What future is there for NHS?

Food for thought

~ for the Future

The current malaise in the NHS is dragging patients down.

They say they are fed up with nurses and doctors looking grey, over-worked and dispirited.

• And even more fed up with longer waiting times,
• being told the post-code lottery means they don’t get a drug,
• or shuffled laboriously through the system to get what should be simple tests.

It is OUR NHS – isn’t it about time we said “enough is enough”?

 

Brave Soul

Dr Kailash Chand, a GP in the north of England, has started a government email petition.   If he gets 100,000 signatures, this automatically  forces a debate in Parliament on the Health and Social Care Bill.

No doubt his bosses won’t be pleased with him (the Dept. of Health doesn’t like those who speak up), but if you want to support him click through to

https://submissions.epetitions.direct.gov.uk/petitions/22670

 

What else?

It is time to challenge the myth/mantra repeated time and again by NHS staff – French care may be better but it is more expensive.

When you compare like for like (i.e. if you take out of the equation all the private rooms, home care, massages etc. the French receive ) and work out who pays what – the French and ourselves are paying pretty much the same.

Perhaps we could go back to a report, written in 2008, for the think tank Reform.  What Prof.Nick Bosanquet, Andrew Haldenby, Laura Hurley, Flavia Jolly, Helen Rainbow and Prof. Karol Sikora wrote is worth re-reading, as a basis for patients to challenge just what is the NHS and La La doing with OUR  money?

The typical UK patient  pays around £2,250 per individual per year, so that everyone is covered by the National Health Service.

So the thoughtful report should be required reading for Cameron and Lansley;  instead of repeating “European healthcare is better”, and leave it at that – perhaps instead of devising all his time and money wasting plans, Lansley would take on board what the Reform Report says – and ACT on it.

So why change?
Over many years, Reform says academic studies have pointed to a gap in performance between the UK and other countries.

Health outcomes are difficult to measure, but the UK delivers a poor level of social equity despite having universal provision.  Other countries have systems that rely on part tax funding – part personal insurance funding for health care.

International options point to two key conclusions:

1.    Drawbacks of voluntary coverage concern both effectiveness – due to the problems of adverse selection – and equity. The only major developed country which operates voluntary health insurance is the USA, and that country is itself divided as to the wisdom of the policy. The NHS does provide cover to every UK citizen (although not for every condition), and that is a valuable strength.
2.    In recent years new insurance-based systems, in particular the Netherlands, have been created. Systems with strong insurance characteristics, such as France, Germany and Switzerland, are reforming in order to manage demand and continue to deliver a better standard of healthcare than the UK. The UK looks out of line with global developments.
The Prime Minister claimed that the NHS was “the best insurance system in the world” because, in systems with greater insurance elements, the costs of healthcare could bankrupt families on normal incomes.

Reform says people living in countries such as France, Germany, Switzerland or the Netherlands have the same kind of protection as the Prime Minister described, including cover against the very high costs of catastrophic illness. The task for the NHS is to combine its universal base with the focus on the patient evident in other countries.

Insurance incentives have the following advantages:

> they provide reasons for individuals and authorities to value the long term;
> they achieve greater value;
> they incentivise individuals to participate in their own healthcare;
> they remove unequal access to treatment; and
> they de-politicise healthcare.
Insurance-based systems are closely focused on individual patient outcomes as healthy patients cost less. This means a focus both on general well-being and on ensuring customers that do become ill recover in the shortest period of time.
In other words, an insurance-based health system encourages preventative medicine – something sadly lacking in the NHS.

Ending the postcode lottery
In insurance based systems patient entitlement is defined, and patients are aware of what drugs and treatments they have access to. This empowers patients and makes the system inherently patient centred, and would overcome the current difficulties in the NHS where some patients in one area have access to treatment while other do not.
The key elements of insurance success
We have seen the advantages of insurance incentives. However, there are a number of crucial elements that are required to make an insurance system work.

Firstly, it is important that a sufficient range of providers are able to operate in the market. Secondly, the core system of compulsory insurance needs to cover the vast majority of health problems to ensure that it is for only a minority of conditions that people are buying healthcare for through self-payment or supplementary insurance. Thirdly, people have to be incentivised to prevent abuse of the system. Finally, information and capability to use that information must be present.

Incentives to stop abuse of the system
People may have an incentive to abuse an over-generous system of provision.

In 2004 the average French GP prescribed drugs worth €260,000 a year and the French used three times as many antibiotics as the Germans.  The French have tried to tackle this problem of overtreatment by requiring co-payments for many drugs and GP visits.

One academic has estimated that between 20 and 30 per cent of healthcare funds in America go toward unnecessary treatments which can in fact have a detrimental effect on public health.

UK families already spend £1,600 per year on healthcare
Reform research shows that the average household invests significant amounts privately on their own health. At a conservative estimate the average household is spending £1,200 a year privately on core areas of healthcare, including private hospital treatment, dentistry, optometry and over the counter medicines.

Alongside this spending individuals are also spending a considerable amount a year on improving their own lifestyles through diet and exercise.The average family spends around £400 annually on areas such as gym and sports club membership as well as complementary therapies.

