NHS Debate Re-opens

For now the Hacking scandal is having a relatively quiet time, but an old favourite has popped back into the news again recently, the NHS reforms.

The row over NHS reforms looks set to reopen, and more publicly than ever.

People may remember the recent listening period that the government held when their proposed changes to the NHS were met with fierce opposition from both the medical profession and the public. After intensive lobbying from the BMA, RCN, and RCGP they agreed to substantial changes.

This would all seem positive, but the problem now is that the changed bill is a complete and utter mess. It is a confused bureaucratic nightmare, with no-one being quite sure what its aim is.

The changes even prompted this motion from a  recent BMA Council meeting, "[this council] rejects the idea that the Government's proposed changes to the Bill will significantly reduce the risk of further marketisation and privatisation of the NHS."

That's why the BMA, the association representing 140,000 doctors, has again stated that it is opposed to the bill, despite the changes, and that it would be better for the bill to be withdrawn altogether.

The biggest news from the BMA meeting was that it agreed to start a 'public campaign to call for the withdrawal of the Health and Social Care Bill.' It seems that far from the easy ride through the commons Cameron had hoped for, there will be an almighty battle for public support.

As well as this, the campaigning group 38 degrees, with 850,000 members, have restarted their campaign against the bill, raising £10,000 (in fact, at last check it was over £30,000) within hours which will be used to hire a legal team to look through the bill line by line, looking for any hidden dangers.

With trust in politics in serious decline after Hackgate, and the Medical profession being the most trusted, I hardly think there will be much appetite in the government for a fight with the BMA. It will be interesting to see how much political capital Cameron is prepared to lose in order to pass the bill.

Without a Lib Dem backlash, which seems unlikely, he will probably manage to pass some form of bill, but what it contains, and how much he loses in the process, remains to be seen.

Shambolic science in the Daily Express

In a week where certain sections of the media are getting a well deserved bashing, it's important to remember the kind of damage they can do through perfectly legal means. Indeed, there is a front page story in the Daily Express today that will garner very little criticism, but could very easily lead to major health problems for its readership because of its abuse of scientific research.

Their front page, as seen to the right, proudly declares that 'Now salt is safe to eat', claiming that reducing your intake 'does nothing to reduce your risk of heart disease.' (They also call Public Health specialists 'Health fascists' for good measure)

It is very easy to see how they came to this conclusion, but easier still to see how they got it completely and dangerously wrong. This headline is essentially extrapolated from one piece of research, published in the Cochrane Library. As such, it comes from one of the most reliable sources possible, and we can be sure that the research is thorough, but it seems the Daily Express only read what they wanted to believe.

The review of literature covered nearly 7,000 participants, and found that although lowering your salt intake was correlated with a lower BP, they couldn't find a link to a reduction in your chances of developing heart disease.

An Attack on Doctor's Pensions

Public sector pensions have been in the news quite a fair amount recently, and there are plenty of commentators around who can explain better than me why the changes are deeply unfair to workers, and so I shan't talk about pensions as a whole. Instead, I want to write about something that I, as a medical student, have a personal future interest in, the NHS pension scheme.

The BMA remains highly critical of both NHS reforms and of proposed pension reform.

It may seem a pretty dull subject, so I shall try to keep this short and to the point, and in those interests here are a few quick facts about the current scheme.

• It was renegotiated as recently as 2008, with the introduction of tiered contributions to ensure fairness for the lowest paid and an increase in the retirement age for new entrants to 65.
• Employers contributions (i.e. the taxpayers) have been capped.
• The scheme is due to be £10bn in surplus by 2015, providing the Treasury with £2bn a year.

Such a scheme would seem ideal for a government looking to cut costs, not only are costs not spiralling out of control, they're recieving money from the surplus! In light of this, it seems even more bizarre that the government, fronted on the issue by Danny Alexander, is issuing threats to public sector workers that they must accept new settlements or lose out even further.

Lies, half-truths and dodgy statistics: NHS

Part of a series on the many lies and exaggerations used by politicians and the media which are backed up by very questionable statistics.

"There are three kinds of lies: lies, damned lies, and statistics." So goes the quote popularised by Mark Twain, his phrase describing just how easy it is to twist any statistic you can find to suit your given belief. I would add another and qualify two of them, there are actually four types of lies: lies, repeated lies, exaggerated half-truths, and misused statistics.

I bring up this now in light of abuses of supposed 'facts' by Number 10, which have very real consequences for us if they are allowed to go unchallenged.

The misuse of statistics in relation to the NHS is the most dangerous of all, these are the 'facts' which are being used to persuade the public at large of the need for reform. Many of them appear in a new leaflet issued by Number 10 and are reproduced by the Department of Health, entitled 'Working together for a stronger NHS'. The facts it uses are not difficult to debunk, but the issue is that many people will read the leaflet and never be exposed to the arguments as to why it is factually incorrect.

The leaflet starts with a series of statements about the rising age of the population, the rising cost of medicines and so forth which are in fact true, though they do not directly support these particular reforms, merely reform in general. It takes a massive logical leap to go from 1) We need reform, + 2) These are reforms, = 3)We need these reforms. It is a fallacy of necessity.

But on with the leaflet. We soon get away from these truths and into very questionable areas indeed, with a whole page devoted to this devastating fact:

"If the NHS was performing at truly world-class levels we would save an extra 5,000 lives from cancer every year."

