NHS rationing

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Hunting Dog
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NHS rationing

Post by Hunting Dog » Fri Nov 29, 2019 6:34 pm

NHS rationing;
Grauniad has this piece about NHS rationing scare quotes "unecessary treatments"

The article seems to be implying that it's a bad thing and restricting patients rights. The bit that stood out to me was
It would also see patients told to have physiotherapy on or use painkillers to dull the pain of an arthritic knee rather than undergo an exploratory operation called an arthroscopy.
I thought that it had been shown that knee arthroscopy was generally of no use, e.g. see here - so that seems to be an entirely logical step to take - but the article seems to be portraying that, and other things, as 'penny-pinching'

Does anyone know much about the other changes suggested?

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Fishnut
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Re: NHS rationing

Post by Fishnut » Fri Nov 29, 2019 6:40 pm

I know that the BBC's Inside Health has covered the rationing in recent years. I can't remember specifics but one of the main issues seems to be that many "minor" conditions are no longer being routinely treated surgically. That may not seem like a problem but a lot of these conditions are ones which are progressive so rather than getting things treated early on and potentially halted, patients have to wait until things have progressed. The justification being given is that not everyone progresses so some are being untreated unnecessarily. But of course the converse of that is that some people are being made to suffer in pain until they tick enough boxes to be allowed to be put on the waiting list to get surgery.
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Re: NHS rationing

Post by murmur » Sat Nov 30, 2019 12:03 pm

Every time there is a story about "rationing" of healthcare one needs to dig into it to establish exactly what is going on.

Sometimes it is stopping using "treatments" or practices which have no evidence base but have continued in use because "Well, we've always done that"; sometimes it is replacement of one drug by a newer, more effective one; sometimes it is a NICE decision based on a cost/benefit analysis showing that the cost far outweighs benefits (see many new cancer drug stories siezed upon by UK-ian tabloids); sometimes it is commissioning bodies deciding not to spend money on ceertain things, which in itself can be for many reasons, some clinically valid, some financial, some for internal political reasons; sometimes it is because some managers are fuckwits who don't understand the clinical area for which they are "responsible"; sometimes the stroy isn't even really about "rationing" at all...

I could go on. The detail is always important.
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GeenDienst
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Re: NHS rationing

Post by GeenDienst » Sat Nov 30, 2019 12:44 pm

The source story, or at least the Graun version, does have buried in it something about pressure from the medical profession to dump pointless procedures.

Here:
An NHS spokesperson said the document was out of date and had not been approved or implemented. They added there was “strong support from senior doctors in the Academy of Medical Royal Colleges for action to eliminate wasteful interventions that don’t benefit patients”.
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Re: NHS rationing

Post by murmur » Sat Nov 30, 2019 6:32 pm

I read "Scoop" Campbell's piece in the deadwood version today: all the "examples" "Scoop" cites fall into areas I mentioned above and none of which alarm me in the slightest, let alone providing evidence of "rationing", as the strapline states. His other health piece, buried deeper in the paper, rather than put on the front page, was definitely scarier.

Do I need to start a new version of my medical mis-reporting thread? Or just one dedicated to the general uselessness of "Scoop" Campbell?
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Gfamily
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Re: NHS rationing

Post by Gfamily » Sun Dec 01, 2019 10:26 am

We were talking to a friend on Friday who has Crohn's disease and is on the anti-TNF drug Humira, which currently costs the NHS about £8K a year for fortnightly injection. Last year Nice authorised the use of biosimilars that could reduce the price.

In the USA, the counter price for Humira went up from $19K to $38K between 2012 and 2018 and the manufacturer has applied for multiple new patents around the drug to get in the way of biosimilars in the US market.
It's now indicated to have increased further to almost $65K per year

One of the areas of negotiations for the trade deal with the USA will be around allowing US drug companies more access to NHS prescribing, which will likely include the removal of the need for NICE approval and extension of US monopoly rights
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turgidprose
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Re: NHS rationing

Post by turgidprose » Sun Dec 01, 2019 10:17 pm

To make it even more fun Humira was originally a spin out from MRC funded research.

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Gfamily
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Re: NHS rationing

Post by Gfamily » Sun Dec 01, 2019 10:37 pm

turgidprose wrote:
Sun Dec 01, 2019 10:17 pm
To make it even more fun Humira was originally a spin out from MRC funded research.
A very pertinent point - an excellent first post too. Thanks (and welcome!)
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murmur
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Re: NHS rationing

Post by murmur » Wed Dec 04, 2019 12:40 pm

And this demonstrates why it is necessary to keep a good eye on what is done and why.

Inadequate diagnosis, leading to unnecessary surgery with attendant increase in risk for the patient and a waste of resources better used for something else.

(Poor or non-existent assessments leading to guesswork and inaccurate or partial diagnoses, hence wrong, inadequate or no treatment have long been a bugbear of mine.)
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murmur
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Re: NHS rationing

Post by murmur » Thu Dec 05, 2019 6:38 pm

And this one and this one are far more to do with what can accurately be described as rationing, stemming from cuts to MH services, both adult and child and adolescent, commissioners not spending money they were given for CAMHS on CAMHS and so not commissioning emergency services for self-harm, nor fully implementing service changes properly, just using them as a means of shifting folk off official waiting lists and on to the unofficial ones which don't exist...

And that's before getting into the false economy of much of the way IAPT was implemented...
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murmur
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Re: NHS rationing

Post by murmur » Fri Dec 06, 2019 11:07 am

And this epitomises the sort of behind the scenes rationing which seriously impacts care delivery and patient safety and which is infrequently reported until faecal matter and revolving object collide disastrously, as at Shrewsbury. (Yes, I know there have been some reports about staffing shortages, but few really look at the consequences, and there are nowhere near as many as there should be for the levels of staff cuts - a lot of complaining about waiting times, but not enough examination of why...Or would that not fit the predominantly right wing narrative in the meejah?)

As an aside, the Independent has reported this story waaaaaaaaay better than "Scoop" Campbell at the Graun (I suspect the Newcastle Chronicle has reported this one better than the Graun, which has barely mentioned it)
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GeenDienst
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Re: NHS rationing

Post by GeenDienst » Fri Dec 06, 2019 11:50 am

ErSelf has a long term and rare condition that could require her to have very major transplant surgery some time, and needs regular follow up to see if the treamtent is still working. A consutant (who was a tw.t) eft, and there wasn't room for her n the other one's list So, she was left without a consultant. Nothing, nada, zip. She tried to get it fixed, but nobody cared. By her own efforts, abetted by her GP she blagged on to the regional specialist centre at Birmingham, way out of area. She explained this to her new prof, who just nodded wearily.

That's not rationing It's got to abandonment,out in the sticks.
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