The basic healthcare package in France, which includes the cost of social security contributions and the cost of a basic supplementary insurance, is £2,021.46.

This is a comprehensive package which covers the cost of consultations, pharmacy, dental costs, surgical costs, hospital stay and ambulatory transport amongst others. Furthermore, the French state currently guarantees patients access to all cancer treatments, including experimental ones.

The option to top up for luxury services or rare drugs
Supplementary insurance would cover a wider range of health treatment and pharmaceuticals that are not available in the core package. Supplementary insurance could be purchased for an additional charge from the Health Protection Providers.

Based on supplementary insurance in other countries, examples of cover might include:
> Additional surgery e.g. additional eye surgery during a cataract operation to alleviate the need to wear glasses.
> Drugs not available in the core package.
> A higher standard of hospital accommodation, such as a private room.

Competition
An essential element of a system that acts as an insurer is competition. Competition drives efficiency and quality of services for patients.   However, competition has to be on a level playing field, and signs are that current plans for commissioning services won’t take into account all the factors.

Role of government
Now, this is where it gets interesting.  I can never understand how a politician, with no training whatsoever, can suddenly find themselves managing a health budget of billions.  No company would run this way.  Yet the NHS expects a rookie Minister to know how to commission health services.

Reform suggests the role of the Government would be considerably reduced.

It would have a regulatory function to ensure that all Health Protection Providers and service providers were of sufficient quality. Further tasks would include allocating contracts for emergency services and deciding the budget of the service on a five year cycle. The reduction of this role would eliminate the need for regional agencies i.e. Strategic Health Authorities.

This would depoliticise the running of the health service, and remove it from the political cycle.

The authors
Nick Bosanquet is Professor of Health Policy at Imperial College London and Consultant Director of Reform.
Andrew Haldenby is Reform’s Director.
Laura Hurley was an intern at Reform during the summer of 2008.
Flavia Jolly was an intern at Reform during the summer of 2008.
Helen Rainbow is Reform’s Senior Researcher specialising in health.
Professor Karol Sikora is Medical Director of CancerPartnersUK and a consultant in cancer medicine.

Report costs:  £20.00
Reform, 45 Great Peter Street, London, SW1P 3LT
T 020 7799 6699
info@reform.co.uk
www.reform.co.uk
ISBN number: 978-1-905730-12-4

Andrew Lansley Rap – or you can watch him on hospital TV

Listen to the Rap –

Warning – use ear defenders

and keep a teenager in the room to translate.

But it gets funnier and more understandable as you go along.

 

If this wasn’t bad enough, wait until you see this……

The NHS has a new weapon

They want to send you home quicker, and save money.

So Andrew Lansley’s face will stare down at hospital patients from their bedside TVs – and if you don’t like it you pay £5 to register and turn him off!

Trying to contact the providers, Hospedia, to ask why?  They were strangely silent.

So not only are you to be chased from your bed by Lansley’s glare – if you don’t like it you  pay the NHS to turn him off.  So it’s a win-win situation for hospitals.

What the papers say

Should you have the misfortune to be hospitalised you will now be greeted by a never-ending video of Andrew Lansley. The Health Secretary’s face appears on bedside screens on a permanent North Korea-style loop, welcoming patients to hospital and asking them to thank NHS staff for looking after them.

To turn Lansley off, patients must register under a pay-as-you-go system which sees them charged £5 a day to access television, email and phone services. Those who do not register are continuously greeted by the Health Secretary saying:

Hello, I’m Andrew Lansley, the Health Secretary.

 I just want to take a few moments to say that your care while you’re here in hospital really matters to me. I hope it’s as good quality care as we can possibly make it and I do hope you’ll join me in thanking all the staff who are looking after you while you’re here.

Give me the Rap any day.

The Independent reported that “In some wards with multiple beds, the screens have the effect of a television showroom, with dozens of Lansleys staring down on the ill.” One man who visited an elderly relative said: “It was eerie. Everywhere you looked there was Andrew Lansley. My mother-in-law had to keep topping up the machine just to escape him.”

Lansley appeared on Today to defend himself, saying he wanted patients to have “as comfortable and as high quality a stay as possible” (a pledge that sits uncomfortably with Lansley TV) and to ensure that they thanked NHS staff. But shouldn’t praise be voluntary? And what of those patients who suffer inadequate care?

Somehow I don’t think  Secretary of State TV is going to rival Strictly Come Dancing.  But anyone who can work out how to turn off Lansley, without costing a fiver, deserves a medal.  Lansley himself didn’t know how when interviewed on Today.

Stop Press

Natalie Howells, Marketing Communications Manager of Hospedia emails me to say:
“Patients can switch off the informational video in one of 2 ways. Firstly, registration costs patients nothing and provides them access to free radio services. Secondly, each bedside system has an off switch on the front of the screen, which can be used to switch the bedside screen off”.

Related articles

• What’s on hospital TV? Non-stop Lansley (independent.co.uk)

Hacked off NHS moles are coming up from their tunnels

See http://www.nhsManagers.net

 

 

This website is well worth watching.

Edited by Roy Lilley, PPA ‘Columnist of the Year’ – Finalist, he manages to make sense of what is happening to the  Health Bill, that LaLa doesn’t want you to know.

