Tuesday, 28 February 2012

What case for change?

"I am a passionate supporter of our NHS, and that is why I understand the passionate debate it arouses. It is also why I resent those Opposition Members who seek to misrepresent the NHS, its current achievements and its future needs"

- Andrew Lansley, Wednesday 28 February 2012

"For example, if our cancer survival rates were at the European average, we know we would save 5,000 extra lives a year"

- Andrew Lansley, Wednesday 1 June 2011

"The cost of new medicines alone, for example, has been rising by nearly £600m a year"

- Andrew Lansley, Sunday 10 April 2011

Sooooo, my dual approach of tweeting and emailing has paid dividends. Well, to be more accurate the countless tweets have so far yielded nothing (thanks very much to those who re-tweeted, by the way), but a couple of emails to healthandsocialcarebill@dh.gsi.gov.uk resulted in a response after eight days (not too shabby at all).

Highlights of the response I received are below:

"Many thanks for your emails dated 20 and 27 February in which you asked to be provided with the sources for two lines from the Overview of the Bill factsheet, published on the Department of Health website
Saving 5,000 additional cancer patients’ lives each year by bringing England in line with the European average is based on the analysis of number of deaths that could have been avoided if England’s five-year survival rates matched the average European five-year survival rates
Further information about the study can be found on page 33 of Improving Outcomes: A Strategy for Cancer- First Annual Report 2011 on the Department's website at 

And yes, you guessed it, bottom of page 33 of that document says:

Abdel-Rahman et al, What if cancer survival in Britain were the same as in Europe: how many deaths are avoidable?, Br J Cancer. 2009 Dec 3; 101 Suppl 2:S115-24 www.ncbi.nlm.nih.gov/pubmed/19956155

I've since replied with the below:

"Thanks very much for your reply.
I'm incredibly interested as to why the 5,000 deaths figure is still being used, based on Abdul-Rahman et al's study, despite it being comprehensively discredited:
Please can you clarify whether you disagree with Dr Goldacre's analysis, and why it is deemed appropriate to continue using the figure a year on, as if it were an accurate, contemporary 'fact' (note the use of the phrase "we would save", rather than "a study based on data no later than the year 1999 estimated that")"

So far, so predictable. However, that was only one half of the response that I received. When I emailed on the 27th of February, I also requested the source for the claim that the cost of medicines is rising by over £600m per year. Here's that part of the response:

"The estimate of £600m is based on the average growth in total drugs expenditure over ten years. The table below shows the total NHS drugs expenditure from 2000-01 to 2009-10 and draws on information contained in the Department of Health Annual Accounts, Financial Returns, and Foundation Trust year-end accounts during that period. 


My reply concerning this was:

"And on the cost of medicines, please can you provide the relevant links to the information that forms the basis of that table. Apologies, but I can't find it in here:

Right, now for the interesting (ahem) bit... let's have a closer look at that table above.

Well, it covers the first 10 years of the 21st century. And it states that the cost of medicine in 2000/01 was £6,690m. Now, if as has been claimed by Factsheet A1 the cost of medicines is growing by over £600m per year, then the cost of medicines in 2009/10 must be at the very least more than £12,090m (£6,690m + 9 x £600m)... agreed? (embarrassingly I had that initially as 10 x £600m, but hopefully now have it right)

Hmmm, how strange. The bottom line of the table states that the cost of medicine in 2009/10 was £11,920m. That's more than £170m less than the absolute minimum figure necessary for the 'fact' to be correct.

So it's wrong. The 'fact' on Factsheet A1 is simply incorrect. Now, anyone who read my previous post on this (my wife, possibly rightly, thinks I'm getting obsessed, but there is a reason for my persistence... I'll get on to that at the end of this post) will know that not only does the £600m per year 'fact' get an airing on Factsheet A1 ('Overview of the Bill'), it also makes a repeat appearance on Factsheet A2 ('Case for change') in a slightly different guise. Such is the importance placed on this 'fact'!

Factsheet A2 states that the cost of medicine has been growing on average by nearly £600m a year. 'Nearly' is nice and vague... I might have to concede that 'nearly' in the context of the figures involved could cover a shortfall in excess of £170m.

But now I'm wondering why the last 10 years has been included, and why go for the average over that decade?

Let's have a look at that table again...

From 2001/02 to 2004/05 inclusive, the annual cost of medicine did rise by over £600m - the highest rise was in 2003/04, when medicines cost £916m more than in 2002/03. In 2005/06, there is what looks like an anomaly... possibly a data error, but also possibly down to an external factor? I don't know, and I await the raw data so I can dig into it, but according to the data supplied, the cost of medicine in 2005/06 was only £28m higher than the cost of medicine in 2004/05.

Now, here's the crucial bit. From 2006/07 to 2009/10 inclusive, the annual cost of medicine rose by less than £600m - the highest rise was in 2006/07 (the year after the likely data anomaly), when medicines cost £563m more than in 2005/06.

Furthermore, the percentage year on year increase in the cost of medicine is consistently lower in the most recent years.

And if you take 2004/05 as the starting point, rather than 2000/01, the average annual increase in the cost of medicine suddenly becomes £390m - bit of a difference from £600m, right? And the £390m is using the most recent five years of available data.

Now, to try and explain why I keep banging on and on about all this... it's because these are the 'facts' being repeatedly used to justify a monumental shake-up to the NHS. Of all the things that could have been chosen, these are what the Government view as the best possible justifications.

A study of cancer patients from the last century, which pre-dates the NHS Cancer Plan, isn't a compelling case for change. Nor is the rising cost of medicine, which is rising consistently lower in recent years than it was.

Please don't accept these 'facts' as justification for the Health and Social Care Bill. They're both incorrect and misleading.

If you want to learn about the performance of the NHS, take a look at this. Highlights include:

- Levels of public confidence and satisfaction in the NHS higher than any other country studied
- UK has one of the least expensive health systems among countries studied

And please don't be fooled into thinking that dismissing the Government's flimsy and erroneous case for change is akin to saying that the NHS is perfect and never needs to improve or adapt.

What worries me most is that if we're being misled about the reasons for the Health and Social Care Bill being introduced, what does that say about the actual content of the Bill and how it will be implemented? For me, it's like cowboy builders turning up at your house and telling you that your roof needs urgent repairs. If you get someone else to go up on your roof, see that the type of work they claimed needed doing so urgently is actually a con job, then how confident would you be in letting them go ahead and do the work? Do you think they'd do a good job?


Wordle: What case for change?

P.S. If I've stuffed up any of the medicine cost analysis, I do apologise, and would be more than happy to correct.

P.P.S. Quick final one for nostalgia's sake - anyone remember "Someone in this country is twice as likely to die from a heart attack as someone in France"? Compare and contrast that often quoted justification for changes to the NHS with this from the Information Centre today...

Heart attack patients: emergency admissions drop while death rate nearly halves in a decade:

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