English NHS doesn’t need polyclinics, study shows

So, will New Labour’s plans to open up GP services to big business be halted by the facts? Obviously not, but it is worth noting who the victims will be in this case (aside from the patients who might suffer worse services) it will be middle-income professionals.

Consider also that the English NHS is controlled by the British government. Would an English parliament make it easier to resist corporate takeover of public services? Who knows? But it is interesting that polyclinics are not being considered in Scotland or Wales…

From the BBC:

Average-sized GP surgeries are just as good as “super-surgeries” at providing extra services, a study suggests.

Ministers in England have asked health chiefs to create a network of polyclinics to provide extra care, such as diabetes clinics and minor surgery.

But a Kent-based GP’s study of 384 practices found no difference between the range of extra services offered by standard surgeries and polyclinics.

The government said polyclinics would provide a valuable service to patients.

Every NHS trust in the country has been told to set up at least one polyclinic, with a whole network being created in London.

Ministers believe the super-surgeries are the best way of moving care out of hospitals and into the community.

But the study by Dr Hendrik Beerstecher, who specialises in research, found large surgeries already operating were no better at providing the specialist care the government is so keen on.

He looked at the range of extra services, beyond the average package of GP care, being provided by a range of different-sized practices up to ones serving a population of more than 30,000.

He found small surgeries – classed as having fewer than 6,300 patients – tended to provide less diverse extra services.

But once the threshold of 6,300 was reached – the average size for a practice in England – there was little difference no matter how big the surgery was.

On average, these had between 10 and 11 extra services.

‘No evidence’

Dr Beerstecher, who is not a member of the British Medical Association, the doctor’s trade union body which has campaigned against polyclinics, said: “I am not sure why the government is pushing ahead with polyclinics.

“As the study shows, there is no evidence that they provide more services so why are we having them set up all across the country?”

Dr Richard Vautrey, the deputy chairman of the BMA’s GPs committee, said: “This proves what we have been saying all along – that we should not be rushing headlong into setting polyclinics up.

“GPs have always been innovative. You do not need a big surgery for this to happen.”

English teeth or profits?

Dentists in England are playing the system to maximise their profits, the government believes.

An analysis of NHS paperwork suggests dentists are recalling healthy patients for check-ups and dividing courses of treatment unnecessarily.

Chief dental officer Barry Cockroft is talking to local health bosses, believing a tenth of appointments could be freed up if the problem was solved.

But dentists said there was no evidence it was happening.

The Department of Health believes the tactic has become widespread since the introduction of a new contract in 2006.

The answer is for the NHS to directly employ dentists.

England needs a health minister

Oh god. Ben Bradshaw again, knocking the Welsh Assembly Government’s policy of booting profiteers out of their health service, something far more popular than flogging bits of the NHS off…

Note that the BBC wrongly reports that he’s the English Health Minister. Mr Bradshaw is English, but he’s a minister in the British government – there is no devolved administration in England, unlike Wales. (Sadly, the absence of an English parliament is not pointed out) Note also that Labour shares power with Plaid Cymru in Wales – Bradshaw is attacking the policies of his own party!

Cardiff-London tensions re-ignite

An English health minister who criticised health policies in Wales has returned to the attack.

Ben Bradshaw told a conference the English NHS provided a better service despite spending less per patient than the health service in Wales.

Mr Bradshaw attacked Welsh policies of free prescriptions and free hospital parking again and said ruling out using the private sector was “dogmatic”.

The Welsh Assembly Government said it was “putting the patients first”.

Earlier this year, Mr Bradshaw sparked a row between the assembly and UK governments by saying the money spent on free parking would be better spent on improving patient care.

His keynote speech to a CBI conference on health in London on Thursday threatens to re-open tensions between Cardiff and Westminster.

He told delegates the benefits of the English approach would become clearer in time.

He said he was “fed up” with being told that England suffered from health apartheid “because millionaires in Wales get their prescriptions free or Scotland plans to allow anyone who wants to park in busy hospital car parks for free.”

Mr Bradshaw said: “What about the fact that in England you can get your operation much more quickly, you don’t have to wait for more than four hours in A and E any more and it is easy to see a GP when you want?

