Election 2010: Health

[Andyhsufc]

So, for the first of the election debates, I thought we could start with that essential service that is the NHS.

Labour have trebled health spending since they have come to power but has that money been well spent? Are targets a way of guaranteeing standards of care or do they damage standards of care?

The Conservatives are promising even more choice about where you have your treatment but is this important to you? They are also promising that they won't cut health spending but is this wise in the current Economic climate?

And the Lib Dems are promising local health boards; are they a good way of keeping care local or just another layer of bureaucracy?

 

[osymandus]

Im for the local health care boards... if they are staffed by either ex front-line or current working medical staff , and you remove the layers of bureaucracy .
A health service is not a business it does not need to be run to targets or goals in the sense that has been copied from the economic systems.

And people who are good at facts and figures should never decide the treatment of other's

 

[Pubey]

Im for the local health care boards... if they are staffed by either ex front-line or current working medical staff , and you remove the layers of bureaucracy .
A health service is not a business it does not need to be run to targets or goals in the sense that has been copied from the economic systems.

And people who are good at facts and figures should never decide the treatment of other's

People who are 'good at facts and figures' don't decide treatments, that decision is always made by the patient and clinician. As a health economist I suppose I'm what you're referring to. We look to make sure that policy and treatments are only available if they have been proven to be both clinically effective as well as cost-effective.

With a fixed budget to work from, and literally millions of treatment options, difficult decisions have to be made.

I don't know what makes the Lib Dem's Local Health Care Boards different to our current Specialist Commissioning Boards.

Medical staff should only be one part of the component of a commissioning board. Economists, managers, service users and a range of 'front-line' staff should be involved so that there is buy-in across the board, and that value for money is ensured.

 

[Rusty Shackleford]

So, for the first of the election debates, I thought we could start with that essential service that is the NHS.

The provision of healthcare services is essential. The NHS isn't.

 

[osymandus]

People who are 'good at facts and figures' don't decide treatments, that decision is always made by the patient and clinician. As a health economist I suppose I'm what you're referring to. We look to make sure that policy and treatments are only available if they have been proven to be both clinically effective as well as cost-effective.

With a fixed budget to work from, and literally millions of treatment options, difficult decisions have to be made.

I don't know what makes the Lib Dem's Local Health Care Boards different to our current Specialist Commissioning Boards.

Medical staff should only be one part of the component of a commissioning board. Economists, managers, service users and a range of 'front-line' staff should be involved so that there is buy-in across the board, and that value for money is ensured.

Actually im not . I know head nurse in a ward in Southend . its the intermediate managers at the "coal face" chasing and interoperating the policy possibly defined by you guys . They are pushed to ensure the targets come before the paintents treatment . The economic part only exists because it became (and again beyond teh scope of your position and hospitals) profitable market niche.

My point is it should be worked in such away as the market is de-constructed . Then those difficult decisions would become a lot easier not driven by a market force but a medical need. Why service users ? Why not patients. Its as bad as saying end users ;)

 

[Rusty Shackleford]

Actually im not . I know head nurse in a ward in Southend . its teh intermdiate managers at the "coal front" chasing and interoperating the policy possibly defined by you guys . They are pushed to ensure the targets come before the paintents treatment . The economic part only exist's because it became (and again beyond teh scope of your position and hospitals) profitable market niche.

My point is it should be worked in such away as the market is de-constructed . Then those difficult decsisions would become alot easier not driven by a market force but a medical need. Why service users ? Why not patients. Its as bad as saying end users ;)

You sure do know a lot of people fella. And the expression you're looking for is 'coalface'.

 

[osymandus]

You sure do know a lot of people fella. And the expression you're looking for is 'coalface'.

Yeah i found that the other day , im bloody knackered keeping up with them all ;)
Thanks edited .

 

[Pubey]

Actually im not . I know head nurse in a ward in Southend . its teh intermdiate managers at the "coal front" chasing and interoperating the policy possibly defined by you guys . They are pushed to ensure the targets come before the paintents treatment . The economic part only exist's because it became (and again beyond teh scope of your position and hospitals) profitable market niche.

