UKC

Almost missed this story as its mainly stuck behind firewalls. Its so crazy you couldn't make it up. The government recently suggested a policy of costing medical decisions that took into account the 'worth' of the patient to society. Human rights who needs em?

NICE, quite rightly, told them where to stick this.

In reply to Offwidth:

With the poor Hating Eton toffs in charge that doesnt surprise me in the slightest. First Steal their Welfare and cut them From further and higher education, create food bank Britain. Let them Flood, next withdraw their Healthcare. They would go for Flat out Eugenics if they Thought they could get away with it.

In reply to Offwidth:

Good grief.

Whatever one's politics that's awful.

What a nice government we have.

In reply to Offwidth:

Any link?

In reality this may actually be the opposite of what you fear... your title talks about SOCIAL worth not financial worth.

Thus if you are a doctor, a nurse, a miner, a teacher, a nice old lady that fundraises for the village hall etc, would you not be of higher social worth than a fat cat banker?

There is a strong argument that if you can afford it then you should use private healthcare - leaving more resources for those who can't afford it - for some reason though this is seen as a bad thing

In reply to Offwidth:

Isn't there an element of this already, has been for decades.

Years ago a friend of mine's Dad had a heart attack, the surgeon told him if he'd been a smoker then they wouldn't have operated as it wouldn't have been worth it.

Similarly with alcoholics getting transplants, when organs are in short supply people want to see them going to people who are more worthy.

In reply to balmybaldwin:

I think it was first covered in the Times (so behind the paywall). It's also in the health service journal where you need to subscribe to read it. I got it from a Roy Lilley blog. http://myemail.constantcontact.com/Cassandra.html?soid=1102665899193&ai...

https://twitter.com/RoyLilley.

In reply to winhill:




This is a case for improving the too small number of people who are on the organ donor Register and carry the card.

I dont Approve of the notion of the worthy of treatment and the unworthy. Its arbitrary and wrong, and it will be the poor who disproportionately get refused treatment, as they have the most Chaotic Lifestyles with smoking, Drink, Drugs, and poor diet more Prevalent.

If Heavy Drinkers or smokers are to be Deselected for treatment, so should Drivers, Climbers, most Sports participants. They all Bring their Injuries on themselves.

In reply to winhill:



Surprised this hasn't hit the front page of the Daily Mail with the headline "Bulgarian paedophiles to get heart transplants on the NHS"

What factors should be taken into account when prioritising healthcare ? Simple first come first serve or do we include such factors as predicted life-span, lifestyle and medical history ? And if we start introducing such factors, is not much further to include contribution to society/criminal record ?

In reply to Offwidth:

There is some sense in this. Expensive health care needs to be rationed somehow. The government are suggesting that it makes more sense to give an expensive treatment to a 25-yr-old with a (possibly) long life ahead of them compared to a 95-yr-old who would get much less extra life out of the treatment.

In reply to Chris the Tall:


It did hit the front page of the DM but as

http://www.dailymail.co.uk/news/article-2561657/Too-old-lifesaving-drugs-An...

So it is interpreted as an attack on the old.

In reply to Offwidth:

I guess RBS Bankers with a worth to society of about -30Bn should be very worried about going to their GP.

In reply to Offwidth:
Edit to add - sorry just read your original post ... you did say NICE told them where to shove it ...

Although I think it is reasonable for the Dept. of Health to consider these kind of thought experiments.

NICE weren't specifically told you must - they were just asked to consider it.

----

The Chief Executive of NICE (Sir Andrew Dillon) was on The Today Programme on Radio4 yesterday morning at 8:20 talking about this:

http://www.bbc.co.uk/iplayer/episode/b03vd5j3/Today_17_02_2014/ (interview starts 2:20 into the stream)

To quote the start of the interview:

"Wider Societal Benefits ... it's been suggested it (NICE) should take into account when recommending treatment ... we can get him to explain this to us though ..."

The government are suggesting that they should have a broader treatment but are not directing them towards a specific mechanism of evaluating the full benefit.

I know that responding to a thread on UKC with actual details about the real story rather than just a Daily Mail reaction isn't necessarily the right thing to do - sorry.

