Good news at the end of November from the ‘fourth session of the Conference of Parties signed up to the UN WHO Framework Convention on Tobacco Control, otherwise known as COP4 WHO FCTC’ (who names these meetings?): world governments have pledged to commit to smoking cessation education programmes, for which there is dire need. Every year, more people are killed by smoking-related illnesses than by HIV/AIDS, illegal drug use, alcohol use, motor vehicle injuries, suicides and murders combined1.The jargon from this convention in Paraguay shrouds something of a landmark change in efforts to combat one of the planet’s biggest health problems.
The most popular method employed to curb smoking rates has been legislation – in recent years, national governments have banned tobacco advertising and smoking in public places, and raised the legal age at which one may buy cigarettes, and smoke them. In Europe, the trend is particularly marked: health authorities in the UK have floated plain packaging as a solution; 2 and the Finnish parliament would like to outlaw all forms of tobacco consumption in an effort to drive down smoking rates.3
It’s easy to see why legislation is a favoured answer to a public health scourge such as smoking. Most obviously, legislation is cheaper than educational programmes and this sits well in ‘an age of austerity’. Furthermore, the short-termism of politics encourages policies with an immediate impact, which reflect positively on politicians in the media and public eye.
But prohibition has a long history of very public and embarrassing failures. There is no reason to suppose that a ban on cigarettes would be any more successful in cutting smoking rates than alcohol prohibition was in the US, or indeed, the UK’s ‘war on illegal drugs’ is today.4 Besides, the tobacco lobbying industry is so powerful that legislation is nearly always contested at great lengths and expense through the courts. In the long run, it appears that education programmes aimed at smoking cessation and prevention are more effective at reducing smoking rates.5 It is easier to nudge a sea-change with educational policies rather than legislation – it just requires more time and investment.
And the lessons for education-based public healthcare programmes can be seen in other fields. In time for World AIDS Day this month, the UNAIDS programme published the heartening news that the HIV/AIDS epidemic has been halted.6 The same could happen in the battle to push back tobacco use around the world – this agreement at the WHO Convention on Tobacco Control in Paraguay is a first step towards achieving this goal.
1 http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/effects_cig_smoking/
2 http://www.guardian.co.uk/society/2010/nov/20/cigarettes-plain-brown-packs
3 http://news.bbc.co.uk/1/hi/8459947.stm
4 http://www.guardian.co.uk/society/2010/nov/01/alcohol-more-harmful-than-heroin-crack
5 http://online.wsj.com/article/SB10001424052748703957804575602822217085074.html?mod=rss_Health
6 http://www.bbc.co.uk/news/health-11819901
Thursday, 9 December 2010
Monday, 19 July 2010
Reforming the NHS
Last week, health secretary Andrew Lansley unveiled his ‘radical’ new proposals for the NHS, outlining changes which many commentators have hailed as the most revolutionary since it’s inception in 1948.
The reforms aim to rid the health service from the tyranny of "unnecessary" bureaucracy by outlining a vision for an NHS led not by politicians, but by patients and healthcare professionals. The restructuring will see the dissolution of strategic health authorities and primary care trusts (which at present manage the majority of the NHS budget) with GPs across the country becoming responsible for managing a sizable £80bn NHS budget. Ministers hope that the new system will reduce bureaucracy and give doctors and patients more control over treatment, whilst also helping to reduce management costs by up to 45% (the NHS is tasked with making some £20bn savings by 2014).
At the heart of the reforms are GPs, which Lansley believes are better placed to make decisions than managers. Through the creation of some 500 GP consortia, the new plans will see GPs working together to select and commission the NHS services their patients need. Each local GP consortium will take charge of local hospital, mental health and community services (specialist services and dentistry excluded), whilst local authorities will take control of public health. The GP consortia will in turn be held accountable by the formation of an independent NHS board which will be responsible for setting standards across the country. Hospitals are to be moved outside of the NHS and are to be turned into freestanding ‘social enterprises’. The gradual phasing out of the 10 strategic health authorities and 150 primary care trusts will occur over the next 4 years as GPs begin to take control of their managerial responsibilities.
