Privatise the NHS

[Fop 1]

There is a trip wire in the British psyche regarding the NHS and if an honest Govt suggested a 3p tax hike specifically for the NHS I think people would respect that IMO. Think the Lib Dems looked into it iirc.

I'd love to see the Daily Mail's "Our taxes are all going to immigrants, asylum seekers, paedophiles and disabled lesbians " headlines if the government of the day ever tried it...

 

 

In all honesty though part of the problem with the NHS is not just management or funding level or anything like that.

 

It goes right back into the UK benefits system, and indeed such thing that the average clientèle of BUPA has on average much better health (although amazingly I have heard of some people living solely on benefits that manage to pay for BUPA for themselves ).

 

The NHS does have bleeds in it, they may or may not be huge ones, but even a lot of little ones add up and can destroy something that should be wonderful (be that health tourism, not contributing whilst earning more through a non-work income than many working and contributing etc.).

[Guest alex]

Well debated btw.

 

Do you think when the NHS was invented and visionaries shone a beam of light across a war torn England they had time to sit in coffee mornings asking people what they thought?

No.

Do you think an institution created over 60 years ago shouldn't move with the times just because the principles it was founded on were virtuous?

[Park Life 70]

Well debated btw.

 

Do you think when the NHS was invented and visionaries shone a beam of light across a war torn England they had time to sit in coffee mornings asking people what they thought?

No.

Do you think an institution created over 60 years ago shouldn't move with the times just because the principles it was founded on were virtuous?

 

Move with the times? Society is going backwards.

[Fop 1]

Well debated btw.

 

Do you think when the NHS was invented and visionaries shone a beam of light across a war torn England they had time to sit in coffee mornings asking people what they thought?

No.

Do you think an institution created over 60 years ago shouldn't move with the times just because the principles it was founded on were virtuous?

 

Move with the times? Society is going backwards.

 

I think it's trying to go in two directions at once, neither being particularly effective, and that results in many things going backwards, NHS, average house size, freedom to travel sooner or later.

 

Scotland should worry when it become independent, there's going to be a lot of English asylum seekers heading there.

[Guest alex]

Well debated btw.

 

Do you think when the NHS was invented and visionaries shone a beam of light across a war torn England they had time to sit in coffee mornings asking people what they thought?

No.

Do you think an institution created over 60 years ago shouldn't move with the times just because the principles it was founded on were virtuous?

 

Move with the times? Society is going backwards.

What a hackneyed response man

It was a straightforward enough question. The UK is vastly different to when the NHS was created. That's what I was getting at, as I'm sure you know.

Edited July 3, 2008 by alex

[Park Life 70]

Well debated btw.

 

Do you think when the NHS was invented and visionaries shone a beam of light across a war torn England they had time to sit in coffee mornings asking people what they thought?

No.

Do you think an institution created over 60 years ago shouldn't move with the times just because the principles it was founded on were virtuous?

 

Move with the times? Society is going backwards.

 

I think it's trying to go in two directions at once, neither being particularly effective, and that results in many things going backwards, NHS, average house size, freedom to travel sooner or later.

 

Scotland should worry when it become independent, there's going to be a lot of English asylum seekers heading there.

 

Access to many guarantees and basics (housing/culture/libraries/food prices/energy) is under much more pressure now than say 20 years ago...There is reams of data out there. If you throw in disenchantment about representation and a failing education system and the growing monopolies in the media, the gap for me between the have's and the have nots is widening alarmingly.

 

As I said earlier buoying up the NHS is a complex paradigm, but it needs to be done with or without Joe Public.

[Fop 1]

Well debated btw.

 

Do you think when the NHS was invented and visionaries shone a beam of light across a war torn England they had time to sit in coffee mornings asking people what they thought?

No.

Do you think an institution created over 60 years ago shouldn't move with the times just because the principles it was founded on were virtuous?

 

Move with the times? Society is going backwards.

 

I think it's trying to go in two directions at once, neither being particularly effective, and that results in many things going backwards, NHS, average house size, freedom to travel sooner or later.

 

Scotland should worry when it become independent, there's going to be a lot of English asylum seekers heading there.

 

Access to many guarantees and basics (housing/culture/libraries/food prices/energy) is under much more pressure now than say 20 years ago...There is reams of data out there. If you throw in disenchantment about representation and a failing education system and the growing monopolies in the media, the gap for me between the have's and the have nots is widening alarmingly.

