Category Archives: Political Representatives and activists

When will public anger over the NHS reach a political tipping point? More NHS mental health patients treated privately…

It seems we are a long way from the tipping point whilst “most” services are up and running for the articulate and coherent. NHSreality has opined that “civil unrest” is not far below the surface, but whilst the Regional Health services can hoodwink their populations, and whilst citizens (mainly healthy) can remain in denial as their elderly and mentally infirm get a “rough deal”, and whilst the media and press, including Toynbee, fail to grasp that “overt rationing” is a pragmatic necessity, post coded and covert rationing will drive more and more into private care, and result in a two tier service. Harry may have had “counselling” but I expect it was private, unlimited, and done by a fully trained psychology counsellor. In the Health service it would be limited to six sessions, provided by a Nurse Counsellor who has done an extra short course, and terminated when the allowed sessions expired.

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Polly Toynbee in the Guardian 13th April asks: When will public anger over the NHS reach a political tipping point?

here is an ebb and flow in reporting on the NHS as Trump, Syria and Brexit dominate front pages. But the pressure-cooker state of the entire service still worsens. This morning’s latest figures are just a snapshot of deterioration – but every target is missed: for A&E, ambulance response times, for treating psychosis within a week, for cancer waiting times, blocked beds and diagnostic tests.

“Demand” is rising, the government says, as if serious illness were a choice, though the pressure comes from well-predicted, rapidly increasing numbers of old, sick people: this February’s A&E figures are, as ever, better than deepest winter January, but worse than February last year, as this crisis ratchets up.

Major A&E centres are treating 81.2% of patients within four hours, against a target of 95%, which used to be hit before 2010. The government likes to blame frivolous users of A&E, but those are easily triaged to on-site GPs. Serious delays are because of very ill people needing to be admitted with no empty beds: bed occupancy is at dangerous levels, as Chris Hopson of NHS providers warns, where doctors often have to decide “one in, one out”, discharging those who still need more care too early.

Take the temperature in virtually every part of the NHS and the wonder is how the heroically overstretched staff keep the wheels on the trolley. Take this week alone: the Royal College of Physicians says 84% of doctors have to cope with staff shortages and gaps in rotas.

GPs? Two years after a government promise of 5,000 more GPs, numbers are still falling. They dropped by 400 just in the last three months of last year: as doctors find the workload unmanageable some escape abroad, take earlier retirement or become locums. Too few new doctors want the burden of running a GP partnership, so 92 practices closed last year, tipping hundreds of thousands more patients on to already overloaded neighbouring GP lists.

Today the Royal College of Nursing, traditionally most reluctant of unions to take action, starts consulting its members on whether to hold a strike ballot. But with public sector pay frozen yet again at 1%, when inflation will shortly hit 3%, nurses are departing – as are doctors – for less stressful, better-paid work. Recruitment from the EU is plummeting, as predicted…..

…This is the dismal background to the reorganisation that the head of NHS England, Simon Stevens, is attempting, almost undercover. His state-of-play review of his five-year forward plan passed hardly noticed, announcing a first tranche of England’s 44 STPs, (sustainability and transformation plans) to reconnect local services fragmented by the Lansley 2012 act.

Most observers think it the right way to go, putting the NHS and social care under a united structure with one finance hub, ending destructive and expensive competition and tendering of services. But hardly anyone thinks this can be done with no new money: every STP calls for capital for new beds and units. Virtually all involve closures and mergers stirring a local political outcry.

Jeremy Hunt, who always presented himself as the patient’s ally, rooting out poor quality, wallowing in the Labour disaster at Mid-Staffs, has fallen uncharacteristically quiet. He has nothing much to say about patient safety in A&Es or elderly patients turned out of beds too soon. Not even deaths on trolleys in A&E corridors in Worcester roused his usual righteous ire.

Concern about the NHS has risen high in recent polling: what no one knows is when public anger will reach a political tipping point. Theresa May and Philip Hammond stay iron-clad adamant: all this is NHS shroud-waving and there will be no more money. Lack of any opposition helps, but can they really tough it out where Margaret Thatcher, John Major and Tony Blair all bent in the face of NHS crises?

