The Failure of Reformism Admitted

The NHS cannot tackle the health gap between rich and poor by itself and can only provide a "sticking plaster" for such inequalities, according to the convener of Holyrood's Health Committee. MSPs on the Scottish Parliament's Health and Sport Committee found that while there had been "many well-intended initiatives" aimed at reducing the differences in health between affluent communities and those in deprived areas "none has made any significant difference". The committee concluded most causes of health inequalities are "rooted in wider social and income inequalities"

Committee convener Duncan McNeil said: "That your income, your education and where you live contribute to how healthy you are is an issue that as a society should bring us significant shame. Since devolution, successive governments have made this a political priority and invested significant amounts of public money in tackling this complex issue. But sadly none have made any significant difference." He added: "Our NHS can offer a sticking plaster, but without a new approach we will not tackle the root causes of inequality and improve the health outcomes of thousands of people across Scotland."

In their report MSPs said "Despite many well-intended initiatives, none has made any significant difference. Indeed, although health is improving, it is doing so less rapidly than in other European countries and although the latest figures are a little more encouraging, health inequalities remain persistently wide."

The Burnt-out NHS

Doctors in Scotland are suffering “stress and burnout” as growing NHS workloads take their toll, medical leaders today warned.  BMA Scotland chairman, Dr Keighley has warned that the fall in hospital bed numbers over a number of years has led to rising waiting lists and more pressure on Accident and Emergency.

Health boards and the Scottish Government are struggling to deal with the pressures of an ageing population, Westminster-led funding cuts and rising expectations from patients which include a shift towards a seven day working week in hospitals. New contracts are now being proposed for doctors, along with “radical” changes to training and greater weekend working. Dr Keighley insisted doctors are ready to look at new ways of working.

The crucial contact between doctors and patients has particularly suffered, according to Dr Keighley.

The “inexorable rise of managerialism” in the NHS has been a “major cause of dysfunction”, he added, and there is a need to return to clinical priorities. “I disagree with suggestions that managerial and process change holds the solution to sustaining high quality care and believe instead that it is only by working with doctors and other healthcare professionals that a solution will be found.

The Unpaid Over-worked "Angels"

The NHS in Scotland is close to breaking point, with most nurses claiming they are forced to work overtime to meet patient needs, a new report has found. A majority of nurses say patient care is suffering because of the pressure they are under, according to a staff survey by the Royal College of Nursing (RCN). Nurses are going unpaid for the extra hours they work because this was not agreed in advance, the report reveals, and time back in lieu cannot be taken because this would leave colleagues even more short staffed.

Nearly 2,000 nursing posts have been axed in Scotland in recent years. The survey finds that 54 per cent of nurses are working beyond their contracted hours each week in order to meet demands, with 58 per cent saying they are under too much pressure. More than half (55 per cent) say they are not providing the level of care they want to as the pressure builds. Only 38.1 per cent in Scotland say they would choose nursing as a career if they had to do it all again.

Norman Provan, of RCN Scotland, said the report must act as a “wake-up call” for NHS chiefs and the Scottish Government. “It is both unfair and unsustainable to continue to rely on the goodwill of nurses to keep health services running. It is apparent that health services are only managing to meet demand because of nurses willing to go the extra mile, for free.” he said.

Cheap hospital food

 Scotland’s biggest health board, NHS Greater Glasgow and Clyde’s catering budget was slashed last year by £1million and documents released under freedom of information laws suggest the average daily spend per person is just £4.08.

Critics say patients could end up taking longer to heal because they are not getting adequate nutrients and vitamins at a time when they need them most.

Dr Margaret Richie, of Edinburgh University, said it was unlikely the limited budget could provide a healthy diet, unless patients were served baked beans every day.

Your Choice - Mending or Ending Capitalism

In America Obamacare, reforms to the health system of that coutry has been called “creeping socialism” by the free-marketeers and the American public has been barraged by propaganda against any form of “socialized medicine”. The problem of medical costs for people in the United States is a severe and often tragic one. In the UK we possess the much acclaimed National Health Service. The NHS is very far from perfect, but it works far better than the health system in the US, where almost all care is bought and sold in the market place. The NHS is the centrepiece of the welfare state. For over 90 percent of the population it provides their only access to health care. It is immensely popular, despite its inadequacies. The well being of workers concerns the ruling class and, for sure,  this is reflected in the priorities of the NHS. Acute medicine for the able bodied of working age is better funded and includes the most prestigious areas of medicine. Those caring for the elderly and the physically and mentally handicapped remain the “Cinderella” services.

