World AIDS Day

Hope to do a proper post on this tomorrow, but for the time being there is this from Joseph Healy, one of the London Green Party’s candidates for the European Elections in May 2009.

——————————————————————————————-

Tomorrow is World Aids Day. The disease is still causing havoc across Africa, Eastern Europe and increasingly Asia. Jean Lambert will be attending a World Aids Day event in London with the Food Chain and I will be attending the pre-launch of a new film on the subject. For anyone in London there is also the screening of this film about Swaziland as part of World Aids Day. Thankfully with the end of Mbeki’s period as South African president, the new Health Minister is tackling the issue seriously.

http://www.worldaidsday.org/Events/Events-listings/01-Dec-2008/World-AIDS-day-special-screening–Without-the-King.aspx

I hope that people will support events in their own areas over the next few days. Many lives can still be saved with a proper prevention programme and a fully financed treatment regime in many poor countries.

Joseph Healy

Lectures…

Well, while I recover from the weekend I have had a great lecture on Ethics and Law today by my favorite lecturer here at uni.

Lectures are often mind numbingly boring but this one was truly enjoyable. A great analysis was given of power and conflicts of interest as well as a good discussion on the ethics of selling organs. Just a couple of quotes which I thought were worthwhile:

“because men care not, in that subject, what be truth, as a thing that crosses no man’s ambition, profit, or lust. For I doubt not, but if it had been a thing contrary to any man’s right of dominion, or to the interest of men that have dominion, that the three angles of a triangle should be equal to two angles of a square, that doctrine should have been, if not disputed, yet by the burning of all books of geometry suppressed, as far as he whom it concerned was able. ” Thomas Hobbes, Leviathan Chapter XI

“All people have the right to sleep under the bridge but for some reason, only poor people take advantage of this”  Mark Twain

Anyway, enough rambling! Except to look forward to the climate change demo on Saturday and hope I can make it to an LSESU Environment and Ethics Week meeting tomorrow…

studentmedic

NHS! (again)

NHS demo yesterday was a success with a good number of people from the Greens there. Well done to all those who helped with the Green Party placards: they were out in force on the day! Wish I could have helped with them too!

The following motion in support of the demonstration and against private involvement in the NHS was passed at the Green Left meeting on Saturday last week. I am not sure if it has been publicised since (having been somewhat out of the loop with e-mails, aside from during procrastination time, due to a heavy week on the wards trying to finish off my A&E module! – also the reason I haven’t blogged for a while):

“Green Left notes the attempts at increasing private involvement in the national health service. Recognizing that healthcare commissioning is to be tendered to private companies (including some with a bad reputation in the USA) and that implementation of the Darzi plan for polyclinics will probably involve some private sector companies, we affirm that this is against the public service ethos central to an ecosocialist future.

We strongly encourage involvement and support of the Keep Our NHS Public demonstration on Saturday November 3rd 2007.”

Anyway, best get back to work… Have a dissertation to write and wouldn’t mind getting a bit further on the new edition of Joel Kovel’s book.

Tyranny of the Bottom Line?

http://news.bbc.co.uk/1/hi/health/7037657.stm

Yet another example of what happens when hospitals put profit before people, when the ‘bottom line’ rules supreme. Instead of prioritising human health and happiness, the bottom line has been prioritised. This is absolutely disgusting and goes to show how powerful the ‘bottom line’ is in forcing individuals and groups to submit to its need to be preserved.

As with so many things, an economic system where capital does not rule supreme would help prevent such things happening. For the time being, at least an NHS where services aren’t outsourced and which is provided with an adequate budget to ensure that all hospitals have adequate nursing care all the time would be a start!

Merge?

The NHS is forever merging smaller hospitals together with claims of greater efficiency and better value for the public. However, the evidence contradicts this. It was stated in the BMJ during 1999, that economies of scale only apply to hospitals that have less than 200 beds. Given that the mean NHS hospital size in the UK is 300, and the optimal size for a hospital is between 200 and 400, why merge hospitals together? In fact, once we reach 600 beds in a hospital, prices start to increase again.

There are other good arguments for smaller hospitals: smaller hospitals are more likely to be directly attached to their local community. This means that the community will be more involved with the hospital, and it will probably be more accountable (or at least more closely watched) than a detached ’super-hospital’. Local services, near people’s homes, make them easier to access, reducing the disincentive to access healthcare and reducing congestion as people don’t need to travel quite so far.

Of course, for some specialist procedures, specialist centres are better and thus it is better to have referral centres – but this is only for a minority of hospital care in the NHS. For ‘bread and butter’ cases, however, small and local hospitals are best.

