems to be saying that there needs to be a move away from hi-tech medicine and a focus on public health...

Do check out Orion Magazine for other eco articles.

Stuart

Inactivity as a contemporary health issue

A small piece that I wrote some time ago...

Providing a definition of inactivity is not straightforward as the health benefits of exercise vary according to the amount of exercise taken, and have been considered to be dose responsive (Irwin, 2003). There is, however, clear guidance as to a recommended level of activity from Heath Development Agency (2000) who suggest 30 minutes of moderate exercise five times a week for adults. The Centre for Disease Control and Prevention (2003) agree with this but also suggests that inactivity is "not engaging in any regular pattern of physical activity beyond daily functioning" (Centre for Disease Control and Prevention, 2003, p1). Clearly there is agreement about how much activity is desirable, but little notion as to when a person might be considered inactive, for example, it would seem nonsensical that if a person only manages 149 minutes of moderate exercise in a week they are sedentary. Suggesting that an inactive person is one who does no more activity than through their general daily functioning takes no account of people who have built moderate activity into their routine, for example if daily life requires a cycle ride to work, the person is clearly not sedentary. It would, therefore, seem appropriate to look at levels of activity on a fairly individual level, rather than as time spent in a gym.

The evidence to suggest that moderate exercise gives health benefits is compelling. Rutter (2003), on behalf of the Public Health Observatory, suggests the risk of coronary heart disease (CHD), stroke, hypertension, cancers, diabetes, depression and cognitive functioning all benefit from moderate exercise, and the Health Development Agency (2002) add a reduction in obesity and osteoporosis to the list. Rutter (2003) goes on to suggest that preventable deaths from CHD alone that can be attributed to a sedentary lifestyle are around 85,000 per year in the UK . Although there are no estimates as to the preventable deaths by other causes due to sedentary lifestyles, as the increased risk of stroke is threefold, compared to twofold for CHD, and stroke being the UK's third biggest killer, it is likely to be of a significant size. Estimates from the US are of a smaller magnitude with Jones et al (1997) suggesting 250,000 deaths per annum. The 1998 Health Survey for England (Department of Heath, 1998) found that only 37% of men and 25% of women were exercising to the recommended levels and that this level dropped with age and in Black and minority groups.

There has been a multitude of studies looking at the relative risks and benefits of exercise. Irwin (2003) examined the effects of 90 minutes exercise per week on women aged 50 - 70 years and found significant weight loss and reductions in body fat. Hu et al (2003) looked at inactivity by US women over a six year period, and found that for each 2 hours per day of watching television increased the risk of obesity by 23% and diabetes type II by 14%. Hu et al (2003) also found that an hour per day of brisk walking reduced the risk of obesity by 24% and diabetes by 30%. Ebbeling (2002) suggested that television watching and obesity is associated by both the inactivity and through increases food consumption during this period. The Ahmed et al (2003) reported that rises in childhood obesity has meant a fall in life expectancy for the first time in 140 years and although extent of causes of this increase in obesity are not clear, they obviously involve exercise levels as well as food consumption.

The Department of Health (1999) aimed to save 300,000 lives through health improvements, and the evidence suggests that exercise levels have a huge impact in mortality as well as morbidity (Rutter, 2003), however the Department of Health seems keen to raise the profile of other public health issues above that of exercise in its performance indicators for public health (Commission for Health Improvement, 2003). In light of the lack of emphasis put on inactivity, it must therefore be considered what impacts can be made on the levels of exercise by public health practitioners.

Beattie (1991) proposed two continuums to health promotion, working with from an individual level to a community level, and from the initiative for change coming from people, "negotiated" or from the state, "authoritative". This model leads to four areas that public health practitioners can be involved in, traditional health education persuasion techniques, personal counselling with clients to health them develop their own health choices, through to working with communities to help them make changes to their health and finally to legislative action centrally. These four areas seem to encompass the variety of roles the public health practitioners can be involved in.

