Category Archives: Rationing

Child mortality matters, but there are limited resources.. Charlie Gard.. Is this denial an allegory of our whole attitude to the Health Services?

There were celebrations following the life and death of  Bradley Lowery in Sunderland. Matthew Clifton reports in “blasting news” 9th July 2017:     The cases of Bradley Lowery and Charlie Gard highlight the importance of tackling child mortality logically.

Sunderland mascot, Bradley Lowery died this week and will be remembered for his continuing positivity right to the very end.

Child mortality matters. Avoiding spending resources on “lost causes” is important for all of us. Government’s duty is to populations ahead of individuals, and when the needs of the two conflict, and there is no way to prevent harm, they should come down firmly on the side of the population. This case is complicated by the private element, offering transport and treatment, the political element – outwith the English Health Service, and by the expectations of the parents (10% survival – meaning what: ventilation for ever?). The ethics of this are complicated… and there are always arguments on many stakeholder sides. 

The sad aspect to be tempted to denial is within the human condition.  reports: Charlie Gard’s parents tell GOSH that ‘if he’s still fighting, we’re still fighting’. 

Is this denial an allegory of our whole attitude to the Health Services?

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Connie Yates and Chris Gard spoke as they handed a petition to Great Ormond Street Hospital in London, calling for Charlie to be allowed to fly to the US for potentially life-saving treatment.

Speaking to reporters, Connie said that Charlie has a 10% chance of survival if he receives treatment in the US – and that that’s ‘a chance worth taking’.
‘He’s our son, he’s our flesh and blood,’ she said. ‘We feel that it should be our right as parents to decide to give him a chance at life.
‘There’s nothing to lose. He deserves a chance.’….

In the United States the death of children is often in the news, but children are always dying. Its just that some parents have the ability to get more (or less) publicity. Enlisting the help of social media, crowdfunding for experimental (unproven) treatments, and getting support from religious authorities helps the media case. Here are some news items form the last few days..

WTCV reports: Death investigation underway after baby is found dead on Tunnel …

Big County Hhome page reports: Abilene man accused of starving infant to near death gets 6-year …

CNN reported 6th July: Georgia mom accused of killing 4 children and their father

Plea deal allows SE. Minn. driver to admit to a DUI for killing boy in child’s wagon

Two other counts are dropped against the man, who was not charged with a felony.


And in Australia midwives need to think carefully about the risks associated with home delivery.

Nigel Hunt and others in Adelaide Advertiser report: Midwife Lisa Barrett charged with manslaughter over deaths of two babies following homebirths

Joan Desmond reports on the National Catholic Register 8th July 2017: Catholic Bioethicist: Authorities ‘Usurped’ Role of Charlie Gard’s Parents – The culture of death has poisoned the relationship of trust that should bind physicians, patients and loved ones

Charlie Gard’s parents have ‘best interests’ tooMatthew Parris

Sometimes we watch a news story that, though important and reported fairly, we somehow feel we shouldn’t be watching at all. Such is the case of the sick baby, Charlie Gard. Words cannot express what every Times reader must feel at the pitiful sight of Charlie’s parents, two good people motivated only by love, wounding themselves before the eyes of millions; and all to no purpose.

I cannot re-hash the whole sad story, nor venture opinions about medical science. I do though have a modest suggestion about the law and how this case might teach us to nudge it. So I shall try to explain why, through nobody’s fault, the judges have been painted into a corner by a six-word phrase whose wisdom and humanity is hard to dispute: “the best interests of the child”.

It’s perhaps helpful to tell you that I have not the least difficulty with the idea of ending life where life is meaningless or unbearable. Nor do I question advice that the “nucleoside” treatment Charlie’s parents want for him stands no chance of success. Great Ormond Street are making the medical case, as any hospital should. Their statement through their lawyers yesterday is a fine, delicate, compelling piece of writing. Do read it: With hardly a word could one disagree.

But let me put it simply: I too would let this baby die, were it not for his parents. This is probably the majority opinion among the public, too. A few may believe in miracle cures, but most would put it, crudely, like this: “Look, he’s going to die anyway. If his parents are so sure he could be saved, why not let them try? He’s unconscious. What is there to lose?”

