Monday, December 17, 2007

The world certainly is wondering...

A couple of stories about the Wonder of the WorldTM that is the NHS. The first involves NICE, which assesses whether treatments provide "value for money" and thus whether they can be administered on the NHS.

And an apparently very effective and non-invasive prostate cancer treatment will now not be available.
A life-saving treatment will be denied to tens of thousands of victims of Britain's most common male cancer after a U-turn by the NHS rationing body.

The groundbreaking ultrasound therapy has been shown to kill nine out of 10 prostate tumours, and five years after treatment, 80 per cent of patients show no sign of the cancer recurring.

Compared with surgery or conventional radiotherapy treatment, it is not invasive and is far less likely to lead to devastating side effects such as impotence or incontinence.

The UK's most prevalent cancer among men, prostate cancer kills 10,000 a year, with 35,000 more cases diagnosed annually. A third of men over 50 contract it.

Primary care trusts have so far been slow to foot the bill for the treatment, which is one-off but costs about £13,000.

This amount compares with £3,000 for radiotherapy, which takes six weeks, and £5,000 for surgery.

It is understood that Nice, which has refused to comment on its new guidelines, will rule that there is insufficient evidence to prove that Hifu has long-term value.

The U-turn comes despite the research published last month in the European Journal of Urology which found that eight out of 10 men were healthy five years after being treated with Hifu.

Fucking brilliant, eh? Measures to combat male cancers are appallingly funded in general; although there are, for instance, regular cancer screenings for women—indeed, smear tests and breast checks are positively encouraged—there are, in general, few such programmes for men.

Indeed, information in general is far less easy to come by: any of you guys out there know what symptoms you should be looking for in regards to testicular or prostate cancer? And have you seen loads of people wearing natty pink ribbons for Prostate Cancer Awareness Week?

The real problem, as Timmy points out, is the way in which the NHS works.
You get what you’re given in a Stalinist system, not what you might want nor what might actually be good for you.

Of course, if you think that this is a bot shit, you could either take out private medical insurance (my near top-of-the-range package currently costs £46.79 per month, although that will increase with age) or you could scrape together £13,000 yourself (sell those shares, increase your mortgage, take out a loan, whatever); after all, what can possibly be more important than your life?

But you had better get rather more than £13,000, because you are going to have to pay for everything.
A WOMAN will be denied free National Health Service treatment for breast cancer if she seeks to improve her chances by paying privately for an additional drug.

Colette Mills, a former nurse, has been told that if she attempts to top up her treatment privately, she will have to foot the entire £10,000 bill for her drugs and care. The bizarre threat stems from the refusal by the government to let patients pay for additional drugs that are not prescribed on the NHS.

Ministers say it is unfair on patients who cannot afford such top-up drugs and that it will create a two-tier NHS. It is thought thousands of patients suffer as a result of the policy.

The Department of Health said: “Co-payments would risk creating a two-tier health service and be in direct contravention with the principles and values of the NHS.”

Thousands of patients suffer? Thousands of patients suffer? Don't you mean that thousands of patients die (I think that we might as well use the plain words here), sacrificed on the alter of equality? Truly, we are ruled by a fine body of people, are we not?

I think that Ministers should be congratulated on defending their principles to the death, don't you? Sure, it's other people's fucking deaths but—hey!—they're only fucking proles, after all.

Again, as Timmy says, this is the ethos of the NHS laid out for all to see.
Better that she die rather than use her own money to live: equality is all.

You've got to love the state-run NHS, eh? It's so good to see that the fucking politicos who are in charge of the entire system have got their priorities right: the political ideal of equality is far more important than actually saving lives.

What a bunch of fucks.


Dr De'Ath said...


I agree, NICE are utter wankers,

It is ludicrous that clinicians do not have more flexibility to treat things differently, however then the Daily Mail starts going on about the 'postcode' lottery!

It would be sensible to allow expensive treatments to be topped up by patients, unfortunately this is far too sensible for the cretins at the DoH

Vicola said...

Bet things would look very different if the politicians and top brass from NICE were forced to use the NHS instead of having top flight BUPA packages.

