Tag Archives: NHS

Manifesto makes a point

The Labour, Conservative and Liberal Democrat manifestos will be published next week. These will provide an invaluable resource for insomniacs and political anoraks around the country, as well as giving us an insight into the likely policy priorities of the next Government.

Manifestos are necessarily limited in what they cover, with the infamous exception of Labour’s 1983 offering, “the longest suicide note in history”. They are usually confined to broad policy statements and worded with enough ambiguity to allow future ministers a liberal interpretation of what exactly are their commitments.

But elections also provide an opportunity for outside interests to enter the policy debate. That’s why the run-up to the General Election has seen various businesses and campaign organisations put forward their own manifestos, visions and policy demands.

One valuable contribution comes from vaccine manufacturer, Sanofi Pasteur MSD’s manifesto, Putting vaccines at the heart of health care. It calls for a full-scale review of vaccination policy to give it a more central role in the provision of health care.

In his first speech as Health Secretary in June 2009, Andy Burnham said that prevention is a “long-term insurance policy against spending challenges”. The focus, however, has been on attempting to change life-style choices. No one is arguing against this, but if policy makers want to enhance prevention, then greater importance should be given to vaccination, which is a far more effective means of preventing ill-health than relying on people to change their eating and drinking habits.

Vaccination can prevent more than 20 infectious diseases and has helped eradicate smallpox. Only the provision of safe water has done more than vaccines to reduce mortality. But too often it is seen as something that is only for children. The NHS Choices website lists 17 vaccines (including next stage doses and boosters) that are offered routinely to “everyone” in the UK. Yet only two, flu and pneumonia, are for adults.

Our immune systems decline with age, which leads to more frequent and more severe infections. And with the over-60s population predicted to increase by 160% between 1999 and 2050, increasing infections in the older population will increase the burden on the NHS.

That’s why Sanofi’s manifesto echoes the calls of European health academics for a “life course” approach to vaccination. Vaccination programmes should start from 50 years of age, before age-related decline in the immune system begins. The recent approval by the Joint Committee on Vaccination and Immunisation for a shingles vaccine to be available on the NHS, albeit from the age of 70, is a start. This could help reduce the incidence of this debilitating disease by half, and thereby save the NHS care costs.

Judging by the three-way bun-fight between Andy Burnham and his Conservative and Lib Dem shadows, Andrew Lansley and Norman Lamb on Newsnight yesterday, the election campaign is unlikely to see serious debate on the future of health policy.

Officials and health professionals will read Sanofi’s manifesto with care but will politicians get the point about vaccination? Perhaps when the election is over, they will read other people’s manifestos.

NHS first, patients second

Yesterday was an inauspicious day for Virgin Group to renter the primary healthcare market. It bought a 75 per cent stake in Assura, the medical services group that forms collaborative joint venture partnerships with NHS GP practices to provide primary care, urgent care and outpatient services, diagnostics and day-case procedures in the community. On the same day the Department of Health ordered primary care trusts across the east of England to suspend procurement for community services.

The unstated intention of the DoH is to halt the independent investigation by the department’s Co-operation and Competition Panel into the legality of Health Secretary, Andy Burnham’s, policy that NHS bodies should be the “preferred providers” of health services before it ruled against his policy.

This is bad news for outside providers, who will see their market shrink. But it is also bad news for patients, as it will reduce choice and leave them with no option but to use an NHS provider, even if they get a poor service from it.

As a special adviser in the Department of Health, I was involved in discussions on Labour’s manifesto for the 2005 election. The final version, on which the Government was elected, committed the NHS to use new providers from the independent and voluntary sectors to provide health services. The purpose for doing so was to add capacity, promote innovation and to drive competition, or “contestability”, within the NHS. The ultimate goal, of course, was to improve the quality of patients’ healthcare.

Burnham’s speech last year to the King’s Fund, in which he stated that the NHS should be the preferred provider of health services, sent a signal that opportunities for the private and voluntary sectors were being closed down. NHS officials in one east of England primary care trust were not slow to get the message and abruptly excluded private and voluntary organisations from tenders.

A final determination of the legality of this move will come after the 2010 election. This is just as well for the Government since the motivation behind it is clearly political. Burnham’s move is designed to appease unions, like the BMA and Unison, who have never been wholly reconciled to the involvement of the private sector in the provision of NHS services. It also helps position him slightly to the left for any future Labour leadership election.

