Category Archives: Patient representatives

Denial for 5 years. On 4th June 2014 Mr Stevens asked for an honest debate…

The reality that Health and Social Care are not either of them free, has not sunk in to the politicians yet. We cannot have “Everything for everyone for ever” and for free, and in their denial, both houses thus conspire to avoid the important debate that Mr Stevens called for on 4th June 2014, almost exactly 5 years ago. If Social Care is means tested, why not Health Care? 

The unedifying spectacle of two potential leaders trying to bribe 160,000 older and richer people who happen to be their members, is the reality of todays politics. No wonder so many people dont vote. We need an honest party to speak “hard truths” to the nation. NHSreality believes the first party to do this, and be understood as honest and working for the overall good of us all, fairly, will eventually win a landslide. It will also win the hearts and minds of the medical professionals….. and they are trusted, and speak to many people daily.

Our political (moron) representatives need to permit commissioners and trust boards to ration overtly, so that their citizens know what is not available. Initially this will have to be by post code, but national guidelines from NICE would help. Eventually, for those services and treatments that none of us can afford, cancer and big operations for example, there can be a National Health Service again, and for cheap and cheerful, high volume low cost services, we can have local post code rationing if we still want it…

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BBC News reports 4th July: Social care: Hunt and Johnson urged to consider NHS-style free service

Public Service Executive reports: Peers call for NHS-style free social care system and an extra £8bn to tackle funding crisis

and the Guardian today also reports the Peers asking for an extra £80m for “vulnerable elderly people”. 

The reality is that for most of us the state safety net is absent. If social care is means tested, then why not health care?

New and higher taxes will never solve the problems of health and social care…

There is a toxic culture, and disengagement everywhere in Health and Social Care. Also in the CQC …

What principles should underpin the funding system for social care? Surely an ID card with tax status and means is now essential….

The reality of the post-code lottery and rationing of health and social care. It will just have to get worse before the “honest debate”…

A Happy Brexmas to everyone as our leaders duck health and social care funding crisis.. The media failure, and political denial can only get worse..

Nov 2016 NHSreality: NHS funding and rationing: The debate (and the denial) intensifies… It’s going to get worse..

Reality is a word rarely used in Health debate and discussion. The Economist comments on post election realities..

A dishonest and covert dialogue is all that is happening at present.. Simon Stevens says he would like to change this. (U tube 4th June 2014)

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The “Economist” acknowledges health rationing, but does not recognise that it is covert…. More and more anger to come.

How long will the UK citizens put up with untruths? How long will it take for the proper debate to begin? The Economist recognises rationing, Enoch Powell in “A new look at Medicine and Politics” recognised rationing in 1966. We cannot go on without knowing what (for us) will be unavailable. It is surely a human right to be able to plan for your own health, your family’s health, your death, and illnesses. No wonder citizens are getting more and more angry..

If we want to win the cooperation and hearts and minds of medical staff we need to find out the truth about what they think. BMA conferences full of retired and burnt out doctors may reject the “long term plan” but there is no link with the doctors at the coal face.

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Not only is devolution a failure (certainly in Wales) but the 4 different systems allow different language of obfuscation, different methods of rationing, and outcomes. The anger will be the same.

The East Anglian daily Times shows how angry and dissatisfied the citizens are becoming. If you multiply the figures up over 200 health staff are attacked daily in the UK.

NHS GPs Economist 0619 Whats up Doc June 2019

Enoch Powell 4 Supply and Demand – Rationing  Minister of health for 3 years 2nd Edition 1974

Toni Hazell 28th June in GP mag: Here are two potential problems with primary care networks.  Huge hurry, and who takes responsibility?

Andrew Papworth reports 30th June 2019 in the East ANglian Times : “NHS staff aren’t punchbags”: Shock as six workers a day attacked in Suffolk by patients.

BMA ARM: Doctors spurn NHS long term plan

NHS patients ‘face more treatment rationing since coalition restructuring’

Wales is bust, and cannot pay for its citizens care. Devolution has failed. This is the thin end of a very large wedge..

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Methods of rationing in 1966. Warrington shows that we have since invented many more….