The National Health Insurance Scheme started in 1912, it was decided to pay the money to the different health insurance agencies already in existence. Some were cooperative undertakings, some were run by trade unions, and some by insurance companies, so that there arose the anomaly of a national, compulsory insurance scheme being administered through separate, private insurance organizations. The benefits tended to vary. Employed workers were covered by but not their wives, children and other dependents. A sick insured worker had the care of a doctor and free medicine, but none of the ancillary necessities were provided – X-ray, hospitalization, surgery, etc. Low wages and recurring unemployment made even care by a doctor and free medicine a doubtful blessing for the average worker. While the sickness benefit remained fixed by law, some of the wealthier organizations gave additional services, dental care, eyeglasses and so on, while the poorer ones gave only the minimum. There were also local health authorities which were responsible for certain aspects of public health These included clinics, midwifery, maternity and child welfare, water supplies, sewage and refuse disposal, control of epidemics and the provision of domestic help for families unable because of illness to look after themselves. The main difficulty lay in the fact that there were over 400 authorities, many of them too small and too poor to carry out their functions. As a general rule, medical help received by this means was not of a high standard.

In 1942, Sir William Beveridge, a Liberal member of Parliament, proposed a comprehensive health service which would “ensure that for every citizen there is available whatever medical treatment he requires in whatever form he requires it...”
The Labour party steered the necessary legislation through parliament and in November 1946 the National Health Service Act became law and came into effect on July 5, 1948.

The National Health Service is available to every man, woman and child in the country without any qualification. Everyone is free to choose his or her own doctor and the doctor is free to accept or reject a prospective patient.

The NHS was regarded as a charge on national income in the same way as education and the armed services. It is recognized that it is as necessary to spend money on healthy bodies and minds as it is to provide education for the people. Welfare provision is contradictory. On the one hand it benefits workers but on the other it also reflects capital’s interest in the reproduction of labour power. The state represents capital’s interest in maintaining the conditions for the reproduction of labour power, but this imposes a cost on capital. There is a constant tension between the desire for healthy, well trained workers and the costs of such provision. In 1951 the Labour government, introduced legislation imposing charges on dental treatment. The following year the Conservatives added additional charges to the service. Pricing  has been expanded over the decades by both parties but  nevertheless remains largely a “free” service available to all. The priorities of the NHS have no bearing on what patients can pay – only to what they need.

“The National Health Service is the envy of the world.”  said Enoch Powell, minister for health in 1962.
“The National Health Service is safe with us.” said  Margaret Thatcher, prime minister in 1983.

The attack on the NHS today takes two forms. The first is the outright demand for privatisation of the entire health service and a full return to the market where people who can’t afford medical fees don’t get treated.  The other attack pretends to favour the principles of the NHS but then argues for the gradual erosion of those principles by moving towards a two-tier system, a private insurance model for wealthier patients while leaving the NHS the unprofitable areas of care, for the chronically sick, the mentally handicapped and the like.

The NHS is a very good example of a past reform vigorously opposed by conservative forces such as the doctors lobby, the BMA, at the time. It was very much in the interests of the great mass of the people, and especially of working class people. It was also, from the beginning, something of a compromise, but a compromise more in our favour than otherwise. Despite all its faults the principles the NHS incorporates are socialist ones. There will always be some system of priority and how is the NHS rations is on the basis of need. He or she who needs more, gets priority over him or her who needs less. It is not rationing by the size of a person’s wallet or purse.

With the deepening crisis of capitalism it is now the National Health Service is fighting for its life. “Saving” money is seen as important, however, reducing the profit level of the multinational drug companies is no part of plans. The NHS continue to allow brand name drugs to be prescribed when generic prescriptions would lower costs. While pharmaceutical company profits have risen enormously the original conception of the NHS has been quietly abandoned.

