Category Archives: Good News

Vaccine credited with HPV virus reduction in Scotland

Without vaccinating boys there is not enough herd immunity. Somehow I feel this report may be rubbish, but on the surface it seems good news. We have made the same mistake as for rubella (German measles) and tried to save money by only vaccinating females.

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BBC News reports good news from Scotland 5th April 2017?: Vaccine credited with HPV virus reduction in Scotland

A campaign to vaccinate girls against a cancer-causing sexually transmitted infection has led to a dramatic drop in reported cases.

Researchers have found a 90% fall in levels of the human papilloma virus (HPV) in Scottish women since the vaccine was made available in 2008.

HPV virus types are thought to account for about 90% of cervical cancers.

Scientists hope the drop in HPV cases will lead to a significant drop in future cervical cancer cases.

The researchers, led by senior epidemiologist Dr Kevin Pollock at Health Protection Scotland, said they hoped to see a decrease in new diagnoses within a year.

He told BBC Radio Scotland: “The two HPV types we were vaccinating against – HPV 16 and HPV 18 – cause about 70% to 80% of cervical cancers within Scotland but the vaccine has exceeded our expectations because it appears to have knocked out another three high-risk HPV types which cause about 10% of cervical cancers.

“So we do forecast within the next few years a 90% reduction in cervical cancer within Scotland.”

Researchers compared the cervical screening and vaccination records of women born in 1995, who had been vaccinated as teenagers, with those from unvaccinated women born between 1989 and 1990.

They found just 0.5% of women from the 1995 group tested positive for the virus, compared with 21.4% of women born before 1990.

The study also showed evidence that the vaccine protected against three other high-risk HPV genotypes involved in the development of cervical cancer.

‘Significant impact’

The research will be presented to the Microbiology Society’s annual conference in Edinburgh on Wednesday by Dr Kate Cuschieri, director of the Scottish HPV Reference Lab.

She said: “These new findings indicate that the positive impact of the HPV vaccine may be even greater than we initially thought.

“Collectively, these data demonstrate the significant and continued benefits of the HPV vaccination programme in Scotland, which has achieved a consistent and high uptake of around 90% in 12 to 13-year-old girls.”

Dr Pollock added: “The very high uptake of the HPV vaccine is strongly associated with these massive reductions in high-risk HPV types that are known to cause approximately 90% of cervical cancer in Scottish women.”

He said the virus was also known to cause a number of other cancers, including vulvovaginal, anal and a subset of head and neck cancers.

“These results suggest that this vaccine will also have a significant impact on these cancers in the years ahead”, he said.

The research, which was funded by the Scottish government, looked at samples from more than 20,000 women, making it one of the largest population-based studies on the impact of the vaccine.

There were 388 new cases of cervical cancer in Scotland in 2014.

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Precedent? Rationing becomes reality to politicians in Scotland. Now to work out how to do it best?

Its ironic that Scotland is short of doctors, GPs especially, when it trains more per capita than any other UK region. Rationing is becoming reality to politicians in Scotland. Now we need to work out how to do it best?

This is such an important precedent. Health Boards are an arm of government. If this “decision” to ration overtly is not challenged by Westminster, then the  other 3 UK Regional Health services can go ahead and ration overtly rather than covertly. Once accepted then the principle applies that we need to be universal over important expensive treatments (such as cancer), and to avoid post-code rationing whenever possible for “fearful” conditions. Rationing will be needed at the top (expensive) and at the bottom (cheap and high volume) end of care. We might agree to pragmatically accept post code differences at the bottom end but surely not at the top end. Now lets hear from the politicians…

on April 3rd 2017 in the Times Scotland edition Helen Puttick reports: System for rationing NHS care developed for Scottish boards

A scoring system for rationing hospital and social care is being developed for care boards in Scotland.

The £250,000 initiative, similar to that used by drugs watchdogs, will pay for a team of economists to create a framework that the NHS and councils can use to decide where to cut funding in services and where to invest.

The move, supported by the Chief Scientist Office, is part of the drive to shift spending away from hospitals into the community to prevent ill health and look after the frail elderly better in their own homes.

Scotland’s new care boards, which manage both community NHS and social care services, could use the system to weigh up controversial decisions, such as whether to maintain a local hospital service or instead create a “hospital at home” team taking more treatment to people’s homes. It is intended to work in the same way as the Scottish Medicines Consortium in Scotland and the National Institute for Health and Care Excellence (Nice) in England, which make often-contentious judgments on which drugs are to be made available to patients on the NHS.