 

As I said earlier buoying up the NHS is a complex paradigm, but it needs to be done with or without Joe Public.

 

Much like the 2050 cull.

 

Which seriously needs to happen, or at least I can't see the UK doing much but sinking without stabilising the population and working from there.

 

At the moment it's like learning to juggle with someone throwing you an extra ball every 30 seconds.

[ChezGiven 0]

When you read this you can see where a lot of pressure is coming from.

 

 

Not surprisingly it's greed driving it.

 

Its not greed, its the basic issue of scarcity of resources forcing people to make choices. Now, as predicted, the choices have become completely unpalatable, something has to give.

 

That article makes most of the points i've been making since they announced the ability to make top-ups anyway.

 

 

No it's the drug marketing model, which sort of falls down when people (even desperate dying people) don't buy your premium drugs.

 

 

Which is an interesting issue in and of itself - as you get more and more expensive drugs for more and more minor improvement what happens? Clearly the drug companies cannot just keep selling older drugs, they HAVE to put out new ones even if the differences are very minor clinically.

 

 

Also the more money that becomes available the more the drug companies will charge - it's like the idiocy of thinking you'll save money with saving power in the long term, when in fact if everyone slashes their power consumption by 30% the power companies will simply quickly put the amount charged up to cover the difference and the consumer will end up paying the same for using less.

 

Twaddle.

 

93% of the costs of the NHS dont relate to medicines, they relate to services, infrastructure and capital.

 

Spectacular inability to follow the argument too fop, as if what you were saying is true then it would hold in France, Germany, Spain and Italy. Whereas it doesnt, as i've pointed out. The argument about NHS organisation is one that is held in the light of our neighbours in europe, what they can afford to do and how they organise their system. That post was just vacuous bollocks.

 

As alex pointed out, the world was very different to 60 years ago, so why should the system not evolve along with the rest of the world?

Edited July 3, 2008 by ChezGiven

[Fop 1]

When you read this you can see where a lot of pressure is coming from.

 

 

Not surprisingly it's greed driving it.

 

Its not greed, its the basic issue of scarcity of resources forcing people to make choices. Now, as predicted, the choices have become completely unpalatable, something has to give.

 

That article makes most of the points i've been making since they announced the ability to make top-ups anyway.

 

 

No it's the drug marketing model, which sort of falls down when people (even desperate dying people) don't buy your premium drugs.

 

 

Which is an interesting issue in and of itself - as you get more and more expensive drugs for more and more minor improvement what happens? Clearly the drug companies cannot just keep selling older drugs, they HAVE to put out new ones even if the differences are very minor clinically.

 

 

Also the more money that becomes available the more the drug companies will charge - it's like the idiocy of thinking you'll save money with saving power in the long term, when in fact if everyone slashes their power consumption by 30% the power companies will simply quickly put the amount charged up to cover the difference and the consumer will end up paying the same for using less.

 

Twaddle.

 

93% of the costs of the NHS dont relate to medicines, they relate to services, infrastructure and capital.

 

Spectacular inability to follow the argument too fop, as if what you were saying is true then it would hold in France, Germany, Spain and Italy. Whereas it doesnt, as i've pointed out. The argument about NHS organisation is one that is held in the light of our neighbours in europe, what they can afford to do and how they organise their system. That post was just vacuous bollocks.

 

As alex pointed out, the world was very different to 60 years ago, so why should the system not evolve along with the rest of the world?

 

There's a lot of very "expensive" drugs being pushed and developed (I notice you ignore my points about the reasons behind that).

 

It's true the world was very different 60 years ago, we didn't have the corporate power to contend with then that we do now.

[ChezGiven 0]

When you read this you can see where a lot of pressure is coming from.

 

 

Not surprisingly it's greed driving it.

 

Its not greed, its the basic issue of scarcity of resources forcing people to make choices. Now, as predicted, the choices have become completely unpalatable, something has to give.

 

That article makes most of the points i've been making since they announced the ability to make top-ups anyway.

 

 

No it's the drug marketing model, which sort of falls down when people (even desperate dying people) don't buy your premium drugs.

 

 

Which is an interesting issue in and of itself - as you get more and more expensive drugs for more and more minor improvement what happens? Clearly the drug companies cannot just keep selling older drugs, they HAVE to put out new ones even if the differences are very minor clinically.

