I’ll be at the Sandhurst Family Fitness ‘Funday’ in the Memorial Park tomorrow afternoon at 1.45pm. The Funday has been successfully running for a few years. It is organised and run by a commitee of local representatives from the Sandhurst GP practices, Sandhurst Town Council and local health and fitness businesses. Come along and get fit in the sun!

Today, the Bracknell constituency witnessed its first political hustings of the 2010 General Election. The mental health charity Rethink invited the Parliamentary candidates to Coopers Hill this lunchtime to take questions from local people. The future provision of local mental health services was obviously of great interest to those who had arranged the meeting, however, other important issues, such as the importance of honour and probity in politics, featured prominently. It was a good opportunity for all candidates present to explain their respective party’s positions on a number of key issues. I, for one, will take any opportunity in the forthcoming campaign to engage ‘face-to-face’ with the electorate of Bracknell constituency.

Today, I had the opportunity to visit Broadmoor High-Security Hospital in Crowthorne (aerial photograph above). As part of a Conservative Party delegation that was led by Shadow Secretary for Justice, Dominic Grieve MP, I was able to get a very good insight into the valuable work undertaken by the hospital. Unfortunately, the national perception of the psychiatric establishment is far from the reality. People are sent to Broadmoor to receive healthcare not punishment. Often a patient has already served a sentence in a ‘normal’ prison and then has been passed on to Broadmoor for treatment. Hopefully in the future, the hospital’s good work in the treatment of mentally-unwell individuals who have committed horrific crimes will become more appreciated.

Every part of England has different healthcare needs. The demographics of each region can vary significantly, both in ethnicity and age. Any doctor will tell you that different social groups need different types of healthcare provision. Experience tells us that there is no ‘one size fits all’ system that will work for a country as diverse as England. Being a GP locum who works in both affluent and socially-deprived areas, I know too well that local clinical priorities need to reflect these differences. And this is the rub for the old Labour party. For those Socialists who aspire to deliver an ideologically-driven, uniform healthcare service are missing a key point: that it does not allow for human behaviour. With increasing local control over healthcare services becoming the political mantra, there will come regional differences in the provision of care. Local people will want local health services to suit them, not a set of centrally-imposed, national guidelines. In semi-rural communities, such as those served by the new Hexham hospital (pictured above), an older population will want a greater emphasis placed upon rehabilitation and elderly medicine. In contrast, an urban centre such as Slough, where I often work, would demand a proportionately greater spend on drug and alcohol addiction and those conditions more associated with the relatively large ethnic minority populations. So, yes there will be differences in healthcare provision throughout England. Detractors will call it a ‘postcode lottery’. Supporters, such as myself, will argue that until local people take ownership of their own individual health and play an active role in determining the health services offered locally, the health of the nation as a whole will not improve. For I believe that taking responsibility on every level is the key to good health. I already accept that if I am selected as a Parliamentary candidate, one of my many responsibilities would be to campaign hard to deliver and protect those healthcare services most needed by the community I represented. My impression is that it will not be long before we are all referring to our LHS (Local Health Service) not the NHS.

There is an irony in a fat government advocating more government to help fat people be less fat. In the same way that I believe that less government is often good government, I also believe that more personal responsibility and less state responsibility will lead to less fat people. There are undeniably many components to why someone becomes fat, however, one of them is personal choice. I have philosophical problems with the state telling an individual that he has made a ‘poor’ choice in becoming fat. If that individual has made an informed choice to eat more than he needs, and let us all admit that most people who are obese have done just that, then that person should be allowed to make that choice without fear of castigation by the state. He should, however, in making that choice, be made to pay for his decision. For being obese has profound cost implications for the state. Not only are there increased costs in health, there also long-term expenditure implications for the social security budget. Nor should we forget the implications for the individual and any of his dependents.

If I was in government I would look at the increasing obesity epidemic and ask myself what could the state do to increase personal responsibility. Levying a fat tax on food has been suggested, maybe even an additional supplementary tax based upon BMI (body mass index) could be pursued. These policies might go some way to reducing a future of obesity for our children. For the present, however, a decision must be made to invest in treatments that work.

The aetiology of obesity can often be complex. The provision of medication to aid weight loss (and in extreme cases surgery) should always go hand-in-hand with a proven commitment on behalf of the individual seeking treatment. Furthermore, many psychological factors are known to contribute to an individual’s excessive weight problem, so the involvement of properly-funded psychiatric services should be part of any programme to reduce obesity. The ultimate solution to the problem rests, however, with each obese individual. No government of whatever hue can change that reality. It may be tough politics, but dealing with obesity is a tough problem that will involve tough and unpopular decisions.