Image via Wikipedia

Roy’s latest article comments that in this new commercial world, if the Department of Health were looking for a logo, they could do no better than “choose a gold plated sieve”.

Why? Roy says “there’s been another major leak”.

Then says, “you have to ask why people leak things.

Why do they risk disciplinary action, maybe even their jobs and careers to do it?

It’s easy to think it is because people think something is wrong and they want to bring it to wider public attention. It’s a bit about that but I think it is more”.

It takes a lot to shove a document into a scanner, put it on a stick, take it home, set up a Hot Mail account with a gobbledygook name and send it out. You have to be brave, determined and thoroughly aware of what you are doing and the consequences. And, you have to be pretty hacked off.

On a Scale of 1 – 10

It is impossible to measure ‘hacked-off-ness’. For convenience I have invented the Lilley Hacked-Off Scale; one to ten. Judging by my post-bag I take the general level of most readers hacked-off-ness to be about eleven out of ten. I’m thinking of recalibrating already.

I don’t think anyone has recovered from LaLa’s pledge of no more top-down reorganisations only to be faced with the lunacy of what followed; redundancies, 364 pages of Bill and the ‘Pause Fandango’.

Then a creeping realisation that the NHS will have all of its hospitals run off-shore as FTs, community services hived-off and the excesses of Monitor who seems to think the NHS should be run as a utility company.

Channel 4 gets in on the act

Throughout it all I was daft enough to think GPs would come good and do the right thing. That went out of the window when Ch4 did its Go-Johnny expose and Lovely-Jubbly appeared in the NHS lexicon.

Well, Ch4 have done it again. Any thoughts that GPs would have any real influence over commissioning has gone out of the same window. Somebody who is about 15 on the ten scale of hacked-off-ness has leaked a document. They made a programme insert about it on the Ch4 news, last night.

We have a copy; here it is. It is the final draft of a document being developed by the DH called ‘Towards Service Excellence’.

http://www.channel4.com/news/leaked-document-shows-how-doctors-can-profit-from-nhs-reform

In any other setting it would be comical in that it recognises what we all know; GPs can’t commission healthcare or run commissioning. Under the arrangements proposed in the document they will have precious little to do with it. It understands that buying healthcare has to be done at scale and pretty well reinvents SHAs.

PCTs will keep going, providing interim commissioning ‘support’, doing what the GPs know they can’t do, but it is clear that the expectation is they will prepare the way for the private sector to come in and take over most of the commissioning and back office functions and provide a service to several CCGs. An elaborate pathway is mapped out for their entrance. PCTs may have a shot at evolving themselves into commissioning support businesses but they won’t stand a prayer against the McKPMGs of this world.

The document makes depressing reading

Not depressing because it is about the private sector.  Depressing in that it describes a convoluted, wasteful, labyrinthine attempt to stick together the broken fragments of the NHS and put it back on the shelf, where it started.

It has a desperate tone and seems to me to be driven by the knowledge that the NHS is on the brink of a nervous breakdown. If you are a Go-Johnny you won’t like it either. It describes an NHS far removed from LaLa’s original idea.  GPs will have little to do with anything.

I read it more in sorrow than in anger. What a terrible waste of money and time this has been.

As Roy says, take some time, see for yourself what it says and whisper a silent thank you to the brave soul who was hacked-off enough to see if you’re as hacked-off as they are.

 

Lansley doesn't get it – but Dr. Gerada of RCGPs does

News from GP’s Conference

 

Addressing around 1500 GPs and health professionals at their annual conference in Liverpool,  Dr. Clare Gerada, Chair, Royal College of General Practitioners, told their Conference that the profession is under pressure to

“replace the language of caring with the language of the market”

and that patients are not commodities to be bought and sold.

 

Echoing the concerns of many patients, she urged GPs never to lose sight of why they entered the profession – to care for the patient as a person.

“In this brave new cost-driven, competitive, managed-care world, I worry about the effect that the language of marketing is having on our clinical relationships. It’s changing the precious relationship between clinician and patient into a crudely costed financial procedure, turning our patients into aliquots of costed tariffs, and GPs into financial managers of care,” she says.

While welcoming the role of GPs in commissioning, Dr Gerada said that the commissioning agenda must not sacrifice long-term benefits for patients in favour of short-term savings.

“People often tell me that GPs make good commissioners because of the population-focus we bring to care. After all as a profession we see 300 million patients per year. If anyone can be said to have their finger on the pulse of the nation, surely it’s us. It’s an argument I’ve supported for decades. But we must tread carefully in this brave new world and do everything in our power to make sure it’s the public’s pulse we have our fingers on… not the public’s purse!”

Warning to doctors

Citing the HMO experience in America, she warns against doctors being doubly compromised between the best interests of patients and the need to save money.

“It’s the government’s job to decide how much we invest in healthcare – and what services the NHS should provide. Governments should have ultimate responsibility for decisions about rationing healthcare, not GPs.”

She concludes: “We all became doctors because we wanted to make a positive difference to people’s lives. It would be hard to devise a better and more inspiring way of achieving this than through the provision of excellent general practice care, within a universal health service. In times of austerity, we need to come together so that we can collaborate, cooperate and innovate… not compete against each other.

