Sheena Asthana
Recent activity
Comments (10)
-
Comment on: Alarm at cancer treatment 'ageism'
I think you hit the nail on the head. I can totally see how an individual clinician may well decide to prioritise treatment for a younger person. As a youngish someone who is hurtling through the adventure of having breast cancer - wih five youngish children - I'm extremely grateful for the excellent care I've received. But clinicians make decisions within a funding context - which currently discriminates against areas with older populations and higher morbidity loads. It is this institutionalisation of ageism that constrains clinical decision making. I would guess that older people in generously resourced areas fare far better than older people in areas that, due to technical flaws in resource allocation formulae have been chronically under resourced. The insanities of funding - and the postcode lottery they produce - is what needs to be addressed.
-
Comment on: We must root out ageism in NHS cancer care
Thank you for raising this important issue. If you look at the comments on the piece about the NHS Commissioning Board rejecting ACRA's resource allocation formula, you will find that such ageism is underpinned by the way in which we distribute NHS funding - and that this is likely to get worse.
-
Comment on: Commissioning board's funding formula move was not 'political', says Dalton
SJ. I absolutely agree that spending money on EFFECTIVE prevention is a priority. My problem lies in the fact that we seem to think that the effective solutions to health inequalities lie in the NHS. Perhaps I am too much of an unreconstructed Trot but aren't we really talking about a problem that is rooted in income polarisation, educational polarisation, lifestyle problems etc? Thus, while there are some things that the NHS can do (e.g. prescribe statins, roll out smoking cessation programmes), these are limited - and quite cheap. I guess my question has to be WHY do we feel the need to take money away from curing/managing health care problems to address societal issues? Isn't the goal of providing equal access to treatment for equal needs a worthy one? I strongly believe in this goal. For me, it is central to the fact that are SUPPOSED to have a UNIVERSAL health service - not a residual service for the poor (which is what the CB seems to believe in). With respect to the correlation between LTCs and deprivation, deprivation is most certainly associated with PREMATURE morbidity and mortality. So it correlates very well with STANDARDISED rates of illness. However, this does NOT result in higher OVERALL needs. If you look at CRUDE rates of illness, these tend to be far higher in older areas - which happen to be less deprived. To give you some examples (which I am sure I have wheeled out in this forum before, so apologies), Tower Hamlets received a per capita NHS allocation of £2,084.35 in 2010-11. Only 3.4 per cent of this area’s population is over 75. Crude mortality Rate (CMR) is 441 per 100,000, Coronary Heart Disease (CHD) QOF registrations 1.78% and cancer registrations 0.77%. A similar profile is found in nearby Newham (3.5% 75+; CMR 540; CHD 1.78%; cancer 0.62%). Newham received £2,116.47 of NHS funding per capita in 2010-11. Dorset, by contrast, has the highest proportion of the population aged 75-plus (12.7%). Its CMR is 1,159 per 100,000; CHD rate 4.83% and cancer rate 2.49%. Its overall per capita NHS allocation was £1,560.50. Hastings and Rother similarly has to meet the health needs associated with an ageing population (12.1% 75+; CMR 1,276; CHD 4.16; cancer 2.01%) with a relatively low revenue base (£1,837 per capita). What this translates into is less funding for disease in areas such as Dorset. Accepting that there will be clinical reasons for treating older people less aggressively, the figures still do not stack up. Take cancer expenditure per cancer patient. Tower Hamlets and Newham spent £13,087 and £11,080 respectively; Dorset and Hastings and Rother £4,075 and £6,282. I simply do not feel this is justifiable. My guess would be that if we looked at access to treatments such as adjuvant chemotherapy in older women with breast cancer, selective internal radiation therapy etc, you'd find a significant postcode lottery - but not one that would fit the 'conventional wisdom' of inverse care. Indeed, anonymous 4:30, we do not know that the poor and disadvantaged do not use health services to the same degree as the more affluent. Evidence of inverse care is highly equivocal. But it's a sacred cow that we seem incapable of challenging. I think it's time we looked at it more objectively - because while promoting the idea that we need to pour more and more NHS resources into younger deprived areas, we are also implying that people who are ill by virtue of their age are 'undeserving' of health services. So, Anonymous 3:54 - we are well on the way to introducing euthansia - though why you think that it a good thing is completely beyond me.
-
Comment on: Commissioning board's funding formula move was not 'political', says Dalton
15% then 10% of the NHS budget was top sliced for addressing health inequalities. I don't know what the precise figure is now. However, that health inequalities adjustment (which is now the public health funding formula) does just what you suggest. It also resulted in very large allocations to deprived PCTs - in some cases over 25% of total revenue when the figure was 15%. I just can't see HOW you can spend that much money on preventive NHS interventions. From that point of view, we should perhaps welcome the shift of funding to LAs - at least this gives us the chance to spend money on the wider determinants of health and health inequalities. Perhaps the thing to look at is how remaining allocations compare to other OECD %GDP expenditure? Then, if you accept that the health inequalities adjustment is directed at the goal of reducing health inequalities, while the acute/mental health etc formulae are promoting equal access to health care for equal needs, these post hoc fudges to ensure that deprived populations get significantly higher allocations than their underlying morbidities would imply (remember, these are usually YOUNG populations) would not be necessary. I hope this makes sense. I find myself losing it with general frustration! Who know NHS resource allocation could be such an emotive topic?!
-
Comment on: Commissioning board's funding formula move was not 'political', says Dalton
Well said indeed Matt Black and Anonymous 4:53. Aside from the fact that the NHS can do little to address health inequalities (is this not medicalising what is essentially a socio-economic and political issue?), the Commissioning Board is effectively legitimising institutionalised ageism. Seriously, one fears to get old. It's really interesting (actually very depressing) observing things in a ageing but affluent patch where the weight of morbidity (and co-morbidity) is great but the resources relatively modest. There is definitely a postcode lottery at work. I wonder, however, whether it reflects the conventional wisdom of the inverse care law. Talking of which, as we have been trying to address inverse care for over 40 years - not least by directing significantly higher per capita allocations at deprived areas, why are we so reluctant to drop this sacred cow? I'm left wing and suffer about as much middle class guilt as the next health policy person. However, the lack of 'science' behind allocation decisions is driving me completely insane. At this rate, we will have the only health care system in the world that does not think that the provision of curative (as opposed to preventive) care is core business. Bah Humbug!
