Authoritarian medicine in Britain -- Health "insurance" with a difference

If they cannot afford to give you a drug or service that you need, you are forbidden to pay for it yourself!

Created 60 years ago as a cornerstone of the British welfare state, the National Health Service is devoted to the principle of free medical care for everyone. But recently it has been wrestling with a problem its founders never anticipated: how to handle patients with complex illnesses who want to pay for parts of their treatment while receiving the rest free from the health service. Although the government is reluctant to discuss the issue, hopscotching back and forth between private and public care has long been standard here for those who can afford it. But a few recent cases have exposed fundamental contradictions between policy and practice in the system, and tested its founding philosophy to its very limits.

One such case was Debbie Hirst's. Her breast cancer had metastasized, and the health service would not provide her with Avastin, a drug that is widely used in the United States and Europe to keep such cancers at bay. So, with her oncologist's support, she decided last year to try to pay the $120,000 cost herself, while continuing with the rest of her publicly financed treatment. By December, she had raised $20,000 and was preparing to sell her house to raise more. But then the government, which had tacitly allowed such arrangements before, put its foot down.

Mrs. Hirst heard the news from her doctor. "He looked at me and said: `I'm so sorry, Debbie. I've had my wrists slapped from the people upstairs, and I can no longer offer you that service,' " Mrs. Hirst said in an interview. "I said, `Where does that leave me?' He said, `If you pay for Avastin, you'll have to pay for everything' " - in other words, for all her cancer treatment, far more than she could afford.

Officials said that allowing Mrs. Hirst and others like her to pay for extra drugs to supplement government care would violate the philosophy of the health service by giving richer patients an unfair advantage over poorer ones. Patients "cannot, in one episode of treatment, be treated on the N.H.S. and then allowed, as part of the same episode and the same treatment, to pay money for more drugs," the health secretary, Alan Johnson, told Parliament. "That way lies the end of the founding principles of the N.H.S.," Mr. Johnson said.

But Mrs. Hirst, 57, whose cancer was diagnosed in 1999, went to the news media, and so did other patients in similar situations. And it became clear that theirs were not isolated cases. In fact, patients, doctors and officials across the health care system widely acknowledge that patients suffering from every imaginable complaint regularly pay for some parts of their treatment while receiving the rest free.

"Of course it's going on in the N.H.S. all the time, but a lot of it is hidden - it's not explicit," said Dr. Paul Charlson, a general practitioner in Yorkshire and a member of Doctors for Reform, a group that is highly critical of the health service. Last year, he was the co-author of a paper laying out examples of how patients with the initiative and the money dip in and out of the system, in effect buying upgrades to their basic free medical care. "People swap from public to private sector all the time, and they're topping up for virtually everything," Dr. Charlson said in an interview. For instance, he said, a patient put on a five-month waiting list to see an orthopedic surgeon may pay $250 for a private consultation, and then switch back to the health service for the actual operation from the same doctor. "Or they'll buy an M.R.I. scan because the wait is so long, and then take the results back to the N.H.S.," Dr. Charlson said.

In his paper, he also wrote about a 46-year-old woman with breast cancer who paid 250 pounds for a second opinion when the health service refused to provide her with one; an elderly man who spent thousands of dollars on a new hearing aid instead of enduring a yearlong wait on the health service; and a 29-year-old woman who, with her doctor's blessing, bought a three-month supply of Tarceva, a drug to treat pancreatic cancer, for more than $6,000 on the Internet because she could not get it through the N.H.S. Asked why these were different from cases like Mrs. Hirst's, a spokeswoman for the health service said no officials were available to comment.

In any case, the rules about private co-payments, as they are called, in cancer care are contradictory and hard to understand, said Nigel Edwards, the director of policy for the N.H.S. Confederation, which represents hospitals and other health-care providers. "I've had conflicting advice from different lawyers," he said, "but it does seem like a violation of natural justice to say that either you don't get the drug you want, or you have to pay for all your treatment."

Karol Sikora, a professor of cancer medicine at the Imperial College School of Medicine and one of Dr. Charlson's co-authors, said that co-payments are particularly prevalent in cancer care. Armed with information from the Internet and patients' networks, cancer patients are increasingly likely to demand, and pay for, cutting-edge drugs that the health service considers too expensive to be cost-effective. "You have a population that is informed and consumerist about how it behaves about health care information, and an N.H.S. that can no longer afford to pay for everything for everybody," he said.