Lawlor et al (1999) studied primary care professional's attitudes to health promotion, and reported that only 33% of general practitioners (GPs) felt there was strong evidence linking sedentary lifestyles with early death. They also found that 30% of GPs did not feel knowledgeable enough to give advice and only 8% gave opportunistic advice to patients. Steptoe (1999) compared GPs with practice nurses and found that only 20% of GPs felt that personal counselling for lifestyle advice was effective compared with 54% of practice nurses, and that 70% of GPs did not think that targeting health promotion to patients with low exercise levels was important. Schemes to enable primary care practitioners to enable patients to access exercise, typically through local leisure centres have been in existence for some time (Health Development Agency, 1998a), but whilst practice nurses see health promotion as part of their role, and feel that it is effective, GPs do not. There is little evidence on the effectiveness of a one to one health promotion approach to exercise, with most schemes, especially those involving gyms, show little sustainable lifestyle change with participation falling after the initial enthusiasm; the exception to this are those schemes that promote walking, particularly brisk walking (Health Development Agency, 2001). There is seems to be little research on how effective public health practitioners can be in persuading GPs to understand the importance of exercise, or even to what extent this is happening, but clearly there is a need for this. With front line health professionals not accepting the importance of exercise or the effectiveness of health promotion, there is little chance of this knowledge being imparted to patients. There appears to be very little evidence as to the cost effectiveness of this approach, although given the problems with sustainability, the cost of leisure centre admission and the time involved counselling by health professionals, the relative costs are likely to be high. There is a further issue with the elderly, as traditional forms of exercise promotion does not suit them (Drewnowski, 2001).

Beattie's (1991) continuums suggest that health improvements can be effected at a community level, which can be from either a "top down", authoritative approach or led by the community to make changes. There seem to be two aspects to improving the physical activity levels within communities, promoting exercise as an addition to day-to-day living, such as visiting gyms and encouraging sports, but also ensuring that aspects of daily life are changed to incorporate exercise. Transport is the most obvious area of this second aspect, increasing car usage is associated with reduced physical activity levels (Turbin et al, 2002) and clearly one option to improve exercise levels would be to reverse this trend.

Fergusson (1999) felt that a range of measures is needed to change behaviour in relation to travel. The Health Development Agency (2001) agrees with this and suggests that local authorities need to be deeply involved with this. There is a need to ensure that people have the ability to make journeys by foot or cycle, and this means that when local authorities plan for services they need to take this into account. Out of town shopping centres and hospitals may allow little opportunity for travel other that by car or bus, which increases inactivity, aside from the knock-on effects of social exclusion, pollution and the decline in community (Rutter, 2003). Van Diepan (2000) found that car usage was associated with lower population densities, i.e urban sprawling, and walking increases as the density of the population rises. It seems obvious that in order to encourage shorter travel distances, local authorities need to understand health, through working with public health professionals, in order to consider impacts to health when making planning decisions. Ensuring that partnerships between health and local authorities are fundamental, allowing health impact assessments to inform planning decisions and for health needs assessments to assist in the local authority's strategic plans.

Whilst it seems essential that local planning is required to ensure that it becomes possible to access services without reliance on cars, this in itself would need to be augmented by other measures to encourage healthy travel. There have been concerns about how safe it is for children to walk to school or for cycling in general. This perception clearly needs addressing and can be managed with the introduction of cycle lanes and traffic calming measures (Mackie and Wells, 2003). Again, these are areas that are under the control of local authorities, but if the highways departments are not working in partnership with planning and health then getting schemes to aid the promotion of healthy travel to work and schools will prove difficult. It is also necessary to involve employers in these schemes. Ensuring that the workplace has opportunities for showering and changing, may well be a crucial factor in an individual's decision to cycle to work (Health Development Agency, 1998b), clearly no one would want to remain in sweaty clothes!

The promotion of cycling and walking to work and school has been shown to be an effective way of increasing exercise levels ( Department for Transport, 2000). Clearly there needs to be a drive by health promoters and primary care professionals, including those in occupational health, to encourage people to adopt alternative, sustainable, forms of exercise. The public health professionals who span health and social services have very clear roles in ensuring that the elements of this form of exercise are in place.

It may be that a community lead impetus to make the changes required for healthy alternatives to travel would be unlikely, given the public's passion for the car (Hathaway, 2000). Those being socially excluded, through lack of access and transport, may not have the political power to motivate communities into action to provide for some of the wide ranging changes required. It seems important to ensure that the clear and pragmatic alternatives to travel are lead by the authoritative corner of Beattie's (1991) model, allowing for individuals and communities to adopt these changes. Seedhouse (1997) in his discussions on health promotion, suggests that health promotion is concerned with societal values and driven by politics to encourage social order and cohesion rather that trying to ensure that individuals are somehow saved from unhealthy habits. Perhaps in the case of sustainable exercise through travel, it needs to be acknowledged that a top down lead is required.

To conclude, it has been shown that there is a good consensus as to the optimal level of activity, and to the vast benefits to both mortality and morbidity that it confers, but there is no agreement as to at which point inactivity is defined. With estimates in excess of 85000 early death due to inactivity and the majority of the population not taking the recommended level of exercise, there is the potential to clear health improvements to be made. There is a great deal of work to be done in raising the level of knowledge in health professionals, as their own understanding of this area is poor. Schemes to encourage exercise, based on education and encouragement to use local leisure centres, have not been shown to be cost effective and do not give a sustainable approach to lifestyle change. Encouraging brisk walking and cycling are the areas that have been shown to provide long term lifestyle change and it has been shown that one way of doing this is through promoting alternative modes of transport to work and school. This requires a partnership approach involving, planning, highways, health professionals and employers, to ensure that the barriers to this are removed and that this form of exercise is encouraged. Whilst there are opportunities for health promotion within each of Beattie's (1991) areas, perhaps encouraging exercise needs to be led politically to ensure that the partnership working removes the barriers appropriately.