If that doesn't convince you we need change, what will? Well, it might be a devastating argument if it had any real basis in fact. The source they use to make this claim comes from the British Journal of Cancer, and was published in December 2009. So it comes from a reputable source and is recent, what could possibly be wrong then? The issue here is that the government has used research which was never intended to predict current rates and possible future improvements, the data covers the period from 1985 to 1999. The very latest data included was from 12 years ago!

Since that time the NHS has improved massively, with the NHS Cancer Plan in 2000 having massive impacts. It may be frustrating for politicians trying to make a point, but health data simply does not fit into their ideal of being immediately available for analysis and scrutiny. There are complex epidemiological factors at play, to the point that even studies which they use from late 2009 have to analyse data that is massively out of date. This is why changes in the health service, even if they were desirable, should never be implemented at this speed, it allows no time for scrutiny of impact and could well be harmful.

Other such lies have been dealt with by Ben Goldacre in this article and I shan't waste any more space here going over them again.

Needless to say, it seems very dishonest of the government to deceive people in this way, but what can be done to stop it? John Majors abuse of statistics led to the formation of the Office for National Statistics, perhaps it is time the NHS had its own independent statistics, to stop it being used as a political football.

Clegg's fake 'red lines' for the NHS.

What follows is a master class for all hopeful future politicians. A handy trait to master is the art of talking tough, to ease voters worries, whilst simultaneously bending over backwards to please your superiors and assorted vested interests. To demonstrate this beautifully, step forward the nation's darling, Nick Clegg.

He today wrote to all 56 Liberal Democrat MPs, in what the Independent called "the clearest sign yet of a major coalition schism over the reforms", setting out his five 'red lines' that were non-negotiable in relation to the NHS reform. He said that these amounted to 'substantial changes' to the bill and would save the NHS from privatisation. The rhetoric is strong, but the measures set out as his 'red lines' are pitifully weak. Here's a look at his five 'red lines', and what they actually mean:

1. Competition should be driven by quality, not price. -

This has already been amended in response to BMA lobbing in March. Whilst competition is now not to be explicitly based on price, the competition itself is still being implemented, leaving the NHS open to EU competition law and turning health care into a market. The role of Monitor will remain as a competition enforcer as opposed to regulating Foundation Trusts as it does presently. This first 'red line' therefore has not only already happened, but fails to meet any of the demands of the BMA or RCN who have been so damning in their verdicts on the Health and Social Care Bill.

Verdict - Already happened.

2. Family doctors should not commission services alone. -

Whilst the last 'red line' has already been changed, there was no need to amend the bill to comply with this red line. It was never, ever going to happen. Indeed, one of the issues with the reforms would be that not only would doctors be commissioning services, but that they would likely turn to private providers to help with commissioning. Doctors tend to study medicine in order to help people. If they wanted to commission services they would have taken an accountancy course.

Verdict - Was never going to happen.

3. GP consortia must not go ahead in 2013 if they are not ready. -

Again, this has already been agreed, as seen in the Health Service Journal interview with David Nicholson back in February. It also does nothing to address the issues raised by the prospect of certain areas being run by consortia outside of their local area, thus destroying the primary goal of these reforms.

Verdict - Already happened.

4. The principles of the NHS constitution must be protected. -

This is a very woolly 'red line' at the best of times, without specific examples you can essentially interpret the constitution to fit any set of reforms that might be put forward. Even so, this again is a case of Clegg demanding something that has already happened. It is explicitly mentioned on pages 330, 332, 333, 340, 365, 375, 395 and 402 of the revised bill.

Verdict - Already happened.

5. GPs must work ‘hand in glove’ with councils. -

This is already included in the bill through the inclusion of Health and Wellbeing Boards, which states the many ways in which the consortia will be working closely with the local authority, 'like hand in glove' as Mr Clegg may prefer.

Verdict - Already happened.

So, having actually looked at his 'red lines', which will apparently ensure 'substantial reforms' to the Health and Social Care Bill, we see that he has actually included four things that have already been included and one measure that was never included in the first place. Quite an achievement.

That only serves to show just how impressive it is that Clegg has managed to turn this letter, which adds nothing new, into a statement which newspapers are proclaiming as the Liberal Democrat fightback. He has managed to create a fake difference of opinions, which will no doubt help him in local elections, whilst causing Andrew Lansley no problems whatsoever.

There are many people within the Liberal Democrat party who are anxious to see real changes to the NHS reforms, including those with real influence such as Norman Lamb and Evan Harris, but Nick Clegg is once again folding as easily as a house of cards caught in a tornado.

He has shown himself to be a vacuous salesman, a pawn of the Tory hierarchy, and in doing so has provided an excellent example of how to dupe the British public into believing you are listening to their demands. Here's to hoping he doesn't succeed.

Hat-tip to Health Policy Insight for some links and highlighting the vacuity of his letter.

An NHS in peril.

Readers will doubtless have heard many of these arguments on this blog in the past, but as this post was written for OpTank, I have tried to write the most complete summary of the reforms that I have done to date.

From 'Moral Leadership' to privatisation

In 1944, with the country emerging from a devastating war and crippling debts, Aneurin Bevan was tasked with introducing a health care system fit for a new era of Britain's history, which would treat patients based on need rather than wealth. In July 1948 he unveiled the National Health Service at Park Hospital in Manchester. The institution, he said, gave us 'the moral leadership of the world.'