Professor Sikora said that oncologists are adept at circumventing the system by, for example, referring patients to other doctors who can provide the private medication separately. As wrenching as it can be to administer more sophisticated drugs to some patients than to others, he said, "if you're a doctor working in the system, you should let your patients have the treatment they want, if they can afford to pay for it." In any case, he said, the health service is riddled with inequities. Some drugs are available in some parts of the country and not in others. Waiting lists for treatment vary wildly from place to place. Some regions spend $280 per capita on cancer care, Professor Sikora said, while others spend just $90.

In Mrs. Hirst's case, the confusion was compounded by the fact that three other patients at her hospital were already doing what she had been forbidden to do - buying extra drugs to supplement their cancer care. The arrangements had "evolved without anyone questioning whether it was right or wrong," said Laura Mason, a hospital spokeswoman. Because their treatment began before the Health Department explicitly condemned the practice, they have been allowed to continue.

The rules are confusing. "It's quite a fine line," Ms. Mason said. "You can't have a course of N.H.S. and private treatment at the same time on the same appointment - for instance, if a particular drug has to be administered alongside another drug which is N.H.S.-funded." But, she said, the health service rules seem to allow patients to receive the drugs during separate hospital visits - the N.H.S. drugs during an N.H.S. appointment, the extra drugs during a private appointment.

One of Mrs. Hirst's troubles came, it seems, because the Avastin she proposed to pay for would have had to be administered at the same time as the drug Taxol, which she was receiving free on the health service. Because of that, she could not schedule separate appointments. But in a final irony, Mrs. Hirst was told early this month that her cancer had spread and her condition had deteriorated so much she could have the Avastin after all - paid for by the health service. In other words, a system that forbade her to buy the medicine earlier was now saying that she was so sick she could have it at public expense. Mrs. Hirst is pleased, but only up to a point. Avastin is not a cure, but a way to extend her life, perhaps only by several months, and she has missed valuable time. "It may be too bloody late," she said. "I'm a person who left school at 15 and I've worked all my life and I've paid into the system, and I'm not going to live long enough to get my old-age pension from this government," she added.

She also knows that the drug can have grave side effects. "I have campaigned for this drug, and if it goes wrong and kills me, c'est la vie," she said. But, she said, speaking of the government: "If the drug doesn't have a fair chance because the cancer has advanced so much, then they should be raked over the coals for it."

Source





Doctors and teachers to act as 'informers' to target violent offenders BEFORE they strike

Under controversial new British plans. Judged guilty while still innocent, in other words. Given the appalling abuses of the existing secretive child welfare system this would be a descent into utter darkness. The Leftist British government obviously has a conception of civil liberties not too different from Joseph Stalin's

Doctors, teachers and social workers will be told to act as informers to identify potential violent offenders for monitoring by the police and other agencies. Ministers hope that by spotting binge-drinkers, drug addicts and young gang members early before they commit serious crimes they can be placed on a national database and steered away from offending behaviour. The plans have been dubbed the Minority Report powers, a reference to the 2002 Tom Cruise movie in which a futuristic "precrime" police unit uses psychics to arrest and imprison criminals just before they carry out attacks.

But civil liberty campaigners and union bosses warned that such intrusive measures by the Home Office would destroy the relationship of trust between GPs and their patients or social workers and clients. They would also put professionals at risk of reprisals if they are seen as police informers. Opposition MPs said recent fiascos involving huge quantities of personal data lost or leaked by the Government raised grave doubts over plans for sharing and swapping private data.

The scheme, outlined in the Government's latest Tackling Violence Action Plan, will mean redrafting the NHS's strict privacy protection rules to encourage health staff to share patients' confidential data as part of "public interest disclosures". The document sets out plans for identifying individuals who may not have committed any offences but are judged to be "at risk of involvement in violence". Tell-tale signs of those 'whose behaviour may be identified as risky' include drug addicts or alcoholics, mental health patients and youngsters who join gangs or who have been the victims of violence either in the home or on the street.

Ministers want GPs, social workers, mental health agencies, housing officials and school or college staff to provide tip-offs so that multi-agency Crime and Disorder Reduction Partnerships, including local police, can act. The only existing systems are for monitoring convicted criminals through probation staff, so new organisations will have to be set up to watch those thought to be at risk of committing violence.

