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...let alone enforceable?

A row that has so far been played out in the pages of the august British Medical Journal has suddenly burst out onto the public stage as MPs have found constituents being told they will have to pay for their NHS treatment because they've paid for additional drugs or treatments, for example that the NHS doctor tells them may help but cannot be prescribed by them.

But is the notion that you can be barred from receiving the treatment your tax already pays for even legal? Apply the same argument to education, for example, and parents who pay for a few weeks extra tuition for their child would be forced to pay for the whole of their state school provided main stream education.

And even if it is legal, how is it enforceable? Should someone who buys some nutritional supplement that a friend recommends in addition to prescription drugs for their illness be forced to pay the full costs of their NHS treatment? Or is there some (arbitrarily?) set level - is it okay to buy an extra packet of over the counter drug but not a cancer drug that NICE won't allow you to have on the NHS even if your NHS doctor says it will possibly help over and above what they can do for you? And how do they know? Is it basically down to whether or not a private consultant requests your medical records from the NHS and the person receiving that request has to snitch on you?

Of course I can see there may be cases where it might be legitimate for the NHS to wash their hands of a patient who has paid for some additional or alternative treatment that actually compromises the care the NHS is trying to give that patient. But if it's complimentary to the treatment the NHS are giving, and only unavailable through them because of NICE, or budgets, or rules, that doesn't apply. Indeed, it would probably be saving the NHS money in the longer run - the quicker you are cured, or the more independent you are, because you have supplemented your treatment, the more resources they have to spend on people who cannot pay the extra, surely?

Again, the comparison with private education is interesting - if someone's additional private tutoring has made them better able to cope with their mainstream school classes in some way, the classroom teacher, surely, has more time to spend on others.

And if it's indeed just if it goes against the advice of the NHS,
should anyone who does not apply government sanctioned wisdom on
healthy living be made to pay for all NHS treatment because their
lifestyle is prejudicial to their health in some way? 

Or, perhaps, could it all be a case of corporate welfare - the NHS has "exclusive" deals maybe with drug companies that, say, give them discounts or some other kind of soft benefit even if only their treatment is used for a particular condition and if people opt to go for a competitor's supposedly better treatment the deals all fall apart. The NHS is riddled with protectionism, particularly in its procurement policies. And yes this itself locks out competition and keeps prices high.

The only real answer is that clinicians themselves should be allowed to select and prescribe their own choice of treatment that they think will help that patient get off their hands as soon as possible and let them get on with curing someone else. Surely that's the whole point of the NHS?

Nearly a month ago, when Chief Constable Peter Fahy of Cheshire went on his rant about upping the alcohol age limit I wrote the following piece but ended up not posting it. Now that thanks to Tim Martin of Wetherspoons (somewhat ironically as I would hold his company to be part of the problem - cashing in on the drinking shed culture and pricing out many estate pubs) an alternative argument similar to mine below has been posited, and picked up by Liberal England and Niles, I thought maybe it was worth reviving. It was a theme I mentioned actually in my candidate vetting interview as one potential way in which local authorities might be able to influence this "binge drinking" issue:

There's all this chatter about alcohol fuelled crime and anti-social behaviour going on. Most sensible folk seem to agree that raising the drinking age is no answer (I would in fact abolish any minimum age completely of course). But I wanted to take a different tack that has niggled away at me for a while. Kind of on the "Bowling Alone" theme of declining social capital. I believe a lot of this trouble is because of the demise of the local pub.

more from san joan's evening
Originally uploaded by J_G_R

Everyone now seems to get together (usually on the same night of course) and gather at drinking sheds in town and city centers. Long ago, when people weren't so mobile late at night and so on, they would go to their local pub. Many of our housing estates even had one built as part of the original planning for the estate, at least as important as a church or a medical centre or a Co-op.

But in there you would not just have the Club 18-30 hell bent on a little youthful havoc. You'd have people of all ages and all social groups on an estate. And it was probably the only one within walking distance so if you were barred it was a real pain to go anywhere else. If you got a little obnoxious or worse on the booze your family and neighbours would get to hear about it pretty quick through someone else who was at the pub when you kicked off. You would have to apologize, and perhaps even beg, or at least eat a bit of humble pie, to get back in. Be a little shamed by the incident.

Now, nobody who knows you sees you out in these anonymous booze barns in the centre of town. One is much like another so if you embarrass yourself at one you can go to half a dozen others for the same bus journey. Reprimands are all down to the police, assisted perhaps by bouncers. And all have to stay within strict boundaries - your cousin is not going to take you out the side door and box your ears (not that I'd advocate such violence as a cure!) until you stop acting like an idiot and can go back in and apologize. You might even feel proud to be on "Police, Camera, Action" rather than ashamed to be acting the idiot in front of your family and neighbours.

I doubt we can roll back the years that have made some city streets (like George Street here in Oxford) end to end gin palaces. Who knows though, maybe climate change, fuel costs, environmental concerns, might one day make us go back to the real local pub and have to face up to our families when we act the alcohol fuelled arsehole.

It's nice to know that I've attracted the attention of some in the corridors of power. After my post the other day about whether it was better to tax emissions or to give out emissions permits and allow companies to trade any surpluses with other corporations that need to buy more for whatever reason, I got an email from Chris Huhne tonight to let me know that he'd put something more about it up on his own website.

I presume he refers to his speech in response to the Stern Report which contains lots of good stuff. Though it doesn't (and nor would I have necessarily expected it to) factor in my personal philosophical bias towards viewing the air/atmosphere as a part of the commons, like land, which ought not to be enclosed if possible and which bias leans me towards taxing emissions rather than trading emissions.

I accept that they sort of emissions taxing I was thinking of is probably not possible at present - that we do not have a "carbon footprint" for every process and that just as it would be technologically difficult in the time frame required for action to introduce personal carbon allowances and trading it would be similarly difficult or impossible to produce a fair tax system without knowing that "carbon footprint" of every process in the economy.

Technorati Tags: climate change, lib dems

The consultation on housing in the county was a sham, as the whole process of local, strategic and regional planning for housing has been right the way through.

Good alternative ideas have been unwelcome for two years now! The option to put thousands of homes on the edge of the city is based on seriously flawed interpretations of the City Council’s own research. The others are an unacceptable, usually undemocratic imposition on smaller towns.

What the city council’s Labour group is proposing is in fact an overall increase in Oxford’s population of a nearly a fifth. Because the only way they can see of providing affordable housing is to allow lots of private market development.

What we need is a mechanism for sustainable use and reuse of what we already have – making the market match the need. Most people in the city’s housing needs survey are already based in the city – we just have severe problems affording what they are in. The absolute shortage of housing is only around a quarter of what the city’s planners have extrapolated from their research as a result.

We can expect more villages to become havens for the wealthy and their public services like schools, local shops and buses to wither and die. And acres of soulless developer boxes spreading out into South Oxfordshire no doubt pretending to be “communities”.

I pledge that, if stopped and questioned for no reason by an officer of the law without having invited him or her into a conversation with me, I will make it my business to make the whole business as long-winded and bogged down in paperwork and police time as possible.