Patient empowerment is also at the core of the shake-up, with an aim to give them more involvement within the decisions that affect how and where they are treated. The freedom to choose is also provided, with the abolishment of GP boundaries, allowing patients to register with any doctor they want. A new body called Health Watch England is also to be set up to help ‘strengthen the voice of patients’ and to share information on the performance of local health services.
The inevitable impact on those working within NHS administrative roles is obvious; thousands of jobs will be lost. There are also concerns over whether GPs have the time or necessary skills to discharge their new responsibilities effectively. It is expected that GPs will have to outsource; commissioning support from private firms, which many believe would do little to reduce spending. It has also been announced that £1.7bn will be set aside for the reorganisation – more than seven times what it aims to save on management.
The public sector union Unison has warned that the proposals were “a recipe for more privatisation and less stability”. It is perhaps this concern of ‘denationalisation’ with the expansion of private firms’ involvement within the NHS which appears to have produced the greatest controversy. Opponents have already pointed towards the ‘conspiracy’ to privatise the NHS, predicting an environment of conflicting interests, where patient needs ultimately fall foul to profit margins.
Nonetheless, we are living in an economic environment which can no longer support the NHS as it stands. The British Medical Association’s response to the restructure, reflected positively in agreement, stating that ‘doctors are ideally placed to help determine the health needs of their local population’. These changes, whilst representing a significant gamble, do offer the potential for savings whilst maintaining a quality health service.
It is clear that the government now has two major hurdles to overcome as the new plans are rolled out over the coming years. Firstly, the restructuring must be carried out efficiently and in consultation with GPs so as to avoid any needless disruption to frontline services. Secondly, and perhaps more importantly, these reforms must bring about the improvements we have been promised they will provide. The future of our national health service now rests delicately in the hands of the coalition Government and it's health reforms. Fingers crossed.
The reforms aim to rid the health service from the tyranny of "unnecessary" bureaucracy by outlining a vision for an NHS led not by politicians, but by patients and healthcare professionals. The restructuring will see the dissolution of strategic health authorities and primary care trusts (which at present manage the majority of the NHS budget) with GPs across the country becoming responsible for managing a sizable £80bn NHS budget. Ministers hope that the new system will reduce bureaucracy and give doctors and patients more control over treatment, whilst also helping to reduce management costs by up to 45% (the NHS is tasked with making some £20bn savings by 2014).
At the heart of the reforms are GPs, which Lansley believes are better placed to make decisions than managers. Through the creation of some 500 GP consortia, the new plans will see GPs working together to select and commission the NHS services their patients need. Each local GP consortium will take charge of local hospital, mental health and community services (specialist services and dentistry excluded), whilst local authorities will take control of public health. The GP consortia will in turn be held accountable by the formation of an independent NHS board which will be responsible for setting standards across the country. Hospitals are to be moved outside of the NHS and are to be turned into freestanding ‘social enterprises’. The gradual phasing out of the 10 strategic health authorities and 150 primary care trusts will occur over the next 4 years as GPs begin to take control of their managerial responsibilities.
Patient empowerment is also at the core of the shake-up, with an aim to give them more involvement within the decisions that affect how and where they are treated. The freedom to choose is also provided, with the abolishment of GP boundaries, allowing patients to register with any doctor they want. A new body called Health Watch England is also to be set up to help ‘strengthen the voice of patients’ and to share information on the performance of local health services.
The inevitable impact on those working within NHS administrative roles is obvious; thousands of jobs will be lost. There are also concerns over whether GPs have the time or necessary skills to discharge their new responsibilities effectively. It is expected that GPs will have to outsource; commissioning support from private firms, which many believe would do little to reduce spending. It has also been announced that £1.7bn will be set aside for the reorganisation – more than seven times what it aims to save on management.