Chris Smyth in the Times 18th April reports: Sick children ‘denied drugs to save money’ and Spendthrift NHS regions face big cuts. This is the reality of todays health services, and which/what quality of service depends on which. post-code you live in. You cannot plan for the deficit, because the “priorities” change from year to year.

George Greenwood for BBC 18th April: More NHS mental health patients treated privately

 

NHS managers still growing as GP posts fall

The Observer reports 15th April 2017: Number of NHS managers still growing as GP posts fall again – Doctors say ministers’ ‘bureaucracy busting’ shakeup has failed to switch resources and manpower to the front line

The number of NHS managers has grown by almost 18% in the four years since the government introduced a “bureaucracy-busting” shakeup of the health service, according to the latest official data.

The rise of about 4,650 in total management posts since April 2013, when the controversial Health and Social Care Act came into force, contrasts with an alarming fall in the number of GPs over recent months at a time of unprecedented demand for health care. The figures have drawn criticism from the British Medical Association (BMA), who say ministers are failing in their central objective of shifting more resources and manpower from back-office posts to the front line….

Managers are at odds over rationing, and management recognises the case, but the “rules” don’t allow them to speak out.

 

Drugs Bust – Opportunistic companies take advantage of a hole in the regulations.

On the surface this looks like a typical South African legal loophole arbitrage opportunity taken by a smart businessman and the manipulated are the British public whose administrators left a loophole in the law. the loophole has been there for years, only recently abused, and has not been closed as yet.
A deeper analysis might suggest that Glaxo was complicit in this immoral action, and that they took advantage by owning a share of the new company. Politicians need to get their act together and block this in future.

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Bill Kember in The Times 14th April reports: Drug giant’s secret plan to destroy cancer medicine – Company staff discussed dumping life-saving stock unless 4,000% price rise agreed

Staff at one of the world’s leading drug companies discussed destroying supplies of life-saving cancer medicines in a battle to impose massive price rises across Europe, The Times can reveal.

The proposal was raised at Aspen Pharmacare during a dispute with the Spanish health service in 2014 over attempts to increase the price of the medicines by up to 4,000 per cent.

The company, which runs its European operations from Dublin, began a continent-wide effort to drive up the price of five cancer medicines after buying the rights from the British company GlaxoSmithKline (GSK).

The price rises meant that the cost of busulfan, used by leukaemia patients, rose from £5.20 to £65.22 a pack in England and Wales during 2013, an increase of more than 1,100 per cent. The price of chlorambucil, also used to treat blood cancer, rose from £8.36 to £40.51 a pack in the same year.

Aspen, a South African pharmaceutical company……

Drugs Bust – Times leader 14th April 2017

Let’s celebrate!” This sign-off to an internal email at Aspen Pharmacare followed the conclusion of a deal, but not the sort of deal any business should be proud of. The South African company had agreed increases of up to 1,500 per cent in the cost of life-saving cancer drugs aimed mainly at children and the elderly after months of threats to withhold them or destroy supplies.

This agreement was struck with the Italian health service but the company was emboldened by its earlier experience with the NHS: Aspen had raised the prices of these drugs in England and Wales by up to 1,200 per cent. This is the latest in a series of scandalous abuses of a drug pricing loophole brought to the attention of the public not by regulators, the health service, police or civil servants, but by The Times.

As a direct result of this newspaper’s public interest reporting, which is under sustained threat from both the government and the courts, a bill is now before parliament that will close the loophole in question and save the NHS and taxpayers hundreds of millions of pounds a year.

There are more practical steps that can be taken to halt the extortionate practices of companies that exploit the marketing rights to out-of-patent drugs. There is also a question to be answered by both the maverick firms that buy up these rights and the giants that sell them. How can any business be a party to withholding or forcing up the prices of cutting-edge medicines, knowing that desperately ill children need them? That the question even arises is a moral outrage.

Aspen is controlled by Stephen Saad, one of Africa’s richest men. In 2009 he oversaw the acquisition from GlaxoSmithKline (GSK) of a portfolio of cancer drugs known as Cosmos, which until then had been sold at a modest profit. As branded drugs their pricing was strictly regulated. Being out of patent, under rules then in force, these prices could be reset at whatever level the market would bear provided they were renamed and recategorised as “unbranded generics”.