A new look at Medicine and Politics: chapter 4 –  J Enoch Powell 1966. We have invented many more since Enoch Powell’s day, and the latest from Warrington is how rich or poor you are…

The answer for this post-code lottery is for GPs to send all their patients elsewhere. Since the money moves with the patient, Warrington and Horton will get none.

https://www.sochealth.co.uk/national-health-service/healthcare-generally/history-of-healthcare/a-new-look-at-medicine-and-politics/a-new-look-at-medicine-and-politics-4/

METHODS OF RATIONING

The preceding pages have been devoted to examining how the medical profession is affected by the system that has been adopted for the purchase by the state of a certain quantity of medical care outside the hospitals. That quantity, as already explained, is indirectly fixed by the remuneration the state offers, which determines in the longer run the number and quality of those contracting to provide that care.

Thus, outside as well as inside the hospitals the figure on the supply side of the equation is fixed at any particular time by those complex forces that determine the state’s decisions on expenditure. With this figure demand has to be brought into balance. Virtually unlimited as it is by nature, and unrationed by price, it has nevertheless to be squeezed down somehow so as to equal the supply. In brutal simplicity, it has to be rationed; and to understand the methods of rationing is also essential for understanding Medicine and Politics. The task is not made easier by the political convention that the existence of any rationing at all must be strenuously denied. The public are encouraged to believe that rationing in medical care was banished by the National Health Service, and that the very idea of rationing being applied to medical care is immoral and repugnant. Consequently when they, and the medical profession too, come face to face in practice with the various forms of rationing to which the National Health Service must resort, the usual result is bewilderment, frustration and irritation.

The worst kind of rationing is that which is unacknowledged; for it is the essence of a good rationing system to be intelligible and consciously accepted. This is not possible where its very existence has to be repudiated.

In the hospital service probably the most pervasive, certainly the most palpable, form of rationing is the waiting list. The waiting list is a complex phenomenon in itself. One component can be likened to a reserve of working materials: if the hospital resources are to be continuously used, there must be a waiting list. The simplest case is that of a consultant available (let us suppose) during a two-hour session. If there were no queue in the out­patient waiting-room, there might be gaps between one consultation and another when the consultant would not be productive— not, at least, in that sense. So it is always arranged that there shall be plenty of people waiting when the great man arrives, so that there is no danger of the expensive mill even momentarily lacking grist. Similarly, if the capital and resources represented by operating theatres and their staffs are to be intensively used, there must be, so to speak, a cistern from which a steady flow of cases can be maintained.

This element of the waiting list is only incidentally a rationing device, though even here time is serving as a commutation for money: a consultant in private practice can accept the dis­continuity of work implicit in a good appointments system, because his patients are in effect buying his waiting time as well as his consultation time or, putting it another way, the patient finds his own time worth more to him than the consultant’s.

Waiting lists, however, normally exceed the minimum related to full employment of the medical resources. They are then directly rationing in their effect. For example, they ration demand for the more able, experienced or celebrated advice and treatment compared with the less: the waiting lists of consultants in the same department of a hospital can differ greatly in length. It is sometimes said that consultants regard a long waiting list as a status symbol and preserve it with the same care and pride as an Indian would a string of scalps. Certainly, consultants are very possessive about their waiting lists. But the taunt is as uncomprehending as it is uncharitable. There has to be some differential rationing for different qualities of an article, and if not price, then, for example, time: better surgeon, longer wait, and vice versa. No wonder consultants, family doctors and patients too resist equalisation of waiting lists, which would mean that rationing by time would have to be replaced by some even less rational or intelligible form of rationing, such as rotation or the initial/letter of the surname.

Generally, the waiting list can be viewed as a kind of iceberg: the significant part is that below the surface— the patients who are not on the list at all, either because they are not accepted on the grounds that the list is too long already or because they take a look at the queue and go away. Naturally, no one knows how many these are. Indeed, the very question is rather absurd, as it implies some natural, inherent limitation of demand. But the part of the iceberg above the water is doing its work, directly as well as indirectly, by attrition as well as by deterrence.

It might be thought macabre to observe that if people are on a waiting list long enough, they will die— usually from some cause other than that for which they joined the queue. Short of dying, however, they frequently get bored or better, and vanish. Here again, time on the ‘waiting list is a commutation not only for money— measurable by the cost of private treatment with less or no delay— but also for the other good things of life. It is an interesting phenomenon of the waiting lists for in-patient treatment that at the holiday season and around Christmas time it may be necessary to go quite far down a lengthy waiting list to get patients willing to accept the long-awaited treatment in sufficient numbers to keep even the temporarily reduced hospital resources fully employed.