What did I do that was so evil that I’m trapped in this awful place….?

– Joseph Nixon

The disgraceful account of Joseph Nixon’s last few days stay in Maidstone Hospital has highlighted the on-going problems within the NHS. The 87 year-old Dunkirk veteran and former Coldstream Guard had contracted a Clostridium difficile infection during his hospital stay and died recently. Jackie Nixon, his daughter, reported that she “ended up having to change (his) bed for him the whole time because otherwise he would be left lying in his own soiled sheets for three to four hours at a time…”. His case vividly illustrates that the standard of delivery of healthcare in this country is far from acceptable.

Clostridium difficile (C Diff) is undeniably a difficult infection to treat. The bacterial infection does not harm otherwise healthy people, however, problems occur when very poorly patients on hospital wards are treated with antibiotics. C Diff can then overwhelm other ‘competitor’ bacteria in the gut leading to profuse diarrhoea, and in worse case scenarios, death through intestinal perforation and septicaemia. Not surprisingly, the elderly are most at risk, with over 80% of reported cases being found in people over the age of 65. Although a challenge to treat, simple procedures such as washing hands between cases and isolation of the patient can help to prevent the infection spreading around the hospital ward. And here is the crux of the problem. To prevent such spread a hospital would ideally have access to isolation wards, the capacity to provide individual nursing and a fully-staffed infectious control clinical team. All of that costs money, and lots of it.

Since 2002, public spending on healthcare in this country has doubled. On Tuesday, the Chancellor announced that NHS funding by 2010 will be £110 billion per year, i.e. the NHS will be spending £3500 per second. I suspect that the ‘average person in the street’ would think that a doubling of expenditure to that level would lead to a better service. By better, I would expect they mean shorter waiting times for GP and hospital appointments, better working conditions for staff and, above all, a cleaner and friendlier hospital environment to be treated in. Unfortunately, the tragic reports today provide further evidence to suggest otherwise. The scandal surrounding Maidstone Hospital has dispelled any claim that the large increase in funds provided by the British public has been well-spent by this increasingly discredited government.

This Labour administration’s obsession with top-down targets and their mistaken belief that the problems within the NHS were simply due to underfunding ,have been shown to have been disgracefully naive judgements. Decisions, such as the on-going, appalling overspend on the Patient Records Project (PRP), have led to financial shortages for front-line staff. The PRP is the most expensive IT project in the world, and I, and many of my medical colleagues, fail to see how the estimated £15 billion pounds budget (latest est. and rising) can ever be good value for money, particularly in a system so starved of funds on the front-line. Why choose to spend so much money on an IT project not deemed a priority by the medical profession? What of the £500 million (and rising) spent on management consultancy fees? What about the unfairness of spending more money per head on health in Scotland than in England? Why are there now more managers in the NHS than medical staff? Why did the Labour government spend all of our money before reforming the system? However, the key question for the Prime Minister from any tax-payer would be the following – If Mr Nixon, a distinguished war veteran, can be so badly treated, where has all the money gone Mr Brown?

Too many questions and yet not enough answers. This government is so bereft of the insight and ability required to manage such an important public service that getting answers will be next to impossible. The Conservative Party has a moral duty to continue to oppose this useless administration, so that the NHS can be properly reformed. By doing so, it will go some way to preventing the tragic case of Mr Nixon being repeated in the future.

On Tuesday afternoon I spoke in the Conference Hall about how Conservatives would care for drug addicts and thereby reduce crime. I said the following:

GOOD AFTERNOON LADIES AND GENTLEMEN.

ONE OF THE MANY REASONS I JOINED THE CONSERVATIVE PARTY IN 1992 WAS BECAUSE I BELIEVED THAT GOOD GOVERNMENT SHOULD BE ABOUT HELPING INDIVIDUALS WHO SEEK TO HELP THEMSELVES. SHORTLY AFTER DAVID CAMERON BECAME OUR LEADER, HE ANNOUNCED HIS INTENTION TO INCREASE THE NUMBER OF PLACES FOR DRUG ADDICTION TREATMENT. HE WAS RIGHT TO DO SO. ADDICTION AFFECTS MANY FAMILIES, BE IT ADDICTIONS TO DRINK, DRUGS OR GAMBLING.