Professor Cam Donaldson, a health economist at Glasgow Caledonian University, who is leading the team, said difficult decisions needed to be made about which services were of most benefit to most people.

In any system that was free “the needs outstrip the amount of resources available” he said, and with the NHS and social care, “that has become an acute problem recently”.

“What we really need to put in place are more robust processes to help health and social care partnerships to manage scarcity,” he added. “Difficult decisions will need to be made in Scotland about which services to fund and to what extent, and which existing services to scale back.”

With little or no increases in global budgets, frameworks need to help shift resources “from low-value services . . . to higher-value services in areas of most need”.

Nice and the SMC evaluate new drugs to decide which the NHS should buy based on the amount of extra quality of life they offer for the price. Professor Donaldson compared the methodology his team will create to this system, but noted that there were some marked differences. For example, the new framework will have to consider where to cut expenditure as well as what to fund.

Professor Donaldson said that the results of a public consultation would also be a factor and the process would be transparent, ethical and have some form of appeals system.

Without such a framework, he said, there was a risk that “whoever shouts the loudest most recently” would receive funding. Resources, he noted, might have to be taken from services that were still productive but deemed less effective than other options.

The £244,000 funding will pay for the development of the system and for four care boards to test how well it works.

At a time when countries around the world are grappling with how to care for a growing elderly population, the research is seen as pioneering. Professor Donaldson said: “A study of this nature has never been undertaken before and would place Scotland at the forefront of this important field of social and economic policy.”

Donald Cameron, the Scottish Conservatives’ health spokesman, said: “Anything that could provide a fairer way for deciding what course of action to take with a patient certainly deserves to be considered. However, any system that is put in place must be equitable and would need to be regularly checked and updated to ensure that it is meeting the needs of patients.”

All main political parties’ pledges for NHS will prove inadequate, says former chief executive

David Lock in 2014 in the Guardian: Rationing NHS care: why we need a serious debate 

 

We need tiered rationing according to means… Drugs costing 8p a day could be  hit by ‘devastating’ NHS rationing plan.. What a good idea. 

Many countries are considering ways to prevent the expensive new patented drugs coming to market quickly. Every year delayed saves money, and the closer to loss of patent the greater the saving. There is a dissonance here. Individuals, their physicians, and of course drug companies, want all the drugs possible, but governments are concerned with populations and their investment should not be in new treatments for rare conditions they cannot afford.. Overt rationing on cost alone would be honest, but would create a health divide amongst individuals: something government has a duty to avoid? We already know that the gini coefficient (wealth inequality) enumerates the wealth divide: do we need another coefficient for the health divide? It is becoming evident that we need tiered rationing according to means.. But the 8p suggestion will never happen because of the politicians. Any one who endorses it will lose their seat..

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John Crowley in the Observer 3rd Jan 2017 reports: The US Has Slowed the Pace of Drug Approval and It’s Costing Lives – Rare Disease Day Offers Great Chance to Revisit Promise of Orphan Drug Act

More than 30,000,000 Americans live with any one of over 7,000 rare and often devastating genetic diseases. This week, in observance of the 10th Anniversary of Rare Disease Day, millions of people around the world will meet with policymakers, hold events and use social media to raise awareness about the impact rare genetic diseases have on people’s live. The slogan for this year’s campaign is “with research, possibilities are limitless.”…..

Laura Donelly in the Telegraph 15th March 2017 reports: Drugs costing 8p a day could be  hit by ‘devastating’ NHS rationing plan  

Drugs costing just eight pence a day could be denied to NHS patients under “devastating” new rationing plans, charities have warned.

Under the plans, health officials will be able to delay introducing life-extending treatments for up to three years, after they have been found to be effective.

The cap is likely to affect one in five new treatments, with cheap drugs which could help large numbers of patients affected, as well as high cost drugs.

Ben Hirschier of Reuters reports 15th March 2015: New UK drug cost rules leave companies fuming

British drugmakers on Wednesday accused Theresa May’s Conservative government of breaking a manifesto commitment to improve access to new medicines, following approval of new cost rules that take effect on April 1.

The angry response from both Big Pharma and biotech firms comes despite a concession by government in the latest version of the scheme, which increases the cost threshold for certain drugs for rare diseases from the previously planned level.

