In Their Own Words: The NHS Rebuttal to the Associated Press (AP)

Update (8.14.2009 – 12:45am Pacific Time):I just received an email from a press officer with the Department of Health Media Centre who has informed me that their “press notice distribution system doesn’t allow us to just send notices and statements on specific issues. And we really do only respond to media queries. We have a public inquiry line if you need regular updates.” Instead, their current focus on dealing with the American press is through The Foreign Office “working with the Embassy in Washington to contact foreign media.” This is a very unfortunate development as the furor being expressed over the NHS comments has largely been driven by social media sites like Twitter and blogs. If you find this post useful then I’d ask you to leave a comment so I can try to email them again in the hopes of getting a policy change enacted. – Hisham

I’m a big fan of the idea behind the National Health Service in the United Kingdom. To this end I’ve been very shocked by the mischaracterizations and half-truths being spread in the United States media by conservatives against Obama’s health care reform push. While reading an Associated Press (AP) article titled “UK health system hits back at US critics” on Google’s news portal, I came across this passage:

The criticism, widely covered in the U.K. media, has clearly stung Britain’s left-leaning Labour government. The Department of Health took the unusual step of contacting The Associated Press and e-mailing it a three-page rebuttal to what it said were misconceptions about the NHS being bandied about in the U.S. media — each one followed with the words: “Not true.”

At the top of the list was the idea that a patient in his late 70s would not be treated for a brain tumor because he was too old — a transparent reference to Grassley’s comments about Kennedy.

And what of Republicans’ claim that British patients are robbed of their medical choices? False again, the department said.

“Everyone who is cared for by the NHS in England has formal rights to make choices about the service that they receive,” it said in its rebuttal.

Then followed a fact sheet comparing selected statistics such as health spending per capita, infant mortality, life expectancy, and more. Each one showed England outperforming its trans-Atlantic counterpart.

The British government offers health care for free at the point of need, a service pioneered by Labour in 1948. In the six decades since, its promise of universal medical care, from cradle to grave, is taken for granted by Britons to such an extent that politicians — even fiscal conservatives — are loath to attack it.

The Associated Press article was copied on nearly every major newspaper website online but there was no link to the NHS email. Not linking to a cited document is troubling because reading the source is far more important than relying on someone’s interpretation of it. With that in mind, I started calling the contacts and friends I made when I did part of my core clinical rotations in a NHS hospital located in the UK before returning to the US to graduate from medical school. I was eventually directed to the UK Department of Health Newsdesk. They were surprised to hear an American actually supported the NHS and were more than happy to send me a copy of the rebuttal emailed to the Associated Press (AP). I’ve republished it unaltered in its entirety below so people can come to their own conclusions. If you’re short on time then skip down to the “Questions & Answers” section.

– Begin NHS E-Mail –

Andy Burnham, Health Secretary said:

“I am exceptionally proud that Britain has a world class National Health Service which treats people on the basis of clinical need – irrespective of their ability to pay. The global groundswell we have seen on Twitter about this and the pride and strength of feeling in some of the posts is testament to its remarkable achievements.

“The NHS delivers fast, high quality and safe care to over 1 million people every 36 hours, waiting times are at record lows, patient satisfaction is at an all time high we have more doctors and nurses than ever before.

“Healthcare should not be a luxury that some cannot afford. We have recently enshrined the core values of the NHS in the new NHS Constitution which will ensure that future generations continue to benefit from the NHS.”

A Department of Health spokesperson said:

“Much of the information currently circulating about the NHS is untrue. The NHS in England provides health services on the basis of clinical need – irrespective of age or ability to pay. The NHS Constitution enshrines these patients’ rights and places a duty on the NHS to promote equality through the services it provides.

“Whether to prescribe drugs or recommend a type of treatment or surgery is, quite rightly, a clinical decision taken on a case by case basis and together with a patient and their family based on all of the available evidence.

“The NHS sees one million people every 36 hours and 93 percent of patients rate their care as good or excellent. In recent years patients have benefited from record levels of investment and more lives have been saved through better prevention and treatment – waiting lists are at their lowest ever levels, there has been a 44 percent reduction in the mortality rate from cardiovascular disease and 50,000 more lives have been saved through better cancer services.”

BACKGROUND

Commonwealth Fund report in 2008 shows that for the past three years that the UK has been one of the highest performing health services for the past three years, particularly on quality, managing chronic illnesses and primary care access.

http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2007/May/Mirror–Mirror-on-the-Wall–An-International-Update-on-the-Comparative-Performance-of-American-Healt.aspx

Key points Care Quality Commission patient survey (13 May 2009)

- 93 per cent of patients rate their overall care as good or excellent.

