So, what do these three strategic shifts really mean? Let’s start with the first one – moving from hospital to community.
Privatised medical providers do not like hospital care. They know that those people who end up in hospital – and all of us do at some point in our lives – will require complex medical treatment.
Those who are in A&E will never get private medical care.
Those who get through that process because they have heart attacks or strokes, or they’ve got cancer, or they’ve had a road traffic accident, or they require a major surgery for whatever that reason might be, will never, in most cases, ever have private medical treatment.
These acute cases all involve complexity, and private medicine really does not want to go anywhere near acute cases and complexity if it can avoid them. So, the whole basis of the transfer of medicine from hospital to community is to outsource from hospitals all those things that can be run by medical algorithms.
Like what? Things like diabetes control, things like the control of cholesterol through statins, everything to do with hypertension and heart disease, and maybe even the control of what I call the diseases of despair, which are things like depression. Those all run, to a very large degree, on the basis of an algorithm that says, if you see this, do that. And those are the conditions. that private medicine loves.
Those things we can do cheaply and simply with partially trained labour should not be done cheaply and simply with partially trained labour because…..well, no really reason is given other than worship at the Church of the National Health Service.
Spud, if he’d been around then, would have been against the introduction of aspirin because all should have an equal chance of trepanning.
About all I can say is that it doesn’t seem like that in Oz. Where by Ritchies’ standards we have privatised medicine.
“Those who are in A&E will never get private medical care.”
Odd. On the one occasion I’ve needed medical care, would have been done by a NHS A&E in the UK, I went private. Consultation, X rays, diagnosis, suggested treatment & out the door in under 40 mins. For true emergency treatment your insurance kicks in at what ambulance you use. With my policy, helicopters. Useful if you’ve a house halfway up a mountain & 50km of bad road to the nearest town.
“Those who are in A&E will never get private medical care.” When I suffered an industrial accident in the USA I was whipped off to a private clinic where they stitched up the wound PDQ.
(My other memory is that I watched the stitches being inserted with great interest. One of the nurses was cooing “Oh, you are so brave, blah, blah, blah.” I assumed that many of their patients came from the more excitable races. Italians and such.)
A couple of years ago a pal of mine had a full-on heart op involving new heart valves and 4 stents, done by the leading cardio at this game using a new procedure he’d devised which didn’t involve lifting the entire ribcage, in an operation as complex as anything you’d see at Barts. It was done in a London private hospital courtesy of his girlfriend’s corporate private health insurance.
So not only does Murphy not know how things are done in Oz and elsewhere, he also doesn’t know how things are done here.
But that’s not surprising. He’s an ideologue. They don’t look at reality. They simply pontificate about their own utopias and how nasty people stand in their way of achieving them.
“the control of cholesterol through statins”: the NHS could save a bomb by stopping giving such futile treatments or at least by restricting them to the small numbers of patients who might conceivably gain from them viz those who have already had heart attacks or angina.
Though even then the gains tend to be so small and the side effects unpleasant enough that the wisdom of using the bloody things is doubtful. Statins are cheaper now they’re off patent but since you take them for a lifetime the costs still add up.
Things in Australia are very good, speaking from recent experience, a few weeks ago a knee gave up on me, Had an appointment with my surgeon a couple of weeks later, knee replacement three weeks after that,
PiP :@ 10.11 “the control of cholesterol through statins”.
Saw an interesting article regarding this last week. According to the study, cholesterol isn’t the boogie man they say it is and it’s statins that are causing artery damage. Not being a medico I don’t know, but given the track record of big pharma I wouldn’t be in the least bit surprised…….
“ Those who get through that process because they have heart attacks or strokes, or they’ve got cancer, or they’ve had a road traffic accident, or they require a major surgery for whatever that reason might be, will never, in most cases, ever have private medical treatment.”
When the consultant recommended that I have a prostatectomy I was asked if I had private insurance, so we can assume that prostate cancer in a 67yo man would be covered.
Furthermore as I haven’t got insurance they’ve given me a fixed price which also covers complications to full recovery. So there’s another bit of bollocks he’s spouting.
An even more interesting contention is in his later post:
In the discussion that I took part in last night, one of the audience themes was the disappearance of the left-wing in politics.
Every single party barring the 5 Reform MPs is Hard Left and in some cases well to the Left of North Korea – and he’s saying there’s no Left wing parties. Whatever he is smoking – I want it…
Privatised medical providers do not like hospital care. They know that those people who end up in hospital – and all of us do at some point in our lives – will require complex medical treatment.
Those who are in A&E will never get private medical care.
