“a case study in the dangers of under-funded mental health services”

Perhaps these services are under-funded because people view mental health issues as a joke to attack their political opponents with rather than any sort of serious issue? Hannan might or might not have mental health issues – that’s between him and his doctor(s) – either way it’s not relevant to his politics.

Dear John

I’ve worked for these bafoons for a bit

http://www.ic.nhs.uk/

and these

http://www.nta.nhs.uk/

and these

http://www.connectingforhealth.nhs.uk/

and at no point in time was any of it worthwhile, was there any reason for any of us being there and was there any benefit to the ‘patients’ or is it customers – I forget – what’s the point of the health service again?

Cheers

Ricky

I have to agree with cim, a good article ruined by a childish joke.

I suggest you edit in a retraction now before this comment thread starts to miss the point of your article entirely.

I disagree with the humourless gits above, an excellent article enlivened by an excellent joke.

The problem is, old people vote disproportionately and trend Tory, so “let’s spend pointlessly vast sums on health… my spend-cutting opponent wants to send to you a death panel” is always going to be a net vote-winner rather than a net vote-loser.

It was a cheap joke, to be fair, but I’m a cheap joke kind of guy, I’m afraid. (I could expound at length about the reasons mental health is under-funded, taking in social stigma and the difficulty of cutting the more visible services that might upset the Daily Mail, but frankly who has the time.)

Richard: Much of Labour health policy has been aimed at finding a way of combining competitive pressure with free healthcare, in order to cut down on the waste. Somehow they’ve buggered this up so spectacularly that the health service has hired thousands of extra managers to run the ‘market’, and the whole thing is a hell of a lot more wasteful than it was to start with. It’s an object lesson in the law of unintended consequences.

John: Yes, I cut a paragraph on just that, actually. The baby boomers are getting old, there are a lot of them, they’ll need a lot of healthcare, and they vote. Their kids and grandkids, who would benefit more from free tuition or cheaper homes, aren’t going to turn up at the polls in the same numbers. You don’t have to be a genius, do you?

Okay, but when even more humourless gits arrive and it becomes impossible to discuss health care don’t say I didn’t warn you. I’ve seen it happen to many times on LibCon

Apart from the joke, which is not that funny and therefore unforgiveable (any funny joke can be forgiven any other sin), this article is pretty damn sensible. There is a lot of fat to be trimmed from the NHS as it stands.

Some copper chums and I got talking a while ago and the comparisons were ridiculous – can you imagine the police funding a crime information centre which focussed on the lifestyles of all known criminals, those on the DNA database and produced statistics on crime inequalities at any thing other than a BCU level (basic command unit – usually about 200,000 people). Whereas the NHS IC (is absolutely massive – I worked in the Leeds HQ – swanky 5 storey building with no-one on less than £25k and some paid much more than the £78 – £93k consultants get). It was appaling. Wander down the road a bit – 400 yards and you hit 1 of the 2 connecting for health buildings. Hercules house in London where the NTA is based is, again, ridiculous. I was charged with commissioning services and got to make friends with some fantastically professional drug practioners and, in complete honesty – whenever I was in the room – even though I carried the budget – I was always the weakest link. That’s £20 billion there – just there, no fuss, no diminution of service, no effect on clinicians or patients – done, 3 signatures and done.

The debate is polemic and I don’t particularly give a hoot where or from whom it comes from – I’m not even that bothered about saving £20bn – I am incredibly bothered about chucking that £20 bn at nurses, docs, infrastructure, patients, cleaners – not ejeets like me who are brilliant at computers and can always find a job because our skills are so generic.

I can agree witgh fat-trimming, though not necessarily with your view earlier that the way the NHS is funded needs to be changed.

It’s always a lame caricature of the right that we lefties want to fund everything to the hilt and don’t understand the need to weigh up the problems of finite resources.

A very good piece, Jonn – a couple of points.

I suspect the response from the Tories (regarding the NHS and spending on health) is driven by party concerns that their imminent election victory might by undermined at the 12th hour by public fears that they might abandon the present structure – but once they are in I am sure they will withdraw any special protection or privileges as soon as they can.

As to the broader issue about competition for resources – well, this can only intensify in direct proportion to the ever increasing demands made on various agencies.

For example, my mate is a social worker and a slash-and-burn approach has already been instigated by managers appointed with a mandate to cut cost.
He has been invited to apply for his own post (which will become an undo-able job) – problem is there are only 2 or 3 posts chased by 5 or 6 candidates.
I’m sure similar scenarios are playing out within other departments.
Oh how he laughs when there is talk of reducing the case load of social workers.