Aneurin Bevan: Architect of the NHS

62 years later and the National Health Service faces the greatest threat to its existence in its history. Andrew Lansley's reforms may not remove the NHS from our lexicon, but it threatens to take its very soul, leading us on an increasingly rapid path towards a time when the NHS will be nothing but a brand name.

This all seems very melodramatic, but looking closely at the reforms shows that they are not merely a reshuffle of management, nor about cutting bureaucracy, but about a fundamental shift in what the NHS stands for and how it works to achieve those ends.

Forcing Competition into the NHS

For reform which is intended to give much more power to doctors in guiding patient care it is notable that nearly the entirety of the medical profession is united in its opposition to much of this bill. The reason being that whilst GP-led commissioning is welcomed, there is a widely held belief that this portion of the bill is merely a fig leaf to mask its more sinister elements, the elements relating to competition.

Monitor, which currently has the role of regulating foundation trusts, will now regulate competition in the NHS, ensuring that any willing provider is able to tender a bid for NHS services. No longer will Monitor focus on patient care, but will instead focus on enforcing competition, fragmenting well established partnerships at a local level when they are deemed 'anti-competitive', and leaving the patients with a poorer service as a result. NHS services will be at substantial risk of closure as the most profitable parts are cherry picked by private providers.

For those reasons, a recently convened Special Representative Meeting of the British Medical Association passed the following motion:

"That this Meeting believes price competition is a hugely retrograde step and:- i) that price competition in healthcare is damaging; ii) that with scarce resources the prime focus will be on cost and not quality;"

Indeed, that very same meeting passed a range of motions providing a devastating critique of the health reforms. People who watched the meeting will know that the Health Secretary was only spared a vote of no confidence because of the plea of the chairman not to hinder negotiations and lobbying. The motion may not have passed, but be under no illusions, few at that meeting had any confidence in Andrew Lansley whatsoever.

Furthermore, even if the detail of the reforms wasn't hugely dangerous, the pace and scale are mystifying. To enforce a £3 billion top-down reorganisation on the NHS at a time when the organisation is being asked to find further savings of £20 billion to protect services for the future is outrageous and wholly unnecessary.

Lies, damn lies, and Cameron's statistics

The government is of course keen to stress that reform is necessary, that the NHS simply doesn't perform well enough as it stands. Facts, however, would seem to dispute those claims.

Firstly, despite the attempts by the secretary of state to hide the research, it is now known that patient satisfaction with the NHS is at an all-time high. Hardly a sign of an organisation in peril.

Secondly, it seems a new favourite claim of David Cameron that we are performing very badly in preventing and treating both heart disease and cancer. He may be better served by first seeking to understand the meanings and trends behind research before diving into the argument with his own ill-judged opinions.

Whilst we may have higher mortality rates from heart attacks than nations such as France (which is the lowest in Europe) we have seen the greatest reduction in those rates during the past 30 years, and on current trends will have lower rates than France as soon as 2012. All this despite seeing a lower increase in health spending.

Again, with the claims on cancer, the independent King's Fund showed that our survival rates were improving. And comparisons to nations such as Bulgaria neglect to mention the fact that the two nations have very different levels of cancer registry coverage, making comparisons naive at best, and deceitful at worst. Perhaps it is for these reasons that the BMA also passed the motion:

"That this Meeting deplores the government’s use of misleading and inaccurate information to denigrate the NHS, and to justify the Health and Social Care Bill reforms, and believes that:- i) the Health Bill is likely to worsen health outcomes as a result of fragmentation and competition;"

In summary

There are positive elements to this bill, but they are few and far between. GP-led commissioning could be implemented without the need for legislation. It is only now being used as the government hopes to pass through damaging reforms in the name of greater power for patients and doctors. And when those reforms are widely rejected by the BMA, the Royal College of GPs, the Royal College of Nursing, the Kings Fund, UNISON, and even ex-GP, now Conservative MP Sarah Wollaston, it is time for a rethink.

In 1951 Aneurin Bevan resigned from the cabinet over the introduction of a 1 shilling prescription charge introduced to boost the Treasury coffers. Lord knows how he would react were he alive to witness the destruction being rained down on the nation's crown jewel by the lunacy of Andrew Lansley.

In his now oft-used quote, Bevan said that the NHS 'will last as long as there are folk left with the faith to fight for it.' With petitions gathering pace, and demonstrations planned, it is time for the public of England to stand up and show that they still have the faith, and that they will fight for their NHS.

Grey Haired Manky Codger

I'm sure many of my readers may well have already seen this, but I needed to share it. My disgust at Andrew Lansley and his privatisation plans are no secret, so obviously a rap about him and how bad his plans are was always going to be a favourite of mine. No doubt it will be sung many times at the march on the 26th in London.

Doctors harden their stance.

I couldn't make a return to blogging without first talking about the BMA meeting that took place two days ago, where doctors came out against just about every single major part of the Tory Health Bill. I call it the 'Tory' bill because it's now also clear that their partners in coalition object to it as well as everyone in health care.

Here's a selection of the motions that were approved by the meeting:

- That this Meeting believes that the current plans for reform are too extreme and too rushed and will negatively impact on patient care. We call upon the Health Secretary to:- i) call a halt to the proposed top down reorganisation of the NHS; ii) withdraw the Health and Social Care Bill; iii) consider and act on the criticisms and advice from the medical profession that were collected during the White Paper consultation; iv) adopt an approach of evolution not revolution regarding any changes to the NHS in England.

- That this Meeting believes that the proposals in the Health and Social Care Bill were not part of the election manifesto of either of the coalition parties, and calls on the government to accept that:- i) there is no electoral mandate for the introduction of such changes.

