What sort of NHS do we want?

It is quite a painful thought to realise that some think that by using IVF through the NHS one may have deprived someone of vital life-saving cancer drugs. Yet, that is what I was left thinking after listening to a debate on the radio the other day: it confirmed what many already suspected - access to IVF services is increasingly something of a postcode lottery across the country as the NHS has continually to tighten its belt as it struggles to stay vaguely solvent.

The programme brought memories flooding back from several years ago when my wife and I went through two IVF cycles through the NHS. Oddly enough, I find I struggle to remember many precise details as the whole process lasted so many years and the stress was so tiring, putting it out of my mind has broadly seemed the best thing to do.

Inevitably, we began with the many years of trying and failing to have a baby, then there were the exploratory tests, there was an operation, possibly two, there was a useless GP who lost our notes setting the whole procedure back months, and by doing so reducing our chances of success – and even of being accepted as patients – as we got steadily older and closer to very inflexible deadlines.

Once we finally were accepted, after a doctor was a little generous with my wife’s (lack of) weight, the drugs started, then the evening injections and the final, vital, trigger injection. The latter has to be given with such precision, the first time we did it we had to find a quiet room in the middle of a wedding reception to administer it. Then a specimen has be provided, the specialists do their wizardry. And then there is the waiting to see if it worked.

And, the first time, it didn’t. What next?

Apart from the inevitable huge disappointment, I remember going to our next appointment at the unit not entirely clear what we could do next; it’s possible that is just my recollection. But, suffice it to say, we started the drugs again, and another trigger injection – this time the specified time was in the middle of the night. To my horror, I managed to bend the needle but hoped I had administered the required quantity of the drug. Another specimen, more wizardry, then more waiting.

This time, it worked, bent needle or not. And our daughter has just turned 3.

Some describe this treatment as a ‘luxury’ but it certainly didn’t feel like it at the time. According to NICE guidelines, clinical commissioning groups (CCGs) should offer three cycles of IVF to all women of 39 or under. When we embarked upon this path, the age limit in our area was 35 and only two cycles were offered; it is certainly not the worst. The guidelines are woefully ignored across the country with only 18 per cent of CCGs offering the full service. What treatment one gets is entirely reliant on where one lives. It’s a hopeless situation which the government is studiously ignoring; its budgeting means that such treatments are a secondary concern.

According the OECD, Britain still spends less - in some cases significantly so - on health per capita than many of our European neighbours, such as France, Belgium, Germany, the Netherlands and Denmark. We spend less per capita than Canada and Australia (and the US, though its health service is something of a basketcase).

It is, therefore, hardly surprising that the OECD finds that, as a consequence of pretty mediocre spending, by the standards of developed Western nations, we currently have a mediocre health service. Their new report finds that we lag behind countries in key areas such as the survival from cervical, breast and bowel cancer. We need 75,000 more doctors and nurses to match the standards of our peer nations (a cause hardly likely to be helped by our government's anti-immigration rhetoric).

In these circumstances, and ignoring the fact that infertility is a recognised medical condition, I can understand how someone might think that a trust spending £6,000 trying to assist a couple have a child might reduce funds available for other therapies. We have learned so much about the importance of speed, when treating cancer, for example, that our reaction to demands for swift medical intervention, is urgent and visceral. And politicians, to extent, can make moves to answer such demands. At the same time, however, it is almost impossible to quantify the long term costs accrued due to stress, depression from infertility, and consequent long term savings from successful IVF treatment. In ways similar to aspects of mental health, it is simply easier to ignore.

Ultimately, it is a matter of ambition: It is about what sort of NHS we want - and are willing to pay for. Should the service be one which is constantly scrimping and saving, where one treatment is competing with another and there is a debate about which is apparently more 'justifiable’? Do we want a health service which doesn't aspire to be the best but instead is stuck on a permanent downward spiral? Politicians can talk about delivering the best health service in the world but this needs backing with hard cash. Putting it simply, this should not be a question of either cancer treatment or IVF. We need, and should demand, both. 

David and Jeremy really don't want 'your kids to die'

There are reports coming from North Korea suggesting Kim Jong-un has ordered the execution of every blood relative of his uncle – himself purged and killed last month – including women and children.

In November last year, the Oxford Research Group estimated more than 11,000 children had been killed in the conflict in Syria.

Across large parts of Africa, militias specialising in terror, such as the Lord’s Resistance Army, abduct, drug and force children to fight, rape and pillage. The statistics are blood-chilling.  Reports suggest tens of thousands of children have been abducted by the LRA in countries including Uganda, the Democratic Republic of Congo, the Central African Republic and South Sudan.

In too many conflicts, children are seen as disposable, cheap cannon fodder; expendable. And, in all the cases above, it can be argued that those responsible for these deaths genuinely do not care other people’s children are dying.

