The life expectancy puzzle
Between 2010 and 2019 improvements in life expectancy stalled in many European countries, but the slowdown was greatest in the UK. and occurred across much of the population. The reduction in life expectancy in England and the slowdown in mortality improvements after 2011 have been attributed to austerity-driven constraints on health, social care and other public services.
The effects of austerity politics cannot be the sole cause of the slowdown. Some European countries (Germany and Sweden) that did not adopt austerity policies did experience slowdowns in life expectancy improvements. In Spain, Ireland, and Greece, which introduced severe austerity measures, life expectancy continued to increase.
No doubt it is complicated, and in need of modelling. A recent King’s Fund report is a good starting point. News from Nowhere notes that the slowdown coincided with the increasing awareness of the failure of market mechanisms to reshape the health service. The NHS started to stall, and the population began to show it.
Source: Veena Raleigh What is happening to life expectancy in England? King’s Fund 10/8/22
https://www.kingsfund.org.uk/publications/whats-happening-life-expectancy-england
NHS dentistry, again
Difficulties in getting an NHS dentist are back in the news. Dentists are apparently shying away from the NHS and newspapers report tales of pulling your own teeth. Between May and July, BBC researchers approached every UK dental practice with an NHS contract (8533 in total) to ask if they were taking on new patients. Across England, 91% of NHS practices were not accepting new adult patients and 79% were not accepting new child patients.
The House of Commons Health and Social Care Committee dubbed the dental contract introduced in 2006 as 'not fit for purpose' and now calls for contract reform. The key item in the current contract is the Unit of Dental Activity, which reimburses dentists for carrying out tasks like preventive care, fillings etc. ‘on the NHS’ NHS dental practices have a negotiated UDA target with upfront payment, but if this target is not met payment is clawed back. If the practice uses up its UDAs earlier than anticipated it is not paid for any additional NHS work (although it can carry on treating private patients). The loss of income during the early phases of the pandemic has made dentists particularly sensitive, and a new contract will appear soon, so watch out for scare stories of the ‘Death of NHS Dentistry’ type.
Source: https://bda.org/news-centre/press-releases/Pages/nhs-dentistry-at-a-tipping-point.aspx
Babylon; digital fairy dust
Babylon is ending its ten year partnerships with two large Midlands trusts, University Hospitals Birmingham Foundation Trust and The Royal Wolverhampton Trust, after only two years. Babylon has been providing a digital service, called ‘AskA&E’, which allows people to check symptoms and decide whether to go to A&E or not. This rival to NHS 111 was much anticipated by the Trusts, which are under pressure from rising A&E attendances.
A second service –‘Babylon 360’ - allows 55,000 patients from nine general practices to access NHS primary, secondary, and community services through a single app — described by the local NHS as a new model of “digital-first integrated care”.
A RWT spokeswoman confirmed all elements of its partnership with Babylon are ceasing. A Babylon spokeswoman told HSJ: “At this time, RWT and Babylon have made a mutual decision to end our partnership, as it is not economically viable for Babylon in the current climate.” Babylon’s dire situation looks like a classic example of over-reach, propped up by over-optimistic investment. The company is listed in the USA, where its shares have fallen to $1 from a start of $11.
Babylon’s problems do not stop there. Its online GP service - ‘GP at Hand’ - gets a fixed amount per patient per year, depending on age and gender. It has experienced more demand than expected and loses money for each patient it takes on. Contingency plans include shortening consultations from 15 to 12 minutes. According to the HSJ, Babylon’s latest annual accounts reveal “material uncertainty” around the company’s financing and raise doubts about the viability of ‘GP at Hand’.
Commentators in the HSJ had many questions and opinions. Does anyone in the NHS carry out basic due diligence on prospective partners for proposed innovations? Is anyone surprised if digital snake oil, peddled by cynical salesmen to digital zealots who live in a fantasy world, fails to improve the NHS? The total NHS renumeration of GPs pays for around 2.5 consultations per year, taking into account associated paperwork, repeat prescriptions, chronic disease monitoring etc. The average patient attends between 5-7 times per year. Is this why conventional general practice is struggling and why Babylon fails?
Sources: Shruti Sheth Trivedi We can’t continue to fund the NHS forever’, says Babylon finance chief Health Service Journal 5 August 2022 and Emily Townsend Babylon ends partnerships with acute trusts Health Service Journal 3 August 2022
Shame and Blame
Hats off to 38 degrees for pulling together the funds for a publicity ambulance that has followed the Tory leadership candidates around the country. Smart, inspiring politics.
Read more News from Nowhere and articles on the NHS in ERA 3 at http://www.healthmatters.org.uk/