 Attacks on the health service are deeply unpopular. One of the easiest ways of dismantling the NHS is to impose strict budgets and  make the working conditions and pay so unattractive and unrewarding that it literally becomes impossible to staff it. Closing a ward here and a ward there, or shutting this or that local hospital and no-one notices that it is gone until it is too late.

As critics of reformism, the Socialist Party are not, of course, opposed to particular reforms. But it has to be understood that no gain is permanently guaranteed so long as the means of production  remain in the hands of the capitalist minority. The never ending struggle to protect the benefits of the National Heath Service is proof of the pudding. To permanently achieve a decent society we must break the power of the capitalist class.

Patients are not Widgets

Dr Brian Keighley, chairman of the British Medical Association (BMA) in Scotland, hit at the NHS Trusts.

 "We now see health boards talking about 'their' patients, almost implying that the doctors it employs or contracts with are mere technicians in the pursuit of their corporate aim. What an insult to those of us who came into medicine to treat patients to the best of their ability." He said: "Bean counting and clinical direction by managers with top-down politically-inspired targets are not compatible with relationships founded on trust between physician and patient. Patients are not widgets and I get upset when they are treated as such, and when I am considered a mere tool within a corporate design. This slavish addiction to an ethos of corporatism and managerialism has led to doctors, nurses and other clinicians becoming progressively disempowered." He added: "What I want to see for my successors in the NHS is a return to what is at the heart of laudable patient safety and quality initiatives - the centrality of the patient and his or her relationship with their doctor, nurse or therapist,"

Not so confidential

A leading Scots GP claims the NHS is profiting from allowing pregnant women's details to be sold to commercial companies, often without their full knowledge or consent. Glasgow GP Dr Margaret McCartney also warns that the NHS and professional bodies such as the Royal College of Obstetricians and Gynaecologists (RCOG) and the Royal College of General Practitioners (RCGP) are guilty of a conflict of interest by collaborating in the advertising of thousands of products to pregnant women and new mothers.

She also criticises Bounty, a promotions company which supplies 2.6 million Bounty bags a year to new mothers, including 812,000 newborn packs distributed through NHS maternity wards. Many of the mothers who sign up to receive Bounty Bags while in hospital are not aware they are agreeing to their email address and telephone number being used by commercial companies, she argues. In some cases they do not even realise the person collecting the information is not an NHS employee, while the inclusion of a child-benefit application form in the packs gives them an "air of officialdom".

Dr McCartney said: "The lack of knowledge about what signing over your details means is troubling in a hospital environment, which should take consent and confidentiality seriously. The hours after birth are hardly an optimal time to obtain formal consent. Do we want parents placed under advertising pressure and for NHS doctors, radiographers and midwives to be the conduit?"

Good health, but at what price?

A woman awaiting a transplant for a rare condition, atypical haemolytic uraemic syndrome (aHUS), an inherited condition that has destroyed her kidneys had her operation cancelled at the 11th hour because the Government refused to pay for the drug she needs to prevent the organ being rejected. Up to 70 patients are in the same position. They have been forced to put their lives on hold, and risk their condition deteriorating, while ministers and officials argue over whether the NHS can afford the drug, Eculizumab, which costs more than £300,000 per patient per year. The health minister, Earl Howe, rejected a recommendation from an expert committee that the drug be "routinely provided nationally".


Instead, Earl Howe referred the drug for further investigation by the National Institute for Health and Care Excellence (Nice), which took over responsibility for treatments for rare diseases. Nice has yet to explain how it is going to assess drugs for rare diseases. Nice's verdict on Eculizumab, brand name Soliris, is not expected before summer 2014. The drugs can be life-saving but are hugely expensive because they affect very small numbers of patients. They cannot therefore be assessed according to the usual cost-effectiveness threshold of £30,000 per patient per year (adjusted for quality of life) .

Experts fear the move could signal a tough new approach to the funding of expensive treatments for marginal groups. But that would undermine the role of a national health system to pool the risks for the whole population in order to fund individuals with exceptional health needs.

MP Madeleine Moon, chair of the All-Party Kidney Group, said: "It was heartbreaking to see the agony that people denied access to Eculizumab went through... The Government has made a heartless decision to allow existing trial and new patients access to the drug but not those who have been refused access on cost grounds by their hospital."