 

 

Also the more money that becomes available the more the drug companies will charge - it's like the idiocy of thinking you'll save money with saving power in the long term, when in fact if everyone slashes their power consumption by 30% the power companies will simply quickly put the amount charged up to cover the difference and the consumer will end up paying the same for using less.

 

Twaddle.

 

93% of the costs of the NHS dont relate to medicines, they relate to services, infrastructure and capital.

 

Spectacular inability to follow the argument too fop, as if what you were saying is true then it would hold in France, Germany, Spain and Italy. Whereas it doesnt, as i've pointed out. The argument about NHS organisation is one that is held in the light of our neighbours in europe, what they can afford to do and how they organise their system. That post was just vacuous bollocks.

 

As alex pointed out, the world was very different to 60 years ago, so why should the system not evolve along with the rest of the world?

 

There's a lot of very "expensive" drugs being pushed and developed (I notice you ignore my points about the reasons behind that).

 

It's true the world was very different 60 years ago, we didn't have the corporate power to contend with then that we do now.

 

As i've just said, corporations sell the same drugs to France, yet they can afford it.

 

I ignored the point as its irrelevant to the debate.

[manc-mag 1]

When you read this you can see where a lot of pressure is coming from.

 

 

Not surprisingly it's greed driving it.

 

Its not greed, its the basic issue of scarcity of resources forcing people to make choices. Now, as predicted, the choices have become completely unpalatable, something has to give.

 

That article makes most of the points i've been making since they announced the ability to make top-ups anyway.

 

 

No it's the drug marketing model, which sort of falls down when people (even desperate dying people) don't buy your premium drugs.

 

 

Which is an interesting issue in and of itself - as you get more and more expensive drugs for more and more minor improvement what happens? Clearly the drug companies cannot just keep selling older drugs, they HAVE to put out new ones even if the differences are very minor clinically.

 

 

Also the more money that becomes available the more the drug companies will charge - it's like the idiocy of thinking you'll save money with saving power in the long term, when in fact if everyone slashes their power consumption by 30% the power companies will simply quickly put the amount charged up to cover the difference and the consumer will end up paying the same for using less.

 

Twaddle.

 

93% of the costs of the NHS dont relate to medicines, they relate to services, infrastructure and capital.

 

Spectacular inability to follow the argument too fop, as if what you were saying is true then it would hold in France, Germany, Spain and Italy. Whereas it doesnt, as i've pointed out. The argument about NHS organisation is one that is held in the light of our neighbours in europe, what they can afford to do and how they organise their system. That post was just vacuous bollocks.

 

As alex pointed out, the world was very different to 60 years ago, so why should the system not evolve along with the rest of the world?

 

There's a lot of very "expensive" drugs being pushed and developed (I notice you ignore my points about the reasons behind that).

 

It's true the world was very different 60 years ago, we didn't have the corporate power to contend with then that we do now.

 

I think that is the nearest thing we'll ever see to Fop holding his hands up and accepting defeat.

[Fop 1]

When you read this you can see where a lot of pressure is coming from.

 

 

Not surprisingly it's greed driving it.

 

Its not greed, its the basic issue of scarcity of resources forcing people to make choices. Now, as predicted, the choices have become completely unpalatable, something has to give.

 

That article makes most of the points i've been making since they announced the ability to make top-ups anyway.

 

 

No it's the drug marketing model, which sort of falls down when people (even desperate dying people) don't buy your premium drugs.

 

 

Which is an interesting issue in and of itself - as you get more and more expensive drugs for more and more minor improvement what happens? Clearly the drug companies cannot just keep selling older drugs, they HAVE to put out new ones even if the differences are very minor clinically.

 

 

Also the more money that becomes available the more the drug companies will charge - it's like the idiocy of thinking you'll save money with saving power in the long term, when in fact if everyone slashes their power consumption by 30% the power companies will simply quickly put the amount charged up to cover the difference and the consumer will end up paying the same for using less.

 

Twaddle.

 

93% of the costs of the NHS dont relate to medicines, they relate to services, infrastructure and capital.

 

Spectacular inability to follow the argument too fop, as if what you were saying is true then it would hold in France, Germany, Spain and Italy. Whereas it doesnt, as i've pointed out. The argument about NHS organisation is one that is held in the light of our neighbours in europe, what they can afford to do and how they organise their system. That post was just vacuous bollocks.

