The NHS today - can it meet everyone's health needs?

Desperately ill patients are being denied expensive drugs that could treat their conditions. Local NHS trusts claim they don't have the money and that treating one person with a drug costing thousands of pounds deprives many others of treatment. They also argue that other factors, such as an ageing population and the cost of new technology are putting strains on the NHS. These issues are being used to undermine the NHS, that is supposed to provide health care to all, free at the point of use. Jon Dale looks at the facts behind the headlines.

"The pressures on the NHS are mounting," says Henry de Zoete, of the right-wing think-tank Reform: "Not only from increasing medical costs such as cancer drugs but also an ageing population and the increasing importance of consumer choice.

"The NHS cannot afford to pay for all care for all patients now and certainly won't be able to in the future. The individual may have to play a greater role." (Daily Mail 14.5.07) He means patients paying towards their treatment.

The population is certainly ageing, as in the rest of Europe. The number of over-65s in the UK is expected to rise by 53% between 2001 and 2031 - to over 14 million, with little change in the younger population. So where there are now about three people of working age for each over-65, in 25 years time there will be two.

The NHS will face a big increase in the chronic diseases that affect older people. Coronary heart disease is predicted to rise by 44%, with hospital admissions rising by a third.

New drugs, new medical technology and treatments for previously untreatable conditions all lead to rapidly growing health costs. Does this mean that the NHS will ration treatment in the future, perhaps by a means test - those with less than a certain income or savings getting free treatment while others have to pay part - or all - of the costs?

This already happens for social care. Health secretary Alan Johnson's recent decision to allow co-payment for drugs is the thin end of this wedge. Co-payment means patients 'topping-up' their treatment by buying drugs not paid for by the NHS.

Government should pay

Any rising costs of providing the health treatment that people need, in full on the NHS, should be provided by the government. The money spent on wars and weapons, or on bailing out rich bankers, shows that the money could easily be found if the government's priorities were different.

But advances in medicine don't automatically lead to higher costs to society. In fact, they may save money through shorter hospital stays, for example after keyhole surgery with modern anaesthetics. They can enable a quicker return to work, as after the carbon fibre mesh repair of hernias, or allow independent living rather than needing care, for example following joint replacements.

If patients are forced to pay for drugs that the NHS won't provide, the gap in health and life expectancy will grow between those who can afford them and those who can't. Desperate people, of course, go to great lengths to raise money - cashing in pensions, insurance policies, and savings and even selling their homes. But many are unable to do any of these. And why should patients' families be reduced to poverty to pay for treatment? These assets can only be sold once. What happens if another family member becomes ill?

Private medical insurance (PMI) companies, like BUPA and AXA/PPP see their chance to make money in this situation. "For PMI providers, cancer can be an opportunity as well as a challenge. In an age of short waiting times and greater choice for NHS patients, cancer could provide an opportunity for PMI providers to differentiate themselves from the NHS and their competitors on an issue that the public really cares about." (Steve Bojakowski: Journal of Management and Marketing in Healthcare August 2007).

Cancer treatment will be just one more commodity to be traded on the health market, if big business has its way.

New drugs, especially for cancer, are often very expensive. Britain has one of the lowest uptakes of new cancer drugs of any advanced capitalist country. Five-year survival rates for cancer are also amongst the lowest.

The government set up the National Institute for Health and Clinical Excellence (NICE) to evaluate whether treatments are 'cost effective' and if the NHS should provide them. NICE has been heavily criticised by health charities and patient groups for rejecting new drugs, with good reason in cases where a drug would clearly be beneficial but is rejected on cost grounds.

But unfortunately some of these organisations receive funding from the same drug companies whose products they are campaigning for to be made available on the NHS. These companies want the NHS to buy their products, sometimes even before there is real evidence that they are better than existing treatments.

A new 'polypill' is being trialed, which combines in one tablet four long-established and cheap heart drugs no longer under patent. This "Red Heart" tablet could benefit millions of poor people around the world who can't afford existing treatment.

"The chances of mainstream pharmaceutical industry taking this on are slim," said Anthony Rodgers, the New Zealand leader of the project. "We spent a few years around 2000-2002 trying to persuade a number of companies to do this, but got nowhere. Basically, their whole business model is around people paying a few hundred pounds a year for the latest blockbuster drug. A pill with established medicines that halved cardiovascular risk and could be available for £20 a year could be seen as a threat." (Guardian 29.9.08)

Far from advancing the development of new treatments, as the pharmaceutical industry claims to do, it is holding back benefits to many that would cut its profits. The industry needs to be brought into public ownership, with no compensation to the multi-millionaires who have made so much from the NHS. Democratically controlled, its scientists and facilities would then be able to develop effective treatments costing far less.

Capitalism is making us sick!

So-called lifestyle illnesses, due to smoking, alcohol abuse and obesity, cause massive costs to society. These are mainly caused by an unequal society, where opportunities to live a healthy lifestyle are linked to wealth.