Once an individual is assessed as a high-risk potential offender, they would be placed on local and national databases and subjected to regular reviews. The Home Office claims such measures will save lives. Ministers have cited examples such as Michael Stone, convicted of murdering Lin and Megan Russell, or Soham murderer Ian Huntley. They repeatedly came to the notice of medics or police, but lack of data- sharing meant threatening patterns were missed. The Home Office said examples of "interventions" for potential criminals included regular visits from social services staff, providing mentors to young people, forcing them to attend weapons awareness classes or more after-school activities to keep them off the streets.

Union officials voiced grave concerns and accused ministers of failing to consult professionals or to address concerns they had already raised. A spokesman for Unison, the public services union, said: "These plans threaten to build a barrier of suspicion between the public and those who deliver their services."

Shadow Home Secretary David Davis said: "This is another ill-thought through measure, no doubt based on flawed databases and unreliable statistical analysis." Shami Chakrabarti, director of human rights group Liberty, said: "Home Office edicts are unlikely to help skilled health professionals make delicate judgments on behalf of their patients. The danger is of vulnerable victims treating their own injuries for fear of being reported to the police."

Source




Black groups don't like Britain's new rules

A new immigration proposal announced recently to increase citizenship fees and landing charges for visa holders arriving in the United Kingdom (UK) has left Caribbean nationals and non-European residents in Britain worried. One of their major fears is that thousands of persons who have been living and working in the UK for decades might receive little or no social security benefits. The Sunday Gleaner has learnt that already, some lobby groups, including the Jamaica diaspora and Facilitator for a Better Jamaica (FFBJ), are examining the proposal and other immigration developments to make an appropriate response and representation.

Under the new immigration proposal, immigrants arriving in Britain will be required to pay an extra 20 pounds landing charge on top of their visa fees. Naturalisation fees attract over 700 pounds, while it costs 75 pounds for a British passport. At the same time, there is widespread speculation that there will be additional increases in immigration fees at the start of the financial year in April.

The extra charge is slated to fund schools, hospitals and other social services said to be under stress from an influx of migrants mainly from countries of the European Union. The British government is expected to rake in 15 million a year from the levy.

At the same time, social benefits in Britain are to be linked with citizenship and those who have been denied British passports will lose a wide range of welfare services, including child benefits, housing benefits and income support. Prisoners who serve time in Britain will automatically lose their rights to British citizenship and the benefits it offers.

Founder of Facilitators for a Better Jamaica (FFBJ) Sylbourne Sydial said his concern was not one of alarm, but one of unease as the new measures being implemented were a "smack in the face of multiculturalism and a shift from the Commonwealth." "Since the formation of the FFBJ's home office consultation team," he said, "we have seen that these different and new proposals - in the form of increase in fees, reduction in vacation period, 20 pounds landing charges and the many changes in the immigration rules - show very clearly that there is a shift in UK policy towards former Commonwealth nations of which Jamaica is a part."

While a number of Jamaicans and other West Indian nations with whom The Sunday Gleaner spoke are seeking to speed up the process of acquiring citizenship, Jamaican-born journalist, Luke Williams, believes the long-term impact on Jamaica and the Caribbean will be devastating. "What is happening is demoralising and is exploitation in many forms including financial and brain drain. It's a double-whammy: They (the British Government) are getting extra money from the high fees and putting pressure on those not considered the best, as well as getting rid of those they do not want," he said. [That's a bad idea??]

A Jamaican-trained medical doctor (Dr Brown) at the Greater Almond Street [Ormond St?] Hospital in Central London noted that many West Indian doctors are now looking alternative places to practise their skills. "Many are looking at places like the US and Canada. Some may even return home as the European Union has opened up and there is an influx of doctors," she said.

Source





Green Hypocrites in Britain

Post below lifted from Blue Crab. See the original for links

On a number of occasions, I have pointed out that the elitists who are pushing the biggest "environmentalist" agendas like global warming have no intention of living with the limits they plan on imposing on the less-than-elite. The phrase I use for that is that they will "wave from the limousine" as they pass the shivering masses. I expect a rousing chorus of "told ya so."

Ministers are using a secret limousine service to ferry them around the country, a Mail on Sunday investigation has discovered. Senior Labour figures are quietly using 60,000 pound ($120,000) gas-guzzlers to whisk them around in comfort - despite claims that politicians have switched to smaller, cheaper models that are less damaging to the environment. Among the prominent politicians using the secret luxury car service is the Speaker Michael Martin and his wife Mary, who travel regularly in top-ofthe- range Mercedes and Jaguars.