Tomrat247 said...

Dr. De'ath,

It is far too sensible for the cretinous DoH for the simple reason that it exposes the categorically shambolic way in which the NHS was run.

Many moons ago I withdrew from a PhD in chemistry due to personal reasons; due to the need for money, being newly married and part supporting my wife through her teacher training I got a job temping for the NHS touchtyping patient notes in an oncology department. It was bank work - processing several hours of dictated notes a day into cogent letters for GP's, patients, other specialists etc.

After 3 months of work there (and 2 extensions to my original month long contract) I was told it was likely I would keep my job temping as long as I would need it (I was that useful - my boss' words). In discussions with an SpR I had quite a good working relationship with I was told in their weekly clinic meetings that many of the doctors suspected that I worked for the daily mail and was doing an expose' on the inner workings of the NHS! We both laughed about this, I explained what had happened and she seemed happy with my explanation. This entire event for me was shocking on 2 levels:
1. It was very, very flattering; I had developed quite low self esteem at that point.
2. The standard of my work (e.g.: the ability to write up simple but comprehensive dictation) was considered above normal for the standard administrative assistant in the department; so much so that I must have had a hidden agenda to want to do my job effectively.

It is this mindset that the NHS has which is completely wrong and has been pointed out in the second point - no one expects the achieve the utmost and so treat it with disdain when people attempt initiative.

On another note: it doesn't surprise me about the NHS's reaction to HIFU - a lot of cancer treatments strike me as quite barbaric (a medical response for cancer in many cases is to mutilate, poison or irradiate you!) HIFU and radio frequency ablation, a similar concept in treatment involve quite delicate, expensive work which is a paradigm shift in cancer treatment (I'm aware that cancer treatment is getting better, but the standards are still quite barbaric - look at Doxorubicin side-effects and mode of action for example.) How do they work out the cost analysis of these things anyway? It almost seems like they dont take into account long term savings sometimes.

Roger Thornhill said...

This goes beyond the problem of monopoly.

The denial of treatment to the lady is nothing short of vindictive - she is being made an example of "pour encourager les autres".

Imagine how long a PCT would keep customers if it had to compete over the same geography with a PCT that did not act in such a fascist way?

Umbongo said...

Wait a few days and, if the fuss doesn't die down, Mrs Mills will be accused of racism* : always the trump card in the Labour pack.

*or maybe climate change heresy

verity said...

The NHS should not exist.

There is no reason for it.

For the premiums paid in, you could be comprehensive private insurance where the provider is responsible to you, the customer, not dog vomit like Labour apparachiks.

The premiums could stay the same and they would still be compulsory, but the salary-earner could direct them to go to a health care insurer nominated by him, not Gordon Brown.

When the customer has the whip hand, treatments are not "denied" on grounds of Sovietesque "equality".

Rob said...

So, here's the state of play, she has two options:

(1) Spend her own money to 'top up' her treatment. This is obviously wrong and she must be punished by having to pay for all of the 'care'.

(2) Spend the top-up money on booze, fags or other drugs. This is perfectly fine and she now can receive for free the 'part treatment' promised by the NHS, at sometime within the next three years or just before she dies, whichever is the latter.

Socialism, no system has ever been so designed to grind people into pathetic dependency and uselessness.

the a&e charge nurse said...

Fucking hell, can't you lot do any better than blame "socialism" whenever there is a divergence of opinion about treatment options [yes, I know it's the panto season but this kneejerk response is akin to shouting he's behind you every five minutes].

Why is it that the NHS is depicted as a monolith whenever it refuses to embrace flavour of the month when it comes to cancer treatment[s] ?

Look at the litany of 'golden bullets' and 'miracle cures' that were proved to be of limited value in the long run, not just for cancer, but for many other conditions as well.

Here's a little challenge for the marketeers [if any of you are really interested in clinical issues, rather than just bleating about imaginary bogey men] - then go to "bestbets" website [via google] type cancer into the search menu [or trauma, or heart disease, or anaethetics, etc, etc].
Tell me how black and white these endless questions, and treatment options are.

