Tuesday 13 January 2015

NHS death service redux

It is really sad to see how difficult decisions can be. I am often reminded of the old Michael Heseltine quote from the 1980's when discussing decline in the coal mining industry - there are no good choices, just bad or worse.

Fast forward to today and we have a big over-spend on unproven cancer drugs. We all know people who have died or are dying of cancer and naturally want the very best for them. The cost is eye-watering and with a £100 million overspend a task force was put in place to review the situation.

It was decided then to reduce spending on expensive unproven drugs and divert the money to more spending on cheaper and proven drugs.

This not controversial in any way, except if you believe in the magic money tree that money is irrelevant and everything should always be done. But if you do that, then after all the reports I have seen on Sierra Leone and the awful situation there, clearly there are greater needs elsewhere. This is where morality and reality clash.

So onto the NHS, Labour - having more or less admitted to 'weaponising' the NHS as part of the election strategy are keen to paint this as Tory cuts. The Tories are keen to point to the independent task for asked to look at this and to the benefits of clinical outcomes.

What is so frustrating is the black and white picture painted at the moment around the NHS. Either it is our national treasure or evil Tories want to destroy it. We have either the UK or US system.

There is no room or political space given to the mixed approaches tried in other countries or analysis of where other countries provide better systems and better care. Just an old, worn out dialectic between the well meaning nanny state or the evil capitalist market.


andrew said...

The thing Milliband must be aware of (as he cannot be that thick) is that if he really does 'weaponise' the NHS, and make it clear it all belongs to the (Labour) NHS party then inevitably having broken the cross-party consensus that the NHS is a good thing, it will be deconstructed by the Cons as not only do they have no interest in keeping it going, they would have gained an interest in getting rid of it.

And you only have to deconstruct it once ( how many re-nationalisations have you seen in the last 30 years)

That this person would be prepared to sacrifice the long term future of the NHS in return for an advantage in May '15 is just another reason not to vote for him.

As your Heseltine quote said :-
There are no good choices, just bad or worse.
And milliband is looking worser and worser

Watching It All implode said...

"It was decided then to reduce spending on expensive unproven drugs and divert the money to more spending on cheaper and proven drugs.

This not controversial in any way"

Perhaps as long as you believe that Pharmaceuticals Co's have not systematically falsified data and harvested profits from producer controlled corporatist health structures such as the NHS.

Read: Deadly Medicines and Organised Crime: How big pharma has corrupted healthcare by Peter Gotzsche.

He is the head of the Nordic Cochrane review, so isnt a lightweight, nor is he some sort of patsy like GSK's favourite cheerleader the excreble Ben Goldacre.

The health system is broken far more fundamentally than just the NHS, which is of course itself broken as a producer control monolith.

BE said...

Andrew is of course absolutely right. Tony Blair of all people once said that to maintain support for universal services such as health, the services have to provide a good service to middle and upper-income people as well as just Labour voters. If Tory voters begin to think that the NHS is just a huge financial burden, the NHS will soon disappear.

EdM must surely realise that to launch an attack on the Evil Tories in this way opens himself up to the charge that at least some of the problems in the NHS were caused by decisions taken under the last Saintly Labour administration? As I think has been set out in one of today's papers.

CU is of course completely right. Many of us would like a proper debate about how to best provide a universal health service without it becoming a millstone, or weapon, or religion.

Bill Quango MP said...

I heard several people on the radio yesterday saying that there nan had paid in all her life to the NHS, and if that drug could make her live another 2 weeks it was her RIGHT to have it.

Caller after caller said the same.
Only one that I remember said that it was too stupid for words. His mum was already blind and deaf and immobile. A few extra months ..what for? Better she went ..she couldn't communicate in any way..

I cannot understand why the clinicians offer the drugs. Just don't mention them at all and say ..we are doing all we can but Nana has only a few days left.
You should prepare.

There should definitely be some sort of pricing. Its also an argument we should have.
Put into the full context.

Do you want heart surgery for children or a month on a 90 year old's life?
Do you understand IF we give everyone everything then YOU will need to pay 25% N.I contributions.

