- Email: [email protected]
An Expensive Table
767
Limited List: No
Agreement on Appeals Negotiations between doctors’ representatives and DHSS Ministers over an appeals procedure in relation to the introduction of a limited list of drugs which may be prescribed on the NHS are not going well. The Department insists it is perfectly willing to allow limited, exceptional breaches of the list by doctors on behalf of specific named patients. The Social Services Secretary, Mr Normal Fowler, told the Commons that he had already agreed with the British Medical Association that there could be an appeals procedure if the mechanism was "non-bureaucratic and applied locally". But the crucial issues were the precise mechanisms of appeal and the need to ensure that such a system did not allow wholesale flouting of the list. Detailed negotiations were already in progress between doctors and the Health Minister, Mr Clarke, he said. Nevertheless it would not be possible to set up the appeals mechanism simultaneously with the introduction of the limited list on April 1. Agreement on appeals may take rather longer than was originally expected by the DHSS, however. The main bone of contention at the moment is the unexpectedly hard-line position from which the General Medical Services Committee has begun its negotiations with Mr Clarke. The GMSC has suggested an "over-ride" system, in which a doctor would be allowed to prescribe a non-allowed drug for his patient but would not have to justify his prescription beforehand. The doctor would, suggests the GMSC, be expected to justify the prescription afterwards, probably to a local committee. Mr Clarke is under instructions not to accept this suggestion at any price. The Government has no doubt the idea would lead to widespread breaches in the list and would eliminate much of the 75 million savings on the annual drugs bill which they hope for. Ministers hope the over-ride suggestion is simply a negotiating stance and that mutually acceptable compromises can still be reached, but the DHSS believes that the introduction of an appeals procedure is being unnecessarily delayed by doctors’ representatives. Research
on
Human
Embryos
and devious devices known to experts in Parliamentary procedure are being deftly used by both supporters and opponents of Mr Enoch Powell’s Private Member’s Bill, which aims to prohibit experimentation on human embryos. Mr Powell’s opponents still hope to outwit him and succeed in denying the Bill sufficient time to become law. Mr Powell has so far proved their equal in cunning, and nobody at Westminster is certain what the Bill’s fate will be. On balance, however, it still seems probable that Mr Powell will end as the loser, and his measure will fail to be enacted. The most
arcane
An
Notes and News EUROPEAN POPULATION TRENDS DEPENDENCY ratios of populations can be expressed in many ways-one is to add the number of children in a country to the number of pensioners, divide the sum by those aged 15-59, and multiply by a hundred. Those who do not bother to do the sums tend to panic and see a dwindling army of workers struggling to pay in taxes for the social services demanded by more and more pensioners living, seemingly, for ever. In the short term this gloomy view is without foundation. By the year 2000 the dependency ratio in Europe will be slightly lower than it was in 1960 (66-99 vs 67-3). That trend is a fairly general one, but it disguises increases in the proportion of the very old within the retired population and may not thus be so reassuring when the bills for institutional care and home help come in. There are a lot offacts in a World Health Organisation review of the European demographic sceneand sufficient differences in national patterns to suggest that WHO’s European office should have left this matter in the hands of the individual governments, most of whom have well-staffed demographic offices of their own. There can be no European solution-indeed there is no European problem. More interesting would have been a critical look at some of the population myths of Europe. To a northern European, "extended family" has grandmother calling out pearls of domestic wisdom to her daughter while stirring the pasta, while grandfather entertains the teeming bambinos. We get a glimpse from this report that this is hyperbole but, as with the statement that in Finland elderly people prefer institutional to family support, it is only a glimpse. WHO cannot see beyond the year 2000 at the moment-but Europe’s population pattern in fifteen years’ time is known with some confidence. It is beyond that, when the ratio of economically active to retired really begins to fall, that European nations may have need to learn from each other. HELPING PEOPLE TO STOP SMOKING WHEN the Department of Health and Social Security inquired whether it could take part in this year’s National No Smoking Day (March 20), the organisers refused. Certainly not until the