In reply to Offwidth: I don't see any problem with that. There are far too many people who are a lifelong drain on society and who, in many cases, do harm to society that denying them treatment that might prolong their lives seems entirley reasonable. "Human rights" is a much abused term that I hear far too much. However, as one of the UK's foremost dudes you would be eligible for any procedure you wanted, whether you wanted it or not.

In reply to Offwidth:

I am amazed and very sceptical. 'Really?' is my serious response. Were the proposals genuinely as malicious as you suggest?

In reply to Choss:

Go on, show me evidence that by paying both tuition fees and cost of living allowance up front at time of use the government are cutting people off from HE.

Yes, they want the money back - eventually - if and only once you earn over a decent threshold - with no interest charged until then - then only taking it back as a small fraction of your income over that threshold.

You may disagree with eventually reclaiming the cost of HE from the user rather that via general taxation, but the new system most definitely does NOT deny access to HE. It is also a lot fairer than than it was under Blair and Brown where the threshold for repayment was well below national average wage.

In reply to Coel Hellier:

But who's actually paid taxes and NI? It's bollox and I think we all know it. Maybe if the NHS didn't piss money away on vast layers of unnecessary management, croneyism, and massively over-inflated private co. deals it wouldn't cost as much and the patient could get the care they need regardless of age.Especially as we're living longer and retirement age has risen.

In reply to wintertree:

Many From poorer Backgrounds dont even get through FE to Reach HE these days because the Eton boys took away their EMA.

The Thought of 60 Grand of Debt is putting poorer people off HE as well.

It sticks in the craw that all these Inherited wealth ministers Benefited From a Free education despite being Privileged enough to pay for it, then pull up the Ladder for the next generation.

In reply to Choss:

And the main reason for this is.... Survey says - YOU.

If you understand how the "debt" works then it is no reason to be put of going for HE. The problem is a lot of people with a political point to make - you included it would seem - bang on and on about it as a "scary debt". This apparently puts of those would would benefit the most from it, forming a self fulfilling prophecy of doom and keeping the low, low.

So wise up, go and look in to how it all works and stop spreading the muck and putting people off with classic Fear, Uncertainty and Doubt. Perhaps you've just bought the party line from various groups who seek to gain publicity and votes by manipulating the people to their detriment.

In reply to wintertree:
I Know perfectly well how it works, and i disagree with it.

I believe in Free Lifelong education for all. Thats how you make it available to everyone and Spread Equality of educational Opportunity.

You wise up yersen. These policies are all about minimising participation for less well off communities. Why Take EMAs away Otherwise? That only affects thed poor.

Why are you not addressing that, Taking away FE Opportunities?

And i Like the way you call poor people 'the low'. Nice touch, very Dickensian

And the way you tell me to wise up, Which in reality has nothing to do with wisdom, but you Mean agree with your way of thinking. Thats Funny.

In reply to Offwidth:



The interviewee (Missed his name) from NICE yesterday morning on R4 presented the situation as rather more nuanced than that. His spin on it was that a superficially appealing idea of including a societal-benefit term in the cost-benefit analysis they perform was being proposed. This has both benefits and consequences, they were asked to assess and present both for further consideration, not to just quietly get on with it nor to kick it into the long grass. Seemed reasonable to me.

jk

In reply to Offwidth:

Well that's a fairly hefty spin on what the government actually asked NICE to do.

At the moment the decision whether to fund a new treatment or intervention is taken on the sole basis of whether the cost of the treatment to the health service (including the change in estimated future healthcare costs), divided by the health gains is below a certain ratio (£20-30,000 per Quality-Adjusted Life Year, the preferred metric of health).

The new proposals were that perhaps the decision rule should consider the wider benefits to society of a treatment. So, for example, if a treatment also somehow reduced crime (e.g. a treatment which reduces drinking or helps people give up illegal drugs) as well as tackling health, this should be considered (which it wouldn't be under the existing system, since that only considers health-related benefits).

It now seems that NICE has said that this is impossible, in no small part (I would imagine) due to the fact that quantifying these other wider benefits is incredibly problematic (quantifying health benefits is difficult enough).