 

As alex pointed out, the world was very different to 60 years ago, so why should the system not evolve along with the rest of the world?

 

There's a lot of very "expensive" drugs being pushed and developed (I notice you ignore my points about the reasons behind that).

 

It's true the world was very different 60 years ago, we didn't have the corporate power to contend with then that we do now.

 

I think that is the nearest thing we'll ever see to Fop holding his hands up and accepting defeat.

 

Ah... manc-fop(lite) your jedi training complete it is not.

[Fop 1]

A four-way split on the NHS

 

By Nick Triggle

Health reporter, BBC News

The devolved administrations have pursued different policies

 

The NHS was set up as a universal health service for the UK.

 

But post devolution it has become clear that very different paths are being followed by England, Scotland, Wales and Northern Ireland.

 

Is this important? Yes, it seems. A BBC poll of more than 1,000 people shows that seven in 10 believe it matters that people get a different service depending on where they live.

 

So what do the four NHS's look like?

 

 

________________________________________________________________________________

___________________

ENGLAND

 

The Department of Health arguably has the hardest job of all.

 

Responsible for providing care to about 50m of the 60m people in the UK, it has set about making the NHS more effective by creating a marketplace.

 

In echoes of the Tories' internal market, Labour has created buyers, the primary care trusts, and sellers, NHS trusts which run hospitals.

 

 

WAITING TIME TARGETS

England - 18 weeks by end of 2008

Scotland - 18 weeks by end of 2011

Wales - 26 weeks by end of 2009

Northern Ireland - 13 weeks by March 2009

 

The nations compared in graphics

 

Patients are treated as consumers and have been given choice over where they receive treatment, while funding has been overhauled so that hospitals and other health centres get paid per patient treated.

 

What is more, private sector providers have been invited in to compete with NHS trusts for patients.

 

The result? Dramatic improvements in waiting times that the other nations have tried to replicate, but a complete breakdown in the relationship between the medical profession and ministers.

 

It means by the end of the year, patients will be guaranteed treatment within 18 weeks of GP referrals - the shortest waiting time in the UK.

 

More recently, ministers have turned their attentions to GPs.

 

Family doctors have been forced to open for longer, while the review of the NHS by health minister Lord Darzi is expected to pave the way for doctors to be housed in super-surgeries known as polyclinics.

 

But to date, there has been limited reform of social care. That is likely to be rectified in the next year with a key policy paper due to be published.

 

Under pressure, ministers have already ruled out the so-called free personal care provided in Scotland.

 

Instead, many experts have suggested some form of top-up system whereby the state provides a basic level with people allowed to use their own money to buy extra.

 

 

________________________________________________________________________________

___________________

SCOTLAND

 

In many ways, Scotland is the polar opposite of England.

 

There is no split between purchaser and buyer with 15 health boards responsible for both commissioning and providing services.

 

And use of the private sector is kept to a minimum with NHS treatment only contracted out where the health service is unable to provide it.

 

The model of care was created five years ago and led to a reduction in managers, with senior doctors taking a lead in overseeing care.

 

It means the clashes between the medical profession and politicians seen south of the border are relatively rare.

 

But progress on waiting times has been much slower. With Scottish ministers promising 18-week waits only by 2011 - three years after the target in England.

 

 

HEALTH SPENDING PER HEAD

England - £1,676

Scotland - £1,919

Wales - £1,758

Northern Ireland - £1,770

 

However, Scotland was widely praised for its decision to give free personal care to the elderly.

 

Elsewhere in the UK, if an individual has assets of more than £22,250 they have to pay for basic help such as cleaning, washing and dressing.

 

But the wisdom of the policy has been questioned recently with experts saying it is not sustainable and many patients complaining local authorities are rationing care.

 

 

 

________________________________________________________________________________

___________________

WALES

 

Wales has grabbed the attention for its decision to scrap prescription charging.

 

The change in 2007 has had reverberations across the UK.

 

Scotland has already said it will follow suit and is in the process of phasing out charges, Northern Ireland is reviewing them, while England, to much criticism, has said it will not follow suit.

 

Wales is also leading the way on the widely unpopular hospital car park charges. They will be phased out by 2011.

 

 

PRESCRIPTION CHARGING

England - £7.10

Scotland - Charges being phased out by 2011

Wales - No charge since April 2007

Northern Ireland - Under review

 

Meanwhile, much good work has been achieved in the area of public health with the close alignment between the 22 local authority boundaries and NHS boards playing a key role in this proactive approach.

