Tuesday, January 02, 2007

NHS turbulence is set to continue

So, was it the best year ever? The Royal College of Nursing certainly didn't agree with Patricia Hewitt's declaration in April. They booed and jeered at the health secretary when she addressed the nurses four days later. The stormy encounter in Bournemouth came at a time of furious debate about NHS deficits and job cuts. Those arguments resurfaced in the autumn, and will rage again in 2007 as NHS bosses face renewed pressure to balance their books. The final figure for the 2006 deficit in England was 547 million pounds.

Ministers point out it represents a tiny share of the overall budget, which has been boosted by record investment over the past eight years. And they are hopping mad about claims that the NHS is losing 20,000 posts - they say this is alarmist because the real number of people who have actually been laid off is close to 900. But critics say that won't be of any comfort to people who've been made redundant, or to newly trained staff seeking work in the NHS. Next year local demonstrations will keep erupting in areas where there are threats to existing services because of reorganisation.

In a recent appearance before a committee of MPs, Patricia Hewitt remained jaunty about her "best year ever" claim - pointing out that patient care in important areas like cancer has been transformed, with reduced waiting lists. She acknowledged the financial pain that will mean some local deficits persisting - but she said she would take personal responsibility on the NHS as a whole breaking even in 2007. There certainly have been improvements to the health service recently - as one would expect, with the extra billions of pounds that have been pumped in.

But sometimes it is the more basic aspects of care that can prove a stumbling block. Look at the recent furore over the long-running problem of mixed-sex wards, which Patricia Hewitt has told health bosses to investigate.

And then there's that perennial NHS problem - how do you meet ever-higher expectations and provide impressive medical technology without breaking the bank? The theory is you set up an independent body called NICE (the National Institute for Health and Clinical Excellence) to gather the evidence and assess drugs for their cost-effectiveness. This doesn't make bitter arguments go away though.

2006 has brought good news for women who are now eligible for the breast cancer drug Herceptin in the early stages of the disease. But the year will be remembered less favourably by campaigners for people with Alzheimer's Disease, as drugs which were previously prescribed for the condition are now restricted. That row will continue next year, as three drug companies mount a legal challenge, claiming that the decision-making was unfair.

Although NICE will also be investigated by the parliamentary health select committee, it is undaunted. NICE has strong political backing and is an increasingly confident organisation, with a role which has expanded to include public health.

By the end of 2008, patients have been promised they won't have to wait any longer than 18 weeks, between seeing their GP and having an operation. It's a tough target - so expect to see the NHS pulling out a lot of stops to try to get there over the next few years.



For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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