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Archive - Month: February 2011

February 17, 2011

Medicine Balls, Private Eye Issue 1282
Filed under: Private Eye — Tags: , , — Dr. Phil @ 12:12 am

Warts and All (Again, again)

Health secretary Andrew Lansley has famously promised ‘no decision about you without you’ and a strong focus on preventing sexually transmitted infections. As the Department of Health reviews its secretive and sexually unhealthy choice of cervical cancer vaccine, is he brave enough to go public about preventing genital warts?

The Eye has long campaigned for an NHS Human Papilloma Virus vaccine programme with Gardasil to protect women against both cervical cancer and genital warts (Eye 23.3.2007). Labour dithered for 18 months and then chose Cervarix, which protects against cancer only (Eye 16.7.2008). The UK has an excellent cervical screening programme that already prevents 80% of cancers, so although the uptake of the vaccine has been very good, there will be little benefit in terms of lives saved for some years yet. The benefit in preventing genital warts – which are very common, cause untold misery and are fiddly and expensive to treat – would have been much quicker, as other countries have found.

In Australia, 70% of women under 28 have been vaccinated with Gardasil. New cases of genital warts among young women started falling after 6 months and now, 3 years into the programme, they have fallen by nearly 75%1. Even cases among (unvaccinated) heterosexual men fell by one third, due to herd immunity. In contrast, since England’s school-based HPV vaccine programme began in 2008, there has been no significant change in numbers of genital warts with some 91,000 new cases diagnosed each year and a further 70,000 cases undergoing repeat treatments. The highest rates of diagnoses are among women aged 16-19 and men aged 20-24. If you doubt the unpleasantness of warts, these photos will set you straight2. Doctors are now facing the anger of women whose sex lives are destroyed because Labour chose the wrong vaccine.

It costs the NHS £31 million a year to treat genital warts, and preventing most of them would free up time for staff to prevent and treat HIV and other infections. In addition, Gardasil prevents 30% of minor smear abnormalities and a rarer but often fatal condition called recurrent respiratory papillomatosis, where babies develop florid warts on the vocal chords and in the throat. Those who survive face multiple and extremely unpleasant treatments, costing the NHS £4million annually. The downside of Gardasil is that its manufacturers, Sanofi Pasteur MSD, have stuck to a price of £240 for the three-shot course, whereas Glaxo SmithKline, makers of Cervarix, undercut their list price substantially in a secret contract with the Department of Health.

This contract is now up for renewal and the government must decide whether to pay more up front for broader protection, knowing that the money will be recouped much more quickly than by sticking to Cervarix. Or it could try to negotiate a lower price with Sanofi Pasteur MSD. Lansley must involve the public in the decision, publish details of the Cervarix deal and at least allow people to pay a top up for Gardasil. 5% of all cancers are caused by Human Papilloma Viruses (cervix, vagina, anus, penis, head and neck) and both vaccines should be available as cheaply as possible within the NHS to all women and men who might benefit, without incurring the extra costs of using a private clinic.

At present we have a two-tier schoolgirl vaccine programme. The well-off and well informed are paying for Gardasil, and everyone else gets Cervarix. A recent study by the British Association for Sexual Health and HIV found that over 90% of sexual health clinicians recommend Gardasil and 61% have paid for their own daughters to be vaccinated with it privately. MD did likewise, but it makes the day job harder. Many doctors are supporting the NHS vaccination programme for their patients whilst secretly taking their daughters out of it and giving them another vaccine. If Lansley is to be a credible Secretary of State for Public Health, he must offer all patients the same protection against disease as the daughters of doctors.


1. Fairley et al Rapid decline in presentations for genital warts after the implementation of a national quadrivalent human papillomavirus vaccination program for young women. 2010 Australasian Sexual Health Congress, Sydney 18-20 October 2010.


February 4, 2011

Medicine Balls, Private Eye Issue 1281
Filed under: Private Eye — Dr. Phil @ 9:47 am

The Health Bill Balls

David Cameron described the Health and Social Care Bill, published on January 19, as a ‘once in a lifetime change’ of the NHS. This is the third ‘once in a lifetime change’ we’ve had in twelve years: Tony Blair and Labour health minister Lord Darzi made the same claim for their reforms. So either we’ve been lied to, or life expectancy is set to fall to four years. The Bill weighs in at 367 pages, even bigger than the 1948 Bill that created the NHS, and it’s an unbelievably tedious read. But there are some surprising changes from the July White Paper.

In the White Paper, it appeared GPs were taking over the NHS with 75 mentions. In the Bill, they get just 2. That’s still 2 more than consultant or nurse, but the consortia they were originally in charge of get 623 citations. Consortia will be controlling most of the NHS budget but now –thanks to the lobbying of large private health companies – the accountable officer doesn’t have to be a doctor. Indeed, consortia aren’t obliged to have a board or any patient representation. But they will be tightly regulated by the NHS Commissioning Board, which can set standards for their creation, direct them, have them taken over, fire their accountable officer and abolish them altogether.1It’s as if GPs are being set up to fail so corporate healthcare can step in.

Pathfinder consortia have set the trend by giving themselves ridiculously corporate names. Fortis Group, The Red House, Bexley Clinical Cabinet, Cumbria Senate. None of these sound remotely NHS. They’re not yet statutory bodies so it’s hard to find out what goes on in their meetings or where the money goes. Some are succeeding in improving care by cooperating with hospital and social care to join up services for patients. But you can integrate care without massive reorganisation, as Scotland has proved. The success of its collaborative approach in improving outcomes and reducing inequalities stems largely from avoiding major structural upheavals over the last 25 years.
The NHS has never succeeded in making the 4% efficiency savings it now needs to hit the £20 billion 5 year target, so it’s hard to see how consortia can succeed in the short term. They will take over explicit rationing of healthcare from NICE and PCTs, and patients are supposed to lobby GPs directly if they don’t like it. And if consortia fail to balance the books, as many surely will, the Commissioning Board can hand them over to UnitedHealth, CareUK or Kaiser.

Foundation hospitals have far more independence than consortia, but are in an equally parlous financial state. Many new buildings look fantastic but typically have a £17-£20 million annual PFI debt to service. Consortia can now go to ‘any willing provider’ prepared to undercut NHS hospitals so many will struggle for business. As compensation, the Bill allows them to do as much private work as they like. Great news for the balance sheet, but not for NHS patients or staff who disagree with a two tier system. And as waiting times rise, as they inevitably do when money is tight, the demand for private treatment rises and compounds the NHS wait.

Labour’s attack on this is weakened by its own clumsy attempts to introduce an NHS market. Private companies were paid above the going rate to cherry pick easier operations, and the money was guaranteed no matter how few patients they treated. Labour too dabbled with the idea of out-sourcing commissioning to large private companies. The Health Bill is far more an extension of the Blair reforms than a retraction. As for patients, Lansley pledge of ‘nothing about me without me’ is looking thin. Like PCTs before them, most patients won’t have the faintest idea what goes on in a consortium. But they will notice money drying up and service cuts. And when they try to complain to Dr Clark, he’ll be down the Red House, up the Fortis Group or in the Senate.

MD 1 Health Service Journal, Essential Guide to the Health Bill, January 21

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