Some charities, including the Alzheimer’s Society, also expressed concern that the measures could mean delays for people with serious conditions in getting new treatments.

The row comes at a sensitive time for the government, which is about to trigger proceedings to leave the European Union but wants to encourage investment by strategic industries, including the high-tech pharmaceuticals sector.

Drug companies are already concerned that Brexit could make Britain a less attractive market, especially if the country ends up outside the current EU-wide system for drug licensing.

The National Institute for Health and Care Excellence (NICE), which determines the cost-effectiveness of new drugs, and NHS England say their new procedures will fast-track the availability of drugs that offer exceptional value.

But drug industry executives believe few, if any, new medicines will actually benefit from this provision and the overall impact of the changes will be outweighed by newly introduced budget curbs.

“Today’s proposals from NICE/NHS England break the Conservative Party’s 2015 manifesto promise to speed up the introduction of cost-effective medicines into the NHS,” said Mike Thompson, CEO of the Association of the British Pharmaceutical Industry.

The new system means that new drugs costing the National Health Service (NHS) more than 20 million pounds ($24 million) a year will no longer be automatically funded, even if they are cost-effective. Instead, companies will have to enter negotiations to justify their use and work out funding.

Alzheimer’s Society CEO Jeremy Hughes said any new drug to help all 850,000 people with dementia in Britain would have to cost just 23.50 pounds a year to fit the threshold.

Similar limitations will apply to drugs for very rare diseases that cost more than 300,000 pounds for each year of high quality life delivered.

Previously, the proposed a cap for rare diseases had been 100,000 pounds but NICE CEO Andrew Dillon said the authorities had revised the plan after listening to feedback.

Even at the higher level, drugmakers argue the introduction of cost caps for medicines treating a handful of patients would be damaging and could threaten the flow of new medicines.

Significantly, the new rules apply only to England, leaving a different system in place for Scotland.

“They will build a Hadrian’s Wall for English patients who will no longer be able to access innovative new treatments that will continue to be available in Scotland,” said Steve Bates, CEO of the BioIndustry Association.

(Reporting by Ben Hirschler; Editing by Ruth Pitchford)

NHSreality wants scapegoats – and suggests the successive ministers of health (for England). Allyson Pollock might agree..

Tell Wales it isn’t working. Inequality is increasing…. better to “aspire to excellence”.

Inequality revisited.

 

Woman with terminal cancer feels ‘abandoned by Stormont’

The recurrence of fear, and the threat of Social Unrest are held in this post, and the link below to a previous post. We need to “know”, and politicians need to show, that the government cares. Its not enough for politicians to just say they care, and never act.. Walk the walk, not talk the talk. It is good news that there is a “New drug for one in five breast cancers”, (BBC News 14th March 2017) but surely health implies care as well as cure. Ms Kennedy needed to feel cherished even if her disease was incurable..

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Catherine Smythe reports from N Ireland 9th March 2017: Woman with terminal cancer feels ‘abandoned by Stormont’

A woman with terminal cancer has said she feels people like her have been abandoned by politicians at Stormont.

Melanie Kennedy felt so strongly about the state of the health service and lack of stable government that she ran as an independent candidate in last’s week’s election.

The mother of two polled 1,246 first preference votes in North Down.

She said it showed that ordinary people are concerned about issues like cancer drugs, waiting lists and mental health.

“With no government and no health minister – it makes me feel like there’s no-one there to fight my corner. It’s heartbreaking,” she said.

‘Driven to this’

Ms Kennedy made her comments as a number of health organisations warned that the continuing political impasse is preventing vital health and social care decisions being made.

The County Down woman was first diagnosed with breast cancer in 2013. While she was initially optimistic about her recovery, she has since been told by doctors that the cancer has spread to her liver and that her condition is terminal.

This experience and finding out that patients in Northern Ireland cannot access the same specialist drugs as those in England drove her to political action, despite her illness.

“For someone in my situation who is on quite harsh treatment, I was driven to this – it took a lot for me to act and create a campaign, but I felt I had to try and fight for justice for cancer patients,” she said.

Ms Kennedy said while the election process took a lot out of her, she has no regrets about standing as a candidate.

“People wanted to talk about real issues such as the health service, education for their kids. While legacy issues are also important, so is the here and now,” she said.

