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NHS “fairness” divides UK political parties
THE LANCET
POLICY AND PEOPLE
T
he principle of equitable access to treatment remains the fundamental difference between the health policies of the two main UK political parties, according to the King’s Fund, an independent charity set up to promote good healthcare policy. Opinion polls indicate that the opposition Labour Party will displace the Conservatives in the general election expected on May 1. But even so, any changes to the National Health Service will be “measured rather than drastic”, predicted the Fund’s Policy Institute director, Ken Judge. The most likely campaign flashpoint is the thorny problem of community mental healthcare and long-term care of the elderly, said the fund’s chairman Robert Maxwell. None of the parties has the answer yet, he believes. The Conservatives are in the more vulnerable position, with many welldocumented cases of people already being denied access to long-term NHS care. Any further withdrawal of its free provision is likely to hit Conservative supporters hardest, Judge commented. And the rapid fall in Britain’s hospital bed count— significantly faster than in other countries, says the Fund—has particularly hit NHS continuing-care facilities. Inequality of access to NHS care has increased during the 18 years of Conservative government, said Maxwell. And although Labour has made more public commitment to dealing with “the socioeconomic determinants of inequalities in health”, Labour has moved much closer to Conservative government policy on the practicalities of funding and resource distribution, Judge said. Whoever wins, the NHS will face the challenge of regional variations in service rationing, and the associated conflict between central guidance and local clinical freedom. “Whether [in-vitro fertilisation] treatment falls within the NHS is clearly a national and not a local decision. Where there is evidence of the value or non-value of treatment, such as for beta-interferon, we think there is a case for more central guidance, if not prescription, than we see now”, said Maxwell.
Pete Mitchell
786
Fury mounts over Canada’s anti-tobacco bill more Canadian will join the roll of n the face of allegations that its those who died sooner than they new tobacco advertising legislation would have otherwise, all because of will further ravage the already devastobacco use”. However, Quebec tated economy of the city of politicians counter that the bill also Montreal, Canada’s governing signals the death knell Liberals have given final for such events as the House of Commons Montreal Grand-Prix approval to their car race; the “Just for unpopular tobaccoLaughs” comedy festicontrol bill. But the legval; a fireworks compeislation must still tition; an international receive Senate approval jazz festival; and a tenbefore it becomes law. nis tournament. Angry That possibility became Montrealers last week somewhat problematic staged a lunch-hour last week after both the protest of the legislafederal and provincial tion, closing their shops wings of the Quebec and clogging downtown separatist party seized “Save our sponsorship” streets. the issue as evidence of The tobacco industry spends about Ottawa’s indifference to the interests Can$60 million each year on the of the province sponsorship of cultural and sporting Although the Liberals say that they events in Canada, with about half are confident the bill will be that amount spent in Quebec. The approved by the upper chamber, they legislation constrains tobacco compahold a Senate majority of nies from most forms of advertising only one and opponents are vowing related to sponsorship of cultural and to kill or hinder the legislation sporting events by limiting them to until after the writ is dropped for a advertisements at the location of the federal election. event and to logos not exceeding “the Health minister David Dingwall bottom 10%” of promotional goods. pleaded for expeditious Senate passage, saying that “for every 15 minutes that this debate continues, one Wayne Kondro
I
CannaPress
NHS “fairness” divides UK political parties
Hope springs in Liberia his past week saw several decidedly upbeat developments in the process of restoring war-torn Liberia. Not only did the United Nations vote to extend its peacekeeping mission there, it announced that elections have been scheduled to take place. From a humanitarian standpoint, long-delayed relief efforts will again resume in the southeastern city of Greenville. UN spokesmen reported that humanitarian agencies have, for the first time since 1992, been able to use a highway that links the isolated town of Greenville with the capital city of Monrovia, nearly 150 miles away. These same spokesmen also said that representatives from various international health and relief agencies made the 4-day journey after West African peacekeeping forces guaranteed their safe passage. It is expected that if the lull in the fighting continues, efforts at rapid and widespread immunisation of children will also be initiated.
T
News in brief Canada euthanasia bill Canada’s Senate is inching towards passage of a private member’s bill that would legalise passive euthanasia by amending the Criminal Code to allow doctors and health-care workers to withhold or withdraw life-support from terminally ill patients. Although it is extremely unlikely that the bill will be passed by the Senate the sponsors want the measure to generate public support. Strike in Australia 2000 junior doctors in New South Wales, Australia, have gone on an indefinite strike, halting all but essential surgery, in protest at the federal government’s restriction on Medicare training posts. Prime Minister, John Howard, said there would be no reversal of the policy but the Australian Medical Association warned that the strike could extend to other areas.
