05 January 2007

"Too posh to push"?

According to an article in today’s Evening Standard (I can’t find the link), Dr Tim Crayford, president of the Association of Directors of Public Health, has said that he doesn’t want the NHS to spend money on caesarean sections for mothers who are “too posh to push”, and instead wants the money spent on providing things like Herceptin to cancer patients.

The Chairman of the Health Select Committee, Kevin Barron, has also weighed in threatening an inquiry by his committee if the Department of Health doesn’t review the issue. I bet they are quaking in their boots.

There are a couple of things going on here: first this story. I thought it sounded familiar, and when I searched “caesarean” on the Evening Standard’s website, I found an article from June 2003 calling for exactly the same restrictions from the All-Party Commons Health Committee - here. Even worse, today’s story is not exactly fresh either, as it is just a rehash of a story appearing on CareandHealth.com dated 22 December 2006.

More important by far is the issue itself. Are “posh” women really depriving cancer patients of life-saving drugs with their unreasonable demands for unnecessary treatment?

I guess I should declare my interest here: Sarah gave birth the NHS by c-section last year. As far as I know, it was only available to her because she was having twins (i.e. she had no other medical reason) but it was not strongly put forward by her doctors (I wanted to say “pushed hard” but the metaphor was unfortunate). It was her two cousins, one a GP and the other a senior NHS consultant who pretty much insisted she took this route, given the not insignificant chance of complications for the second birth. In the event Georgina (who came out second) was a breach baby, so if Francesca had been born naturally, the chances are that Sarah would have then had to go through a stressful emergency c-section right after giving birth. So I wonder, who are all these “posh” women having medically superfluous c-sections on the NHS? If they are so posh, why aren’t they going private?

The bigger issue is simply that this is a classic New Labour cynical manoeuvre - blaming a defenceless and innocent group of largely imaginary people to deflect attention from the utter failure of the Government to address its inability to turn higher spending into better public services. According to the various press article, a c-section costs the NHS around £2,800 - £780 more than a regular birth - a drop in the ocean. A single injection of Herceptin costs £400, a full course costs £21,800 (according to a 2005 article in the Daily Telegraph) - that’s a lot of c-sections.

Of course, the NHS provides a lot of unnecessary treatments, if your definition of "unnecessary" is to treat anything which is not life threatening. Damn it, they provide hot baths and cups of tea to patients who are presumably “too posh” to have cold showers and a glass of water - why not pump all that money into “saving lives” as well. The fact is that we all pay for the NHS (ironically, Sarah is, as I type, working on her personal tax return and will no doubt be submitting a cheque which will more than cover the treatment she received last year), and it is there to help all of us whether we are on death’s door or whether we simply would like a doctor to keep us fit, active, healthy or even just productive (and yes, Sarah was working again within about four days).

If the Rt Hon. Kevin Barron MP or Dr Crayford thinks that the NHS needs to provide Herceptin they should be calling the Government to account to find the money to pay for it instead of wasting it on teaching civil servants how to tidy their desks! (The £7m spent on this bizarre initiative alone would have paid for 321 women to be treated by Herceptin or 2500 c-sections - take your pick).

PS: A further example of the sort of waste I am referring to: our twins arrived seven weeks early on 28 July - when Sarah was under the knife, I jokingly asked if we needed to cancel the c-section planned for 1 September…. Don’t be silly, said the nurse, we’ll take care of that. But lo and behold, five weeks later, we got a call from the hospital asking if we were coming in for the operation… you’re joking? I said… apparently the “system” hadn’t been updated (more like there is no system) and they hadn’t noticed the two Baillieu babies lying in the neo-natal for three weeks. I hope they were able to slot someone else in that morning and that the staff didn’t wait around with no-one to slice open. If they’d known, they could have quickly stitched Kevin Barron’s mouth shut - now that would have been money well spent.
UPDATE: There is a further article in today's Telegraph, which mentions an important statistic omitted from the Care and Health article - "Most caesareans are carried out because of medical complications, a slow progressing labour or the mother having had the surgery during a previous birth. The proportion performed as a result of a request by the mother is about 1.5 per cent of all births." - as I said above, Crayford and Barron are tilting at imaginary windmills.

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