Britain Plans To Decentralize Health Care

July 26, 2010

The New York Times

By: Sarah Lyall

Perhaps the only consistent thing about Britain’s socialized health care system is that it is in a perpetual state of flux, its structure constantly changing as governments search for the elusive formula that will deliver the best care for the cheapest price while costs and demand escalate.

Even as the new coalition government said it would make enormous cuts in the public sector, it initially promised to leave health care alone. But in one of its most surprising moves so far, it has done the opposite, proposing what would be the most radical reorganization of the National Health Service, as the system is called, since its inception in 1948.

Practical details of the plan are still sketchy. But its aim is clear: to shift control of England’s $160 billion annual health budget from a centralized bureaucracy to doctors at the local level. Under the plan, $100 billion to $125 billion a year would be meted out to general practitioners, who would use the money to buy services from hospitals and other health care providers.

The plan would also shrink the bureaucratic apparatus, in keeping with the government’s goal to effect $30 billion in “efficiency savings” in the health budget by 2014 and to reduce administrative costs by 45 percent. Tens of thousands of jobs would be lost because layers of bureaucracy would be abolished.

In a document, or white paper, outlining the plan, the government admitted that the changes would “cause significant disruption and loss of jobs.” But it said: “The current architecture of the health system has developed piecemeal, involves duplication and is unwieldy. Liberating the N.H.S., and putting power in the hands of patients and clinicians, means we will be able to effect a radical simplification, and remove layers of management.”

The health secretary, Andrew Lansley, also promised to put more power in the hands of patients. Currently, how and where patients are treated, and by whom, is largely determined by decisions made by 150 entities known as primary care trusts — all of which would be abolished under the plan, with some of those choices going to patients. It would also abolish many current government-set targets, like limits on how long patients have to wait for treatment.

The plan, with many elements that need legislative approval to be enacted, applies only to England; other parts of Britain have separate systems.

The government announced the proposals this month. Reactions to them range from pleased to highly skeptical.

Many critics say that the plans are far too ambitious, particularly in the short period of time allotted, and they doubt that general practitioners are the right people to decide how the health care budget should be spent. Currently, the 150 primary care trusts make most of those decisions. Under the proposals, general practitioners would band together in regional consortia to buy services from hospitals and other providers.

It is likely that many such groups would have to spend money to hire outside managers to manage their budgets and negotiate with the providers, thus canceling out some of the savings.

David Furness, head of strategic development at the Social Market Foundation, a study group, said that under the plan, every general practitioner in London would, in effect, be responsible for a $3.4 million budget.

“It’s like getting your waiter to manage a restaurant,” Mr. Furness said. “The government is saying that G.P.’s know what the patient wants, just the way a waiter knows what you want to eat. But a waiter isn’t necessarily any good at ordering stock, managing the premises, talking to the chef — why would they be? They’re waiters.”

But advocacy groups for general practitioners welcomed the proposals.

“One of the great attractions of this is that it will be able to focus on what local people need,” said Prof. Steve Field, chairman of the Royal College of General Practitioners, which represents about 40,000 of the 50,000 general practitioners in the country. “This is about clinicians taking responsibility for making these decisions.”

Dr. Richard Vautrey, deputy chairman of the general practitioner committee at the British Medical Association, said general practitioners had long felt there were “far too many bureaucratic hurdles to leap” in the system, impeding communication. “In many places, the communication between G.P.’s and consultants in hospitals has become fragmented and distant,” he said.

The plan would also require all National Health Service hospitals to become “foundation trusts,” enterprises that are independent of health service control and accountable to an independent regulator (some hospitals currently operate in this fashion). This would result in a further loss of jobs, health care unions say, and also open the door to further privatization of the service.

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British Chief Scientist Says Britain Must Embrace Genetically Modified Food

January 7,2009

Guardian.co.uk

By John Vidal and Felicity Lawrence

Britain must embrace genetically modified crops and cutting-edge developments such as nanotechnology to avoid catastrophic food shortages and future climate change, the government’s chief scientist will warn today.

In the clearest public signal yet that the government wants a hi-tech farming revolution, Professor John Beddington will say UK scientists need to urgently develop “a new and greener revolution” to increase food production in a world changed by global warming and expected to have an extra 3 billion people to feed by 2040.

“Techniques and technologies from many disciplines, ranging from biotechnology and engineering to newer fields such as nanotechnology, will be needed,” writes Beddington in a paper, seen by the Guardian, to accompany his speech to the Oxford farming conference.