Last three times I went to hospital it was for a check-up and it was done privately. Smoothly as well – the statements is manifestly false to the point where it could be proved to be a lie in a court of law.
Those who get through that process because they have heart attacks or strokes, or they’ve got cancer, or they’ve had a road traffic accident, or they require a major surgery for whatever that reason might be, will never, in most cases, ever have private medical treatment.
These acute cases all involve complexity, and private medicine really does not want to go anywhere near acute cases and complexity if it can avoid them. So, the whole basis of the transfer of medicine from hospital to community is to outsource from hospitals all those things that can be run by medical algorithms.
The initial diagnosis and treatment might be in A&E but they will (assuming they have medical cover) have follow-up treatment which the private sector can and does administer. As for ‘medical algorithms’ – is Spud planning to outlaw computers or diagnostic software? Reintroduce the BBC B as the default computer of choice – what an absolute fucking moron.
Like what? Things like diabetes control, things like the control of cholesterol through statins, everything to do with hypertension and heart disease, and maybe even the control of what I call the diseases of despair, which are things like depression. Those all run, to a very large degree, on the basis of an algorithm that says, if you see this, do that. And those are the conditions. that private medicine loves.
I don’t think even the likes of Alex Jones would be this demented. Bit insulting to the Doctors also.
They are largely consistent with this whole idea of moving from treatment to prevention as well, because treatment to prevention doesn’t mean we’re going to stop actually treating people at all. In the way that Wes Streeting thinks about this, the move from treatment to prevention is about prescribing a great deal of drugs in anticipation that somebody might be ill. So, I’ve just mentioned them, all those things for statins and cholesterol and high blood pressure, low blood pressure, and everything else that many people, by the time they reach my age, are taking on a very regular basis. It is apparently quite common for a man, once they’ve reached retirement age, to be on at least ten regular drugs a day. That’s what prevention means. And you can understand why privatised medicine loves this idea.
He sounds like an early 20th century physician saying: ‘That penicillin will never work’ – just batshit insane.
First of all, these algorithms can be run by relatively lowly trained people. There is now a massive move inside the NHS and amongst some of the Royal Colleges of Medicine, rather surprisingly, to replace the role of the doctor inside UK medicine with the role of the physician associate.
What does the physician associate do? Well, they’re a person who’s got a couple of years of post-graduate medical training – the equivalent of a glorified master’s degree if you like – but really have none of the skills that are provided to a doctor as a result of them doing five years of a medical degree and a year in hospital post qualification and then usually a significant number of postgraduate qualifications as well.
The physician associate is there to simply deliver the algorithm, to prescribe the routine medicine, to make sure that when they put all the routine medicines that have been prescribed to a person back into the algorithm, that AI says there are no conflicts between them.
Once again we see his default setting. The producer is king – in this case the Doctor. They need to be able to protect their earnings and continue to artificially restrict the supply of new doctors come what may. I know his continued living situation requires his ex-wife’s pension but he could at least declare the obvious Conflict of Interest here.
Now that is, by the way, important, because one in eight admissions of older people to hospital are because of conflicts within the prescribed medical regimes that they have been given to deal with the complexity that they apparently suffer from. But that can all be managed by these relatively low-grade staff who are cheaper, of course, to employ and who will, of course, deliver vast profits to private medical companies because the drugs bill will go through the roof.
So, treatment to prevention means more prescriptions, and that means more profit.
Just the same as moving people out of hospital to community does the same, because the community will not employ full-scale GPs, but will instead employ people like physician associates or the paramedic who I saw the last time I went to see what I thought was a GP, but was not.
So, two of these three shifts already look like they are about putting private medicine in charge.
I can’t fisk any more of this shit – even by his standards this post is evidence of serious decline in mental function. It’s beyond drivel – mental incontinence, and still he ploughs on, like some insane LLM spouting rubbish until the end of time
BiND
I assume you’ve discussed radiotherapy vs surgery with an oncologist. Urologists almost automatically advise surgery….I had RT: no side effects at all, except some radiation proctitis that required cauterisation.
@Person in Pictland
A 28 pill packet of normal dose statins cost the NHS £1.10 so about £14 per year. It’s a ludicrously cheap medication. A cardiologist once told me that when used as primary preventative measure, for 9 out of 10 people they will make no difference, but for the remaining one in 10 they will make a profound difference to their life expectancy and quality of life. I was slightly below the limit where statins were recommended but I convinced my doctor to subscribe them in line with the new draft guidance that had just come out.