- That this Meeting deplores the government’s use of misleading and inaccurate information to denigrate the NHS, and to justify the Health and Social Care Bill reforms, and believes that:- i) the Health Bill is likely to worsen health outcomes as a result of fragmentation and competition.

As well as these more general points, each individual part of the bill was itself dissected and rejected. And whilst the BMA called for the withdrawal to the bill, it stopped short of opposing it in its entireity. However, people watching the meeting online will have noticed this was more of a result of the Chairman's plea to not tie the negotiators hands rather than any particularly good parts of the bill, the proposer of the motion to oppose the entire motion got the loudest standing ovation of the entire day.

Equally, Andrew Lansley was only spared a No Confidence vote because Hamish Meldrum appealed to the meeting and because the Special Representatives would have no more confidence in whomever replaced Andrew Lansley.

Whilst at the time I was disappointed the tone wasn't more strident from the BMA, I now see it has its benefits. The claim from David Cameron that the BMA is 'just another trade union' is frankly laughable in light of this meeting. The debates held were a million miles from the Punch and Judy politics of the House of Commons and despite being baited by politicians who insisted they would ignore the insights of doctors the BMA insisted on continuing to engage.

Frankly, Parliament could learn a lot from the democracy of the BMA. And they should certainly listen when the people who know the NHS the best say that this will destroy it.

P.s. I noticed that a favourite way to claim doctors were onside was to point to the number of GPs who were already involved in pathfinder schemes. I should make it clear to Lansley, these GPs didn't take part because they like the scheme (at least the majority didn't), most did so because PCT's are in meltdown because of these changes and someone needed to step in to fill the gap or patients would suffer. Unlike Lansley, GPs were simply putting patients before ideology.

Lansley promotes sham treatments.

As if destroying the NHS wasn't quite enough to be getting along with, Andrew Lansley has decided to put his neck on the line by defying the EU to help protect the market for Chinese Herbal Remedies. He's getting around the new ruling by the EU by reclassifying 'Herbalists' as authorised healthcare professionals.

I'd suggest that while he's at it he also suggests a name change, from Herbalist to 'Crackpot sellers of magic leaves'. Yes, some traditional medicines do have health benefits, and the ones that do are now 'Medicine'. Anything that falls into 'Alternative Medicine' is there for a reason. It doesn't work.

I suppose that when you're buggering up the NHS it can't do too much more harm to encourage the sale of medicine that doesn't work.

Judgement day for the NHS.

Today is the day that debate starts on Andrew Lansley's 'Privatise the NHS' Bill. It isn't actually called that, but let's call a spade a spade, that's what it is. If this goes through, private companies will not just gain a toe-hold, but a massive foothold. Even the Tory MP and GP Sarah Woolaston likened the bill to 'throwing a grenade into the middle of the NHS'.

David Cameron today tried to sell the reforms by insisting that the NHS isn't good enough as it is, and that it needs reforms to catch up to health care systems around the world. He of course ignores the fact that often the NHS comes out very highly indeed in comparisons of systems, but let's address what he says about us not performing well.

The King's fund, a non-political and highly respected health think tank, say that the case for reform have been 'over-sold'. The figures being used by Cameron and Lansley only go up to diagnoses in 2002, just a year after the Labour government started to really drive up spending on health.

The Conservative's need to play down the success of the NHS, it's the only way they can sell reform. But there facts just do not stack up.

I have written extensively on this, which you can find here. I will leave you with the remarks of the Lancet. Anyone in science will know the high standards of the editorials in the Lancet, and its esteemed reputation. Their blunt analysis is this:

"As it stands, the UK Governments new bill spells the end of the NHS."

Save the NHS

I've written so much about the disastrous reorganisation plan of Andrew Lansley that it has its own section on here, but yet more misery has been piled on the Health Secretary as yet another big voice in health care has come out against him. This time it's the NHS Confederation, which encompasses the RCGP, the BMA and the Faculty of Public Health.

The voices expressing doubt about the reforms are getting ever louder, with the latest report calling the reform 'extremely risky', and warning it will mean the closure of hospitals and the reduction of NHS care. Rarely is the NHS as united as it currently is against these reforms, yet still he pushes them through without even a glance at the ever-growing list of detractors.

The problem facing those who criticise the reforms is that they are already being implemented, it is not something that will come down to a single vote as was the case with tuition fees. GP's are already taking over commissioning responsibility, and unless the campaign applies some serious pressure these reforms could be pushed through by stealth before anyone has a chance to oppose them.

The next big sting for Lansley is likely to come on Tuesday, when a Health Select committee will report on the reforms, and the whispers are that they aren't exactly providing a ringing endorsement. How much longer can Lansley really keep going in the face of so much criticism? Word is that Cameron is now casting a personal eye over the reforms after they've picked up such criticism, and Tory bloggers seem to think Lansley is one of the most likely to be moved on in the next cabinet reshuffle. But by then, it may be too late.

That's why campaigns that have started up, by the like of 38 degrees, need to start being much more aggresive in speaking out, and need to do so quickly.

Lansley: Now his own MPs are challenging him.

It must be a lonely life for the health secretary right now. He thought he had a beautiful vision for the NHS, full of lollipops and rainbows. But since he spelt it out few have come to applaud him, and many have begun lining up to criticise. 

Running a rogue department, now even fellow Tories are getting nervy.