 

It has meant improvements to school nutrition and child obesity programmes have been introduced long before they took off elsewhere.

 

But while Wales has received favourable headlines for these policies, it has also suffered its fair share of attacks.

 

The Welsh government has been perhaps most vulnerable over waiting times.

 

During the election campaign last year, opposition parties were quick to point out waits for treatments had increased since devolution.

 

Ministers have responded by setting their own waiting target - 26 weeks by the end of 2009.

 

 

________________________________________________________________________________

___________________

NORTHERN IRELAND

 

While the polyclinics debate has being raging in England, it may come as a surprise to learn that Northern Ireland has been experimenting with something very similar in recent years.

 

Parts of the country, in particular in Belfast, have set up the so-called super-surgeries.

 

This has seen GPs, nurses and social care staff working side-by-side in large health centres.

 

 

LIFE EXPECTANCY

England - Men 77.2, women 81.5

Scotland - Men 74.6, women 79.6

Wales - Men 76.6, women 80.9

Northern Ireland - Men 76.1, women 81

 

This is not quite as radical as some of the centres being proposed in England, which will see a host of hospital care also included.

 

But it does mark a sea-change in NHS provision, which since 1948 has tended to be split down distinct professional lines.

 

It has also meant many of the clashes seen in the other countries between councils and NHS trusts over the care of patients released from hospital have been avoided.

 

The model of care is born from the fact that each of the five trusts have responsibility for both social care and NHS care.

 

But in many other respects, NHS policy has developed at a much slower pace than elsewhere because of the political situation which has meant only limited periods of self-rule.

 

http://news.bbc.co.uk/1/hi/health/7457357.stm

[Fop 1]

Arthritis drug access 'curbed'

 

Rheumatoid arthritis affects people's joints

 

People with rheumatoid arthritis are to have access to a particular class of drugs limited by a drugs watchdog, campaigners say.

 

The National Institute for health and Clinical Excellence is set to say patients in England and Wales should only be able to try one anti-TNF drug.

 

Currently, patients can move on to a second or third anti-TNF if their first drug stops working.

 

Arthritis charities estimate 40,000 people will be affected.

 

 

It is rationing without rationality

Abigail Page, Arthritis Care

 

Anti-TNF (anti-tumour necrosis factor alpha) therapy drugs - adalimunab, etanercept, infliximab - can slow the progress of disease and help to reduce symptoms such as joint pain, swelling, mobility and fatigue.

 

Each drug works and is administered in slightly different ways.

 

NICE is expected to say that giving patients two, or even three, anti-TNFs is not cost-effective and that doctors should offer patients the next drug in line - rituximab - which costs about £3,000 less per year than the cheapest anti-TNF.

 

However, around a quarter of patients do not gain any benefit from rituximab.

 

'One roll of the dice'

 

Arthritis charities say that cutting the anti-TNF options from three to one, combined with a decision earlier this year to reject another arthritis drug for NHS use means patients' treatment choices will be severely limited.

 

And they say thousands could be left with no effective way of managing their condition.

 

The National Rheumatoid Arthritis Society warned that patients could face high levels of pain and the possibility of surgery and long term disability.

 

Its chief executive Ailsa Bosworth, said: "NICE are re-writing the rules of rheumatoid arthritis treatment in this country ignoring the clinical effectiveness of drugs and ignoring the views of patients and clinicians."

 

Ms Bosworth, who has had rheumatoid arthritis for almost 30 years and is now on her third anti-TNF drug, added: "NICE is systematically taking away clinically effective and proven treatments from patients and giving them just one roll of the dice when it comes to anti-TNF treatment."

 

Abigail Page, head of policy and campaigns at Arthritis Care, said: "It is short sighted and pernicious that NICE can look only at cost to the NHS, not at total cost to the taxpayer in terms of benefits and social care. It is rationing without rationality.

 

"When will the government do the maths and see that treating someone is often far cheaper than not treating them?"

 

Rob Moots, of the umbrella group Arthritis and Musculoskeletal Alliance and a professor of rheumatology at Liverpool University, said: "It's almost impossible to know which anti-TNF will work for a patient at the outset.

 

"Before this decision we could try patients on each of the three treatments in turn to find one that was effective for them - now we only have one shot at success."

