Junkfood Science: Looking before we leap

June 28, 2007

Looking before we leap

Healthcare news from England has been copious this past week but, oddly, virtually none of it has made its way onto our news despite its relevance for us. Instead, our media seems to be presenting us with a single portrait of nationalized healthcare in England — an idyllic one, where no one is ever denied care or ever waits, everything is free, there is plenty of money and no shortages, and everyone is healthier than us because the healthcare is better. Anytime we hear only one story, it’s time to do some investigating.

As healthcare professionals, many of us know many intelligent and caring doctors and nurses in the UK whom we tremendously respect and correspond with regularly, and there’s a generous exchange of medical research and ideas. We all recognize the value of information. It can help us ensure our patients get the best care possible. Without questioning things, digging deep for the facts, and exploring all sides we can’t hope to reach sound conclusions.

The same goes for considering whether to abandon our entire healthcare system for one like the UK’s. There are very different realities coming from healthcare professionals working in the UK, as well as from the British media, than we're hearing. Let’s look at a few of those stories for ourselves.

Sunday, the Observer reported that efforts to cut costs were leaving increasing numbers of their most vulnerable citizens being neglected and suffering:

We have discovered that an insidious kind of rationing is happening in England and Wales, more covert - and in some senses more cruel - than the kind we read about when an expensive cancer drug is not prescribed by the NHS. It is a rationing that involves not giving baths to frail elderly people who are unable to clean themselves, cutting back on the daily visits from care staff, closing day centres, not visiting homes to ensure they have the right medication. No dramatic headlines perhaps, but home care is a lifeline for thousands of old people.

Nearly 160,000 households occupied by pensioners have stopped receiving the care they need from social services in the past decade - a tide of neglect that will have long-term consequences for the whole country. As local authorities' budgets have come under pressure, the eligibility criteria that an older person has to meet to receive free care have been made so restrictive that in many areas only someone who is dangerously ill will be given support....

A few weeks ago, the Telegraph reported that “Cancer survival rates worst in western Europe.” These were the findings of the European Society for Medical Oncology (ESMO) Guidelines Working Group, published in the Annals of Oncology:

British cancer patients are substantially more likely to die of the disease than those in other western European countries because of poor access to the latest drugs, according to an authoritative report to be published today....While more than half of patients in France, Spain, Germany and Italy have access to new treatments provided since 1985, the proportion in the UK is four out of 10....They found that the proportions of female cancer patients surviving five years beyond diagnosis in France, Spain, Germany, Italy were 71 percent, 64 percent, 63 percent and 63 percent respectively. In the UK it was 53 percent.

This confirmed the report of the Commonwealth Fund's International Working Group on Quality Indicators which found cancer survival rates were lowest in the UK and patients had the longest waits for elective surgery. “Roughly 40 percent of cancer patients never get to see an oncology specialist. Delays in receiving treatment are often so long that nearly 20 percent of colon cancer cases considered treatable when first diagnosed are incurable by the time treatment is finally offered,” Michael Tanner of the Cato Institute wrote in the Detoit News. And say what we might about pharmaceutical companies, they save lives, too. “U.S. companies have developed half of all the major new medicines introduced worldwide during the past 20 years,” said Tanner. “In fact, Americans played a key role in 80 percent of the most important medical advances of the past 30 years.”

Medical News Today reported that the number of women having abortions since 2005 has risen to the highest levels ever. According to Anne Weyman, chief executive for the Family Planning Association:

[This] isn’t surprising given that contraceptive services are in crisis and at their lowest point for many years. Services are being cut and clinics are closing up and down the country. In England, the average amount spent on each woman's contraception is about eleven pounds. Some Primary Care Trusts have admitted they spend just 18 pence. This is unbelievable and wouldn't be tolerated if it happened in another part of healthcare. Women get blamed for irresponsible behaviour - when the real cause is Primary Care Trusts neglecting their duty to provide comprehensive contraceptive services....

