Am I the only one who feels a bit queasy every time I see a poster in a shop window promoting the Health Lottery? Not, until recently, because of any opinions about the rival claims of this organisation and the National Lottery (in fact, I have only just realised that there are different operations going on here).
It just seems to highlight everything that is wrong, and probably going to get worse, about our national health service. If you Google for NHS lottery, you will get a mixed bag of results, some relating to the aforementioned game of chance, others to the variable health service available, depending on where you live.
To save us all the trouble of finding out for ourselves, the government has produced an NHS Atlas of Variation. If you assumed that someone with dementia would have access to the same treatment in Kent as Lancashire, you would be wrong. NHS funding for a care home place for someone who requires continuing care? Much less likely in the West Country than Northumberland. If you need bariatric surgery, the East Midlands is a better bet than East Anglia. These are just a few highlights. The analysis was based on 71 key indicators, including hospital admission rates, treatments that Primary Care Trusts choose to fund, mental health provisions, cancer treatments, etc, and it shows wide differences that cannot be explained by variations in patient illness or patient preferences.
Add to this recent stories in the media highlighting poorer treatment received from the NHS by people with learning disabilities, with dementia, and those with physical disabilities, and "health lottery" really does seem to sum it up.
During the past week, organisations representing nurses and midwives joined doctors in confirming their opposition to the proposed changes to the NHS: people at the sharp end seem unanimous in fearing that however well-intentioned, expecting GPs to take on commissioning of health services will make outcomes even more variable. As funding available for the NHS continues to be squeezed, and the private sector is allowed to take over those areas where they see scope for turning a profit, again, it will be the patients who pay the real price. Expect the recent spat between private cosmetic surgery clinics and the government about responsibility for putting right dodgy breast implants to be repeated multiple times, as entrepreneurial set-ups find the cost of dealing with unforeseen consequences unacceptably high.
Health Lottery indeed. Incidentally, the other Health Lottery is either a clever collaboration between 51 community interest companies (CICs) intended to generate more funds from the public for health-related causes, or an attempt to persuade people away from the National Lottery - which apparently gives a higher percentage of the ticket price to the causes it supports - thus reducing the amount of money available to good causes in general. There is some debate about the ethics of the situation, amongst MPs, third sector organisations, and other interested parties, including the Gambling Commission.
The bottom line, though, is that we all have a choice about which, if either, of the lotteries we choose to support. When it comes to the NHS, there is only one, and when we need its services, we really have very little choice in the matter.
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