A very good article here by the way on the realities of NHS hospital wards.
http://www.guardian.co.uk/commentisfree/2009/aug/27/nhs-health

And just to add a bit more spice into the debate here is a very good read on palliative care services.
http://www.davidalton.com/hlpalliativecarebill.html

It is claimed that 300,000 patients with a terminal illness cannot access appropriate services – this from the article;
Progress is slow and not all the resources are reaching front-line specialists. The National Council for Palliative Care estimates that, while 95 per cent of patients using hospice or palliative care have cancer, 300,000 people with other terminal diseases are excluded. Yet even for those with cancer the provision is far from satisfactory. According to Marie Curie, more than 155,000 people die of cancer every year, yet Help the Hospices points out that there are only 3,250 hospice beds available, and 2,489 of these are supplied by the voluntary sector.

End of life suffering – pretty barbaric whatever your political persuasion?

Sunny: quite. I think, if anything, it’s more important that the left thinks about how to get more out of public sector spending, because we think the state should be doing so much more.

There is a lot of fat to be trimmed from the NHS as it stands.

Yes and no, or more accurately no and yes.
(Oh, and the MH joke wasn’t a joke, as it’s unfunny: basically just alleging Hannan is insane, rather than being a turd. Working in MH, and having used services there are many many, often bad-taste jokes to be made, but that ain’t one of ‘em).
Frontline services (especially MH ones and any involving social care aspects) are starved of cash, with oodles being ‘outsourced’ under WCC (world class my arse) to ostensibly make efficiency savings, but when you examine the ‘newly configured’ services you soon realise there is less clinical work and support being done. In my neck of the woods, while we have managers spilling out of shiny new PCT offices, community based MH services (high-impact therapy sessions in the community, for instance) haven’t got a home, and it’s seriously been suggested that we hire church halls for this (great for confidentiality,eh, with waiting clients in earshot of sessions) while the managers have suites of offices, thousands of pounds of interactive whiteboards, touch screen Powerpoint facilities etc. Fewer CPNs, more commissioners, who are bloody well getting ‘advised’ by bastard McKinseys…
The waste has nonetheless been enormous.
When people talk about investment in the NHS I wonder if there’s some reliable data on how much capital investment has been planned, centrally funded and delivered by Labour over the last 12 years?
I wouldn’t be suprised if, removing the PFI schemes, the actual amount of infrastructure and capital investment is much smaller than imagined.
There’s no doubt that New lab’ve spent £Billions extra but much of this will have been wasted on management consultants, IT systems that have failed, layer upon layer of managerialism.
Trouble is how to eradicte this bullshittery, while also increasing investment to the front line. I believe the Tories would just indiscriminately cut, once in power. Part of me wonders which is worse: seeing nobody get any money (Tories) or seeing the wrong bloody people (managerialists, advisers, and bullshit management and IT consultants) get all the money (New Lab)

I’m not convinced the NHS is as wasteful as this makes out.

On the financial measure, the NHS costs roughly the same in terms of % of GDP as most other comparable health systems in Europe, and famously it costs just half that of the failed US model (how much fat is there in a model which hoovers up 1/7th of the world’s largest economy yet still cannot provide coverage for 50m of its citizens? And remember, that is mostly a privately funded system).

And remember, it costs only as much now – go back five years and we lagged well behind France and Germany in proportion of money spent v GDP.

We often hear about the rise in numbers of “Managers” but again this is meaningless without any details about what these people do. I’m not defending the manager role at all, just that sweeping generalisations muddy the waters. Doubtless there are likely to be thousands of roles that, with a bit of tinkering with processes etc, probably don’t need to be there at all.

However, in essence administrators take the paperwork burden away from the front line, and in these litigious times, there is plenty of paper to be shuffled around. I’d rather doctors and nurses spent more time with patients – let accountants do the sums and IT managers sort the networks.

Jonn @ 5:

Somehow they’ve buggered this up so spectacularly that the health service has hired thousands of extra managers to run the ‘market’, and the whole thing is a hell of a lot more wasteful than it was to start with.

..but all those extra managers are ‘necessary’ to ensure that the market works.

NB: Those quote marks are not so much scary as sarcastic.

BenM: You miss my point, perhaps because I didn’t express it as well as I should have done.

My concern is not that the NHS is particularly wasteful (although it clearly does waste a fair chunk of money). My concern is that it gets special treatment. No party dares freeze NHS spending, even though that means radical cuts elsewhere.

I think we underfund transport and housing in this country. I don’t think we underfund healthcare any more. Yet it’s the latter that’s least likely to face funding cuts. I think that’s wrong.

“I can agree witgh fat-trimming, though not necessarily with your view earlier that the way the NHS is funded needs to be changed.”

I see. I still think liberalising funding would be a good way to reform, especially in the longterm. But there are other things beside that which could be done to save money now.

Excellent article (opening joke aside) and it’s the point many people have been making ever since Cameron decided the health budget was untouchable. The NHS is a highly inefficient way of converting money into health-care, everybody knows this, yet any suggestion that the budget be frozen in order to force efficiency savings is dismissed as wanting to sack doctors and nurses.