Government was seen to act constructively on smoking prevention, they decided privately. The Department’s response to this snub was to organise a conference on the eve of National No Smoking Day so that, on March 19, the DHSS was seen to be associated with the day and its aims by hosting a discussion of the role of the NHS in smoking prevention for some 200 participants. Mr John Patten, Under Secretary of Health, opened the conference by asserting glibly the Government’s commitment to reducing the toll of sickness and death attributable to smoking. The audience reacted with polite scepticism by pointing out the two banana skins over which skidded Governmental rhetoric: voluntary agreements with the tobacco industry on advertising and continuing sports/arts sponsorship. After this opening skirmish, the minister departed, giving way to more convincing statements of concern. Dr Alan Marsh, from the Office of Population Censuses and Surveys concentrated
Expensive Table
The Conservative backbencher Mr Albert McQuarrie (Banflshire) is furious with his local Grampian Health Authority. While the authority complains of cash shortages restricting its treatment of Mr McQuarrie’s constituents, he reveals that the authority has nevertheless bought’itselfa new boardroom table-at a cost of 13 000. The salt in the wound, says Mr McQuarrie, is that the table was ordered from Brighton, Sussex. "We have plenty of excellent carpenters in Scotland who could have knocked them up a good table at a tiny fraction of the cost," he says.
RODNEY DEITCH
on smoking in adolescence: one in every five schoolboys would leave school smoking 10 cigarettes a day or more and these boys would go on to become regular smokers (girls lagging behind by about a year). What, Dr Alan Marsh asked, was unique about the smoking habit that unless it was taken up before the age of 21 it was highly unlikely to be taken up? Was the biphasic action of nicotine particularly helpful during the violent mood swings of adolescence, so that the teenagers who did take up smoking attributed developing control and understanding of emotions to cigarettes rather than to age? And why were so many young people immune to the lure of tobacco? A stirring account by
1 Demographic Trends in the European Region Health and Social Implications (WHO Reg Publ Eur Ser no 17). Edited by Alan D. Lopez and Robert L. Cliquet. Obtainable from WHO sales agents. 1984.
Pp
188. Sw fr 22.
Limited List: No
Agreement on Appeals Negotiations between doctors’ representatives and DHSS Ministers over an appeals procedure in relation to the introduction of a limited list of drugs which may be prescribed on the NHS are not going well. The Department insists it is perfectly willing to allow limited, exceptional breaches of the list by doctors on behalf of specific named patients. The Social Services Secretary, Mr Normal Fowler, told the Commons that he had already agreed with the British Medical Association that there could be an appeals procedure if the mechanism was "non-bureaucratic and applied locally". But the crucial issues were the precise mechanisms of appeal and the need to ensure that such a system did not allow wholesale flouting of the list. Detailed negotiations were already in progress between doctors and the Health Minister, Mr Clarke, he said. Nevertheless it would not be possible to set up the appeals mechanism simultaneously with the introduction of the limited list on April 1. Agreement on appeals may take rather longer than was originally expected by the DHSS, however. The main bone of contention at the moment is the unexpectedly hard-line position from which the General Medical Services Committee has begun its negotiations with Mr Clarke. The GMSC has suggested an "over-ride" system, in which a doctor would be allowed to prescribe a non-allowed drug for his patient but would not have to justify his prescription beforehand. The doctor would, suggests the GMSC, be expected to justify the prescription afterwards, probably to a local committee. Mr Clarke is under instructions not to accept this suggestion at any price. The Government has no doubt the idea would lead to widespread breaches in the list and would eliminate much of the 75 million savings on the annual drugs bill which they hope for. Ministers hope the over-ride suggestion is simply a negotiating stance and that mutually acceptable compromises can still be reached, but the DHSS believes that the introduction of an appeals procedure is being unnecessarily delayed by doctors’ representatives. Research
on
Human
Embryos
and devious devices known to experts in Parliamentary procedure are being deftly used by both supporters and opponents of Mr Enoch Powell’s Private Member’s Bill, which aims to prohibit experimentation on human embryos. Mr Powell’s opponents still hope to outwit him and succeed in denying the Bill sufficient time to become law. Mr Powell has so far proved their equal in cunning, and nobody at Westminster is certain what the Bill’s fate will be. On balance, however, it still seems probable that Mr Powell will end as the loser, and his measure will fail to be enacted. The most