He warns that time lags for the use of new technology on farms means action is vital now and argues that it is no longer possible to rely on improving yields from crops in traditional ways. “Over the last 50 years improving yields has accounted for 75% of increase in output. However, yield growth rates are now slowing,” he says.

Instead, he argues that new technologies such as GM will be critical in meeting economic, environmental and social goals. Beddington says the revolution is needed primarily to counter climate change and help provide food for the 9 billion people worldwide expected within 30 years.

“It is [also] predicted that demand for energy will rise by around 50%, and for fresh water by 50%, all of which must be managed while mitigating and adapting to climate change. This threatens to create a ‘perfect storm’ of global events,” he says.

The government has wanted GM crops to be much more freely grown for many years but has been reluctant to reopen the debate following intense campaigns against the technology by environment and development groups in the 1990s.

Although Beddington has spoken in support of GM before, his keynote speech – to a conference of farmers and supermarkets – shows that ministers believe it is time to accelerate the debate on the issue.

Intense lobbying by food companies, the growing significance of climate change, recent international food crises and a major independent Royal Society report have all helped to give the government the authority to put GM back on the national agenda.

For six months the government has been preparing the way with a series of reports on consumer opinion. Announcements from the Department for the Environment, Food and Rural Affairs (Defra) over the summer also began to frame GM as a new moral imperative in feeding the world. The Cabinet Office strategy unit also highlighted GM as an urgent domestic issue back in the summer of 2008. It said: “Consumer confidence in UK regulations, regulators and food supplies might be prejudiced if GM feed was found in systems claiming to be GM-free or if non-authorised varieties were detected in the UK food chain. If non-authorised material is found, there are also significant cost implications associated with recall.”

The assumption that new technology is the answer to the global food crisis is expected to be fiercely challenged by development and environmental charities campaigners who accuse the government of not having looked at the real causes of the global food crisis.

They point out that a UN-sponsored four-year review, involving more than 400 international scientists and chaired by Defra’s own chief scientist, Professor Robert Watson, concluded in 2007 that GM technologies were unlikely to have more than a limited role in tackling global hunger.

According to the Watson-led review, the scientific evidence on the claimed benefits of GM suggests they are variable, with increases in yield in some areas but decreases in others, and both greater and lesser pesticide use in different contexts. But crucially it concluded that global hunger is as much to do with power and control of the food system as with growing enough food.

Yesterday, Hilary Benn, the environment secretary, launched the government’s food strategy for the next 20 years. He told the Oxford conference that Britain must grow more food in a different way to respond to rising temperatures and world populations. “Food security is as important to this country’s future wellbeing – and the world’s – as energy security. We need to produce more food.

“We need to do it sustainably. And we need to make sure that what we eat safeguards our health,” he said.

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Tamiflu Causes Sickness & Nightmares in Children

July 31, 2009

Times Online

by David Rose

More than half of children taking the swine flu drug Tamiflu experience side-effects such as nausea and nightmares, research suggests.

An estimated 150,000 people with flu symptoms were prescribed the drug through a new hotline and website last week, according to figures revealed yesterday.

Studies of children attending three schools in London and one in the South West showed that 51-53 per cent had one or more side-effects from the medication, which is offered to everyone in England with swine flu symptoms.

The research by the Health Protection Agency emerged as Sir Liam Donaldson, the Chief Medical Officer for England, said that swine flu infections “may have reached a plateau”.

Releasing the latest figures, Sir Liam said that an estimated 110,000 new cases of the H1N1 virus were diagnosed by doctors in the week to Sunday. That did not include those using the new National Pandemic Flu Service for England to obtain antiviral drugs without seeing their GP.

Sir Liam said that the deaths of 27 people in England were confirmed to have been linked to swine flu, compared with 26 last week. As of Wednesday morning 793 people were in hospital in England with the virus, and 81 were in intensive care.

Yesterday Natasha Newman, 16, of Highgate, North London, was seriously ill in hospital in Athens after contracting swine flu while on holiday on the island of Cephalonia. Her parents, Julian Newman and Nikki Boughton, were at her bedside at the Agia Sofia children’s hospital, said a spokeswoman for Mr Newman’s business, J. Newman Textiles. “This is a very distressing and worrying time,” she said.

