The History behind the drugs crisis.. Evidence that the thinking world know the truth and are beginning to voice it. So politicians do not think?

This post, and the links below it are evidence on the History behind the drugs crisis.. Evidence that the thinking world knows the truth and are beginning to voice it. So politicians do not think? Instead of medications, and Iatrogenesis risk, we should be using physical and psychological therapists whenever possible. NHS is heading for financial meltdown – but nobody seems to care – or learn! 

From June 2011, and re-published on 8th August 2014 in HistoryExtra, a BBC History Magasine, “In case you missed it Chris Bowlby takes a look at the history behind current government plans to reform the NHS.”

The painful truth about rationing in the NHS

As part of its plans for reforming the NHS in England, the government is looking at how our medicines are selected and what they cost. This may sound like a remote and technical question. But it has been a prominent and controversial issue in our long debate about what kind of health care the state can really offer – and afford. ( Rationing and Models )

As part of its plans for reforming the NHS in England, the government is looking at how our medicines are selected and what they cost. This may sound like a remote and technical question. But it has been a prominent and controversial issue in our long debate about what kind of health care the state can really offer – and afford.

The creation and selling of medicines was well established before the creation of the NHS. Doctors knew that patients expected medicines as a kind of symbolic proof of adequate care – whether the medicine was clinically essential or not.

So when the NHS arrived in the late 1940s – initially offering free prescription – long queues formed, and the government began to panic. Dr Martin Gorsky of the London School of Hygiene and Tropical Medicine notes that civil servants failed completely to anticipate “pent up demand”.

Health minister Aneurin Bevan knew the scale of need, but saw excess too. “I shudder to think,” he wrote in 1949, “of the ceaseless cascade of medicine which is pouring down British throats at the present time. I wish I could believe that its efficacy was equal to the credulity with which it is swallowed.” The Treasury swiftly demanded the introduction of prescription charges, and began its own campaign to rein in medical spending.

Such disputes highlighted the most sensitive issue in British health care: rationing. In theory, the NHS provided for limitless care based solely on clinical need. In practice, various forms of rationing, some more overt than others, have always applied. Deciding who received which medicine became a fascinating battleground between government, doctors, patients and pharmaceutical companies.

Development of new medicines and treatments added to the pressures. Antibiotics, pioneered in the 1940s, were publicised as a miraculous new cure. Their increased use for more trivial conditions was driven not only by medical enthusiasm but also by impatient patients. Minor illnesses, it was assumed, were no longer something you simply had to endure until nature made it better. In mental health, too, the move since the late 1950s from confining patients in asylums to ‘care in the community’ was, Dr Gorsky points out, accompanied by a more extensive use of drugs.

So the NHS bill for expenditure on medicines rose relentlessly, aided by pharmaceutical companies’ skill in marketing products and influencing the medical profession. Companies insisted that their profits were essential to fund research on new medicines and sustain an industry providing Britain with skilled scientific jobs.

Governments tried from time to time to reduce the cost. In the 1950s ministers held talks with the industry over ‘fair’ levels of profit; in the 1960s restrictions were placed on promotional spending. And in the 1980s, a list of cheaper generic products was announced, to be substituted in NHS provision for more expensive branded drugs.

Underlying all this was an attempt to decide where the NHS’s limited resources were best spent, seeking what Gorsky calls “a scientific method of assessing cost-effectiveness”. The National Institute for Health and Clinical Excellence (NICE) was created with the task of measuring what treatments deliver in terms of effects on a patient’s life.

This has introduced a new element into the debate but has hardly silenced the clamour. Doctors resist what they see as interference with their clinical judgement. The media avidly covers claims that patients are denied crucial new treatments. And the pharmaceutical industry protests that its future will be undermined if the NHS spends too little on its products.

So the challenge of health service spending remains. Despite cherished beliefs that care is free and unlimited for all, resources are, in the end, limited. “One person’s hip replacement can mean the loss of someone’s palliative care,” as Gorsky says. That kind of trade-off may not always be so visible. But the pills we are – or are not – prescribed make brutally clear what, for all its promises, the NHS can really provide.

The creation and selling of medicines was well established before the creation of the NHS. Doctors knew that patients expected medicines as a kind of symbolic proof of adequate care – whether the medicine was clinically essential or not.