I feel that, if mildly, myself. Many feel it more strongly, many too strongly. The public demonstrations outside the High Court and the hospital are inappropriate and have an unhealthy smell of the mob justice that seems to have infected us in recent times. The sentiment that anybody’s opinion is as good as anybody else’s has corroded national life. Death threats to hospital staff are odious, owing something to the lynch-mob, “enemies of the people” mentality fanned by some of the popular press when Gina Miller took the government to court over Brexit. Lawyers and judges are right to bristle. Careless expressions of the democratic impulse have been way too strong.

But the response of a nettled professional class has also been too strong. Public opinion does count. Book-learning isn’t everything. The 19th-century jurist AV Dicey has been much quoted of late — “The judges know nothing about any will of the people except insofar as that will is expressed by an act of Parliament” — but Dicey is wrong. Judges have immense leeway in interpreting the letter of the law, and (consciously or otherwise) have always been influenced by the prevailing climate of opinion, and rightly. The very term “reasonable”, central to the interpretation of law, makes implicit appeal to public moral sentiment.
How, then, have judges (as it seems to many) lost sight of the man on the Clapham omnibus in the Charlie Gard case? The answer is that the judges have to keep sight of due process and the rule of law. The law says the “best interests of the child” must prevail, so because the parents’ belief that nucleoside treatment may save their baby is almost certainly wrong, the courts keep ruling against them. That legal principle, “in the best interests of the child”, has a long history here and abroad, both in statute and in precedent. It has stood the test of time. It is simple, intelligible and usually right. In most cases public sentiment would support it, for the obvious reason that parents don’t always act in the best interests of their children, and the courts should be able to stop them, whatever the parents want.
In medical cases courts can overrule parents, however loving, who for religious reasons would deprive their children of medical treatment. Most of us would agree. We know the law may interfere in family matters not only in cases of neglect or abuse, but in cases where there is disagreement in good faith with devoted parents on a matter of conscience or belief.
Why then does public sentiment shrink from overruling the parents in the Charlie Gard case? The answer is simple. Almost nothing is at stake for this child, and so, weighed against the lifelong grief of parents who will always believe their baby might have been saved, we would (most of us) let the parents’ interests prevail over the very nebulous “interests” of the child. But that does at first sight seem to conflict with a law that says the child’s interests, though feather-light, must outweigh.
Perhaps there’s a way through? Perhaps we could keep the “best interests of the child” rule, but define a child’s interests in a way more generous to its parents.
You will know that judges cannot rewrite statute or precedent, but in English law they can nudge both by the creative way they may reinterpret the meaning of legal language. Judges do this all the time: an important way of letting law change with the times.
Chris Gard and Connie Yates will always believe an American doctor might have saved their son. If the courts stop them trying, all the years they have left will be haunted by grief that he was wrestled from them by the law. If Charlie could ever be conscious of this, would he have wanted it?
May we not have interests of which we will never be conscious? Is it not in the child’s interests that his parents be spared great harm after his death? Had I a son, and were I hospitalised in a permanently vegetative state, there’s surely a sense in which I would still have an interest in my child’s welfare. Why can that not be true the other way round? My proposal needn’t trump the child’s more direct interests, and might only have comparative weight where the child’s direct interests (as in the Charlie Gard case) are anyway negligible, for he hardly has a life.
The Ancient Greeks believed a whole life was devalued for want of a good death, whether or not the deceased knew it. A good death for Charlie now would be one where he died in circumstances where his parents knew they had done all they could. Why not let them; and let that be Charlie’s legacy too?

Letter responses:

Sir, Matthew Parris’s article on the Charlie Gard affair (“Charlie Gard’s parents have ‘best interests’ too”, Comment, July 15), is compassionate and thoughtful. But the idea that because Charlie is unconscious and will not suffer, there is no harm in allowing the proposed treatment — and some reassurance for the parents — is a recipe for experimentation on the unconscious patient in someone else’s interests.

We have chosen judges to make these Solomonic decisions. Parris’s argument that such judgments should take public opinion into account, and that judges have “lost sight of the man on the Clapham omnibus”, is spurious. Judges listen to the facts and decide according to the law.

