3rd July 2015

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Lord Darzi
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Health Chat 15th July - King's Fund - London

 Details here.

Unintended consequences
News and Comment from Roy Lilley

Sometimes you just can't do right for doing wrong. The immutable laws of unintended consequences will throw a whizz-bang and spoil the party.


Reappointing Jeremy Hunt, aka LaLite, was very unusual. I can't ever remember a SoS for health being reappointed, spanning a general election. Having two goes at the job. In political terms he's played a blinder. Faced with the chaos of Andrew (Remember him) Lansley's misbegotten 'reforms' LaLite steadied the ship, quietly bunged 800m+ in through the back door and impressed the front line with person visits..


He couldn't admit to a catastrophe and having moved on from his silly speech about the NHS coasting, has tried to behave like the reforms haven't happened and seems to have a genuine interest in the service and its outcomes.


Tarzan's 5YFV was a gift from the gods; whether it works, or not. Will we end up hearing the cash, from the savings, rattling in the tin?  It's a bit of a stretch and the only show in town. Never mind. LaLite can look busy.


Looking busy is about all he can do. There is no money, no appetite for structural change, no Parliamentary time for new laws. Tarzan is in charge. 


LaLite is reduced to the role of Tinker-Man. He can poke his head under the bonnet of his classic 1948 NHS Tourer, polish the carburettors and fiddle with the washer bottle.  That's about it.


His latest tinker is to publish the price of prescription drugs over 20 on the packet so we'll know how much the NHS is spending to fix us up. Whatever next? An invoice for all our treatment, stamped 'paid in full by the taxpayer'... perhaps.


Transparency in drug-costs might have the effect of patients of a certain age not wanting to have 'all that money' spent on them. It might make us a bit more compliant and take our drugs properly. Or....


Well it might have a totally unintended consequence.


Let's start (with the help of the fabulous HSCIC) with a few little factoids...

  • Just under 2,000 prescriptions are dispensed every minute. About a billion a year. Two thirds more than a decade ago. We have 18 a year each. The cost? It's holding steady; 8.5 billion in 2012, which is similar to the total net cost in 2009. Generic prescribing has helped.
  • Prescriptions, dispensed without charge for pensioners, people in receipt of benefits, -16yrs, pregnant and certain long term conditions means 9 out of ten prescriptions are 'free'.
  • Prescriptions to treat diabetes accounted for the biggest net cost by treatment area for the sixth year running; 767.9 million.  A 2.2 per cent rise on 2011. In total, 42.2 million items were dispensed for diabetes, a 2.2 million item increase on 2011.
  • Efforts to reduce antibiotic prescribing appear to have floundered. They are up; by 6%. Oh, and 80m goes on paracetamol.

A prescription costs 8.20. Now, here's the interesting bit... why is it only the price over 20 will be published?  Why not everything?


Well, if we look at, say, Simvastatin; the average cost per tablet is 4p and the average number of tablets 36. If the Tinker-Man publishes the cost of that we might wonder why we've paid 8.20 for it and want some money back! Similarly, a course of a popular, generic antibiotic might be as cheap as chips and certainly nowhere near eight quid.  


Just over 70% of all prescriptions are dispensed generically and the ingredient costs are likely to fall well short of eight quid. Some people may well find a private prescription is cheaper.


Link to that the increasing number of app' and online subscription services, such Babylon, Lloyds and DoctorCareAnywhere, to giving private, easy-access to GPs and a big chunk of the NHS starts to look very flaky.


Why mess about trying to get an appointment with your local GP?  Do it immediately, on-line.  Why pay 8.20 for a prescription worth 3 when you can have a cheaper, private one, delivered to your desk?  It wouldn't work for everyone but there is a big chunk of the Waitrose and John Lewis market that will seize it.


Unintended consequences?


Have a good weekend.



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