Wednesday, 10 July 2013

Is the NHS dead?

If you care about the NHS read this article. #MSBlog #MSresearch

Nicholas Black. Can England's NHS Survive? N Engl J Med 2013; 369:1-3July 4, 2013. 

Excerpts:

..... The past few months have witnessed the most intense and prolonged criticism of England's National Health Service (NHS) in its 65-year history. Some critics have suggested that the NHS faces a crisis that can be resolved only by altering the fundamental principle on which it was founded ....

..... Never before has the NHS had to cope with no increase in funding for a sustained period. With rising demand, the NHS is required to improve its productivity at an unprecedented rate of 4% per year. The government is convinced that to achieve this improvement, two fundamental changes are needed.....

...... The first concerns the local commissioning organizations .....

...... Prolonged financial stringency and a reorganization were challenging enough without a high-profile report suggesting that NHS hospitals may not be safe....

...... For the NHS to survive in its present form, it will need to overcome four formidable challenges. The first is financial constraint. Although the government claims to be maintaining funding in real terms, high rates of inflation in health care plus some financial maneuvers, such as withholding from the NHS any funds in its budget that it hasn't spent, mean there has been an actual funding reduction of almost 1% per year since 2011. Of greater concern is that social services have undergone a substantial cut of about 7% per year since 2011, which is resulting in more emergency admissions to hospitals and delays in discharges......

...... The second challenge is that the NHS may face opposition to its attempts to improve productivity. During the first 2 years of austerity, improvement was achieved mostly by freezing (or even reducing) staff pay, a policy that will not be sustainable. Similarly, driving down prices paid to suppliers for consumables cannot be extended indefinitely.....

..... The third challenge is a lack of managerial capacity, stemming largely from the government's imposition of a reorganization that had little support from key staff members. This problem has been exacerbated by widespread criticism of managers, in the wake of the Francis Report, by members of the public, the media, and politicians.....

...... Finally, there is concern that the way the NHS has been reorganized will impede attempts to achieve greater integration of services across health care and with social services — integration that is essential to achieving efficient, high-quality care.....

...... So, will the NHS survive these challenges? .......

...... Although some of the challenges in England are unique, the underlying problem of meeting rising demand for care with steady or diminishing resources is faced by many countries. Just as we can learn from other health care systems, our experiences over the next few years in redesigning the organization and delivery of services will undoubtedly provide lessons for others.....





"This picture is from the Kings Fund and tries to illustrate the complexity of the new NHS changes. This short video illustrates this very well."

"For those of us on the front line of MSer care we are seeing the impact of these changes already. The complexity of the changes are bewildering to say the least, and to pin down people to take responsibility for making life and death decisions about changing MS treatments has been a roller coaster ride for me. In England we are not allowed to switch MSers on natalizumab to fingolimod who are at high risk of developing PML because NICE has not given fingolimod the green light for this indication. It doesn't matter if one, two or three people develop PML and die from this complication. NICE has ruled and that's it. What has happened to good old fashioned pragmatic clinical decision making?"

"We have lobbied NHS England via the Association of British Neurologists to get the DMT prescribing policy changed, but the mechanism of doing this very complicated and will be delayed by 6-12 months. What the NHS doesn't seem to be aware of is that they are opening themselves up to a serious medicolegal challenge if they don't change this policy soon."

"No wonder MSers think the NHS is failing them; if there are no mechanisms in place for taking relatively simple decisions what happens with more complex ones. The NHS is a behemoth that has become even more complex, not less complex."
"I personally see the NHS breaking up very soon. I have already highlighted the pernicious influence that private prescribing is having on the NHS. Private prescribing has undermined the two founding principles of the NHS: free at point of access and equity. We are planning a live debate on this exact issue later this year as it has major implications for MS care in England. Do we want a two-tiered NHS? Should the wealthy have access to treatments the poor can't afford? Have your say, we need to know what you are thinking."

Other posts of interest on NHS changes:

Multiple Sclerosis Research: Private prescriptions within the NHS
15 May 2013
"Our post on 'Topping-up the NHS with private prescribing' has generated a healthy debate. In response to a query yesterday I thought I would highlight an example of private prescribing within the NHS in relation to the ...
http://multiple-sclerosis-research.blogspot.com/

Topping-up the NHS with private prescribing - Multiple Sclerosis ...
13 May 2013
Topping-up the NHS with private prescribing. "At the MS Frontiers meeting, last week, one of the MSers dropped a bombshell in a trial meeting we had. He believes that if MSers want access to new and expensive DMTs and ...
http://multiple-sclerosis-research.blogspot.com/

Multiple Sclerosis Research: Off-label prescribing
16 Dec 2012
Hence the frustration of Maurice Saatchi at the unwillingness of his wife's oncologists to prescribe experimental drugs for his wife and his push for a private members bill. " 'Doctors are too scared of getting sued to make any ...
http://multiple-sclerosis-research.blogspot.com/

ABN Debate: Brenner vs. Giovannoni on treating active MS
24 May 2013
"I also threw in a curved ball by getting Dr B in the case to prescribe more active DMTs using a private prescription under the NHS; please note this was a fictitious scenario, but quite possible in the 'new NHS'. The socialists in ...
http://multiple-sclerosis-research.blogspot.com/

Multiple Sclerosis Research: Is the NHS over?
17 May 2013
"The following are the preliminary results of the survey we have been running in response to the private prescriptions debate that has been raging on the blog. If you have missed out I would urge you to read the two posts ...
http://multiple-sclerosis-research.blogspot.com/

8 comments:

  1. From a political perspective, it is a breach of the social contract theory: I have kept up my end of the contract by paying all of the taxes required and by giving-up certain rights, yet the State is failing to abide by their obligations. If the bl**dy State wants my taxes, they should provide the best treatment available. If they cannot provide this, they should stop taking my money under false pretences and allow me to make a free-market choice as to my treatment.