The public sector union Unison has warned that the proposals were “a recipe for more privatisation and less stability”. It is perhaps this concern of ‘denationalisation’ with the expansion of private firms’ involvement within the NHS which appears to have produced the greatest controversy. Opponents have already pointed towards the ‘conspiracy’ to privatise the NHS, predicting an environment of conflicting interests, where patient needs ultimately fall foul to profit margins.
Nonetheless, we are living in an economic environment which can no longer support the NHS as it stands. The British Medical Association’s response to the restructure, reflected positively in agreement, stating that ‘doctors are ideally placed to help determine the health needs of their local population’. These changes, whilst representing a significant gamble, do offer the potential for savings whilst maintaining a quality health service.
It is clear that the government now has two major hurdles to overcome as the new plans are rolled out over the coming years. Firstly, the restructuring must be carried out efficiently and in consultation with GPs so as to avoid any needless disruption to frontline services. Secondly, and perhaps more importantly, these reforms must bring about the improvements we have been promised they will provide. The future of our national health service now rests delicately in the hands of the coalition Government and it's health reforms. Fingers crossed.
Wednesday, 5 May 2010
Vote for Science
With only hours left now until voters head to the polls, how will the outcome of the election influence the UK’s scientific community?
The economic crisis has threatened many areas of government spending, and whoever wins the keys to number 10 is going to have to make unpopular decisions about where to cut government spending. But how will the science budget be affected, and what priority do the three main parties place on research funding as both a key to economic recovery, and as an academic necessity? A brief trawl through the three main parties’ manifestos reveals a little about what to expect from them regarding the future of science (and particularly science funding) in the UK.
All three of the main parties acknowledge the importance of investment in science as a tool to promote economic growth. Labour argues that during its tenure, investment in science and research has doubled in real terms, and that under a continued Labour government, science would remain a priority. A great deal of emphasis is placed on converting research into innovation; targeting science funding according to its applicability to business. Conservative science policy is similarly business-focused, featuring promises to create more high-tech jobs and joint university-business R&D institutes. The Liberal Democrats science policy diverges from the other two parties, with commitments to increase the number of scientists by “tackling the gender gap at all levels of scientific study”, and to open up public access to all state-funded research.
How useful is it to tie the value of science directly to business? Undoubtedly a healthy R&D environment can only aid economic growth, so perhaps in a recession is appropriate to channel research funds towards business relevant science. However, putting aside the observation that science seems to be the only academic pursuit that has to constantly justify its usefulness, narrowing scientific investment into just what is immediately applicable, may be somewhat short sighted. Often the impact of “blue skies research” will only emerge years later (see for example green fluorescent protein, originally a mere biological curio when discovered in the 1960s, now an indispensable, and Nobel Prize winning tool of molecular biology).
Neither Labour nor the Conservatives makes any mention of this issue directly in their manifestos; i.e. how would the science budget, whatever its eventual magnitude, be divided up between the business- and interest- driven research. A little indication was given in interviews with the Guardian newspaper, in which the Labour Business Minister Pat McFadden (note not the Science Minster Lord Drayson), said Labour would continue to support “curiosity driven research”. The Conservative Science and Innovation spokesman, Adam Afriyie, went somewhat further by stating his party’s intention to postpone the government’s Research Excellence Framework. This is a controversial system, whereby funding for universities is linked to research impact, so Conservative plans to review it could offer some defence for low impact disciplines. The Liberal Democrats, in stating in their Manifesto that research funding decisions would be “made on the basis of peer review not Whitehall interference”, go further still, indicating the party’s commitment to the independence of science from politics. This sentiment is echoed in a pledge to amend the Ministerial Code in order to prevent government from mistreating scientific advisors and protect academic freedoms. These changes would help to prevent repetition of the scandal that arose over the sacking of Professor David Nutt in October last year. The Liberal Democrats also support of scientists’ stances on issues such as libel reform and alternative medicines.
