Health
Medicare is bleeding to death. Will Labor ever do anything about it?
GP visits are down 37% since the government took office. But all we get is spin. Decades of inadequate funding and poor policy has driven Medicare to the point of crisis and beyond — and the crunch-point coincided with the election of the Albanese government. It looks as if GP clinics had held out in Continue reading »
Curing Australia’s dependent personality disorder
I arrived in Australia with my family at the time when Malcolm Fraser was the Prime Minister of Australia. He was preceded by Gough Whitlam and succeeded by Bob Hawke and Paul Keating. They were all intellectual, individualistic and humane leaders. I had never felt more secure and proud to be Australian. However, the subsequent Continue reading »
In God we trust
The following words are from Canadian Dr. Yasser Khan (Eye-Facial Plastic Trauma Surgeon) who returned from a humanitarian surgical mission at the European Hospital in Khan Younis, Gaza. He said he has been to over 40 different countries for humanitarian work. What he saw in Khan Younis were, “the most horrific scenes in my entire Continue reading »
‘Please Close My Hospital’
The fundamental problem surrounding the current political debate about the future of the NHS is that it is ignoring the fundamental issue: the current pattern of provision.
On the one hand, the Government is proposing building more hospitals and a 15-year plan for more staff – without any suggestion of how it will cough up the money to pay for it all or enact the immigration policies that would welcome new and needed foreign health workers.
On the other, Labour promises new targets for ambulances and diagnoses times, cutting deaths from heart disease and suicide – targets that presumably can be used to manage NHS managers, who too often carry the can for political failure. While it has gone quiet on “salaried GPs”, more helpfully the Opposition proposes repayment of health professionals university debts and bans on junk food.
However, the missing narrative remains the need for radical change to the NHS’ patterns of care. Neither party’s proposals have the courage to address that.
There is handwringing on both sides about the comparatively low provision of hospital beds. Yes, Germany and France both have more beds per 1,000 population than the UK, assuming they count beds in the same way as we do. But as a percentage of healthcare spend, according to the Office for National Statistics, the proportion of UK expenditure on hospital care (41.8%) exceeds Germany (28.9%), France (38.3%), and even European countries with similar numbers of hospital beds per 1,000 population, like the Netherlands (33.7%) and Sweden (38%).
Simply put, we over-hospitalise, partly because we don’t invest in more appropriate – and cheaper – types of care and partly because the one-stop-hospital-shop is pretty convenient for some of our most powerful clinical workers.
What the health of the nation needs most is a radical reconfiguration of services to less acute, more appropriate, and less expensive care.
The current provision of services does not match current patterns of need, especially among the elderly chronically ill. The political debates give lip service to the need for 'integrated care’ but ignore the elephant in the room – the all-consuming ever-dominant hospital. This lack of acknowledgement undermines the possibility of service transformation by continuing to entrench both money and power in big acute hospitals.
Of course we need hospitals, but not nearly as many as we have currently. I say that as someone who spent two nights in my own local NHS hospital following hip replacement surgery recently. That could not have been done in my home nor (easily) in a community health centre. Some conditions, some services, do need acute hospital facilities.
However, health policy experts estimate that as much as 60% of the NHS’ clinical budget is being spent on the chronic conditions of elderly people and ageing baby boomers which can be cared for in facilities other than hospitals – smart homes, care homes, hostels.
In my own case, my local hospital is located less than a mile from my home, which is great. Within two further miles, however, are two other large acute teaching hospitals that could have provided the same care.
Now, I know friends in rural Scotland, for example, will point out that they have to travel tens of miles to their local hospital. But in our urban areas, we have plenty of hospitals, many of them sited and built before the motor car. Indeed, a former director of healthcare in the London region opined that we could close at least a half dozen acute facilities in the metropolis without any significant impact on the population’s health.
Currently, we do not have enough low-level chronic facilities or home care professionals – neither in cities nor in the shires – because the current configuration of the NHS is so dominated by acute hospitals and by the medical professionals who work in them.