“These things matter more to the public. We are already delivering them in England and we have been doing so while spending less per head on health than in Scotland and Wales.”

‘Widely welcomed’

Responding to the criticism, an assembly government spokesman said: “Devolved government means that each administration is free to pursue its own priorities.

“Mr Bradshaw is entitled to his views.

“Free prescriptions and parking reforms have been widely welcomed by patients in Wales.

“We are putting the patient first and removing barriers to accessing healthcare.

“We see prescription and car parking charges as a tax on the sick.

“Investment in improving access to healthcare will improve the health and well-being of the people of Wales.”

At the Plaid conference this weekend, Adam Price called on Welsh Labour to break free from Westminster. Certainly, at the moment it’s path is leading away from New Labour. If only English Labour would do the same…

English eyes are smiling?

Some good news, first: those nice people at, erm, NICE (the National Institute for Clinical Excellency) have reversed their position on the sight drug Lucentis. Patients with age-related macular degeneration will now be able to receive the drug from the NHS on diagnosis, rather than having to wait until they are blind in one eye.

The Lucentis saga might not have happened if we had a) an English parliament controlling the NHS and b) public ownership of the pharmaceutical companies.

The bad news is that doctors are failing to inform cancer patients of drugs they could get for their illness:

A quarter of specialists polled by Myeloma UK said they hid facts about treatments for bone marrow cancer that may be difficult to obtain on the NHS.

Doctors said they did not want to “distress, upset or confuse” patients if drugs had not yet been approved by the NHS drugs watchdog NICE.

Primary Care Trusts can provide drugs ahead of NICE approval but many do not.

The National Institute for Health and Clinical Excellence is currently reviewing several treatments for myeloma, including the drug Revlimid (lenalidomide) which trials suggest could extend the life of patients by three years.

One in four of the 103 myeloma specialists in England, Wales and Scotland questioned confessed that they had avoided telling patients about licensed drugs still awaiting approval by NICE.

And more bad news is that the English NHS is heading for a huge surplus – meaning that money that could have been spent on treating the sick now has been held for – what purpose? Future investment, possibly. But in future, will this be the profit margin, near two billion pounds…

Private equity pirates seize NHS firm

From the Morning Star:

Private equity snaps up NHS-funded firm

HEALTH-CARE charities and unions warned on Monday that care services are increasingly falling into the hands of profiteers thanks to the government’s insistence on outsourcing health to the private sector.

Private equity firm GI Partners revealed on Monday that it has snapped up Care Aspirations, which is funded by the NHS to provide care for people with severe learning disabilities and conditions such as epilepsy, autism and Asperger’s syndrome.

The NHS sends such patients to the company’s 11 private hospitals and care homes, guaranteeing it a regular income from public funds and making it a prime target for asset-stripping equity firms like the US-financed GI Partners.

Care Aspirations said that, thanks to NHS subsidies, its value had doubled in two years and it was now worth an estimated £70 million.

GI Partners, which is already worth about £2 billion, proudly declared that its intention was to “target such businesses with predictable, recurring cash flows, with a value that could be monetised to return capital to shareholders.”

A spokesman for the Adolescent and Children’s Trust said that “this means it is more interested in maximising profits and operating for short-term gain than providing long term care for the most vulnerable.”

And NHS union UNISON slammed the government’s outsourcing of health services to private companies as “exposing public services to the dangers of global markets.

“More than £80 billion of taxpayer’s money now goes to the private sector and to the private equity firms who increasingly own our public services. The government shouldn’t turn its back on the NHS,” the union said.

NICE to see you

I quote in full the editorial in the Morning Star the other day. (Sadly, a point that is missed is the fact NICE only rations drugs in the English NHS, which unlike other health services in the UK, is not controlled by a directly-elected devolved institution.)

Forced to face truth
(Sunday 17 August 2008)

NICE, the National Institute for Health and Clinical Excellence, has been on the back foot for some time.

Everybody, from drug companies indignant that their product hasn’t been approved for purchase and supply by the NHS, to patients angry that their quality of life is being hampered by NICE rejection of drugs or its judgement that they do not supply value for money to the NHS, has launched denunciations of the organisation and, in some cases, court actions to alter its decisions.

