Thursday 20 February 2014

Treasury intervention at Papworth prioritizes debt over saving lives‏

As a recent double-lung transplant patient I was shocked to read that Papworth hospital is under threat of closure from the Treasury.  As the UK’s largest cardiothoracic hospital, it is one of only seven hospitals in the UK that performs heart and/or lung transplants, and, with the exception of Harefield (where I had my surgery), has almost double the number of patients in after-care then its nearest rival.

Yet this hospital’s vital and successful role in the UK’s delivery of transplants, amongst other essential services, is now at risk. The Government is demanding yet another review about moving Papworth services in part or in entirety to Peterborough City hospital, to help bail out the latter from its crippling debts. This comes despite the fact Peterborough’s debts are entirely unconnected to Papworth, which is one of the NHS’s strongest financial performers.

Transplants are incredibly complex procedures that need highly experienced clinical teams and specialized equipment for the surgery, and before and after care. It isn’t an exaggeration to say that the excellence behind these established teams is keeping people alive for longer.

Katherine Graham, who received a heart and lung transplant at Papworth last September, said: “I have seen at first hand the amazing work and dedication of staff and have received first class care at all times.” This personal experience is reflected in the hospital’s Friends and Family test score of 85%, the highest in East Anglia.

Yet Graham believes that a move to Peterborough “would result in diluting our care and the expertise that has already been achieved at Papworth and would jeopardize our futures.”  She’s right to be concerned. In addition to being debt-laden, in its most recent Care Quality Commission (CQC)  inspection Peterborough hospital failed to meet two essential standards, including providing appropriate care for its patients.

Back in July 2010, when the Government published its white paper on its intended radical NHS reforms, the foreword, signed by Cameron, Clegg and then-health minister, Lansley, said:
“Patients will be at the heart of everything we do. So they will have more choice and control, helped by easy access to the information they need about the best GPs and hospitals. Patients will be in charge of making decisions about their care.”

Controversially patient choice was intended to create a market in healthcare in which hospitals with excellent standards of care would thrive as more patients chose to attend them, while those who gave poorer care would be left to close if they couldn’t attract more patients by improving their services, and therefore gaining increased funding.

There are huge problems with designing healthcare provisions on this model, not least the fact that the poorest or most ill patients have less capability to travel far for treatment, but the Treasury’s intervention over Papworth undermines the reforms’ positive focus on patient experience as it is perversely penalizing one hospital for being successful and rewarding the other for failure.

Yet it is evocative of the future direction the Government is taking with hospital restructuring. Still brooding after appeal court judges ruled it acted illegally in cutting A&E and maternity services at London’s Lewisham hospital, the Government is pushing a critical amendment to the Health care bill through parliament. It would allow administrators to force changes upon financially viable hospitals which neighbour failing hospitals, without the need to consult patients or doctors.

It is a fallacy to say that patients will have any real influence over NHS spending when services at their local or chosen hospitals can be closed without clinical justification, or, in many cases, when closure would actual harm outstanding care. The drive for improved health standards that patient choice was meant to champion cannot succeed if hospitals which provide excellent care are seconded to those that have the highest debts.

I am incredibly grateful to the NHS and the team at Harefield who helped give me back my life through a transplant. I would be devastated if my friends’ chances of getting the same life-changing opportunity at Papworth are jeopardised by this Government’s chaotic and unfair attitude to hospital reorganization which prioritizes reducing debt over saving lives.

Tuesday 11 February 2014

Will new Government occupational health assessments result in benefit disqualification?

This week the Government announced the creation of a new Health and Work service. Once set-up, anyone off sick for more than four weeks will be offered a work-focused occupational health assessment to help them get back to work more quickly.

It is unclear at the moment how this will play out in practice. The service is intended to be non-compulsory, but so was the DWP's Universal job match service. However as of March last year, the Government announced that Jobseeker Allowance claimants could be mandated to use the service or risk losing their benefits. It isn't inconceivable either that an employer will coerce an employee to take part in an assessment with the implicit threat that failure to do so would be seen as proof that they aren't as ill as they say they are. With legal aid for work disputes now cut, an ill person may feel obliged to go through an assessment for fear of being sacked without financial recourse to appeal.