Many of the relatively new Integrated Care Boards are trying to come to grips with this, exercising analytically informed commissioning decisions (of considerable volume and money) in a manner that seeks to change patterns of care. But they are being undermined in their efforts, often being forced by their regional supervisors to first meet the expenditures – frequently in excess of prescribed budgets – of local hospitals, led by hospital managers and clinicians who know that whatever they spend will be covered before any shift of funds to non-acute care. It’s that perverse.
Only large-scale commissioning decisions to close hospitals as part of a programme that simultaneously opens and staffs home care, urgent care centres, smart homes and chronic care facilities is capable of providing the fundamental change we – as potential patients – and the NHS require. Of course, standing in the way are not only the acute elephants but also the political dinosaurs who wish to retain a hospital within site of every ballot box.
The current political talk of reform – on all sides of the political spectrum – only protects the status quo. That’s not good enough.
Greg Parston is a Visiting Professor at the Faculty of Medicine, Institute of Global Health Innovation
‘Breathtaking’
This chat about the ‘Breathtaking’ television drama contains powerful stuff from Dr Rachel Clarke, who, incidentally, actually discloses that she herself sought help for Covid crisis PTSD: Regrettably this is further proof that government doesn’t care for us or about us.. It should make, I hope, all of us voters, think about future government…... Read more
Government’s response to Long Covid inquiry an exercise in sophistry
Preparing government responses to reports from Parliamentary inquiries often involves finding a plausible excuse to reject a perfectly sensible suggestion. The Department of Health and Aged Care failed this task in its response to the House of Representatives Long COVID inquiry. The inquiry began in September 2022 and received almost 600 submissions. It held four Continue reading »
Revealed: Five Politically-Connected Healthcare Giants Rake in NHS Contracts Worth Billions
five politically-connected healthcare giants have profited from a share of public contracts worth at least £70 billion – despite a murky history of scandals and regulatory violations, a new report reveals.
Corporate Watch, a corporate-critical grassroots research organisation, spent several months delving into government procurement data on Bridgepoint, Bupa, Centene, Spire, UnitedHealth Group (UHG) and their myriad of subsidiaries.
In partnership with Good Jobs First, researchers targeted these companies because all five are members of the Independent Healthcare Providers Network – a lobbying group with close links to Rishi Sunak’s post-pandemic Elective Recovery Taskforce, which has effectively ‘turbo-charged’ private healthcare capacity.
During the past 10 years, these firms won a share of public health and social care contracts with a combined value of £70.59 billion, with serious questions also emerging about the opacity of reported contracts, as well as the integrity and reliability of the data made publicly available.
Between 2013 and mid-2023, £61.87 billion of this overall total was awarded without a breakdown of how much money each of the winning bidders were paid. More than one-fifth of contract award notifications did not even report a total value, meaning that the true figures could be far higher.
Other significant obstacles to reporting included missing details related to the extension of existing contracts, inconsistent figures across datasets, and a lack of uniformity in the way data was presented.
Even so, the length of awarded contracts appears to have been increasing over time, as the Conservative administration has sought to ‘lock in’ privatisation, with some tenders set to run for up to 15 years.
Corporate Watch and Good Jobs First uncovered a plethora of financial scandals and violations of patient and worker safety.
In particular, corporate giants Centene and UHG have faced hefty penalties for defrauding patients and public healthcare systems in the United States, where both are based, including to settle allegations of overcharging for Medicare, a US Government health insurance programme, through duplicated or inflated claims.
Perhaps the most egregious scandal to have engulfed any of the UK-based companies targeted in the report was the case of Ian Paterson – a former breast surgeon currently serving a 20-year prison sentence for performing unnecessary or unapproved procedures on more than 1,000 cancer patients at Bupa and Spire hospitals in the West Midlands, with a further 1,500 victims discovered on an old IT database in February 2023.