Because those 2s/3d contributions Nana made all her life aren't paying for her treatment today.

BE said...

BQ, I am fed up with being told the reverse: I moan that the NHS share of my monthly taxes would pay for the top-level BUPA twice over, at least. Yet whenever I mention this I am told by whoever has not stopped listening that my taxes are a form of insurance and that everyone gets old/sick/poor and that the NHS will still be there for me.

I don't buy it, personally. I know, for example, that I am paying through the nose for other people's state pensions and that by the time I retire I will get the square-root of rod all.

dearieme said...

I saw a consultant last week. He said "we tend to overtreat"; he offered me treatment but made it pretty clear that he thought I should decline it. I did.

As for keeping vegetative Nan alive - ask the buggers to pay even 5% and they'd change their tune.

andrew said...

BE 6.09

The NHS part of your taxes may pay for bupa twice over, but I imagine the bupa charge you are thinking of is the cost of a relatively healthy person aged 20-55 in full time employment.

Oddly, the bupa cover for someone aged 75 who is overweight, was a smoker and has late onset diabetes will be between vv expensive to unavailable.

That cost does not the cost of scraping you off the pavement if someone runs you over etc.

Neither does it cover the cost of my OH's mum who was in a psychiatric wing for 4 months.

or another friend's child who has been in

Stepping back, in GDP terms the UK covers its entire population for a lot less than some other countries spend to cover about half.
Apart from Cancer and some preventative work it is amongst the best services in the world.

One of the marks of a civilised society is something like the NHS.

A shame neither side is willing to admit how expensive it really is as otherwise it will be deconstructed.

BE said...

Well I am glad someone is benefitting from the money I earn.

DtP said...

It's kinda difficult to sort the NHS out when there's an election in the way.

Simon Stevens has proscribed a link between funding and ownership. The problem is lack of auxillaries but that's not important right now. The lack of leadership and confusion has been problematic. Today hasn't been a good day but...

If Labour only have the NHS then surely that's a busted flush unless Mrs Ebola pops round with the Retros Dancing Troupe?

dearieme said...

"in GDP terms the UK covers its entire population for a lot less than some other countries spend to cover about half."
i.e. it's better than the USA's omnishambles.

"Apart from Cancer and some preventative work it is amongst the best services in the world." i.e. at the bottom of the developed world's list, bar the USA

CityUnslicker said...

andrew - I am on Dearime's side. The NHS is hugely underperforming for the investment in many areas.

On some areas it is over-performing. As a whole it is too big and unwieldly to succeed,

If it is sucha success, how come it has no imitators?

BE said...

CU, presumably the NHS would have hundreds of imitators, if only voters in other lands were as enlightened. As Andrew correctly points out, people die in the street in Germany, France, the Netherlands, Singapore, Australia, Sweden, Canada, Switzerland, Japan, and all those other uncivilised societies.

suffragent said...

Unlike the UK where they die of infection or malnutrition in the hospitals

BE said...

Suffragent, can't you see that hospital infection and malnutrition are the mark of a civilised society?

Bill Quango MP said...

ND had his NHS story the other day.

here's one of mine.

Father in law went in for hip surgery. Botched hip job. Caused much pain. Then he caught MRSA. Then wasn't given anything to drink for days and had to phone his daughter to drive up from Brighton to London and bring him a carton of Evian so he didn't die.
Had another op ..that was no better. Made his hip worse.
Caught MRSA again..really badly. was near death.
He discharged himself and went to another hospital, still NHS, and they sorted him out.

The doctor who did the first two ops was later exposed as a bogus surgeon. In the local paper!

Readers may remember my PA, Miss CD, who caught cancer,.
It wasn't diagnosed by the GP or the specialist. It was her dentist who thought it might be an abscess..but then said after 3 months its growing..This is something bad.

Was cancer .. of the face that is normally terminal.Not being diagnosed for 6 months meant it was a big, growing tumor.

NHS treatment in local hospital - full recovery.

You just never know.

Jan said...

I think your stories Bill demonstrate there is some very poor practice going on which is sorted out by a few good people. The quality control is s*** as goes for much of the public sector.