Ms Kennedy said that while the politicians talk, patients are being let down.

“The health service in Northern Ireland was already behind other parts of the UK, there was a lack of long-term stability and strategy and now we’re back to square one. It is the ordinary people like me who are suffering.”

She said time is a luxury that she and other people who are terminally ill cannot afford.

“The reason I started all this was that I asked myself, ‘where do I turn?’

“I could be told in the next couple of months, there’s no more treatment for me and I should go home and make my plans and say good goodbye to my children,” she said.

“It’s almost negligent that there is no cancer strategy from the politicians here in Northern Ireland. Early treatment is critical – it can mean the difference between getting well and going on with your life and ending up in my shoes. I don’t want anyone else ending up in my shoes.”

Cynical de-commissioning bringing back fear.. Dying patients waiting hours for pain relief in NHS funding shortfall.

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NHS pays up to treat rare conditions. it is easier to fund rare than common expensive treatments.

Tell me what you fear, and I will tell you what has happened to you, the psychologist D W Winnicott wrote in the 20th century. What citizens are afraid of in health is being treated unfairly, or (more likely today) neglected unfairly. It is good news to hear that some rarer conditions will be funded. The post code lottery however applies as Scotland, Ireland and Wales have yet to decide. Winnicott was not thinking of the “family” as you in the above quote, but replacing you by “your family” gives an insight into what is happening to the fears of the population. Bear in mind that it is easier to fund rare and expensive treatments, than common and expensive ones…

Kat Lay reports 25th Feb 2017: NHS pays up to treat rare conditions

The NHS has agreed to fund new treatments for three rare conditions that affect about 145 people a year.

Cancer patients who relapse after stem-cell treatment will be given a second transplant; people with dense deposit disease, a kidney condition, will be given the drug eculizumab; and riociguat, which treats pulmonary arterial hypertension, will be prescribed for people if other treatments fail.

NHS England had said that a second stem-cell transplant was too expensive and compared poorly with other drugs and treatment, but critics cited evidence that it cured one in three people.

In a statement on Facebook, the family of Abi Longfellow, a 14-year-old girl who has been campaigning for eculizumab so that she can have a kidney transplant, said that they would have to move quickly as the delay had caused complications to her condition.

John Stewart, of NHS England, said that the decision to pay for the treatments, which had not previously been available, was the culmination of a plan for 22 new “treatment options” and was possible because of “additional investment coming on stream from April”.

In a statement on Facebook, the family of Abi Longfellow, a 14-year-old girl who has been campaigning for eculizumab so that she can have a kidney transplant, said that they would have to move quickly as the delay had caused complications to her condition.

John Stewart, of NHS England, said that the decision to pay for the treatments, which had not previously been available, was the culmination of a plan for 22 new “treatment options” and was possible because of “additional investment coming on stream from April”.

More money needed… lets pour a little more into the holed bucket – and reduce the quality of care by rationing new treatments

The bucket of money for health spending has many holes in it, and the rate at which it leaks out the bottom, even with covert rationing is faster than we can print/put money in. Headlines such as Oliver Moody in the Times 18th Jan 2017: Extra £156 billion needed for healthcare, and 2 years earlier from Dennis Campbell in the Guardian: NHS will need extra £65bn by 2030, say analysts – Health Foundation says service is unlikely to meet unrealistic productivity targets and may have to ration access to treatment, show the inflationary nature of health costs. The OBR is rightly part of the department of justice…… The injustice of covert rationing is becoming evident. The good news is that rationing of new drugs is overt…

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The text of the Times article explains just how irresponsible the politicians are in their denial is:

Britain’s public finances are on an “unsustainable path” with an ageing population and the rising cost of healthcare, a watchdog warned.

A 50-year forecast from the Office for Budget Responsibility (OBR) said that chancellors would need to raise taxes or cut spending if the government were to stand any chance of fulfilling its pledge to balance Britain’s finances. It said an extra £156 billion would have to be found by 2066-67 to fund the gap in healthcare costs.

The OBR said that spending on both the NHS and the state pension were due to rise faster than economic growth and that, without policy action, public sector net debt would surge from 82 per cent of gross domestic product to 234 per cent in 50 years’ time.

Government borrowing would rise to 16.6 per cent of GDP and the annual budget deficit would widen from 0.7 per cent of GDP in 2021-22 to 1.8 per cent by 2025-26.

