Health

Room for improvement: How drug consumption rooms save lives

A new report by Jarryd Bartle, a drug policy consultant and university lecturer, calls for Britain to introduce life-saving Drug Consumption Rooms:

  • Drug consumption rooms are an evidence-based harm reduction intervention which allow people who use illicit drugs to do so within a medically supervised environment.

  • The use of drug consumption rooms in other jurisdictions has been shown to reduce drug-related deaths, reduce health burdens and decrease public injection and syringe litter.

  • Supervised Drug Consumption Rooms are effective at engaging hard to reach, highly marginalised populations with drug treatment, healthcare and other services. People in treatment use less illegal heroin and other drugs, potentially reducing the scale of the illegal drugs market.

  • Concerns that drug consumption rooms will increase drug use, attract substance users to an area or increase local crime are not supported by research.

  • A large majority (89%) of drug users are willing to use a drug consumption room.

    The UK is falling behind the rest of the world, including countries such as Australia, Canada, Denmark and France which are increasingly adopting drug consumption rooms as part of drug harm reduction strategies. 

  • This paper recommends that the UK prioritises the introduction of an integrated drug consumption room in an area identified as being of increased risk of drug-related harms.

  • Drug consumption rooms currently sit in a legal gray zone, leading to a lack of willingness by local authorities to introduce this proven harm reduction strategy. This could be addressed by:

    • 1. An explicit statement by the Home Office that the operation of DCRs is a matter for local authorities; specific rules could then be agreed by police forces, the Crown Prosecution Service (CPS), health bodies and local authorities; and

    • 2. The UK Parliament passing legislation that makes it explicitly legal to take controlled substances within such facilities in specified circumstances.

Making​ ​Sense​ ​of​ ​the​ ​NHS

Exactly how much the Treasury should provide the NHS is a political decision, based on the state of the UK economy, international comparatives, the coherence of NHS strategy and the competing demands for support. But there is wide agreement that exactly how those funds should be allocated should not be a political decision.

The cross-party convention proposed by Norman Lamb, or the Royal Commission proposed by Lord Saatchi, could help create this division of responsibilities. They should consider five major NHS structural changes to realise its potential:

  • NHS England is too big to manage. It needs to be split into six autonomous NHS Regions—run as independent public corporations like the Bank of England or BBC, not by a vast central Whitehall staff.

  • The limits of NHS provision—at present open-ended—must be identified. Only then can resources be focused on their most urgent uses.

  • Patient co-payments, common in almost every other healthcare system (and already current in NHS dentistry and prescriptions), needs to be extended, with care, to reduce marginal and unnecessary demand on NHS services.

  • Our ageing population means that the number of GPs and geriatricians must be increased, particularly geriatricians, whose numbers are outstripped by demand.

  • The 12% of the UK population with mental health issues need greater prioritisation and specialist resource.

The benefits of this clearer, more manageable strategy include:

  • Improved morale, recruitment and retention of a workforce that feels more valued and able to achieve identified aims, rather than having to deal with continual crisis.

  • Localised autonomy to innovate, reduce waste and learn from others.               

  • Better balance of NHS resources with demand, which is outstripping supply because (a) they are free, (b) an older population needs more geriatrician care, (c) mental health needs more specialists and (d) a wealthier population demands more healthcare in general.

  • Improving the quality of healthcare and balancing the books by focusing money, personnel and equipment on their most cost-effective uses. More skills need to be pushed down the line: consultants to primary care, GPs to nurses and pharmacists.

Read the full paper here.

Instrumental Variables: How the UK can become a world leader in medical innovation

A little under a year ago, the New York Times reported on do-it-yourself insulin pumps. Tech savvy people, mostly parents to diabetics, were pairing glucose sensors with insulin pumps. These would allow caregivers to constantly monitor glucose levels. Some even made what are, in effect, artificial pancreas, with the glucose sensor triggering the insulin pump, automating insulin delivery.

In September, the FDA approved MiniMed 670G, a mostly automated insulin pump, for sale to the general public. The device was made available spring 2017. The device is only available in the US, and Medtronic, the device manufacturer, has stated there is no timeline to bring it to other markets—diabetics can only access the years old previous version.

