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George Jung
01-18-2014, 11:24 PM
Cal Thomas: The NHS: Dogma vs. experience






(http://journalstar.com/news/opinion/editorial/columnists/article_89834ed4-8d36-5e7c-ada9-1aef4e8ad3fe.html)

(http://journalstar.com/news/opinion/editorial/columnists/article_89834ed4-8d36-5e7c-ada9-1aef4e8ad3fe.html)
















BELFAST, Northern Ireland -- While the Obama administration offers life support to its Affordable Care Act, in the UK a growing number of people are asking whether it's time to pull the plug on the National Health Service (NHS), which is in critical condition.
For many years the UK media have carried stories that not only bode ill for the future of government-run health care, but also continue to serve as a "code blue" warning to the U.S. as to what might be in our future if we decide to go down that road.
Writing in The Daily Telegraph under the headline, "It's time to make difficult decisions about the NHS," columnist Judith Woods says, "The NHS, dying on its feet for decades, is in a critical state. The promised injection of cash may stabilize it temporarily, but the chances of a full recovery are nil."
She is not alone.
A headline in The Guardian, declares the NHS "on the brink of extinction."
While in America there are concerns about an insufficient number of younger people signing up for Obamacare, in the UK among the latest causes for concern is a plan that the Guardian writes "...would only see new drugs licensed for NHS if judged to be a benefit to wider society."
Does this sound like a close relative of eugenics? Let us not talk of "death panels," or should we? In the UK, the National Institute for Health and Care Excellence decides whether new medicines should be approved. Might it someday also come down to some official deciding who gets treatment and who doesn't? Changing the name of the decision-making entity doesn't alter the intent, or the outcome.
Already, according to the Daily Mail, citing a report by the European Commission (EC), "Britain has fewer doctors per person than nearly all other European countries." There are just 2.71 doctors for every 1,000 people. The EC reports the UK ranked "24th out of 27 countries in the EU, behind some of the poorest countries, including Bulgaria, Estonia and Latvia." General practitioners are paid 1,500 pounds (about $2,500) a shift to cover nights and weekends in overburdened ERs. Can one see this crisis looming on America's horizon as the current supply of doctors proves inadequate to treat a flood of new Obamacare patients?
What's more, stories about incompetence and corruption within the NHS, once the exception, are now common. "Blood donors turned away by clinics' incompetence," says a headline in the Daily Mail.
The NHS was supposed to reduce the number of people who seek treatment in emergency rooms. Instead, the BBC reports, some patients visit them as many as four times a week. Citing data from 183 sites obtained under the Freedom of Information Act, BBC News writes, "...nearly 12,000 people made more than 10 visits to the same unit in 2012-13. A small number of those -- just over 150 -- attended more than 50 times." The same has proven true for Obamacare. Obama said that coverage would result in fewer ER visits, when in fact studies already show that the newly covered are visiting ERs more frequently.
An editorial in The Daily Telegraph says, "The NHS is cursed by a devotion to dogma." People have come to expect "free" care and the cost of "free" is breaking the system. The editorial recommends everyone visiting a GP should be required to pay 10 pounds ($16) to "discourage those with minor ailments" from making a trip to the ER.
Dr. Mark Porter, chairman of the council at the British Medical Association, has said that if the NHS were a country, it would barely have a credit rating. He warns: "A growing and aging population, public health problems like obesity, and constant advances in treatment and technology are all contributing to push NHS costs well above general inflation."
If the NHS can't be sustained in the UK, why would anyone believe an American experience will be different? The ACA, of course, is not nationalized health care (people pay insurance premiums, after all) but some think it could evolve into that.
If it's a question of dogma vs. experience, experience should prevail. The UK experience with nationalized health care can teach America something.









I suspect this is bloviating - but curious if our Island friends can illuminate this a bit.

Gerarddm
01-19-2014, 01:43 AM
I am always suspicious of any argument that postulates that just because something is X over there, then of course it must ( must! ) be X over here ​in the future.

