Tuesday, March 21, 2006

The NHS Is A Wonderful Thing

I went to see my doctor this morning to discuss various diabetes-related matters. Regular readers of the blog will know that I have some disagreements with NHS priorities to start off with. If we're going to have tax-funded healthcare (a principle I agree with), then the money should be spent first and foremost helping those who stick to the laws of the land, and those who have health conditions that are not of their own making.

One of the things I have discussed with various healthcare professionals is getting an insulin pump (which gives a steady stream of insulin, and thus more accurately replicates the natural functions of the body). Opinion is divided over this - some think it helps diabetics greatly, others think the benefits are more marginal. My doctor this morning said they were good, but not as good as they could be if you could have a device that measured blood sugar automatically and adjusted on that basis. Nevertheless, two friends of mine are fortunate enough to have pumps, and say that it has enhanced their care of diabetes, and their quality of life, greatly.

I say fortunate enough, because the NHS does not provide funding for insulin pumps as a matter of course. In my home area, some consultants move heaven and earth to raise money for their patients to have pumps; others think it is not necessary. Today, I found out about the arrangements for Oxfordshire. Oxfordshire's NHS authorities will not fund any new pumps, but if patients move to the area and have pumps, then they will fund them.

I'm interested in the justification for this. Obviously one of the big fears about a switch to insulin pumps is the cost of such a treatment. That's fair enough, and if it is more costly, then questions do need to be asked about its efficiency. But why should that justify some diabetics in the county having considerably greater expenditure lavished on them than others? Similar arguments apply if the authorities believe that insulin pumps give a greater quality of care. Why should some Oxfordshire residents benefit from the fact they lived in a more enlightened area before moving to their new county?

If, on the other hand, the continuity in insulin pump treatment is decided on the basis of trying to cause less upheaval for the patient, then this is also questionable. Why should a more expensive treatment be given to a patient if it is considered to be less effective?

Of course, I'm not at all convinced that the treatment is that much more expensive than the current method of insulin "pens" used for regular (4 times a day) injections. I'm on disposable pens, and I know that three years ago they cost £6 a pop, or £30 for a box of five. A pen, on average, lasts me about five days, so over the course of a year (assuming it is the same cost), it will be about£440. But I use two types of insulin each day, so to get the true cost, you would need to double that. Add to that the cost of the needles I use, and you're getting near £1000. That, I have been told, is the rough cost of insulin used for an insulin pump. The only additional cost would come from buying the pump in the first place. Admittedly this would be expensive, but the drawbacks would almost certainly be outweighed by the benefits in care.

Nevertheless, I think this raises serious questions about the way that the Health Service operates. Yesterday I derided calls for elected police chiefs, but today I am going to call for a greater degree of accountability within the NHS. The standards of care across the country vary not just through different material circumstance, but through conscious local choice. Yet there is no accountable mechanism through which those decisions can effectively be monitored. I would not want health officials to be directly elected - but I would like to see regional assemblies created with the power to determine where health funding goes. Either that, or a national list of treatments that will be funded on the NHS, so the government of the day can be held to account over its administration. The question of allocating police resources depends upon crime hotspots and local knowledge. There is no local difference that explains why a diabetic in Oxfordshire should be denied treatment available to a diabetic elsewhere.