It's very simple either we [as a society] prefer a relatively inexpensive [when compared to many parts of Europe, and certainly the USA], equittable, and [relatively] comprehensive service, or we let the insurance bureaucrats, and profiteers determine, who is entitled to what, on the basis of
ability to pay.

Consider this, if you were HIV+ back in 1985, the NHS still looked after you [as best they could back then] but UK insurance companies wouldn't go near you with a barge pole, why is that ?

Devil's Kitchen said...

A&E C/N,

Can't you address the case in hand and stop trying to distract everyone with spurious "marketeer" insults? It makes you no better than those who cry "socialism" constantly.

Should Mrs Mills (who was a nurse, for what it's worth) be allowed to pay for the extra drugs herself -- no one is asking the NHS to pay for the Avastin, only for what it was originally going to pay for -- or not?

If not, why not?

Second, to address your point: "Consider this, if you were HIV+ back in 1985, the NHS still looked after you [as best they could back then] but UK insurance companies wouldn't go near you with a barge pole, why is that ?"

Because nobody is going to give you insurance once you are already ill: that isn't insurance, is it? No. That's a begging bowl and it's not how insurance companies work.

That is how charities work, A&E; they deal with those who beg. Insurance companies deal with those who take out policies before they become ill, not after.

Even your beloved NHS -- which is, at least notionally, funded by National Insurance premiums -- works that way. You pay in a large amount, probably many, many years before you actually need to use it, on the basis that one day you will need it. In the meantime, your premiums are paying for the treatment of those who are ill now.

And for fuck's sake, THE US SYSTEM IS NOT THE ONLY INSURANCE SYSTEM AROUND. I am getting slightly tired of pointing out that almost every system in the Western world provides better outcomes than the NHS and not one, not one of them, operates like the NHS with the state as both payer and provider.

Yes, they are expensive, but most people don't mind spending the extra money to make sure that they get the treatment that they need: after all, you can't take the cash with you when your tumour metastases. That is why I currently spend an extra £47 per month on private medical insurance as well as paying my compulsory NI.

The difference between paying into a private insurance fund and paying yet more money to the state is that I know what my policy covers, in detail. I know how much I pay and what I pay for. If the insurance company breaks the contract I can sue them. None of this is applicable to the government which is free to break its contract at any time (and effectively often does).


the a&e charge nurse said...

Devil - I hope you have the read the fine print of your health policy [assuming you have the time and energy] - although not everybody will be as meticulous, which can be a bit of a drag when it comes to arguing the toss with some bureaucrat at the end of a phone about what treatment you are actually entitled to.

I'll give you one little example, an elderly woman falls, fractures her hip, and ends up in A&E [having been brought in by ambulance, of course].
The first thing she starts sreaming about is not morphine, but a private bed [and she hasn't even had an x/ray yet] - sadly, her policy does not include retreival to transport her to a private hospital.

Remember, retrieval is not always straight forward, perhaps she fell because she'd had a small heart attack, or was on warfarin and was now developing a significant haemorrhage - these issues all involve decisions about medical management, potential liability if she arrests en route, etc, etc.

Anyway, what a depressing thought, insurance companies aren't interested in you when you are actually ill - lets hope these companies don't find out about the many thousands of people with yet to be diagnosed conditions, such as hypertension, evolving tumours, mental health problems, type II diabetes, and of course HIV, Hep B or C, [>200,000 cases of hep C infection in the UK, incidentally].

The bit that is really important about the NHS is that contributions are put to the common good, and [in theory] decisions are based on clinical need rather ability to pay - when people rubbish NICE it's usually on the basis that this organisation is too dim to appreciate what the average Daily Mail reader is able to see, that the latest drug, or treatment is fucking brilliant, and has aleady been in use in the States/France/Germany/Switzerland, etc for donkeys years.

But don't worry too much, the momemtum is increasingly with those who believe that greater plurality will result in better health services [in short, the NHS is being dismantled].

Maybe the insurers and private providers will be better, then again maybe they won't - but which ever way the mop flops there will ALWAYS be heartbreaking stories, such as the situation Colette Mills finds herself in - it's just that the resons for ordinary people being fucked over will be slightly different, thats all.