What matters to patients

“You expected me to talk about the Health Bill in England, but this Bill, like other reorganisations across the whole of the United Kingdom will come and go. Instead I have chosen to talk to you about what matters to our patients, now and for ever – a doctor who cares.

“I am convinced that there are enough of us to create a revolution in health care. Not a revolution that the Government is talking about in the Bill – in structures, payments and competition. But a revolution in values – one that will provide excellent care to our patients.”

She urged GPs never to lose sight of why they entered the profession – to care for the patient as a person.

But although she received a large standing ovation – there were those who weren’t so keen.  One wonders if they were the doctors that welcome Lansleys reforms – and see the opportunities when it comes to  commissioning contracts?

Andrew Lansley

In his speech at the RCGP’s conference, Andrew Lansley said offering patients more choice did not amount to privatisation.

Announcing that monitoring of NHS healthcare is to be extended to 11 extra areas of medicine, the health secretary told the GPs in Liverpool that auditing would be extended to areas including HIV and breast cancer.

He said publishing better data would allow patients to make more informed choices and specialists to “compare themselves with the best”.

What choice?

Lansley defended plans to give GPs more commissioning responsibility under the government’s NHS reforms, the government’s Health and Social Care Bill would encourage competition.

“For years, GPs have been telling me, ‘if only they would listen to us, we could do it so much better’,” he said.

“Well as I say, I am now ‘they’. I am listening to you. And I do want you to do it better.

But to patients already seeing waiting times going back to the bad old days, most don’t particularly want choice.  What they want is to be able to go to a local hospital and not have to wait for an appointment.  Nor do they want to be part of political claptrap excusing abdicating of responsibility.  They just want to have their operations or tests done as quickly as possible, in infection-free centres.

Speaking to BBC News before Saturday’s conference, Mr Lansley said that offering more choice for patients did not mean privatisation.

“We’re not looking to turn the NHS into some kind of private industry, far from it.

“It’s a public service and it has to be integrated around the needs of patients.

“But there is a role, a big role, for patients in being able to exercise choice and therefore by extension where patients exercise choice, you have to have a choice amongst providers.”

Mr Lansley told the conference outcomes for patients in areas of medicine including breast cancer, prostate cancer and chronic obstructive pulmonary disease would be “audited, monitored and regularly published in the future”.

“From December we will pilot the publication of clinical audit data to detail the performance of clinical teams. This will then be rolled out across England from April next year,” he said.

“Better data means better quality in the NHS – for patients, for their specialist clinicians, and crucially for you – both as their GPs and as the future commissioners of those services,” he said.

Er – has anyone told Lansley that to get this data, someone is going to have to fill in more forms?  Leaving even less time to deal with patients – the actual reason why the NHS exists.

He still hasn’t got the message, has he?

 

Dr. Grumpy has a very appropriate gripe

 

Things that make him grumpy

 

In his latest email,he says,

“I have nothing against doctors making money. Hell, I’m trying to do that myself.

So medical journals are full of ads offering ways for doctors to increase revenue. Some of them practical, some hokey, and some that really piss me off.

Like this one:

“I have nothing against doctors who are doing concierge work, or sinking money into tech stuff, or marketing their practice.

But what ticks me off about this ad is that of the 4 things they claim to offer, doing what’s best for patients is the very last thing listed”.

And good for him…….. he says

“If I ever reach the point where making money, investing in gadgets, or marketing my practice take precedence over doing what’s right for patients, I hope someone tells me it’s time to hang it up.

And if you’ve reached that point and don’t see a problem with it, than maybe you’ve forgotten why you became a doctor”.

No-one listens to Andrew Lansley

Over on this side of the pond, Lansley keeps on spouting his mantra about putting patients first – but no-one listens, least of all the NHS.

I have lost count of the conferences that are being organised by associations and entrepreneurs to grab some of the NHS ‘development’ cash that is floating past.  Each one purports to be about ‘putting patients first’.  And NONE of them has a single patient, or patient representative actually speaking.

But they will all make money for the organisers as the conferences regurgitate the bottomless pit of money available in NHS for ‘training’;  heaven forbid an actual patient gets up and tells the medics what WE want.  We are only patients. 

 

Fat Tax

Could a Fat Tax

 

help NHS?

 

Denmark has become the first country in the world to levy a tax on fatty foods .  The Danes hope this tax will reduce consumption of saturated fat by 10% across the country.

The tax is intended to encourage people to buy healthier foods, by making unhealthy foods more expensive.  But could this be an answer for the NHS’s lack of funds?

How will it work?

The charge will be levied at 2.5 Krone per kilogram of saturated fat.

This means butter will cost around 30p more that before.

Crisps will cost an additional 8p

Mince will cost 13p more per 1/2 kilo.

With the amount of crisps eaten in Britain, 8p per packet would add a sizeable chunk to NHS funds.

If the Dane’s example increases pressure for a similar tax in the UK, this will please NHS doctors and dieticians, worried that Britain suffers from the highest levels of obesity in Europe.