References

Ahmed K, Revill J and Hinsliff G (2003) Official: fat epidemic will cut life expectancy The Observer, Nov 9

Beattie, A. (1991) Knowledge and Control in Health Promotion: a Test Case for Social Policy and Social Theory; in Gabe J, Calnan M. and Bury M. (editors) (1991) The Sociology of the Health Service Routledge

Centers for Disease Control and Prevention (2003) General Physical Activities Defined by Level of Intensity Available online: http://www.cdc.gov/nccdphp/dnpa/physical/pdf/PA_Intensity_table_2_1.pdf (Accessed 12/12/03)

Commission for Health Improvement (2003) Indicator listings for Primary Care trusts Available online:

http://www.chi.nhs.uk/Ratings/Trust/Indicator/indicators.asp?trustType=4 (Accessed 29/12/03)

Department for Transport (2000) Encouraging walking: advice to local authorities Department for Transport

Department of Health (1998) Health Survey for England Available online:: http://nesstar.esds.ac.uk/nesstarlight/ (Accessed 1/12/03)

Department of Health (1999) Saving Lives: Our Healthier Nation Available online: http://www.archive.official-documents.co.uk/document/cm43/4386/4386-00.htm (Accessed 1/12/03)

Drewnowksi A and Evans . W J (2001) Nutrition, physical activity, and quality of life in older adults The Journals of Gerontology: Series A, : Biological sciences and medical sciences . Vol. 56A pg. 89

Ebbeling C B, Pawlak D B and Ludwig D S (2002) Childhood obesity: Public-health crisis, common sense cure; The Lancet ; Aug 10; 360(9331) pg. 473

Fergusson M, Davis A and Skinner I (1999) Delivering Changes in travel behaviour, Lessons from health promotion Institute for European Environmental Policy

Hathaway T (2000) "Planning Local Movement Systems" in Sustainable Communities - The Potential fo Eco-Neighbourhoods H Barton Editor, Earthscan Publications Ltd

Health Development Agency (1998a) Effectiveness of physical activity promotion in primary care Available Online: http://www.hda-online.org.uk/html/research/effectivenessreviews/review14.html (Accessed 12/12/03)

Health Development Agency (1998b) Effectiveness of health promotion interventions in the workplace Available Online: http://www.hda-online.org.uk/html/research/ effectivenessreviews/review13.html (Accessed 12/12/03)

Health Development Agency (2001) Coronary Heart Disease: Guidance for implementing preventive aspects of National Service Framework ; Available online: http://www.hda-online.org.uk/documents/chdframework.pdf (accessed 28/12/03)

Hu F B, Li T Y, Colditz G A, Willett W C, Manson J E (2003) Television watching and other sedentary behaviors in relation to risk of obesity; JAMA ; Apr 9; 289 (14) pg. 1785

Irwin M L, Yasui Y; Ulrich C M and Bowen D (2003) Effect of exercise on total and intra-abdominal body fat in postmenopausal women JAMA ; Jan 15; 289(3) pg. 323

Jones, J.M., & Dupree-Jones, K. (1997). Promoting physical activity in the senior years. Journal of Gerontological Nursing, 23(7),41-48

Lawlor D A and Keen S and Neal R D (1999) Increasing population levels of physical activity through primary care Family Practice 16(3); pg. 250-

Mackie A and Wells P (2003) Gloucester Safer City : Final report Transport Research Laboratory Available online: http://www.trl.co.uk/1024/mainpage.asp?page=140 (accessed 28/12/03)

Rutter H (2003) Transport is a heath issue South East Public Health Observatory; Available online: http://www.sepho.org.uk/viewResource.asp?uri=http%3A//www.sepho.org.uk/resources/%3Fid%3D7662 (Accessed 12/12/03)

Seedhouse D 1997 Health Promotion - Philosophy, Prejudice and Practice John Wiley & Sons Ltd, Chichester

Steptoe A, Doherty S, Kendrick T, Rink E and Hilton S (1999) Attitudes to cardiovascular health promotion among GPs and practice nurses Family Practice 16(2) pg. 158-

Turbin J, Lucas L, Mackett R and Paskins, J (2002) The Effects of Car Use on Children's Physical Activity Patterns , Centre for Transport Studies, University College London Online:- Available at http://www.cts.ucl.ac.uk/pdf/HEPA.pdf (21.11.03)

Van Diepen AML (2000) "Trip making and urban density: Comparing British and Dutch survey data" in Compact Cities and Sustainable Urban Development G De Roo and D Miller Editors, Ashgate, Aldershot

Health Care and Peak Oil - comparison with the 2000 fuel protest

From Paul Roth's Blog on Peak Oil and the effect that it will have on health care: "The ability of a short-term fuel disruption to cause a health-care crisis was demonstrated in the United Kingdom in September of the year 2000."