arcane
An
Notes and News EUROPEAN POPULATION TRENDS DEPENDENCY ratios of populations can be expressed in many ways-one is to add the number of children in a country to the number of pensioners, divide the sum by those aged 15-59, and multiply by a hundred. Those who do not bother to do the sums tend to panic and see a dwindling army of workers struggling to pay in taxes for the social services demanded by more and more pensioners living, seemingly, for ever. In the short term this gloomy view is without foundation. By the year 2000 the dependency ratio in Europe will be slightly lower than it was in 1960 (66-99 vs 67-3). That trend is a fairly general one, but it disguises increases in the proportion of the very old within the retired population and may not thus be so reassuring when the bills for institutional care and home help come in. There are a lot offacts in a World Health Organisation review of the European demographic sceneand sufficient differences in national patterns to suggest that WHO’s European office should have left this matter in the hands of the individual governments, most of whom have well-staffed demographic offices of their own. There can be no European solution-indeed there is no European problem. More interesting would have been a critical look at some of the population myths of Europe. To a northern European, "extended family" has grandmother calling out pearls of domestic wisdom to her daughter while stirring the pasta, while grandfather entertains the teeming bambinos. We get a glimpse from this report that this is hyperbole but, as with the statement that in Finland elderly people prefer institutional to family support, it is only a glimpse. WHO cannot see beyond the year 2000 at the moment-but Europe’s population pattern in fifteen years’ time is known with some confidence. It is beyond that, when the ratio of economically active to retired really begins to fall, that European nations may have need to learn from each other. HELPING PEOPLE TO STOP SMOKING WHEN the Department of Health and Social Security inquired whether it could take part in this year’s National No Smoking Day (March 20), the organisers refused. Certainly not until the
Government was seen to act constructively on smoking prevention, they decided privately. The Department’s response to this snub was to organise a conference on the eve of National No Smoking Day so that, on March 19, the DHSS was seen to be associated with the day and its aims by hosting a discussion of the role of the NHS in smoking prevention for some 200 participants. Mr John Patten, Under Secretary of Health, opened the conference by asserting glibly the Government’s commitment to reducing the toll of sickness and death attributable to smoking. The audience reacted with polite scepticism by pointing out the two banana skins over which skidded Governmental rhetoric: voluntary agreements with the tobacco industry on advertising and continuing sports/arts sponsorship. After this opening skirmish, the minister departed, giving way to more convincing statements of concern. Dr Alan Marsh, from the Office of Population Censuses and Surveys concentrated
Expensive Table
The Conservative backbencher Mr Albert McQuarrie (Banflshire) is furious with his local Grampian Health Authority. While the authority complains of cash shortages restricting its treatment of Mr McQuarrie’s constituents, he reveals that the authority has nevertheless bought’itselfa new boardroom table-at a cost of 13 000. The salt in the wound, says Mr McQuarrie, is that the table was ordered from Brighton, Sussex. "We have plenty of excellent carpenters in Scotland who could have knocked them up a good table at a tiny fraction of the cost," he says.
RODNEY DEITCH
on smoking in adolescence: one in every five schoolboys would leave school smoking 10 cigarettes a day or more and these boys would go on to become regular smokers (girls lagging behind by about a year). What, Dr Alan Marsh asked, was unique about the smoking habit that unless it was taken up before the age of 21 it was highly unlikely to be taken up? Was the biphasic action of nicotine particularly helpful during the violent mood swings of adolescence, so that the teenagers who did take up smoking attributed developing control and understanding of emotions to cigarettes rather than to age? And why were so many young people immune to the lure of tobacco? A stirring account by
1 Demographic Trends in the European Region Health and Social Implications (WHO Reg Publ Eur Ser no 17). Edited by Alan D. Lopez and Robert L. Cliquet. Obtainable from WHO sales agents. 1984.
Pp
188. Sw fr 22.