    I loathe high taxation and the big State concept, so for me, the effect of this hideous disease on my mental and emotional health is compounded by the sclerotic bureaucracy that refuses to allow me any chance of beating this disease and its symptoms. As I’ve said before, it is economic lunacy to almost guarantee that MSers will be dependent upon the State when access to better treatment will allow them to be contributors (financial and otherwise) to society.

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  2. Not sure it will survive another Tory Government that’s for sure. There are too many MP’s & Lords voting on NHS issues that have financial interests in private medicine suppliers, which is surely corrupt. I remember the desperate state of the NHS after 18 years of Tory rule, but this lot weren’t even elected and need support of the Liberals to carry out their evil work.
    We have a Minister of Health that wanted to ban the NHS tribute during the Olympic opening ceremony and that should tell you all you need to know about Government attitude.
    Labour are far from perfect, but I firmly believe the NHS is an awful lot safer in their hands.

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    1. Ignoring the hyperbole about “evil” political parties, I’m mostly concerned about the financial impact of failed IT projects, the huge managerial hierarchy, health tourists and the expansion of services and treatments (some good, some questionable) that could never have been foreseen by the architects of the NHS. Working on projects in the private sector, I know how we are called to account every step of the way and would even lose our jobs if we executed projects the way the civil service does. (This is not restricted to the NHS: MoD projects are also appallingly managed, as I suspect are most other public sector projects).

      Transplant surgery, cancer treatments and dementia care are all late-20th century NHS demands: prior to that, transplants did not happen, people died from cancer (often without knowing what it was that was killing them) and the elderly were cared for by extended families and geriatric wards.

      We can’t just have knee-jerk reactions to the NHS, we need open and reasoned debate about whether society can afford the investment needed to keep up with 21st century medical progress. Additionally, there needs to be real engagement with the electorate about what treatments / services should be available on the NHS. I have a friend currently undergoing IVF treatment on the NHS. She has one child already, but wants another. She is in her early 40s and due to timing and life choices, she didn’t have her first child till she was 40. I struggle with the idea that thousands of pounds are *probably* going to be wasted (given the incredibly high failure rate of IVF) on bringing a new person into society, when an existing person (me) is relegated to second-class treatment. My friend would argue the NHS should fund her IVF as she has paid taxes, but I question whether IVF is a medical service or a lifestyle service?

      We then move onto plastic surgery: if a girl is bullied for ears that stick out, should she have NHS treatment to have them pinned? I would argue yes. If the same girl was bullied for having small breasts, should she have enlargement surgery on the NHS? I would argue no, but I would argue a woman having reconstructive surgery after mastectomy should have it as an NHS treatment.

      I am aware these are highly subjective attitudes and others would argue the opposite. I am open to debate, but it is a debate that must be had. The NHS is not a sacred cow and should not be immune from scrutiny nor criticism, just because it was founded on a truly beautiful concept.

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  3. That the NHS was a Labour invention and one of the greatest achievements made in the UK has always stuck in the craw of the Tories. The would abolish it if they could but knowing the uproar this would create, are choosing to do it by stealth. We must fight this by any means necessary and ensure that the Tories don't get in next time to complete their vandalism. Andrew Lansley, the architect of the changes has always held a grudge against the NHS as a stroke he suffered wasn't diagnosed quick enough. One can only see by the drip drip of bad news stories in the press to see what the agenda is.
    NICE needs to sort it out regarding quicker access to highly effective DMTs and realise that stopping MSers getting disabled is a major cost benefit to the UK economy as a whole. Neurologists (and MSers) need to keep lobbying.
    Right, that's my socialist South Wales rant over!

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    Replies
    1. With you alll the way MD2, ( I always knew you were one of the good guys).
      A two tier privatised system is being implemented and forced on the Nation NOW and people really need to open their eyes.
      It's all too easy for people to use the, "well if I can afford to go private it will free up resources", that simply, well isn't that simple and quite frankly the 'I'm alright Jack' approach.

      When it's gone it aint coming back, see how far your private health plan will go then. Does anyone really believe private insurance will keep on paying for one's treatment year on year ?
      Let open market give a more competetive and monetary prudent service ? Like the utilities I suspect, which will only get more expensive and out of control.

      The Government needs to Govern and not sell off it's rsponsibillities,
      Socialist Black Country rant over.

      Regards as always.

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    2. Lets see what the politicians have to say.

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  4. I think it's NICE that needs over hauling. Who are these people that make the decisions? What do they base their decisions on?

    The NHS was founded at a time when most people died within 10 years or so of retiring,and there weren't so many wonderful drugs, surgery and machines that help keep people alive.

    Now we have an ageing population requiring more health care and more pensions. Unless we are willing to pay more taxes for our NHS we won't be able to afford it with its current ethos of being free at the point of access.

    How should it be funded?- and don't just say big corporations and wealthy individuals should pay more.

    Maybe we all have to pay for laundry, food etc when in hospital?
    Maybe emergencies and and life threatening diseases are on the NHS, but not IVF etc. And who decides?

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  5. I just don't believe that Labour would do much different. Remember it was they who brought in ATOS and they have repeatedly refused to go against the reform of DLA. The culture of bullying within the NHS was alive and kicking during their time in office. Their solution to everything seems to be 'systems' to sort things out, i.e. even greater bureaucratisation. But I do agree that the Tories are not to be trusted.

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