"The NHS will last as long as there are folk left with the faith to fight for it"
Aneurin Bevan

Thursday, 24 November 2011

Not in my name

The government is very keen on using people with long term conditions as an excuse for their changes to the NHS. They say that without the changes we will use so much healthcare that we will bankrupt the NHS. I am not against change, but I am against blaming people for unpopular change.

On the 18 January 1976, at the age of 11, I was diagnosed with type 1 diabetes. I remember, during one of the appointments I had with the diabetes specialist, I was told that in later life I would have kidney problems; there was no "if", it was a definite statement based on the middle aged diabetics that he was treating at that time. I distinctly remember the specialist telling me that by the time I am 50 I will need a new kidney.

A lot has changed since then. I am three years off the half century and my kidneys are still working. Part of the reason for this is because of the preventative medication I have been taking for the last 15 years or so (ACE inhibitors and calcium channel blockers for hypertension). Part of this is because of better management of my condition through purer insulin and through finger prick blood tests. None of this costs much, in fact through new processes of making insulin the price of insulin has dropped over the last 30 years. It is cheap to keep me alive!

Dialysis, organ transplant and the long term follow up care for a patient with a transplanted organ is expensive. In 1976 a health economist could have looked at me and visualised a deep pit being dug to consume future piles of NHS money. The health economist would have been wrong. I am sure that I have cost the NHS a lot less than could have been predicted 35 years ago.

I am going to be uncharacteristically optimistic here: I do not think I will be a big drain on NHS finances in the future either. This is why I wish the government will stop using me as their reason for breaking apart the NHS.


  1. All economists are bad at predicting the future, even health economists.

    I think you're right to be optimistic. But then again, I am a health economist.

  2. You are the excuse - You will have a personal care budget. You, who is good at looking after yourself, with your education and comfortable homelife, will not stretch your budget too badly. The more needy will. They will need health care insurance. Cue the insurance companies advising the govt on personal budgets!American health care, here we come!!

  3. @Mary Taylor

    Yes, spot on! The government says that people with stable conditions like mine will "be offered" personal budgets first. Once there is a sizeable collection of people with personal budgets, the government will then roll them out to everyone with a long term condition because, they will say, "it works with the first batch, so it will work for everyone!". When you are assigned a personal budget who decides what the limit will be? Ultimately it will be the Clinical Commissioning Group who will be paid on a capitation - that is, a fixed amount per person regardless of their conditions. Restricting personal budgets will be an attractive way for clinical commissioning groups to balance their books or even to make a surplus (they will be paid a bonus if they make a surplus).

    And don't think that everyone else will be exempt. Once patients with LTCs have personal budgets (and top them up with insurance) it won't be long before everyone else will have a "personal budget" in the form of basic emergency care and insurance for catastrophic cover.

    If offered a personal budget I will refuse one. I hope as many others will refuse them too. The NHS is based on a simple principle of healthcare according to need, and a personal budget is totally at odds with that principle.