Charlie’s interests are not “nebulous”, as Parris puts it. They are very real, and include not being used as an object of experiment. Only if there is real evidence that the proposed treatment has a chance of working should he be subjected to it.

Hard cases may often make — as in this case — bad law.
Dr Tim Howard

Corfe Mullen, Dorset

Sir, I am becoming increasingly dismayed at the view that the only people who have a right to decide what is in Charlie Gard’s best interests are medical experts. Over the past few weeks I have seen Pope Francis’s offer of help at the Vatican hospital described, bizarrely, as “cruel” by one leading commentator.

The Pope is expressing some fundamental views of the Catholic faith, namely that every human being has an inalienable dignity. If treatment in the US, whether experimental or not, is the parent’s only hope, then compassion says let the parents have the chance to try the treatment.
Mark Behan

Blackburn, Lancs

Sir, Doctors at Great Ormond Street have done all they can for Charlie. However, it was not right that the hospital sought a High Court ruling to end Charlie’s life. Neither is it right that the law should arbitrate between hospital and parents. Agencies of state should not decide this matter.

While there is an option, however experimental, it should be encouraged. Public donations have raised funds for the little boy to go to America for evaluation and possible treatment. Doctors here should support this. Charlie’s parents should not have been dragged through such inhumane proceedings. And at a secondary and utilitarian level Charlie Gard might be of help and benefit to others in time to come.
The Rev Dr Robert Anderson


2,000 foreign GPs needed to tackle growing shortage. How about an apology to 20 years of rejected applicants to medical school?

When the Times reports (Kat Lay) that there is such a vast shortage of GPs that we are going to repeat the recruitment drive of the 1950s, then you know there has been a dereliction of manpower planning. The duty of government is to protect it’s citizens. It has failed. Short termism, and not listening to the profession has led to this demise. Rationing of medical school places, avoiding more graduate entry, and preferential selection of female candidates at age 18 when they perform better than men, are to blame. Somebody needs to recognise that it takes 10 years to train a GP, and longer if they have children. Part-time GPs are unable to deliver as much continuity of care. The shape of the job is partly to blame as well. It’s too late. It’s going to get worse, especially for those living in deprived areas. And the overseas doctors recruited will block places for our own in 10 years time! Perhaps they could all be over 60 and on short term visas? And how about an apology to those aspiring med students who were rejected?

Kat Lay in the Times, 8 th July reports: 2,000 foreign GPs needed to tackle growing shortage

The NHS is set to recruit 2,000 foreign GPs — quadruple the previous target — in a drive to combat a shortage of family doctors.

Simon Stevens, chief executive of NHS England, said it would target other EU countries as well as Australia and New Zealand.

Last year health service bosses set a target of recruiting 500 overseas GPs at an expected cost of £30 million. The new target comes after figures showed that the number of GPs was in decline, despite a government pledge of 5,000 more by 2020.

In an interview with the Health Service Journal, Mr Stevens said: “Although there are some good signs of progress on increases in the GP training scheme, nevertheless there are real pressures around retirements.

“And so the conclusion we’ve come to is that in order to increase the likelihood of being able to have 5,000 more doctors in general practice, we are going to need a significantly expanded industrial-scale international recruitment programme. We intend to launch that in the autumn.”

He added: “Rather than the current 500 or so GPs that are being targeted for international recruitment . . . it probably needs to be four times more than that, from international sources — [from the] rest of the EU and possibly New Zealand and Australia.”
The total number of full time-equivalent GPs dropped from 34,914 in March 2016 to 34,372 in March this year, according to figures from NHS Digital.
Doctors’ representatives raised concerns about the long-term viability of overseas recruitment, given uncertainty over the status of EU nationals in the UK after Brexit.
The British Medical Association called the measure “a sticking plaster”.
Dr Richard Vautrey, acting chairman of the BMA GP committee, said: “Overseas doctors have for decades provided a valuable contribution to the NHS, especially in general practice where they have a strong track record of providing first-class patient care.
“However, this announcement is yet another clear admission of failure from the government, which is effectively conceding it cannot meet its own target of recruiting 5,000 extra GPs without an emergency draft of doctors from abroad.”
He called for a long-term solution to address workload pressures on GPs, which he said were putting students off choosing general practice as a career.
Professor Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: “Workload in general practice is escalating — it has risen 16 per cent over the last seven years — yet investment in our service has declined and we are desperately short of GPs and nurses.
“It is imperative that we do everything possible to address this, including recruiting more GPs, retaining existing ones, and making it easier for trained GPs to return to practice after a career break.”
She welcomed the extension of overseas recruitment, and called for “the position of EU GPs already working in UK general practice to be safeguarded beyond doubt as part of Brexit negotiations”.