I would take issue with your assertion that “the NHS should be universal and it should be tax-funded”. Let me be clear, I do agree with a taxpayer funded health service for those unable to obtain private insurance, and also to deal with A&E / maternity (areas the private sector doesn’t much like). But in my view we should be looking to get as many people as possible out of the NHS and using private health insurance. The many reasons for this include –
a) increased private sector competition will force lower premiums and increased efficiency, lowering the overall cost of the nations healthcare
b) taxes can be lowered in line with the reduced requirement on the NHS to fund treatment for all
c) the NHS can retarget its treatment towards the section of society that doesn’t have insurance, providing a better treatment for those patients that remain with it
d) overall standards of healthcare would improve as private companies are forced by competition to ensure that, for instance, the 200,000 patients left in soiled sheets each year are not left in such a condition.

Oh, there are private A&E services, MarkM.

Here is the price menu for ‘Casualty Plus’.
http://www.casualtyplus.co.uk/page.php?n=15

Please note they can only manage bread and butter type problems, neither do they offer any kind of follow up.
Nonetheless, a ‘standard’ medical consultation will cost you £55 (price on request if you want to see a consultant).
They do not advertise a price for x/ray or ultrasound and I assume C/T or MRI is not on the menu.
A pregnancy test will set you back £35.
A plaster cast starts at £39 same price as a pair of crutches.
An ECG will set you back £50.

So lets put all that into practice – say you are an elderly faller with a suspected ankle fracture.
The minimum price starts with £55 for a medical consultation
? price for an x/ray
? price for analgesia
£39 for the cast and a further £39 for crutches.
Lets include a further £50 for an ECG since the fall may have been secondary to an arrythmia.
We don’t know how much the pain killers will cost you ……… oh, and no orthopaedic follow up is offered post treatment (you need the NHS for that).
I do not know if they offer transport – and I do not think they offer kind of home physio or O/T assessment.
We can probably fore go a pregnancy test in these circumstances.
The site proudly claims that their nurses are registered with the NMC – a tautological statement if ever I heard one.

Incidentally when a case does go tits up in the private sector, guess who gets to clean up the mess – I didn’t hear Dan the Man trumpeting this fact to his neo-cons mates on American telly.

“…and also to deal with A&E / maternity (areas the private sector doesn’t much like).”

Don’t right off private action altogether on that front. There is a very successful voluntary ambulance service that serves the Jewish community: http://www.hatzola.net/index-1.html

Nick [19] – I will concede that Hatzola are a very decent bunch of guys and I do not wish to denigrate the service they provide to the Jewish community (and the Jewish community alone).

But, they have VERY limited training – for example, unlike crews working for the London Ambulance Service they cannot offer drugs, they cannot perform an ECG (essential for determining the most appropriate pathway for ST-elevation infarcts), neither can they intubate a patient who has an immediate airway problem (or is in cardiac arrest).

I accept there are horses for courses but when the shit hits the fans it really is best to stick with a trained paramedic during any pre-hospital emergency.

I don’t have any ideological objection to private provision of healthcare, really. (It can at least be useful to keep the BMA in line.)

But I don’t think any privately-funded service will ever be universal. Given the US example I’m also not buying the efficiency argument. Most of the world’s health services seem to be based on some form of social insurance, whether implicit (i.e. tax funded, like the NHS) or explit (France etc). I don’t think that’s a coincidence, I think that’s because it’s what works.

Jonn – or it might be that doctors, as a group interest, are especially good at developing institutions that insulate them from market competition, a possibility discussed in this pretty cool pamphlet: http://www.iea.org.uk/record.jsp?type=release&ID=142

Of course, nowhere has regulatory capture been more successful than in the US where doctors manage to charge huge amounts for often fairly perfunctory service. Perhaps if this is to some extent inevitable (doctors being too clever to outwit in the longterm) then perhaps some form of social insurance is indeed the best we can hope for.

[18] A&E charge nurse

And that’s why I say A&E should stay under the NHS. There’s just too much going on in an emergency to worry about whether you’re being taken to an insurance approved hospital (although I would expect if A&E were opened up to competition, you’d see those quoted prices coming down too).

For what’s it’s worth I think we should adopt a variation on the French model (apart from their peculiar obsession with suppositories for everything) where, rather than paying taxes, and then at some inditerminate future point, seeing the health care benefit of that tax, you are refunded at the end of the year for not using it (i.e the size of the “refund” depends on the amount of usage).

It’s not without problems, for example I’m not sure if/how it’s means tested or what happens for chronic/long term illness but it does at least make some connection, in the mind of patients and staff, between paying for health care and receiving health care (the lack of such a connection here in my view leads to the damaging notion that the NHS is “free”), whilst at the same time avoiding the insurance policy sharks/ambulanceman asking to see credit card scenarios.

Best of all, it would take away much of the current governments rationale for nagging us to death about healthy lifestyles – an economic consequence for self inflicted illness is far more persuasive than any amount of nagging from Caroline Flint et al.

“Offensive article clearly written by a prat”.

Agree, it’s badly written, confused and partisan (even by LC standards).