Professor Tim Goodship, chair of aHUS Action, said: "A transplant transforms people's lives. This opportunity has been dangled in front of them and then withdrawn. I feel it is just cruel."

We need a need-based health service

The NHS is failing to provide needs-based care in areas of blanket deprivation, GPs working in Scotland's poorest areas will tell MSPs. The GPs from The Deep End group, which represents 100 practices in the poorest parts of the country are expected to warn that the health service's approach is a "recipe for widening health inequality" when they appear before the Public Audit Committee.

The report warned that the distribution of GPs in Scotland does not reflect the higher levels of poor health and greater need in poorer areas and that "deep-seated inequalities remain between the least and most deprived communities" despite research showing higher rates of multimorbidity (more than one chronic medical condition) in patients from the most deprived areas.

This, combined with "dysfunctional links between general practice and other parts of the NHS", is "a partial explanation of 20 years of failure in addressing inequalities in health. The GPs called for more time for doctors seeing patients in deprived communities, as well as better integration with other services such as social work and addiction services. "The focus should be on sustainable development, with an emphasis on continuity and the productive power of long-term relationships."

Hospital bed-boarding

Patients are being put at risk in Scotland by a lack of consultants and a shortage of acute hospital beds the Royal College of Physicians of Edinburgh (RCPE) has highlighted. A growing number of patients are being forced to stay in wards not designed to cater for their illness in a practice known as “bed-boarding”. Doctors say this delays treatment and increases the time patients stay in hospital, making them more likely to contract a superbug, like MRSA, or suffer from blood clots.

Eight out of ten physicians questioned for the survey say bed-boarding takes place year-round, and every expert said the practice had a negative impact on the quality of care patients receive. Seven out of ten RCPE members say putting patients in inappropriate wards has a negative impact on death rates and that it increases the chances of a patient being readmitted to hospital due to them not getting the correct care during their initial stay.

Nursing the figures

It’s estimated 5000 NHS workers, including around 2500 nurses, have lost their jobs in the last three years. NHS chiefs spent £94million on temporary nursing staff last year – to fill the gaps left after they axed the 2500 nurses. The cost of using supply and agency nurses in Scottish hospitals soared by £4million compared to 2010, a report has revealed. And the number of staff hours taken up by temporary nurses rose by 1.5million to 6.3million.

Ellen Hudson, of the Royal College of Nursing Scotland, said: “It is vital that bank nursing is available to cover shortages when staff are off sick.However, the bank should not be used to cover long-term vacancies caused by recruitment freezes as it would be much better for patients if they’re filled with permanent staff.”

The RCN said the small increase in the number of nursing and midwifery staff was largely accounted for by the inclusion of nursing and midwifery “interns” in the workforce figures. The internship scheme is available to newly qualified nurses who cannot gain employment. They work a 22.5 hour week and the internship lasts one year. So is not a true reflection of the nursing workforce.

its an emergency

Major trauma, the commonest killer of children and adults under 45, accounts for 1,300 deaths every year in Scotland. Major trauma often involves patients arriving at hospital with multiple, complex injuries which could result in death or permanent disability, usually sustained in an accident such as a car crash or gas explosion, or from a violent situation such as a shooting or stabbing. More than half of all trauma patients have major head injuries.

Scotland is lagging behind other developed countries in its provision of care for victims of major trauma and needs to radically overhaul its approach. A report by the Royal College of Surgeons of Edinburgh said death rates for severely injured patients who are alive when reaching hospital is 40 per cent higher in the UK than in North America. But while England has reformed its healthcare policy to improve survival rates, the situation in Scotland has not yet been addressed.


Margaret Watt, chair of the Scotland Patients’ Association, said: “This is nothing short of scandalous. We have known for some time the health service in Scotland is lacking in specialist care. Trauma patients should have access to the best qualified, best doctors for the job. The report comes from specialists who work in the frontline and know what they are talking about. They can not be ignored. It will be no good politicians coming back and saying they will look into it. These recommendations are already long overdue. They should already be in place. They need to act now to ensure Scotland’s patients get the life-saving care they expect and deserve. Scotland used to be the world leader in health care – to lag behind the rest of the world is just not an option.”