After his conviction in April 2017, Spire released a statement saying that “what Mr Paterson did in our hospitals... absolutely should not have happened” and expressing “how truly sorry we are” – only to then sue the NHS four months later for allegedly failing to warn it of his conduct. That action came just weeks after the firm was sued by hundreds of Paterson’s patients, who claimed Spire had allowed the surgeon to continue work well after his 2012 suspension by the General Medical Council.
Meanwhile, Bridgepoint subsidiary Care UK has been repeatedly slammed for cost-cutting at the expense of both staff and patient welfare. In 2022, it was fined more than £1.5 million after a resident choked to death.
Similar criticism has been levelled at Bupa, with its UK care facilities variously described over the years as “disgraceful”, riddled with “systemic failings”, and sources of “serious concern”.
In Australia, the 2019 death of an elderly cancer patient, admitted to hospital with maggots crawling in an open and fungated ear wound, saw the firm's CEO forced to “unreservedly” apologise for “totally unacceptable” shortcomings in its aged care network.
The list of top executives and shareholders at each of these firms are politically-connected figures.
When the Government announced the launch of its Elective Recovery Taskforce in December 2022, it was little surprise that David Hare and Jim Easton had seats at the table. As chief executive of the Independent Healthcare Providers Network, it is Hare’s job to represent the interests of firms including Bupa, Centene, Bridgepoint and UHG at Westminster; while Easton previously held several senior NHS positions before becoming CEO of Practice Plus (a Bridgepoint subsidiary) in 2012.
Care UK co-founder John Nash, and UHG’s former head Simon Stevens, who was chief executive of NHS England between 2014 and 2021, join the ranks of at least 16 members of the House of Lords who have at various times declared interests in the companies featured in the recent report.
The wife of Conservative Health Minister Neil O’Brien also currently acts as GP engagement lead for Centene subsidiary Circle Health, while former Tory MP Mark Simmonds has previously worked as a strategic advisor at the firm.
COVID-19 appeared to provide the context for the Government to accelerate a policy of privatisation stretching back over decades. As demand for private treatments slumped, private healthcare providers were given publicly-funded bail-outs – which available evidence suggests actually did little to benefit the NHS or its patients. Significant financial commitments have now been made, either through the issuance of new awards or the inflation and extension of existing arrangements.
The paucity of publicly-available data on these commitments, alongside the list of scandals and regulatory violations, compiled by Corporate Watch and catalogued on Violation Tracker UK and Violation Tracker, raises serious questions about the Government’s decision to entrust the provision of public healthcare to these five companies – themselves just a small handful among hundreds of other firms being awarded contracts, with little competition.
Do you have a story that needs highlighting? Get in touch by emailing tips@bylinetimes.com
UN human rights office ‘appalled’ at rape and execution of women and girls in Gaza
‘Credible’ reports of war crimes against Palestinian women by Israeli soldiers detailed in UN OHCHR statement – yet ignored by western ‘msm’
The horrific treatment of women and girls by Israeli soldiers – including rape and execution – has been condemned by the United Nations Commissioner for Human Rights in a damning statement today from the ‘Special Procedures’ group of human rights experts, saying that the actions of the IDF are likely to amount to prosecutable war crimes.
The statement says that the group:
expressed alarm over credible allegations of egregious human rights violations to which Palestinian women and girls continue to be subjected in the Gaza Strip and the West Bank.
Palestinian women and girls have reportedly been arbitrarily executed in Gaza, often together with family members, including their children, according to information received.
“We are shocked by reports of the deliberate targeting and extrajudicial killing of Palestinian women and children in places where they sought refuge, or while fleeing. Some of them were reportedly holding white pieces of cloth when they were killed by the Israeli army or affiliated forces,” the experts said.
The experts expressed serious concern about the arbitrary detention of hundreds of Palestinian women and girls, including human rights defenders, journalists and humanitarian workers, in Gaza and the West Bank since 7 October. Many have reportedly been subjected to inhuman and degrading treatment, denied menstruation pads, food and medicine, and severely beaten. On at least one occasion, Palestinian women detained in Gaza were allegedly kept in a cage in the rain and cold, without food.
