NHS may be restricted to core services

The NHS is slowly moving in the direction of becoming a very costly organization that consists solely of bureaucrats and provides no services at all

The National Health Service might provide only core services, with patients forced to pay for any other treatment or meet it from private insurance, the government has revealed on Monday.

News that ministers were examining the possibility of defining the services that the NHS is obliged to provide free to everyone was disclosed in the small print of the public services policy review launched on Monday by Tony Blair, the prime minister, and Gordon Brown, the chancellor. It says the government should “look at the possibility of drawing up a package of services that all users are entitled to”. Nice, the National Institute for Health and Clinical Excellence, could be asked to do that.

The health department confirmed it was “looking at the possibility in the normal process of policy development” and agreed that deciding what everyone was entitled to would also involve deciding “what they are not entitled to”.

Academics said that amounted to defining a “basic basket” of services the NHS would fund, but warned it was fraught with technical and political difficulties. Anna Dixon, deputy director of policy at the King’s Fund think-tank, and a specialist on international health systems, said: “It sounds like establishing a core package of benefits that the NHS will fund – and that is something that has long been debated in academic circles. But politicians ... have always shied away from being more explicit about entitlements.”

Social insurance systems tended to be much more explicit about what was and was not covered, with private insurance markets developing to cover excluded treatments, she said. But she warned that when lists of exclusions were drawn up, “they often do not feel right to the public”. It was “a very difficult exercise” and one that, if undertaken, “is going to be very controversial”. It would raise issues over whether infertility treatment, or so-called lifestyle drugs for obesity or impotence, should be included.

David Hunter, professor of health policy at Durham University, said: “It is very difficult to define what is in the basket, so either it doesn’t get done or very little gets left out. You don’t save much, and you are still left with the issues of how to ration care and assess quality and cost effectiveness” – something Nice was already doing but “in a rather less prescriptive way”.

Patricia Hewitt, the health secretary, was deputy chairman of a pharmaceutical industry-financed study in 1995 that called for restrictions on free services. But she disowned the report on becoming health secretary, saying the government’s big increase in NHS spending removed the need for such measures.

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Australia: Anger over 8-year wait for surgery

MORE than 1500 patients from across Queensland face a wait of up to eight years for operations. The Australian Medical Association says hundreds of those waiting for ear, nose and throat surgery at the Royal Brisbane Hospital may never be treated. Patients are not being told the likely wait and many give up waiting and seek private treatment.

People with the longest waits are those classified as Category 3 patients - needing operations to fix sinus problems and recurrent tonsillitis. They are constantly pushed to the bottom of the list while surgeons treat more urgent cases. State president of the Australian Medical Association Zelle Hodge said the waiting time had blown out due to a lack of resources. She said 1500 patients were waiting for surgery. "People aren't told by the hospital how long the waiting list is and I think when they eventually find out they just don't believe it," she said. "Even I find it boggling to think of an eight-year wait, but it is true. "Although people will move up the waiting list, they keep getting pushed down again because of new urgent cases that keep coming in. "Unfortunately the Royal Brisbane looks after the majority of ear nose and throat patients in the state so that makes the situation worse. "Many people give up waiting and seek treatment from private hospitals, while others who can't afford to do that will continue to wait and never get their operation."

Queensland Health says that it has reduced waiting times for patients classified as urgent and life threatening cases. In January there were 187 patients waiting longer than the clinically recommended time of 30 days, compared with 360 in October last year. But figures also reveal an increase in semi-urgent and non-urgent patients waiting longer than the target times. A quarter of semi-urgent Category 2 patients now wait longer than the target of 90 days, and more than one third of Category 3 non-urgent patients are waiting longer than the recommended 365 days. The total number of patients waiting longer than recommended is 10,200.

The Queensland Cancer Council said even cancer patients were being forced to wait too long. Coalition health spokesman John-Paul Langbroek said that Queensland Health performed fewer operations than the public health system in other states. "ENT is failing patients anyway, but to be saying eight years to people, well they might as well be saying they can't provide the service at all," he said. Queensland Health said emergency surgery must always take priority over ot,her surgery.

The above article by HANNAH DAVIES appeared in the Brisbane "Sunday Mail" on March 18, 2007

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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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