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

Thursday, 1 May 2014

Self-care "Payment by Results"

For forty years I have had regular doctors' appointments for my diabetes. This has been mostly with hospital doctors, but from about the mid 90s it was GP diabetic clinic appointments too. For the first thirty years they all had the same format: blood results, told to do better, given form for the next blood test, dismissed. Years after I had taken my last exam, every six months I would be given a test, fail it and then be chided for not trying harder. I would always leave those appointments angry. My blood tests were not bad, they were simply not perfect; and it wasn't that I was not taking responsibility for my condition, I was, I just had a busy life and sometimes I could not understand why I had high results or how to get them lower.

Then about ten years ago, for some reason, my diabetic appointments changed from a personal test of my responsibility to a conversation with my doctor. No longer were my non-perfect results treated as a personal failure, and entirely my responsibility. Now the doctor was interested in how I could be helped to understand my results and improve them. The doctor no longer looked down on me as a problem, but instead treated me as part of the solution. This is Shared Decision Making.

Today the right wing organisation, 2020Health have come up with an idea that the rate of tax I pay should depend on my blood sugar.
We propose ‘Payment by Results’, a financial reward for people who become active partners in their health, whereby if you e.g. keep your blood sugar levels down, quit smoking, keep weight off, take on more self-care there will be a tax rebate or an end of year bonus. This could be monitored by the GP, linked to QUOF or facilitated by electronic patient records.
(I have no idea what QUOF is. Are they referring to the Quality and Outcomes Framework that is usually initialised to QOF?)

So now, the very person who I hold in my deepest confidence - my GP - will be determining my tax bill. Does this make sense?

We know that type 2 diabetes is associated with deprivation, National Diabetes Audit 2009-10 says "Type 2 diabetes is strongly associated with age, ethnicity and social deprivation":
The prevalence of Type 2 diabetes rose from 3.18 per cent in the least deprived quintile (Q1) to 4.49 per cent in the most deprived quintile (Q5). Furthermore, the effect of deprivation on the prevalence of Type 2 diabetes is most pronounced in the 16 to 55 years age range (Table 2). In those aged 70 years and over, similar numbers of Q1 (12.1 per cent) and Q5 (14.8 per cent) have Type 2 diabetes, but under the age of 55 Type 2 diabetes is more than twice as common in Q5 (3.0 per cent) as Q1 (1.3 per cent). This may reflect lifestyle differences in exercise, diet and weight.
Because there are more type 2 diabetics in the most deprived areas, this means that the 2020Health's "Payment by Results" will be applied to the poor, who are least able to afford a healthcare plan that has a financial basis, rather than the rich. Further, after the debacle of the care.data programme, where Tim Kelsey will be selling your GP medical records to insurance companies, we now have an equally abhorrent idea that your "electronic patient records" will be made available to HMRC. When will these right wingers realise that our confidential medical records should remain confidential?

Finally, it is worth quoting Dr Phil Hammond's reaction to this report: