Public Health: UK gov forced to guarantee cancer care

Several months ago, the UK's Labour Government set in motion a move from medical care to "talking therapies." There was also talk of "social care" - leaving the sick at home instead of in professional units

Recently, some nursing homes providing care for the elderly and chronically sick, many of whom need constant care and a strict drugs regimen, have been told that their contracts with local authorities will not be renewed and no new patients sent for care: all, they say, will have to be looked after by relatives and visiting medical staff.

This is the brave new world of public health as seen by the present socialist government in the UK.

This month, it has announced a consultation on the creation of a "personal health budget" which - it claims - will increase choice and reduce waiting lists which are at an embarrassing level 12 years after the Labour party came to power promising reform and (literally) singing "Things can only get better."

But those personal budgets will be paltry compared to the real cost of treatment: cancer drug

The government says that the plan is to provide free care for the elderly: but the care that is being implemented, even now, is hardly care at all for those who need constant care.

"Andy" (Labour politicians often have chummy names) Burnham says that research money for cancer and dementia will be "ring fenced." But other research is fair game for drastic cuts to provide the funding for the measures envisaged by The Social Care Bill. He has told The Times that he can find GBP60 million from the R&D budget in the Department of Health and a further BP50 million from public health promotions.

Spending on promotions, however, is speeding up in the run-up to elections in May (at the latest) next year. Incredibly, the government - which on any reading of the figures is broke - has just announced a whole series of promotional events at the taxpayers' expense: there's a "get dancing" tour to promote ballroom dancing, a marketing agency has been appointed to send out SMS messages about something so impressive it's already forgotten, a national (England only - Labour doesn't control the Scottish purse so it can't use public money to promote itself) poster campaign about C)2 emissions - and on, and on, and on...

There have been multiple media releases from the Department of Health about its various consultations and campaigns, all suggesting that the savings will happen after the election.

Burnham also, reportedly, says that he can reduce spending on management consultants by GBP60 million each year - management consultants have, over the past 12 years, suggested one major reform of the NHS after another - and the end result has been more expense and longer waiting lists, fewer medical staff on duty and broken hospital equipment unused because the hospitals can't afford to repair it.

And he intends to find another GBP20 million from a "productivity drive" - forgetting that the NHS is already creaking because the imposition of EU working hours legislation has dramatically cut the hours medics are allowed to work (many admit to lying about their hours so as to give proper care) and that his own government has recently - in another of its myriad press releases - said that it intends to require agency staff to be granted the same employment terms as permanent, directly engaged, staff: this will lead to greater costs and therefore fewer agency staff being engaged. That's not going to help efficiency.

The government estimates that 280,000 elderly and disabled "high need" patients will get free personal care at home. A further 130,000 will get other help, for example property alterations or equipment, so they can stay at home longer.

"We can categorically state that cancer and dementia funding will not be affected," an NHS statement said this morning in response to a media blitz by, particularly, cancer groups in the past 24 hours.

An Audit Commission report published last week said that community care (including General Practitioner) costs rose by 4% last year whereas hospital costs rose by 7%.

The Audit Commission, generally regarded as non-partisan, produced a report that was remarkably coincidental with the Government's time and message requirements: "The national figures for 2008/09 suggest that there was no shift from hospitals to care closer to home in the community, either in terms of investment or activity. These trends seem to be continuing into 2009/10, with inpatient and day-case activity continuing to grow at the same rate, largely fuelled by less complex cases." But the comment is not quite as pro-government as it first appears.

Nursing homes are part of the system for shift from hospitals to "care closer to home." For local authorities to decide not to use that part of the system is not what the Audit Commission had in mind.

Burnham and his team hope to push the Bill through before the election.

It needs careful consideration and thought: there are some serious structural questions to be examined, and those should not be done in a hurry.

So what about Scotland? As a semi-autonomous region of the UK, it implemented free care at home for the elderly in 2002. Scotland has a small population - even so, its 2002 cost has almost doubled since implementation. Now it's GB257 million and rising. They blame the increase on two factors: more people are staying at home, particularly if they would have to pay their own fees in a nursing home; and more people staying at home are suffering from more complex conditions and requiring more care than was thought.

The result is that local authorities are seeing significant annual rises in costs, sometimes as much as 4% year on year.