- A significant improvement in the experience of patients relating to infection control

- An increase in the number of patients who claimed that they were ‘always’ treated with respect and dignity during their hospital stay.

QUESTIONS & ANSWERS

Q1) The stricken senator Ted Kennedy, at the age of 77, would not be treated for his brain tumour if he was in Britain because he is too old—Charles Grassley, Republican senator from Iowa.

In England, health services provided by the NHS are delivered on the basis of clinical need, not age or ability to pay.

There is no ban on anyone of any age receiving any treatment. Treating people fairly and appropriately, and taking account of their individuality is more likely to improve access to the NHS, improve service outcomes, provide a better experience for patients, and improve value for money.

The NHS Constitution states that the NHS provides a comprehensive service, available to all irrespective of gender, race, disability, age, sexual orientation, religion or belief. It has a duty to each and every individual that it serves and must respect their human rights. At the same time, it has a wider social duty to promote equality through the services it provides.

The requirements set in the constitution will be reinforced by the Equalities Bill, which is currently being considered in the British Parliament. Under this legislation age discrimination in the provision of services or performance of a public function will be made illegal. This will apply to publicly and privately funded health and social care.

Of course, whether to prescribe drugs or recommend surgery is rightly a clinician decision, one taken on a case by case basis in discussion with the patient and their families on the basis of all of the available evidence.

Q2) In England, anyone over 59 years of age can’t receive heart repairs, stents or bypass because it is not covered as being too expensive and not needed—an anonymously authored, but widely circulated, email, largely sent to older voters.

The Department of Health can confirm that this statement is not true. Access to treatment should be offered on the basis of clinical need.

You may be interested to know that a national audit report on cardiac surgery, which has just been published shows that, in the United Kingdom, 20% of all cardiac surgery patients are over 75 years old.

Q3) The British healthcare system is infamous for denying state-of-the-art drugs to cancer patients—National Center for Policy Analysis.

Where new drugs – whether for cancer or for other conditions – are found to be clinically and cost effective by the National Institute for Health and Clinical Excellence (NICE), the NHS is required to provide funding for them.

The NHS Constitution sets out the right of patients to have access to NICE-approved drugs where their doctor agrees that is clinically appropriate. NICE recommends the great majority of the cancer drugs (and drugs for other conditions) that it appraises for use in at least some patients. NICE adds real value by identifying the groups of patients who will gain most benefit from a particular treatment.

In recent years the NHS has seen record levels of investment which will reach £110 billion by 2011. Any publicly funded healthcare system has to make difficult decisions about what treatments are available so that patient benefit is maximised. We are working with NICE to make sure that new drugs are appraised as soon as possible after they receive a license, so that there is rapid and authoritative national advice on their use.

So each treatment is assessed fairly, NICE looks at the benefit of these treatments and at the cost of getting this benefit in the long-term. This is not about affordability in the short-term. It is about whether the claims of pharmaceutical companies are backed by the evidence and a careful judgement about what represents both value for taxpayers’ money and the best deal for NHS patients.

NICE’s guidance is based on a thorough assessment of the available evidence and is developed through wide consultation with stakeholders. NICE is seen as a world leader in the development of guidance on the clinical and cost effectiveness of new and existing technologies and its technology appraisal and clinical guidelines methods have been commended by the World Health Organisation.

4) In Britain, 40% of cancer patients are never able to see an oncologist; there is explicit rationing for services such as kidney dialysis, open heart surgery and care for the terminally ill – Conservatives for Patients’ Rights

Cancer

“NHS waiting times are now at their lowest level since record began, with a median wait of: 7.7 weeks from referral to admitted patient treatment across all clinical areas; 4.2 weeks from referral to non-admitted patient treatment across all clinical areas (ie not referred on for in-patient treatment).

“In May 2009 the average wait for a diagnostic test had fallen from 6.1 weeks to 1.9 weeks.

“In 2008-9 overall, 98.1% of patients were seen. diagnosed and treated within four hours of their arrival at A&E, up from 97.9% in 2007-8.”

Heart

There is no explicit rationing of open-heart surgery in England.

During the time since the publication of the National Service Framework for Coronary Heart Disease in 2000, there has been significant investment in facilities, equipment and staff to improve cardiac care and this has enabled a substantial increase in access to cardiac treatment. A recent study showed:

- For heat valve surgery, there has been a 47% increase in numbers in England between 2000 and 2006. (44% for UK)

- For coronary artery bypass grafts (CABG), there has been a reduction but this is because of significant increases over the same period in the less invasive technique known as percutaneous coronary intervention (PCI) where there has been 149% increase. (same % increase for UK).

