Thursday 24 November 2011

Cameron’s attack on ‘sicknote culture’ could spectacularly backfire

Speaking today to the Daily Mail about sickness benefits, David Cameron couldn’t have been more right when he said the “whole system is in a mess”. But his new proposals are likely to make things worse.

Cameron is keen to “press ahead” with stripping GPs of the ability to sign people off work for more than four weeks. After this period an independent assessor will be needed to verify if that person needs to be off sick. Considering this is the same Government that wants to give control of the majority of the NHS budget to GPs, its faith in local doctors seems surprisingly contradictory.  With the Government still embroiled in arguments with clinicians over its planned NHS reforms, the Government could find there is little appetite for these new proposals with either GPs or the electorate - indeed an Ipsos Mori survey in June this year showed that nearly nine in ten respondents trust their doctors to tell the truth.

What is clear is that, if implemented, these changes will add another expensive layer of bureaucracy onto a benefits system this is already struggling to cope.

Atos Healthcare is the independent assessor contracted by the Government to carry out the Working Capability Assessment (WCA) that the vast majority of applicants for Employment Support Allowance (ESA) must undergo. Frankly, the assessment isn’t working. 40% of decisions that people are ‘fit to work’ are overturned at the appeal stage, and these original decisions are very heavily based on the findings of the WCA. It is not solely ‘borderline’ cases that are eliciting appeals. In June evidence was submitted to a parliamentary select committee that highlighted the case of Mr C who died in the five months between his medical assessment, in which he was declared fit to work, and his appeal hearing. In February this year Scotland’s Evening Times reported the deaths from chronic illnesses of two men who were waiting for appeals to be heard against their recent loss of Incapacity Benefits. I could go on.

The Government already pays Atos £801 million over a ten year period yet, despite many ministerial promises of improvement, it’s clear that the Government has a long way to go until it gets to grips with how to assess how someone’s illness affects their ability to work. Until it manages to get WCA appeal rates under control, there is little point adding another hefty bill to the taxpayer’s purse to extend the number of ill people required to undergo independent assessments.

Cameron says that GPs “resent being asked to sign sicknotes” yet I can’t imagine any GP embracing a system that might tell patients to go back to work against their own doctors’ advice. And what will happen to those patients who are told they are fit to work when they aren’t? Will their pay be stopped while they appeal the decision? Will they face being sacked for ‘lying’ to their employer?

I can only presume that in these tough economic times, in which many people are struggling with the steep rise in the cost of living, Cameron believes that cracking down on “sickness fraud” will be a vote winner amongst the electorate. Yet that argument only holds when the wider public holds an ‘us’ and ‘them’ view – when we believe that it would never be ‘us’ who are presumed to be lying about being ill.

The Government is only getting away with the terrible mess surrounding the WCA, and the staggering £80 million cost to the taxpayer to manage the hefty appeals process, because it isn’t yet seen as a mainstream concern.  As soon as anyone who is off ill for more than 28 days is told to undergo similar tests - and the word spreads about what a hit and miss process it truly is - Cameron could face a massive backlash against his benefits policies. Most people want to work hard and show loyalty to their employer: in exchange they expect to be able to take time off to recover from unexpected illnesses, even if that recovery process takes longer than hoped. I can see few people accepting this greater state intrusion into their lives.

Wednesday 9 November 2011

Global crisis in antibiotic development is a threat to us all

I've just got in from speaking at the parliamentary launch of a new campaign called Antibiotic Action. It was a great morning with a strong attendance of doctors, pharmacists and MPs - including Andy Burnham, shadow health secretary.

The day was to raise awareness about the dire crisis in global antibiotic discovery and development. In 2009, the World Health Organisation announced that antibiotic resistance posed one of the three greatest threats to human health. Yet since then the chronic lack of development of new antibiotics has continued while the antibiotics currently on the market have become less effective.  Indeed by the end of 2012 as little as two new antibiotics are expected to have been created in the preceding four year period, compared to sixteen that were invented between 1983 and 1988. Even more worryingly today one attendee told me that the market for developing antibiotics in Europe is non-existent and very small in the US. Indeed the only country interested in developing these new drugs is China.

Despite the fact that the market for antibiotic investment has effectively collapsed it has so far remained a silent crisis, gaining little recognition amongst the wider public. This is despite the fact that the shortage of effective drugs is one of the causes behind the rise of hospital superbugs – an issue that has seen a slew of Government targets and patient campaign groups to try and eradicate the problem. While it is true that some hospital acquired infections such as MRSA do occur due to dirty wards, the rise of superbugs should act as a warning that bugs are, if you like, becoming cleverer, and that our discovery of antibiotics to treat such infections has not kept pace with such mutations.

The reoccurrence of TB, which at one stage was almost wiped out in the UK, and of a very resistant strain of gonorrhea show that we are dangerously short of new antibiotics in a world of increasingly drug-resistant illnesses. Indeed only last month the Health Protection Agency warned that the most common antibiotic used to treat gonorrhea is no longer effective at combatting the disease, raising the spectre of “the very real threat of untreatable gonorrhoea in the future.”

As someone with an incurable illness, Cystic Fibrosis, who is dependent on a raft of antibiotics to try and maintain my health for as long as possible, I can attest to the cost to society of a rise in untreatable afflictions. Aside from the heavy medical bill associated with treating an incurable illness over a prolonged period of time, the social implications are considerable. If in the future we prove unable to tackle life-threatening infections such as TB than we face a society in which more people will be forced out of the work place due to serious ill-health and increasingly pushed to the sidelines. We need just look at our obesity crisis, and subsequent spiralling diabetes costs, to understand the implications of allowing a health crisis to run out of control.

Today's parliamentary launch of Antibiotic Action called on the Government to form an all-party parliamentary select committee to examine this looming health crisis.  The campaign group has highlighted several underlying issues that need to be overcome to kick-start investment in new drug discovery.  A crucial concern is a lack of return on investment that antibiotics generate for pharmaceutical companies. This is partly due to the cost of clinical trials and the perception by purchasers, such as European Governments, that antibiotics should be low cost. Further, a focus on genome treatments, to cure genetic conditions such as mine, has meant a shift from funding new antibiotics, despite the fact that genome treatments have yet to come to fruition.

Antibiotic Action recognises that researchers, regulators and pharmaceutical companies must now work together to overcome these obstacles as, quite literally, the status quo cannot remain as it is. Unless new antibiotics are developed then the ones that are in current circulation will gradually become less effective as they are overused to treat bugs that have ‘evolved’ to become resistant to the treatment available.

Any further delay in addressing the burgeoning problem threatens the very foundation of 21st century health care that we all demand, as the use of antibiotics underpins the practice of modern medicine. Shocking as it may seem to a post-penicillin society which expects antibiotics to cure life-threatening infections, but without a new generation of antibiotics we face a future in which a patient, who might have survived radiotherapy, kidney transplants or heart surgery is at risk of dying from basic infections caught during after care.

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