The Saga of the NHS continues - in the BBC & elsewhere

I'm long overdue to post... and hope that this entry will serve.....

Several of my previous posts have dealt with the failings and trade-offs associated with government administered health care.  Unbeknownst to most Americans, Britain's NHS 'devolved' into 4 'national' services some time ago, serving, England, Scotland, Wales, and Northern Ireland. 

This recent series of articles by the BBC:

http://news.bbc.co.uk/2/hi/health/7149423.stm

http://news.bbc.co.uk/2/hi/health/7140980.stm

describes how England, Scotland, Wales, and Northern Ireland have diverged in their provision of health care since the 'national' system was broken into 4 parts some time ago.  While each participates in the 'NHS', the reality is that each independently administers its own Health Service.

As readers of this blog might have predicted, there has been propaganda about the benefits associated with 'devolution':

http://news.bbc.co.uk/2/hi/uk_news/scotland/3850805.stm

but when serious analysts wanted reliable data, most of what they got was rubbish:

http://news.bbc.co.uk/2/hi/health/4361964.stm

Commendably, interested parties have persisted in their efforts to understand the NHS, and the first two stories from the BBC above summarize their findings.  Below is a cut and paste from one of them about the characteristics of the different national systems:

England - NHS market created whereby hospitals and community services have to compete with the private sector for patients, resulting in big falls in waiting times

Scotland - Doctors have much more of a say in services, with limited involvement from the private sector. Meanwhile, patients enjoy free personal care, unlike the means-tested systems elsewhere

Wales - Close working relationship between the NHS and local government, which has meant more innovation on public health, but less emphasis on waiting times

Northern Ireland - Somewhat hamstrung by political situation, but re-organisation of trusts pushed through and good integration between social care and NHS

More information is available from these sites (the BMA site is rich with info, the others are rich with flavor):

http://www.bma.org.uk/ap.nsf/Content/devolution2007~devolution2007political

http://www.guardian.co.uk/society/2008/jan/02/nhs.health?gusrc=rss&feed=networkfront

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2008/01/02/nhs702.xml

Each of these systems has developed a very distinct priority list and identity in a very brief period of time. These almost certainly reflect the desires of their subscribers as communicated by their elected officials.  As such, it represents both good and bad: good that subscriber preferences influence the care that is delivered; bad that up until now, these desires may have been voiced, but not responded to.  Already, news outlets in England describe service availability as a 'postcode lottery'.  For individual patients, these differences can matter very much: it may be that the service you most require is significantly more available somewhere else than where you happen to live.  I do wonder if we will observe internal migration driven by service availability.....

Suffice it to say, it is not reasonable to expect the performance of these systems to come closer together over time - they are almost certain to continue diverging.  Times change, and these systems are certain to change trajectories as well.  As the above stories make clear, it is difficult to characterize the performance of these systems, which in turn frustrates assessing the effects of any changes that are made.  Worse, as some of these 'nations' become more wealthy, it is very likely that they will elect to invest more resources in their health care system, which will produce substantial disparities across these entities.  The poorer systems will find it much easier to obscure information than to keep up, and hence the quality of the information going forward is likely to go down, not up.  Finally, it is clear that England has embraced the idea that the private sector does many things as well as or better than the NHS - and is allowing a private system to grow in parallel to its NHS.... which raises the distinct possibility that the private sector might completely supplant the NHS for England's wealthier people (not just the rich).

All of this should influence how we think about 'health care reform' during the upcoming election season.  We should understand that, absent strict and forceful central control, that there will certainly be variation in any nationally administered health care system.  We should also understand that variation may represent good, in that it might represent the adaptation of the local system to the preferences of the local populace.  We should also understand that governmentally administered health care - in this case the NHS - does not necessarily have one best structure.  Finally, when candidates or their 'experts' talk about Britain's NHS, it should be fair game to ask them 'which NHS?', as it is clear that each of these entities is now distinctly different in important ways.  Do they mean Scotland's system, which is run by doctors? Do they mean Wales, with its free prescriptions? Do they mean Northern Ireland's system, which has integrated social services as a way to increase prevention and control costs?  Or do they mean England, where there are now clearly two health care systems, one for those who can afford to get out, and one for everyone else (complete with means testing) ?

