I have this persistent weakness, doctor. I keep feeling sorry for politicians. I know they are all volunteers and do foolish things. But people are so unkind to them, even when they mean well.
Last week I managed to feel sorry for Andrew Lansley. Early in the week the health secretary wrote a modest Times article, so modest that I missed it, unveiling 111 as the non-emergency alternative to 999: a “seamless” one-stop shop for everything from medication to access to a GP.
It is an idea that has been around for years. The 0845 number for NHS Direct is popular, but not widely enough known, the new system will be more local and more efficient, etc. Lansley has been proposing a three digit number since at least 2007.
But Lansley did not explicitly write “NHS Direct will go”. So when he later made that clear during a hospital tour it generated negative headlines instead of the positive ones he had failed to secure earlier.
The whole exercise was denounced as a money saving dodge. Andy Burnham (I hear he is standing for a vacant party office) condemned it. Lord Prezza (he is standing for one too) weighed in to launch a campaign online.
Oh dear. Lansley is now assuring people that this exercise - it is already being piloted, which is always sensible - is not about saving cash and not about sacking nurses, but about doing Alan Milburn’s scheme better.
Have you got that? No? Well, I am not surprised. When a new government makes public spending cuts its flagship policy, voters - and public sector workers - are bound to push everything through that prism. It is the flip side of the Austerity Britain message.
You can see the same muddled messages at work over the latest salvo of abuse launched against the National Institute for Health and Clinical Excellence’s refusal to authorise the use of the “miracle” bowel cancer drug Avastin on the NHS.
“Why can’t we have this drug?” thundered the Daily Mail. Well, one reason is that it costs £21,000 for a 10 month course which only prolongs life by an average six weeks (NICE’s figures) and the Daily Mail both campaigns tirelessly for public spending cuts and against NHS waste.
The Tory tabloid might do better urging its older readers to use those NHS bowel cancer test kits which come through the post and have only a 50 per cent take-up. It might even wonder whether NICE, much admired around the world, is right about Avastin - and healthcare systems which do use it merely extravagant.
Lansley and David Cameron have muddied the cancer debate (no, I don’t feel sorry for them) by promising that £200m cancer drug fund to second guess NICE, a slimmed down £50m of which will come on stream next April.
“That won’t buy much Avastin, will it?” backbench MPs and the Mail will soon protest, doubtless pointing to cases like that of Barbara Moss, the 54 year old teacher who paid for her own Avastin in 2006 and is still alive. Alas, we all know wonderful cancer survival stories but they don’t prove anything.
Ministers may come to rue that fund.
Lansley has long been a supporter of “risk sharing” procedures like the one devised by Janssen-Cilag for its multiple myeloma drug Velcade in 2007, after NICE ruled against its £25,000 cost.
But in this instance performance related pay is easily measured via blood counts. Might it not be easier for all concerned if drug firms simply offered bigger, early discounts, rather than devising cunning schemes, NICE’s own chair, Sir Michael Rawlins, told the Financial Times last week.
More rational, less emotive, it should appeal to the three digit side of Lansley’s character.