Peerie Maa
01-19-2014, 09:24 AM
When government holds the purse strings each government will apply its dogma, and meddle with the running of the service in accordance with what that dogma tells them.
We have had the imposition of targets, the imposition of "trusts" between the hospital and government ( a great method of allowing the cutting of funding by government and then laying the blame for subsequent failure away from the holder of the purse strings and onto the trust management). The trusts naturally put yet another layer of managers in place, whose salaries have to be paid for. The drive to meet targets when there is less money for first line care causes the cutting of corners, etc.

There are a lot of issues there.
Patients using A&E is driven by the way funding and employment contracts for GP's was changed, with the effect that they are less available out of hours. So people go to A&E as it is always open.

National Institute for Health and Care Excellence was mentioned, read about them here: http://www.nice.org.uk/

At the end of the day, as with any system it is down to affordability, and in our case civil servants and politicians inability to do joined up thinking.

This might be of interest, it's a big file though: http://www.nhs.uk/NHSEngland/bruce-keogh-review/Documents/outcomes/keogh-review-final-report.pdf
Its summary states:

Although all 14 trusts face a different set of circumstances, pressures and challenges ahead, this review has also been able to identify some common themes or barriers to delivering high quality care which I believe are highly relevant to wider NHS.

These include::

the limited understanding of how important and how simple it can be to genuinely listen to the views of patients and staff and engage them in how to improve services. For example, we know from academic research that there is a strong correlation between the extent to which staff feel engaged and mortality rates;

the capability of hospital boards and leadership to use data to drive quality improvement. This is compounded by how difficult it is to access data which is held in a fragmented way across the system. Between 2000 and 2008, the NHS was rightly focused on rebuilding capacity and improving access after decades of neglect. The key issue was not whether people were dying in our hospitals avoidably, but that they were dying whilst waiting for treatment. Having rebuilt capacity and improved access, it was then possible to introduce a much more systematic focus on quality. But more clearly needs to be done to equip boards with the necessary skills to grip the quality agenda;

the complexity of using and interpreting aggregate measures of mortality, including HSMR and SHMI. The fact that the use of these two different measures of mortality to determine which trusts to review generated two completely different lists of outlier trusts illustrates this point. However tempting it may be, it is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths. Robert Francis himself said, ‘it is in my view misleading and a potential misuse of the figures to extrapolate from them a conclusion that any particular number, or range of numbers of deaths were caused or contributed to by inadequate care’;

the fact that some hospital trusts are operating in geographical, professional or academic isolation. As we’ve seen with the 14 trusts, this can lead to difficulties in recruiting enough high quality staff, and an over-reliance on locums and agency staff;

the lack of value and support being given to frontline clinicians, particularly junior nurses and doctors. Their constant interaction with patients and their natural innovative tendencies means they are likely to be the best champions for patients and their energy must be tapped not sapped;

and the imbalance that exists around the use of transparency for the purpose of accountability and blame rather than support and improvement. Unless there is a change in mind set then the transparency agenda will fail to fulfil its fullpotential. Some boards use data simply for reassurance, rather than the forensic, sometimes uncomfortable, pursuit of improvement.

Tom Hunter
01-19-2014, 09:54 AM
Judith Woods article calls for reform, not an end to NHS.
The full headline of the Guardian article is: “The NHS is on the brink of extinction – we need to shout about itGovernment policy and privatisation mean the NHS as we know it will be gone in as little as five years if no one speaks up”

I was not able to source the Guardian quote, but the NHS does have a drug review process and they will not cover drugs they do not consider cost effective. Sometimes this is controversial because of patient impacts, for example they did not approve a drug that granted 4 months of life (on average) to prostate cancer patients at a cost of $90,000 dollars http://www.theguardian.com/society/2012/feb/02/cancer-drug-too-expensive-nhs There are also cases where they fail to approve treatments and drugs that do not work any better than current treatments but cost much more. Those get used in the US, and cost us money for nothing. Cal Thomas uses the word “might” when he wants you to believe the British will start doing terrible things to themselves. It’s unlikely that they will.