So when the NHS arrived in the late 1940s – initially offering free prescription – long queues formed, and the government began to panic. Dr Martin Gorsky of the London School of Hygiene and Tropical Medicine notes that civil servants failed completely to anticipate “pent up demand”.

Health minister Aneurin Bevan knew the scale of need, but saw excess too. “I shudder to think,” he wrote in 1949, “of the ceaseless cascade of medicine which is pouring down British throats at the present time. I wish I could believe that its efficacy was equal to the credulity with which it is swallowed.” The Treasury swiftly demanded the introduction of prescription charges, and began its own campaign to rein in medical spending.

Such disputes highlighted the most sensitive issue in British health care: rationing. In theory, the NHS provided for limitless care based solely on clinical need. In practice, various forms of rationing, some more overt than others, have always applied. Deciding who received which medicine became a fascinating battleground between government, doctors, patients and pharmaceutical companies.

Development of new medicines and treatments added to the pressures. Antibiotics, pioneered in the 1940s, were publicised as a miraculous new cure. Their increased use for more trivial conditions was driven not only by medical enthusiasm but also by impatient patients. Minor illnesses, it was assumed, were no longer something you simply had to endure until nature made it better. In mental health, too, the move since the late 1950s from confining patients in asylums to ‘care in the community’ was, Dr Gorsky points out, accompanied by a more extensive use of drugs.

So the NHS bill for expenditure on medicines rose relentlessly, aided by pharmaceutical companies’ skill in marketing products and influencing the medical profession. Companies insisted that their profits were essential to fund research on new medicines and sustain an industry providing Britain with skilled scientific jobs.

Governments tried from time to time to reduce the cost. In the 1950s ministers held talks with the industry over ‘fair’ levels of profit; in the 1960s restrictions were placed on promotional spending. And in the 1980s, a list of cheaper generic products was announced, to be substituted in NHS provision for more expensive branded drugs.

Underlying all this was an attempt to decide where the NHS’s limited resources were best spent, seeking what Gorsky calls “a scientific method of assessing cost-effectiveness”. The National Institute for Health and Clinical Excellence (NICE) was created with the task of measuring what treatments deliver in terms of effects on a patient’s life.

This has introduced a new element into the debate but has hardly silenced the clamour. Doctors resist what they see as interference with their clinical judgement. The media avidly covers claims that patients are denied crucial new treatments. And the pharmaceutical industry protests that its future will be undermined if the NHS spends too little on its products.

So the challenge of health service spending remains. Despite cherished beliefs that care is free and unlimited for all, resources are, in the end, limited. “One person’s hip replacement can mean the loss of someone’s palliative care,” as Gorsky says. That kind of trade-off may not always be so visible. But the pills we are – or are not – prescribed make brutally clear what, for all its promises, the NHS can really provide.

Chris Bowlby is a presenter on BBC radio, specialising in history. This series is produced with History & Policy. You can find out more about them and read their papers at www.historyandpolicy.org

Lord Darzi calls for overt rationing. We can’t afford what we are doing – but which politician will do anything about it? Stop ‘pointless’ cancer care for dying, says former minister…

Cancer patients denied drug – restriction, prioritisation or rationing?

The good news this week – is usually too expensive. But there is hope on depression, and exchanging drugs for therapy.

Deserts based rationing again: NHS watchdog to put young people first for new medicines. Today’s Talking Point for The Times community team

Talk about understatement. “…there is growing evidence of the rationing of care”.

English Regional Health Service (RHS) rationing: cancer patients will be denied life-extending drugs

Rational Rationing in Pharmaceuticals, Cancer, Health in general, and other areas.. is off the agenda

The Overt Rationing News – just for the last few days

Cancer diagnosis and treatment dilemmas. All could be addressed by overt rationing.. Pretending we can solve with short term plans is denial, and an insult to our intelligence.

Deserts Based Rationing: The Government appears to support it

Rationing in the recent news. Obscene denial of the truth by politicians…There’s a painful list of conditions we are no longer treating on the NHS

Physiotherapy can transform the NHS and lives of older adults

Schizophrenia: Talking therapies ‘effective as drugs’

 

 

 

 

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This entry was posted in A Personal View, Patient representatives, Rationing, Stories in the Media on by .

About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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