Increasing obesity will cause big health problems and demands on the NHS in the future, with more diabetes, heart problems and arthritis. Children need safe places to play outdoors and balanced diets. But schools sell off playing fields, councils close swimming pools, roads are full of traffic and parks aren't always safe.

There's much more profit from selling computer games than balls and skipping ropes - and from selling sugary, fatty snacks rather than fresh fruit and vegetables. Massive advertising and marketing is directed at young 'consumers' to make their families buy expensive unhealthy products, while public services are cut back.

A socialist society would ensure that everyone has the chance to lead a healthy and active lifestyle - not just those able to pay for one. Shorter working hours would give people time to prepare fresh food and enjoy exercise. Decent housing and public transport would do much to remove major causes of illness and injury.

Giving workers and their families control over every aspect of their lives would cut out the stresses of capitalist society, that contribute much to mental illness. Right-wing think-tanks, the Daily Mail and New Labour won't argue for any of this. Working class people need a party that will.

Technology to benefit patients

A telemedicine system developed at Queen Victoria Hospital (QVH), East Grinstead, in 1999 enables referring hospitals to electronically transmit images and clinical information in a secure manner.

Images from a digital camera installed at three local Accident and Emergency departments (A&E) are transmitted via email to QVH. A consultant can view transmitted images of potential referrals while in the operating theatre treating another patient. As a result the patient does not have to be transferred to QVH for an initial opinion and the surgeon does not need to leave theatre to provide it.

Such technology could remove an argument trusts often use when trying to close A&E departments - that a shortage of consultants means it is safer for patients to travel to a major centre rather than be seen closer to home. But such technology should only be introduced under the democratic control of health workers and representatives of the wider community, so that patients' interests are paramount.

Our profits come before your sight

The 'Campaign to get Avastin on the NHS' website, set up by a battling family from Halifax, links to a video of a 74-year old man losing his sight. His family clubbed together to pay for Avastin, a treatment he could not get on the NHS. His granddaughter quite rightly says that there is a growing gap between rich and poor and worries that by the time she is old, the NHS won't fund treatments she needs.

This video is on the 'Centre for Medicine in the Public Interest' website (http://www.cmpi.org), which attacks state-funded medicine around the world. Its co-founder, Peter Pitts, is senior vice president and director for global health affairs for Manning Selvage and Lee, an American public relations company. Among its major clients are drug companies including the Swiss giant, Roche.

Avastin would only cost the NHS £25 a dose to treat wet macular degeneration - the eye condition the Halifax man suffers from. But it is not licensed to treat this condition.

Avastin's manufacturer, Roche and its American partner Genentech, also make Lucentis. The drugs are equally effective. But Roche only applied to license Lucentis - which costs £1,000 a dose!

Roche made £3.5 billion profit in the first half of 2008. This isn't mentioned on the 'Centre for Medicine in the Public Interest' website.

Driving up the cost of medicines

The chairman of NICE, the drugs overseer, Professor Sir Michael Rawlins, has warned that pharmaceutical companies are driving up the price of vital new medicines in order to boost profits and protect executive bonuses. "We are told we are being mean all the time, but what nobody mentions is why the drugs are so expensive."

He said that one of the reasons is the need for companies to keep their share prices high. "Pharmaceutical companies have enjoyed double-digit growth year on year and they are out to sustain that, not least because their senior management's earnings are related to the share price.

"It's not in their interests to take less profit, personally as well as from the point of view of the business. All these perverse incentives drive the price up."

Professor Rawlins said that companies are also facing a drop in profits as some of their biggest earners go 'off patent', allowing rivals to produce cheaper versions. "And so part of the cost is cushioning against that," he said.

The companies also have to cover the cost of marketing new drugs, which could far outstrip the cost of actually developing them.

"Marketing costs generally are about twice the spend on research and development... many firms had taken a view that they would charge as much as they could get away with." (Independent 18.8.08)

The nationalisation of the pharmaceutical industry under democratic workers' control and management would ensure that no resources are wasted on 'marketing'. If the industry was democratically planned and run worldwide, the health and well being of the world's population could be massively improved, giving everyone efficient access to the best treatment.

The Socialist Party says:

End and reverse privatisation of the NHS.
Medical advice, treatment, investigations, management, administration, cleaning, catering and all other health services should not be run for profit.
For all NHS services and buildings to be under public ownership.
Rebuild the NHS as a publicly funded service free at the point of use.
Local health services should be run and planned by democratic committees that include representatives of NHS workers and the local community. The NHS should be run and planned nationally by health workers and a government that puts health before private profit.
Nationalise the pharmaceutical and medical supply industries under working-class control and management to end the massive subsidy these parasites drain from the NHS. Integrate these services into a democratically controlled NHS. Compensation to be paid only on the basis of proven need. Plan their resources to provide needed treatments.
A socialist programme to end poverty and inequality - the biggest killers and causes of ill-health.

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In The Socialist 14 January 2009:

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