There is a lot of sloppy thinking in the piece, for example: Already, according to the Daily Mail, citing a report by the European Commission (EC), "Britain has fewer doctors per person than nearly all other European countries." There are just 2.71 doctors for every 1,000 people. The EC reports the UK ranked "24th out of 27 countries in the EU, behind some of the poorest countries, including Bulgaria, Estonia and Latvia." General practitioners are paid 1,500 pounds (about $2,500) a shift to cover nights and weekends in overburdened ERs. Can one see this crisis looming on America's horizon as the current supply of doctors proves inadequate to treat a flood of new Obamacare patients?

According to Thomas Britian has a doctor shortage so is unable to treat all the people in Britian. He goes on to show that America has a doctor shortage too. He does not seem able to understand that we have a doctor shortage with or without Obamacare.

Thomas asks: “If the NHS can't be sustained in the UK, why would anyone believe an American experience will be different?” Because America is not Britain, and Obamacare is not the NHS is a pretty obvious answer.
His whole piece is laden with sloppy thinking and some very selective use of quotes.

George Jung
01-19-2014, 10:16 AM
Thanks for the replies and insights. Cal Thomas isn't one of my 'shining lights' in terms of objective reporting, but thought the thesis of his piece worthy of some attention. I hadn't realized NHS in the UK was experiencing any turmoil. The middleman effect is everywhere, I suppose, just dressed up differently.

skuthorp
01-19-2014, 10:19 AM
The present conservative government here is making noises about our alterations to national health insurance scheme and the subsidised drug scheme at the behest of the US. It's ideological of course, but even now electorally unacceptable.

George Jung
01-19-2014, 10:22 AM
'...at the behest of the US...' - what's that?

skuthorp
01-19-2014, 10:26 AM
"Secret' trade agreement, involves medical drugs, patent extentions, corporations being able to sue for loss of 'future profits' caused by say environmental and health legislation. Plain cigarette packaging comes to mind.
http://www.smh.com.au/federal-politics/political-news/coalition-blocks-senate-from-secret-details-of-transpacific-partnership-trade-deal-20131208-2yzh2.html

George Jung
01-19-2014, 11:00 AM
Disheartening. So.... why is your govt. doing 'kissy kissy' with the USA on this? Is this tit/tat on some other issues?

oznabrag
01-19-2014, 11:30 AM
"Secret' trade agreement, involves medical drugs, patent extentions, corporations being able to sue for loss of 'future profits' caused by say environmental and health legislation. Plain cigarette packaging comes to mind.


My question is, at what point do the mass of people recognize these people for the blood enemies they are?

Keith Wilson
01-19-2014, 12:18 PM
A little data: The UK spends 9.3% of GDP on health care. Everyone is covered. The US spends 17.9% of GDP. (Source (http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS)) If the UK spent on health care at the US rate, it would amount to about $3300 US additional per year for every man, woman, and child in the islands.

George Jung
01-19-2014, 02:38 PM
I apologize for introducing 'drift' into my own thread; but tangentially, it's connected. In SD (just north of us), the cowboys aren't nearly as independent and free as they'd like us all to believe.

http://www.argusleader.com/article/20140119/NEWS/301190022/Legislature-Support-builds-stronger-oversight-insurance
"
"Three bills introduced by Gov. Dennis Daugaard’s administration that would enhance consumer protections in the insurance industry are known unofficially as the, “You’re kidding me bills.”

The name originates from consumers who learned that the state’s Division of Insurance lacks the legal authority to stop companies from engaging in unfair claims practices and does not have the authority to fine a company unless it agrees to be fined.

The division’s primary mission is to protect consumers from so-called “bad actors” in the industry, but by its own admission, the division is severely hamstrung.
Three governors in the past 20 years have tried to enact unfair claims laws in South Dakota based on model legislation from the National Association of Insurance Commissioners — a version of which almost every other state has adopted. The five attempts from 1994 to 2008 met fierce resistance from the insurance industry, and lawmakers rejected each effort"

Sorry its not highlighted - the forum is acting wacky for me.

But it comes down to - who are your elected representatives working for? I lived in SD - and I can tell you, it's not for the citizens. Most folks don't pay attention.