A sharing, caring Scotland

A total of 2,025,400 people had put their names forward for the NHS Organ Donor Register as of 31 March - almost 40% of the population. Across the UK, the number of people on the organ donation register stands at 30%.

Three people in the UK die every day because of a lack of access to organs. The Scottish government also said the number of people who died while waiting for organs fell from 38 in 2010-11 to 36 in 2011-12. The tragic fact is that more than 600 people in Scotland are still waiting for a life-saving transplant.

Docs Get Ready to Fight

The British Medical Association is poised to ballot its members on industrial action for the first time in 40 years. Under the Dept. of Health plans, doctors' pension contributions would increase immediately by up to 2.4%, with continued increases over the next two years. It also wants to raise the retirement age to 68 and end the final salary scheme for hospital doctors. Although the DoH proposals are intended to apply to NHS workers throughout the UK, Scotland has its own devolved NHS pension scheme which is overseen by the Scottish Public Pensions Authority. However, if the Scottish Government decided to break with the reforms it is likely Holyrood would have to pick up the tab for any shortfall.

Dr Dean Marshall, outgoing chairman of the BMA's Scottish General Practitioners Committee, said doctors north of the Border had been let down by Holyrood's inaction and the Scottish Government's "complicity" with Westminster on the issue.

Dr Marshall said: "Is it fair for NHS staff to be taxed for the Government's failures to properly regulate the banking sector? And while the Scottish Government argues it does not agree with these plans it appears to be going along with the UK Government and is therefore complicit in taxing public-sector workers for the failures of the private sector. Scottish ministers could seek to do something different and I urge them again to find that solution – not just invite us to new talks"

Dr Marshall said doctors were unhappy that pension reforms were being "foisted" on them just four years after they agreed substantial changes to their package.

He added: "We agreed to tiered contributions where higher earners contributed more than lower paid workers. We agreed to the increased retirement age of 65 and we agreed to a cap on employer contributions so that the taxpayer would not pay for any future shortfall in the scheme. These changes worked and the NHS Pension Scheme is in surplus to the Treasury to the tune of £2 billion, and this is projected to continue into the future."

The old neglected again

Older patients are “not safe” on hospital wards in Scotland because of a lack of qualified nurses to care for them according to Royal College of Nursing (RCN) findings. The report suggests there is just one nurse caring for nearly ten patients on old people’s wards. A survey of almost 1,700 nurses found that 78 per cent said comforting and talking to patients was not done or done inadequately on their last shift because of low staff numbers. Some 59 per cent said promoting mobility and self-care was left undone or unfinished, with 34 per cent saying they could not provide patients with food and drink, and 33 per cent claiming they were unable to fully help patients to the toilet or manage incontinence.

The RCN warned there was a danger that “care becomes compromised” and said that many nurses say “they are too busy to provide the standard of care they would like”. The report said: “Older people in Scotland are being let down by a lack of professionally qualified nurses in hospitals, despite nationally agreed planning for the nursing workforce. Despite older people often having the most complex needs, the evidence suggests that they regularly suffer from a severe shortage of nurses and healthcare support workers (HCSWs), coupled with an inappropriate skill mix of HCSWs to nurses."
The RCN called for a “patient guarantee” to set out the number of nurses needed on older people’s wards.

It emerged the number of nurses in Scotland’s hospitals plummeted by thousands in just over two years, with further nursing posts lost during the last few months of 2011. The RCN said the number of nursing and midwifery staff employed in Scotland had fallen by 2,190 between September 2009 and the end of 2011.

According to the RCN Scotland director, Theresa Fyffe, the number of nurses employed was at a six-year low. She said: “As health boards come under increasing financial pressure to deliver the same services to more and more people, they are saving money when nurses leave by not replacing them or by replacing them with nurses and healthcare support workers at lower-paid bands."

The charity Age Scotland demanded dramatic improvements to care services in the community, to keep older people “safe and out of hospital”.

NHS rationing

What is the value of a few precious extra months of life? It's a very difficult question to answer, but if Scottish Medicines Consortium's is to be believed then, it is not worth £2.5 million.