Also, there is the unintended consequence of limiting pension amounts which many full-time (mostly male) doctors are endanger of breaching.  This is resulting in them (and many higher paid public service workers, e.g. head teachers) taking early retirement.

Additionally, no real account has been taken of the large number of female GPs who (like my daughter) chose to jobshare so they can accommodate family life.  It will not be long before GPs (like primary school teaching), will be an overwhelmingly female profession.  There is a lot to be celebrated in rise in the number of female doctors over the last 25 – 30 years, but the nation needs to account for the different life work patterns when planning the workforce.

The Training of doctors…. unfortunately it is too late to recover in even the 5 years promised by government… Decommissioning of operations

Gender bias. The one sex change on the NHS that nobody has been talking about

Medical Schools: your chances – applications-to-acceptance ratio was 11.2.

Hands up – who want’s to be a GP today? Recruitment is at an all time low despite rejecting 9 out of 11 applicants for the last few decades..

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David Millett for GPonline 17th July: Emergency draft of 2,000 overseas GPs is ‘clear admission of failure’, says GPC

Scottish GPs accuse government of ‘long-standing underfunding’

The same is true of the other regions. Deliberate rationing by undercapacity…

BBC Scotland reports 14th July : GPs accuse government of ‘long-standing underfunding’

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The Royal College of GPs has accused the Scottish government of “long-standing underfunding” of GP practices.

It has also criticised the “confusion” surrounding £500m of future spending commitments.

The comments come in a written submission to Holyrood’s Health and Sport Committee.

The Scottish government said it had already committed to investing “a further £500m in primary care by the end of this parliament”.

The Royal College of GPs (RSCP) called on the Scottish government to say exactly how much it would spend on general practice in the next four years.

It follows a statement by Health Secretary Shona Robison after the government announced that its share of health spending would be increased to 11% of the overall health budget by 2021.

Ms Robison said: “This forms the first stage of the Scottish government’s commitment to provide an extra £250m in direct support of general practice per year by 2021 – increasing the overall investment in primary care by £500m.”

The RCGP said Scotland “does not yet have understanding of what ‘in direct support’ may mean and the point has been raised with Scottish government that the term is too broad and lacks sufficient clarity”.

It added: “General practice is in severe need of a clear, positive future, illustrated by adequate governmental investment, if it is to attract sufficient numbers of medical graduates to general practice specialty training.

“If the long-standing underfunding and confusion that we are currently experiencing is to continue, we will keep witnessing a considerable number of general practices closing and transferring the running of their practices to Health Boards due to insufficient resource through which to remain solvent.

“Patients will continue to be found queuing outside practices for the uncertain opportunity merely to register with a GP. It is a major deficit to bear such long-standing underfunding and confusion.”

Increased staffing

Responding to the RCGP’s submission, a Scottish government spokesman said: “As the First Minister announced last year, a further £500m will be invested in primary care by the end of this parliament.

“This spending increase in primary care, to 11% of the frontline NHS budget, will support the development of a multi-disciplinary approach, with increased staffing as well as investment in GP services and health centres.

“Health Secretary Shona Robison recently set out that £250m of this new investment will be in direct support of general practice, helping to transform the way services are delivered in the community – an approach that was agreed with the British Medical Association.

“In this financial year, over £71m of that funding is to support general practice by improving recruitment and retention, reducing workload, developing new ways of delivering services and covering pay and expenses.”

‘Reneging on promise’

Scottish Labour said the RCGP’s comments were “absolutely damning”.

