3:52pm Wednesday 27th January 2010
THE healthcare debate sometimes seems like a bruising battle between old rivals: the English, the Scots, the Welsh and the Northern Irish with the English on the losing side.
From the battle lines of resentful English shires grows a mutinous grumble of discontent about devolution. It is blamed by some for inequality and injustice as the Scottish Parliament, the Welsh Assembly, the Parliament of Northern Ireland and other bodies take decisions which mean patients in some parts of the UK enjoy medical privileges denied to those who live on the wrong side of national borders or the Irish Sea.
The phrase “medical apartheid” has even begun to creep into the vast lexicon of terms used to describe health inequalities, a term even more loaded than the tried and tested “postcode lottery”.
Last week the National Institute for Health and Clinical Excellence (Nice) recommended that the drug tocilizumab (brand name RoACTEMRA), used to treat rheumatoid arthritis, was not cost-effective.
But patients in Scotland will receive the treatment after the Scottish Medicines Consortium, the body regulating drugs in the Scottish NHS, decided it should be available.
A similar debate erupted in 2007 after Nice rejected the lung cancer drug tarceva, which was then made available on the NHS in Scotland.
In education the debate over free tuition fees for Scottish students and free personal care for the elderly rages on. Resentment of plans to abolish prescription charges in Scotland next year and about the Barnett Formula, the way cash is allocated to Scotland, Wales and Northern Ireland, remains high in England.
You’ve probably heard the disgruntled mutterings in your local pub about how the English pay the lion’s share of taxes while the rewards are reaped by Scotland and Wales – and they still cheer any other side but England in the World Cup.
Redditch GP Dr Simon Parkinson, the secretary for the Worcestershire Medical Association, believes these differences in healthcare provision between England, Scotland, Wales and Northern Ireland are likely to increase. He said: “Scotland has a very traditional NHS ethos and their minister doesn’t believe in privatisation and believes in the founding principle of the NHS. Our Government doesn’t. They are different.
“One can say that unless there is significant changes that this difference will get bigger so we don’t have one NHS, we have four. The Scottish system is increasingly different. Some of my colleagues think it is better. When I hear my Scottish colleagues talk at conferences they feel sorry for us.”
His views were echoed by Dr Richard Harling, director of public health at NHS Worcestershire, who said the Scottish healthcare system in particular was moving further away from the English but he said he did not believe that these changes were “necessarily wrong”.
But what is more obvious are differences in health between people in the same city, possibly even in the next street, which have nothing to do with this debate and are, perhaps, far more significant.
In the recent past people in the most deprived parts of Worcester such as Warndon, Tolladine and Dines Green died up to 12 years before those in more affluent areas.
The difference is perhaps most stark if we compare deprived Warndon with neighbouring Warndon Villages, often seen as the city’s white collar suburb, where health chiefs have been trying various initiatives to close a nine-year average difference in life expectancy between the two areas.
Health is deeply intertwined with a complex network of issues such as housing, diet, education, income, genetics, the family and lifestyle choices such as smoking, drinking, diet and exercise levels.
This is why NHS Worcestershire has spent so much time, effort and money on these deprived areas, injecting millions of pounds into reducing obesity, smoking levels, drinking and encouraging people to take more exercise.
Dr Parkinson said: “Health inequalities is an interesting subject and one gets the feeling that nobody has quite cracked it. The educated and well-off know how to get healthcare but the unhealthy, deprived patients – not all of them – seem to not want to engage with healthcare and reaching out and getting hold of them can be difficult.”
Barbara Moss, aged 55, of Aconbury Close, Worcester, who was forced to pay £21,000 from her own pension to fund her own care as she battled bowel cancer, has experienced first hand the inequity of the healthcare system.
Because she paid privately for so-called top-up drugs (cancer drug Avastin) she lost her right to free NHS care, although she won back £13,658 of her medical costs from NHS Worcestershire in November 2008.
She said: “In England they look more at the cost factor than other countries. They try and measure the value of life, which is an awful thing. That is an injustice. We have got all these drugs that can save people’s lives and if we don’t accept these drugs the trials will collapse.
“We have to keep up with the rest of Europe and keep up with the available medication because cancer will be cured, I’m convinced of that. But we have to review the whole of the NHS right now.”
Mike Foster, Labour MP for Worcester, said his priority would always be redressing health inequalities within his own constituency rather than any that may be perceived between England and other parts of the UK or Europe.
He said: “We need to improve the areas where health inequalities are worse. It is one of the challenges left for the NHS to meet. My instinct is that Scottish health outcomes are worse than the UK. For me, I want to see the resources available in the NHS go towards improving health generally and to where there are pockets of poor health outcomes.”
© Copyright 2001-2012 Newsquest Media Group
http://www.worcesternews.co.uk