 

This is the second time NICE has said access to anti-TNFs should be limited.

 

It originally ruled that patients should only have one anti-TNF in 2006, but the decision was criticised by charities and the Royal College of Nursing and the watchdog agreed to review it last year.

 

NICE confirmed it was publishing a final appraisal document on Monday, but would not discuss its contents in advance.

 

It will cover England and Wales, but the Scottish equivalent of NICE is likely to follow suit.

 

http://news.bbc.co.uk/1/hi/health/7513484.stm

[Rob W 0]

how do you decide when to STOP paying for new drugs?

 

if it continues like this 100% of the Budget will go on the NHS

[Fop 1]

how do you decide when to STOP paying for new drugs?

 

if it continues like this 100% of the Budget will go on the NHS

 

 

There's two sides to that:

 

Drug company profits - they have to produce new drugs or they'll lose profits on generic drugs.

 

Tax - telling someone that's worked and paid NI all their life that they can't have a drug, equally whilst giving someone that hasn't at all something for free.

 

 

Basically the Government needs to be much tougher with the drug companies and the patients, instead of just allowing accountants to decide what is "effective".

[ChezGiven 0]

how do you decide when to STOP paying for new drugs?

 

if it continues like this 100% of the Budget will go on the NHS

 

 

There's two sides to that:

 

Drug company profits - they have to produce new drugs or they'll lose profits on generic drugs.

 

Tax - telling someone that's worked and paid NI all their life that they can't have a drug, equally whilst giving someone that hasn't at all something for free.

 

 

Basically the Government needs to be much tougher with the drug companies and the patients, instead of just allowing accountants to decide what is "effective".

 

The government is so tough on 'innovation' that they set a limit on how much they are willing to spend for improvements in quality and/or length of life. This government and in particular NICE have decreed that adding one year of decent quality of life onto a person's life expectancy is worth £30,000. If the cost is more than that they refuse it. Its not just drugs either, its loads of new surgical equipment and techniques that are a product of technological innovation.

 

Anyway, since the 1960's the PPRS set a 17% limit on drug company profits from the UK market. This has been reformed this year and many are waiting to see what will happen. If you want a balanced view on things, GSK, my old company, used to earn £800m in revenue in the UK. The 17% profit was modulated by accountants but essentially came out at no more than 25% in each year. GSK employs 45,000 people in the UK and spends over £3bn in its global R&D, much of which is spent in the UK. Seem like a fair deal? In 2007, 800 high-tech jobs at GSK went in the UK due to increasingly difficult market conditions. The last bastion of the UK manufacturing sector and will ill-informed, mis-judged idealism finally take it down? Unlike the thickos controlling economic policy in this country for the last 30 years, the picture needs clear, sober and objective analyses.

 

Anyway, accountants dont decide whats effective. NICE is run by clinicians and each piece of guidance it produces is done in conjunction with the Royal Colleges and the main Patient groups.

 

Tax - quite right, its all about choices though. The limited NHS budget creates a choice between competing priorities. If the NHS tried to meet every 'medical need' (and a debate on that term was the subject of my PHD) it would go bust (just as Rob said). So, it is forced to make choices.

 

My point today, in the current climate is that the choice has to be given back to the patient. They should decide if they want additional insurance and access to 'best in class' treatments, or settle for less and more disposable income in the short-term. We should have a safety net system, where access to general medical services is guaranteed and that the poor and the needy should be means tested (sorry buts its a necessary evil). Private and public insurance should be available through your employer, taxes should be reduced and the short fall made up by contributions to schemes. The NHS will live on but the govt are throwing more and more money at it. Ever stopped to think we might be better off if we organised it differently.

 

Cheers for all who contributed so far to this thread, i used it as 'market research' at work the other week

[Fop 1]

how do you decide when to STOP paying for new drugs?

 

if it continues like this 100% of the Budget will go on the NHS

 

 

There's two sides to that:

 

Drug company profits - they have to produce new drugs or they'll lose profits on generic drugs.

 

Tax - telling someone that's worked and paid NI all their life that they can't have a drug, equally whilst giving someone that hasn't at all something for free.

 

 

Basically the Government needs to be much tougher with the drug companies and the patients, instead of just allowing accountants to decide what is "effective".

