Quality v. Quantity. The NHS Debate.
Professor Karol Sikora has thrown a starving cat into the pigeon loft of irrational debate on the NHS. Feathers are flying.
Professor Sikora, a noted cancer specialist, has advocated ‘rationing’ as a cure for the NHS’s financial ills. He quite reasonably states that the NHS “simply can’t do everything for everybody”. So far, so good.
Not that rationing doesn’t already take place within the NHS; just in dark corners, on a local level, where hopefully the recipients don’t make too much of a noise in their local newspaper. It is as well to bring the issue into the daylight.
However, and it is a mountain of an ‘however’ as far as I am concerned, Sikora believes age has to be a factor when allocating drugs within limited budgets – he is suggesting that ‘expensive cancer drugs to be rationed for the frail elderly in favour of being given to younger patients’.
Let’s kick into the long grass first the canard that ‘the elderly have paid into the NHS all their lives and to deprive them of health care just when they need it most’ is morally wrong. Not all the elderly have so paid. Some were work shy dole bludgers all their lives; some only arrived here the week before last courtesy of their relationship with another British citizen, so whilst it is romantic to hold fast to the vision of war veterans ‘who gave their all for this country’ – it is not necessarily, nor automatically, true.
The real problem is how do you define ‘elderly’. Past retirement age? Many are still working. Beyond ‘economic usefulness’ to the country? Maybe not in paid employment, but looking after grand children to allow someone else to work though? Perhaps working on a PhD to distill 40 years of experience into a form that can be accessed by others?
An arbitrary age barrier simply won’t work – how do you quantify the value to society between a 66 year old retired cabinet maker who is teaching under-privileged children his craft at a local youth group and a 35 year old drug addict?
“My view is that age should be taken into account when comparing the potential benefits of expensive treatments,” he said. “As technology improves, we simply can’t do everything for everybody.”
That statement will be music to the ears of NICE (the National Institute for Health and Care Excellence) which is currently cogitating on the thorny issue of whether to take age into account when deciding whether a drug is prescribed on the NHS. NICE is approaching the issue with a strictly utilitarian agenda:
Nice is proposing that, for the first time, “wider societal impact” is considered when deciding whether a drug is approved. This would take account, for example, of the impact on society of a patient being able to work or look after children. Age, it says, is inevitably part of that.
‘Beyond economic repair’ seems to be a term fated to move from the motor car industry to the NHS – so where does that leave those who have never been of economic use to society? No job, no children, no prospects – no cancer cure?
Last month Nice turned down a breast cancer drug, trastuzumab emtansine (brand name Kadcyla), costing £90,000 a patient on the grounds that it was not effective enough to justify the cost. It is estimated potentially to extend a patient’s life by six months.
Sikora argued it may be justified for the NHS to fund this drug in young women. Why? An extra six months is not going to put a dent in the national debt, whatever rate you pay tax at – nor is it going to make a material difference to child care. Orphaned at 7 years and six months, or on your eighth birthday? Harsh but true.
I would argue that the NHS should ration – but in line with the French system, which seems eminently fair. The French draw a firm line between life threatening illnesses, and life enhancing treatment.
If you are suffering from a life threatening illness, then no matter what your age or status in life – everything is free. Everything. Prescriptions, transport to and from your various treatments. Even the famed ‘cure’ – a stay in one of the many spas, designed to put you back on your feet after debilitating treatment. The only thing you pay for is your food whilst in hospital, a particular bête noire for moi, who was at various times either forbidden to eat it, unable to eat it, or wouldn’t have dreamt of eating it – but I can understand the principle – why should you eat for free simply because you are in hospital – pensioners don’t, in the UK the state pension is raided after ‘x’ number of days!)
‘Life enhancing treatment’ is different, and the state only pays for around 60% of that. The rest you either fund yourself or hold an insurance policy which pays for the excess should you ever need it. That covers things like breast surgery, IVF treatment, getting your ears pinned back, and tattoo removal – or even having a baby, or root canal treatment, (assuming there is a difference between those last two).
That seems a fairer rationale for rationing than an arbitrary age. Given that the NHS has to curtail costs at some point – where would you draw the line? Did you realise that NICE was proposing to draw it under“wider societal impact”?
A qualitative evaluation of your worth to society decided by faceless bureaucrats? Votes Labour? Hmmmn.
- Fat Steve
May 5, 2014 at 8:04 am -
As usual Anna on the button and flawlessly logical —I particularly like the distinction between life enhancing and life threatening —but a 60% contribution to life enhancing in all cases seems a trifle arbitrary but way better than now
- right-writes
May 5, 2014 at 8:07 am -
I like the direction the NHS is going in…
Smoke? Treatment withdrawn.
Drink? Treatment withdrawn.
Fat? Treatment withdrawn.
Old?
Broken Leg?
The envy of the world…
- Mudplugger
May 5, 2014 at 3:47 pm -
But if you choose to participate in certain sexual practices widely known to be high-risk without protection, the NHS will willingly throw hundreds of thousands at your treatment for the consequent HIV/AIDS without question. Strange that.