Automated insulin pumps illustrate two important aspects of drug and medical device regulation. First, existing regulatory systems have been slow to adapt to changes in the development of new medical devices, and medical innovation more broadly. Second, safe and effective medical devices are often unavailable in the UK, while British newspapers abound with stories of life-saving drugs unavailable in Britain.

Brexit gives the UK the opportunity to tackle both challenges and to become a leader in medical innovation. The European Medicines Agency (EMA), as well as the Medicines & Healthcare products Regulatory Agency (MHRA), the UK’s own regulatory body, were both designed for a different era.

They were created for big medicine, when large, multi-national corporations were the primary drivers of innovation. The world is in the early stages of changes in the nature of medical innovation. The era of big medicine will soon be behind us. To take full advantage of the coming changes in the structure of innovation, regulatory policy must adapt.

The UK has two advantages which could allow it to lead the charge in medical innovation.

First, the UK has a well-educated population, even relative to other developed countries, scoring near the top of the pack in maths and science, according to the multi-national TIMSS exams. It also has disproportionately strong higher education, with more universities in the world top 10, top 50, and top 500 than any country except for the US, according to most rankings. It has the human capital 2 necessary to be at the cutting edge of innovation.

Second, Brexit caused a large regulatory shock. Most regulatory changes take substantial time because of slow moving bureaucracies. Because of Brexit, the UK must make rapid changes. The question is, what type of changes should they make?

Read the whole paper.

Reforming the National Health Service

In this report, retired industrial line manager and entrepreneur Chris Davies reflects on his experience of four decades of NHS care, and details the numerous occasions on which Britain's health service has failed him. He argues that the NHS is a fifties-style nationalized service that does “time wasting and inconvenience on a monumental scale" and is fundamentally incapable of serving its customers effectively. Davies goes on to advocate reforms far more radical than anything yet contemplated by the British government: his blueprint would see the entire NHS estate sold to competing, private groups; it would establish a national insurance fund financed by the proceeds of those sales and by employer and employee contributions; and it would introduce a co-payments system whereby patients had to pay 20 percent of medical bills themselves, up to reasonable annual limit.

Read this report.

 

Depoliticizing the NHS

This paper documents the bewildering and counter-productive range of political initiatives and interference which has wreaked such havoc on our nation's healthcare system.

The paper's proposal is for a distinguished panel of health professionals to be appointed to run the NHS, to allocate its budget, determine its priorities, and operate it according to medical needs rather than political aims. A YouGov poll taken on the subject shows massive popular support for precisely such a proposal, with 69 percent in favour and only 12 percent against.

The NHS budget would be set by Parliament every five years, and up-rated each year in line with inflation. The ASI's YouGov poll showed that this idea, too, enjoys widespread popular support, with 74 percent in favour. The suggestion that "the NHS has become a political football" receives 72 percent backing.

Read the paper here.

Road Map to Reform: Health

In this report, part of the ASI's influential Road Map series, the authors seek to retain what is best about the NHS, in particular the fairness that it represents. The report is based on the principle that everyone should have high-quality healthcare free at the point of need, and assumes that most healthcare will continue to be funded through taxation. Nonetheless the authors also propose to unleash the power of enterprise and innovation in how healthcare is actually provided. This requires breaking through the ideological barricades - a public-private mixture is really the only way forward.

Read the report here.

NHS Reform: towards consensus?

This report, which calls for an end to today's centralised health service and the adoption of competing european style social insurance system, has been endorsed by prominent health experts. The main thrust is that the government should neither provide nor finance health, it should merely regulate. Instead hospitals and doctors should be made fully independent of Whitehall, in the form of local trusts. Families would subscribe to one of a number of social insurers, who would then buy services from one of the independent providers. Ex-minister Frank Field says that "if the present government's reforms do not soon show signs of success, a system of competing health suppliers regulated by government and run on insurance lines will begin to be practical politics."

Read it here.

 

Getting Back Your Health

People in good health should be able to get part of their taxes back and take the money to a private health insurer or company health plan, according to actuary and City University professor Philip Booth in a new report for ASI. This would give patients better choice, driving down costs and driving up quality as new healthcare providers bid for their custom.

Read it here.