First in line were the major public sector unions, then the BMA, the Royal College of GPs, the Royal College of Nursing, as well as the new head of the RCGP. All of them came out to criticise the plans, and often in dramatic terms. Now, one of his own MPs, who also worked as a GP, joined in the criticism, saying that 'to avoid privatisation of the NHS, he must change course.'

An important part of the reforms that she mentions, and which hasn't been discussed in detail as yet, are the new competition laws being forced upon the NHS. No longer will your GP be able to refer you to an NHS hospital without first getting a quote off private providers. As I'd imagine there are few GPs around who are up to speed on EU competition law, you can safely assume that they won't fancy being dragged in front of a court to explain why they fell foul of the competition laws. To save the hassle they will hand over the power to experienced private companies, who are more than comfortable with taking the risk.

This isn't hypothetical, it's already happening with the Great Western Commisioning Consortium of Ealing, who recently tendered out responsibility over patient referral to United Healthcare, a large private health care multinational, who will have no qualms about denying the NHS services in favour of private competitors.

As well as this, it is safe to assume that new private companies will be happy to run loss-leader services to undercut the NHS and get a foothold in the new system, whilst driving NHS services into the ground and forcing them to close.

I'll let Sarah Wollaston, the Tory MP, have the last word:

"If commissioners cannot design care pathways free from the spectre of lawsuits from private providers, they will hand over to commercial commissioners prepared to take the rap. If those private commissioners turn to private providers at the expense of NHS providers, then my e-mailer [who asked if the NHS was being privatised] might not have been so wide of the mark after all."

Get a grip Andrew.

Mental health care takes a blow.

First we were told we'd have no more structural reorganisations, before being presented with the biggest reorganisation in the NHS's 62 year history. Then we were told that the NHS would be protected, that it would receive an increase in cash, before it turned out it would have a real terms cut. He even signed a petition to reopen a local cardiac centre in opposition, before changing his mind when he was the one with the power to do so. 

The biggest threat to the NHS in its history?

Now, the country's most incompetent minister (possibly bar Nick Clegg) is at it again, scrapping the pledge to put mental and physical illness on a more even keel, and in doing so letting down millions around the country with mental health issues. We currently spend less than 2% of the total health research budget on mental illnesses, a figure that was set to rise to 11% of the total under a 2009 Labour strategy.

But despite promising to treat mental and physical illness equally, Lansley has decided to scrap the initiative, with no sign of any new strategy forthcoming. The health secretary, it would seem, is comfortable with the idea that only 2% of research funding will go to mental health care. Yet another balls up from him and his rogue department.

There's a great piece on it in the Independent, here.

Hackers, Fees and Morons.

Haven't really got the time away from work at the moment to right a long, rambling blog to fit in with the many other similar posts around here, so instead I'll just write a little bit on a lot of the stories floating around.

Julian Assange Arrested -

Well, this wasn't exactly unexpected, I doubt he'll even get extradited, never mind sentenced, and all in all it doesn't matter one jot to the future of WikiLeaks as an organisation. The charges bought against him have already been laughed out of court once in Sweden, and there doesn't seem to be any new evidence since then. The only reason this has come back to the surface is some busy body politician in Sweden has had a quick word with a smaller court and they've decided to reopen it.

I'd like to think that our judicial system is more robust than that and so won't cave in to the massive political pressure to extradite him. As I said though, even were he to be charged this would make no difference. As of right now, WikiLeaks is much stronger than just one man, who is essentially now just a front man. He acts as a lightening rod whilst the thousands of other journalists and cyber-geniuses at WikiLeaks get on with releasing the rest of the leaked cables. It's strange to think we've got so much information so far and we're not even up to the 1,000 mark out of 250,000 cables.

It'd also be interesting, to put it very mildly, if he did get charged and WikiLeaks decided to release the passcode for the 'insurance file' they uploaded. I dare say there's likely to be some pretty explosive stuff in there.

Tuition Fees come to a head -

Tomorrow's the big day, the tuition fees vote. I expect it to go through, but we can only hope that more MPs see sense between now and then. Only a moron like Clegg could claim that slashing HE funding by 80% and then trebling fees is in some way 'progressive'. he then dismisses a Graduate Tax as 'unworkable', without a seconds pause for thought. It has far more going for it than the plans currently on the table.

Yes, some people will pay less under these new proposals, but the majority will pay more. And this funding isn't upping the money that goes to universities, the fees coming out of students pockets is just being used to plug the gaping hole left by the withdrawal of government cash. For the large number of people on middle incomes, too rich to get support, but too poor to quickly pay off loans without incurring interest, then these proposals will hit you hard. Very hard.

And the idea that all is well because you only start paying back at £21,000 is complete tosh as well. Although they made it slightly better today by making the amount rise with inflation, the fact remains that by the time the plans come into effect that £21,000 will be worth less than £18,000 in today's money because of inflation. Hardly a massive jump is it.

The Lib Dems have a choice, be loyal to the Tories, or be loyal to students and loyal to their word. Only a No vote is acceptable, abstaining is not nearly enough.

Lansley completes his collection -

My favourite figure Andrew Lansley has succeeded in completing his collection, after his plans were trashed by his own side, following of course the objections from GPs, the BMA, Health Workers and many others in the profession. The Tory chair of the Health Select Comittee has already warned him about the pace and scale of his reforms, and now a figure from within No. 10 has told the Financial Times:

"Andrew [Lansley] has all the answers when he is asked the questions about how the implementation of all this will work. We're just not sure they are the right ones.” Ouch.

