From the cognitive disconnect pages
Our thoughts go out to our friends across the pond today and to parents with sick children there. The King's Fund and the Institute for Fiscal Studies released a new analysis of National Health Services and found healthcare spending in England has more than doubled in real terms just since 1999/2000. “Our analysis shows that the NHS is facing the most significant financial challenge in its history,” said John Appleby, chief economist at the King’s Fund.
Yet, even with these realities, stories on other pages of the papers today demonstrate that government often has nonsensical spending priorities.
The King's Fund and the Institute for Fiscal Studies report on the financial prospects for the NHS from 2011 to 2017, examined the government’s plausible options and the consequences of each, stating that the “prospects for future funding now look bleak.”
The financial crisis is estimated by the Treasury to have dealt a permanent blow to the size of the UK economy, with a significant knock-on impact on the strength of the public finances. Given this, it is hard to see how the next spending review…could unveil further real terms increases in the NHS budget without significant reductions in spending elsewhere, or the introduction of tax-raising measures.
As the Times wrote, the report found that “even under the most optimistic funding scenario, the NHS will struggle to meet people’s healthcare needs without significantly increasing its productivity after 2011.” The productivity of government-provided services, according to the Office for National Statistics, however, has fallen every year between 1997 and 2007 (by an average of 0.4%), while it has grown in the private sector by 2% per year. The King’s Fund and Institute for Fiscal Studies report said that “even if the NHS budget is not cut in real terms, future funding is likely to fall short of the population’s healthcare needs by more than £30 billion [$49.55 billion in U.S. dollars].
While facing cuts in services, the report said, if the NHS freezes it budget, it still needs to bring in about “£10.6 billion — equivalent to an extra £340 per family” in additional revenue (taxes). According to the news, Niall Dickson, the chief executive of the King’s Fund, said: “The scale of what is about to hit the healthcare system is unprecedented. It would be a grave mistake to underestimate the challenge ahead.”
Is the government reading the news?
The Wales Western Mail reported on a report from the charity Sands which said funding pressures and shortage of qualified maternity care providers was contributing to nearly 300 infant deaths a year in Wales. Calling the situation a “national tragedy,” Neal Long, Sands’ chief executive, said that for far too long, the rate of infant deaths and stillbirths have been ignored “and yet there is a growing body of evidence to suggest that many babies’ lives could be saved.” This situation has been well-documented for years, while worsening.
The report echoed earlier work by the charity Bliss [covered here], which last year found that minimum staffing standards are still not being met in Wales and that units regularly have to close to new admissions due to lack of staff. It said that mothers and babies are being transferred between units, in some cases very long distances, which puts and intense strain on families at a critical time.
Health Minister Edwina Hart was reported as responding to concerns about neonatal service by announcing a £4million [$6.61 million] cash injection over two years for neonatal transport service. With the average cost of a transport helicopter alone about $5 million, let alone transport isolettes and trained medical professionals to transport critically ill babies, the money isn’t likely to go very far. The senior nurse manager of neonatal services at Gwent Healthcare NHS Trust said that all Welsh neonatal services are still facing chronic funding problems. The all-Wales review of neonatal services, she said, had found that services were in crisis and needed £12million just to sustain them, and that there was a shortage of 170 neonatal nurses just in Wales. Nothing, however, was ever done.
The RAND Europe study on neonatal services released last year was not mentioned in the news. It found that neonatal intensive care increases the survival rates of newborns, especially those with low birth weight or gestational age. “Effective neonatal care also improves morbidity rates, improving the long-term health prospects and quality of life for premature or low birth weight babies. In doing so the long-term burden on state sponsored health and social care systems is reduced.” As it explained:
Low staffing levels is a pervasive problem in UK neonatal services: all three regions of the UK fall short of the recommended staffing levels laid down by the British Association of Perinatal Medicine (BAPM). Scotland is well-staffed at consultant level, but lacking in neonatal nurses. Northern Ireland has a particular deficit of nurses, and staffing levels in Wales are critical at both the consultant and specialised nursing levels. In particular, there is evidence that the absence of dedicated neonatal transport teams produces staffing problems on neonatal wards. Across the UK as a whole in 2006, 78 pe cent of neonatal units had to turn babies away because of lack of capacity. This figure is eight percent higher than in 2005.There was little evidence of shortages in staffing or cots in the non-UK neonatal networks [United States, Canada, Australia, etc.] considered in this report… the evidence suggested that the infrastructure supporting neonatal services in Wales is less developed than in Scotland or Northern Ireland…
It’s almost inconceivable the frustration and heartache neonatal nurses and parents of critically ill newborns under NHS must feel. For years, they’ve tried to get needed medical care that all evidence shows can greatly improve babies’ survival and future health and well being, as well as to lower long-term medical expenses for the healthcare system. Meanwhile, the government continues to spend countless millions of pounds (dollars) on frivilous programs with no evidence they work in order to address a nonexistent health crisis.
The Edinburgh Evening News reported another government program is spending “apparently £23 billion [$37.99 billion U.S. dollars]” to offer free holidays, called an “outdoor education,” to Scotland’s children to get them moving and build character. It plans “to send every 11-year-old on a five-day adventure break, kayaking, climbing and abseiling among other things… [and] free swimming for all children, at least two hours of PE a week and more outdoor activities, most of which are meant to tackle childhood obesity levels.”
The Scotsman reports that the money NHS Lothian spends each year on weight loss and anti-obesity interventions grows. “In Scotland there has been a massive rise in the number of free medicines being requested to fight obesity – 25 times higher than a decade ago and up six percent alone in 2007.”
Calling it a “record government investment,” the government has also invested £56million [about $92.5 million U.S. dollars] over the next three years to encourage children to eat “healthily,” the news said.
Remember that Scottish Diet Action Plan launched in 1996, aimed to get everyone in Scotland to eat healthier to lose weight and prevent “obesity-associated” diseases? This massive initiative included every popular healthy eating idea that’s probably ever been proposed. Hungry for Success, part of the Action Plan geared to school children was well-funded, with $126.09 million (US dollars) committed to its first three years and more for the next three.
It was a flop. After a decade of intense interventions, it showed no effect on children’s’ consumption of fruits and vegetables. It also failed to have any impact on reducing children’s rates of “overweight and obesity.” The results were not at all surprising to medical professionals because the interventions were based on flawed premises on the causes of children’s diversity in sizes.
Not only does the government’s own data show that none of its massive anti-childhood obesity programs are based on evidence, it also shows the money has been spent on an unsupportable crisis. When the Scottish government developed its massive Hungry for Success program to eradicate childhood obesity, there was no epidemic of childhood obesity.
As we know, by reporting only the percentages of growing children crossing new arbitrary definitions for “overweight or obese,” it’s easy to create the illusion of skyrocketing obesity rates. But that doesn’t reveal the changes in actual heights and weights among children. It only gives half of the story.
As readers remember, researchers at the Department of Public Health, UMDS, St. Thomas’ Campus in London, had tracked the growth of English and Scottish children from 1972 through 1994, recording actual heights and weights measured each year among representative samplings of children, ages 5 - 10, as part of the National Study of Health and Growth study. By every test of health examined, the government found children were healthier. The most notable sign that Scottish children were growing healthier and better nourished was a steady increase in their heights over the decades.
Instead of an epidemic of children popping out like obesity balloons about to burst, their weights (the other part of the BMI equation, and the only one heralded) grew almost exactly matching the growth in heights.
Which would you choose to spend taxpayers’ scarce healthcare money on: medical care for critically-ill babies or free vacations and fruit? The choice might be clear to us, but we’re not from the government.