We all pay the same tax…. but “Scotland gets cancer drug that is too expensive for England”. The Times advocates rationing ..

Whilst it will not mean a disaster in differential outcomes for the population, this post-code differential highlights the anomalies of our 4 regional health services. It reinforces the WHO opinion that there is no longer an NHS. It brings back fear when we should be reducing it, and it makes it clear that rationing overtly is the pragmatic answer. I too would exclude Kadcyla for terminal patients. The main beneficiaries of the Scottish decision are Roche shareholders.. The Times leader advocates rationing, but not necessarily “overtly”.

 Chris Smyth reports 12th April 2017 in the Times: Scotland gets cancer drug that is too expensive for England

A life-extending breast cancer drug rejected as too expensive for England and Wales is to be made available to Scottish patients.

Scotland has also become the first part of the United Kingdom to offer a pill that cuts the risk of HIV infection by 90 per cent after NHS England fought a court battle to avoid paying for it. Campaigners warned that English taxpayers would not put up with subsidising treatments in Scotland that they could not get themselves.

Scottish public spending is £10,500 a head against £8,800 in England, with the NHS getting £2,100 and £1,900 per person respectively. English and Welsh taxpayers contribute more to Scottish health spending through the Barnett formula.

The drug Kadcyla can offer an extra nine months of life to patients…

We should all care about the UKs unequal health services. “Who Cares: the play that puts the NHS under the knife”

All the Health Services are sinking – who will be bold enough to re-design their replacements, before its too late to take to the lifeboats?

Terrifyingly, according to the World Health Organisation definition the UK no longer has a NHS

The Times leader encourages rationing – a policy denied by all politicians. “Drug Frontier” – It is wrong that a cancer drug is available in Scotland and not in England or Wales – 11th April 2017:

adcyla is an advanced breast cancer drug that prolongs the life of patients for an average of nine months and in some cases for much longer. It is also, at £60,000 to £90,000 a patient, one of the most expensive cancer treatments ever brought to market. Despite this the drug is readily available to women in 18 European countries, including Germany, Austria, France and Scotland. But it is not available in England or Wales.

An important cause of this disparity is health spending per head that is significantly higher in Scotland than in England, thanks largely to the generosity of the Barnett formula by which block grants from Westminster to Holyrood for public service subsidies are calculated. For the 1,200 women in England and Wales who could benefit from Kadcyla, and who help to fund both their own and Scotland’s health services through their taxes, this is not merely back luck. It is an unconscionable injustice.

These women and their families may ask what can be done to fix such blatant unfairness. Experience suggests an answer, but not a satisfactory one. Recent pricing battles between pharmaceutical companies and the National Institute for Health and Care Excellence (Nice) involving other cancer drugs have shown that when Nice and the NHS bring to bear the full force of their leverage as one of the world’s biggest drugs buyers even the biggest companies can be persuaded to lower their prices.

“The system is working,” Sir Andrew Dillon, Nice’s chief executive, claimed last month. If so, it is working in a way that leaves patients in limbo and desperately anxious while the regulator and the drugmakers bargain with each other. In the case of Kadcyla, it has so far not worked at all. Roche Pharmaceuticals, the drug’s Swiss manufacturer, has been under pressure to lower its cost for three years and has not budged. There is still hope, since the company may decide that discounted sales to such a big customer are better than none, but as the two sides haggle, patients die.

The gap in per-capita health spending between England and Scotland is narrowing but still conspicuous. It roughly halved from £213 a person a year in 2010-11 to £103 a person four years later. The difference is not funded by any underlying strength of the Scottish economy, which has contracted as world oil prices have fallen by more than half in the past six years. It is funded chiefly by Westminster, as shown by the overall gap in per-capita public spending between the two countries. Even as Scotland’s national income has fallen with its oil revenues, its total spending per head has remained at least 18 per cent higher than in England.

The two countries’ health services are independent of each other and can set their own priorities. Simon Stevens, chief executive of NHS England, has admitted that certain costly cancer drugs once available either as a matter of course or through the Cancer Drugs Fund will no longer be because he has prioritised GP surgeries and mental health. The fund is in any case overspent and being wound up. The list of drugs not available on the health service will lengthen.