This newspaper has established that a fleet of expensive cars operates discreetly from South London, away from the Westminster base of the official Government Car Service. Kelly Executive earns 500,000 pounds a year carrying out up to 50 journeys a day for politicians, including the Speaker, from its fleet of 30 chauffeur-driven limos. The Government also uses a number of similar private companies in other cities. Ministers and Labour MPs such as Mr Martin frequently use the firms to pick them up from the airport and take them home. Significantly, none of the limousines appears on the public list of cars in the official Government car pool, which handles the transport arrangements for Ministers and civil servants.

Last year the Government announced it had spent 900,000 pounds buying 110 hybrid-engined cars for the Government Car and Despatch Agency to cut down on carbon-dioxide emissions, to show voters that it was doing its bit to save the planet. However, it is an open secret that many Ministers do not like the Toyota Prius - of which 98 were bought. It has been nicknamed "the milk float" by Government drivers who say the car is slow and has a "tinny rattle". Ministers privately complain that they miss the comfort of the executive cars that the Prius replaced.

Kelly Executive has 20 S-class Mercedes, which emit up to 355g of CO2 per kilometre - well above the 226g level at which London Mayor Ken Livingstone has levied a new environment-driven congestion charge of 25 pounds a day.

The Speaker uses Kelly Executive in London, but when travelling to his constituency home in Glasgow he favours local company Little's Chauffeur Drive, which boasts of "utmost discretion and an impeccable chauffeuring service" used by "the world's most important people".

Yes, indeed. They will tout their carbon-neutrality while riding in the finest - and least eco-friendly - cars. No worries. They'll wave if you can see them through the blackout windows. Meanwhile, in other "eco-friendly" news, the Telegraph points out that "fair trade" coffee is anything but.

"Fairtrade purports to work within the market economy but its rise has been largely based on marketing subsidies and public-sector procurement," says Tom Clougherty, policy director of the Adam Smith Institute. Despite huge pressures on the public purse, local councils are squandering large sums becoming Fairtrade towns and cities, distributing posters and leaflets to nanny people into only buying Fairtrade. Meanwhile, the Fairtrade Foundation has received over 1.5m pounds from the Department for International Development. It wants more. In December, reminiscent of 1970s-style industrial policy, it called for 50m of development aid to be spent as "strategic investment" on Fairtrade.

Monday sees the start of Fairtrade Fortnight, the time each year when we are hectored into paying more for a cup of coffee. Charities, politicians and primary school teachers will deliver the scheme as an undisputed good. With all this effort, it is a pity Fairtrade does not work.

Fairtrade's supporters blame the plight of coffee farmers on world prices and ruthless multinational companies. But supporters ignore the real causes of poverty among growers. Farmers I interviewed in Kenya told me that the problems they face are not caused by global influences but their own government's interference. They are forced to use milling companies granted regional monopolies, who fleece them. They want to boost productivity by using fertiliser, but they cannot afford the inflated prices demanded by the government fertiliser monopoly. Imported tools and machinery would transform their output but are subject to punitive tariffs. Police roadblocks slow their goods and involve money exchanging hands.

On top of that, the growers selling to fair trade programs are also selling on the free market. The free market pays premium for high quality so the best beans are sent to the free market. The leftovers are sent to the "fair trade" market to garner the guaranteed higher-than-market value prices. It has never been easier - or more lucrative - to rape the planet.





We don't need to define Britishness



British national identity is becoming more and more like the weather: everybody talks about it but nobody can do anything about it. And come to think of it, it is especially like British weather: so tepid most of the time that it is difficult to describe.

This is not necessarily a problem: having a sense of your own country's character as a vague, largely invisible thing which hums away quietly in the background. Until, of course, the woolly, taken-for-granted conception is challenged by an internal threat which makes use of precisely that amorphous lack of definition to create malignant - potentially lethal - social divisions

And that is where we find ourselves. Last week's report from the Royal United Service Institute went so far as to say that Britain's lack of clear conviction over the value of its identity and political culture had left it a "soft target" for terrorism - which is not the same thing as being soft on terrorism, as some sections of the media concluded. The British security services are among the few national agencies not lacking a clear set of objectives. They are not soft on terrorism.