 

The government is so tough on 'innovation' that they set a limit on how much they are willing to spend for improvements in quality and/or length of life. This government and in particular NICE have decreed that adding one year of decent quality of life onto a person's life expectancy is worth £30,000. If the cost is more than that they refuse it. Its not just drugs either, its loads of new surgical equipment and techniques that are a product of technological innovation.

 

Anyway, since the 1960's the PPRS set a 17% limit on drug company profits from the UK market. This has been reformed this year and many are waiting to see what will happen. If you want a balanced view on things, GSK, my old company, used to earn £800m in revenue in the UK. The 17% profit was modulated by accountants but essentially came out at no more than 25% in each year. GSK employs 45,000 people in the UK and spends over £3bn in its global R&D, much of which is spent in the UK. Seem like a fair deal? In 2007, 800 high-tech jobs at GSK went in the UK due to increasingly difficult market conditions. The last bastion of the UK manufacturing sector and will ill-informed, mis-judged idealism finally take it down? Unlike the thickos controlling economic policy in this country for the last 30 years, the picture needs clear, sober and objective analyses.

 

Anyway, accountants dont decide whats effective. NICE is run by clinicians and each piece of guidance it produces is done in conjunction with the Royal Colleges and the main Patient groups.

 

Tax - quite right, its all about choices though. The limited NHS budget creates a choice between competing priorities. If the NHS tried to meet every 'medical need' (and a debate on that term was the subject of my PHD) it would go bust (just as Rob said). So, it is forced to make choices.

 

My point today, in the current climate is that the choice has to be given back to the patient. They should decide if they want additional insurance and access to 'best in class' treatments, or settle for less and more disposable income in the short-term. We should have a safety net system, where access to general medical services is guaranteed and that the poor and the needy should be means tested (sorry buts its a necessary evil). Private and public insurance should be available through your employer, taxes should be reduced and the short fall made up by contributions to schemes. The NHS will live on but the govt are throwing more and more money at it. Ever stopped to think we might be better off if we organised it differently.

 

Cheers for all who contributed so far to this thread, i used it as 'market research' at work the other week

 

 

The chancellor just backed away from corporate tax raises this week for that very reason, instead he's likely to raise his revenue by hitting smaller business (that can't just move wholesale, or just for tax purposes, abroad) and private citizens.

 

So it's never a clear as all that.

 

Not to mention the repeated ignored issue of NEEDING to produce new drugs to keep profits (even if they aren't much if any more effective than the previous generations).

 

 

 

NICE may technically have clinically trained people in it, but they are accountants in their job there, nothing else.

 

 

 

The whole thing (in the UK) still goes back to needing to sort out the UK health and benefits system from the ground up - that's in a health and welfare sense, not a drug company profit sense, as that's an issue with completely different goals.

[Fop 1]

I must admit I'm quite impressed with the cervical cancer jab, astroturfing masterclass.

[Rob W 0]

when they brought in the NHS things like new teeth and glasses were free - so everyone went out for them - it didn't last very long.................

 

It's bloody tough to have to tell people you AREN'T going to treat them but I really can't see any alternative

[ChezGiven 0]

I must admit I'm quite impressed with the cervical cancer jab, astroturfing masterclass.

 

http://en.wikipedia.org/wiki/Astroturfing

 

????

 

The decision on the vaccine was basically a choice between Gardasil (French / US) and Cervarix (UK manufactured).

 

Gardasil protects around 80% against the cancer and Cervarix a bit more. Gardasil however also protects against genital warts and costs more. So the choice was go for the more expensive Gardasil and protect againt the warts too (cost of managing warts to NHS = 22m p.a) or go for Cervarix and forego the benefits of protecting against genital warts.

 

As the cancer vaccine investment was designed to reduce the rate of cancer and not genital warts, the decision to implement Cervarix was taken. This was less costly but more effective against cancer itself. As Rob just said, hard to tell people they arent going to get treatment but in this case its easier as the people who are going to get genital warts dont know it yet, so they arent personally affected by the decision. They are, at the moment, only statistical probabilities rather than being actual patients denied a genital wart vaccine.

 

The decision making was undertaken by an independent academic group of bio-statsitical modellers who made a closed recommendation to the DH, who will now implement the programme in September.

 

What PR/astroturfing has to do with that is anyone guess.

Edited July 28, 2008 by ChezGiven

[Fop 1]

I must admit I'm quite impressed with the cervical cancer jab, astroturfing masterclass.