Relevant Green Party Policy

H304 Primary and hospital care will be more closely integrated. District staffing structures will be reviewed, with the aim of integrating hospital-based specialists into primary care and community health workers into hospital practice. The hospital programme will emphasise the development of appropriately-sized district and community hospitals, with a reduced role for larger regional centres. However, some specialised services will continue to be provided on a regional or sub-regional basis.

Virgin Stemcells

Richard Branson is to launch a stem cell bank (reported here by the BBC). Fantastic: capitalist, market economics getting in on something which is about saving lives. Is there anything it doesn’t permeate into?

Of course, some parents won’t be able to afford this technology. Do we really want to see the situation, say 20 years down the line, where parents who couldn’t afford to preserve some cord blood from their kids are left lamenting the ‘what if?’. It is a bit gross and perverse. With such a technology, I think there is an argument for banning it until it is proven to work. Once there is proof, the NHS should offer it for all babies or make the decision that it is prohibitively expenive and keep the ban. That is really the only way to prevent a massive double standard – otherwise it is incredibly unjust.

Morally, it is the equivalent of giving only those who can afford it the opportunity to have their cancer operated on.

=========================

In other news, Hillingdon PCT has proposed to hand over almost all of its functions to the private sector. The Trust’s Chief Exec has been quoted as saying, ““I want to get rid of everything, outsource it”.”

“PCT could slash 90 per cent of staff. A troubleshooter chief executive plans to strip an ailing primary care trust down to its core functions and reduce the number of staff from 300 to 30. Anthony Sumara, who has been interim chief executive of Hillingdon PCT since October, proposes to put three out of four commissioning support services out to tender, and to hand clinical services to a new provider. Under the proposals, the PCT would retain only its core functions like governance and emergency planning, as well as patient and public involvement. The move could see the PCT, which has �54m of historic debt, and is predicting an in-year deficit of �11m, reduced from a staff of ‘300 to 30′, he said. But he said the chances of the board agreeing to the move were 50:50. The Proposal to Procure commissioning strategic outline case was published by the PCT on January 23. It states: ‘Outsourcing the majority of the PCT commissioning functions gives the greatest benefit and the greatest probability of success,’ when compared with three other options: doing nothing, building internal capability and developing synergies with other organisations. If the project gets approval in June the contracts will go out to tender. Mr Sumara told HSJ: ‘I want to get rid of everything, outsource it – and we are distancing the PCT from its provider functions.’ The government’s commissioning framework allows PCTs to choose which areas they wish to outsource. The DoH is expected to publish its list of recommended commissioning experts within weeks. Hillingdon is looking at three of the four main categories identified in the framework: assessment and planning; contracting and procurement; and performance management to ensure better accountability. The organisation is currently working on defining what residual functions a PCT should hold. Mr Sumara said responsibility for monthly emergency planning, managing the outsourcing, governance of money, accountability and development of the market would remain with the PCT. ‘You need a PCT because you need a statutory body to receive the money from government. We are also deciding what will happen to the provider side – should it come under the hospital or become a social enterprise ? We will keep public-patient engagement as we have a better idea on how to engage with the public locally and the voluntary sector than, say, [information analysts] Dr Foster,’ he said. ‘The PCT is not giving up responsibility. We are doing this as part of our recovery and to get some clarity around what a PCT should be doing. It’s commercialising, not privatising and the public don’t care – it’s not about the provider services, it’s about men in grey suits. It will still be free at the point of access.’ The next step is to develop the outline business case for consideration by the board in April 2007 and appoint a dedicated project team. The strategic outline case states: ‘Hillingdon PCT commissioning is currently weak and not fit for purpose. For example, acute providers will continue to over-perform by �9.8m in 2006-07, adding to the historic debt.’ Mr Sumara said: ‘At the moment it is 50:50 whether it will be approved but I do think it will save us money and I do think it will get the go-ahead. I don’t think we are big enough for some companies but they will start with us with a view to providing a service across London.’ Some of the risk factors considered in the proposals include: the supplier’s set-up costs exceeding the potential gains of the contract; the delivery of financial balance for the PCT taking longer than currently planned; the requirement to repay the historic debt making the contract unattractive to outsourced suppliers; and an adverse reaction from the public.” Keep Our NHS Public Website.

I needn’t say much more really. The march towards privatization by this government seems almost unstoppable. Despite the fact that it has been shown not to work in the interests of the public (take the railways with astronomical train fares or british gas cutting off pensioners or royal mail’s struggles as just a few examples).

The private sector will take the easy, profitable cases and leave the rest for the NHS to deal with. The private sector is not interested in doing the best for people in the slightest. It is out to make money, and money it shall make.

More information, here, on the Keep Our NHS Public website.

A quick trip around the blogs today. Derek Wall and Sian Berry (the Green Party’s co-principal speakers) make a statement highlighting the social problems surrounding Microsoft’s replacement for Windows XP: Vista. Derek, I should add, is a supporter of open-source – an excellent way of breaking big business monopolies on production by working co-operatively and providing the products of work for the public to use and adapt for free.