Yesterday, the Telegraph reported on a new Healthcare Commission report finding that a stunning one in four NHS hospital systems had failed to comply with basic hygiene standards:

A Healthcare Commission report shows 99 of 394 healthcare trusts admitted to failing to have adequate infection control, safely decontaminate reusable medical equipment or keep their facilities clean....The proportion failing to meet the required standards on ensuring reusable medical devices are properly decontaminated was 14.3 per cent, up from 12.6 per cent in 2005-06. Katherine Murphy, of the Patients' Association, said: “We are killing more people with C. difficile than on our roads. The death toll with MRSA is equivalent to two train crashes every week.These are avoidable infections. Every week there is a different priority for the Government. Infection control has never been given a high priority."

Anna Walker, the chief executive of the Healthcare Commission, said she believed the drop in the three hygiene-related standards was because trusts were monitoring the issue more rigorously than before. She said: “There is greater clarity about what is required of trusts and, secondly, they know the spotlight is on this issue and they are looking at it more thoroughly. From the point of view of patients that is a good thing."

Today, the Scottish News reported on new patient waiting time goals:

Health secretary Nicola Sturgeon has pledged to bring in a new waiting times target for patients as part of an NHS action plan....would include a target of patients being treated within 18 weeks of being referred to more specialist care by their GP. Currently patients wait up to 18 weeks from seeing a consultant for treatment. But they can still wait up to 26 weeks for a specialist appointment after being referred by their GP, although this is to be reduced to a maximum of 18 weeks at the end of this year.

On Monday, the Guardian reported on a new study just released by the British Medical Association finding that the public was as unhappy with the NHS reforms over the past ten years, as was the medical profession. Apparently, some of the controversy is on the issue of charging for services due to limited resources, something the BMA opposes, but consumers are finding preferable to long waits and limited services.

[O]nly 34% of the public thought a decade of reform had made the NHS any better, while 42% thought there had been no improvement. Against this background of apparent public discontent, doctors will today mount a full-scale attack on NHS reforms, accusing the government of “contemptuous disregard" for the views of the profession and of introducing changes “that are not fit for purpose and are damaging to medicine and healthcare in the UK."

The survey results run counter to most of those commissioned by the government and the official watchdog, the Healthcare Commission, which have traditionally found most patients are happy with their doctors and the treatment they receive on the NHS. Vivienne Nathanson, head of science and ethics at the BMA, said the survey “reflects a big difference of opinion between the government, patients and doctors".

The findings of the survey of around 1,000 members of the public in England, questioned on the street, generally reinforced the views of doctors - but there was divergence on the issue of charges in the NHS. The BMA is adamantly opposed to any charges, but 53% of the public thought there was a case for a small charge for some services where resources are limited.

The Times reported last month that annual spending on the NHS has increased to $184 billion (in U.S. dollars) and “health outcomes have improved, although not as dramatically as the injection of funds would suggest.” But it accompanied news of rationing of services and cost containment measures, as well as problems with red tape and higher taxes.

While we envision a government-run healthcare system that’s more streamlined, with less bureaucracy and waste, a BBC News story illustrated the skyrocketing growth of the National Health Service bureaucracy: [doctors and nurses are the bottom two lines; managers and consultants are at the top]

It’s hard for Americans to get a complete picture of what things are like. The perspectives of medical professionals working in the British healthcare system can help. It also helps to understand the history of their system. Dr. Satyajit Bhattacharya, a doctor working in the NHS, wrote an overview ten years ago in the Indian Journal of Medical Ethics. While the NHS set out with goals to “provide an adequate and comprehensive healthcare system, available to all citizens, funded from taxation, and free at the point of delivery,” the cash supply versus demand had reached crisis proportions by 1987, he reported. He outlined the multiple reforms which ensued, as well as their effects on the:

· medical infrastructure (Hospital systems are now independent trusts and many in the red, resulting in “cutting down on what they perceive as non-essential services,” he wrote. “Closure of wards and in some instances casualty departments has led to increasing demands on the existing beds and facilities, with longer waiting times for patients.”)