I AM A DOCTOR WORKING WITH DRUG ADDICTS AND HENCE HAVE SEEN FIRST-HAND THE TRAGIC CONSEQUENCES OF DRUG ADDICTION. IT WAS WHILST CARING FOR THESE SOCIALLY-DISADVANTAGED PEOPLE THAT I CAME ACROSS THIS DOCUMENT. THIS IS A LIST OF “TEST ON ARREST” OFFENCES, FROM THEFT AND BURGLARY THROUGH TO FRAUD. IF SOMEONE COMMITS ONE OF THESE CRIMES HE/SHE IS AUTOMATICALLY GIVEN A DRUGS TEST. MORE IMPORTANTLY FOR THE OFFENDER, HOWEVER, IT LEADS TO ADDICTION TREATMENT WITHIN 48 HOURS. IF, HOWEVER, A DRUG ADDICT HONESTLY AND INDEPENDENTLY SEEKS TREATMENT FOR THEIR PROBLEM, THEY HAVE TO WAIT 2 WEEKS. SO, WHAT DO YOU THINK HAPPENS? CRIMES ARE COMMITTED TO QUALIFY FOR IMMEDIATE TREATMENT.

WHEN THE CONSERVATIVE PARTY GETS INTO POWER NEXT MONTH, IT SHOULD REMOVE THIS INCENTIVE TO COMMIT CRIME AND PROMISE TO PROVIDE MORE DRUG TREATMENT PLACES. BY DOING SO, IT WOULD REDUCE CRIME AND IMPROVE THE LOT OF SOME OF THE MOST VULNERABLE IN OUR SOCIETY. IN SHORT, IT WOULD BE A POLICY THAT IS TOUGH ON CRIME AND COMPASSIONATE ABOUT THOSE WHO ARE TRAPPED IN THE VICIOUS SPIRAL OF DRUG ADDICTION. IT WOULD BE AN EXAMPLE OF PROPER SOCIAL JUSTICE IN ACTION.

Overall, survival for all cancers combined in the UK as a whole is not only below the national average, it is also noticeably similar to some eastern European countries that spend less than one third of the UK’s per capita healthcare budget

– The Lancet Oncology Journal

In 1979, the Conservative Party came to power to cure the ‘sick man of Europe’. The unchecked powers of the Unions, most ably assisted by the Socialist Labour Party, had ravaged the British economy. Britain was sick and decrepit. Malaise, inflexibility and economic low self-esteem were widely reported. It took the Conservatives to administer the medicine, a not always pleasant experience for some, but as history has shown us all, a necessary economic tonic for Britain as a whole.

Yesterday, evidence was presented that confirmed that Britain is once more the sick man of Europe (see table above). Despite record increases in NHS expenditure since Labour came to power, British cancer mortality rates still rank amongst the lowest in Europe. The Lancet Oncology Journal claimed, on the basis of their figures, that the government’s cancer plan introduced in 2000 in England (2001 in Scotland) was not working. Cancer charities have since cited the absence of proper radiotherapy services as a major cause of poor survival rates. Tellingly, the report called for a “fundamental assessment of the ways in which the NHS operates”.

So, in summary, despite record investment, much legislation, the employment of more doctors and nurses, the reorganisation of primary care administration (three times), the introduction of private funding via the PFI initiatives (often leading to budget overspend), the appointment of a ‘Cancer Tsar’ and the contracting of a vast array of management consultants at large cost, this ten year-old Labour government has failed to put Britain on a par with the health of the rest of Europe. What a total disgrace. Furthermore, at a time when they have failed our cancer patients, they have embarked upon a hospital closure campaign that will adversely affect healthcare services. And yet, they still continue to tax us more and more.

Once more it would appear that it falls to the Conservative Party to administer the necessary medicine. It will not be an easy task. Confronting the entrenched interests that blight the NHS, dealing with the learned helplessness of the medical staff, eradicating poor clinical practice, emphasising services that are evidence-based as opposed to those “that we have always provided”, removing unnecessary management, localising decision-making, and most importantly, diminishing the power of the Department of Health, are goals that will not be easily achieved. We must, however, be determined to do so. For if we are successful, Britain will be bequeathed a health service that is fit for a First World nation in the 21st century.

The decision by NICE last year to deny the English and Welsh access to Velcade, a drug clinically proven to extend the lives of those with myeloma was yet another example of how the devolution set in play by the Labour government has lead to blatant unfairness in the provision of healthcare in Britain. Whether NICE feels Velcade is worthy of being provided on the NHS or not is not my point. If we believe in a nationalised healthcare service, ‘free’ at the point of delivery to all Britons irrespective of their means, how can we tolerate any regional discrepancies in its provision?

