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Stand and deliver

Today, the pharmaceutical industry is demanding our money or our lives, and this time it's no joke, especially if you're old and American

Your money or your life... policy makers should heed the plight of the aged citizen

Remember the famous gag by noted cheapskate Jack Benny? A highway robber demands Your money or your life! Benny hesitates, then replies, I'm thinking. I'm thinking.

Today, the pharmaceutical industry is demanding our money or our lives, and this time it's no joke, especially if you're old and American (see www.suddenlysenior.com/greedinc.html - a website for grumpy old US seniors)...

'Because drug companies operate as US government-supported monopolies, brand name drug prices are limited only by the vigour of manufacturers' greed. With prices soaring way beyond affordability, it's little wonder that hundreds of thousands of uninsured seniors have turned North in desperation.'

The article goes on to describe the well worn trail between the US and Canada. North of the border, pharma regulations are different and the drugs are cheaper, which reminded me of two things:

The first, being in a hotel in Florida. At breakfast we were shown to our table by an elegant lady, who looked dressed for a night at the opera. She was glamorous and poised. She was also elderly. She was charming, erudite and informed.

It was impossible not to comment. Why the hell was she up at six-thirty in the morning, doing a meet-and-greet job in the dining room? Tricky question to ask, really. Curiosity got the better of me! Goodness, I said, this looks like an early start...?

Yes, she replied, but at my age I'm lucky to have a job! After a few curious questions asking why we were in the US and what-not, a conversation developed and we learned a horrifying truth. Something shocking.

This wonderful lady was, in fact, 69 years old. Her name was Lillian. Her husband, at 68, was dependent on medication, for which Lillian worked hard (four bright and early mornings a week) to buy.

The US is a wonderful country of plenty, of vitality and of innovation. It also has no soul. It is a measure of a society how well it takes care of its old and sick.

The second thing? A group of UK doctors, called Doctors for Reform, hit the headlines with an idea that we should all pay a bit more for healthcare.

Bear in mind this came in the week that most of the public, politicians, health reporters and commentators, while trying to unscramble where all the extra money invested in the NHS has gone, universally pointed to pay hikes for doctors and nurses. GPs in England are now the highest paid in Europe.

The consequences of their new payment by points system was underestimated; hospital consultants were paid to do more NHS work, but as they were already doing more work, there has been no productivity gain.

'Agenda for Change', the new pay-spine idea brought in to replace the arcane Whitley Council grading system for all NHS staff, is £80m over-spent.

So, what a good week for the doctors to ask us to stump up more cash! I wonder who's doing their public relations work? Dopey-R-Us, maybe?

The problem is that the idea has, what the news industry describes as, 'legs'. It means the story ran for a couple of days.

Despite the fact that there is no public appetite to pay any more tax or top-ups, and both of the main political parties have said a definite 'no' to the idea of anything other than a free NHS, the Docs for Reform pressed their case. Barmy, or what.

Their case was (notwithstanding the fact that more money than anyone could ever imagine has been tipped into the NHS in recent years), that some hospitals are still over-spent, ipso-facto we need to shell out yet more hard-earned cash.

Wrong. The fact that the new money has produced nothing more than a smile on the face of the nearest Mercedes dealer does not mean that money cannot be invested wisely; and certainly not a reason for reforming doctors to try and get their hands in our wallets.

Paying for healthcare is what makes US seniors very grumpy and Lillian get out of bed before you do. We don't want that.

What we do want is the money without the politics. The fact that the politicians have piled modernisation, initiatives, targets and pay rises on pliant hospitals and PCTs, and they have not properly costed the consequences of any of them, is the point. The only point.

Politicians have meddled, fiddled and tweaked with the NHS. Since 1997, we have had four secretaries of state and over a dozen junior ministers. No consistency, no continuity and no bloody idea. They all want to make their mark, change something and get on the telly. None of them have a business background, or run anything bigger than the queue for the bike shed, let alone the world's largest nationalised industry.

When Gordon Brown became the Chancellor of the Exchequer, his first job was to make the Bank of England independent. Now he is set to be the Prime Minister, his first job should be to make the NHS independent of the political process.

An NHS working to achieve national goals within treatment frameworks and watched over by a regulator, which reports to Parliament once a year, would be a brave but decisive step to create a lasting legacy for the new PM in his first hour of office.

In truth, it is not NHS managers who have let us down and it is not really the staff who have had pay rises. It is not the public, who often waste resources by not turning up when they should or by turning up when they shouldn't.

It is the politicians, drawn like moths to the flame of change, modernisation and desperation. The politicians who think about polling day more than they think about patients. They have let us down. The political process has let us down and the people who use it to rebut the obvious, deny the truth and dissemble from the bloody obvious. If you are in any doubt, think of Lillian.

The author

Roy Lilley is a (sometimes controversial) healthcare author and broadcaster

2nd September 2008

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