Labour’s manifesto for the 2010 election will not be as welcoming of alternative providers, but there will still be scope for them to provide NHS services. It is clear though, that the independent and voluntary sectors still have a lot of persuading to do to overcome resistance from within the NHS. This will be the case even under a sympathetic Conservative administration.

A determined campaign by private and voluntary providers will need to begin the moment the election campaign finishes.

A rescue remedy that I just can’t swallow

The House of Commons’ Science and Technology Committee have recently finished taking evidence on its inquiry into Alternative Medicine.

Perhaps the most notable outcome of the oral evidence sessions was the ever-increasing acceptance that homeopathic remedies – on which the NHS’s four homeopathic hospitals spend £10million per year – are nothing more than placebos. A senior representative from Boots testified to the Committee that “a large number of our customers actually do believe [homeopathic remedies] are efficacious”. The use of the word “actually” is a virtual admission that there’s nothing of value in the snake oil!

The rigorous double-blind tests that pharmaceutical drugs and vaccines undergo seem not to apply to homeopathic remedies. Presumably this is because it’s either widely perceived that natural compounds cannot harm (er… isn’t arsenic natural?) and/or that they have such little effect on the human body that they require no such scrutiny. Yet while natural remedies are easily available on the shelves at our chemists, we are denied vaccines that have been tested rigorously enough to be widely available in other countries, sometimes because of the cost to the state. And this is despite compelling evidence that manmade drugs and vaccines work. Whither smallpox, typhoid and cholera?

So why should such a massively profitable industry be allowed to get away with peddling fraud? I guess the answer is in the question: rather than being a cost to the state, it generates income. To be fair, the remedies may have a placebo or therapeutic effect that genuinely makes people feel better, but are we really happy to rely upon a placebo when the alternative could be a drug proven to deal with the medical problem we suffer?

What we should be doing is educating people to make the right choices from informed positions. The risk with homeopathy is that we deny ourselves and our children remedies that work, simply for the sake of a flawed notion that Mother Nature can cure our ills.

So, here’s a chance for Government to show real leadership and courage: the findings can recommend dropping funding and endorsement of homeopathic remedies unless properly tested. For homeopathic supporters, it would be a bitter but overdue pill to swallow. I suspect they ought not to worry – we’ll probably just be handed a placebo.

Needled by vial hysteria

I gave blood today: my personal contribution to the NHS. I had no Hancock-like fears about donating the full pint. The NHS’s blood transfusion service ran a smooth operation and I was a grateful recipient of my free cup of tea and biscuits.

We give blood not because we necessarily expect to need a transfusion in the future, but because we want to make an individual contribution to the nation’s health service. By contrast, we have ourselves or our children vaccinated because we want protection from infectious diseases. There is still a wider societal benefit: the higher the rate of vaccination, the lower the pool of people at risk of infection who, in turn, could pass on their infection to others.

This principle of vaccination protecting not just the individual but wider society was severely undermined by the campaign against the MMR vaccine by the now-disgraced Dr Andrew Wakefield and some of the more cynical and hysterical sections of the media. This week, a panel of the General Medical Council (GMC) found him guilty of “dishonesty and misleading conduct” in pursuing his claim of a link between the MMR vaccine and autism.

As a result of his campaign, public confidence in the MMR jab was severely damaged and vaccination rates fell dramatically. This led to an upturn in the incidence of measles, a disease that can be fatal. Thanks to a national MMR vaccine catch-up campaign launched in 2008, coverage is going up again. But in the years 2006 and 2007, there were 1,726 confirmed cases of measles in England and Wales – more than the previous ten years put together. There was one death from acute measles in England in 2006 and another in 2008, while between 1992 and 2006 there were none.

The whole sorry saga around the MMR vaccine shows how seriously the Government and the vaccine industry need to take the issue of public confidence. Apart from the provision of safe water, no other health intervention has done more than vaccination to reduce mortality. Scaremongering campaigns such as the one on MMR, show that it is possible to whip up fears about its efficacy.

I know from my time as a special adviser in the Department of Health how much effort ministers and the Chief Medical Officer had to make to rebut frenzied media coverage generated by Dr Wakefield’s campaign. They didn’t do this simply to avoid unpleasant newspaper headlines, but to protect public health.

There is no shortage of Government initiatives to support the pharmaceutical and, by extension, the vaccine manufacturing industry. But after this week’s GMC verdict, it is perhaps time for it to consider what more needs to be done to strengthen public confidence in the benefits of vaccination and give it a more central place in the provision of healthcare. That way, we can increase our immunity against both preventable diseases and alarmist media campaigns.