Another hit to health reform.

It's been nearly a week without a post, many apologies for that, it's not that I've been particularly busy but just that I didn't feel like posting. So for the return I thought it's time to revisit my old favourite subject... How much of an idiot Andrew Lansley is and his attempts to break down the NHS.

You probably won't have noticed it in the news, (good news about the NHS never seems to be given a lot of airtime or print space) but yet again the NHS has been found to be one of the best health care systems in the world. This time for its access to healthcare and in terms of efficiency. You'd never believe it from all the hype you hear about over-paid executives from the right-wing press, but yes, the NHS is one of the most efficient systems with its money.

So, after news like that you'd expect maybe a well done for all the hard work from the health secretary right? Maybe a little pride in one of the nations favourite and best-performing institutions? No sir, not from Andrew Lansley. All you got from him was moaning about how bad the NHS performed in other areas (with some very dubious claims) and an insistence that only his reforms could help mend the system. I really don't get why this man is in charge of something he clearly loathes.

No-one ever claimed the NHS is perfect, because no health care system in the world is perfect. But to just brush off any praise and insist on focussing purely on negatives is a ridiculous stance for a man in charge of our health.

And now onto the latest in a long series of high profile criticisms of his planned reforms, which I've previously wrote about not once, or even twice, but a fair few times now. (I can't help it if people keep adding their names to the 'Andrew Lansley is an idiot' fan club)

The new head of the Royal College of GPs, a distinguished doctor who has helped massively improve health in deprived areas, has herself come out against the reforms, saying (amongst other more detailed criticisms) that:

"I think it is the end of the NHS as we currently know it, which is a national, unified health service, with central policies and central planning, in the way that (Aneurin) Bevan imagined."

Bearing in mind that his plans are supposed to be about giving GPs the power they so desperately crave to help patients without the interference of 'evil' PCTs, isn't a bit bizarre to Lansley that the RCGP and its leader have both now come out with damning attacks? What will it take for him to see that he is in fact a lunatic with a plan that no-one wants?

There is negligible support within the health care profession for these reforms. The fact that Lansley promised no more 'top-down reorganisations' seems to have been lost in the carnage of the multitude of other broken coalition promises, with Lansley's plans being the mother of all top-down reorganisations. It could cost over £3bn on a risky reorganisation at a time when the NHS is being told to save money, it makes no sense whatsoever.

It makes me sad that someone so stupid can be in such a position of power over something the country and I love so much. If Cameron has even one brain cell to share out amongst the cabinet, please lend it to Lansley for a while.

Edit: This seriously annoyed me when I read it just after originally posting. The current chief executive has said that any staff who oppose the reorganisation should offer their resignations as they will be a 'drag' on the health service in transition. Absolutely outrageous. I'd suggest the only person who should be offering their resignation any time soon is David Nicholson for such an arrogant statement which shows such disdain for the opinions of those working in the NHS.

He has to go, it's that simple. You cannot insult the personal views of so many of your workforce, suggesting they leave for disagreeing with you and expect to remain in a job.

Letting emotion rule the roost.

Sometimes in Medicine people let their hearts overrule their heads, and it inevitably ends up hurting patients. I have a feeling that this is exactly what's happened with the decision to take away the power from NICE to decide which drugs should be paid for on the NHS. Instead we'll have a postcode lottery, with a real probability of money being wasted on popularist treatments that aren't actually as effective at what they do and drain money away from where it is really needed.

I've written before about how NICE gets undeserved scorn from some areas of the press, and perhaps that's inevitable given that their job involves denying the funding of drugs to patients. But the fact of the matter that while people might not think it in good taste to look at aspects of health care from a cost-effectiveness point of view, that is what you have to do when there isn't a limitless budget. You have to prioritise treatments, and that means that some people will inevitably lose out. All you can do is make sure the smallest amount of people lose the smallest amount possible. In fact, despite it's reputation for negative decisions, NICE has approved 83% of all new treatments it's had to consider funding.

You don't have to look far to see that people won't always be able to see what the best treatments will be for themselves. The very fact that the NHS spends £4 million a year on Homeopathy, a treatment which has been thoroughly debunked and shown to have no positive effect beyond that of a placebo, is proof enough that people will happily shell out hard cash for worthless treatments.

That is why NICE is so essential, it takes out the political and business influence from something that should be purely based on rigorous clinical assessment of its cost/benefit. Of course government's are going to want to provide the drugs that give the most positive headlines, and the pharmaceutical companies are going to want to claim every drug they produce is worth spending fortunes on, but we can't let those vested interests get in the way of giving patients the best care we can with the funds available.

We shouldn't give in to the powerful lobbying of the big pharma companies, who will benefit massively from this new supposed 'value-based pricing' which will take out the ability of an independent body to just say no to these companies. When you have a body that can simply say no, this isn't worth the price you're charging, it forces pharma to up their game and provide value for money.

Of course, this isn't the only time I've suggested reform of pharmaceutical companies, and it's not that I want to damage them, but I think reform is needed so that they serve he patients interests before they serve their stockholders.

If you want to see what happens when pharma holds all the cards and claims that this is in the interests of the patients, then look to the USA. Admittedly, their problems run deeper than simply the drugs companies, but they are a major reason why their health care costs have increased exponentially since the 1980's, to the point they pay the most per capita anywhere in the world. Yet, for all this money being spent on the top drugs, they have some of the worst health outcomes of any developed country. Lots of money spent on health care is only beneficial if it's targeted in the right areas.

