Dec 2007 17

We already have not just a two-tiered health service but a many tiered one.  The top tier is occupied by the roughly 13 per cent of the population who have private medical insurance.  The other tiers are composed of the various sections of the population who get very different results from the NHS.  A recent Civitas study exposed how the middle class are able to play the system and get better results than the poor.  With all that in mind it is pretty clear that a dogmatic insistence that everyone treated by the NHS occupy some nominal single tier is a bit of a joke.

Unfortunately, a report in the Sunday Times set out how that joke isn’t proving terribly funny for Colette Mills, a former nurse.  Her local NHS Trust uses Taxol to treat breast cancer but she thinks that her chances would be a lot better with Avastin.  She is willing to pay for the drug and any costs to the hospital associated with using it, about £4,000 in total, but is not able to afford the £10 to £15,000 cost of treating her condition entirely privately.  That would mean paying for nurses’ time, blood tests, scans and the countless other costs associated with cancer treatment.

So, let’s get this straight: the hospital she is being treated at will treat private patients with Avastin, will treat NHS patients for free but won’t let an NHS patient pay a little extra for a drug that might save her life.  All because "co-payments would risk creating a two-tier health service and be in direct contravention with the principles and values of the NHS".  Are those principles worth people’s lives?

A two-tier system will necessarily exist in any rationed healthcare system.  You’ll never be able to provide all the healthcare people can use, to everyone, at any time.  That will always leave some people, who are able to pay, wanting to buy more.  Even if you ban private treatment people can still go abroad.

With that in mind making it artificially difficult to move up a tier doesn’t strengthen the principle of a universal NHS.  All it does is mean that a lot of ordinary people can’t get drugs reserved for the super-rich.  One can believe that the NHS should provide Avastin itself.  However, so long as it doesn’t it is fundamentally inhumane to make it unreasonably difficult for people to move up a tier when their survival is at stake.  To risk Colette Mills’ death in a vain hunt for an illusory principle.

Dec 2007 17

Researchers at the Karolinska Institute in Sweden have taken a look at the amounts spent on cancer care in the UK and have found that the Department of Health’s picture of low cancer survival rates but low costs isn’t quite accurate.  The Department of Health’s analysis apparently fails to include spending by cancer care charities like Marie Curie Cancer Care.  OECD data suggests that the UK spends £143, compared to the £80 that the Department of Health claims.

While the Swedish researchers acknowledge that UK cancer spending "is a very muddy picture" where precise and reliable figures are hard to come by this is another nail in the coffin of the "spend more and the health service will work itself out" approach.  The numbers released by the Karolinska Institute suggest that the UK spends 36 per cent more on cancer care than Germany.  Despite that additional spending in the UK a German man diagnosed with cancer has a 25 per cent higher chance of surviving five years and a German woman a 26 per cent higher chance of surviving that long compared to UK patients.

Professor Karol Sikora, advisor to the World Health Organisation who uncovered these figures, offers some recommendations on how to improve the situation:

"I think we should involve the independent sector and get systems that are more efficient and we should be looking at how things are done in America and Europe – there are simply no waiting lists there.

People in Europe cannot understand waiting for cancer treatment.

That is one thing that bedevils healthcare in the UK. No-one waits 31 days for radiotherapy in Europe yet that is our new target here. Most people currently wait much longer.

There is no reason why we can move from a target driven culture to a highly efficient system with no waiting lists with the money we are currently spending on cancer in the UK."

It is the uniquely centralised, politicised and monopolistic fashion in which healthcare is organised in the UK which leaves so many paying such a tragically high price for poor healthcare performance.  As Professor Sikora says we can learn lessons from other nations in Europe who do things differently.

Dec 2007 14

Just a thought – after a week which has seen sell-out and apparently legendary concerts by the reformed Led Zeppelin and The Verve, the O2 (as the Dome has been renamed) is now being described as the world’s best entertainment venue.

All this success only makes it more amazing that the Dome was a synonym for failure, over-budget profligacy and right-on irrelevance. It’s telling that the only real difference between 2000 and 2007 is that the public sector is no longer in charge of the place…

Dec 2007 14

During the research for a project I’m working on I found myself looking through GlaxoSmithKline’s accounts.  Remembering the debate over the Public Sector Rich List I got curious and wondered just how much JP Garnier – the reputedly well-paid boss at a big private company like GSK – gets paid.  The figure is $5,413,000.  That’s a lot of money, not bad if you can get it.  However, GSK are really massive and, after you’ve converted it to pounds, wondered how much more it was than the £1,256,000 that Crozier takes home in total remuneration.

I’ve done those calculations.  They are entirely reliable with the proviso that the exchange rate is today’s rather than last year’s.  Royal Mail revenue and operating profit figures are from their accounts:

(click to enlarge)

What that shows is that Royal Mail pay Crozier more compared to their profit and revenue than GSK pay Garnier.  Adam Crozier is, at least compared to JP Garnier, well paid even relative to the scale of the company he is running.  Even at the very top end the public sector now pays really well.

Given that public sector organisations don’t depend on success in the market to attract customers or strong financial results to attract shareholders there is no reason to assume these salaries are likely to be justified.

Dec 2007 14

Two new videos from the Centre for Freedom and Prosperity in the US make a compelling case for tax competition and reductions in corporation tax rates. Exactly the sort of thing we all need to do more of.

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