However when it comes down to the actual spending commitments to science, there is little difference between the three main parties. All have agreed to maintain the ring-fenced science budget, meaning that once money has been allocated to science, it cannot be reassigned to different areas. However, given the economic situation the UK faces, none are prepared to commit to an increase in science investment, and so whatever the outcome on Friday morning, the UK scientific community can expect some frugal times to come.
Useful links:
http://www.conservatives.com/Policy/Manifesto
http://www2.labour.org.uk/uploads/TheLabourPartyManifesto-2010.pdf
http://www.libdems.org.uk/our_manifesto.aspx
http://www.guardian.co.uk/science
The economic crisis has threatened many areas of government spending, and whoever wins the keys to number 10 is going to have to make unpopular decisions about where to cut government spending. But how will the science budget be affected, and what priority do the three main parties place on research funding as both a key to economic recovery, and as an academic necessity? A brief trawl through the three main parties’ manifestos reveals a little about what to expect from them regarding the future of science (and particularly science funding) in the UK.
All three of the main parties acknowledge the importance of investment in science as a tool to promote economic growth. Labour argues that during its tenure, investment in science and research has doubled in real terms, and that under a continued Labour government, science would remain a priority. A great deal of emphasis is placed on converting research into innovation; targeting science funding according to its applicability to business. Conservative science policy is similarly business-focused, featuring promises to create more high-tech jobs and joint university-business R&D institutes. The Liberal Democrats science policy diverges from the other two parties, with commitments to increase the number of scientists by “tackling the gender gap at all levels of scientific study”, and to open up public access to all state-funded research.
How useful is it to tie the value of science directly to business? Undoubtedly a healthy R&D environment can only aid economic growth, so perhaps in a recession is appropriate to channel research funds towards business relevant science. However, putting aside the observation that science seems to be the only academic pursuit that has to constantly justify its usefulness, narrowing scientific investment into just what is immediately applicable, may be somewhat short sighted. Often the impact of “blue skies research” will only emerge years later (see for example green fluorescent protein, originally a mere biological curio when discovered in the 1960s, now an indispensable, and Nobel Prize winning tool of molecular biology).
Neither Labour nor the Conservatives makes any mention of this issue directly in their manifestos; i.e. how would the science budget, whatever its eventual magnitude, be divided up between the business- and interest- driven research. A little indication was given in interviews with the Guardian newspaper, in which the Labour Business Minister Pat McFadden (note not the Science Minster Lord Drayson), said Labour would continue to support “curiosity driven research”. The Conservative Science and Innovation spokesman, Adam Afriyie, went somewhat further by stating his party’s intention to postpone the government’s Research Excellence Framework. This is a controversial system, whereby funding for universities is linked to research impact, so Conservative plans to review it could offer some defence for low impact disciplines. The Liberal Democrats, in stating in their Manifesto that research funding decisions would be “made on the basis of peer review not Whitehall interference”, go further still, indicating the party’s commitment to the independence of science from politics. This sentiment is echoed in a pledge to amend the Ministerial Code in order to prevent government from mistreating scientific advisors and protect academic freedoms. These changes would help to prevent repetition of the scandal that arose over the sacking of Professor David Nutt in October last year. The Liberal Democrats also support of scientists’ stances on issues such as libel reform and alternative medicines.
However when it comes down to the actual spending commitments to science, there is little difference between the three main parties. All have agreed to maintain the ring-fenced science budget, meaning that once money has been allocated to science, it cannot be reassigned to different areas. However, given the economic situation the UK faces, none are prepared to commit to an increase in science investment, and so whatever the outcome on Friday morning, the UK scientific community can expect some frugal times to come.
Useful links:
http://www.conservatives.com/Policy/Manifesto
http://www2.labour.org.uk/uploads/TheLabourPartyManifesto-2010.pdf
http://www.libdems.org.uk/our_manifesto.aspx
http://www.guardian.co.uk/science
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