The party’s health spokesman Anas Sarwar said: “Nicola Sturgeon has promised to boost the proportion of spending on GPs and it now appears she is going to renege on that promise.

“The importance of GP surgeries cannot be stressed enough. Particularly as we face an ageing population, with people living longer, primary care will only become more and more important.

“The reality is that under the SNP our health service is not prepared for this.

“We would do things differently. Labour’s government-in-waiting in Westminster would hugely increase the money available to our NHS as part of our plan to create a society that works for the many, not the few.”

‘Doctors are furious’

Scottish Conservative health spokesman Miles Briggs branded the government’s spending plans “a funding con”.

He said: “Nicola Sturgeon happily stood with GPs and backed their campaign for an extra £500m to be directly invested in general practice.

“Now this has been cut in half, and the SNP is offering some waffle about the money being spent more generally.

“It’s no wonder doctors are furious about this deception.

“The nationalists were happy to lap up the support of GPs when this commitment was made, but now seem to have completely u-turned on that promise.”

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Stroke survivors ‘are dumped by the NHS’. Dead patients don’t vote, and those near death don’t appear to count…

If you have a stroke on your way to the hereafter, your life expectancy is short, demand for services is high, and nobody listens to you, even if you can be understood.  Dumped is the right political word. Congratulations to the reporter on his understatement however, The real word, especially with regard to intensive physiotherapy, is abandoned. Dead patients don’t vote, and those near death don’t appear to count. Commissioners have a perverse incentive to save money, richer areas can have more physio as more patients go privately, and the post-coded, covert rationing lottery continues..

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Jon Ungoed-Thomas in the Sunday Times reports: Stroke survivors ‘are dumped by the NHS’

Sufferers feel abandoned after leaving hospital and face waiting up to a year for the right treatment — or paying for it themselves

Stroke survivors are being left to languish at home with a “shocking” lack of support. Many say they feel abandoned by the NHS.
Juliet Bouverie, chief executive of the Stroke Association, said a new national plan was required to help the 1.2m stroke survivors in the UK. Some have to wait up to 12 months for psychological help.
“As a stroke survivor, your life and the life of your family is turned upside down,” she said. “Many stroke survivors say they feel abandoned, as if they have dropped off a cliff. The provision in some areas is shocking.”
About 100,000 people suffer a stroke every year in the UK; it is one of the country’s leading causes of death.
Andrew Marr, the broadcaster and journalist, who suffered a stroke in January 2013, said better support for stroke survivors — many of whom are of working age — could help them return more quickly to employment. He was back at work within six months, but largely because he paid for additional physiotherapy.

Stroke survivors can wait up to four months for speech therapy and up to a year for psychological support, according to data from the Royal College of Physicians. Stroke survivors say there is insufficient physiotherapy, a treatment which would ensure the best recovery.

Andrew Marr, who had a stroke in 2013, paid for physiotherapy to help him get back to work sooner<img class=”Media-img” src=”//″ alt=”Andrew Marr, who had a stroke in 2013, paid for physiotherapy to help him get back to work sooner”>
Andrew Marr, who had a stroke in 2013, paid for physiotherapy to help him get back to work soonerDavid Cheskin/PA

A stroke strategy, launched in 2007, outlined a 10-year plan to overhaul stroke services and has seen significant improvement in acute treatment. The Stroke Association is calling for a new action plan to build on improvements and outline a new strategy for the rehabilitation of stroke victims.

Nathan Ridgard, 40, a self-employed businessman and a father-of-two from Harrogate, North Yorkshire, suffered a stroke on New Year’s Eve 2012. After being discharged from hospital, he said he was given some leaflets by the NHS on coping with a stroke, but struggled to read them because of his poor vision.

“I just felt I had been dumped out in the world,” he said. He received some NHS physiotherapy, but also paid for private sessions to supplement them. He has since made a good recovery.

Professor Tony Rudd, National Clinical Director for stroke at NHS England, said: “The quality of care and survival rates for stroke are now at record highs. We are working with the Royal College of Physicians and others local health service leaders to improve rehabilitation care for everyone who suffers a stroke.”