“We are particularly distressed by reports that Palestinian women and girls in detention have also been subjected to multiple forms of sexual assault, such as being stripped naked and searched by male Israeli army officers. At least two female Palestinian detainees were reportedly raped while others were reportedly threatened with rape and sexual violence,” the experts said. They also noted that photos of female detainees in degrading circumstances were also reportedly taken by the Israeli army and uploaded online.
The experts expressed concern that an unknown number of Palestinian women and children, including girls, have reportedly gone missing after contact with the Israeli army in Gaza. “There are disturbing reports of at least one female infant forcibly transferred by the Israeli army into Israel, and of children being separated from their parents, whose whereabouts remain unknown,” they said.
“We remind the Government of Israel of its obligation to uphold the right to life, safety, health, and dignity of Palestinian women and girls and to ensure that no one is subjected to violence, torture, ill-treatment or degrading treatment, including sexual violence,” the experts said.
They called for an independent, impartial, prompt, thorough and effective investigation into the allegations and for Israel to cooperate with such investigations.
“Taken together, these alleged acts may constitute grave violations of international human rights and humanitarian law, and amount to serious crimes under international criminal law that could be prosecuted under the Rome Statute,” the experts said. “Those responsible for these apparent crimes must be held accountable and victims and their families are entitled to full redress and justice,
While Israel’s atrocity propaganda claiming ‘systematic’ use of rape as a weapon of war have been characterised by an absence of evidence and a demand to be believed regardless how lurid and unfeasible the claims have been, and have quickly collapsed under scrutiny – yet have been propagated by western media and governments anyway – the UN experts’ sober claims carry weight and a call for serious investigation, but has been entirely ignored so far by the UK and US ‘mainstream’ media:
SKWAWKBOX needs your help. The site is provided free of charge but depends on the support of its readers to be viable. If you’d like to help it keep revealing the news as it is and not what the Establishment wants you to hear – and can afford to without hardship – please click here to arrange a one-off or modest monthly donation via PayPal or here to set up a monthly donation via GoCardless (SKWAWKBOX will contact you to confirm the GoCardless amount). Thanks for your solidarity so SKWAWKBOX can keep doing its job.
If you wish to republish this post for non-commercial use, you are welcome to do so – see here for more.
Ultra Processed Brain Power
It rather looks as though the ultra processed food companies feeding us all that packaged food and drink may well not good for our brain power – not only do adults get locked into this feedback loop but it is likely be be even more worryingly dangerous for our children’s development. Less than a two... Read more
Prescription Meal Kits Are a New Tool for Managing Diabetes
This story was originally published by Civil Eats.
Recently, at age 72, Shane Bailey changed her grocery store routine. Her first stop is now the produce section to pick up kale, her new favorite food. She prepares it with collard greens, mixes it into stir-fries, and boils it in vegetable broth. Another new love is white sweet potatoes mashed with a dab of butter. She also has a new go-to sandwich: avocado, low-fat mayonnaise, white onions, and alfalfa sprouts between toasted rye bread. “Oh my God, it’s to die for,” she said. She then raves about donut peaches. “Google it!” she insisted. “It looks like a donut, but it’s a peach.”
Bailey was introduced to these new kitchen staples through a prescription meal kit delivery program, known as Healthy Food Rx. A collaboration between local community organizations, the Public Health Institute (PHI), and a large philanthropic fund, the 12-month program delivered meal kits twice monthly for adults with diabetes in Stockton, California. Although the city is located at the top San Joaquin Valley, a major agricultural region, fresh produce is sparse and people in many Stockton neighborhoods struggle with food insecurity.
Over half of the town’s 320,000 residents are diabetic or prediabetic, according to PHI. The Healthy Food Rx program aims to help change that, recognizing the large body of research linking food insecurity and diabetes. So far, the approach — delivering meal kits with enough food for two meals and pantry staples, paired with nutrition fact sheets and cooking lessons — appears promising in managing diabetes.