- Overall the increase in numbers of cases of revascularisation techniques ( CABG and PCI) for 2000 to 2006 is 71% for England ( 70% for UK). (Revascularisation describes the process of restoring blood flow to narrowed or blocked coronary arteries, which occurs in coronary heart disease).

Recently published audit results for cardiac surgery for 2003 to 2008 for the UK showed that:

- The proportion of older patients over 75 and 80 receiving a CABG has continued to increase (20% of all cardiac surgery is on patients over 75)

- Surgeons are performing a CABG on progressively higher risk patients year on year but mortality rates continue to decrease.

Kidney dialysis

Rationing of kidney dialysis services is not acceptable in the UK. Specialised Commissioning Groups (SCGs) are responsible for ensuring that sufficient and high quality renal replacement therapy is available for the residents of each Strategic Health Authority area. The Department of Health is working with SCGs to help them to increase dialysis capacity in line with demand.

Following the publication of the renal National Service Framework, the Department of Health allocated additional capital investment for renal services totalling £60m over the period 2000-01 to 2005-06. This three-year settlement provided primary care trusts (PCTs) with the initial incentive to kick-start local reforms, which would improve their dialysis services in order to meet the local needs of their populations.

Patient choice

Patient choice is at the heart of Government policy. Since April 2009, patients have had the right to choose which hospital they are referred to their GP if they need to see a hospital specialist. They can choose from any hospital offering a clinically appropriate service that meets NHS standards and costs.

– End NHS E-Mail –

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August 13, 2009 | Filed Under Medicine 

Comments

7 Responses to “In Their Own Words: The NHS Rebuttal to the Associated Press (AP)”

  1. JK Robinson on August 13th, 2009 9:34 am

    Thank you Hisham. Like you, I was frustrated when I could find the AP article everywhere (including the China Daily), but not the information giving rise to its writing. Of course, this is the endemic (nay pathetic) status of “journalism” today. We don’t seem capable of cogent debate on any serious issues in part because (1) we have individuals who distort truth for their own purposes, (2) multitudes who accept distortions as truth without critical analysis, and (3) media content with reporting distortions as “news” without further investigation, fact checking or thought. The first condition, I suppose, will always be with us. Unfortunately, there is probably no hope as to resolving condition number two so long as our mainstream media are content with superficial, tabaloid reporting.

  2. Jim on August 13th, 2009 2:03 pm

    Thank you so much for publishing this information! I was really disturbed myself that I couldn’t find the source material ANYWHERE on the internet. What was even scarier was how dozens and dozens of pages had just picked up the AP version of the story. No original reporting whatsoever!

  3. Anonymous on August 13th, 2009 7:24 pm

    I’ve been looking for the original text everywhere and, thanks to you, I now have it. By promulgating the truth, we can push back against the falsehoods spread by media demagogues, proliferated by an obsequious media machine, and accepted blindly by those who refuse to face reality and think critically. I’m going to share this e-mail with my friends. Thanks again for this post!

  4. lak1 on August 14th, 2009 4:51 am

    The doctors and nurses(and other healthcare workers) in the NHS are our greatest resource. NHS has many benefits apart from employing me for past 25 years. However Sennator Kennedy would not be treated in the UK as the treatments he had are not available in the UK and someone of 77 would not be flown to US for it. Although children with brain tumours are sometimes flown to US for treatment.
    We do not have the same outcomes as other western nations as we do not have easy access to technology. We do not scan as swiftly diagonsis is made later, we do not have modern facilities- a modern proton beam centre let alone one per million of population,we do not have the same access to modern drugs and methods. Why because Brits do not question their care, and blindly suppot NHS, while managers spend money counting empty beds and find new ways of describing patients rather than as waiting for treatment. While 16 y olds hand out free Tamiflu to any one who telephones and says they feel unwell with fever. It is correct to question our NHS it could be better if money was spent better.

  5. Fort Worth, TX on August 14th, 2009 5:50 am

    Thank you for getting this article out – I’ve been looking for it everywhere! I’ll be sending this link to all my friends and family, no matter what side of the debate they’re on.

  6. Hisham on August 18th, 2009 3:55 am

    I recieved this comment by a gentleman by the name of Burt via Facebook. My apologies for the technical difficulties with the anti-spam measures.

    —

    Thank you for publishing this full letter from NHS. We recently received a query on our Forum at Angioplasty.Org from a patient concerned about an article claiming that no one over 59 in England could get a stent, and that Obama\’s plan was going to copy that. Your blog provided us with a quick and definitive rebuttal to that argument!! It was also the only place I could find this information. Thank you again (we linked to your blog).

    FYI, The topic in question is at http://www.ptca.org/forumtopics/topic_health_care_reform.html

  7. Philip on August 19th, 2009 2:46 am

    May I also add my thanks for providing this article.

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