Andrew Lansley is playing political games with the NHS, and so far its fallen on unsympathetic ears from all areas of health care. This is the latest in a long line of failures. Let's keep providing money for treatments that are shown to work, and provide the best care possible. Let's keep NICE.

The Great American Health Care Joke

Turns out that a good number of American's really will never know what's good for them, or at least be made that way by some of the more bizarre parts of their media. (On another note, check out the top of FOX News' website. Under the badge their slogan is 'Fair and Balanced'. Akin to the Daily Mail saying 'We don't hate immigrants)

I'm talking about that demon of the right, American health care reform. Reform that doesn't go half of the way to taking the country up to the standards of the rest of the developed world, but at least its a start. So you'd have thought people would support helping even out the horrendous inequalities in their system and helping money go to the patients care rather than the insurance companies, but no, the majority hate that idea. 55% of them support repealing the whole thing, and 6% aren't sure.

In a commonwealth fund study (that compares Australia, New Zealand, Canada, Holland, Germany, the UK and the US) the US came bottom overall, and either bottom or second bottom in every single measure. All this despite spending by far the most money on its health care system in the world. (Interestingly, the UK spent the second least, and came 2nd, despite some seeming intent on slagging off the NHS)

So, for the most amount of money of any country spending on health care, they get a system that's not as good, not as effective, and leaves millions of people without any cover whatsoever. They're simply left to their illness. It's frightening.

You can't leave your health to the mercy of the markets, these insurance company's have no desire to help people beyond the point that they can make money out of them, and when it's a matter of life and death that's just not good enough. In the same way a I advocated for reform of drug companies to take away the demons of profiteering, American's need to accept that to have a civilised health care system you need to share the burden between everyone. If you leave it up to people then obviously they won't want to be on the same policy as someone who is ill and will cost them money, but that's the way it has to be so that no matter who you are or what you earn, your life is considered worth saving.

So, we can only hope that this new fad of going to the courts to overturn the law in 20 states will die out, and that over time people will see that it really is in the interests of everyone to share the burden of health care.

Poor Neglected Blog

I've neglected this blog for a while, maybe a reason why I lost two followers recently (which shouldn't have bothered me, but you know, its like friends on Facebook, it may be narcissistic but you always want more). So, spurred on by the return of Liam's blog I'm going to try and return to my heyday, which means I waste time here rather than on iPlayer.

So instead of jumping in with a long rambling post, here's some tidbits of what's happened on all kinds of different subjects that I was mean enough not to give my opinion on at the time:

Comprehensive Spending Review

Obviously, I had to include this in here briefly. In short, it was a shambles, a dangerous gamble by a ragtag government where half are intent on helping their pals by shrinking the state and the other half, well, the other half are Lib Dem's. The less said about them the better.

What's frankly scary and hilarious at the same time is that Osborne and Clegg can claim that these cuts are 'fair and progressive', a claim it took the IFS less than 24 hours to completely debunk, not exactly watertight. The only way Osborne has been able to claim that this CSR and his budget were fair and progressive were by including measures that Labour introduced in Darling's budget! The pure cheek of the man claiming that his budget is fair on the back of changes that they scathed at the time. I can't remember much support from the Tories for the 50% tax rate or the supposed 'Jobs Tax'.

Then you learn that the budget hits families twice as hard as banks, hits women far harder than men, will weaken the incentive's for people to work, and other than the top 2% of earners those who lose the most of their income are the poorest 10% of people. How is that fair? How is that progressive?

Football

Well, I should start with Blackpool, who were frankly robbed of a victory against City at the weekend, though I suppose that's the way it goes in football sometimes. We played as well as I've seen all season, better even than at Liverpool, but just couldn't make it count. (Though a wrongly disallowed goal and a goal that shouldn't have stood for them doesn't help) If we can carry on like that all season though, we'll be fine. The test comes after January, if we can keep up the standards and if we have enough strength in depth to keep plugging along to the end.

And the other big football story, Wayne Rooney. He has now apparently signed a new deal with United, after a messy and silly tiff he seemed to have going on. To claim that Manchester United didn't have enough ambition was silly and to not show a little more respect to a manager who protected him from so much in his time was plain rude. Yes, United may have lost some big names without bringing in equally big names, but that isn't how they operate, and I don't doubt for a second Alex Ferguson's ability to spot young talent and keep his club challenging at the top end of the table for years to come. (But for this year the league is Chelsea's to lose)

Also, if you want comedy gold mixed with an incisive football mind, look no further than Ian Holloway.

Jamie Oliver

Recently, I've been watching quite a lot of Jamie Oliver's stuff on 4od, starting with his new documentary on the American Food Revolution, it really is great. I was never really that much of a fan when I wasn't exaclty sure what he did, but he's taking on a massive problem (no pun intended) in obesity and doing remarkably well.

The things that are served as school dinners are disgraceful (not just in America) and its no wonder that obesity is now the biggest killer in the western world. Our diets aren't fit for purpose and it takes a strong man to take them on. Whatever you think of his techniques, you can't deny that his ambitions come from a good place and if not his way, then how?

Illusions on iPlayer

A while ago I mentioned some really interesting things that had been on Horizon about essentially bringing people back from the dead. They've got another great one out now about how our eyes, ears and even touch don't always tell us the truth about what's going on, and about how that's not necessarily a bad thing.

Worth a watch if for nothing more than getting to have a go at a lot of pretty cool illusions.