My point is it should be worked in such away as the market is de-constructed . Then those difficult decsisions would become alot easier not driven by a market force but a medical need. Why service users ? Why not patients. Its as bad as saying end users ;)

I know a nurse in a ward in Southend too... in fact I probably know about 40. I'm not sure what your point is. Yes there are obvious problems where a department is struggling to meet their 18WT (or any target), and perhaps there are cases where the care provided for a service user patient is not ideal. However the 18WT has been successful in massively reducing average waiting times for treatment. Plenty of the resistance to 'Targets' is based on anecdotal evidence just like yours.

Rationing, for want of a better word, isn't due to profiteering, as you claim. It's completely fundamental when demand exceeds supply. Someone has to decide what to use when:

Drug A is better than Drug B
Drug A is better and more costly than Drug B

Q: Could a clinician alone, a manager, or even a Local Board make that decision?

A: Maybe, however what you end up with is decent and well managed hospitals offering the best care, but other hospitals not able to. Then you get the Daily Mail saying how Mrs P can get Drug X, but Mrs Q lives 2 miles down the road but can't get Drug X. We then don't have a universal NHS any more - and there isn't equal access/choice for all.

I don't understand what "My point is it should be worked in such away as the market is de-constructed . Then those difficult decsisions would become alot easier not driven by a market force but a medical need." means.

The NHS is currently raped by the pharma market. The proportion of the NHS's budget that is spend on drugs has been consistently increasing in the past 20 years, as well as the total NHS budget increasing. At some point this has to stop. It's likely that the NHS is going to have its budget cut, and the so called bureaucrats/intermediate managers are going to be required to ensure that the best level of care is provided across the whole service. Leave it to clinicians, or 'medical decisions' and your budget would have been spent by May! They (rightly) aren't interested about anything else other than the patient in their care, which is why they aren't budget-holders

 

[osymandus]

I know a nurse in a ward in Southend too... in fact I probably know about 40. I'm not sure what your point is. Yes there are obvious problems where a department is struggling to meet their 18WT (or any target), and perhaps there are cases where the care provided for a service user patient is not ideal. However the 18WT has been successful in massively reducing average waiting times for treatment. Plenty of the resistance to 'Targets' is based on anecdotal evidence just like yours.

Rationing, for want of a better word, isn't due to profiteering, as you claim. It's completely fundamental when demand exceeds supply. Someone has to decide what to use when:

Drug A is better than Drug B
Drug A is better and more costly than Drug B

Q: Could a clinician alone, a manager, or even a Local Board make that decision?

A: Maybe, however what you end up with is decent and well managed hospitals offering the best care, but other hospitals not able to. Then you get the Daily Mail saying how Mrs P can get Drug X, but Mrs Q lives 2 miles down the road but can't get Drug X. We then don't have a universal NHS any more - and there isn't equal access/choice for all.

I don't understand what "My point is it should be worked in such away as the market is de-constructed . Then those difficult decsisions would become alot easier not driven by a market force but a medical need." means.

The NHS is currently raped by the pharma market. The proportion of the NHS's budget that is spend on drugs has been consistently increasing in the past 20 years, as well as the total NHS budget increasing. At some point this has to stop. It's likely that the NHS is going to have its budget cut, and the so called bureaucrats/intermediate managers are going to be required to ensure that the best level of care is provided across the whole service. Leave it to clinicians, or 'medical decisions' and your budget would have been spent by May! They (rightly) aren't interested about anything else other than the patient in their care, which is why they aren't budget-holders

Should have said the Ward nurse in charge of the Acute unit ;) You should know my brain doesn't work properly here i had the whole thing typed in my brain sadly it stayed there .

The first part of your last point , far better states mine so im stealing it.
However your next part highlights the issue i stated , the budget frame work. It was lifted lock stock and barrel from a system that is concernced with making and defining profit and loss . Commoderties not peoples.

So in your first point its not the fact that anyone of these informed people could make the decision , its why the system makes them .

If the Pharmo's are raping the arse off not just our NHS (and this is a Rhetorical question), that means the whole thing needs reconstructing , and the value of items be secondary to teh value of individuals ?