Separate, don’t mix, paying and provision. Like here, for what is left of medical care in Germany, you can choose to insure yourself publicly or privately. Likewise nothing stops the privately insured being treated in publicly-run hospitals. Private hospitals are more than happy to take publicly insured clients for those services they are “licensed” to offer to all.
Maybe your favourite correspondent has been confusing Rocco’s fictional works on the services provided by private facilities with some kind of documentary series, and thinks that there really are all kind of “perks” on offer to normal patients.
all those things for statins and cholesterol and high blood pressure, low blood pressure, and everything else that many people, by the time they reach my age, are taking on a very regular basis. It is apparently quite common for a man, once they’ve reached retirement age, to be on at least ten regular drugs a day.
@V_P
Do you not think a great deal could be explained right there if he’s writing from experience? (Bearing in mind his obese middle aged male status.) SIDE EFFECTS!
AndyF @12.13, when I was still paying for my script it was £9.20. According the UK Gov website, the cost to OUR NHS for my medication was £1.09.
85% of prescriptions are dispensed free……………..
Theo,
The lead urology nurse went through all three options in detail a couple of days before I saw the consultant. It was my choice although he did sort of point me in that direction as well. It was all the hormone therapy that put me off radio treatment, especially the thought of it lasting up to 3 years.
There are profitable courses in medicine, and there are courses that can never earn back their keep.
He’s trying to keep the profit in the NHS without saying it that way. If private medicine can pick and choose which areas to take, they’ll (of course) take the profitable ones.
“A 28 pill packet of normal dose statins cost the NHS £1.10 so about £14 per year.” Thank you for that but the £14 p.a. can’t possibly be the total cost to the NHS. What about the doctors’ appointments? What about the blood tests? What about the costs of treating the side effects?
I’ve just come back from a privately-owned hospital whose mere existence refutes Murphy’s claim. I went there for a consultation (possibly leading to future treatment, possibly not, depending on the result of tests and other examination) because the NHS has failed me again and my wife is frightened that my condition might be life-threatening (yeah – it’s my life but she knows more about this stuff). I looked around the waiting room and nobody looked rich, most looked old but there were two youngsters and several middle-aged.
When I was two, my great-grandmother as matriarch decided that the family would support and use the NHS as a patriotic duty and I have striven to follow that command but there comes a point where it ceases to be patriotic because the damage to me from the NHS failure will result in worsened (albeit by an amount that Murphy will ignore) results for the UK as a whole and the personal cost of NHS failure exceeds the cost (almost entirely financial) of using private medicine.
So – those in A&E who survive but are not cured may well end up seeking private health care. Murphy is wrong, as usual.
Pretty much the entirety of Medicine is based on ‘if you see this do that’.
Hence House runs on differential diagnosis. A balance of probability, risk, detectability, treatability and cost. An algorithm no less.
Re: Statins
There is a concept in medicine called NNT – number needed to treat – the number of people needing treatment for some particular effect. So if you have an NNT of 10 to, say, avoid one stroke or heart attack over 10 years, in someone with heart disease and a previous thrombotic event, compared to non-treatment, then the cost is 10x the individual cost to avoid that event. The other 9 folk probably see no benefit and may have side effects.
That 1 of 10 stat earlier in this thread is an example….
For treatments that cost pennies, its a rounding error in the other costs – tests, professional fees etc. as someone mentioned.
But if it’s $100k (modern cancer treatment?) then the sums start to add up. NICE use a Qualty Adjusted Life Year, QALY, to judge cost effectiveness, which used to be 25K sterling per QALY, for the NHS to treat.
There are also NNH – number needed to harm.
Try searching for statins on http://www.thennt.com for more.
*Declaration of interest – former Chief Pharmacist in UK and NZ.
BiND
Yes, my three months of androgen suppression therapy were grim – hot flushes, night sweats, poor concentration, loss of body hair. Yet my neighbour had AST for a year but didn’t notice a thing. A friend and relative had surgery, and had severe but short term side-effects. There’s no one-size-fits-all treatment, as I am sure you realise. Anyway, good luck!
In a large 5-year trial of one statin in British men with some constellation of risk (purely biochemical if memory serves), the NNT for the statin was closer to 50. Of course the result was heavily publicised, with blaring headlines such as “statins cut heart deaths by 28%”.
The trials for statins start one month in from beginning to dose the group. Anyone who drops out due to side effects isn’t counted or followed up. The published results and Pharma salesmen are very keen on relative risk reduction rather than absolute risk reduction, say 50% RRR for a ARR of 1% pa to 0.5%
Theo,
Thanks. No good choices unfortunately.
It’s a poorly designed trial that can’t follow a subject who discontinues treatment for occurrence of the ultimate endpoint.