It's not too much to ask: Best care for those in greatest need

Columnist

Tuesday 25 September 2012

Is jam today a viable policy in 2012?

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Colette Douglas Home

Under the SNP Government life is a little sweeter. It's a pleasure to drive across the Forth Road Bridge without having to queue at a toll booth. It is the same at the chemists. I still can't get used to walking out with my prescribed medicines free of any charge. Then there are free eye tests and free bus passes for the over 60s.

Good for Scotland. What a place to live. What a place to grow old in, with free personal care for the elderly enshrined in policy.Or is it too good to be true? I'm afraid so.Thanks to the courageous Professor Keith Oldroyd, director of research and development at the Golden Jubilee National Hospital, Clydebank, we now know one cost. Some Scots are getting less than the best when suffering from life-threatening illnesses.People in the west of Scotland who suffer heart attacks are being deprived of the most effective available drug, ticagrelor. Scotland, he says, lags years behind when it comes to introducing new drugs and techniques. And it's down to a shortage of funds.Meanwhile, money is wasted in free services for those who can well afford to pay – and some are even willing.That free trip across the Forth Road Bridge alone has cost the public purse around £80 million since its introduction in 2008. It's a useful sum of money in these hard times, you might think, but it pales to nothing when set against the cost of free prescriptions.Scotland spent £1.18 billion on free prescriptions in 2011-12. Nearly 95m items were handed over without charge. Don't get me wrong – I'm not suggesting the poor should pay, but shouldn't the well-off and the rich? Here is one price of such universal largesse. When the Scottish Medicines Consortium approves a treatment, doctors are told to wait because of cost restrictions. By contrast England and Wales must introduce a new drug within three months after NICE approves it.Some Scottish health authorities do break ranks. Thus patients in Lothian can get heart treatment denied to those in Glasgow. It's not just a postcode lottery it's a social lottery, according to Prof Oldroyd. The articulate get what they demand while the weak and unknowing get what's going. It's not fair. It's not acceptable and it's not necessary. What sane adult would choose free bridge crossings, free prescriptions, free eye tests and free bus fares at the cost of "trailing the rest of the UK and Europe in introducing the most effective treatments for heart attack victims"?The examples are startling. Have a heart attack in Aberdeen and up to 120 minutes later you'll be given a stent – a marvellous device that should protract your life. Anywhere else in Scotland you'll probably be denied a stent after 90 minutes.I know rationing is a reality. But it is shocking when cancer specialists in Scotland report to a parliamentary inquiry that they "cannot prescribe drugs which are seen as standard around the world". If we must spend money on a referendum (and there's a cost that could be saved) I'd rather it covered an issue like this one.As a society we are clear about our priorities. The most vulnerable must be protected. But surely they will be best protected when public money ceases to be handed to the haves as well as the have-nots. The ability to pay must always be the ruling principle in hard times.There is talk of inter-generational resentment. The young will increasingly see themselves burdened by the old. They carry student debt and face the prospect of high mortgage repayments (when they can eventually afford a home of their own). They foresee a future where they become wage slaves to maintain ageing baby boomers who have had it good since the cradle – and who continue to receive benefits from the state whether they are rich or poor.They have a point. But priorities have changed for baby boomers, among whom I number. Time is catching up with us. Many contemporaries are now cancer survivors while others have pacemakers or stents. We've had security in numbers all the way through our lives. Now we know the bulge we represent is taking its toll in health costs. We've been around long enough to grasp that we can't expect top quality drugs and surgical procedures and universal financial perks. Faced with a choice between paying a bus fare, shelling out for a prescription or getting the best cancer treatment, guess which most would choose?We don't want to burden the young. They are, after all, our children and grandchildren. That's why I would retain as much free personal care for the elderly as possible. Funding care for grandparents is a cost to every generation, even if they pay with their house.Last year the cost had risen to £450m. If, as is predicted, our financial recovery takes two decades, one million Scots will be hard of hearing and 400,000 will be blind. Their care must be a priority. If we are to maintain a decent, civilised society we need to confront these issues honestly. We can't keep everything we have, so what do we want?Surely the answer is that we want the best available care for those in greatest need. That means we first look after the sick, the poor, the vulnerable and the old. With that as a starting point it becomes easier to strip away the rest.It will leave the rich, the affluent and the squeezed middle obliged to adjust their spending to include prescription charges, eye tests, bus fares and road tolls. There may be howls of dismay but all can seek solace in the knowledge that when the chips are down, when their children are sick, their life is at risk or their old folk need care, Scotland will be able to afford the best drugs and innovative techniques on a par with its UK and European neighbours.And that surely will be a change for the better.

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It's not too much to ask: Best care for those in greatest need

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