Iit’s central point seems to be

“Whoever is in power, there are difficult choices ahead on public spending priorities”

Which is hardly revelatory and isn’t seriously disputed by any of the main parties

[25] If we do adopt the French system I hope we don’t end up consuming as many antibiotics
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1471971

Or antidepressants
http://www.000health.com/healthnews/11189-antidepressants-a-call-against-the-overconsumption.html

Or pain killers
http://www.ncpa.org/sub/dpd/index.php?Article_ID=3819

No wonder their health spend has always been greater than ours.

“Offensive article clearly written by a prat”.

I do wish you’d stop reading my stuff, dad.

Matt,

My central point has bugger all to do with the one you’ve identified because, as you correctly not, that’s about as profound as damp toilet paper.

My point is that we fetishize the health service in this country. That distorts our spending priorities. I think the health service could do more for less, but it won’t while it doesn’t have to.

Also, I’m a left-winter attacking a Tory policy from the right – how exactly does that make me ‘partisan’?

“My point is that we fetishize the health service in this country. That distorts our spending priorities. I think the health service could do more for less, but it won’t while it doesn’t have to.”

I agree with your analysis but the problem is the familar one with all our public services under nu lab, that of trying to do too much and doing none of it well. Why is it, for example, that the NHS can afford to advertsise “sexual health services”, “healthy eating” and pay for snake oil cures (homeopathy, osteopathy) and yet we cannot afford cancer drugs, clean wards, or GPs after dark ?

The NHS has made the mistake that most departments have, of listening to pressure groups, allowing them to set the policy agenda, and labouring under the left wing delusion that somehow all needs can be met. They cannot.
At risk of echoing an unfortunate phrase it needs to get back to basics, that means providing evidence based healthcare which will treat diseases that actually kill significant numbers of people.

@ 26 some of those may be cultural factors (I mean if you grew up with nothing to listen to except Edith Piaf and John Michelle Jarre you’d probably need anti-depressants too ?)
My impression, from talking to someone who was born and grew up there is that accessing health care is far easier than it is here.

Matt:
“Why is it, for example, that the NHS can afford to advertsise “sexual health services”, “healthy eating”

…examples of public health. If anything we don’t spend enough on public health, although I’m not convinced whether healthy eating campaigns are effective.

Matt:
“and pay for snake oil cures (homeopathy, osteopathy)”

We spend about tuppence ha’penny on that. It’s silly, but it’s nothing compared to…

“and yet we cannot afford cancer drugs, clean wards, or GPs after dark ?”

Cancer drugs are bloody expensive and often don’t work. Pharma companies have got very good at using the Daily Mail to bypass the proper regulatory route.

Getting GPs to open late is also more expensive than you’d think.

Dirty wards is a cock up, plain and simple – no idea what’s caused this, to be honest. I don’t think it’s lack of funding though.

[28] I think the health service could do more for less – we already do more for less if we compare our spend to that of Germany, France, Switzerland and the USA.
http://www.docstoc.com/docs/8092034/OECD-Health-Data-2009—How-Does-the-United-States-Compare

The biggest change I have seen in health is the drive toward fueling consumerist fantasies (epitomised by the swine flu debacle).

Aside from that the fight for cash goes on within health itself – for example should we pay a kings ransom for drugs that might give a few more months of life for patients with end-stage cancer or do we invest more in accessible palliative care services?
http://www.adamwishart.info/2009/06/the-price-of-life-bbc-documentary.html

http://www.telegraph.co.uk/health/healthnews/6087834/Sutent-for-kidney-cancer-approved-on-NHS-but-other-drugs-turned-down.html

Hannan name checked again?

ARRRRGGGGGGGGGGGGHHHHHHHHHHHH!

Daniel – what can I say – I’m a fan…

So I am, in a “if this man gets anywhere near power that will mean civilisation is crumbling and we should take up arms and lead a revolution” type of way.

xxxx

“Getting GPs to open late is also more expensive than you’d think”.

It seemed affordable until about 3 years ago. The reality, as you well know, is the ill conceived nulabour meddling with GP contracts which allowed them to buy out (for a pittance) the decades old obligation to provide an out of hours service.

“We spend about tuppence ha’penny on that”

Lots of tuppence hapennies add up to a lot of wasted money

“Pharma companies have got very good at using the Daily Mail to bypass the proper regulatory route.”

In other words only the unelected beuarocrats of the nu labour health comissariat, sorry NICE, should get to decide which pateint groups are sufficiently fashionable/making enough noise this month to be worthy of public funding. How dare the taxpaying public attempt to influence healthcare policy !!!

“…examples of public health. If anything we don’t spend enough on public health, although I’m not convinced whether healthy eating campaigns are effective.”

I disagree. The NHSs primary job is to treat illness, not promote health. Telling me to eat less salt/drink more water/grill rather than fry bacon/whatever the current fad is, is unscientific, ineffective and wastefull.

Fuck off, Munro.

[31] Dirty wards is a cock up, plain and simple – no idea what’s caused this, to be honest. I don’t think it’s lack of funding though.