What I think is particularly galling for the English is the fact that more money is spent per head on healthcare in Scotland despite more tax being collected ‘South of the Border’. This has been the case for many years since the introduction of the so-called Barnett formula. The 2005 figures for annual health expenditure per head were as follows (source: NAO) –

England £1,350 per head
Scotland £1,563 per head

So, when Gordon Brown talks about increased spending to match European levels take note; we have had a NHS system in Scotland funded at European levels for many years. It would, therefore, be interesting to know what its ‘output’ has been? How healthy are our Scottish neighbours?

Today, the government has revealed that Scotland has the highest rates of cancer in the UK. According to the Office for National Statistics, there were 446 new cases of cancer per 100,000 males and 379 per 100,000 females north of the border between 2002 and 2004. In contrast, England had 394 and 338 cases respectively. Furthermore, Scotland also had the highest overall death rate for cancer in the UK. And let’s not get on to the Scottish incidence of ischaemic heart disease, smoking rates and intravenous drug use, for that would be truly depressing.

Sadly, these worrying results are despite NHS Scotland achieving the following:

• 75 doctors for every 100,000 people (compared to 55 in England)
• twice as many hospital beds as found in England
• an average GP list size of 1,400 (compared to 1,840 in England)

These figures, in the light of the health outcomes mentioned above, clearly indicate that increased spending within an unreformed health system does not improve the public’s health. For if improved health outcomes were that easy to achieve, the Scots’ would be shouting over Hadrian’s Wall about their outstanding health record. They’re not. Ill health is primarily caused by an individual’s social circumstances: diet, housing, prevalence of smoking, marital breakdown, the preponderance of illicit drug use (to name but a few). Hence, increasing spending on hospitals, as Scottish politicians have been particularly apt to call for, will not make much impact upon the incidence of the chronic diseases that bedevil the Scottish people.

The changes needed in Scotland to improve health are more profound. Firstly, there needs to be a shift away from the state towards the individual: one’s health should primarily be one’s responsibility. Secondly, government money should be concentrated on improving housing and public health provision, not on high-profile new hospitals. And finally, Scotland should start voting Tory again, for that will be the only way that the first two changes will ever be implemented.

It is a welcome change to hear common sense emanating from the British Medical Association (BMA). I should declare that I cancelled my BMA membership shortly after qualifying as a doctor. To my mind at the time, the organisation had rountinely failed to do what it should, i.e. stand up for doctors’ best interests. Not only that, their regular pronouncements on the state of the NHS appeared wedded to the original, out-dated, Socialist ideal. More importantly, by being both left wing and a poor advocate for the medical profession, I believed that the BMA was not serving patients’ best interests.

Recently, with the MTAS debacle, there has been more evidence of their ineffectual performance. It took doctors themselves to whip up support for resistance to the government’s imposition of the disastrous system before the BMA came belatedly on side. So today, I was very surprised to read that the BMA, having vocally supported doctors’ militancy, have now advocated a policy on NHS provision in this country that I can honestly support. To date, the BMA and its numerous committees, had a left wing ‘air’. Not anymore. For they have announced that they would support a slimming down of services offered under the NHS, i.e. rationing of care. For the BMA to be advocating such a radical move illustrates how acute the problems are in the NHS.

Britain has an ageing population and an increasing appetite for medical intervention. We all expect more from our health service than did our grandparents. That stoical generation are now few in number, and have been replaced by people who want and expect more. Ask any doctor about patient demands and you will get the same response: “increasing greatly”. The likely consequence of this justifiable expectation is a rationing of services provided by the NHS. In effect, it will become an acute service combined with specialist treatment of ‘major’ conditions.

The trouble with this conclusion are the political ramifications. Try being an MP in a constituency where only ‘necessary’ services are being provided by the local hospitals. Not many votes to be had there I suspect! And that is the problem. It is easy for the BMA to call for a slimming down of the NHS healthcare provision for their leaders are not elected on the basis of NHS performance. Unfortunately, politicians of all persuasions still are affected by health issues. Until healthcare provision in this country is depoliticised (by, say, creating the independent health board that the BMA suggests), the changes necessary to maintain an acute health service that benefits all in this country will not be made. The NHS needs tough medicine to cure its ills. If it does not take it soon, I fear its life expectancy will shorten.