Friday, October 18, 2013

Tackle inequality not just disease

A new study by NHS Health Scotland has examined 30 years of health trends in Scotland and found large differences in preventable causes of death across social groups. In simple terms the gap between rich and poor is leading to thousands of unnecessary deaths in Scotland.

Increasing inequality in morbidity and mortality from the poorest and to the wealthiest, is described as 'a gross injustice'. The report positively highlights periods of decreasing inequality in the UK and elsewhere, showing that this trend is not inevitable and further action can make a difference.

International research (Phelan and Link) indicates that approaches which focus on reducing immediately visible causes (such as tobacco and alcohol) and targeting professional support to those living in deprived areas, will ultimately fail to eliminate health inequalities. This research hypothesises that socioeconomic inequality is a fundamental cause of health inequality.

The report describes trends in absolute and relative inequalities for 47 to 50 causes of death for men and women across Carstairs deprivation deciles between 1983 and 1999 and men aged 20‐64 years across occupational social classes between 1976 and 1999 to determine whether new socioeconomic inequalities in mortality emerged for certain causes of death whilst declining for others in Scotland during this time. In addition, they tested Phelan and Link’s theory by comparing socioeconomic gradients for avoidable and non‐avoidable mortality and assessing whether inequalities in mortality increase with increasing preventability of cause of death.

They found that absolute and relative socioeconomic gradients for specific causes of mortality decreased whilst others emerged. There was a clear socioeconomic gradient for avoidable causes of mortality, but not for non‐avoidable causes of death. Where causes of death became more preventable, it is clear that relative inequalities in mortality increased.

The results have important policy implications for any efforts to reduce health inequalities in Scotland. Evidence that all‐cause socioeconomic inequalities in mortality persist despite reductions for some specific causes, and that inequalities are greater with increasing preventability, suggests that focussing on reducing individual risk and increasing individual assets will ultimately be fruitless in reducing inequalities and may even increase them. Elimination and prevention of inequalities in all‐cause mortality will only be achieved if the underlying differences in income, wealth and power across society are reduced.

This report is further and detailed evidence to support the view, advanced by SHA and others, that behavioural change programmes have limited impact. Seriously tackling health inequalities requires a comprehensive and cross cutting policy response that is not limited to the NHS.

Thursday, October 10, 2013

NHS Scotland puts a sticking plaster on cash shortfall

Audit Scotland has published its annual report into the finances of NHS Scotland.

The key message is:

“The NHS in Scotland managed its finances well in 2012/13 but needs to focus more on long-term financial planning and sustainability to make the changes needed to meet increasing demands. In 2012/13, pressures on the NHS’ capacity became more apparent and the health service spent more on short-term measures to deal with them.”

Put another way, the NHS is putting sticking plasters on long term funding problems.

The report also indicates that demands on healthcare are rising and signs of pressure on the NHS were apparent. In particular, some boards missed waiting times targets; staff vacancies increased; and spending on bank and agency staff and private health care rose.

Agency staff and private care spending is a good example of short term spending that is hugely wasteful. The report calls for stronger long-term financial planning to address this.

The report also highlights spending of over £115 million on the top ten high-cost, low-volume (HCLV) drugs in hospitals in 2012/13. These can be a pressure on
NHS boards as spending increases at a higher rate than other costs and it can be less predictable. The top ten drugs are generally a specialist type of drug used to treat rheumatology conditions and irritable bowel conditions (anti-TNFs) and cancer drugs. Spending on HCLV drugs increased more than spending on overall hospital drugs and drugs prescribed in general practice over the past two years.

This again highlights the importance of addressing drug costs in NHS Scotland.

Tuesday, October 1, 2013

US Government shutdown shows why we should reject private health

The US government shutdown should remind us of the power of the US private health care lobby and why we don't want it here.

I was listening to an American political analyst on the radio this morning commenting on the US Government shutdown. This astonishing mess is caused by the Republicans wanting to shut down Obama's modest health care reforms, before they even start. He starkly described the USA political system as being as dysfunctional as Italy.

That may well be true, but for me it demonstrated something else about the US political system - the lobby power of the private health care lobby. A few years ago we sponsored a showing of Michael Moore's film 'Sicko' at the Glasgow Film Theatre, followed by a debate on healthcare. We had politicians from all the political parties on the panel, but they all agreed on one thing - thank god for the NHS!

This film shows just how powerful the lobby is in protecting their massive profits that results in the most expensive health care system in the world. Billions spent on administration rather than care - a system that excludes millions from health care and bankrupts even more. Health bills are the major cause of bankruptcy in the USA. My favourite clip is Moore taking public service workers, including firefighters who survived 9/11, to Cuba to get free health care that they couldn't get at home.

So why does this matter in the UK. Well in England the NHS is moving rapidly in the same direction. Under the guise of competition, the English NHS is allowing the very same health care corporations to get a very big foot in the door. Once there, they will defend their profits in same way as they do in America. The Tories will be bought and paid for, just as the Republicans are in the USA.

In Scotland, we should be very grateful for devolution and the political consensus on the NHS. We resisted the New Labour reforms  and scrapped the Tory trust model that placed marketing managers before nurses. The political consensus has largely held, to the level that commercialisation is actually unlawful in some circumstances. Private contractors have largely been banished and services brought back in house, reuniting the health care team. Only the CBI is left arguing for privatisation, an issue I was sparring with them over at the Health Committee last week. Even they are largely going through the motions at the behest of English member companies. The only significant blemish is the PPP hospitals and community facilities that waste scarce £millions every year. Sadly, they are likely to do so for years to come as the SNP introduce new PPP schemes through the hub Initiative and so called NPD model.

Of course we are not entirely exempt from the consequences of Tory NHS privatisation in England. The aim is to cut spending and that has a knock on effect on Scottish budget allocations. That's why Scots joined their colleagues in Manchester on Sunday in the largest demonstration Manchester police had seen for a generation.

So when we look in astonishment as the richest country on the planet closes down its government. Remember that the cause is private health care corporations and their lobbying muscle. Then vow to redouble our efforts to campaign against it happening here.