The NHS had 400,000+ beds in 1948 – we now have just over 150,000.
According to this item 32,000 beds have been cut in the last decade
http://www.dailymail.co.uk/news/article-1021814/32-000-NHS-beds-lost-Labour-say-Tories.html

This surgeon describes the near impossibility of obtaining a specialist bed for severe trauma cases (because bed occupancy runs at near 100% in many hospitals).
http://www.independent.co.uk/life-style/health-and-families/health-news/whistleblower-surgeon-breaks-cover-over-nhs-beds-crisis-459454.html

In short we have seen the bed base slashed in the NHS while sicker and sicker patients are crammed onto wards that are invariably full while those that have been awarded a bed are discharged as soon as is humanely possible.

To compound this difficult situation ward cleaning has been ‘out-sourced’ usually on the basis of the cheapest, although seldom the best, tender.

Of course if you are a psychiatric patient occupancy rates are even higher.
The Royal College of Psychiatrists recommends that bed occupancy rates should not be higher than 85% if a safe environment is to be provided. Yet bed occupancy at some sites was often higher than 110%.
http://www.cqc.org.uk/newsandevents/pressreleases.cfm?cit_id=35233&FAArea1=customWidgets.content_view_1&usecache=false

FFS Matt, do you even have a vague inkling what it is NICE does? Really?

in other words only the unelected beuarocrats of the nu labour health comissariat, sorry NICE, should get to decide which pateint groups are sufficiently fashionable/making enough noise this month to be worthy of public funding

Are you actually mad? NICE reviews drugs based solely on evidence of their benefit/cost ratio relative to other treatments. In practice, that means that any drug which is demonstrably more effective than other treatments is allowed.

The drugs which don’t get allowed are the ones where there is no conclusive evidence that they are more effective than the current gold standard (but which have been approved based on their performance against placebo, and heavily marketing based on anecdote and on non-conclusive trials) .

Jonn’s a healthcare industry journalist, I used to be a pharma marketing consultant. You might want to consider the possibility that we know what we’re talking about on this one.

Okay, I should apologize. Matt, I’m sorry. I made the mistake of assuming you might want to have a real debate about these complicated and difficult issues. However, I realize now, from your references to the ‘nu Labour commissariat’ and this bizarre belief that NICE is some wicked government agency set up to kill grandma, that I’m wasting all our times.

Live and learn, eh?

38#: “In short we have seen the bed base slashed in the NHS while sicker and sicker patients are crammed onto wards that are invariably full while those that have been awarded a bed are discharged as soon as is humanely possible.”

Compare that with this news report from June 2008:

“The government has come under fire after figures showed a £1.658bn surplus in the NHS last year.”
http://news.bbc.co.uk/1/hi/health/7440519.stm

And this report in August 2008:

“The NHS in England is heading for an estimated surplus of £1.75bn in the current financial year, official estimates predict.”
http://news.bbc.co.uk/1/hi/health/7584868.stm

Evidently, the NHS is not constrained by its budget.

[42] although £1 billion represents a hundredth of the total health budget it is still hard to square a surplus after the likes of Stafford (a Trust that had to shave £10 million of its own budget in order to achieve Foundation status)
http://witchdoctorlearning.files.wordpress.com/2009/03/investigation_into_mid_staffordshire_nhs_foundation_trust1.pdf

Simple fact is we need either more beds or fewer admissions – if the numbers don’t stack up then perhaps the Tories (in time) will introduce new ways of paying for the shortfall?

I was first sad then cross to learn that a young Scots woman, who was pregnant and critically ill with swine flu, had to be flown to Sweden for special ECMO [*] care because there are only 5 beds and the necessary specialist support staff with this capability available to serve national needs, all located at Glenfield Hospital, Leicester, and all 5 beds were in use at the time:
http://thescotsman.scotsman.com/scotland/Scottish-swine-flu-mother-in.5493106.jp

Fortunately, it is reported after treatment and care in a Stockholm hospital, she is now back in Scotland.

[*] Extracorporeal membrane oxygenation: http://guidance.nice.org.uk/IPG39

@44, so she’s in Scotland and the hospital’s in Leicester, hence she’d've had to be flown there anyway. Why does it make any difference whether the plane goes south or east?

The NHS has been running a financial surplus, as we have noted above. Despite that, there are only 5 ECMO beds with support staff, all located in Leicester, to meet the healthcare contingencies of a country with a population of 61 million, and all the beds were in use. Sweden, which evidently had beds and staff to spare, has a population only a bit larger than that of Greater London.

[44] the ECMO shortfall was easily anticipated – a nice take on it here;
http://drgrumble.blogspot.com/2009/07/best-prepared-country-in-world.html

http://www.medpagetoday.com/MeetingCoverage/SCCM/8202

[45] this (NHS patients being shipped to beds overseas) may turn out to be a much bigger issue than any of us realise – a very good analysis here;
http://juliemcanulty.blogspot.com/2009/06/not-european-private-healthcare-bill.html

http://www.dh.gov.uk/en/Consultations/Closedconsultations/DH_089029

God knows how all of this will play out when the bun-fight for resources heats up in earnest.