Mike Rayner, Director of Oxford University’s Health Promotion Research Group said “It’s the first ever fat-tax. It’s very interesting. We haven’t had any practical examples before. Now we will be able to see the effects for real.”The move is predicted to put pressure on other Governments including the UK to follow suit to curb rates.

Supermarkets have been expecting this.

Across Europe, with Governments going backrupt, supermarket managers have been juggling with prices on products.  During recession, what these stores lose out on from poorer customers buying cheaper brands, they make up on wealthier customers who ‘down-size’ and cook at home rather than going out to a restaurant.

What’s the gain?

In Denmark,  with a population of just over 5 million, the tax is expected to raise about 2.2bn Danish Krone (£140m);  cut consumption of saturated fat by around 10pc, and butter consumption by 15pc.

Less than 10pc of Danes are clinically obese, putting them slightly below the European average.  But researchers at Denmark’s Institute for Food and Economic estimate that close to 4pc of the country’s premature deaths are a result of excess consumption of saturated fats.

Hungary, at the start of this month imposed a tax on all packaged foods containing unhealthy levels of sugar, salt, and carbohydrates, as well as products containing more than 20 milligrams of caffeine per 100 milliliters of the product.

For Britain, where more than 20pc of the population is obese, the number will be considerably higher.  Using the back of my trusty envelope, I calculate that if Britain imposed the same level of tax, and we ate approx. the same amounts as the Danes (which we do), the NHS could gain £1,680,000,000 per year – enough to pay for a lot of NHS care.

A 2007 study by Mr Rayner’s group concluded that a combination of taxes on healthy foods and tax breaks on fruit and vegetables could save 3,200 lives a year in the UK.

Health Minister Andrew Lansley has up until now resisted calls for taxes on unhealthy foods,  yet he constantly moans about the fact that UK is full of obese people costing the NHS money.  It’s time La La escaped out of Wonderland and came into the real world.

However, he may be over-ruled.  Mike Rayner says “I think we’re going to have them (fat taxes) in Britain whether Mr Lansley wants them or not, because the obesity crisis in the UK is such that we need to take more action.

With any luck, once La La has got his incredibly unpopular Health bill through the House of Lords, with any luck he will be moved side-ways into a job where he will cause less harm, and we get a Minister who understands the NHS.

And for once I can’t see many – except for kids spending their pocket money on crisps – who will object to a Fat Tax.

It's time after-care for cancer patients got up-dated

Image via Wikipedia

Macmillan’s medical director

hits out

No sooner had I written about assembly-line medicine, and how the Dept. of Health is blaming us, the PBP (poor Bxxxy patient) for lower survival rates post-cancer, compared with European countries,

than up comes Prof. Jane Maher , Medical Director of Macmillan, with some telling things to say about the way we are looked after once we finish hospital treatment.

What does Jane Maher say?

She feared 500,000 people’s symptoms for conditions, including osteoporosis and heart disease, are being missed by GPs.

GP’s lack of knowledge about the long-term side-effects of cancer drugs and a lack of communication with hospitals were to blame.

“Doctors are failing cancer patients ‘far too often’ by not spotting other medical problems caused by their treatment”, says Prof. Maher.  Lack of knowledge about the long-term side-effects of cancer drugs, and a lack of communication with hospitals, were to blame.  Which echoes what cancer patients say, commenting they feel ‘abandoned’ once they have left hospital.

‘GPs and oncologists are failing cancer patients far too often,’ she told The Guardian.

‘By not sharing vital information and recording [this] clearly on the patients’ medical records, they are putting a significant number of cancer patients at risk of having their work, health, relationships and home lives unnecessarily spoiled by long-term side-effects of their treatment.‘

‘GPs need to recognise that people who have had cancer may have health problems related to their treatment, and GPs are the best people to pick these up. But that doesn’t happen nearly enough at the moment.’

Doctors needed to ensure that cancer survivors’ medical records included more detail about their disease and type of treatment.

‘At the moment GPs aren’t recording whether someone has had chemotherapy or radiotherapy,’  partly because they don’t get enough information from hospitals, but also because they don’t realise why it’s important for them to do that.’

So PBPs  bumble along as best we may, and in the meantime officialdom pumps out mis-information:

Official Myths – from NHS/Dept. Health/GPs and Uncle Tom Cobley

Here are some official ‘sayings’;  they have little or no validity, but are taken as gospel by the medical profession:

• Dept. Health says :It’s our fault that we have bad post-cancer survival rates as we have a bad take-up rate for screening. Fact:  World Health Organisation say UK has one of the best rates in Europe for take-up of breast screening, etc.
•  NHS/Consultants say: Once you’ve finished cancer treatment, “you’re clear”.                    Fact:  There is a risk of cancer survivors developing a second cancer
• NHS tells you: Once you leave hospital, you have finished treatment.                                Fact : Long-term consequences can arise anything from a few weeks after treatment to many years later. There is no evidence that the development of late consequences decreases with increasing survival time after treatment.
• NHS say: If you experience side effects, your GP is the person to consult.                                  Fact – my GP was more honest than most, admitting “you know more about cancer than I do”, when I went to ask about horrible side effects.  And no, he couldn’t help – it was back to the Internet.
• Pharma company leaflets say:  if you experience side effects consult your GP.             Fact:  (and cue for hollow laughter)  T’aint so – most GPs have no training in dealing with side effects from these drugs.