I  cannot  but  reflect sardonically  on  the  effort  I  myself expended, as Minister of Health, in trying to ‘get the waiting lists down’. It is an activity about as hopeful as filling a sieve, although this is not to deny that some of the measures applied and pressures exerted might conceivably have had some useful side-effect in improving, in a slight degree, the direction of effort. There were the circulars enjoining such devices as the use of mental hospital beds and theatres, or of military hospitals. There were the stiff cross-examinations of staffs and hospital authorities in the endeavour to discover what contumacy might explain their continued non-compliance with the official exhortations. There were the special operations to ‘strafe’ the waiting lists, urged on the fallacious ground that a stationary waiting list is not evidence of deficient capacity— otherwise it would lengthen —but of a backlog which, once ‘cleared off’, ought not to be allowed to recur.

Alas, the waiting list that melted under an assault of this kind was back again to normal before long. There were always special, local and temporary explanations that could be cited, such as a sudden coincidence of staff off duty through leave, sickness or change of post. But all too evidently the causes at work were general and deep-seated. There was a mean around which the figures fluctuated, but that was all. Naturam expellas furca, tamen usque recurret: though you drive Nature out with a pitch­fork, she will still find her way back.

In a medical service free at the point of consumption the waiting lists, like the poor in the Gospel, ‘are always with us’. If at any moment of time they do not exist, they have to be re-invented, or rather they reproduce themselves effortlessly and automatically. Ministers come and Ministers go: the hospital service spends a rising fraction, or it spends a falling fraction, of the national income; but the ‘waiting list at 31st December’ in the Ministry of Health’s annual reports still stays the same, a reliably stable feature in an otherwise changing scene. On New Year’s Eve 1959 it was 442,519; on New Year’s Eve 1960 it was 475,643; I962, 474,353; 1963, 470,297; 1964, 475,863; 1965, (oh dear!) 498,972. And what had it been, pray, on New Year’s Eve 1951, back in those early, primitive days of the National Health Service? Why, 496,131.

At the same time, Ministers of Health are broadly truthful when they say that for cases diagnosed as urgent or critical the waiting list, practically speaking, does not exist. This is far from disproving the function and necessity of the waiting list as a rationing device. For one thing, ‘urgent’ and even ‘critical’ are not objective magnitudes; on the contrary, they are assessments that have already taken the volume of supply into account. In any case, there is no clear-cut dividing line between the ‘urgent’ cases, seen or treated at once, and the ‘non-urgent’ cases on the waiting list— or, as the case may be, not on the waiting list at all. The latter are squeezed down— or off— by the former. To point to the fact that no ‘urgent’ case goes untreated as evidence that supply and demand can be brought into balance without rationing is like arguing in a famine that because nobody dies of starvation, there need have been no rationing system.

A  DOUBLE  STANDARD

In the last resort the waiting list, or the queue in the general practitioner’s surgery, is one aspect of rationing by quality. In the days of the reform of the poor law and abolition of outdoor relief for the able-bodied, this used to be known as the principle of ‘lesser eligibility’. What are called the ‘deficiencies’ of the National Health Service— the large number of patients per general practitioner, the age and quality of many of the hospital buildings, and so on —are not deficiencies in the literal sense of the word, that the service falls short to a measurable extent of an objectively definable standard. They are those consequences of the quantity and quality of medical care being purchased by the state that help to equate the demand with the supply. The supply of medical care of all kinds through the National Health Service is rationed by forcing the potential consumer to choose between accepting the quality and quantity offered or declining the care offered. If he declines the care offered, he can either renounce or defer treatment altogether or he can endeavour to purchase it outside the National Health Service.

This is why it is absurd to declaim against a ‘double standard’ of medical care, inside and outside the National Health Service respectively. The standard inside is that which balances demand with the amount supplied by the state; the standard outside is that at which the supply and demand for medical care balance in the market, given the existence of the National Health Service. The standard in question is not necessarily one of purely medical treatment, if indeed the purely medical aspect of care can be divorced from the others. For example, it may well be that a patient acutely ill or gravely injured may be treated as skilfully, efficiently and safely in a National Health Service hospital as in an expensive private hospital or ‘nursing home— often, I would guess, more so. But the paradox is capable of rational explanation. The ancillary aspects of medical care— amenity, privacy, attention in convalescence, a degree of freedom, choice and individual self-assertion—may be valued no less than the essentials that affect life and limb. Indeed, they are sometimes valued more highly, surprising though that may seem. There can also be an element of pride, prejudice, snobbery— call it what you will— that values the identical article more highly when it is purchased than when it is received gratis.