Prostate cancer is the most common cancer in men in Scotland, with 2700 cases diagnosed every year. It kills two men every day. There are 19,000 Scottish men currently living with the disease.

Last October, Alex Salmond, the First Minister, signed up to a charter calling for better treatment for patients.

The Scottish Medicines Consortium has denied Scottish men a drug that prolongs life. It said the cost of abiraterone at £3000 a month did not justify the health benefits – even though it can extend lives by more that three months .

In a letter to the Scottish government, sufferer John Thomson writes "It is a disgraceful decision, cruel and unjust, that abiraterone is not available simply because of cost. How do you evaluate the cost of drugs against someone’s life?...This drug not only gives men an extra few months but also some quality to those last few months...It is unfair for some people to access the drug and not others. Money should not be an issue."

Heart care 'more likely for rich'

An estimated 182,000 people in Scotland have coronary heart disease (CHD), around 3.3% of the population. Rates of heart disease in Scotland remain the highest in Western Europe, despite new cases falling by nearly a third in the last 10 years.

There is evidence that rich people are more likely to receive NHS treatment for heart disease than poor people, according to the public spending watchdog.

In some more deprived areas around 25% of men over 75 have CHD but, according to Audit Scotland, people in deprived communities "are not always getting the same level of treatment as the rest of the population"

Treatments such as angioplasty, which widens the arteries, or heart bypass surgery, are over 20% less than expected in deprived areas. The least deprived areas saw over 60% more than expected. Audit Scotland said this "implies a lower level of access to these treatments for people in more deprived areas".

health and safety??

Hospital chiefs are discouraging “whistleblowing” nurses from reporting their concerns about patient safety and staffing levels, nursing leaders have warned. More than one-third of nurses in Scotland (37%) said they had been discouraged, or told directly, not to report their concerns to their NHS health board or employer.

The Royal College of Nursing (RCN) revealed more than 80% of nurses in Scotland said they had highlighted problems. But, in more than half of cases, no action was ever taken. The overwhelming majority (84%) of nurses in Scotland fear they will be victimised if they speak out about the problems.

Theresa Fyffe, RCN Scotland director, said: “It is extremely worrying that nurses are being explicitly told not to raise concerns, particularly after all we have learned about the consequences of ignoring issues around patient safety. The survey clearly shows nurses are committed to improving care for patients, but more than half, 55%, say no action was ever taken when they raised their concerns...We are very concerned that nurses are not being listened to particularly as we know more than 2000 nurses have been cut from the NHS workforce in Scotland since September 2009, and staff are feeling over-stretched and under pressure. In these circumstances it is more important than ever they are listened to when they raise their concerns about patient safety and about staffing levels.”

http://www.heraldscotland.com/news/health/third-of-nurses-told-they-should-not-whistleblow-1.1138132

making cancer victims suffer

New research by a leading charity reveals that hundreds of cancer patients are living close to the breadline due to their illness, with 73% experiencing a loss of income and increased costs such as hospital travel and higher utility bills. Cancer patients in Scotland are skipping meals and worrying about losing their homes because of a drop in income and higher living costs.

Around 30,000 people in Scotland are diagnosed with cancer each year, costing many of them thousands of pounds.

Elspeth Atkinson, director of Macmillan Scotland said: “Cancer is an expensive disease to live with, but this research shows just how close to the breadline many cancer patients really are."

Research has shown that more than half of all terminally ill cancer patients do not claim benefits they are entitled to. Complicated benefits forms, a lack of awareness of entitlements, embarrassment or simply feeling too ill or emotionally drained, prevents many people accessing welfare benefits.

http://www.heraldscotland.com/news/health/cancer-patients-forced-to-live-in-poverty-1.1130821

Cancer of Capitalism

Professor David Cameron, an expert in breast cancer from Edinburgh University, said new treatments were increasingly being developed which targeted specific subtypes of cancer, helping make them more effective.

"These drugs are expensive. Some of that is the real cost of developing them and some of that is if you are only going for a subset of cancer then your total predicted sales will be less," Prof Cameron told The Scotsman. "The business model of the company will be that in order to develop the money to develop the drug your subsequent sales in the patent lifetime have to be sufficient to cover all your costs. So actually, the cost for rarer cancer is likely to be higher and not lower."