The envy of the Pink World perhaps.
- Mudplugger
- FrankH
May 5, 2014 at 8:11 am -
Before you kick that duck into the long grass it’s worth remembering that the elderly don’t have a monopoly on work shy dole bludgers or coming from the four corners of the world to take advantage of our “envy of the world” health service. Dole bludgers and health tourists can be any age. And those of us coffin dodgers who aren’t dole bludgers etc have paid more in by virtue of paying longer. I paid for well over 40 years, I’m sure I’ve paid more than an 18 year old who’s just managed to get his first job.
OK. Carry on.
The French system does seem to be better though. I wonder, why isn’t it the envy of the world?
- Ian
May 5, 2014 at 9:54 am -
A friend wrote “I spent thirty years working in the NHS treating children with squint and amblyopia. These are not life threatening illnesses. However, left untreated, the sight of an eye can be totally lost and the child left with a life changing cosmetically unsightly condition. If treatment was not free, many children would not get treatment.”
Does the French system charge for conditions like these in children?
- Jim
May 5, 2014 at 10:21 am -
Oh how we laughed when those kooky right wing Americans said that socialised medical systems result in Death Panels…………welcome to the future of the NHS, where whether you live or die will be decided by a faceless group of bureaucrats. Strangely enough I suspect that anyone with suitable political clout will always get the thumbs up……
- Don Cox
May 5, 2014 at 4:53 pm -
Medicine that comes out of the profits of insurance companies also involves death panels.
- Ho Hum
May 5, 2014 at 5:13 pm -
I wish I had seen this before I did my homework, looking up JDs and the like. I wouldn’t have bothered. LOL
- Ho Hum
- JimmyGiro
May 5, 2014 at 4:58 pm -
Ooh, a random swastika.
- Ho Hum
May 5, 2014 at 5:10 pm -
And just what do you think those nice American office people called ‘Claims Management Spcialist II – Medical’, or suchlike do, exactly?
There are thousands of them, too, if you want to try to work out the real ‘management costs’ of their healthcare system
- Don Cox
- Glory Days
May 5, 2014 at 11:11 am -
If the markets for health care, drugs and insurance were truly level, open and unmanipulated then almost everybody could fund surgery and a very large % of drugs with cash, or via very reasonable insurance policies.
Before anyone points to America as an example of flawed thinking I will say now that it is the most controlled, unopen, unlevel, manipulated market one could possibly find. A government protected racket in other words.
- Joe Public
May 5, 2014 at 9:20 pm -
Unless you’re a ‘Veteran’. As in serviceman / servicewoman rather than ‘elderly & experienced’.
- Joe Public
- Ms Mildred
May 5, 2014 at 11:16 am -
For between 5-6 years now my other half has been under the cloud of cancer of the bladder, not a smoker or a lover of alchohol. We both still pay tax. I spent 14 years after 40 years in NHS doing health survey government work and then helping the disadvantaged in a legal advice setting. On the way I helped care for no less than 3 unrelated persons developing dementia. Now my nearly 84 year old husband is not dementing, but he has lots of problems. Some of my husbands treatment was curtailed due to a fire at a factory making BCG, the standard instillation for grade 2 bladder cancer. Boy were we relieved whan he did not have to submit to 6 weekly treatments what, for him, was total torture. Then were shocked when told he needed a circumscision……is that neglecting the elderly? What is the point of preserving the lives of the ‘useless elderly’ if they are abandoned in old age to a painful end? If that is so, please allow us an easy way out to save ‘them the expense’ of treating us when we annoy them by daring to be ill.
- ivan
May 5, 2014 at 11:42 am -
If the NHS were serious about saving money they would start by dismantling the top three tiers of management without handing out golden handshakes or vast pension pots. Duplication of management is not needed but that is what there is – typical Whitehall gold plating and/or jobs for the boys.
- Blastproof
May 5, 2014 at 12:43 pm -
Well done Anna, keep up the good work.
- Ellen Coulson
May 5, 2014 at 1:20 pm -
Perhaps they should stop pushing statins on all and sundry especially considering all the ill effects they have!
- Pericles
May 5, 2014 at 2:43 pm -
Did you know they’re proposing to eradicate all signs of Josef Statin in Georgia? (That’s the country in the Caucasus, not the land of Oglethorpe.)
Excellent article, Anna; the French system — at least as far as health care goes — always seems sensible.
(Even Obamacare might have been sensible, had he put some effort in to it.)
ΠΞ
- Pericles
- Ellen Coulson
- Ho Hum
May 5, 2014 at 5:15 pm -
OK, it’s Bank Holiday Monday. Go to park. Pick up stick. Throw stick. Watch all the happy little woof woof’s yapping away and gnawing it into twigs
I’m going to do the cat thing instead…
- Robert the Biker
May 6, 2014 at 7:21 am -
With me, it goes:
Pick up stick
Throw stick
Woofer looks at me as though to say “If you wanted the bloody stick, why did you throw it away?”