Finally, it is worth noting that health care remains a hot topic among the readers of the BBC.  These recent news stories have generated nearly a thousand published comments as I write this...

http://newsforums.bbc.co.uk/nol/thread.jspa?forumID=3997&edition=2&ttl=20080102172314

And once again, the news from Japan makes me curious about its system:

http://news.yahoo.com/s/ap/20071228/ap_on_re_as/japan_ambulance_death

For those of you for whom this link does not work, it is the story of an 89 year old woman who spent two hours in an ambulance while its crew attempted to get her admitted to a 'hospital' - my guess is to an ER. The story claims that the first 30 hospitals were 'full' or had no docs available to see her.  Once again, we cannot verify any of the information in this story.  It is cause for concern, especially for elderly Japanese, who seem increasingly likely to become casualties of a government administered health care system which has completely failed to generate the resources necessary for care for Japan's rapidly aging population.

Comments

[StopUnum]

Unfortunately, it would appear throughout the United Kingdom we are currently experiencing the corrupt influence of an "outlaw" branded American insurer called Unum [previously trading as UnumProvident] of Chattanooga, Tennessee.

Your blog fails to mention the recent BBC investigation by Mark Daly into the continued bad faith practices of the Unum Corporation and its covert "influence" on the current British Government for welfare and NHS "reforms" but you will find the BBC story at the bottom of each page on www.stopunum.com

NHS devolution throughout the U.K. has not prevented "Pathways to Work" going national and other so-called innovative "initiatives" from the American based "outlaw" branded Unum Corporation or indeed, its various financially sponsored UK "charities."

Is it the case, the unfair and illegal practice employed by Unum to dismiss private policy claims [throughout the U.S and the U.K.] is being touted as proof of its credentials and ability to remove state welfare claimants from benefit and "help" reform the NHS?

For unknown reasons [at this stage], some currently in the British Parliament seem to embrace such criminal behavior, as well as promote the use of Unum's non-medical bio-psycho-social model for "assessments" of the chronically or mentally ill and/or disabled citizens.

http://www.stopunum.com/open-letter-to-all-lords-and-mp-s-houses-of-parliament-london/

Sadly, Unum is currently providing "rehabilitation training" to NHS doctors nationally. Apparently, trained "Pathways to Work" assessors will be stationed in doctor's surgeries and many other suggestions from this unscrupulous company e.g. to corrupt NHS doctors by paying bonuses for not signing sick notes etc. have already been put in place throughout the devolved NHS structure.

Private American wealth care [managed and controlled by ruthless insurance companies] is an absolute disaster, as Michael Moore's recent SICKO movie aims to highlight.

http://www.stopunum.com/unum-wealth-care/

The #1 [in both the U.S. & U.K.] "insurance" giant Unum seems to be extremely gifted, not only at continuing to con and deceive many policyholders [the "chosen ones" the ex-professionals with higher value long term claims] with false "safety net" promises but also setting British political agenda's, which appear designed to make Unum the "One" state provider of Health & Welfare services.

And watch out America, it would also appear the British state is starting to be used as a "reference site" back in the U.S. where this very "Christian" company is about to face numerous RICO ACT trials but with very little doubt will manage to continue to exercise additional American political "influence" to further increase its commercial wealth-care interests.

SICKO coming soon to a British NHS near you?
Let's sincerely hope not...

http://www.stopunum.com/a-sicko-12-step-rehab-programme/

The people in England need to wake up. Unfortunately, Wales currently has a Unum Professor [ex DWP] in charge of its NHS "reforms" and according to the most senior employed Unum doctors and Professors operating out of Unum's sponsored University facility in Cardiff Wales, disease does not exist, it's all in the mind and work is really good for you…

Hopefully, the ethical members of the British Medical Profession with morals will take a stance on all this nonsense very soon. If not, perhaps they will live with regret one day, just like this American doctor did for a long time.

http://video.yahoo.com/video/play?ei=UTF-8&b=6&vid=734753&gid=126556

And as they say in Scotland – It’s Time…

PS - The Japanese Government revoked Unum's trading license as punishment for falsifying records.

In October 2005, John Garamendi CA Insurance Commissioner threatened to revoke Unum's trading license for the state of California if it continued cheating policyholders.

Sadly, nothing at Unum has changed! The infamous hungry vulture award company is still ravenous for money, at anyone's expense.

The millions of dollars in fines and serious threats have clearly failed to deter this unscrupulous business from illegal business conduct.

May the US pending RICO Act trials put some of these corporate criminals away for a very long time and may the British public throughout the United Kingdom wake up to the terrible international scam - the Unum number "One" Health & Welfare Co. swindle...