But my concern is that anyone who willingly agrees to a Health and Service review may well find the results come back to bite them. Someone sick for more than four weeks may well have applied, or be about to apply, for Employment and Support Allowance. This is paid out at the same rate as Job Seeker's Allowance, and is only increased to the higher amount after a person has been claiming for more than three months and once further information has been given to the DWP.

As it stands, in June last year the DWP introduced new rules as to who is eligible for ESA. These include harsh rules for disqualification for misconduct which state that the benefit can be withdrawn for up to six weeks if the claimant:

"fail without good cause to attend for or submit to medical or other treatment (excluding vaccination, inoculation or major surgery) recommended by a doctor with whom, or a hospital or similar institution with which, the claimant is undergoing medical treatment, which would be likely to remove the limitation on the claimant’s capability for work."

If a claimant has willingly attended an occupational review and has not implemented its suggestions because they do not agree with them, then it is conceivable that this refusal may well harm the person's right to access higher-rate ESA. And given the Government's track record with hiring companies like Atos who don't appear to understand the real nature of disability, it is conceivable that a person rejects the advice purely on the grounds that it conflicts with that given by their own GP or the self-knowledge they have built up over the years of managing a long-term condition.

Remember, 40% of people with long-term incurable illnesses have been told by Atos after an assessment that they are expected to recover.

It is also easily conceivable that a business will use the assessment, whether it is accurate or not, to claim that the person is well enough to return to work immediately, and if they do not do so will be at risk of being fired.

These are my early concerns and will hopefully not come to fruition. But as always with policies imposed upon disabled people rather than created through discussion with them, it will be disabled people who will have to bear the pain of this new policy if it does turn out to be another 'tool' to push people off benefits or back into work before they are well enough.

Monday 27 January 2014

Are patients less deserving of good care if they don't make a fuss?

Last week Professor David Haslam, the head of the National Institute of Health and Care Excellence (NICE), the body that governs which drugs to license for NHS use, said UK patients should become more 'American'. The idea being that we are too easily pushed around by our doctors and instead we should see ourselves as "equal partners" with our doctors and demand access to drugs we are entitled to.

Haslam's belief that we should monitor what drugs doctors make available to us, could make individual patients scapegoats when duty-bound professional bodies are buckling under the pressure to provide equal care.

Having the confidence to challenge authority, researching the drugs available to you and understanding your medical condition are all abilities that are largely determined by the way we were bought up, the education we have had and the social support network we have around us. Not everyone can afford the internet, not everyone feels confident to challenge people that are more knowledgeable than them and not everyone has other people they can turn to for help when trying to understand their medical condition.

There is also the irony, that those who are healthier could receive better care than those at their sickest, as sometimes patients are just too ill to be demanding and need to be completely reliant on their doctors to steer them through their illness. In this scenario, without a family member that can afford to take time off work to act as the patient's advocate, he or she may well find their care drops as they cannot cope with the responsibility thrust upon them by bodies such as NICE.

I'll always champion people taking control of their own health, because in the long-run I believe it helps improve both quality and quantity of life, but the NHS is a wonderful institution because it strives to provide equal care regardless of its patients' life experiences. As soon as it starts expecting patients to self-police the way our doctors treat us then we are heading down the road of widening health inequalities, where those who are weakest or have poorer access to support, resources and education will be sidelined in favour of patients who have learnt how to demand better care.

Haslam has said: “I think it is essential for the future of the health service and for the future health of the nation that patients understand their conditions, their treatments and work with their health advisors so they can have the best care." Behind this statement seems to be the threat, that in the not too distant future, patients who don't try hard enough to understand their medical condition will only have themselves to blame if their care isn't of the best standard.

NICE is currently carrying out work to find out why some patients cannot access drugs that it has endorsed. Haslam would do better concentrating on discovering the causes behind the post-code lottery for drugs, then trying to push for a future in which a patient must be made the scapegoat for a politician's failure to get to grips with providing standardised NHS funding and levels of care.