Scotland’s Health Matters October 2022
Is NHS Scotland being privatised by stealth?
The Scottish government had allocated £18 million to pay private hospitals to treat NHS patients privately to clear backlogs even prior to covid. This despite claiming that they had ceased privatisation in NHS Scotland. There was an intention in the 2015-16 programme for government to eliminate the use of the private sector in the NHS over 20 years. Despite a 2017 conference pledge to keep the NHS always in public hands, Sturgeon presidend over two national contracts with private sector health providers to improve waiting times.
In June 2019 they were keen on using all available private sector capacity allocating £183 million for private sector providers for the period May 2019 to January 2020. NHS Greater Glasgow and Clyde, the biggest health board in Scotland, received £5.28 million for operations including hip and knee replacements, cataract and ear, nose and throat operations. NHS Borders got £231,000 to pay private providers, and £350,000 to send patients to private hospitals in Newcastle.
Privatisation either takes the form of outsourcing (sending mostly orthopaedic patients to independent hospitals) or insourcing (private companies carrying out procedures in NHS facilities).
Scottish Life Expectancy
Life expectancy in Scotland is falling, with a 10% higher number of excess deaths over the last six months, writes Helen McArdle in the Herald (‘Does Ireland offer clues to improving Scotland’s health?’, 1/10/22). Scottish life expectancy had been rising between 1981 and 2011, by 7 years in men and 5 in women. Then it stalled until 2019, with a mere three weeks added. Covid saw life expectancy fall sharply for men and women, meaning that male life expectancy in 2020 was 76.1, lower than a decade earlier.
Ireland on the other hand has the highest male life expectancy in Europe at 82.6 years, slightly up from 2021. Much of the improvement is due to significant reductions in major causes of death like cancer and circulatory system diseases. Overall mortality has decreased by 10.5% since 2008. In 2016 Ireland’s male life expectancy was 79.6, slightly over the age, with females at 83.4 slightly below the EU average of 83.7. Ireland did not see a drop in 2020. Norway’s figure was 82.9 years and Iceland’s 82.5 years in 2019.
Scotland is today 19th in Europe, with the UK overall at 16th.
Ireland does not have an NHS but has more doctors and hospital eds per head, more CT scanners, and higher health spending, with the poorest third of the population getting free healthcare. When the credit crunch hit in 2008/09, Ireland cut some healthcare provision, welfare benefits for parents and young people and education spending, but Professor Richard Layte, sociologist and health researcher at Trinity College Dublin, says none of the cuts were ‘savage to the point where those services stopped running’.
Other nations like Greece, which were forced to bring in savage austerity measures, have also seen increased mortality. In Scotland it is believed to be because of high levels of deprivation and chronic disease. But the omens are not good for any immediate reversal in fortune, with a cost-of-living crisis meaning people are not eating or looking after themselves, and jobs under threat. Losing a job is associated with a 63% increase in premature mortality risk.
More Scots than ever are opting for private operations, rising 72% between January and March this year, for such things as hip and knee replacements, hernia repairs and cataract surgery, not life threatening, but life limiting and causing a lot of pain, which in itself is debilitating and seems to decrease life expectancy.
Scotland still had 59% of its excess deaths not attributable to covid as the primary cause in the six months to September 25th. Deaths are generally running at 10% above the norm. Infant deaths are up 12% on the five-year average, that is 46 infants dead above the average number. Each death is a tragedy, but surely infant deaths are the most tragic of all.
Why is life expectancy falling?
People cannot easily access GP appointments, and 44% of cancers are not discovered until people present at A&E. Only 76.3% of urgent cancer referrals led to patients starting treatment within the target 62 days.
Delays in A&E treatment increase the mortality rate, with those who spend six to eight hours waiting to get to a hospital bed more likely to die in the subsequent 30 days. Half a million people have waited more than four hours in A&E since May last year. Only 63.5% of patients were seen and then admitted or discharged within four hours. Two patients suffered fatal heart attacks waiting to be seen in A&E at Glasgow’s Queen Elizabeth University Hospital. Triage of patients is meant to happen within 15 minutes of people arriving at A&E.