This piece is in two parts, the second is available here. Paul talks about the need for fuel shortage plans, similar to the Energy Decent Action Plans being worked up by the Transition Towns Groups.

"In contrast, peak oil will not only limit oil-based transportation, but it will disrupt the manufacture of everything containing petrochemicals (ie all plastic, synthetic clothing, kitchen appliances, computers). They will not be sitting in warehouses waiting for normality to resume. They will not be there in the first place. So energy descent will not present a transportation challenge. Secondly, the crisis ended in just over a week, allowing things to get back to normal quickly. Peak oil will be permanent, and there will be no quick fix."

Organic food 'better' for heart

From the BBC: http://news.bbc.co.uk/1/hi/health/6272634.stm

"Organic fruit and vegetables may be better for you than conventionally grown crops, US research suggests."

Peak Oil and health care

Peak oil, where the supply of oil plateaus in contrast to continually rising demand, should be exercising politician's mind across the world, however we hardly hear about it. We are probably hitting peak oil now and the Australians (ASPO) have released and excellent paper on the effects on health care.

One of the key concerns is the centralisation of services and will affect access by patients in the face on increasing costs of transport.

This is a quote from ASPO:
"There has been for years an increasing trend to centralise services which is driven by:
• The cost of resources, the need to minimise duplication and to extract maximum use from equipment and institutions with huge capital and operating costs.
• Medico-legal pressure to have as many services as possible provided in centres of excellence with expertise in uncommon conditions.
• Shortages of qualified staff

This process is continuing and gathering pace, it must be reassessed in the light of peak oil. The NHS in the UK is currently proposing to downgrade facilities at a wide range of hospitals and relocate them to Super- Hospitals to save money. Even at present levels of fuel prices and within the existing limits of mobility, this proposal is causing alarm. The added impact of peak oil will tragically show this to be a lethal and short sighted error of judgement."

Dr Paul Roth has an excellent blog which is a must read.

NHS Emissions

The New Economic Foundation have got their teeth into the NHS. From the BBC:

"Each year, the UK's health service spends £400m on energy and emits about one million tonnes of carbon, think tank New Economics Foundation said.
"Its NHS Confederation-commissioned report said 5% of UK road transport emissions were from NHS-related trips.
"Staff, patients and visitors travelled almost 25 billion passenger miles in 2001, predominately by cars and vans.
"Waste was also an area for concern: "One in every 100 tonnes of domestic waste generated in the UK comes from the NHS, with the vast majority going to landfill."

http://news.bbc.co.uk/1/hi/sci/tech/6226166.stm

5% of journeys are related to the NHS... yet the NHS continually moves towards centralised services in the name of clinical safety and operational efficiency.

A New Prescription for the NHS?

Keep Our NHS Public

A New Prescription for the NHS?
Public Meeting


Can Gordon Brown solve the problems of the NHS once and for all?
As Prime Minister he will confront a service in the midst of major reform, much of which is controversial and lacks any evidence to say that it will work. So what are the alternatives for the NHS? We are all crying out for a lasting solution.

What is working and which polices should be scrapped?
How can we make the most of the strengths of our NHS?
Are we heading in the right direction, and what can we learn from other countries?

Speakers include...
Frank Dobson MP
Stuart Jeffery (Green Party health spokesperson)
Norman Lamb MP (Liberal Democrat health spokesperson)
Neal Lawson (Compass)

The time and the place...
July 24th 2007, 7.00pm, Grand Committee Room, House of Commons


To register simply email your registration request and details to us (see below). There is no charge, but if you can, we ask you to make a donation towards the cost.

Please tell us the following...
Name
Organisation/group (if applicable)
Address
Post code
Email
Number of places required

Email your registration request to...
olivia@nhscampaign.org or david@nhscampaign.org

Or send your details to...
NHS Support Federation
Community Base
113 Queens Road
Brighton
BN1 3XG

Tel: 01273 234822

Abortion

Cardinal Keith O'Brien's comments have stirred up the abortion debate today. His comments about the number of children dying have been widely criticised, but I think it is useful to hear all sides and teh strength of convictions in a debate, especially one that stirs emotions as deeply as this one. The Green Party of England and Wales has a fairly middle of the road policy on abortion (shown below), but I feel certain that it doesn't sit easily with some.