This newspaper accepts that as people live longer and treatments get costlier the NHS must ration its services or find more sources of funds. The case for a new funding model is only strengthened by the fact that a world-class treatment is available in Scotland but not in England. The case for Roche to cut its prices is even stronger.

 

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.

 

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”.

The “burning deck”…. A great opportunity for no-fault compensation. Paying for Grandpa – how to pay for it all

The Mirror and all the other newspapers, BBC and all TV/Radio reported this week the words of our Hospital Inspector (England): NHS ‘on a burning platform’ with patients at risk warns England’s top hospital inspector – Professor Sir Mike Richards warned thanks to rising demand and “economic pressures” safety remains a “real concern“. Damien Gayle in the Guardian reports: NHS ‘standing on burning platform’ of outdated acute care model – Campaigners say inspectors’ report highlights impact of cuts to urgent and emergency services with demand putting patients at risk

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Following the NHS comparison report 2015 – (The Economist Intelligence Unit) in 2015

and on Jan 13 2017: England’s National Health Service: No more money for the NHS

The Economist (apologies for reproducing the whole article) prints: Paying-for-grandpa (How to pay for it all in the on line edition ) which compares the virtues of three options, more money, new models of care (Sustainability Transformation Plans), and a German style social insurance scheme. The latter is the only real option, and the author advocates either hypothecated taxation from wages, or a tax on hereditary wealth. The problems are partly around self employed (and there are many more of them than there were), who will largely avoid the former, and the really wealthy who will evade the latter.

A hybrid might be possible, but unless and until we deal with a tax on real wealth (not waiting until death), like the French, we will not have a system which feels equitable to the majority. The problem with taxing wealth is that any announcement will mean it leaves and goes overseas.. So it needs a world solution to wealth tax, and that is a long way off.

NHSreality firmly believes there should be a national debate, but it looks as if this may be omitted, and an announcement will be made. One wonders if it will be honest enough to address rationing overtly.

But in the post truth world appearances matter more than debate about ideology. The Telegraph (Laura Donelly) reports 28th Feb 2017: Every hospital ordered to change its logo by NHS “identity managers” in move which prompts ridicule.

The issue of Medical Negligence claims arose this week, and with the intention of a quick fix and raising £250m the government announced a change to the discount rate ( Ogden actuarial tables) at which compensation is calculated – to a negative or minus 0.75%. (The Scotsman –Car insurance costs set to soar after ‘crazy’ compensation rule change) (The Guardian –NHS faces £1bn annual bill after ‘reckless’ change to injury payouts) They quickly seemed to change their minds when the longer implications on personal injuries to victims of the health services were factored in over time.  (Insurance CEOs to meet UK finance minister over discount rate cut – trade body)

The fact that younger drivers would be uninsurable and perversely tempted to drive without insurance added to their change of heart.. But No Fault Compensation would be so much better. When a doctor makes a mistake at present he is thinking of his insurance, the time taken in the complaint process, and his mental health. He should be thinking of the patient and their family, and apologising as soon as possible. This is a great opportunity to re-visit no-fault compensation, at the same time as we change the whole basis of health funding.

March 3rd edition of Economist: (How to pay for it all on the on line edition )

Rob Merrick in The Independent 28th Feb 2017 reports: GPs urgently examine 173 cases of patients who may have been harmed after massive NHS data loss – But Health Secretary Jeremy Hunt denies Labour claims of a ‘cover-up’ and insists no evidence has yet been found of patients being put at risk

Adam Brimelow reported in 2013 for BBC News reports: NHS spends £700 on negligence cover for every birth – one wonders what the figure is now some 4 years later? NHS negligence claims bill tops £1bn (BBC 17th Jan 2015). It is possibly £2 bn!

In the National Interest we need to establish financial control…

The rising costs of failure: Worst hospitals cost NHS £300m

Former Natural History Museum boss wins £500,000 payout after ambulance was 17 minutes late

Patient complaints hit a ‘wall of silence’ from NHS – No fault compensation would help change the culture…

BBC – 10 charts that show what’s gone wrong with social care –

Nick Triggle for the BBC 2nd March: NHS standing on burning platform, inspectors warn

Hypothecated Taxation for the UK Health Services – India Keable-Elliott (report)

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