Both walk over to stick
Look at stick
Get out ball instead
Yay! Ball!
- Robert the Biker
- JimmyGiro
May 5, 2014 at 6:17 pm -
It will not be the qualitative evaluation of your life, it will be the value of their status as ‘public sector workers’; the biggest scroungers in the business. I bet UNISON and UNITE will ensure that their members each receive a voucher for eternal life upon retirement.
Did you know that JSA costs about £5 billion per annum; yet the DWP, whose task it is to ensure benefits are thoroughly scrutinized to the point of despair, costs over £8 billion per annum to administer, claiming an annual saving of about £1 billion on benefits fraud; yet the public are encouraged to see the unemployed as the wasters!? The whole system could be automated, such as a citizens wage, and even allowing for the odd billion in fraud, would still save the country £7 billion per annum.
Clearly the State system is an extortion racket; and like all criminal systems, deploys images of despair to induce compliance. The NHS is surely the image of heaven and hell to goad the sheeple to unwavering obedience to the Nomenklatura.
- Glory Days
May 5, 2014 at 6:33 pm -
I will reserve judgement on the first paragraph, but never a truer word spoken re the last one.
- Oi you
May 5, 2014 at 7:25 pm -
Biggest scroungers in the business? Oh yes!
- Engineer
May 5, 2014 at 7:34 pm -
To be fair, the DWP £8 billion administration cost covers not just JSA, but pensions and other benefits as well. The total department budget is about £200 billion, so 4% of it on admin isn’t that bad.
- guthrie
May 5, 2014 at 9:13 pm -
There’s also the outsourcing to private companies to do what the job centre staff used to do in terms of monitoring and hectoring the unemployed. Strangely enough, it seems the private companies can’t manage it any cheaper than the DWP can, or in some cases have worse outcomes.
- guthrie
- Glory Days
- Engineer
May 5, 2014 at 7:30 pm -
Picture the scene in a couple of decades time – an NHS specialist’s consulting room.
“Ah – Mr Sikora. Do sit down. Now, we’ve had the test results, and in consequence we have a dignosis. It’s treatable, but I’m afraid you’ve passed the age cut-off by a couple of months, so there’s nothing we can do, I’m afraid. You’ve probably got about three months; do try to enjoy them. Terribly sorry about that, old chap. Do be kind enough to shut the door on your way out….”
- FrankH
May 5, 2014 at 8:53 pm -
Are you new to this planet? Rules imposed by the Professor Sikoras of this world don’t apply to Professor Sikora.
- FrankH
- Joe Public
May 5, 2014 at 9:35 pm -
Perhaps we should encourage smokers, sugar eaters, dangerous-sports enthusiasts etc to enjoy their lives more. Abolish the Health & Safety at Work Act. Allow children to play conkers & climb trees at school. Re-engineer level crossings to have but a single barrier on the near-side of approach roads. The opportunities to remove state-sponsored ‘societal cotton wool’ which merely increases the pool of potentially burdensome citizens, seems endless.
- Mudplugger
May 6, 2014 at 7:50 am -
A bit harsh on the Health & Safety at Work Act – that’s quite innocent and broadly beneficial.
The real target for your ire should be the conditional fee system, those parasitic no-win-n0-fee lawyers, filling the daytime TV channels with their teasing adverts and cold-calling randomly to annoy. It is they alone who have encouraged the claims culture, to which the corporate insurers have then responded by forcing all their client organisations to impose ridiculous restrictions to defend their own risk-exposure. They all quote ‘Health & Safety’ but, in practice, it’s all about the lawyers’ and insurers’ pockets, lining the former and saving the latter.
Stop that root-cause and all the nonsense will soon go away – “Follow the money” as ‘Deep Throat’ once so astutely advised on Watergate.
- Mudplugger
- Tedioustantrums
May 5, 2014 at 10:45 pm -
I despair of the NHS. They make the slightest issue complicated. You go to the Doc for one thing and come out with several.
They no longer treat diseases they treat symptoms.
Years ago I went to my GP. I’d been feeling tired. Nothing to do with the huge amount of work I was doing. Anyway amongst the questions he asked me was one about getting exercise. I answered that I got up from my desk chair at times and got out of the car sometimes too. He said he got out of his car to go and by his fags.
Different days.
- Duncan Disorderly
May 6, 2014 at 10:35 am -
Of course health care must be rationed. Resources are limited with demand limitless. I recall learning at school that spending on healthcare was predicted to go down in the years after the NHS came about as the health of the nation improved. That didn’t happen, because expectations of good health went up. Ever tried to get a GP appointment? Rationing is used to determine who gets seen first, courtesy of the GPs triage specialist, the receptionist.
Only a maniac thinks that the American system should be emulated. Cost control seems to have gone out of the window. If the uninsured get a serious illness, they can expect to lose all their money.
- Ho Hum
May 6, 2014 at 10:40 am -
And if you did economics, healthcare is often put forward of an example of perfectly elastic demand
The more that is supplied, the more will be demanded
- Ho Hum
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