Stuart

The Green Party of England and Wales policy on abortion:

Abortion

H320 The fact that the number of abortions carried out in England and Wales continues to rise should be of concern to all. Given the health risks associated with any medical and surgical procedure and many people's moral discomfort with induced terminations, it is entirely understandable that many wish to see this number significantly reduced.

H321 The Green Party recognises the problems caused by unwanted pregnancies and supports a multi-policy strategy to reduce them, including:

a)ensuring adequate sex education in all schools (see ED307). This should be done at a sufficiently early age that children should be fully aware of the potential consequences of sexual activity before they are likely to become sexually active. Schools should also teach life skills, including those relating to caring for and raising children, so that young people feel better prepared to become parents when the time is right for them (see ED305).

b)ensuring adequate financial and social support for parents, particularly lone parents and those with disabled children, so that women do not feel pressure to terminate a pregnancy purely because they would be unable to make financial ends meet (see EC730-733 and 'Social Welfare').

c)ensuring adequate provision of free family planning advice by properly trained health workers and counsellors (see H301) and the provision of free contraceptives. To ensure proper protection of their rights and wellbeing, children under the age of consent should feel fully able to seek such support and facilities without their parents necessarily having to be informed.

H322 The Green Party will not support any change to the current laws on abortions which would aim to make it more difficult for women to obtain them. Such a change in the law would do nothing to address the underlying factors which lead to women seeking abortions. Instead, it is likely to drive them into going elsewhere for the operations - either overseas or to illegal practitioners in this country - which will increase both the distress and the health risks for those involved.

H323 The Green Party recognises that the decision whether or not to continue with a pregnancy is never undertaken lightly. The Green Party believes that counselling should be offered to every woman considering an abortion. However, the ultimate decision about whether or not to terminate a pregnancy should always lie with the pregnant woman who has to deal with the consequences of that decision.

Choice, marketisation and Buddhism

"it can be seen that the free market system itself is ultimately based on a minumum of ethics..." PA Payutto - Buddhist Economics.

The marketisation of health care has created a system that is becoming increasing free, and is being driven to be free. Choice is the buzz word.

Free markets are driven by profit and greed, these have no place in health care. The US system has demonstrated that beyond all reasonable doubt.

Stuart

Organic parkinsons?

Aberdeen researchers have found that exposure to pesticides increase the risk of parkison's disease (high expose by 39% and low level exposure by 9%).

The anti-organic lobby continue to claim that there is no evidence that organic food is better for us, and while this study looks at agricultural workers, it is clear that growing organic food would not have this detrimental effect on them.

How anyone can suggest that consuming poisons is no worse than not consuming poisons defies rational thought.

Stuart

Managers wasted on drugs?

The Health Service Journal ran a piece on the money being wasted by GPs on overpriced prescriptions (i.e. prescribing expensive versions of drugs when cheaper generic are available). Apparently £200 million could be saved by better prescribing - the extra spending is mostly through GPs listening to the drug companies touting their wares rather than listening to NHS prescribing advisors. Apparently the drugs companies spend £850 million each year on marketing products to GPs.

Rather than comment on the madness of the market place in health care, as I am sure you are expecting me to, I thought I would share with you the conference that the HSJ is running on medicines management.

"Medicines Management Across NHS Interfaces - Maximising the contribution of medicines management to deliver cost-effect, patient centred care". Does anyone remember Gus Hedges? Drop the Dead Donkey's character Gus was famed for management gobbledygook - e.g. "I just wanted to watch the editorial unit synchromeshing with the production matrix...".

Stuart

Care costs

From the Torygraph: "Hundreds of thousands of elderly people are facing massive increases in the amount they pay for basic services such as washing and dressing which allow them to live independently in their own homes."

Caring for people is expensive and there is a disgusting lack of investment in it. I suspect the Torygraph would lambast any move to put more money into social and health care, so where does that leave the poor?

Financial pressures are blamed for these increases, but would the Telegraph back rises in taxes - I think not . Would they claim that millions are waste - I think so. Care has to be paid for, the poor can't afford to pay, so it comes down to the richer people to pay - which seems the only fair (and viable) option.

Of course millions are wasted though... however millions are wasted because of the marketisation of social care - driven in by the Tories.

Stuart

N.B. I take the line that it is important to read papers and journals that you have fundamental and ideological problems with, after all we need to know what they are saying.

HEALTH SERVICES AT RISK OF CREEPING LIBERALISATION

This is from Green MEP, Jean Lambert:

HEALTH SERVICES AT RISK OF CREEPING LIBERALISATION

‘Our national health service is at risk from creeping liberalisation and legal uncertainty’ UK Green Euro MP Jean Lambert has warned following the European Parliament vote on a report examining the implications excluding health services from the Services Directive would have.