Side effects NHS etc. brush under carpet

A survey by Macmillan Cancer Support in 2008 showed that while

44 per cent of cancer patients were not aware of the possibility of long-term physical side-effects

78 per cent of them admitted to experiencing at least one of a list of possible side-effects in the preceding 12 months, including: .

• Fatigue
• weight gain
• lymphoedema
• neuropathic pain
• heart damage leading to an increased risk of cardiovascular disease
• lung damage
• bowel and bladder dysfunction
• increased risk of osteoporosis
• carpal tunnel syndrome
• eye problems, etc. etc. .

And they seem to have forgotten skin problems, splitting and crumbling nails, etc. etc.

Many patients can also suffer psychosocial consequences, including anxiety and depression, memory loss and problems with concentration. This can lead to increased risk of job loss, financial problems, marital breakdown and divorce, and lower educational attainment for children and adolescents with cancer.

Feeble Excuses for bad care

Dr Clare Gerada, chair of the Royal College of General Practitioners said doctors needed help with the issue.

Admitting that GPs were generally unaware of the risks associated with specific treatments, she said: ‘If Prof Maher and the NHS tell us exactly what cancer someone has had, and what treatment, and what the possible risks are of that, and in a way that’s easy to understand, we will do things better.’

My personal view is, if we are aware, why aren’t doctors?  Surely we tell them enough times of the problems we are experiencing, but it seems they aren’t listening.  It’s time Dr. Gerada told her members to wash out their ears.

What’s being done?

The National Cancer Survivorship Initiative was launched in 2008 in response to the Cancer Reform Strategy, with the aim of co-ordinating a response to this challenge across all care settings.  This is a collaboration between Macmillan and the NHS.

Yet three years later, the website is still under development, and nothing seems to have been accomplished.

We still have the assembly-line system, which is way out-of-date – the NHS needs to follow what’s happening in the Personalised Medicine field, and STOP WASTING OUR MONEY on useless treatment.

But with side effects destined to increase, now that procedures such as Platinum-based treatments are getting more sophisticated,  doctors must be trained how to deal with our problems.

Or else Macmillan-funded GPs must be available to patients as and when needed – not locked away out of our sight.  It’s our donations that fund them – why can’t we book a consultation with one?

Osteoporosis
The latest Hormonal treatment, including the use of gonadotropin-releasing hormone analogues for prostate cancer and aromatase inhibitors for breast cancer, is associated with an increased risk of bone fractures due to osteoporosis.  NICE has recommended that women with early invasive breast cancer should have a baseline DEXA scan to assess bone mineral density.

Increasingly urologists are adopting the same approach with men with metastatic prostate cancer. Osteoporosis, when identified, should be treated with bisphosphonates and exercise.

What is role of GPs now?

GPs need to be aware of the possibility of late effects for patients with a history of cancer. When a patient presents with new symptoms,

1. consider if they are related to the past cancer, its treatment or possibly the development of a new cancer.
2. patient records should be clearly coded with details of past oncological treatments and also coded as ‘At increased risk of …’ if appropriate.
3. Cancer specialists need to provide clear information to both patients and GPs about possible long-term consequences, and GPs need to ensure that information is appropriately recorded and coded on the patient’s GP records.
4. Practices should create a register of those who have had oncological treatment including radio and chemotherapies, so that those patients can be highlighted on their computer system and alerts set.
5. Proactively ask patients about possible treatment-related problems and potential psychosocial effects as part of any regular review, and consider offering patient information on long-term effects.
6. Remember that second cancers are common in patients who have already had one cancer.  It is vital to give suitable lifestyle advice to all cancer patients to try to reduce that risk.
7. Actively identify and manage other risk factors for those patients at increased risk of developing cardiovascular disease or osteoporosis.

Cancer follow-ups are a waste of time

According to Prof. Maher, the current follow-up system for cancer patients is a waste of time and needs to be completely overhauled.

Instead cancer patients should be given ‘the skills and knowledge to self-manage their condition, and provide support if needed, which would be far more effective at spotting re-occurrences of cancer.’

At the moment cancer patients who survive initial treatment enter what is called the ‘follow-up system’ – regular appointments to check that the cancer has not returned. Jane Maher, says: ‘The curent system is wasteful, ineffective, and not the best way to spot many recurrent cancers.’

There is surprisingly little evidence that this method is the best way to spot recurrences of cancer or the other possible long term health consequences of being treated for cancer.

Jane draws on recent work which ‘suggests that around 70% of recurrence for breast cancer could be detected by either patients noticing symptoms themselves or by surveillance testing alone, with a face-to-face appointment if needed.’

She continues ‘this is only possible if patients are helped to understand their illness, can access regular tests and know how and when to contact specialists if problems arise.’

One in five people living after treatment for cancer will develop long term emotional, psychological and physical problems that seriously affect their quality of life. Yet there are few, if any, NHS services specifically for cancer survivors.

The NHS needs to radically transform the way it provides support for patients following hospital treatment.  If enough patients tell their GP about Prof. Maher’s chilling words, perhaps we might get the attention and care we need, without going round and round the houses looking for joined up care.

