Healthcare multiple choice — what would you choose?

If you were a government health official, where would you choose to focus limited healthcare resources — money and the time and attention of healthcare professionals — in order to most improve people’s health and provide the best evidence-based medical care? This week’s news from the UK provides an insightful array of choices:

· Vaccinations for seniors and others at high risk of flu

In the news: OnMedica reports that more than half of at-risk patients didn’t get their flu vaccinations this past year, increasing the health complications for these patients, including seniors and people with diabetes, asthma and heart disease. The professional letter just sent to doctors by the Department of Health reports than only 47.1% of high risk patients had been vaccinated.

· Hygiene and infection control for hospitals, health units and ambulances

In the news: The Care Quality Commission identified 21 trusts in England which were failing in basic cleanliness and sanitation, according to BBC News. Its assessment found 13 of 21 trusts failed to meet infection control standards and protect patient safety, resulting in continued extremely high infection rates. “Too many hospitals are not taking this seriously enough and it is having horrific results for patients,” said a spokesperson with Patient Concern.

· Strengthen efforts to improve the standards of medical care at the more than ten health trusts with acutely high death rates of hospital patients

In the news: Ten health trusts were found to have even poorer rates of patient deaths than the hospital where at least 400 patients died needlessly because of “shocking and appalling” standards of care [covered here]. As the Sunday Telegraph reports, their mortality rates are more than 27% greater than should have been expected.

· Cancer care

In the news: BBC reports cancer survival among patients in the UK remain below other nations. Eurocare found that UK ranks among the five lowest countries in five-year survival rates for all cancers.

· Cardiac care, surgery and clinical care

In the news: Belfast Telegraph reports that more than 500 outpatient appointments were cancelled every week last year in Northern Ireland because no staff was available in the NHS health system to care for them. This heightens concerns for patients “who may have already been waiting a considerable time for that appointment and wants his or her condition investigated,” said the article. NHS spends £7million every year to send cardiac patients outside the system for treatment, according to the NHS. The Royal Victoria Hospital, a centre of excellence for cardiac surgery, can only handle around 1,000 operations each year and another 400-plus patients are sent to hospitals in England or the Republic for vital surgery.

· Preventive dentistry for children

In the news: The Northern Echo reports that the latest figures on tooth extractions have jumped 30% in only four years, in what critics claim is a damming indictment of British dentistry, with patients unable to get needed dental care that might have saved their teeth.

· Nurses and trained medical staff

In the news: According to News of the World, thousands of hospital patients are needlessly dying, with the primary factor that dozens of trusts are not spending enough to provide safe levels of qualified staff. According to Nursing Times, the Healthcare Commission identified chronic staff shortages as the key reason for failings in NHS trust’s performance. A new report from the National Nursing Research Unit examined nursing staff levels at 147 hospitals and found that those with high patient mortalities had the lowest nurses-per-patient ratios and that low nurse staffing levels doubled risks for high patient mortalities. “By far, the strongest indicator of trust performance is nursing and qualified staffing levels,” said Dr Simon Jones, chief statistician of King's College in London. The rest is explained by other factors, such as staff working more effectively. A second report from Florence Nightingale School of Nursing and Midwifery at King’s College compared surgical outcomes with nursing levels at 30 trusts. It found a “large and consistent effect of nurse staffing on mortality outcomes in surgical patients,” but it wasn’t just warm bodies that counted, qualified staff was the most significant factor.

Last November, just six days before Health Secretary Alan Johnson announced its new public health campaign, Change4Live, internal documents had been made public in the media as a result of a Freedom of Information request. They revealed that more than £500 million [$735 million U.S. dollars] were being slashed from the NHS budget over the next three years, forcing cuts in staff and frontline services such as emergency and maternity care and children’s services. The Scotsman described the cuts in detail, adding: “Making cuts by failing to replace staff has been cited as a way of saving money by several boards.”

So, this week, the NHS has rolled out two new major health initiatives... as part of its $631.52 million Change4Life anti-obesity campaign [covered here]:

Fat tests for every adult over the age of 40

In the news: NHS Health Ministers announced a new national government program of Health Checks, which will call every adult between the ages of 40 and 74 into their GP for a fat test, to have their BMIs measured. Everyone determined to be overweight is to be referred to weight management or exercise programs. As the Telegraph reports, GPs will be expected to test 2.25 million people every year, with each person to be called back an average of once every five years for another check.

It has also decided to shift the focus of its Change4Life and advertising campaign to target ethnic minorities and older men, according to Brand Republic.

Put NHS workers into weight loss programs

In the news: Overweight NHS staff are being told by their employers that they need to set a good example of healthy eating, lose weight and sign up for weight loss programs to achieve a “healthy weight.” The credibility of the government’s health messages, the Department of Health states, is supported by the behavior of health professionals and the examples they set. Having slim health visitors, midwives and healthcare providers, according to the government, will “boost the credibility of the healthy living messages they give to mums to be and families.” Having 'attractive' nurses is more important than having sufficient numbers of qualified nurses.

If there is a take home lesson in all of this, perhaps it’s that we might be wise to consider whether we want government to make our health decisions and decide what is best for us. Can we trust government to objectively prioritize needs, to enact interventions with the soundest evidence for safety and effectiveness, and to place peoples’ needs ahead of powerful lobbying groups and political agendas? The evidence is a good place to start to find the answers.