Tag: "NHS"

Update on “The Envy of the World”

That’s how the Labour Party for years described the British National Health Service.

Eleven NHS trusts were put into “special measures” after an investigation found thousands of patients died needlessly because of poor care…

Inspectors visited 21 hospitals, run by 14 NHS trusts, which had the highest recent mortality rates in England. They found that some of the risks to patients were so severe that they were forced to step in immediately.

During the visits, decisions were taken urgently to close operating theatres, suspend unsafe “out of hours” services for critically ill patients, order changes to staffing levels and to force hospitals to tackle major backlogs of scans and X-rays that had gone unexamined…

Figures showed up to 13,000 excess deaths since 2005 at the 14 trusts investigated, advisers to the review said. (More from The Telegraph)

Privatizing Primary Care in Britain

The problem:

Two thirds of the U.K.’s National Health Service patients have to wait more than 48 hours for a doctor’s appointment and few slots are available outside regular work week hours.

The solution:

A private doctor’s surgery…is attracting thousands of patients who have given up on the [NHS]. Open seven days a week, usually until 11pm, the clinic gives half-hour appointments, which is three times longer than usual. Despite charging £70 ($109) a visit, it already has almost 6,000 Britons on its books. Customers are welcomed into the spotless and modern center by friendly receptionists whose motto is to “put patients first.” (Daily Policy Digest/Daily Mail)

Use of NHS Liverpool Care Pathway Expanded to Kill Children

In a disturbing article, The Daily Mail reports that NHS hospitals now put children on the Liverpool Care Pathway, withholding food and fluids from young patients and severely disabled newborns. Critics say that it is impossible to say when a patient will die. Using the Liverpool Care Pathway makes death become a self-fulfilling prophecy.

Should People Who Cause Their Own Illnesses Pay for Their Own Health Care?

David Friedman weighs in:

I recently came across a news story about a British legislator who proposed that patients suffering from life style illnesses, medical problems mainly due to behavioral choices such as being overweight, ought to have to pay for their own medicines rather than having them provided for free by the National Health Service. It is a proposal that I expect will provoke strong responses both against and for…

[I]t is not clear just how the logic of endogenous disability can be dealt with in a governmental system such as the National Health Service. There is a serious problem of lack of bright lines. Many sufferers from type 2 diabetes, an example mentioned in the news story, may have it because they choose to be greatly overweight, but presumably not all. Similarly in other cases.

Okay, commenters. What do you think?

British Woman Denied Life Saving Drug, Even Though It’s Free

This is from the Daily Telegraph, courtesy of David Henderson:

A 29-year-old woman will die without a new drug that the NHS is refusing to provide despite the manufacturer offering it to her for free, it emerged today.

Caroline Cassin, 29, who suffers from Cystic Fibrosis (CF) has been offered a new drug free of charge for a limited period by the makers but her NHS hospital is refusing.

Her family says she will die soon without it, yet managers at Heartlands Hospital in Birmingham say it would be unethical to provide the drug under the deal, only for it to be withdrawn later.

The drug, Kalydeco also known as ivacaftor, costs £182,000 per patient per year, and works for five per cent of people with CF who have a certain defective gene, around 270 people in England.

The Latest From The Economist on The “Envy Of The World”

  • The NHS is preoccupied by austerity: it must find £20 billion (about $30 billion) worth of efficiency savings by 2015.
  • Further, the health service is still reeling from a failed central-computer project that has ended up costing over £12 billion (almost $19 billion).
  • Most importantly, innovations do not spread in Britain’s health sector because the NHS has no mechanism for ensuring they do, or for rewarding the inventive.
  • The service is centrally funded and emphasizes the universality of its care rather than its results.
  • As a result, the system is likely to prove better at controlling costs than at encouraging good ideas to thrive.
  • Additionally, because hospitals do not directly compete with one another (nor are they allowed to acquire one another unless they are in dire financial straits), PICS [which reduces errors and mortality] is not likely to be unilaterally adopted by other institutions.

More on the British National health service in The Economist.

Charge: Britain is Allowing Thousands of Seniors to Die Prematurely

NHS doctors are prematurely ending the lives of thousands of elderly hospital patients because they are difficult to manage or to free up beds, a senior consultant claimed yesterday…

Professor Patrick Pullicino said doctors had turned the use of a controversial “death pathway” into the equivalent of euthanasia of the elderly. [T]he Liverpool Care Pathway [LCP], a method of looking after terminally ill patients that is used in hospitals across the country…can include withdrawal of treatment — including the provision of water and nourishment by tube — and on average brings a patient to death in 33 hours…There are around 450,000 deaths in Britain each year of people who are in hospital or under NHS care. Around 29 percent — 130,000 — are of patients who were on the LCP…

Professor Pullicino claimed that far too often elderly patients who could live longer are placed on the LCP and it had now become an “assisted death pathway rather than a care pathway.”

Source: Daily Mail.Thanks to Linda Gorman for the pointer.

Health IT Spending Is Not Working in Britain

The National Programme for IT in the National Health Service was launched in 2002 with a 2010 goal of providing every NHS patient with his very own electronic medical record. Yet in its most recent report, the British National Audit Office states that the Department of Health there has been a:

steady reduction in value delivered not matched by a reduction in costs. On this basis we conclude that the £2.7 billion spent on care records systems so far does not represent value for money, and we do not find grounds for confidence that the remaining planned spend of £4.3 billion will be different.

As in the U.S., the system was sold with claims that it would improve services and the quality of care. In fact, many of the proposed applications, like internet appointment scheduling, electronic prescribing, computerized order entry in hospitals, and a secure organizational broadband communications network are already in use, without government subsidy, in the U.S.

Price Controls Create Drug Shortages in Britain

In February, the Financial Times reported that, Britain’s Royal Surrey Hospital made £300,000 in profits last year by buying £4,600,000 of prescription drugs at prices arranged by the British government [gated, but registration is free] and then exporting them to foreign buyers. European Union laws make this practice perfectly legal, and the recent weakness of the pound against the Euro means that a drug sold at negotiated prices in England can fetch much more in Germany.

One in 10 UK pharmacies is arbitraging drugs and by May an estimated £40 million in drugs destined for the NHS were being diverted every month. Because manufacturers allocate supplies according to the price paid, shortages have developed in the treatment of cancer, high blood pressure, epilepsy, asthma, osteoporosis, and high cholesterol — despite official promises that “patients must come before profits.”

Worrisome Lessons from Britain

Paying for private consultation has cost Jenny Whitehead her place on the National Health Service (NHS) surgical waiting list. A NHS spokesman said that “Anyone who chooses to pay for a private outpatient consultation cannot receive NHS treatment unless they are then referred on to an NHS pathway by their consultant.”

In 2008, the NHS tried to deny all care to cancer patients who paid for drugs not offered by the health service. The government said that it had ordered the NHS to stop withdrawing care from people who paid privately for unobtainable drugs or treatments.