Friday, September 14, 2007

NHS - England, Northern Ireland, Scotland, Wales

Our country’s official title must baffle many from other countries – the United Kingdom of Great Britain and Northern Ireland. I’m not sure when the official title was passed into law. The country of England conquered Wales in medieval times and never really conquered Scotland. They were only united when the only direct heir to the English throne was King James IV of Scotland upon the death of Queen Elizabeth I of England. The Irish history is even more complex but when the Republic of Ireland became an independent state in the early years of the 20th century, the people of the north chose to remain allied with Great Britain but as the name suggests like some sort of bastard rump (that is not meant to be offensive, just a reflection that the name suggests you are not British, although part of the country).

In recent years much political and administrative power has been “devolved” to the individual countries or regions to the extent the Scottish Nationalist Party now forms the government in Scotland and is, again, promoting independence from the United Kingdom of Great Britain and Northern Ireland.

The National Health Services of the four regions are, to a greater or lesser extent independent of each other, although all receiving their funding from central U.K government.

On Monday Dr Rant, in a wonderful piece entitled Hypocritic Oaf, ranted about an episode of the daily domestic BBC Radio 4 current affairs programme Today in which the BBC journalist John Humphreys interviewed our Secretrary of State for Health and widely slagged off our GPs. I have not been silent myself in criticism of the BBC’s coverage of the NHS. At times its seemingly unbiased reporting is very much on the government’s side, and I believe it does need a new Health Editor.

However, on visiting the Today website, I find quite copious, comprehensive and balanced information about NHS reforms.

I was particularly impressed that the BBC commissioned reports from the King’s Fund (a public health independent charitable think-tank), which has recently undertaken a review into funding, and its structure, of the national NHS.

I have downloaded and read, so far, the King’s Fund/BBC Today reports on the NHS in England and Scotland.

There have been many criticisms of the availability of cancer drugs in NHS England and Wales - not approved, often for financial reasons, by the National Institute for Health and Clinical Excellence. The Welsh drugs approval authority kowtows to NICH (see this BBC report about the availability of the cancer drug Sunitinib and the All Wales Medicines Stratgey Group's statement about its relationship with NICH), Scotland has its own approval body which has approved them (though not Sunitinib). There have been several cases where cancer patients have had to move to Scotland to receive certain drugs.

Looking at the Kings Fund/BBC Today reports into NHS in the four regions I am somewhat surprised.

NHS Scotland’s report runs to 24 pages, NHS Northern Ireland 18 pages, NHS Wales 13 pages and NHS England to 10 pages. Same questions.

NHS Scotland obviously has better statisticians or realises the importance of data for planning or has more statisticians per head of population or pays them more or …

The standardisation of data across the Scottish health boards far surpasses that in the various types of English trusts, the data collection and analysis of which follows no national standards. Better data collection and analysis should certainly lead to more informed planning.

NHS Scotland reported 45 hospital openings and 56 closures since 1997.

NHS Northern Ireland reported 1 hospital opening and 13 closures since 1997.

NHS Wales responded “We do not currently have records which detail this information as requested.

Ok – you are dumb as the fuckwit dumb bureaucrats reported for NHS England (see below).

But NHS Wales reasonably continues:

We consider that to do so would create misleading data as the figures and comparison make a simplistic comparison which is unrepresentative of the overall position from which improvements across delivery of health services takes place, We would point to the fact that (small) facilities are often replaced by (fewer) more joined up, modern, bigger facilities whilst also recognising that there have been many schemes where developments have taken place on existing hospital sites. Additionally, the requested information would take no account of changing modes of care”.

Fair enough – but you are saying our local facilities are being replaced by further-afield facilities!

NHS England reported 82 hospital openings and about closures cynically responded “The information is not held centrally”.

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