Boston mayor says the only good medicine is government medicine

I'm betting that he does not line up in emergency rooms very often

Mayor Thomas M. Menino embarked on a highly public campaign yesterday to block CVS Corp. and other retailers from opening medical clinics inside their stores, an effort that exposed a rift between Menino and the state's public health commissioner, a longtime ally. Menino blasted state regulators for paving the way Wednesday for the in-store clinics, which are designed to provide treatment for sore throats, poison ivy, and other minor illnesses.

The decision by the state Public Health Council, "jeopardizes patient safety," Menino said in a written statement. "Limited service medical clinics run by merchants in for-profit corporations will seriously compromise quality of care and hygiene. Allowing retailers to make money off of sick people is wrong."

In a separate letter, Menino urged members of the city's Public Health Commission to consider barring the clinics from Boston. CVS executives said they plan to open 25 to 30 MinuteClinics in Greater Boston before the end of the year, although they have not specified how many of those will be within the city's limits.

The Boston Public Health Commission spent nearly an hour discussing the impending arrival of the clinics and ways they could potentially be stopped. The panel took no action, but instructed the health agency's attorney to investigate whether it could adopt regulations forbidding stores with clinics from selling tobacco products, forcing them to make an untenable financial choice. The city says 31 CVS stores and 56 other pharmacies in Boston have city-issued licenses to sell tobacco.

In a statement issued last night, executives of MinuteClinics said they "would be happy to talk to Mayor Menino about any of his concerns." "We at MinuteClinic are committed to providing convenient, affordable access to quality health care," the statement said.

By issuing a broadside against the clinics and the state's approval of them, Menino placed himself squarely in opposition to a former longtime deputy, John Auerbach. Before becoming the state's public health commissioner last year, Auerbach spent nine years as executive director of the Boston Public Health Commission.

Auerbach's state agency yesterday released a statement defending its decision on the clincs: "The members of the Public Health Council were deliberative and thoughtful in their review of the limited service clinic regulation. We believe these types of clinics, operated either as part of a retail operation or in a nonprofit setting, can provide the public access to safe, convenient, and quality care for minor health issues."

The clinics are not designed to treat chronic diseases such as cancer or diabetes or serious emergencies. The facilities will be staffed with nurse-practitioners who are trained to spot patients with more severe illnesses or in need of specialized care and send them to a doctor or an emergency room. The regulations apply to any retail company, hospital, or community health center that wants to open a limited-service clinic outside traditional settings.

Members of the Public Health Commission acknowledged many of the mayor's concerns yesterday, but they also said a solution needs to be found for patients who can't get easy access to primary-care doctors or who spend hours waiting to have routine illnesses treated in emergency rooms. Commission member Hortensia Amaro, a Northeastern University professor, said her own experience trying to make an appointment illustrates the crisis. "It's almost impossible to get a primary-care doctor in Boston," she said. "I've waited nine months to get an appointment, and I have great insurance."

Still, members of the commission said clinics inside retail stores might only exacerbate long-standing problems in the healthcare system. Dr. Paula Johnson, a board member and physician at Brigham and Women's Hospital, said episodic visits to a drug store clinic could defeat efforts to provide patients with a reliable continuum of care. "We could be setting ourselves up for some real problems," she said.

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NHS 'now four different systems'

There are now four different NHS systems operating in the UK since devolution, according to health chiefs. As the NHS enters its 60th year, NHS Confederation boss Gill Morgan has told the BBC the health service is now in a unique position in its history. Ms Morgan said while the underlying principles of free health care still stand, patients in the UK's four nations are getting different services. Patient groups said the situation was breeding envy.

Ms Morgan, whose organisation represents NHS trusts and health boards, said there was no longer a universal system across the UK, as there had been when it was set up by the Atlee government in the summer of 1948.

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

She told the BBC News website: "We basically have four different systems albeit with the same set of values. "This period [since devolution] has been unique in the history of the NHS as it was essentially the same across the UK before devolution. "We have had a complete split in philosophy. "The model in England is about contestability and choice driving service improvements. Outside organisations have been brought in and patients can shop around. "That model has been rejected by the other three."

In Scotland, where people have been given free personal care - unlike the means-tested systems elsewhere - Ms Morgan said there has been much more consensus. She described the approach as the "collectivist model". "They have very little contestability. "They have been slower to improve waiting than England, but much less tension between doctors and managers. "In Northern Ireland there has been very big structural change and more integration between health and social care." And in Wales, which has received praise in England for introducing free prescriptions, she said the close working relationship between local government and the NHS had had an impact on public health.

She said it was too early to say which was more successful and in the coming years the differences would become even "greater". "All we can say is that patients are experiencing different systems, each one has its advantages and we will have to wait to see what happens."

But Joyce Robins of Patient Concern said the differences were "breeding envy". "Patients are increasingly looking across national borders and wondering why they are not getting the care others are getting. "I am not sure that is good for the NHS."

Michael Summers, vice chair of the Patients Association, said England was lagging behind the rest of the UK. "England - for some reason - seems to have been the poor relation." And Professor Chris Ham, a former government adviser and Birmingham University heath expert, said the NHS had proved an important battleground since devolution. "Health is the most important service devolved governments have power over."

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