Alex Marapao leads a cooking class that is streamed to participants in the Healthy Food Rx program. Credit: Abbott Fund
Along with addressing the sharp rates of diabetes in Stockton, a larger goal of the program is to build the case for a program like this to be treated as medicine. It’s part of a nationwide food as medicine movement to prescribe nutritious foods, recognizing the medical capacity of food to help manage or prevent chronic diseases.
So far, the majority of programs under this banner prescribe fruits and vegetables or medically tailored meals that have been pre-prepared and designed to support a particular condition. While home-delivered meal kits have yet to gain widespread traction as a medical intervention, advocates hope that it could offer a more educational approach — while eliminating transportation issues — to supporting people with chronic diseases, which is nearly half of the US population.
Engineering Dietary Shifts
After just six months, Bailey attributes to Healthy Food Rx a dramatic shift in her diet despite a lifetime of ingrained habits. She especially loved the optional cooking and nutrition classes that were offered alongside the meal kits. “It has opened up a whole new area in my shopping list under fresh vegetables,” Bailey said. “It has taught me how to cook things, like dandelion greens and kale, that I never knew existed. It has been very educational.”
The shift has also helped her better manage her Type 2 diabetes. She’s observed a reduction in her A1C levels, a measurement of blood sugar levels used to diagnose diabetes, which fell from 7.2 to 6. It’s a significant drop: An A1C over seven is considered uncontrolled diabetes, increasing the risk of other health complications. Now, her blood sugar levels are in a manageable range. She’s also lowered her dosage of the diabetes medicine Trulicity.
Of course, Bailey’s outcomes may be also attributed to her mindset, one particularly receptive to change. She calls herself a “lifelong learner,” and because she’s retired on a fixed income, she seeks out every free educational opportunity she can find.
Crushed by negative news?
Sign up for the Reasons to be Cheerful newsletter.
[contact-form-7]
This is a broader problem with evaluating lifestyle change programs: They tend to draw people motivated to change. That said, other participants in the program also saw their A1C levels fall into a healthier range.
In fact, an internal study of 450 program participants found a clinically significant decrease in A1C levels — an average 0.8 percent decline — within 12 months for participants with uncontrolled diabetes. The study participants also reported that the dietary shifts helped them exercise and take health education classes more often.
While the study’s limitations make it comparable to an internal evaluation — there’s no control group or peer review — it points to initial promise of meal kits that utilize fresh fruits and vegetables in managing diabetes. (Bailey, who is still in the program, wasn’t in this study.)
A meal kit distributed through the Healthy Food Rx program includes fruit, vegetables, and pantry staples such as nuts and canned tuna. Credit: Abbott Fund
Most of the participants stuck with the program, too: Eighty-five percent stayed for the first six months, and 64 percent stayed for all 12 months. That’s a higher retention rate than other prescription produce programs typically see. Maggie Wilkin, the study’s lead author and the director of research and evaluation at PHI, said the way the kits help participants prepare meals provides a low barrier for participation — the education classes are optional and the kits are delivered by DoorDash, which partners with over 300 anti-hunger organizations.
And it certainly helps that the food is enjoyable. “The feedback we get on these recipes is phenomenal,” said Alex Marapao, a nutrition educator at Stockton’s food bank who is responsible for packaging the meal kits. She curated them with the town’s predominantly Latino population in mind, developing recipes that were nutrient-dense and culturally appropriate, while exposing people to new, easy-to-prep dishes like pressed kale salads. They’ll also throw in staple foods such as eggs, brown rice, or Greek yogurt, depending on what’s available.
Francesca Castro, a clinical research dietitian at Memorial Sloan Kettering Cancer Center who was not involved in the study, was encouraged by the results. “The diabetes results are definitely promising, especially the retention rate,” she told Civil Eats. However, she still considers it preliminary. “These studies are helpful to build the bigger argument and to help build the case for more rigorous studies down the line,” she said.
“In general, as we get more and more research, we’re learning that diet plays a role in everything,” added Castro.
