Cancer drug consultation flawed

Keep Our NHS Public are an excellent group. Below is a press release which adds to the recent news about top-ups. The two tier service that is emerging is fundamentally against the founding principles of the NHS. We shouldn't ban people from having NHS treatment because they try additional drugs, but neither should we stop effective drugs from being available on the NHS. The NHS should be able to clearly demonstrate that any treatment that is not available is not effective and is a waste of time and money. Sadly this is not the case at present.

Press release from KONP:

There is no reason why the best drugs cannot be available to all NHS patients, the Keep Our NHS Public campaign has said, but the Government has wrongly excluded this option from the current consultation over cancer drugs.

Following the report by Professor Richards, the Government’s clinical director for cancer, Keep Our NHS Public said the consultation was flawed as the consultation document accepts that private drugs are acceptable alongside NHS care but does not ask the fundamental question of whether this is appropriate.

In his report Prof Richards states that ‘I believe that the option of NHS top-ups should be rejected,’ yet his recommendations accept this in practice, despite the fact that the number of patients requiring such treatment is small and the cost negligible in the context of the NHS budget.

Professor Wendy Savage, chair of Keep Our NHS Public, said:

“This undermines the key principle of the NHS – that a patients’ wealth should have no bearing on the quality of the care available to them. It introduces a two tier system and already the private insurance business is welcoming the profits they can make.”

“There is no justification for a situation where desperate families have to use life savings to afford effective drugs denied them by the health service. But the option of providing all necessary care on the NHS is not mentioned in the consultation document. No figures are given for the cost of equitable NHS provision, which on the basis of the available evidence is likely to be less than 0.001% of the annual NHS budget.”

“The Government’s policy, while appearing compassionate on the surface, is in fact deeply disturbing. We call on all concerned citizens and organisations to respond to the consultation on these lines and involve their MPs to fight this dangerous move that threatens the very basis of the NHS.”

Green spaces improve health

Fascinating piece of research published last week in the Lancet on the connection between green spaces and health. It's all pretty obvious stuff really, the closer you live to the natural world the healthier you will be. A bit of a no-brainer really, but the research gives us a useful reminder about how we should design our living spaces.

Plant more trees should now be on the lips of every public health professional!

Top-up payments

The issue of top-ups is a tough one. The key problem is that this decision could open the door to the government making decisions more on price than effectiveness, which goes contrary to the NHS principles. It could easily mark the end of free health care at point of need. That said, how can the NHS refuse treatment to someone who wants to add expensive treatments that would not be particularly effective?

The NHS now needs to be far more careful that it provides the most effective care and not dumb down the level of interventions on the basis that people can top-up. They should ensure that no-one has to top up care, but with the proponents of high cost interventions hard selling their services, the public are unlikely to get good information to base decisions on.

Meanwhile the right wing health capitalists intent on making huge piles of cash are laughing all the way to the Leeds...

Interesting press release from the NHS Support Federation below:

NHS Support Federation News release Immediate:

4 November 2008 NHS top-ups a victory for the individual, but what about the rest?

Reacting to the plan to allow patients to top-up their NHS treatment with private care the NHS Support Federation said

“This is a victory for individual patients just trying to get themselves the treatment they want, often in tragic circumstances. But the obvious question is what about the patients with similar illnesses that can’t afford to go private.”

“The NHS was born out of the need to give everyone equal access to healthcare. Safeguards to protect these principles are essential. How far can we go without this defining principle of the NHS becoming meaningless in reality.”

“NICE will come under pressure to reassure the public that NHS patients are not being denied access to effective treatments.  And if treatments are held back because of their cost it should only be after the public have had their say.”

“We need NICE to continue to help ensure NHS treatments are safe and effective. Their role in establishing affordability is less well understood by the public. The NHS itself needs to be more accountable. We cannot off load this responsibility.”

Paul Evans, director NHS Support Federation

Report from the National Association of Links Members

A damning report was published by the National Association of LINKs Members (NALM) this month. Local Involvement NetworKs (LINKs) were set up to replace Patient Fora, which in turn replaced Community Health Councils. Each iteration has reduced the say that patients have over their local health services. The CHCs has some reasonable powers.

LINKs have been going for 7 months and I'm sure everyone across the country has heard of them and is itching to get involved...

The report from NALM has shown just how badly some councils have been at setting LINKs up. Members have not been paid expenses, some councils have top sliced high levels of funds and there appears to be a lack of training for members.

I am writing to Alan Johnson to express these concerns, I would encourage others to do the same.

Drugs in the water

Health Care Without Harm's latest newsletter has an excellent piece on the disposal of medicines and how they are contaminating water supplies.

Some of the effects of this problem have been known for a while, such as the effects on fish of the hormones in effluent. It is easy to suppose that this is just another in the long list of environmental polluters that we have to put up with - in the past we suffered with lead in the paint and the air, and there are plenty of more recent pollutants.

On of the frustrations with drugs being added to the list of environmental hazards is that they are not being disposed of / collected properly. HCWH state the low percentage of drugs being collected back when not used and it is reasonable to speculate that much of the rest is flushed down toilets.

The other key issue is the over reliance of drugs. I have blogged before on the problems of polypharmacy - which are many. Interactions are clearly the main issue but aside from increasing the profits of BigPharma we ought to add the pollution to water supplies to the list of problems.

Lib Dem health policy... to tax the poor?

The latest wheeze from the LibDems is for tax breaks for people leading healthy lifestyles. I assume that this is to penalise those who don't follow them, so why do the LibDems think this moves them away from a 'Stalinist' approach?

Norman Lamb seems to be looking for health care taxation that is heading towards insurance based systems.

Health and healthy lifestyles are correlate closely with wealth, i.e. the richer you are the healthier you will be and the more likely to have the appropriate health behaviours that will attract lower taxes. Lamb is talking about a points system for check ups, screening and exercise taken.

This seems completely regressive, and while I'm sure the Lib Dems think it will change behaviours (and it would have a small effect initially), this tax regime would predominately give tax breaks to the rich. The rich get richer and the poverty gap widens from its already yawning chasm.

Poor health is influenced heavily by the relative gap in wealth. Widening it will make the health gap bigger.

Postcode Lottery

The report from the Kings Fund today tells of the differences in spending across each Primary Care Trust in England against a variety of illness categories. The differences are stark and on the face of it worrying - they certainly make for interesting reading.

Two key questions stick out. Firstly should we be concerned? If one PCT prioritises care in one disease area over another in response to local need, surely this is what we would want? PCTs will almost always spend all the money they are allocated on health care so one assumes that demands for different types of services differ in different areas. I am also sure that PCTs have not got the balance of spending right (not that they ever could - this is a complex and fluctuating need) and they certainly don't alway take local preferences and issues into consideration.

Secondly, if there is reason to be concerned what should be done? One of my key issues with PCTs is their lack of accountability to local people. They act to serve local people and have a duty to commission care for local people but the are accountable to the Secretary of State only. Locally ellected representatives don't get a say. Sure they can make a lot of noise but that is all.

Theer seems no reason for PCTs to remain like this. It would be a very simple move to put the under the same line of accountability as social services (generally county councils or unitary councils) and ensure that local democracy has a say.