And Jane, one thing you haven’t mentioned – patients need to be LISTENED to – and not dismissed out of hand when we query our treatment, or even offer a possible solution.  There is a thing called the Internet – and sadly many of us HAVE to learn how and where to look up treatment options – otherwise we would find outselves on the medical scrapheap.

http://www.guardian.co.uk/world/2011/sep/25/cancer-patients-side-effects-treatment?newsfeed=true

http://news.bbc.co.uk/1/hi/health

/8429995.stm

 

http://www.dailymail.co.uk/health/article-2041878/Doctors-failing-500-000-cancer-patients-spotting-medical-problems-caused-treatment.html

Could the NHS be run by foreign doctors?

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BBC asks question

on their Website

 

Top story on website (4.9.11) said

“Senior officials discussed handing the management of up to 20 English NHS hospitals to overseas companies, emails released by the government indicate.

Talks included plans to hand over one hospital at a time due to “political restraints”, the Observer reports.

It comes as Lib Dem peer Shirley Williams said she has “huge concerns” over the NHS reform plans.

Health Secretary Andrew Lansley says claims the government aims to privatise the NHS are “ludicrous scaremongering”.

The emails were released after a Freedom of Information request by non-profit investigations organisation Spinwatch.

They are reported to show that consulting firm McKinsey was acting as a broker between the Department of Health and “international players” for contracts worth hundreds of millions of pounds.

One email talks about “interest in new solution for 10-20 hospitals but starting from a mindset of one at a time with various political constraints”.

The Department of Health said it was not unusual to hold meetings with external organisations and that NHS staff and assets would always remain wholly owned by the NHS.  Er – does PFI spring to mind?

Would it work?

Predictably, Christina McAnea, head of health at the union Unison, said:  “People are rightly proud of an NHS that puts patient need before private profit, and voting through this Bill will be the end of the NHS as we know it.”

But today’s NHS is NOT putting ‘patient need before private profit’.  Already organisations and charities are expressing concern that patients are suffering because of measures designed to save money, by contracting out services.

Andrew Lansley must be concerned at the way the Health Bill will be hauled apart this week in Parliament.

Handing over a sample hospital to a foreign company to run might – just might – shake up the NHS to provide a better service to patients.

Who should be involved?

If the NHS selected three hospitals to try this out, we could learn from other country’s practices.

India

An Interpreter friend who spends her working day in NHS hospitals commented on the excellence of hospitals in India.   Here, the best hospitals have a system where patients’ test results, together with doctor’s comments, are emailed to them at home.

If anyone has tried to get test results from scans, X-ray, Ultrasound, blood tests, etc. out of a hospital here this sounds like Utopia – but is normal at some hospitals in India.

Many UK patients are now flying to India for operations;  whilst I question if a long haul flight is best undertaken by someone recovering from anaesthesia etc. there is no doubt that this service is expanding.  So what are hospitals doing better in India?  And what could we copy?

France

From David Cameron downwards, the Coalition Government constantly talks about the benefits of French health care.  So why not let us see if it is better by getting a French team to take over one of our hospitals?  Perhaps Mid-Stafford, or one of those recently in the news for the worst reasons?

For a start, we would learn you don’t need referral letters;  French medics think we do have a brain and can self-refer (under certain guidelines).

USA

Yes, there are horror stories – but there are also many success ones.  Researching new treatments for Diabetic Neuropathy, I am told by top UK doctor that the Mayo Clinic in the States is world leader in diabetes treatment.  They seem to have excellent results by using exercise, so I contact Diabetes UK to ask them what they know of this exercise programme.  Back shoots email:  “what is the Mayo Clinic?”  Makes one weep.

But we are supposed to have over two million patients with diabetes in UK – why not let Mayo Clinic take over one of our diabetic outpatient departments at least?  So our doctors could learn from them.

Currently

Under its ‘one size fits all’ policy, the government is trying to overhaul the way the NHS in England works, giving GPs and other clinicians much more responsibility for spending and encouraging greater competition with the private sector.

Lansley has said: “The reality is that we’re giving more power and choice to patients over how they get treated, keeping waiting times low and cutting bureaucracy so more cash gets to the front line”.

Meanwhile, Lady Williams said the battle over the Health Bill was “far from over” and the reforms “need not mean upheaval and disintegration”.  Writing in the Observer, she said:  “I am not against a private element in the NHS, which may bring innovation and good practice, provided it is within the framework of a public service – complementary but not wrecking”.

But most observers fear that, instead of listening to informed opinion, Lansley will go about introducing reform across the board, not waiting to see if something works in one hospital, then gradually rolling this out across the board.

If La La and his cohorts could be made to think of the benefits to patients, rather than massaging their political egos, it would be very, very interesting to hand over – say – three  of our underperforming hospitals to three providers from three different countries, and monitor what happens.

 

Tell your MP what you think of Health Bill

Image via Wikipedia

And keep up momentum for change

Thanks to the huge outcry against their original NHS plans, the government has been forced to make some changes to the Health Bill – but not enough.

A committee of MPs have already started discussing the government’s latest NHS plans. These 25 MPs have a choice to make.