· medical practice (Medical practice has been compromised, he wrote, exampling discontinuation of elective surgeries, expensive drugs, and even hospitals refusing to admit any patients over age 75.)

· research (“Research funding is one of the first casualties of healthcare penny- pinching,” he wrote. “This was predicted, and has already begun to happen.”)

· morale (Efforts to downsize the workforce as a means of economizing has “led to job losses, increasing workloads and a severe crisis in morale and a growing sense of insecurity.”)

He concluded: “A demoralized workforce of health workers and a disgruntled population who view their NHS in a poor light cannot be reassured by the utterances of a paternalistic government, or by the sight of growing numbers of managers grappling with unbalanceable budgets.”

An article entitled “Low Morale in the British National Health Service” in a 1999 issue of the Journal of Public Health Policy verified the morale problems. How are things today?

For that, we can go to nurses who always know the inside scoop. :)

Nurses for Reform is an organization of nurses in Britain and Europe that’s devoted itself to helping improve the healthcare systems there. In their mission statement, they say they believe in telling the truth and that only by putting patients and consumers’ interests first will healthcare improve. In 1948, the British government had promised them that the NHS would provide all medical, dental and nursing care and it would be free for everyone. Yet, after sixty years of attempting to make socialized medicine work, they said, the NHS is in a perilous state.

Helen Evans, the director of Nurses for Reform, wrote an impassioned article this week for Americans, imploring us to actually investigate Britain’s experience with state-sponsored medical care before we head down the road they’ve already traveled. She wrote:

[F]or free hospital care, Britons pay an awfully high price. Just ask the nearly 1 million British patients on waiting lists for treatment. Or the 200,000 Britons currently waiting merely to get on NHS waiting lists....Across Britain, patients wait years for routine — or even emergency — treatments. And many die while waiting. Indeed, the NHS cancels around 100,000 operations because of shortages each year....

After admittance to state hospitals, more than 10 percent of patients contract infections and illnesses that they did not have prior to arrival. And according to the Malnutrition Advisory Group, up to 60 percent of NHS patients are undernourished during inpatient stays.

Consequently, many Britons have turned to outside practitioners for treatment, and the private health-care market has boomed. Today, more than 6.5 million people have private medical insurance, 6 million have cash plans, 8 million pay out-of-pocket for a range of complimentary therapies, and 250,000 self-fund each year for private surgery. Millions more opt for private dentistry, ophthalmics and long-term care.

Meanwhile, despite the state's continued claims that it can deliver quality health care to all, government ministers are increasingly willing to quietly outsource health care to the private sector. In other words, instead of directly providing health care through the NHS, the British government is shifting to simply paying the bills....But even with these efforts, the British government has found it hard to cover its expensive obligations. So in addition to waiting lists, substandard care and increased outsourcing, the government has adopted outright rationing to control costs.

Many Americans don’t realize that among efforts to contain costs, they have a government-appointed body which decides which drugs, procedures and treatments are available to the public. “Charged with controlling costs and watching the bottom line, these bureaucrats are expected to save money — not lives,” she said. This system has barred the purchase of the breast cancer drug, Herceptin, and Alzheimer’s medications such as Aricept, she exampled.

Thanks to the medical blogging world, nurses and doctors are also helping to give us a more rounded picture than we get in our news. The Dr. Rant team is a group of NHS doctors who regularly blog abouttheir system. For doctors and nurses wanting an inside view of what it’s like to work in British system, this blog is a must read.

A consistent theme of shortages, cost cutting measures and rationing, along with people who care, quickly emerges from the UK. For our sakes, they’re hoping that we’ll hear what they’re trying to tell us.

© 2007 Sandy Szwarc

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