Without pontificating on the quality of those various decisions, which cover treatments for diseases ranging from cancer to Alzheimer’s disease, there are still many issues raised by the debate and a variety of conclusions which do not reflect directly on NICE, but rather on its function in our society.

It cannot be purely coincidence, for example, that the spotlight is turning on the institute’s function in determining value for money at precisely the time that privatisation – code-named choice by new Labour – is biting hard and siphoning millions of pounds a year out of the NHS budget.

While granting that, with an increasingly elderly population, the calls on the service will be growing and there must be some limits on expenditure, it is also blatantly obvious that privatisation and its super-profits is doing its share to restrict the options open to prescribing physicians.

And the fragmentation of the NHS into a myriad different budget-holders with different policy-making bodies and objectives can’t be helping, either.

Naturally, patients, their families and friends will have different priorities as to which treatments should be approved and that is certainly never going to change, but there is a great deal that can be done to make things better and the managers and leading lights in the institute are being inexorably pushed into highlighting the actual difficulties which militate against this.

These managers are, in the face of the continuing attacks on the organisation’s judgements, starting to hit back at their critics, and their choice of targets is revealing.

NICE chairman professor Sir Michael Rawlins opened the attack on pharmaceutical companies which, he says, are driving up the price of vital new medicines in order to boost profits and protect executive bonuses

He says that the companies are out to sustain double-digit growth, not least because their senior management’s earnings are related to the share price.

And NICE chief executive Andrew Dillon joins the fray, isolating the postcode lottery which has been generated by the absurdly structured trust system which runs the NHS in the 21st century.

Both these gentlemen are pillars of the Establishment and are not exactly the sort of people you would look to for a radical analysis of the ills of capitalism.

But they are both highlighting precisely those ills.

A profit-motivated, privately owned and unaccountable drugs industry is driving up drugs prices on behalf of managers and sharehoders and doing vast damage to patients in the process.

And a market-oriented cost-cutting NHS structure is resulting in gross inequalities of treatment.

Messrs Rawlins and Dillon are making the clear argument for the nationalisation of the big pharmaceutical companies and a full restructure of the NHS.

Although they may shy away from articulating that conclusion, their arguments back up the case that has been made time and again by health professionals and socialists for many years.

Half of cancer patients struggle to pay prescription charges

BBC News health reporter Michelle Roberts writes,

Nearly half of cancer patients in England are being forced to cut back on food or heating in order to pay for their prescriptions, a poll suggests.

And almost two-thirds (59%) miss out on simple leisure activities, like family days out, to cope with their medication costs, says Macmillan Cancer Support.

Its online survey of 477 cancer patients found 44% were struggling to cope with drug costs.

The charity wants prescription charges abolished in England.

Prescription charges were scrapped in Wales in 2007 and will be phased out in Scotland by 2011.

Northern Ireland has frozen its charges while it considers whether to abolish prescription charges following a recent review.

In England, the government has ruled out any move towards free prescriptions.

Ministers are planning to launch a consultation in the near future, but this will only be looking at “cost-neutral” ways of tweaking the system, including who should be exempt from charges.

Sadly, Roberts doesn’t make it clear that it is the British government that controls health policy in England and Alan Johnson, health minister, has made it clear that abolition of prescription charges is not on offer. Perhaps if he was health minister in an English parliament he’d have a different outlook…

Macmillan Cancer Support thinks prescription charges are a tax on illness, as do many other charities in England.

And The Morning Star, which calls the charges “outdated and unjust“, reports that the labour movement is taking action:

Swindon Trades Union Council recently launched a campaign to abolish prescription charges, with a website at abolishprescriptioncharges.wordpress.com

Swindon TUC secretary Martin Wicks said: “The fact that people with life-threatening illnesses have to pay for their drugs is a national scandal. If patients receive chemotherapy in hospital, it is free. But, if it’s in tablet form, you pay.

“Moroever, there is usually a cocktail of drugs associated with chemotherapy, each of which is a separate prescription.

“This scandal underlines the need for the labour movement to step up the pressure on the government for the abolishing of prescription charges in all of the UK.”