Derek also makes some important comments stressing the Green Party’s support for the PCS union’s strike to save 100,000 jobs and preserve our public services.

Jim at The Daily (Maybe) comments about Brian Haw and the merits (or lack thereof) of making him a figurehead for the anti-war movement. I fully agree with his comments here, very well put!

=====================================

NHS Together is an alliance of trade unions working together (even the BMA is involved in this one!) to campaign for a better health service. They are arranging a national day of action on the 3rd March: look out for events in your area – new events are going up all the time.

It is about time we all took a stand, together, to put a stop to the government’s ride to greater and greater private involvement in the NHS. In terms anyone can understand: private companies have a responsibility to make money. This is their prime responsibility, not the well being of patients. Corporations don’t give a rats arse about patients- they are money making enterprises. Do we really want that kind of system running our NHS? Health care cannot be reduced to a simple monetary exchange: it is about something much more valuable than that!

Life isn’t all sweets and cakes…

Finally, for the first time in a month, I have good net and computer access. Hopsefully this will be accompanied by a rise in the quality and number of posts!

===============

A poll (reported here in the Guardian) has found British kids spend (or have spent on their behalf, more likely) more money on fizzy drinks and sweets than children in any other EU state. This shows, once again, how vital it is that health education is taken seriously and that regulations are toughened regarding food products aimed at children.

Whilst it is important that we aren’t killjoys (after all, as we all know, fun is great!), regulations need to reduce the amont of sugar and other ‘baddies’ people consume, particularly young children who can’t really make informed choices about their diets. There may be a case for ‘health taxes’ here as long as they are carefully used. Ideally, regulation will attempt to deal with the majority of the problem.

One of the first things that should be done, in my opinion, is the banning of the sale of sweets at the checkout in supermarkets. It is well known that these are strategically placed to encourage impulse buying and unhealthy eating. How about putting apples and other fruits at the checkout so people can impulse buy healthy produce (hopefully locally produced and organic too! – I’ll post about sustainable food production here soon).

=============================

Stuart Jeffery blogs, here, about cars and their bad health effects. Not only are they a problem, but they are massively anti-social (walking being the opposite: healthy and pro-social). Thankfully, the government, in its infinite wisdom chooses to make public transport the expensive and inconvenient option to get around. Only when public transport provides good value for money will ‘middle england’ be encouraged out of his car. Future health benefits are outweighed by immediate convenience for the vast majority of people.

studentmedic

A land of plenty?

Modern, british society has made many advancements in protecting the rights of vulnerable groups. One group, which has arguably been left behind is the elderly. For this reason, if no other, it is vital that issues surrounding elderly people and their treatment are brought to the fore.

As an example, a campaign being run by Age Concern regarding malnutrition in hospitals (although this not only attacks what is effecting the elderly; malnutrition can effect anyone spending a long period in hospital).

 It is thought that 14% of people over the age of 65 are malnourished. It is vital that ideas such Help The Aged’s ’seven steps to end malnutrition in hospitals‘ are taken seriously and action taken to effect the changes. They are simple, but helping the elderly is not as politically sexy as some other health issues despite costing 7.3 billion pounds per year and, far more importantly, impacting the well-being and quality of life of so many elderly people.

 The elderly deserve better.

Other points from Age Concern regarding Ageism in the NHS, here.

Health Taxes

Happy 2007! 

The Christmas break is well and truly over, as demonstrated by my inbox being jammed full of e-mails on the Green Party lists, my legs constantly aching from standing for too long on the wards and my blood pressure rocketing… (I have a lovely essay to do).

===============

A topic which has recently caught my attention, is that of taxes on ‘unhealthy’ substances, such as sugar and fat. It is an interesting idea, not least because it sounds strikingly authoritarian to dictate to people what they can and cannot eat. Should the ‘health apparatus’ be informing people or compelling people?

 An argument I have seen posited is that such taxes are the only alternative to rationing healthcare by not treating the obese. Wouldn’t the end outcome of such taxes simple be that the well-off would keep their autonomy and the poorer in society would loose that autonomy since they would not be able to afford it? Hardly fair for an NHS which is funded through general taxation… Is the NHS not there to treat people regardless of their health ’sins’? What next? Perhaps we should tax people who take part in dangerous sports in order to fund their treatment and to discourage such hazardous activities.  It reminds me of a quote in the front of the Oxford Textbook of Medicine: The aim of medicine is surely not to make men virtuous; it is to safeguard and rescue them from the consequences of their vices. The true physician does not preach repentance; he offers absolution. (H. L. Mencken, 1923)

Hmm, I wonder. It is an interesting idea…