Bob: This argument reminds me a little of all the complaints that Britain wasn’t ready for the once-every-two-decades snow storm back in February. It’s possible that the odds of every needing more ECMO beds are pretty small, and that it just didn’t seem to be worth spending the money to have more of them available.

Sure, we could double the number of those beds to make sure we don’t have to fly anyone to Sweden… but that would mean resources taken from elsewhere. (Yes, there’s been a surplus, but that just means you’re stealing money from the future, rather than from other services now.) Then we’d end up complaining that there wasn’t enough ICU or something.

Maybe – I don’t know this for a fact, but maybe – it’s actually more cost effective to only have five of those beds and rent them from our neighbours when we need more.

#48: “Sure, we could double the number of those beds to make sure we don’t have to fly anyone to Sweden”

Before accepting the proferred (unconvincing) analogy with snow ploughs in February, I’d really like to see the official, costed rationale for only maintaining 5 ECMO beds, kit and staffing to meet the healthcare contingencies of a country with a population of 61 million.

It’s not as though the ECMO beds could never, ever be used for other purposes in emergencies, including Intensive Care (IC) or High Dependency (HD) uses, especially as concerns have already been expressed about limited UK capacity in available IC beds:

“Swine flu pandemic could cause shortage of intensive care beds – Children’s units in hospitals will be particularly vulnerable, researchers predict”
http://www.guardian.co.uk/world/2009/jul/24/swine-flu-intensive-care-shortage

Judging by this official census in July 2009, at a few thousand, the numbers of IC and HD beds are not exactly abundant:
http://www.dh.gov.uk/en/Publicationsandstatistics/Statistics/Performancedataandstatistics/Beds/DH_077451

Btw for the moment, never mind about other calls on IC and HD beds, compare the small number of IC and HD beds available (a few thousand) with the stats on the numbers of heart attacks a year in Britain:

“The UK has one of the worst heart attack rates in the world. It’s estimated that someone has a heart attack every two minutes in the UK. More than 1.4 million people have angina and each year about 275,000 people have a heart attack. Of these, more than 120,000 are fatal.”
http://www.bbc.co.uk/health/conditions/heartattack.shtml

Quick treatment at the time can help to reduce the permanent damage inflicted by heart attacks and strokes and that’s before we get on to other traumas.

[50] the NHS is the best in the world when it comes to heart attacks;
http://www.bmj.com/cgi/content/extract/333/7557/11-b

ECMO beds cost £4,000 per day according to this item
http://www.youtube.com/watch?v=Psci-wZKN_s

#51: “the NHS is the best in the world when it comes to heart attacks”

- the link posted relates to a report of 2006. The latest report is here: “How the NHS manages heart attacks – 8th Public Report 2009″
http://www.rcplondon.ac.uk/media/Documents/press-release-documents/public_report_2009.pdf

For decades – since the 1950s, in fact – I’ve been well used to hearing/reading regular public claims made in Britain about the NHS being the “best in/envy of the world”.

My problem is a difficulty in finding that same claim widely acknowledged in independent assessments made abroad, such as by the World Health Organisation or by the Health Power House in Sweden:
http://www.healthpowerhouse.com/files/canadaIndex03.pdf

The claim would have rather more credibility if it was endorsed by the King’s Fund instead of by NHS medics, employed by the HNS, who might feel promotion prospects could be jeopardised if they are critical of the NHS:
http://www.kingsfund.org.uk/

Btw almost exactly 5 years ago, to my immense surprise, I found myself wired up in an intensive care unit in my local hospital after a heart attack so I admit to having a personal interest in the number of Intensive Care beds.

In the Euro Consumer Heart Index 2008 Report, the UK ranks at No 9 among 29 countries in the performance league table:
http://www.healthpowerhouse.com/files/euro-heart-index-2008.pdf

[53] – thanks for the interesting links, Bob B.

The comparisons are slightly skewed by the fact I am talking specifically about NHS treatment of heart attacks, while some of the data (in the links you provide above) pertain to cardiac care in its totality.

Our hospital runs a 24/7 primary angioplasty service, so if you call an ambulance (and NOT Hatzola – see [19]) and a pre-hospital ECG reveals an ST-elevation infarct the crew will take the patiently DIRECTLY to the cath-lab (by-passing A&E …… no pun intended).

The reduction in pain to balloon time is thus reduced quite significantly, and, as they say during a heart attack, ‘minutes = muscles’.

I hope you received prompt and effective treatment when you developed heart problems, although I accept 5 years ago the NHS had far greater scope for improvement for this condition.