The principle of lesser eligibility has always been applied, cannot help being applied in some form, wherever provision is gratis. It was applied before the National Health Service started in the voluntary and municipal (ex-poor law) hospitals and, indeed, from the beginning of time wherever medical care was rendered free at the point of consumption. Since eligibility is a form of rationing, we naturally find that it, like the waiting list, is also used to establish an order of priority. This is the reason why, for instance, the geriatric and long-stay mental hospital wards are, and have always been, the most ineligible in the service. The priority accorded to the demands of acute illness requires that rationing be applied more severely to the chronic.

Two instructive contrasts outside the National Health Service will illustrate the rationing function which lesser eligibility performs in it. One is the striking contrast between the two forms of old people’s accommodation: the workhouse and the new-style old people’s home. The former was designed to meet a legally unrestricted duty to admit; the latter corresponds to a discretionary and highly discriminating right to admit or not to admit. Consequently the poor law institution had to ration by ineligibility, and still in practice does if it continues to exist, while the new-style home explores ever-rising standards of amenity and care under the shelter of a rationing system of a different kind. Similarly, the paradox of the relatively high standard of the subsidised local authority house, although it is subsidised, is explained by the fact that the demand is tailored to the supply by the discretionary waiting-list itself, and consequently the supply can be rendered in a relatively eligible form.

Parkinson’s Law

The fact that the necessity for these covert forms of rationing springs from the very nature of the National Health Service and not from any particular level of supply attained in it is borne out by ‘Parkinson’s law of hospital beds’, which asserts that the number of patients always tends to equality with the number of beds available for them to lie in. Thus, the ratio of hospital confinements to total births ranged in 1965 from as low as 53.8 per cent in East Anglia to 78.4 per cent in Wales—the national average   was  69.8  per cent. Yet the pressure on maternity accommodation was at least as high in the latter part of the country as in the former. Again, the number of hospital beds for acute disease in the North-West of England is almost twice as great as in the South-East: in 1961 there were 3 per thousand population in East Anglia against 5.6 in the Liverpool region. Yet the pressure of demand, as evidenced, for example, by length of waiting lists, shows no comparable variation. There is, as has been said above, no reason to suppose that an increase in the quantity or quality of care provided by the National Health Service would reduce the need for rationing. On the contrary, every increase in eligibility must involve an intensification of the other forms of rationing, such as waiting.

It is unfortunate that the nature and the value of rationing by waiting and by ineligibility in the National Health Service are not recognised, at least by the professions. For these are the features that make it possible to avoid invidious discrimination in administering the service and, at the same time, secure a certain rational allocation of priorities. Instead, these features are treated as evidences of ‘inadequacy’ and as blemishes that it lies within the power of politicians to remove, given the insight and the will.

Martin Bagot in The Mirror updated 2yh June reports Warrington’s plans to charge 20K for a hip replacement. It would be cheaper and safer to go abroad.

 

 

Everyone as an opinion on their Health Service. Enoch Powell saw through its weaknesses in 1976.

The small book by Enoch Powell “Medicine and Politics 1975 and after” (his period was 3 years as Health Minister) should be obligatory reading for all doctors. He could less politely have said that the Emperor has no clothes. . Read a review by retired BMJ Editor Richard Smith. 

He tells us that of course the health care is rationed, and that this is deliberate but covert. He (page 37) discusses some methods of rationing, but since his day we have invented many more than the waiting lists and waiting times that he refers to.

Parkinson’s Law of Hospital Beds (page 43) “asserts that the number of patients always tends to equality with the number of beds available for them to lie in”. But he was not aware that clever administrators can use trolleys, but not count them as beds. Therefore more and new covert rationing….

Finally I wish to quote his last word on rationing:

“It is unfortunate that the nature and value of rationing by waiting and by ineligability in the NHS are not recognised, at least by the professions (and by implication the rest of the country). For these are the features that make it possible to avoid invidious discrimination in administering the service and, at the same time, secure a certain rational allocation of priorities. Instead, these features are treated as evidence of “inadequacy” and as blemishes that it lies within the power of politicians to remove, given the will.”