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An endangered species? You may be lucky to find a GP soon…

An endangered species? You may be lucky to find a GP soon… It will be better in the cities as they have the best schools, and most of the part time, and predominantly female, GPs come from suburban schools. The current situation cannot be solved quickly, and any sensible professional would never have got to this situation. Therefore they should not be expected to find a short term way forward.  Meanwhile the Guardian reports: Record number of GP closures force 265,000 to find new doctors … It’s going to get worse.. and part of the problem is the belittling of GPs in Hospitals, and the lack of exposure medical students get to GP. Access and waiting times are both threatened, even for GPs

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15th July and the Times reports: Hundreds of GP practices forced to close or merge

More than 200 GP practices across England have closed or merged in the last year.
Data from NHS Digital reveals that while just eight practices opened, 202 closed or merged. Practices were affected in all regions, but the north of England experienced the most change, with more than 60 closing or merging, while more than 50 closed or merged in the South East. The Midlands and the east of England had the most new surgeries.
Last year, NHS England announced a £500 million “turnaround package’“ to help struggling surgeries. NHS England data shows that between last summer and this, the same time period covered by the 202 closures and mergers, more patients became registered with GPs across the entire country. Taking into account that some patients may register with more than one GP, 58,492,541 patients were registered with a GP on July 1 this year, up from 57,744,814 the year before.
Helen Stokes-Lampard, chairwoman of the Royal College of GPs, said: “When practices are being forced to close because GPs and their teams can no longer cope with ever-growing patient demand without the necessary funding and resources, it’s a huge problem.” Dr Richard Vautrey, acting chairman of the British Medical Association’s GPs committee, said: “With over 200 practices closed or merged in the last year and many more struggling to manage their workload pressures, it is time for government and NHS England to step up their efforts to resolve this crisis before even more patients lose their much loved local GP service.”

The Yorkshire Post: ‘Hundreds of GP practices closed or merged in a year’

In Wales the BMA – Welsh General Practitioners Committee (GPCW) has not been listened to for years. BMA in Wales wants faster action on GP ‘crisis’ – BBC News and Hywel Dda is one of the worst (and most rural) areas in Wales.

BMA heatmap reveals scores of struggling GP practices across Wales …

Half of North Wales GP surgeries on ‘verge of closure’ claims doctors …

GP practice closures ‘at record levels’, GPC chair tells BMA annual …

In Scotland on 4th December 2016 the Herald reported: Scotland’s GP crisis deepens as vacancies soar

SCOTLAND’S GP crisis has deepened with one-in-three practices reporting a vacancy, the British Medical Association claims.
Last year the BMA found that almost a fifth of practices surveyed had at least one vacancy for a GP but the figure has since risen from 17 to 28 per cent.
The shock figures follow the closure of a rural GP clinic. Glencairn Medical Practice shut the doors of its Fenwick premises in East Ayrshire on Friday….

BMA – List closures in Scotland

In N Ireland: 20 GP surgeries face closure in Northern Ireland affecting 120,000 …

Patients ‘forced to change surgeries as record number of GP practices …

and in GP magasine in May Nick Bostock reports: General practice in parts of Northern Ireland ‘one closure from collapse’

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Big pharma is taking the NHS to court this week – research is not “nationalised” for a reason..

The reason why research is not Nationalised is the risk. Capital markets have seen the back of numerous research companies over the last 20 years. The National Medical Research Institute, (Now the Crick Institute) does do research, is more into checking that original research. As it should be it does not waste or risk taxpayers money. Patents run out, and the time lag of 12 years seems reasonable in a world where there are so many risks, litigation for side effects, and many failures for every success. Once the patent has expired replacement generic products will compete and the price of the Gilead product will fall. If the product was made by a UK company we might be celebrating the word-wide patent, the jobs created, and the supremacy of UK research. If we need to ration out drugs and vaccines which work, we should think again. It is the low volume high cost products that need to be provided In Place of Fear. (A Free Health Service 1952 Chapter 5 In Place of Fear). The high volume low cost products need to be rationed, equally, for all of us.