Building the Case for Prescription Meal Kits
Currently, doctors refer patients to the Healthy Food Rx program, but the hope is for it to be one day prescribed by doctors and funded by Medicaid and private insurance.
Food as medicine programs are now in the early stages of being formalized into health care settings and insurance coverage. So far, a handful of states — including Massachusetts, Oregon, California, Arkansas, New Jersey, and North Carolina — have received temporary approval by the federal government to cover food as medicine programs under Medicaid. The approval was granted in most states through a five-year, experimental waiver.
“We have fortunately a lot of programs being integrated into Medicaid right now under our federal waiver. The goal is that these will be permanent benefits under Medicaid here in California,” said Katie Ettman, the food and agriculture policy manager at the think tank SPUR and a member of the Food as Medicine Collaborative. “The idea is that we’re setting up long-term sustainable funding and access for patients.”
Last year, SPUR and the Food as Medicine Collaborative worked with lawmakers to introduce a bill that would make California’s food as medicine programs a permanent provision of the state’s health insurance plans under Medicaid, but it didn’t make it through the state legislature. Ettman said they plan to introduce it again later this year.
“The feedback we get on these recipes is phenomenal,” said Alex Marapao. Credit: Abbott Fund
Prior to the use of this waiver, food as medicine programs were largely philanthropic efforts by nonprofits or hospitals with community benefit spending. “They were … helping to improve health outcomes, but they weren’t necessarily being treated like any other health care provision,” Ettman said. The programs often benefit from philanthropic efforts, but that funding can be sporadic and short term, leaving patients hanging.
“I remember the moment when we [had to tell patients], ‘This is the last prescription that we can give out,”’ said Emma Steinberg, a pediatric hospitalist dividing her time between San Francisco and Boston. “It’s a pretty terrible feeling as a provider to have had this really amazing tool that works well … and then have to be like, “Oh, sorry, no, we can’t do that anymore, because there’s just no money for it.”
Yet Steinberg is hopeful that this will begin to shift as the evidence continues to build for the role of nutrition programs in managing chronic disease. It’s a connection that she said became more glaring during the early pandemic. “Unfortunately, we saw during Covid that diet-sensitive diseases were a huge predictor of more severe disease,” she said.
The Future of Diabetes Care in Stockton
Since the early pandemic, people in Stockton have faced deepening food insecurity. The town’s emergency food bank has observed a steady uptick in clients. In 2022, the food bank reports that it served nearly 300,000 families from the town and surrounding country, which has a population below 800,000 people. This surpasses the number of families it served in 2019 by 141 percent. Both a rise in food prices and end to pandemic-era food aid have made the lack of access to food there much more dire.
This makes food interventions, like the Healthy Food Rx program, all the more critical. But like many food as medicine pilots, it’s not clear how long it will continue. “We are looking into ways to make this program more sustainable over the long term,” said Maggie Wilkin, the study’s lead author. While the initial study has ended, she said they will soon start recruiting for another study on the Healthy Food Rx program, while expanding the food box deliveries to 800 to 1,000 participants from Stockton.
Become a sustaining member today!
Join the Reasons to be Cheerful community by supporting our nonprofit publication and giving what you can.
Wilkin also points to how the program’s local partnerships — with the food bank and the referring federal health clinic — have helped participants continue to receive nutrition and diabetes support even after their 12-month cohort wrapped up. Some are still visiting the food bank.
“It’s really important that you have that infrastructure to provide some sort of sustained health outcomes rather than just a one-time produce prescription,” said Wilkin, who adds that the program is part of a wider support network for diabetes patients.
Participant Shane Bailey is continuing to receive food boxes for another few months as part of an ongoing study. “I think it should continue forever,” she said. “I would love to have the box every week, not every other week.” Regardless, she won’t stop making a beeline for the produce section for her new favorite foods every time she enters the grocery store.
The post Prescription Meal Kits Are a New Tool for Managing Diabetes appeared first on Reasons to be Cheerful.