Although Jean Lambert has welcomed the European Parliament’s move to maintain its position, excluding health services from the scope of the Services Directive, she has slammed the failure to guarantee patients rights and the sustainability of healthcare systems.

Speaking after the vote Jean commented; “The Services Directive continues to pose more questions than it answers leaving the health service extremely vulnerable.

“We are now apparently refusing to set boundaries on the role of the market in relation to the right of member states to decide on the method, financing and scope of the health services they provide. Unless the European Parliament adopts a clear legislative framework we are actively encouraging the Court of Justice to decide what is, or is not, a medical treatment and whether or not it should be reimbursed or require prior authorisation.”

As the Rapporteur on regulations concerning social security co-ordination between EU countries, Jean Lambert continued; “The reimbursement situation is not a new system; it has been in place for over 30 years and has proved invaluable to thousands of citizens. Its scope and workings should not be put in the hands of the Courts – but must be determined by the Parliament and Governments.”

ENDS

Big Pharma rules UK?

From the BBC: "Cancer doctors have told the BBC they fear the NHS will not be able to afford the new generation of cancer drugs."

The cost of drugs has been rising at about 7% every year compared with the rest of the costs of the NHS at about 3%. Big pharma has the NHS over a barrel and spend a great deal of time selling its wares through talking to patient groups, doctors and the media. Headlines such as 'NHS refuses to treat alzheimers patients' are a clear example - perhaps it is because the new drug is unproven, unreliable, ineffective , and therefore pointless.

Big pharma have been running away with this and there are no easy solutions. For greedy corporate capitalists it must be heaven to work in a sector with a guarenteed 7% year on year increase.

The Green Party policy is clear on medicines:

H318 Novel compounds will not be introduced into general use unless they can be shown to have significant advantages over existing drugs. Limited list prescribing will be extended across the full range of pharmaceuticals. The direct advertising of prescription- only medicines to the medical profession will cease. Information to the medical profession will be the responsibility of medical schools and independent authorities with no vested interest in companies which manufacture or market pharmaceuticals.

H319 The Green Party recognises the huge profits made by the drug companies out of the NHS. This is often through a form of cartel pricing, and we do not believe it is right that the National Health Service as a public health service should have to pay unfair prices. Therefore we will set up an independent NHS Pharmaceutical Body with power to set the price of drugs provided to the NHS. The Body will be composed of doctors, healthcare professionals, economists, and a legally trained chairperson, which will look at the cost of research and development in drugs and their manufacture, and receive evidence from chemists, the pharmaceutical companies, and other countries' health services. The Body will then decide what is a fair price for a drug which is to be provided to the NHS by the manufacturer, and that will be the price which the NHS will pay for the drug.

Stuart

Any hospital as long as it is the one next door

From the Guardian: " Labour's health policy giving people the right to choose between NHS hospitals in England is regarded by most patients as irrelevant, the government's health watchdog will disclose this week.

"The Healthcare Commission found the issues people regard as most important are whether they have confidence in a hospital's doctors and nurses, whether staff answer questions clearly and whether they wash their hands after contact with a patient before they touch another."

This is scary stuff, it appears that people are not interested in travelling 50 miles to get their operations at a slightly better hospital, they would rather the one next door was up to scratch...

Of course the whole choice agenda underpins the current NHS care marketisation. A similar report was removed from the DH website last year after they figured just how embarrasing it was for Labour's flagship policy.

Stuart

NHS quangofied

I sent this to the Guardian a couple of days ago in response to the BMA's call for the NHS to be turned into a quango.

Sir: The call by the BMA for the NHS to be managed by an independent body free from political influence will simply reduce the accountability of our health service to an all time low. Instead we should follow the example of social care and move control of health care to local government.

Only when people have a say in how the NHS is run will they be truly engaged; health care requires difficult choices - choice that should be made by users, not by unelected unaccountable bureaucrats. The NHS is a flagship service of this country and should not be turned into a quango.

Stuart Jeffery
Health spokesperson for the Green Party

Petitions

Another great petition that is worth signing...

http://petitions.pm.gov.uk/NHSprivatisation/

"We the undersigned petition the Prime Minister to Stop the diversion of National Health Service monies to the private sector through the award of contracts to private companies to establish CATS centres."

Privatision is creeping across the NHS. We must call a halt to it - I urge people to sign.

Stuart

Big pharma attacks complementary therapies

The pharma lobby have attacked university courses in complementary therapies as 'gobbledygook'. Hardly a surprise...

Big pharma has little interest in seeing other approaches to health care being promoted - they are interested in the sale of drugs and the subsequent profits only. This attack has come from Professor Colquhoun, of University College London's department of pharmacology.

