Monday, 13 January 2014

Liverpool Care Pathway - NICE One!

This little Piggy went to the market; this little Piggy went QOF, QOF, QOF all the way home...

The Telegraph reports 
The body in charge of rationing NHS drugs has spent thousands of pounds on upmarket hotels, champagne and shopping trips to John Lewis.
Officials at National Institute for health and Care Excellence (Nice) which has come under fire in the past for restricting life-saving drugs and treatments on the grounds of cost, ran up the £115,000 bill on taxpayer-funded credit cards over the past two and a half years.

The Mail Online says –

The money comes out of the NHS’s £106billion budget, so the more that NICE and other bodies spend on credit cards, the less there is available for treatments, scans and frontline staff.

In recent years, NICE has banned numerous promising drugs from being available on the NHS because it deems them too expensive. 
Last year alone, the watchdog turned down 16 out of 17 new cancer treatments, even though several had been shown to extend patients’ lives for weeks if not months.

NICE responds –
“The small number of official credit cards used by senior members of staff at NICE are used exclusively for business purposes and are subject to strict guidelines. Expenditure is checked and approved and is subject to internal and external audit. Our travel, expenses and hospitality policies are set at levels which are consistent with other public bodies and along with the details of the expenditure, are open to public scrutiny. We provide appropriate access to the expenditure incurred, via our website and in response to requests.”
NICE says, “Our travel, expenses and hospitality policies are set at levels which are consistent with other public bodies...”

Charities – the so-called third sector – are funded out of voluntary public donation. Governments – local and central - are funded out of conscripted public subscription. Both, by definition and by default, are public bodies.

NICE says,
Searcy's manages room hire at the Royal College of GPs and the Commonwealth Club where NICE holds meetings.
NICE says its policies are "consistent with other public bodies". What is to be deduced from that assertion?

Aveco hired rooms at the House of Lords...

This is the Mail Online
The charity chief who defended six-figure salaries for executives at aid charities had his 60th birthday party paid for by donations.
Sir Stephen Bubb held a £1,500 reception for 90 guests in the House of Lords, where guests enjoyed afternoon tea.
But instead of footing the bill himself, Sir Stephen, head of the Association of Chief Executives of Voluntary Organisations (Acevo), got his employer to cover half the bill – £765 – despite the organisation being funded by charities.

The Guardian
Bubb would, no doubt, also defend the six-figure salaries of NHS Execs - as did Sir David Nicholson, the outgoing NHS England Chief Executive, also criticised for his own £211,000 salary.

NICE policies are "consistent with other public bodies".

All executive directors at NICE are appointed on a permanent basis under a contract of service at an agreed annual salary with eligibility to claim allowances for travel and subsistence costs, at rates set by NICE, for expenses incurred on its behalf.

Reporting bodies are required to disclose the relationship between the remuneration of the highest-paid director in their organisation and the median remuneration of the organisation’s workforce. The banded remuneration of the highest-paid director in NICE in the financial year 2011/12 was £180k–£185k (2010/11: £185k–£190k). This was 4.5 times 2010/11: 4.7) the median remuneration of the workforce, which was £40,157 (2010/11: £39,567). In 2011/12, no employees (2010/11: nil) received remuneration in excess of the highest-paid director. Remuneration ranged from £8k to £174k (2010/11, £8k–£175k) - NICE
NICE policies are "consistent with other public bodies".

Sir Stephen Bubb is the recipient of accusations that he supports NHS privatisation. What he supports is collaboration.
Last night Sir Stephen said: “I unashamedly believe in a greater role for charities in providing public services and have actively argued for this. Acevo believes that a level playing field in NHS commissioning means that charities can step up to the plate to deliver a wide range of services ranging from hospice care to mental health.” The Independent
Ed Milliband takes a similar view. Ed sent a congratulatory note to Stephen at his birthday bash. This is Ed giving evidence in Public Services and the Third Sector: Rhetoric and Reality –
As you say, currently 2% of public spending or so goes on the third sector. We have identified in the action plan, which I know you have seen, five areas where we think the third sector can make more of a contribution and play more of a role, but I suppose what I have learnt during this process of, first of all, being Minister for the Third Sector and now as Minister for the Cabinet Office is that the key to this is what happens on the ground. It is local commissioners and the decisions that they make. Do they recognise the contribution and the role that the third sector can make, how do they shape services, either locally or regionally and what involvement does that mean for the third sector? So to set a top-down target for this, I do not think would be sufficiently responsive to local circumstances. The other thing I would say (and Phil may want to add something on this) is that it is really important, and I have tried to do this throughout the time I have been associated with this area, to be realistic and credible about expectations and how quickly this is going to be moved. I have said before, I think, that the amount of third sector delivery will increase, but I think it needs to be appropriate to third sector organisations being ready to do that, wanting to do that, and, as I say, being appropriate to local circumstance and local needs. I think to set a top-down target from government would not be the right way to go.
Well, Ed, they're all really going gung ho now, ready to profit from that delivery. And it's mutually beneficial all round, too.

This collaboration extends to the private sector, also. The NCPC offer "Corporate Partnerships" with the private sector, including pharmaceutical companies. NHS England plan to act as facilitators of research undertaking a policy of "presumed consent" in their Business Plan.

Ed sent a congratulatory note to Stephen at his birthday bash. Tony and Cherie sent a congrats card. And Tony's really profited from the gravy train that is government at all levels these days, Europe-wide. All jolly NICE, too. And all this dosh to dib for and contracts to award.
End of life care accounts for a high proportion of NHS spending. The Demos think tank has estimated it as at least a fifth of NHS costs and a total of about £20 billion
There is considerable scope for improvement using interventions such as early identification triggers, advance care planning, co-ordination of care and effective multi disciplinary team (MDT) working.
[Commissioning End of Life Care]
And whither is this going, this grand tripartite alliance, this medical-pharmaceutical complex that is fast resembling a Corporate State?

Further reading -
Liverpool Care Pathway - Fallen Unto Iniquity

Liverpool Care Pathway - Either, Or... Else

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