Peter Holden, the British Medical Association’s lead expert on swine flu, suggested that Tamiflu was being overused and did not need to be offered to everyone with mild symptoms. “The National Pandemic Flu Service has been a great success, and was needed to take the pressure off GPs,” he said. “But the threshold for getting Tamiflu should be quite high.

“For patients who are not in the high-risk groups — such as pregnant women, people with bad asthma or with suppressed immune systems — this virus typically causes mild symptoms and does not require a course of Tamiflu. Patients in the at-risk groups should be referred to their GP, who will use their clinical judgment.”

A total of 103 children took part in the London study, of which 85 were given the drug as a precaution after a classmate received a diagnosis of swine flu. Of those, 45 experienced one or more side-effects. The most common was nausea (29 per cent), followed by stomach pain or cramps (20 per cent) and problems sleeping (12 per cent). Almost one in five had a “neuropsychiatric side-effect”, such as inability to think clearly, nightmares and “behaving strangely”, according to the research, published in Eurosurveillance, a journal of disease.

The study was carried out in April and May when the drug was being issued as a preventive measure. The findings were echoed by a study of children at a school in the South West where a pupil had caught the disease in Mexico.

Health officials in Japan have recommended against prescribing Tamiflu to teenagers over fears it causes a rise in “neuropsychiatric events”. The researchers said that clinical trials had shown that about 20 per cent of adults reported side-effects of either nausea or vomiting after taking Tamiflu.

Both the Department of Health and the Medicines and Healthcare Regulatory products Agency said that the drug was safe, and that the benefits of treating early symptoms and avoiding potentially serious complications could outweigh the risks of side-effects.

Sir Liam said that despite a 10 per cent rise in the estimated number of cases in the week to Sunday, the latest figures reinforced “a growing impression we have had a peak”. He said that a surge would still be expected in the winter flu season, but added: “I think we are a little more confident we may be seeing a downturn in this flu.”

Scale of the outbreak

— 110,000 new swine flu cases in England last week, based on data from GPs

— 150,000 people obtaining Tamiflu without seeing a GP since last Thursday

— 51% to 53% proportion of children reporting side-effects from taking Tamiflu

— 1 in 158 people in England have contacted their GP with flu-like symptoms since outbreaks began. The rate is 1 in 77 for children aged 1 to 4

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Doctors Warn Against ‘Swine Flu Parties’

June 30, 2009

CNN

By Mark Tutton

LONDON, England (CNN) — Health experts are warning parents against holding “swine flu parties” in the hope of infecting their children with the H1N1 virus.

Talk of swine flu parties has emerged on Internet forums. The idea is that exposing a child to the H1N1 virus while it remains relatively mild will give the child immunity if the virus returns in a more virulent form later on.

The idea is an extension of chicken pox and measles parties that were once a popular way of exposing children to those diseases so that they might acquire resistance to subsequent infections.

But health officials have been quick to condemn the idea. Speaking at a conference, Dr Richard Jarvis, chairman of the British Medical Association’s public health committee, said “I have heard of reports of people throwing swine flu parties. I don’t think it is a good idea.

“I would not want it myself. It is quite a mild virus, but people still get ill and there is a risk of mortality.”

Last month, Richard Besser, the acting head of the U.S. Centers for Disease Control and Prevention, also warned against deliberately exposing people to the virus.

While it’s not clear if any swine flu parties have been held, Justine Roberts, the founder of Web site mumsnet, today told BBC Radio 4 that some people have been discussing the idea.

“We have heard of people saying ‘can we come round to your house when you get it?” she said.

“There’s definitely a prevailing view that it might be better to get it now and some people are not despairing if there is a case in their school.”

Flu epidemics often come in waves and there are fears that a more virulent form of H1N1 may strike in the fall. That happened with the Spanish flu pandemic in 1918.

Researchers at George Washington University in Washington DC have studied the 1918 pandemic and have found that in areas where there were more cases during the first wave of Spanish flu, there were fewer deaths during its second wave, in the fall of that year.

The suggestion is that exposure to the first wave of the flu conferred immunity to its second wave.

But H1N1 is still very much an unknown quantity. Experts warn that little is known about the virus and that actively encouraging its spread could risk the health of those who are most vulnerable.

While the symptoms associated with swine flu are not usually life threatening among people in good health, it can be deadly for elderly people or those with other medical conditions.

The latest figures from the World Health Organization show there have now been 311 confirmed deaths around the world from the H1N1 virus first identified in Mexico this spring, and just over 70,000 infections in 113 countries.

Click here to read the full story from CNN.