Perhaps Prof Colquhoun ought to complete one of these degrees? Surely it would be difficult to understand it without sitting at least half way through the course, especially if you come from a field that has little understanding of CM!

Stuart

Parking charges

So hospitals are raking it in through car park charges. It is a difficult one this, on the one hand we need to discourage the use of cars, on the other hospital car park charges often hit poor and vulnerable people.

Of course if hospitals had been built in the centre of towns with good supporting public transport, then we wouldn't have a problem, there could be an expectation that public transport is the best way to get to hospital. Sadly our hospitals are often built out of town - we are told that ambulances can access them better there! Of course if the roads were clearer in town (where people actually live) then ambulances would have no problem accessing the hospitals.

Stuart

Stay healthy

"Tony Blair is thinking the unthinkable about the NHS. He's proposing that people should be given money by the government to spend as they like on healthcare - even if it's in the private sector." Channel 4.

So what is wrong with this?

1.Thinking about purchasing of healthcare is not something that I want to do when I need the healthcare, my concerns would be to get effective treatment.

2. Worrying about the costs of health care is exactly what the NHS was set up to avoid.

3. What happens when the cash runs out, healthcare is not equal provision - personally I don't want to receive any healthcare, I'd quite like not to need to - the NHS was set up to provide healthcare to those who need it, not those who can afford it.

Stuart

PFI Petition

Interesting PFI petition on the government's petition website.

"We the undersigned petition the Prime Minister to Show the cost to the taxpayer of PFI projects"

Only 108 signatures... compared to the million people worried about their cars??? Health service sustainability or being able to drive as much as you want for a few more years until climate change and peak oil stops them - people need to think about their priorities!

Stuart

Financial recovery by reducing paper clip consumption

Don't get me wrong, I am all for reducing consumption whereever possible but to expect to keep a hospital solvent through not buying pens is a bit much. Staff obviously will have to buy their own or get them from drug reps. Neither is very satisfactory.

Wouldn't it be good if we gave enough money to our NHS so that it could run?

Stuart

Hillingdon PCT is sold off

It had to happen sooner or later. Hewitt has promised it and now Hillingdon PCT is delivering.

Anthony Sumara, Hillingdon PCT's interim chief executive is putting a proposal to the Trust's board that most of the PCT's function is sold off to the private sector, including control of the £258 million budget.

From the FT: "The move, which is likely to provoke bitter opposition from the health service unions, would see the private sector taking over not just the provision of community services but the assessment, planning, contracting, procurement and performance management of £258m a year's worth of health care for its local population."

The PCT will remain accountable for its spending (and over spending) though... In management school, I was taught that accountability should go hand in hand with responsibility. Clearly I was taught badly.

This move will hand the purchase and planning function to a private company that has shareholder's interests as its top priority. The company will be accountable to these shareholders, not the public and patients in Hillingdon. Is this what we want?

Stuart

Pollution and CHD

From the BBC: "Researchers studied 66,000 women in and around 36 US cities, finding pollution levels varied between four to nearly 20 micrograms per cubic metre. The University of Washington team said each 10 microgram rise was matched by a 76% rise in the chances of dying from heart disease or stroke."

No surprise there. Remember the EU study: around 40,000 deaths p.a. attributable in the UK to PM10 (mostly from cars).

Of course the worse place is to sit in your car in a traffic jam.

Stuart

Affluenza

From a US site:

1. The bloated, sluggish and unfulfilled feeling that results from efforts to keep up with the Joneses. 2. An epidemic of stress, overwork, waste and indebtedness caused by dogged pursuit of the American Dream. 3. An unsustainable addiction to economic growth.

New book out in the UK Allfuenza by Oliver James.

Affluenza: n. a contagious middle class virus causing depression, anxiety, addiction and ennui. (Oliver James, 2007)

Looks like a good read...

Stuart

The political economy of health care - A clinical perspective by Julian Tudor Hart

I've just finished this excellent book, The political economy of health care - A clinical perspective by Julian Tudor Hart. This book has to be a 'must read' for anyone passionate about the NHS.

Tudor Hart sets out the historical context of the NHS working through the formation of local schemes to provide health care and through into the development of the NHS. His attack on commercialisation in health care is warrented and perceptive.

He provides a focus of the creative side of health care, how the NHS creates health gain for people through developing professionals rather than developing commercial applications. He talks too of solidarity, 'all for each and each for all', of how we must not consider ourselves so rich that we cannot afford to look after the poor. See "From each according to his ability, to each according to his need"

Stunning book, albeit a little heavy in places. I had to read it in bite sized chunks!