Staff shortages have worsened, with 7,500 unfilled NHS vacancies (up 23%) and delayed discharge of patients is caused by a lack of social care provision in the community. Numbers waiting over two years for inpatient treatment are up by 350%.
The main underlying cause of poor life expectancy is poverty and austerity, which have not improved to any extent over the life of the Scottish Parliament. Why not? Partly because the Scottish government operates on a fixed budget, crumbs thrown from Westminster. Scotland’s funding is tied in with the Barnett formula which means Scotland gets a per capita amount according to English political priorities, where the NHS is under serious threat.
kills twice as many women as men, around 75 women a year in Scotland, with others hospitalised. It is believed that oestrogen hormones may act as a trigger for attacks. In 2020, 76 women died in Scotland and 37 men, up 15% from the previous year. Some women report asthma attacks are worse around menstruation, and sometimes worse in pregnancy (although sometimes it improves during pregnancy). The Scottish government is still considering candidates for a Women’s Health Champion post which has been promised since August 2021.
According to the two doctors leading the campaign to save the NHS, our health service is in critical condition and may not survive. Dr Julia Patterson, founder of EveryDoctor, a 1500-strong doctor led campaign in England, and Dr Maria Corretge of Scotland, say patient care is suffering and doctors cannot give the care they want. They claim political mismanagement is killing people.
The SNP admits there is a problem but offers little in the way of solutions. Dr Corretge is a geriatrician who says treatment was much better 20 years ago. St Michael’s Hospital in West Lothian faces permanent closure and there has been no fuss made. After the 2018 review, GP practices were supposed to take the pressure off hospitals by becoming super-practices with access to physiotherapists and other health professionals. The flip side of that was never explained, that if a practice faces closure, notes of interest by new ‘providers’ must be sought and if there is more than one note, it must go to tender. If no-one tenders, the practice closes. There is no default for it being taken over by locum GPs via the health board.
Dr Corretge says doctors discharge as many people as they can from hospital, to free up A&E. She claims public debate has been ‘kidnapped by independence’, with party members reluctant to criticise.
In England, GP practices are being bought by American health insurance companies. In Scotland and England, decisions are often taken by non-medical staff with little or no consideration of the impact on patients. Dr Corretge says services are better in continental Europe.
may soon be a thing of the past, due to the falling fees paid by the Scottish government. At present, dentists are paid £1.30 for every £1-worth of treatment (the multiplier), falling from Saturday to £1.20 (multiplier of 0.2), £1.10 from January and from next April they will get no multiplier. Dentists say they just cannot afford to continue, as charges for lab work have increased by 50% in recent months. All that will continue is emergency treatment, pain relief, dressings and repairs, but not for dentures, crowns or even multiple fillings.
Tooth extractions have gone up by 26% on pre-pandemic levels, and desperate people have been resorting to DIY dentistry as they are in so much pain and cannot get NHS treatment.
in Scotland is lagging behind England, according to Dr Maria Corretge, consultant in geriatric medicine at NHS Lothian. A process called thrombectomy is now available across most parts of England but is not established in Scotland. The procedure catches blood clots, but its absence in Scotland has led her to recommend stroke patients going south for treatment. It has been delayed in Scotland due to a lack of radiologists, blaming this on Nicola Sturgeon’s decision when health minister to cut places in medical schools.
The Stroke Association is dismayed that Scotland is lagging behind. Ischaemic strokes can be treated with an injection of Alteplase which dissolves clots and restores blood flow to the brain. Thrombectomy is used for a small number of severe ischaemic strokes.