“Rising healthcare costs could make it harder for the chancellor to balance the budget in the next parliament and put the public finances on an unsustainable path over the longer term in the absence of further tax increases or cuts in other public spending,” it said.

Rosemary Bennett reports on a “little finger in one bucket hole” (social care) attempt: Tory council plans tax hike to fund social care as Surrey County Council does it’s best within the current rules of the game. It won’t be enough..

Chris Smyth reports in the Times 19th Jan 2017 : Fifth of new medicines to be rationed – NHS cost-cutting raises fears for patient safety

This is the type of “knee jerk” response which is irrational and which NHSreality has warned about. As new drugs come on line they are usually delayed in NICE approval until their patent has nearly expired. This was covert and unplanned. Now the announcement in the headline above makes it overt, but it denies British citizens access to drugs which other countries will have. Private Medical demand will increase, as will inequalities. A two tier system emerges by default, which increases fear in those excluded. One answer is to ration at the cheap high volume end of care, which encourages self reliance and autonomy.

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Going bust when it’s not allowed – all English Regions bar one.. The knee jerk response has yet to happen, as has the “honest debate”.

What is going to be excluded Mrs May? Please don’t be tempted by a knee jerk response..

 

Trolley Wars: It is good news that it’s being talked about – but as for action….

In the Times 9th Jan 2017 Sam Coates reports: Just a handful of patients on trolleys now, says Hunt and Michael Savage reports: “Talk of an NHS crisis is overblown, Tories Insist” & “Two patients die each day from thirst or starvation“… Laura Donnelly reports in The Telegraph 7th Jan 2017 ‘Humanitarian crisis’ in NHS warns British Red Cross as A&Es are overwhelmed by demand”  and, in keeping with the “post truth” service,  says “Heads of NHS trusts urged to play down scale of crisis on wards“.. Katie Gibbons in the Times tells it as it really is: Shortage of beds “means doctors choose who lives” (Hospital: Wednesday, BBC Two 9pm) More importantly, Jane Merrick opines “Our health service needs a national solution” – The crisis in A&E has caught the public’s attention and needs to be addressed by all parties, (see below) but all these avoid the “R” word, as does Chris Ham in his letter to the Times today… Rationing by denial?

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Mike Adamson of the Red Cross opines in the Times 9th Jan 2017 on the trolley delayed patients: Try telling patients on a trolley this isn’t a crisis – The Red Cross believes that the suffering in A&E is not unlike that in war zones

….This humanitarian crisis needs urgent action.

In considering making this statement, I went back and looked closely at the definition of a humanitarian crisis: it refers to the scale and depth of need facing a population.

In this case we are seeing large numbers of vulnerable people facing a threat to their health, safety or well-being. At the most extreme end this has led to deaths; in a broader way it has led to prolonged physical and mental distress….

We are talking about this now because there has been a significant change in the system over recent months, as demonstrated by the Nuffield Trust research last week showing that a third of NHS trusts were at their highest or second-highest level of pressure. Over new year we were called in to support the East Midlands Ambulance Service across Nottingham, Leicester, Lincoln, Kettering and Northampton. One hospital in the southwest last week specifically requested our help in A&E to get things moving….

It is clear this is not something that is going to go away overnight. We all need to work together to solve this problem…..

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Mayday Mayday – for the Health Services: Hospital faces charges over Caesarean tragedy. Dead patients dont vote.

Patients suffer in GP funding lottery. Ager and civil unrest to follow?

Child cancer results improving. In a “cradle to grave” Health Service we are not doing badly at cradles.. but we are doing badly as patients approach their grave.

Dead people don’t vote… End-of-life care ‘deeply concerning’

The NHS and reckless election promises. How about posthumous voting?

Advanced directives needed. Choice in death and dying. Lord Darzi warns of “draconian rationing”. GPs need to be involved at the interface of oncology and palliative care.

Grieving for the NHS. The softer specialities and locums. Ration for higher earners, and where insurance could cover.

Doctors form new pressure group to prevent “marketisation” of NHS – Rationing by chaos

Palliative and Terminal Care should be fully funded.

The Full text of Kate Gibbons article is here: shortage-of-beds-means-doctors-choose-who-lives

Jane Merrick opines: our-health-service-needs-a-national-solution

cost-of-caring- Letter from Chris Ham