Morten Thayson in the Independent reports 12th July 2017: Big pharma is taking the NHS to court this week – people are already dying for profit and it could now get worse

Last year the pharmaceutical giant behind the hepatitis C cure boasted a 45 per cent net profit margin while almost 400,000 around the world people died of the now curable disease. And globally, taxpayers are the biggest funders of early stage medical research which leads to these companies’ profits

The UK drug industry is taking the NHS to court over a new price cap on medicines. The drugs price cap is a disaster for patients, but the solution is not taking the NHS to court – it’s tackling the greed of big pharmaceutical companies.

The pharmaceutical industry has established itself firmly at the top of the Forbes list of the most profitable industries in the world. A significant contribution is made by public health services like the NHS. But seemingly, that’s not enough. The Association of the British Pharmaceutical Industry has applied for a judicial review against the NHS over its attempt to protect its crumbling budgets from corporate rip-off.

The knowledge that the treatment you need exists, but isn’t available to you, is a more common experience in the UK, as the NHS has to resort to rationing and even straight out rejection of new drugs because they’re too expensive.

The NHS now rejects a third of all new cancer drugs over cost-efficiency concerns, leaving many cancer patients unable to access the treatment they need. And because of astronomical costs, the NHS has had to ration a new groundbreaking cure for hepatitis C to only the very worst cases of more than 200,000 people, leaving the vast majority to continue to suffer from the disease.

Many are quick to point the finger at the NHS over lack of access to medicines. But the fact of the matter is that rising drug prices, together with austerity measures, are destroying our health service. The rise in NHS drug costs in the last five years has now hit more than twice the entire NHS deficit of £1.85bn. It’s because of these skyrocketing drug prices that the NHS took the decision to place a price cap on new drugs earlier this year, allowing them to delay the introduction of new drugs that would cost more than £20m pounds a year.

If we want to secure better access to medicines, we must tackle the problem of high drug prices, and this means transforming the whole way new drugs are developed. Pharmaceutical companies argue that high prices are due to research and development costs. But almost all of the biggest pharmaceutical companies spend substantially more money on marketing than they do on research.

Last year Gilead, the American pharmaceutical giant behind the above-mentioned hepatitis C cure, boasted a 45 per cent net profit margin – which would be unheard of in most industries – while almost 400,000 people died of the now curable disease globally.

This gives some idea of the extent of the problem globally. Imagine the impact on people in countries which don’t even have accessible health systems. The pharmaceutical industry has proved time again they cannot be trusted with the control of vital medicines we need. If we want access to new medical treatments, we need to rethink the way they are controlled.
The UK pours huge sums of money into medical research and development. Globally, taxpayers are the biggest funders of early-stage medical research. But because of few or no conditions of our research, pharmaceutical companies can take over that research and market the resulting drugs at considerable profits. The only way to heal the gaping hole drug prices have cut in NHS finances, it to make sure that we at least demand affordable prices from the drugs that are developed with our tax money.
For the sake of our NHS – and for the billions of people globally who cannot access the medicines they need – we must take back control of the health technology that our tax money is paying for. If we’re lucky, we end up paying twice for our medicines. If we’re unlucky, the consequences are even worse.
There are alternatives, which mean that the private corporations don’t gain intellectual property privileges gained through public funding. Our NHS demands a different answer – one that puts people ahead of profit.

While working on an HIV Cure, Gilead gives Europe an HIV Vaccine

Viral Hepatitis | Gilead

PDF]Hepatitis B and C Treatment Expansion – Gilead Sciences, Inc.



Drugs giants challenge NHS rationing plans in court. If the government wins the case should be appealed to the European Court before it no longer has the right to judge – after Brexit.

Planned deferment or delay is another form of rationing. Once a new drug has passed all the hurdles, in a non rationed system it should be released for general use. The plan to defer and delay the right for doctors to use a new product is rational rationing, and perfectly appropriate. This case will depend on the use of the English language, and exclusions, prioritizations and deferments will all be referred to. There is plenty of precedent: occasions when a drug has been discouraged or disallowed until it’s patent is nearly over (usually 12 years), and in the USA delay of Salbutamol spray for asthmatics was responsible for many deaths. One can only speculate at the US reasons for delaying such a life saving drug. In a mainly private and insurance based system there could be few reasons for the delay, other than a political one. The delay allowed copycat products to be ready and waiting when salbutamol (Ventolin) was allowed. 