I am not aware of any debate about considering the social worth of the individual receiving the treatment, which appears to be what your man Roy Lilley is trying to frame the concept of wider societal benefits to mean (wrongly). I'm happy to be proved wrong on this though if you can provide evidence beyond some scaremongering blogging and the Daily Mail.

There are a huge number of other issues in decisions like this, for example whether all health gains are equal irrespective of who receives them, or how much you take into account the future potential healthcare resource use of the recipient of the treatment (since if you save the life of a child, they have many more years of using up NHS resources, but the logical conclusion of that argument is Logan's Run, which I don't think anybody is sensibly advocating). It's complicated. Trying to suggest that the government are hoping to pursue some kind of pro-rich person agenda through it is a little bit nuts (and I'm not fan of the present government, they're a shower of evil bastards).

In reply to Choss:


There is no such thing as a free lunch, someone has to pay for it. You seem to think it should always be someone-else paying for things that you want.


You seem unable to discuss any issue without childish tribalism, demonising your opponents and cannot recognise that politics (or any aspect of life), is about choices, many of them difficult. Not everything can be afforded, even if lots of things may be individually worthwhile (or some sort of case can be made out for them being worthwhile, which is not the same).

Your attitude to your political opponents suggests that in the 1930s you would have been shouting that "it is all the fault of the Jews" or "all the fault of the freemasons", now you just shout "it is all the fault of the Tories", while in the middle ages you would have been part of a mob burning witches. It is possible to have different opinions to others about what is possible or sensible, but to still recognise that they may be men or women of goodwill and intelligence, but they reach different conclusions to you or have different priorities. Indeed, it is essential for democracy to be able to do this, you should respect your opponents position even when you do not agree with it.

Judging by your postings, you seem quite incapable of doing this about any subject, which are all twisted to fit your pre-conceptions. Also, what is with the random capitalisations?

In reply to Simon4:

If you care to double check youll find me saying you wise up yersen was a jokey response to them telling me to wise up, which i took as stupid and Derogatory towards me. showing that i Understand were discussing Opinions, not as they thought wisdom.

I post From the Heart. If you dont like my posts skip em. Thats easy enough.

Random caps is just my thing. Its art.

And youre wrong about me Completely. Im the one who would be Standing up for the Minority.

In reply to jkarran:


I listened to that piece too and as you say, it all sounded pretty reasonable. Having said that, I'd hate to deny Choss his daily opportunity to froth at the mouth and hyper-ventilate at the very suggestion of not automatically being given something for free, irrespective of the demands of fiscal reality.

In reply to Fraser:

all cool here Fraser

In reply to Choss:

One no. spleen vented: no charge.

Bargain!

In reply to Choss:


By being privately educated from 5 to 18 they'd have saved the taxpayer quite a bit which would counter the 3 years of free university that they got.

Anyhow, they're hardly "pulling up the Ladder" considering that participation rates are at an all-time high, much higher than when Cameron etal went to university.

In reply to Choss:


I agree. And free housing for all. Surely housing should be available to everyone? And free food for all. Surely food should be available to everyone? And free cars for all. Surely in this day and age mobility is such a social good that it should be available to everyone? And free holidays for all. Surely a couple of weeks away at a nice place is a basic right, and so should be available to everyone.

In reply to Coel Hellier:

Finally Coel, a political manifesto i could actually vote for

In reply to Coel Hellier:


Participation rates from the lowest social demographic are really really rubbish; in 2010 youngsters from the richest areas were three times more likely to go to university than youngsters from the poorest areas.

http://news.bbc.co.uk/1/hi/education/8481334.stm

In reply to Choss:


I would quite like to see the statistics that you're alluding to, regarding uptake of FE stratified by income band, pre- and post- scrapping of EMA in 2010.

This is because if you listened to the kids on the bus talking about what they were going to spend their EMA on, it didn't have anything to do with education or maintenance.

In reply to climbwhenready:

You ask me to Produce hard stats based on Teenage Tittle tattle you Heard on a bus.

Bit of irony there, but Nice try.

In reply to climbwhenready:

There is plenty of research evidence of fees and associated debt having a larger influence on the poor, eg http://tinyurl.com/kj9u8yh
. However, lets put that on another thread eh?

In reply to Offwidth:

Sorry Offwidth. Im partly to Blame. I made an overarching Opinion relevant to your OP, then was pushed into defending a tangent of it.