Richard Smith non-medical blogs on Enoch Powell’s book – The best book ever written about the politics of the NHS

The Socialist Health Association also summarises the book (A large part or almost all – I failed to spot omissions)

In a world where nobody trusts any experts, who will trust the UN report? Not our politicians it seems…

The comments are in the BMJ are appropriate “The deepening crisis in the UK requires society wide, political intervention.

Austerity bites – falling life expectancy in the UK

But nobody will listen, and the government has already rejected the findings as “false news”. Not enough deaths yet it seems… The post code lottery of service rationing by commissioners in response to their “rules” means that without honesty we cannot progress. The politicians” loyalty is to their party above their people, in many aspects of life. This is evident to many in the caring professions and is why hearts and minds do not buy into repeated reforms based on unreality.

Healthcare is personal to voters, but distant and about populations for politicians, until they have an angry family in front of them. 

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Sophie Arie in the BMJ reports 23rd May 2019 (BMJ 2019;365:l2321 ) : UK’s “austerity experiment” has forced millions into poverty and homelessness, say UN rapporteur

The United Nations has accused the UK government of unnecessarily causing a “social calamity” with an “austerity experiment” which has forced millions of people into poverty, causing record levels of hunger, homelessness, and decreased life expectancy for some.

But the government has rejected the findings, insisting that the country is “one of the happiest places in the world.”

“UK standards of wellbeing have descended precipitately in a remarkably short period of time, as a result of deliberate policy choices made when many other options were available,” said Philip Alston, the UN’s special rapporteur on extreme poverty and human rights, in a report published on 22 May.1

In the world’s fifth largest economy, there are 14 million people—a fifth of the population—living in poverty, the report said, citing independent experts. By 2021, close to 40% of children are predicted to be below the poverty line.

“Much of the glue that has held British society together since the second world war has been deliberately removed and replaced with a harsh and uncaring ethos,” Alston wrote, describing austerity policies introduced after the 2008 global financial crisis as “pursued more as an ideological than an economic agenda.”

Worse could be yet to come for the most vulnerable, who face “a major adverse impact” if Brexit proceeds, he said.

The report was based on an 11 day visit to the country last November and extensive consultation with over 300 charities, respected research bodies, and other organisations, as well as government ministries, the National Audit Office, and the Equalities and Human Rights Commission.

But a spokesperson for the Department for Work and Pensions said, “the UN’s own data shows the UK is one of the happiest places in the world to live, and other countries have come here to find out more about how we support people to improve their lives.”

They added: “This is a barely believable documentation of Britain, based on a tiny period of time spent here. It paints a completely inaccurate picture of our approach to tackling poverty.”

The government has repeatedly argued in the face of Alston’s criticisms that the UK is enjoying record lows in absolute poverty, children in workless households, and low unemployment.

It did, however, announce some changes that Alston called for in an initial report in November, saying it would adopt a uniform poverty measure (to replace four different measures), to systematically survey food insecurity, and to further delay the rollout of universal credit, the reformed benefits system that has been widely criticised.

But Alston dismissed these as “window dressing,” saying there was a “total disconnect” between those in office and the reality around the country. He called for local government funding to be restored and a benefits cap and two child limit on benefits to be reversed.

Alston will present his report to the UN Human Rights Council in Geneva on 27 June, but the UN has no powers to compel countries to respect their commitments to human rights conventions. Human Rights Watch, the Joseph Rowntree Foundation, the Child Poverty Action Group, and other charities and experts in poverty urged the government to recognise the problem and act on the report.

The BMA’s board of science chair, Parveen Kumar, said in a statement, “The government must be open and acknowledge the importance of these findings. Ministers should consider health impacts in any policies they chose to pursue.”

Scotland reintroduced statutory child poverty targets in 2017 after the UK government abolished them a year before. But a report from the independent Poverty and Inequality Commission, after analysing the country’s December budget, warned that the Scottish government will miss its own child poverty targets unless it increases investment significantly.

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Austerity: a failed experiment on the people of Europe – NCBI

9th June in the Guardian: After seven years of pain, the austerity experiment is over | Larry Elliott …

 

Is it wrong to earn a living or make a profit out of health related services? Does it matter if the profit goes overseas if the provider is more efficient than our own?

In a factually truthful account of how we have tried to exclude inefficiencies, improve purchasing and delivery, Ian Birrell points out that we have outsourced many services. Many firms, including both domestic, and foreign ones based overseas, make profits from “patients’ misery”. All healthcare for curative services has an element of pain or misery, and once extended to prevention becomes part of the “worried well” psyche prevalent in our affluent society. Anyone would think it was wrong to earn a living or make a profit out of health related services. Does it matter if the profit goes overseas if the provider is more efficient than our own? Should the longer term implications of delegating more and more to overseas businesses be discussed?