Fortunately, in a small state run mutual such as Wales, there is no meaningful disincentive other than overtly rationing because we need to control costs. By being honest all the different jurisdictions can help to reduce costs, reduce expectations, and treat the taxpayer and citizen as partners in their own health mutual. (Good News?) NHSreality hopes the ABPI wins it’s case, as it will make the politicians take on the dishonest language of covert rationing. If the government wins the case should be appealed to the European Court before it no longer has the right to judge – after Brexit.

In the near term there is no doubt that rationing should be legal. Without it we will go bust. The pace of technology advances faster than our ability to pay. Demographics mean we live longer and need more care, and The Information Age  means that we want to know the truth… But remember, the government and the politicians duty is not to individuals but to populations…. They must start listening to public health doctors instead of Single Interest Pressure Groups such as the APBI.

Chris Smyth reports in the Times 10th July 2017: Drugs giants challenge NHS rationing plans in court

The pharmaceutical industry is taking the NHS to court in a highly unusual effort to block “wrong and unnecessary” rationing plans.
Drugs companies argue they are acting in patients’ interests by trying to kill off powers that allow health chiefs to delay or restrict medicines to save money, even if they have been ruled to be cost-effective by experts.
However, the sight of pharmaceutical giants dragging the NHS through expensive litigation will be uncomfortable for an industry that is trying to build bridges with the government over Brexit and industry strategy.
The Association of the British Pharmaceutical Industry is seeking judicial review of changes that allow NHS England to delay or restrict treatments if the total cost to the health service exceeds £20 million a year.
The rule applies to medicines already judged good value for money by the National Institute for Health and Care Excellence (Nice) and has been condemned by patient groups after it emerged that one in five new drugs could face delays. The threshold came into effect in April but has yet to be trigged.

Richard Torbett of the ABPI said: “We are talking about cost-effective medicines and the idea that the best medicines that help more people are going to be captured by this contravenes the fundamental right to access to cost-effective medicines . . . To arrive at this position where it’s the most important new medicines are the ones that get delayed, that seems back to front.”
He said that legal action was the “absolute last resort” but argued that NHS England had refused to consider options that would affect fewer people.
“We think the legal case is so strong that if we hadn’t taken this action given the strength of feeling somebody else would have looked to do so, possibly an individual patient,” he said.
“I believe we’re doing the right thing in terms of getting patients access.”
Rachel Power, chief executive of the Patients Association, said: “NHS England’s decision not to fund new medicines recommended by Nice was an astonishing admission that our NHS can no longer afford to keep up with scientific breakthroughs. This is a direct result of the government’s decision to under-fund the NHS. Patients throughout England will hope that this legal action forces a re-think.”
Baroness Morgan of Drefelin, chief executive of the charity Breast Cancer Now, said she hoped the legal case would “provide clarity on the issue of timely access to drugs in England”.
She said that the £20 million threshold would be a “major hurdle” for cancer drugs, adding: “We remain extremely concerned that the budget impact test could see NHS patients experience delays in accessing vital and cost-effective drugs.”
Simon Stevens, head of NHS England, has taken a tougher line on such spending, saying there is no reason why new drugs should “crowd out” spending on extra nurses, mental health staff or other effective ways to treat people.
NHS England and Nice declined to comment, but senior health officials are irritated that public money will have to spent to defend the action. Last year NHS England won a similar challenge against its decision to cap how many people would be treated each year with a breakthrough hepatitis C medicine.
Mr Justice Blake wrote in that case that “it is undesirable that the defendant as a public authority devoted to healthcare should have its budget for health provision reduced by irrecoverable legal costs it has incurred to meet a failed challenge”.
Mr Torbett insisted that all drug companies were behind the decision, expressing hope that the action would not disrupt recent efforts to build goodwill with minsters, which include handing over £250 million to the government this year to plug a hole in the drugs budget.
“Of course we would rather not be here but it’s not going to get in the way of collaboration with government and we hope it won’t prevent them from doing that as well,” he said.
A High Court hearing is expected in the next few weeks.