 

http://en.wikipedia.org/wiki/Astroturfing

 

????

 

The decision on the vaccine was basically a choice between Gardasil (French / US) and Cervarix (UK manufactured).

 

Gardasil protects around 80% against the cancer and Cervarix a bit more. Gardasil however also protects against genital warts and costs more. So the choice was go for the more expensive Gardasil and protect againt the warts too (cost of managing warts to NHS = 22m p.a) or go for Cervarix and forego the benefits of protecting against genital warts.

 

As the cancer vaccine investment was designed to reduce the rate of cancer and not genital warts, the decision to implement Cervarix was taken. This was less costly but more effective against cancer itself. As Rob just said, hard to tell people they arent going to get treatment but in this case its easier as the people who are going to get genital warts dont know it yet, so they arent personally affected by the decision. They are, at the moment, only statistical probabilities rather than being actual patients denied a genital wart vaccine.

 

The decision making was undertaken by an independent academic group of bio-statsitical modellers who made a closed recommendation to the DH, who will now implement the programme in September.

 

What PR/astroturfing has to do with that is anyone guess.

 

 

Do you know what astroturfing is?

 

 

Also do you know how many lives the vaccine will actually save in the UK per year, contrasted with the cost?

 

(when you take into account that it only offers immunity to two of its strains [the two most common admittedly], but that even those with the those strain the likelihood of cancer developing isn't high and that with the current screening processes in the UK the likelihood of fatality being even less)

 

 

Like I said it was an absolute astroturfing master-class, but how NICE can justify in cost-effectiveness wise is beyond me (when they deem other more cost effective things as "not cost-effective" anyway - of course politically the PR value is huge).

Edited July 28, 2008 by Fop

[ChezGiven 0]

NICE didnt make the decision. NICE dont do vaccines, such a know-all and didnt even know that?

 

Do you know what Health Technology Assessment is? Evidence Based Medicine? Incremental cost-effectiveness analysis?

 

Thats how they made the decision. The incidence of the cancer is about 1000 per year, so when the current cohort reach maximal risk, the numbers of lives saved will be greater than 700, which is what they use to compare to the cost.

 

Does astroturfing have a different definition to the one in that wikipedia link btw?

[Fop 1]

NICE didnt make the decision. NICE dont do vaccines, such a know-all and didnt even know that?

 

That explains that then.

 

Still morally (and I know you like that) it's hard to see how the NHS and Government can deny other treatments for a sexy, but over all not very cost effective treatment like this.

 

 

Do you know what Health Technology Assessment is? Evidence Based Medicine? Incremental cost-effectiveness analysis?

 

Thats how they made the decision. The incidence of the cancer is about 1000 per year, so when the current cohort reach maximal risk, the numbers of lives saved will be greater than 700, which is what they use to compare to the cost.

 

And again given the limited immunity, the likelihood of developing cervical cancer even when infected with the strains for which immunity is likely given, and the likelihood of death even when you do have it, it's a very small number compared to the yearly cost of immunisation (of course it's a great money spinner for the drug companies with the contract and a very good political tool as well).

 

 

Does astroturfing have a different definition to the one in that wikipedia link btw?

 

Slightly in this case, it involved paying many freelance writers to magazines to come to conferences (and paying for their time there - something they were slapped on the wrist for when they were caught - of course by then they'd won the PR battle) being given lots of positive information before being set loose, as well as a sustained "information" campaign at a low healthcare level - building up of artificial grass roots "support" being a key measure in many businesses getting what they want.

 

The whole thing is a model of how to sell (the original US campaign won a lot of awards at [their PR Oscars] for it's method of selling the vaccine over there) something that isn't actually particularly cost effective, but marketed the right way is almost impossible to deny.

 

Unless of course you know how the PR works then you realise how much people are being taken for a ride.

[ChezGiven 0]

http://www.bmj.com/cgi/content/full/337/ju...3e94c0830ba845c

 

The decision was made in the UK on the basis of this analysis.

 

If you want to call that PR, i'll have to call you insane. The Health Protection Agency believes that programme will generate 80,000 QALYs (thats life years adjusted for quality). They came to that conclusion independently. If its a good deal in the UK, its a good deal anywhere. the fact of the matter is prevention is the highest value intervention you can make in any are. The price is fuck all too.

 

Who are you talking about in the US btw? You know you dont need to do subtle marketing in the US, you just advertise the drug on the telly.