#54: “I accept 5 years ago the NHS had far greater scope for improvement for this condition”

Quite so, although I’ve no personal complaints about my experience from then, the media news reports about the NHS and treatment of heart attacks from those years are hardly reassuring:

From August 2000:

“Thousands of people die unnecessarily from minor heart attacks because NHS hospitals fail to provide adequate care, a study has found.”
http://news.bbc.co.uk/1/hi/health/904500.stm

From February 2005:

“Many hospitals in England are failing to offer heart attack patients the rehabilitation care they deserve, a medical charity report has warned.”
http://news.bbc.co.uk/1/hi/health/4229869.stm

IMO we need to take claims about the NHS being the “envy of the world” etc with large doses of salts even when the claims are made by Lord Darzi on the BBC Today programme during an interview by John Humphreys in May last year.

As best I can tell, the citizens of other west European countries mostly find the services of their national healthcare systems to be generally better. What makes me rather concerned about the Conservatives and the NHS is the disturbing fact that in 1997 Britain had about half the number of physicians per head of population that France had – try the comparisons in this feature in: The Economist of 27 July 2000 (subscription barrier):
http://www.economist.com/world/britain/displaystory.cfm?story_id=E1_PQTNND

[55] yes, historically the NHS has always had a relatively low number of doctors per 1,000 head of population.
http://www.oecd.org/dataoecd/53/12/38976551.pdf

Even so ambulance call-outs doubled over the 10 years before 2,000, while demand for ‘green taxis’ continues to escalate.
http://emj.bmj.com/cgi/content/abstract/22/1/56
http://news.bbc.co.uk/1/hi/health/7789236.stm

Meanwhile GPs cover 250 M-I-L-L-I-O-N consultations each year – 15% of the entire population in a 2 week period.
http://www.gpcurriculum.co.uk/rcgp/12_facts.htm

A&E visits rise inexorably now topping 19 million, this despite the introduction of Walk in Centres (who see 2.5 million patients) and NHS direct which fields millions of calls.

In other words health is rather like the M25 – any spare capacity is immediately taken up by insatiable demand.

Whatever health structure emerges under the Tories it must take account of the fact the UK has its fair share of hypochondriacs, many who seem to be driven by unrealistic consumerist fantasies.
For example, the number of those seeking services (above) do not correlate with prevalence of significant morbidity – especially the ability of the man in the street to recognise a real emergency.

The swine flu debacle exemplifies the legion of neurotics who have virtually no insight into the effect their unreasonable behaviour has on those with proper diseases (like heart attack).

Nowadays a common cold is almost certainly meningitis until disproven by an ID consultant.

Well it’s cuts all the way in my bit of the NHS. The government keeps announcing “extra money” which it had already given us the year before in the baseline!

The Tory’s localism worries me greatly as the system is currently far too local. We spend a stupid amount of time trying to get other PCTs to pay for patients. If you are expensive you can only really get community treatment in your local area as no-one wants the risk of being responsible for the expensive.

This means that a few years ago you could have been placed in a nursing home outside your borough. Not anymore – and we fight over “repatriating” patients from 2 miles away, across the border.

Commissioners are not all managers btw.

The public don’t seem to realise that their PCTs are being privatised. I know it’s complicated, and there probably hasn’t been a press release to regurgitate, but people are oblivious.

SecretLondon: “The public don’t seem to realise that their PCTs are being privatised” – Do you mean the Transforming Community Services agenda, eg PCTs being forced to spin off their provider arms?

That’s not quite privatization, although it can be. I’ve heard that in a lot of areas they’re just passing them onto to the nearest Foundation Trust. In which case they’d stay within the NHS but create a massive conflict of interests.

I’m unclear as to why we need to worry about privatisation of the NHS.

Judging by comparative medical outcomes, other west European countries seem to be performing better than the NHS with mixtures of providers, some private, some public and some private non-profit:
http://www.healthpowerhouse.com/files/canadaIndex03.pdf

According to the Office of National Statistics, productivity in the NHS has been declining:

“The NHS has seen a year-on-year fall in productivity despite the billions of pounds of investment in the service, latest figures show. The data from the Office for National Statistics showed a fall of 2% a year from 2001 to 2005 across the UK.”
http://news.bbc.co.uk/1/hi/health/7610103.stm

The NHS will face “significant cuts in its services” from 2011 unless it can become more productive, the King’s Fund said in response to [the 2009] Budget:
http://www.hsj.co.uk/news/finance/budget-2009-improve-nhs-productivity-or-cut-services-kings-fund/5000749.article

[59] I’m unclear as to why we need to worry about privatisation of the NHS – then think about dentistry
http://news.bbc.co.uk/1/hi/health/7881865.stm

Dr Grumble frames the issues far better than I ever could
http://drgrumble.blogspot.com/2009/08/why-is-nhs-being-privatised.html

Again, the completely irrelevant comparison is made with the American system of healthcare instead of with the social insurance systems for personal healthcare costs in west European countries which are ranked by independent assessors as supporting superior healthcare services to the NHS in performance league tables.

In such comparisons, the NHS comes out as rather mediocre and America, if included in the assessments, as even worse.

I’m becoming increasing worried by the persistent refusal of healthcare professionals to look objectively at the evidence from European healthcare systems and their fixation with invoking the spurious example of American system of healthcare which most independent assessors rate as very inferior in terms of average outcomes for patients.