Will they wave through the government’s latest NHS proposals?

Or will they ask tough questions and expose the dangerous problems with the government’s plans?

If MPs think their voting public doesn’t want the ‘new’ clauses in the Bill, or questions what is already in place – they will ask more questions.  And the more they ask, the more the Government will realise they HAVE to respect what the public wants.

So make sure your MP knows what questions you want them to ask committee members.

How?

Email your MP now and tell them you’re still concerned about the government’s plans:

https://secure.38degrees.org.uk/were-still-watching

You can ‘personalise’ this letter – in fact it’s a good idea to add your comments so MPs know the letters come from genuine constituents.

However, if you have already written on this subject – leave the poor MP alone!

Last election one charity tried to get on the bandwagon and get us all bombarding our MP asking questions about cancer, after Breakthrough Breast Cancer had already done a superb job.  It doesn’t work.  To keep your MP on your side let them know what you think, and what you would like them to do – then leave them to get on with it.

However, there is nothing to stop you emailing this article to friends – and getting THEM to write!  And because of the clever way those IT boffins have worked it out, anyone, wherever they are in Britain, who clicks on

secure.38degrees.org.uk/were-still-watching

can write same petition – but get it sent their MP.

Why do this?

Hidden in the Bill’s small print are some causes for concern:

1. It looks like they are still trying to water down or abolish the health minister’s ultimate responsibility to provide NHS services (at the moment the buck stops with the health minister – they’re trying to change that).
2. Experts warn that private companies may end up in charge of determining what services you can get on the NHS and who provides them (in other words, doing the work of new “NHS commissioning bodies”).  This is fine if your local NHS hospital teams up with a private hospital that runs efficiently – but no good if we end up with more PFI disasters.
3. There’s too much emphasis on competition – rather than encouraging different bits of the NHS to work better together.

Soon, your MP will vote on the government’s plans. But right now, your MP can help make sure these issues are tackled, by putting pressure on MPs who are on the health committee to do a proper job.

Over the past few weeks, thousands of the public have been deciding the future of our NHS campaign. The results were overwhelming. In a 38 Degrees poll, 97% of us voted that there is still more to do to protect our NHS for future generations, so we should keep the campaign going as one of our top priorities.

By working together now, we can make sure that everywhere MPs on the health committee go, they’re facing tough questions about protecting our NHS.

Please take 2 minutes to send your MP a quick message and tell them if you’re still worried about the government’s NHS plans.

How much are we costing the NHS?

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AND HOW MUCH NHS FUNDS ARE YOU THROWING AWAY?

 

So you don’t like the tablets?  They make you feel ill (particularly if they are for cancer).

You don’t tell your doctor, but just quietly throw them in the rubbish bin.

 

Anecdotal evidence shows that frequently patients are afraid to tell doctors they aren’t taking drugs any more

– so isn’t  it time doctors reviewed our medicines on a regular basis?

When it comes to the expensive drugs, why not ask us outright if we are still taking them?  People would be less inclined to lie when faced with an outright question, and this might save the NHS a whole lot of money.

By keeping quiet, we are costing the NHS £millions every year.

NHS surveys have said that over 60% of us are known to give up on the five-year hormone therapy course after cancer, because we don’t like side effects. Fine – as long as we tell our doctor and these are struck off our prescription list.

Sitting in a waiting room talking to fellow patients (as one does), we swop ‘woes’.  That’s fine – we can discuss the merits of ginger for hot flushes, and which cream works best on dry skin.  But what really worries me is when I am told “Oh – I’ve given up on that drug – but don’t tell my doctor”.

OK – it’s their descision if they don’t want to take a drug any longer.  The more patients that draw attention to this the better, then drug companies might look into side effects and do something to help prevent them.

But just not tell the doctor, so they keep on prescribing?  No wonder the NHS is running out of money.  Drugs can cost from £20 a month to hundreds or even thousands.

What happens in the States?

There, because of the way insurance works, patients seem more aware of drug costs.  But they say Doctors often don’t know how much laboratory/blood tests cost.

As reported by the WSJ Health Blog,

A new study finds that simply making physicians aware of the cost of regular blood tests cut the daily bill for the tests by as much as 27% … At the beginning of the program, the daily cost per non-intensive care patient was $147.73. Over the 11 weeks of the study, that dipped as low as $108.11 in the eighth week.

As the report says, “rather than proposing grand plans, like reforming Medicare, which often come to a political standstill, it’s small ideas like this that will help get health costs under control.

Recently, I went to see a doctor privately.  He needed blood tests, but as I was paying for these myself, he spent some time going through my notes to check if I had had tests done within the time frame.  Eventually I came out with a bill of £110 – instead of the £404 it would have cost in laboratory charges if the NHS were paying.

Why?  Because on the NHS often doctors don’t have time to go through your notes, so issue a blanket request for blood tests.  You are going to have the Vampires taking blood (bless them), so they might as well fill one or two more phials whilst they are at it. The cost comes at the laboratory, which charges individually for each test done.

So think about it – and help save the NHS millions.  Don’t throw pills away – own up!

And if the NHS extended appointment time from ten minutes to twenty or even thirty minutes, this actually might save them (and us) a lot of money.