Avoiding differences

Tweet

I’m not sure that the ‘compact’ between Labour and Plaid lives up to the hype surrounding it.  Whilst Plaid seem to be playing up the headline policy gains, I suspect that the most important part of the agreement will be the setting up of three liaison committees.  This ability to influence government proposals before they become public looks likely to have more impact than the headline policies themselves, and may well do more to advance the national project.  If Plaid is to have more influence than the sole Lib Dem will have as a result of being appointed to the cabinet, it will probably be through these committees rather than as a result of the policies announced so far.

One of the policies which has been announced was the new treatment fund, but it has always looked to me like something of a gimmick.  It will no doubt be popular with those who benefit from it, and with the pharmaceuticals industry.  It’s not clear yet how it is to be funded (is it money diverted from elsewhere in the health service and then ring-fenced, or is it additional funding which is ring-fenced?) but there are two problems with ring-fenced funding like this in the health service.

The first is that whilst the ‘winners’ are easily identifiable, the ‘losers’ are much harder to identify, but losers there will be; and the second is that the funding available will never actually be enough to satisfy all of the potential beneficiaries, given the continued advent of new treatments and their very high cost.

However, it was the Plaid claim that this will end the “postcode lottery” which means that people in Wales and England are subject to different rules when it comes to access to certain drugs which caught my eye.  The phrase “postcode lottery” is one I’ve posted on before; it suggests that people are treated in a random way based on where they live, and that there’s an element of luck involved.  That is a complete misrepresentation of the truth. 

The reality is that the differences in approach stem from different administrations adopting different policies and setting different priorities.  Whether either or both of the administrations are setting the ‘right’ priorities is an entirely proper subject of debate, but this isn’t a question of ‘luck of the draw’.  Differences are a direct consequence of devolution, leading to the election of governments of a different hue.  Advocating identical outcomes is, in essence, an argument for more centralisation, not devolution, and sounds strange coming from a party with a theoretical vague long term aspiration to increase the policy divergences between Wales and England.

Paracetamol and millionaires

Tweet

Given the high profile of the Welsh Government’s commitment to free prescriptions, I find it hard to believe that any Health Board in Wales would have decided to ban GPs from prescribing certain medicines without consulting the government.  And the calm response by “a spokesman” also suggests that the decision by the Hywel Dda Board did not exactly come as a surprise.

It amounts to the introduction of what Welsh politicians usually like to call a “post code lottery”; which items can be had for free will now vary from one part of Wales to another.  It touches on the long standing issue that there is a lack of consensus about which decisions should be taken nationally and which should be taken locally. 

As a general rule, I tend to favour local democracy rather than central imposition; but in this case, health boards are not subject to local democracy, and this looks like a case of local appointees trying to weaken or undermine a decision taken by electorally-accountable politicians.  Purely for that reason, I’m surprised at the calm response of the government – unless, of course, they are actually looking for a way of back-pedalling on their commitment.

From the figures included in the report, it appears that the introduction of free prescriptions has had no impact on ‘over-the-counter’ sales, which have remained static, but it has increased the number of prescriptions for those same medicines by a significant margin.  It therefore appears, at first sight, as though the extra prescriptions are not for people who would otherwise have purchased the same medicines.  And as far as I’m aware, there is not a single reported instance of a millionaire obtaining a prescription for paracetamol.

But I’d like to understand better where that increase has come from before coming to a conclusion.  Is it the case that people are now going to see the doctor when they wouldn’t have bothered before?  Is it that doctors are now issuing a prescription when they might previously have just said “take a couple of paracetamol”?  What’s the impact on health of removing that option?

From the reports so far, the decision appears to have been taken on purely financial grounds, without considering that health impact at all.