                                                                     

Now consider this headline:

David and Jeremy want your kids to die (unless you’re rich)

It appears above a blog by comedian Rufus Hound in which he talks about his decision to stand as an MEP for the National Health Action Party. Evidently, Hound feels passionately about the NHS and is furious about what the coalition is doing with it. He deserves credit for wanting to stand for election and actually try and do something about it, rather than being a chatshow-sofa and stage bound dilettante comedian like Russell Brand.

But it’s also very clear that while David [Cameron] and Jeremy [Hunt] may well be making an enormous hash of the NHS with their exceedingly top-down and bureaucratic reforms, they do not want anyone’s ‘kids to die’. I know it's hyperbole but it’s an absurd, ad hominem, attack which does Hound no credit at all and is unlikely to be the message the NHAP really wants communicating. 

Too often in political discourse, sensible debate gets sidelined and replaced by lazy stereotypes and cheap bribes. For example, it isn’t ‘class war’ to raise the top income tax band to 50p; voting for the Labour Party is not akin to supporting the gulags and terror of Stalin and supporting the Conservative Party does not equate to being a fascist. If Hound wants to command serious attention, he should let the details of his blog do the talking and not resort to such a crude, simplistic, headline. 

It’s well known that the prime minister lost his son Ivan back in 2009, after suffering from cerebral palsy and epilepsy. At the time, David Cameron paid very heartfelt tributes to the efforts of the NHS. Hound may profoundly disagree with the government’s reforms – and even the most generous critic can find much to question – but to suggest Cameron ‘wants’ other parents to suffer the heartache and pain he went through is particularly unpleasant. 

At least we have a piano

There's no question the NHS needs to improve. Its recovery rates from too many cancers are woeful. Yes, they've improved, but they remain woeful. Agency nurses, who may be good individually but lack local loyalty and accountability, are too widespread. GPs have contracts which pay for responsibility without accountability, while A&E avoid working weekends and leave it to junior doctors to tackle the chaos of Saturday night.

The system makes mistakes. I have a family member whose broken back was missed by an X-Ray; my grandmother died at Wexham Park Hospital, much to the apparent irritation of a senior nurse and a close family member lost a baby when she shouldn't have done. These were not good experiences.
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But, and it is a big but, the Channel Four news programme last night comparing the death rates of the NHS with the United States health system left me little short of livid with frankly shoddy use of statistics.

Ostensibly they have a good story. Sir Bruce Keogh, the NHS medical director, is to investigate after being shown statistics which reveal the death rate in the NHS was 58 per cent higher than the United States back in 2004, 45 per cent in 2012.

Channel 4 claimed to have access to exclusive data but the viewer only heard comparisons between the United Kingdom and the United States; other countries' figures were kept secret for reasons of 'confidentiality' which is a shame.

But no mention is made of the methodology. Professor Brian Jarman has been credited with highlighting the unusual death rate at the Stafford Trust and he deserves credit. But, his 'HSMR' system is no longer used by the NHS. It doesn't, for example, include deaths within 30 days of discharge.

No comparison between hospital deaths and home deaths in either country was made.
In US, 29 per cent of people died in hospital in 2010. In this country, it's roughly about 58%. Moreover, the cost of treatment in a US hospital was not mentioned, let alone end-of-life bills.

The programme had several moving, disturbing stories from family member whose loved ones died, having apparently suffered unnecessarily, while in hospital. All undoubtedly tragic. Yet, no further investigation is done. No causal link between the deaths and the NHS is made. They just died in hospital.

No comparison is made between health spending per capita. In 2011, in the United States it was $8,608, while the UK spend $3,609. Quite a contrast.

Life expectancy isn't noted either. For all the US spend per head on health care - and let's ignore the multitude who get no health provision at all, as the US government does - it lags behind Britain. For men in the UK it is 79, in the US 76. Meanwhile for women, in the UK you can expect to reach 82, in the US 81.
And for the record, US GDP per capita in 2012, according to the World Bank, was $49,922, the UK's $36,941.

But, I repeat, this is not to say genuine issues were not raised and investigations should be held into aspects of NHS care and death rates. But casual statistical use undermined an otherwise good story. And this is not what Channel 4 News normally does.

And perhaps most riling of all, the Channel 4 journalist was terribly impressed to find piano music echoing from the hospital she visited in the United States. Mayo hospital was 'impressive, with piano music paying in the lobby and sunshine streaming into the rooms' her blog read. Not sure there's much British hospitals can do about sunshine, especially in comparison with a centre in Phoenix, Arizona.

But, I was even more impressed to find a pianist playing a grand piano in the atrium at Guys and St Thomas' during my frequent visits there a few years ago. Better than piped muzak in dull, hotel-style ersatz, this was a patient having fun.