The Scottish government has set up three hubs in Edinburgh, Dundee and Glasgow, and it is hoped that the national service will be able to treat 600 to 800 patients a year. The UK as a whole has 24 tertiary neuroscience centres providing the service and Scotland hopes to have a 24/7 service established as soon as possible.
seems to be affecting increasing numbers of people since the covid pandemic, involving forgetting people’s names, inability to form sentences and short-term memory lapses like leaving food cooking. Many people affected are under 60, so not likely to have any form of dementia. This type of symptom is most associated with myalgic encephalomyelitis (ME or chronic fatigue). It is also a symptom of Long Covid, which affects 2 million people in the UK. Severe covid appears to have adversely affected people’s IQ, reducing it by an average 10 points.
The damage is equivalent to 20 years of ageing. Experts say this is due to the immune system releasing fighter cells against covid, which then turn on healthy blood vessels and may restrict oxygen to the brain.
Some have reported blacking out. This appears to affect also those who never had covid, but had the covid jag. Some doctors blame depression and/or isolation caused by lockdown, with isolation reducing brain volume in areas associated with learning and memory. The only antidote doctors seem to have is to take up a hobby or learn something, which stimulates the brain.
Some medication given to Alzheimer’s patients may have devastating side-effects. Current practice is to clear away amyloid, a protein which builds in the brains of Alzheimer’s patients instead of circulating in the blood as it usually does. Clumps of amyloid collect between neurons and disrupt cell function, causing brain damage. Anti-amyloid drugs cause the immune system to attack these clumps, but 40% of patients on a trial for aducanumab reported brain swelling called amyloid-related imaging abnormalities (ARIA), as well as headaches, confusion, dizziness and nausea, and in 10% of cases brain haemorrhages.
Aducanumab appears also to cause shrinkage of brain size (brain atrophy) and failed to bring any major improvement in symptoms when tested in America. Another drug lecanemab causes fewer cases of ARIA but does sometimes cause brain swelling and bleeding, although this may be due to the drugs attacking healthy cells as well as unhealthy and inflaming the brain. Scientists increasingly believe amyloid may be a correlation to Alzheimers rather than a causation. Even when all the amyloid is cleared, sometimes patients do not see any improvement in Alzheimer’s.
Worldwide there are 143 drugs currently undergoing Stage 3 trials, the last stage before seeking approval for drugs to be marketed.
Is becoming much more widely recognised but is still often missed. Sepsis is a reaction to an infection causing 48,000 deaths in the UK every year. Blood tests show up sepsis, but they also need to be reviewed very quickly or the condition will rapidly deteriorate. Fever and diarrhoea are signs of infection, treatable with antibiotics which usually clear it up. If they do not, there still may be reasons other than sepsis. All those with infections should be monitored closely for nine red-flag signs including a rash that does not disappear when pressed with a glass (although this could be meningitis), heart rate over 130 beats a minute, drop in blood pressure, not passing urine.
Giving oxygen, intravenous antibiotics, fluids and constant checking of blood and urine for deterioration are vital and doctors should request an Intensive Care Review urgently if the condition does not improve. If you think things should be escalated, push the medical professionals for a second opinion, and keep pushing until they tell you why it isn’t sepsis.
Women may be being misdiagnosed with depression or menopause when what is wrong is an under- or over-active thyroid. Women who get a blood test will find out immediately if their thyroid is overactive (hyperthyroidism) where levels of two hormones in the thyroid are too high, causing palpitations, rapid weight loss, sweating and itching. More common is hypothyroidism, where too few hormones result in weight gain, fatigue, feeling the cold, constipation, dry skin and hair. Women are ten times as likely to be affected as men.
Research last year published in the Lancet suggested that women who experience recurrent miscarriage (3 or more in a row) should have their thyroid tested. Other adverse outcomes can be pre-term birth and pre-eclampsia.
If not the thyroid, it may be a simple iodine deficiency, or using amiodarone for heart rhythm disorders, or even a complication of ‘severe covid. Part of the problem is there is no nationally agreed standard of what a ‘normal’ thyroid is, and the usual prescribed medication can
have differing effects depending on the patient’s age. It is important that the right diagnosis is made and then monitored in case the expected results do not materialise, whereupon different medication (or none) may be needed.
Julia Pannell 31/10/2022