The infant mortality rate in America in the OECD league table is a disgrace for an affluent country:
http://lysander.sourceoecd.org/vl=1468968/cl=36/nw=1/rpsv/factbook2009/11/01/02/11-01-02-g1.htm

This news report on the World Health Organisation’s first ranking of national healthcare systems was in the Independent of 21 June 2000:

“The first attempt to rank the world’s health systems by how well they meet the needs of their populations has put the UK in a disappointing 18th place, behind France, Italy and other European nations. . . The US spends more than any other country on health as a proportion of its gross domestic product but ranks only 37th, below Chile, Morocco and Israel.”
http://www.independent.co.uk/life-style/health-and-families/health-news/unresponsive-nhs-ranked-18th-in-world-712332.html

[61] I don’t think the main thrust of Dr Grumble’s is about comparing the NHS with the States – the moral of the piece (in my opinion) is that pigs do not become any heavier simply because somebody weighs them, or should I say NHS services are not necessarily improved by bean-counters logging the activity of front line clinical staff.

In fact the process of continual weighing (if we stay with the pig analogy) may have the effect of diverting resources AWAY from where they are most needed since there are cost implications associated with the measurement process.

But let’s stay with alternative (European) health care models – which other EU country with anything like the UKs population and complexity provides better outcomes for LESS cash?

#62: “But let’s stay with alternative (European) health care models – which other EU country with anything like the UKs population and complexity provides better outcomes for LESS cash?”

Comparisons based on cash spending on healthcare are misleading because of choice of exchange rates, differences in relative healthcare prices etc. To overcome those problems, international comparisons of healthcare spend are usually made on the basis of the percentage of national GDP spent on healthcare

OECD member countries are ranked here on total expenditure on health as a percentage of national GDP – btw note that the high American figure will include private spending on cosmetic surgery:
http://oberon.sourceoecd.org/vl=2931447/cl=19/nw=1/rpsv/factbook2009/10/02/01/10-02-01-g1.htm

The 2009 performance league table of national healthcare systems by Health Powerhouse – an independent Swedish healthcare policy think-tank – ranks the NHS at 19th among 32 countries:
http://www.healthpowerhouse.com/files/canadaIndex03.pdf

The implication is that Finland, Luxembourg, Ireland and Spain in western Europe are doing well with better ranking in the league table than the UK while spending a smaller proportion of their national GDP on healthcare.

I don’t think we can simply overlook the discomforting report by the ONS about declining productivity in the NHS while government spending on healthcare has been rising strongly nor the warning by the King’s Fund posted above about constraints ahead as the growth in public spending on the NHS tails off.

“The NHS has seen a year-on-year fall in productivity despite the billions of pounds of investment in the service, latest figures show. The data from the Office for National Statistics showed a fall of 2% a year from 2001 to 2005 across the UK.”
http://news.bbc.co.uk/1/hi/health/7610103.stm

Btw healthcare for cash is a risky comparison to make since, arguably, one reason the NHS has been relatively cheap to run is because the NHS has been able to abuse its status as a verging-on monopoly provider of healthcare services by exploiting staff – hence the low pay of nurses and NHS support staff and the long hours junior hospital doctors have had to work. It has been widely reported that the NHS ranks as the third largest employer of staff in the world.

However, none of this can justify the fixation that NHS healthcare professionals and some political activists have in persisting to make silly comparisons between the NHS and the deeply flawed American system of healthcare.

[63] I assume you are avoiding cost comparisons because the NHS spends less of GDP than most of its European neighbours – in fact, until recently it spent far less, certainly if we compared the NHS to France, Germany or Switzerland.

You highlight Ireland as one country that outperforms the NHS?
Well I have worked with many Irish nurses and few have ever made this claim (although they are sometimes bemused by how often the system is abused by those who have access to it).

The Two Weeks on a Trolley team (doctors & nurses working in Ireland) seem to hold a similar jaundiced view of standards of health care there.
http://twoweeksonatrolley.blogspot.com/

This from the most recent post;
“In Ireland, despite having recently had over a decade of unprecedented economic growth, we still have a third world health service. Expensively trained Irish healthcare professionals can be found all over the world, as they make their escape from an environment which is one of the most demoralising in the developed world in which to work. Patients still languish on trolleys in emergency departments, as they wait for one of the precious beds in our understaffed, filthy, crowded wards”.

More on the Irish system.
http://www.wsm.ie/story/2294
“This Republic’s two-tier heath system is established government policy, allowing some people to buy their way to the top of the treatment queue. It’s a disgrace but it is by no means the end of the story. What is now becoming increasingly obvious is that there is also a government policy to under-fund the public health care system so as to build demand for ‘private’ health care. Sounds cynical? Look around and see what’s happening. (Eighteen months to get your dodgy knee seen by a specialist in a public clinic. Not happy? The same doctor can see you privately next week!)”

So Bob B – I ask you is this the sort of thing you where thinking about when you claimed that the Irish system is better than the NHS?