The real argument of the RUSI study was that Britain was leaving itself open to the recruitment of Islamist terrorists by its failure to instil a confident, graspable sense of what this nation believes and stands for, and of what exactly it means to belong here. In fact, the defence experts said - as have so many others that by now the statement has become almost platitudinous - that the philosophy of multiculturalism and the diversity which it has consciously encouraged have helped to fragment society.

So officially, everybody is pedalling furiously away from multiculturalism. Not only government ministers and opposition leaders but even figures such as Trevor Phillips of the Equality and Human Rights Commission have proclaimed the need to dismantle it. But somehow all of this opprobrium does not filter down to the classroom or to public sector agencies (such as the BBC, local government bureaucracies and the NHS), which are still explicitly committed to "diversity programmes" that positively encourage the continuing separateness of ethnic communities.

It would be easy to see this as simply an accident, a kind of absent-minded philosophy creep in which the original good intentions just got out of hand, as things so often do when they are administered by bureaucrats. So deeply entrenched - and so embedded in the employment practices of the public sector - was the idea of "tolerating differences" that nobody noticed for the longest time that it had slipped over into "encouraging differences".

If that were the case, this would be a relatively easy problem to solve: a few stern ministerial guidelines and departmental directives ("URGENT: the word 'diversity' to be replaced by 'unity' in all official policy pronouncements") could, over a period of a year or two, turn the situation round. But everybody recognises that it is not that simple. Which is to say that everybody knows that we have a far more profound dilemma: Britain does not have a unified, coherent, identifiable self-image, either as a people or as a political entity, which it can offer to incomers as an inspiration and a ready-made value system.

There is a reason why all the attempts to define Britishness seem to end in fatuity: not only because they dribble off into nebulous virtues such as tolerance and decency, which should be common to all civilised people, but because the British opinion-forming classes tend to find the whole concept of national identity either sinister or risible. And it is perfectly plausible to see this as a virtue: a strong, cohesive sense of national loyalty certainly can transmogrify into blood-and-soil nationalism of a horrifying kind, and the ironic distance which the British maintain from even their most important historical institutions has the unmistakeable ring of grown-up wit.

Even in my more sentimental American-expatriate moments, I can see why, to most British eyes, flag-waving US patriotism seems childlike and naive. In many respects, the American model is peculiarly unhelpful, even though it is the one to which Gordon Brown and now Jack Straw cleave as they desperately seek a way out of the crisis that their own party's policies have created. Mr Straw hinted only last week that perhaps the written constitution idea was the way out of our mess since it seemed to be so successful in the US at implanting what he called an "enviable notion of civic duty". Indeed it does. But that is there, and we are here.

Americans are unlike almost all other peoples of the world in that they all either are themselves, or are descended from, people who went to the country as an act of will (apart from those who were taken there against their will whose descendants, unsurprisingly, have had more difficulty in assimilating than almost all later migrant groups). This makes them ideal subjects for the great 18th-century Enlightenment experiment: a newly invented country with a carefully devised written constitution and a self-conscious assumption of an identity that was defined in deliberate rebellion against an old aristocratic order.

To settle in the US is, in effect, to sign the "social contract" that the founding fathers envisaged: accept the rules and the principles on which this country is established and you can belong here. That's the deal that is spelt out very clearly to every prospective citizen and, for the most part, it works. Older nations that chose to redefine themselves by overthrowing their history - such as France, where the revolution turned into the Terror - have had less happy results.

Britain is particularly ill-suited to adopting the apparatus of a revolutionary republic. You know what a Brown-Straw (not to say Cameron) written constitution would look like, don't you? A list of bland aspirations with a presumptuous and irritating "Bill of Rights" attached.

Britain's historical identity has been produced by accretion, subtle accommodation and fudge: to define it is impossible because it has had no consistent conscious intent. Which is fine, because we don't need to define ourselves, we just need to stop hating ourselves. [Or having self-hatred preached at us]

What is at the heart of the aggressive form of "multiculturalism", as most ordinary people suspect, is not tolerance but self-loathing: the deprecation of our own culture and history that elevates almost anybody else's values above our own. It is not the indoctrination of some mystical sense of Britishness that is required but a restoration of the quiet pride and conviction that used to enable Britons to maintain the highest standards of civil behaviour in the world.

Source