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Ian Birrell in the Times asks 4th June 2019: Worried about US healthcare giants? They’re already here.

The response could not have been clearer when Woody Johnson, US ambassador to Britain, suggested that American firms would want access to the NHS in any post-Brexit trade deal. “The NHS is not for sale,” thundered the health secretary, Matt Hancock. “The NHS as a publicly run, publicly owned institution is part of our DNA,” added his predecessor, Jeremy Hunt, now foreign secretary.

This was a predictable response as political rivals seized on the ambassador’s “terrifying” comments, especially when both men are engaged in a leadership battle. But it is also untrue. Lucrative chunks of the NHS have already been handed to rapacious American healthcare giants with disastrous consequences. And this pair of posturing politicians have done little to thwart them.

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Remember Winterbourne View, where the BBC exposed abuse of patients with autism and learning disabilities in a secure hospital unit eight years ago? The response was unequivocal: such people should not be held in these places since community care tends to be cheaper, kinder and more effective. Yet efforts to end such abusive detention failed. For as the NHS pulled out, private firms muscled in on contracts worth up to £14,000 a week, while many staff continue to be paid little more than minimum wage and there is no real accountability.

More than 2,200 such patients remain trapped in assessment and treatment units and the proportion in privately run beds rose from a fifth to more than half in a decade. Acadia, a Tennessee healthcare firm, spent £1.3 billion on the Priory Group, which takes £720 million annually from taxpayers. Universal Health Services, another US firm, recently snapped up psychiatric services including Danshell, owner of a Durham hospital that just featured in another Panorama exposé of abuse. Its UK operations are run by Cygnet Health Care, which having tweeted it was “shocked and deeply saddened by the allegations” nonetheless boasts in its latest accounts of revenues from 220 NHS purchasing bodies and profits surging to £40.4 million.

It is shameful that our fellow citizens can still be stuffed in places where they are subjected to solitary confinement, violent restraint, hatch feeding and forced sedation. The legacy is damaged minds, devastated families, sometimes even death. This scandal offers frightening insight into wider failures in psychiatric services. It is taking place in secretive units — scores of them owned by American firms and funded by the state.

The private sector is not solely to blame. But instead of posing as valiant guardians of the NHS, how much better if we could trust a health secretary to protect patients from foreign firms making profits from their misery.

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Poverty and Wealth, and pregnancy rates. Will the slave society mean that Middlesborough et al supply the future low paid workforce?

The Economist in an article on 20th April reports on the state of childbirth demographics, and the differences between rich and poor areas.  Surprisingly, Wales is improving compared to the North East and even in Breast Feeding, although the length of time this applies to is not recorded in the Guardian figures…. How many of the IVF conceptions (3% of all) are private and how many public? The health divide ….. The Economist says it explains: Why the middle-aged are replacing teenagers in maternity wards – The conception rate is rising for women over 40, even as it crashes among under-18s.

There are many interesting graphics below, and the Teenage Pregnancy Rates in England and Wales) are most interesting. They do not include Scotland and N Ireland. Presumably Scotland similar to Wales, and N Ireland will have many, and fewer terminations because of their archaic laws.

Since most pregnancies are “high risk” in older first timers, will this mean that midwifery led units disappear? They should. (The risks in having babies in rural areas – midwifery-led units questioned by consultant.)

Will the slave society mean that Middlesbrough et al supply the future low paid workforce?

Maybe Later baby – The Economist 20th April

…. The conception rates of the youngest and oldest mothers are now close to converging (see chart). Middle-aged maternity may soon be more common than teenage pregnancy.

Advances in health care help to explain the convergence. Although assisted conception accounts for only a small proportion of pregnancies, it is growing more popular and more successful. Between 1991 and 2016, birth rates from in vitro fertilisation treatment increased by more than 85%. In 2016 more than 20,000 babies were born following IVF (out of a total of 696,000 births that year). About three-fifths of women who use it are 35 or over. Demand is likely to increase as women learn of others whose treatment has been successful. Ms Fenelon was inspired by a magazine article about egg-freezing……
Patrick Butler in the Guardian 2018: New study finds 4.5 million UK children living in poverty

New measure by Social Metrics Commission aims to focus political attention on the issue

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