Stuart

Cars and health

Two reports this week about the effects of traffic on health here and here. While the Times suggests that the suggestion that damage to cyclist's lungs from traffic fumes is as bad as smoking may be overstated, it is clear that there is a growing consensus about the toxic effects of our addiction to cars.

When coupled to the obesity epidemic and the report that the childhood obesity targets set by the govt are not going to be met we have to question why we love the car so much.

Stuart

Profit - Loss

PFIs will make £23 billion in profits over the next 30 years for the private companies that now own our hospital buildings. That's £766 million per year profit from taxpayers money.

The NHS was in deficit by £512 million last year.

I'm no economist, but...

Rather than paying over the odds to lease our hospitals from these private companies wouldn't it be preferrable to use our money for health care?

Stuart

Sir Gerry and the NHS

Sir Gerry Robinson's comments on the work with the NHS for the BBC can be summarised:

1. The NHS should not be treated like a normal business
2. The government should not interfere with it

To the first point - absolutely! The NHS has changed from a service to a business over the past 17 years with the fastest moves to becoming a business happening in the past 7 years. This is fundementally wrong. The NHS should primarily be about provision of services to vulnerable (ill) people when they need it - people that society as a whole has a duty to look after. The NHS can learn a thing or two from the business world, but it should not model itself on them.

To the second point - yes and no. The NHS has to be accountable to the public. Currently ministers are campaigning against changes in the NHS - so who is accountable and to whom are they accountable? The NHS should be accountable to local people through local government. This change would be rocky for a few years, but in the longer term people would smooth out with an increased sense of control and responsibility by residents for the NHS.

Stuart

Early Day Motion

The Early Day Motion below has been submitted by Timothy Farron (a Lib Dem). It would seem that trying to get our MPs to sign up to this would be a good idea. Use www.writetothem.com as one of the best methods of lobbying them.



Subject: Early Day Motion (ICATS)House of Commons - Early Day Motions
Date tabled: 14 December 2006
510 - INDEPENDENT SECTOR INVOLVEMENT IN THE NHS

Tim Farron

That this House notes Department of Health plans to hand clinical assessment treatment and support (CATS) services in Cumbria and Lancashire for general surgery, ear nose and throat, gynaecology, urology, orthapaedics and rheumatology to an independent sector provider; further notes that some elective surgery is also to be handed to independent sector providers in Cumbria and Lancashire; expresses grave concern that the private companies Netcare and Capio have been identified as preferred bidders for these services without any consultation with NHS staff or the public; is concerned that the proposed handing over of 70 per cent. of referrals to independent-sector run CATS service centres will lead to huge reductions in income for NHS trusts, leading to job losses, financial destabilisation and possible hospital closures; opposes the handing over of further NHS funds to profit-making independent companies; fears that the increased transfer of services to the independent sector will lead to the cherry-picking of the most lucrative NHS services, leaving the NHS only with those services that are not profitable; is not aware of evidence to suggest that the transfer of NHS services to the independent sector constitutes equivalent value for money or medical safety to providing services inside the NHS; and calls upon the Government to suspend plans to introduce additional independent sector involvement in the NHS until a full appraisal of the costs and benefits of this strategy to date has been undertaken.

Early Day Motion

The Early Day Motion below has been submitted by Timothy Farron (a Lib Dem). It would seem that trying to get our MPs to sign up to this would be a good idea. Use www.writetothem.com as one of the best methods of lobbying them.



Subject: Early Day Motion (ICATS)House of Commons - Early Day Motions
Date tabled: 14 December 2006
510 - INDEPENDENT SECTOR INVOLVEMENT IN THE NHS

Tim Farron

That this House notes Department of Health plans to hand clinical assessment treatment and support (CATS) services in Cumbria and Lancashire for general surgery, ear nose and throat, gynaecology, urology, orthapaedics and rheumatology to an independent sector provider; further notes that some elective surgery is also to be handed to independent sector providers in Cumbria and Lancashire; expresses grave concern that the private companies Netcare and Capio have been identified as preferred bidders for these services without any consultation with NHS staff or the public; is concerned that the proposed handing over of 70 per cent. of referrals to independent-sector run CATS service centres will lead to huge reductions in income for NHS trusts, leading to job losses, financial destabilisation and possible hospital closures; opposes the handing over of further NHS funds to profit-making independent companies; fears that the increased transfer of services to the independent sector will lead to the cherry-picking of the most lucrative NHS services, leaving the NHS only with those services that are not profitable; is not aware of evidence to suggest that the transfer of NHS services to the independent sector constitutes equivalent value for money or medical safety to providing services inside the NHS; and calls upon the Government to suspend plans to introduce additional independent sector involvement in the NHS until a full appraisal of the costs and benefits of this strategy to date has been undertaken.