Though how you can say Rationing, for want of a better word, isn't due to profiteering, as you claim. It's completely fundamental when demand exceeds supply. Someone has to decide what to use when:

And then admit one of the fundamental suppliers of the health care industry (the Pharmos , though i will add the IT sector's and medical technology companies as well), and claim its supply and demand , which is controlled by the Pharmo's is not profiteering on their part seems a little odd ?

 

[Pubey]

And then admit one of the fundamental suppliers of the health care industry (the Pharmos , though i will add the IT sector's and medical technology companies as well), and claim its supply and demand , which is controlled by the Pharmo's is not profiteering on their part seems a little odd ?

yeah of course pharma (and other private suppliers) are profiteering. They have the NHS over a barrel... and the pressure from many angles (patients, patient groups, government and pharma) means that other areas of the NHS have been ignored.

 

[osymandus]

Also while fair enough wait times are reduced but would this not have happened with more clinical staffing levels ?

And while efficiency is increased paitent care as reported by patients to the surveys and their reports (which is also anecdotal , as are all reports per sa) has decreased.

 

[Rusty Shackleford]

yeah of course pharma (and other private suppliers) are profiteering. They have the NHS over a barrel... and the pressure from many angles (patients, patient groups, government and pharma) means that other areas of the NHS have been ignored.

Don't you think that companies who develop products that save people's lives are entitled to make some cheddar from their efforts?

 

[osymandus]

yeah of course pharma (and other private suppliers) are profiteering. They have the NHS over a barrel... and the pressure from many angles (patients, patient groups, government and pharma) means that other areas of the NHS have been ignored.

I think this reflects more on the attitude as a society we have to wards teh idea of health care that probably needs closer scrutiny . I wasn't having a pop at your role . And After having to do some research also for my late fathers condition . Its populist issues that get the money (Types of Cancers over Neurological conditions ).

I dont envy anyone doing the job (or NICE even), it just seemed its another part that needs refinement and change as well as our government.

 

[osymandus]

Don't you think that companies who develop products that save people's lives are entitled to make some cheddar from their efforts?

That's the rub of it . If they are how much ? Can they really hold people to ransom for a profit margin , or do they have a responsibility to help their society for smaller gains ?

 

[Rusty Shackleford]

That's the rub of it . If they are how much ? Can they really hold people to ransom for a profit margin , or do they have a responsibility to help their society for smaller gains ?

A private enterprise has no responsibility to society. Pharmaceutical companies will only continue to develop miraculous cures if there's something in it for them. Why shouldn't genius be rewarded?

 

[Napster]

Let's get something in perspective. Pharmas spend cash and time developing drugs. Very few molecules make it to market. Those that do are copied and produced within seven years. Of course they should benefit from the risk they undertake in the R&D stage, and when the patents run out. Maybe an alternative sees them donate a % of the profit to charities etc...

 

[canveyshrimper]

A private enterprise has no responsibility to society. Pharmaceutical companies will only continue to develop miraculous cures if there's something in it for them. Why shouldn't genius be rewarded?

Particularly if they can stop beagle pups from smoking 20 Capstan Full Strength a day.

 

[osymandus]

A private enterprise has no responsibility to society. Pharmaceutical companies will only continue to develop miraculous cures if there's something in it for them. Why shouldn't genius be rewarded?

Well ask Nikolai Tesla, Albert Enstien , and all the others that one , very few genus appear to operate for finacial reasons (thats where the JP Morgans of teh world came into it).

Its a nice idea in theory yet the enterprise won't exist without society , it would just be its founder with a really good idea but no physical outlet. Their fellow citizens (or plebs) are the resources just as much as any manufacturing commodity ?

 

[osymandus]

Let's get something in perspective. Pharmas spend cash and time developing drugs. Very few molecules make it to market. Those that do are copied and produced within seven years. Of course they should benefit from the risk they undertake in the R&D stage, and when the patents run out. Maybe an alternative sees them donate a % of the profit to charities etc...

I agree. However like any market leaders some have cornered and manipulate (not just Pharm's). We're not talking a destruction of a free market here just a sensible balance.

 

[Rusty Shackleford]

I agree. However like any market leaders some have cornered and manipulate (not just Pharm's). We're not talking a destruction of a free market here just a sensible balance.

The free market is the only sensible balance that exists. Once governments and special interests enter the fray, sense goes out of the window.