In reply to Choss:



I accept that, but you made the assertion! I am genuinely interested to know if there's evidence about it. If there is, I should change my viewpoint about what EMA was spent on.

The link you posted seems to be about HE though.....

(I also don't want to hijack the thread if this is going to go further)

In reply to Choss:


I'm imagining specs of spittle round the mouth after that splendid rant.

In reply to victim of mathematics:

Here is the guardian article:

http://www.theguardian.com/society/2014/jan/24/societal-benefit-medicines-w...

I still cant see anything in this thread that counters Roy's detailed concerns. Yes I'm aware of the current funding arrangements and prblems (and the need for rationing of some sort). Yes I'm aware of rationing in some areas based on what are regarded by consultants as problematic personnal health choices (where of course the patients dont go away they just move hospital). The proposal still looks wrong to me from a perspective of medical ethics and law; politically speaking its dumb in the extreme (its as if pensioners didnt vote much) and it contains all sorts of expensive impracticalities. All-in all crackpot policy making.

Is it right to think a healthy youth maybe deserves an expensive treatment more than someone very old and on their last legs? Sure if that is a case by case medical decision rather than by rule just on age.

In reply to GrahamD:

Then youd be wrong. very calm, no rant, thats just how i Speak.

Last Time i did lose the plot and my personality on here, and rant, over Christmas i was rightly Banned. Cool as a cucumber Today. No worries

In reply to Offwidth:

One of the things which the Chief Exec of NICE was saying was that the economic cost/benefit of a treatment could come out positive or negative depending upon a whole host of things.

For example - say someone's out of work on benefits they could on the face of it be considered a big negative cost and no candidate for treatment.

But if they're out of work because they they're overweight; the cost of providing medical treatment to help them lose weight could be considered a another negative cost - so again surely no candidate for treatment.

But hang on, what if the medical treatment (say a gastric band) allowed them to get out and into work then that could be a massive positive effect - so surely a candidate for treatment.

So it all depends which was one of the reasons that NICE were pushing back upon it directly but still investigating alternative mechanisms.

In reply to Choss:


Perhaps I didn't mean poor people. Perhaps I meant people who are daft enough to let themselves be influenced by ideological pap spouted by others to such a degree that they do not aspire to take the free-at-point-of-use education that the state is offering them.

As those of us who live in the real world know, very little in this life is truly free, and whilst you may not agree with the current funding for HE, it should not put those with financial poverty away from HE, only those with aspirational poverty who would rather just complain about everything.

In reply to Offwidth:


Listen to the Today program link someone posted earlier, the answers to your concerns are in there from the horse's mouth.

jk

In reply to jkarran:


Never let fact and evidence get in the way of a good tirade.

In reply to jkarran:

Nothing in that interview helped change my mind. I would argue he was being politic wrt the DoH in a public broadcast. I'm all too familiar with the protocols having friends who have controlled media for cheif execs (esp in the NHS). He was clearly nervous about explicit links to age as this is a huge political hot potato. Old people feel entitled having usually paid tax and NI for all their life and they vote: so any age link that appears unfair is big trouble. Crude economic calculations producing a yes/no decision at a particular age, irrespective of other factors is always going to be politically stupid and morally wrong.

In reply to Offwidth:


Indeed. But (unless my memory is failing me) Dillon stated quite specifically that crude age based filtering is undesirable and that great care would be needed in design and implementation of any changes to avoid that happening. Yes, he was obviously being careful (goes with the territory and he did it well) but so far as I recall he shared your reservations.

Time will tell.
jk

In reply to jkarran:

As I said NICE kicked the plans into touch because of those reservations so what exactly are we arguing about? Is it how hard they really 'kicked' as guestimated from the Today show given the presentation requirements around this. I think this is difficult and unwise and would suggest Roy Lilley is much more likely reading between the lines correctly. He is of course an ex-conservative voting commentator with senior NHS management experience who believes in a well run NHS based on best management theory and practice. he also has an impressive track record in recent years in cutting the crap from obscure areas of prospective legislation and DoH announcements with potential serious consequences.

In reply to Simon4:


Much better to have consistent capitalisations, for example "BBC".