(You may have noticed I've gone a little more link crazy than normal. I just thought it'd make it a little more credible if I showed you where I got some of my stuff from and that it isn't all made up baloney.)

Lining up to stop Lansley

Remember how I said last time that I liked being backed up on how bad this NHS reform is? Well, happy days for me because since then another two unions have come out against the proposals. Considering they were supposed to be about giving clinical staff more powers, doesn't it seem odd that they're lining up to criticise them?

Now it's not only the Royal College of GP's who've said it would amount to 'the break up of the NHS', but the British Medical Association and the Royal College of Nursing standing against the speed and scale of the change. A change that isn't needed and will waste billions of pounds at a time when resources are already stretched!

The BMA said this: 'The insistence on a market-based approach risks fragmentation, inefficiency and increased transaction costs.’ whilst the RCN plumped for this, 'we are concerned that flexible local implementation of the reforms could result in the development of unacceptable regional variations in access to services or quality of care.'

Oh, and of course, put that on top of the fact that UNISON are taking the reforms to court because they haven't been consulted on them and you have not a single voice in support.

Now, to any normal person, being told you're wrong by the collective wisdom of GP's, Nurses, Doctor's and other healthcare workers would seem pretty damning and you'd radically change your ideas to keep them happy. After all, they're the ones on the front line of the service that you need to keep on side for it to work.

Oh no, not when you're Andrew Lansley and the world's biggest jackass. His response? 'Health Secretary Andrew Lansley, who will address the Conservative Party conference on Tuesday, has rejected the criticisms, arguing reform of the NHS is a necessity.'

Oh well, if you say so, after all you know best right, better than all those people who've worked there day in and day out for most of their lives. Idiot. He harps on about how the people who know how best to sort out the health system are the ones who work in it, but then completely ignores them when they all stand shoulder to shoulder to tell him his idea is pants.

I wish he'd stop with his crazy crusade to break up the NHS, people like it the way it is, leave it alone man!

Back from the Dead

This is about Horizon from last night, it had some incredible stuff, definitely worth an iPlayer visit if you like what you read.

Humans are very intricate machines, but that means we're also very sensitive to change. In terms of temperature, we vary very little from our standard 37 degrees celsius. If we dropped 1 degree it would be painful, about four or five and you'd feel pretty woozy before passing out. Stay there, and you'd die. Which makes it all the more strange that a woman whose core temperature fell to 14 degrees, a drop of 23, managed to survive for around 2 hours with no heart beat. She had no pumping blood, no breathing, not even any signs of brain activity. By any conventional measure she was dead. But a few months later she was alive, exactly as healthy as she was before.

Now is it just me in my little nerdy medical school bubble that thinks that's pretty cool?

It was precisely because she was so much colder than she should have been that she survived. Without blood the brain would usually starve and die irreversibly, but she was so cold that the brain stopped functioning before it had a chance to starve. It essentially went into hibernation, ready to be warmed back up again. As soon as she started getting heat back, her heart started beating and her brain started again. She wasn't back to normal in a day, or even a week, but the fact she recovered at all is incredible enough.

That might have just been sheer luck, but now hospitals can use the same principle to operate on people who would otherwise have been consigned to death. They can stop the blood flow without starving the organs, something you can't do any other way.

With the patient on the operating table they cool them down to around 18 degrees by taking out the warm blood, passing it through a freezing heart lung machine, and putting it back in. Then, slightly less high tech, they surround them with ice packs. They can then shut down the heart lung machine, have no pumping blood getting in the way, but rather than the patient dying in a matter of seconds, they have about an hour in which to work. Obviously, they can't push the window much further because no-one is going to risk a patient just to prove a point.

Then there's the even more exciting use for the idea. Most young deaths are caused by trauma, and in trauma cases (hit by a car, stabbings etc.) there's a very short amount of time to help someone before its too late. But what if you could give someone an extra hour, how much more help could you get then?

When you get to A&E for a very serious case and you're heart isn't beating, one of the things they may well do is open up your chest to massage your heart. Some doctors figured, whilst we're in there, why not infuse the blood with freezing cold saline to drop their body temperature rapidly. If they could preserve the brain for long enough, they'd have more chance to repair the damage. In an environment where every second counts, having an extra hour would be worth more than words could say. Millions of people could be saved.

Then just as if we hadn't had enough, there was what for me showed the future of medicine. People always say its genetics and I'm sure that will transform it, but this could be huge. Its just an idea at the moment, but when its fleshed out it could be incredible.

A researcher showed that cells don't automatically die when starved, they die once they start getting oxygen again because they can no longer perform their old job. Once a cell becomes useless it essentially commits suicide. Now this works well in the human body, keeping us refreshed, but obviously if too many cells decide enough's enough at the same time then you're in trouble.

What this guy found is that a certain part of the cell, the mitochondria, controls the cell death, and it might be able to be interfered with. If you could stop the cell committing suicide, you could essentially put someone into limbo, giving you enough time to repair them. The exciting thing would be, if this could be given as some form of injection or infusion, you'd have no need to be in an operating room to be frozen. You could get to a stage where paramedics in the field could hit the pause button on you and whizz you back to the hospital without you dying a little more every second.

If you can stop cells dying, the possibilities for how you could use it in medicine are truly endless. Survival rates for all sorts of things would rocket immediately. Death wouldn't be inevitable in any situation. We're not even close to having it ready right now. But at least we know its a possibility, and one day we might make it.