Josh Hamilton, Robert Ivker
Vol 349 • March 15, 1997
POLICY AND PEOPLE
T
he principle of equitable access to treatment remains the fundamental difference between the health policies of the two main UK political parties, according to the King’s Fund, an independent charity set up to promote good healthcare policy. Opinion polls indicate that the opposition Labour Party will displace the Conservatives in the general election expected on May 1. But even so, any changes to the National Health Service will be “measured rather than drastic”, predicted the Fund’s Policy Institute director, Ken Judge. The most likely campaign flashpoint is the thorny problem of community mental healthcare and long-term care of the elderly, said the fund’s chairman Robert Maxwell. None of the parties has the answer yet, he believes. The Conservatives are in the more vulnerable position, with many welldocumented cases of people already being denied access to long-term NHS care. Any further withdrawal of its free provision is likely to hit Conservative supporters hardest, Judge commented. And the rapid fall in Britain’s hospital bed count— significantly faster than in other countries, says the Fund—has particularly hit NHS continuing-care facilities. Inequality of access to NHS care has increased during the 18 years of Conservative government, said Maxwell. And although Labour has made more public commitment to dealing with “the socioeconomic determinants of inequalities in health”, Labour has moved much closer to Conservative government policy on the practicalities of funding and resource distribution, Judge said. Whoever wins, the NHS will face the challenge of regional variations in service rationing, and the associated conflict between central guidance and local clinical freedom. “Whether [in-vitro fertilisation] treatment falls within the NHS is clearly a national and not a local decision. Where there is evidence of the value or non-value of treatment, such as for beta-interferon, we think there is a case for more central guidance, if not prescription, than we see now”, said Maxwell.
Pete Mitchell
786
Fury mounts over Canada’s anti-tobacco bill more Canadian will join the roll of n the face of allegations that its those who died sooner than they new tobacco advertising legislation would have otherwise, all because of will further ravage the already devastobacco use”. However, Quebec tated economy of the city of politicians counter that the bill also Montreal, Canada’s governing signals the death knell Liberals have given final for such events as the House of Commons Montreal Grand-Prix approval to their car race; the “Just for unpopular tobaccoLaughs” comedy festicontrol bill. But the legval; a fireworks compeislation must still tition; an international receive Senate approval jazz festival; and a tenbefore it becomes law. nis tournament. Angry That possibility became Montrealers last week somewhat problematic staged a lunch-hour last week after both the protest of the legislafederal and provincial tion, closing their shops wings of the Quebec and clogging downtown separatist party seized “Save our sponsorship” streets. the issue as evidence of The tobacco industry spends about Ottawa’s indifference to the interests Can$60 million each year on the of the province sponsorship of cultural and sporting Although the Liberals say that they events in Canada, with about half are confident the bill will be that amount spent in Quebec. The approved by the upper chamber, they legislation constrains tobacco compahold a Senate majority of nies from most forms of advertising only one and opponents are vowing related to sponsorship of cultural and to kill or hinder the legislation sporting events by limiting them to until after the writ is dropped for a advertisements at the location of the federal election. event and to logos not exceeding “the Health minister David Dingwall bottom 10%” of promotional goods. pleaded for expeditious Senate passage, saying that “for every 15 minutes that this debate continues, one Wayne Kondro
I
CannaPress
NHS “fairness” divides UK political parties
Hope springs in Liberia his past week saw several decidedly upbeat developments in the process of restoring war-torn Liberia. Not only did the United Nations vote to extend its peacekeeping mission there, it announced that elections have been scheduled to take place. From a humanitarian standpoint, long-delayed relief efforts will again resume in the southeastern city of Greenville. UN spokesmen reported that humanitarian agencies have, for the first time since 1992, been able to use a highway that links the isolated town of Greenville with the capital city of Monrovia, nearly 150 miles away. These same spokesmen also said that representatives from various international health and relief agencies made the 4-day journey after West African peacekeeping forces guaranteed their safe passage. It is expected that if the lull in the fighting continues, efforts at rapid and widespread immunisation of children will also be initiated.
T
News in brief Canada euthanasia bill Canada’s Senate is inching towards passage of a private member’s bill that would legalise passive euthanasia by amending the Criminal Code to allow doctors and health-care workers to withhold or withdraw life-support from terminally ill patients. Although it is extremely unlikely that the bill will be passed by the Senate the sponsors want the measure to generate public support. Strike in Australia 2000 junior doctors in New South Wales, Australia, have gone on an indefinite strike, halting all but essential surgery, in protest at the federal government’s restriction on Medicare training posts. Prime Minister, John Howard, said there would be no reversal of the policy but the Australian Medical Association warned that the strike could extend to other areas.
Josh Hamilton, Robert Ivker
Vol 349 • March 15, 1997