Friday 11 December 2009

According the UK Shadow Minister of Health - what will happen if they win next election?

The UK healthcare system ranking as no 14 in the 2009 European Health Consumer Index as well as the recent reports about the very large difference in cancer survival rates across the country makes it quite obvious for everyone that something have to be done to reform the UK healthcare system. Given that it seems very likely that there will be a change in government after the next election I’m happy to have had the opportunity to discuss with Mr Mike Penning the Shadow Health Minister for the Tories about their plans for reforming the British healthcare system.

Initially he plays it safe by explaining that the starting point for the Tories is that Blair won the argument that NHS needs more money and that they will match the increase in funding already decided by the Labour government. But he continues that this massive increase in funding have up-to now not been matched in outcomes.

Stroke, cardiac, major trauma – all area areas where he sees that they are lagging behind in development. I might here be able to ad Allergy – having listening to Professor Prof.Dr. Monchy at the Universty Medical Center Groningen and learned that in the UK 68% of patients assumed to have Allergies are not tested at all for Allegies a figure that in Germany is 15%, in Spain 27% and Italy 28%. The country that comes closest is Denmark with 40%...

Now Mr Penning explains that the problems are based in the fact that departments are very silo based – and that there is a need to look at the public health agenda. I.e. he thinks that it’s not possible to only address health at the emergency entrance. Since leadership is important the Tories will change the department of Health to the department of Public Health as a clear signal that this needs to be addressed.

I must admit that when I heard this I thought for myself that I would have looked more at the financial silos and I was quite happy when at the end of our discussion when we were talking Qualies it became clear that they did have a double approach to the silo issue. More about this further down because before we have time to go there he states that it has been a massive increased spent in bureaucracy– because of the increased of targets driven healthcare. The hospitals have had to work to meet these targets – instead of deliver on outcomes. So priorities have been driven by bureaucracy rather than clinical needs. He also promises that this means that the Tories will abolish the targets!

If the problem description probably is quite PC I’m sure that their solutions are more controversial and I had to ask if national guidelines still will be used. And yes the answer is that they will but he underlines there is no point in diagnosing bowl cancer if you then don’t treat the patients. I read this as there will be a slight different focus in the way guidelines are written compared to today but didn’t go into details.

Another area for change is their ambition to extend the choice – in elective care – and to ensure that information enabling choice is available. The rational for this is that the information now being published was available but not transparent – so what needs to be done is to ensure that this information is freed up! This would empower the patients. I ask about the information that Dr Fosters gathers and he explains that this info isn’t available for the general public or even a Shadow Minister of Health like himself, only for the Department of Health etc . Mr Penning wants instead create one single portal into the web where you should be able to check survival rate etc.

He exemplifies the problem with the recent Dr Foster report that looked at particular hospital and found quite remarkable bad management despite that an excellent report have been published one month earlier. This report came after CTC made a decision to send in team due to the suspicious mortality rates they seen in non public material. Question is how this could have been possible. The answer to this is that according to Mr Penning is that:

1. Tories do not want any pre-booked inspections and on this they will go against till management of care if needed!
2. They want the monitoring of the foundation hospitals to be not only on finance but also the clinical side in order to get a better balance in the inspections.

Asking about top-ups he explains that they will accept top-ups in certain situations meaning that if there are drugs that are available in others countries that you receive a prescription on you should have the right to continue with that particular drug.

So then we came back to the Silos. And admittedly one of the things I find most interesting is that he claims that they will change the definition of the Qualy used by NICE. The problem as he sees it is that the Qualies do not take into account enough factors for example if we have a drug that would extend life. He thinks that it should also look at what the alternative cost would be – for example if you would need 24 hours care at home or hospital instead of this drug. I.e. what should be important for a reimbursement decision is the total cost of the state when a patient has a specific disease. If this could in the same way most NICE work do set the standard of how health technology assessments should be done across Europe I would be very happy!

He mentions that he also thinks there is a need to look at the way we are negotiating with the drug companies – for example on how early the NHS would be involved in the clinical trials. A topic that I need to look more into at a later stage – its quite fantastic for me to realise that a big buyer of medicines like the NHS actually do not negotiate on price!

Quite a lot to do so I’m curious about the plan for execution. He explains that there is a 3. 6 and 9 months program as well as one for 2 and 3 years time. They are already discussing with the civil servants .But in many cases we cannot get the info before we are in place. Still civil servants seem to be aware that the current government is out of ideas and changes have to occur.

So he hopes that after 4 years – there will be more people with better outcomes, some living longer some just treated better. Key will be a massive increase in patient outcomes. Well I just hope that his realism about the quality outcomes by the NHS lasts long enough for all of this to take place.

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