Monday, September 15, 2008

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.

Sunday, September 7, 2008

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.

Tuesday, August 12, 2008

Fluoride and sugar

The fluoride fight continues, congratulations to Pendle district council for rejecting calls to fluoridate their tap water yesterday. Mass medication is illegal and immoral. Any benefit of fluoride in the water has not been shown to outweigh the risks. What is needed is a reduction in the vast levels of refined sugar in processed foods - as exemplified by Angus Deaton last Friday when he quipped that breakfast cereal companies wanted to find a way on increasing the sugar content above 115%.

Refined sugar is a truly crap invention, no food value, addictive and teeth rotting. Mind you jam would be difficult to make without it...

We need more education on health in our schools and for parents. We don't need people medicated against their will.

Wednesday, August 6, 2008

Tory pests

Yesterday's press release by the Conservatives that there have been 20,000 infestations in the NHS is a poor piece of spin. They do not suggest what level of infestation is acceptable or whether rates are rising or falling. Of course it would be interesting to repeat the exercise when / if the Tories are ever in government! The Times sees straight through it suggesting a complete lack of context and says that the results 'do not appear remarkable' - you have to question the editorial decision to publish unremarkable news in a national daily paper...

What is remarkable is that the Tories were responsible for outsourcing cleaning in the 1980's and cannot be trusted with the NHS, despite their rhetoric.

Of course hospitals will have infestations of various insects - they are on a planet that is crawling with insects. How Andrew Lansley can expect them to be pest free.

The funniest comment was posted on The Times's website in response to their article: "...not to mention the IT consultants, who have a voracious appetite, multiply like mad, eat through the budget and leave a trail of wreckage. (Frank Upton, Solihull)".

Also - sorry for not blogging for a while!

Saturday, July 19, 2008

Ritalin, the new Soma

There is a piece in this week's Health Service Journal on the level of prescribing of Ritalin. The area with the highest level of prescribing has a rate 23 times higher than the area with the lowest level. This means that in the Wirral, 144 out of 1000 children were prescribed Ritalin in 2007 - that is one in seven. Isle of Wight was second with one in nine. The lowest area will have a rate of about one in 160 children.

There is no way that this drug is being used to treat a medical condition for most of these children, it is being used to treat a social condition. This is straight out of Brave New World.

If there really was this level of ADHD in these areas then this should be treated as an epidemic with the seriousness of Avian Flu or Foot and Mouth. Of course there is no such problem, just a lost generation.

Friday, July 18, 2008

Reducing the NHS's Carbon Footprint by clamping

This was in the news earlier this week and I should have blogged it then. It does make you wonder what planet some people are on, clamping ambulances at the hospital will not solve the parking problem, bring in more revenue and it will not reduce the carbon footprint of the NHS...

clamp

Sunday, July 13, 2008

Richard Smith on Comment is Free

Richard Smith, Chief Exec of United Heath Europe has a piece on the Guardian's Comment is Free site. He is, of course, putting the case for companies like his to get more profit from taxpayers. Advertising they used to call it... Anyway his posting does not mention his vested interest at all and has sparked a deluge of criticism.

This is a selection:

alasdaircameron:

Richard Smith is executive director of Unitedhealth Europe, a private healthcare provider seeking to make huge inroads into the UK NHS 'market'.

Yet again the Guardian has somehow decided to give him a platform to tout for business.

n.b. Unitedhealth in the US (tha parent company) don't do universal provision, have a record of trying to wriggle out of treaing those taking up its policies, and in February 2008, New York State Attorney General Andrew M. Cuomo announced that he was conducting an industry-wide investigation into a scheme by health insurers to defraud consumers by manipulating reimbursement rates. The announcement included a statement that Cuomo intended "to file suit against Ingenix, Inc, its parent UnitedHealth Group (NYSE: UNH), and three additional subsidiaries."

Just what the UK needs. Richard Smith can dress it up all he likes, and theorise that the private sector can do public service ethos, universal provision, all cheaper, and still return a profit for shareholders. The specific corporations looking to storm into the UK do NOT have a track record to justify this idealised view that the private sector is always best.

BishopHill (this is brilliant):

Private companies undoubtedly improved delivery of gas and electricity services.

viridios (me):

I must say firstly that the lack of acknowledgment of Richard Smith's position in United Health is bizarre. It took me two clicks to find the page where his seriously vested interest is shown. While the bias in the article was clearly evident, there was no clear declaration of the interest behind it. CIF should do better than this.

To suggest that the NHS is inefficient and needs propping up by bringing in the private sector is simply untrue. The lack of historic investment has meant that the excellent service the NHS has provided over the last 60 years has been done so on a fraction of the funding of most comparable countries. Low levels of funding are not indicative of inefficiency of the organisation - in this case the opposite is of course true.

Private provision of health care is wrong for many reasons, most of which have been covered already (cost, profit, inefficiency - I smiled at the comment that the electricity is supplied more efficiently now that it is privatised, I noticed such an increase in the quality of the electrons coming out of the fuse box!!!).

If anyone wants an example of a world class health care system that is completely state funded and state provided, yet spends less as a proportion of GDP and far less in cash terms than the UK, then look at Cuba.

Two issues need further highlighting in this debate. Firstly the lack of accountability already in the NHS suffers further erosion with private companies. For example, who is held to account for the problems that United Health may cause for patients? The professional bodies are certainly still there and do a useful job, but what if it is a more systemic issue - how can people effect change?

Private provision adds another barrier to an already unaccountable system. What people want (and need) is more of a say in local health care services not less.

Secondly, the principle of what health care should be has received little attention. Are we looking for cash cows for shareholder? Do we want to buy and sell bits of health care? Do we want to know that part our care comes from one provider and another part from another company, neither of which share information? Do we want to accept that taxes go to shareholders? Do we want health care to be a commodity to be bought and sold?

I want health care to be focussed on providing effective, efficient and seamless care to those who need it. You don't get this with the private sector.