Press release: How to solve the crisis in A&E, and reduce health inequalities 3.6.13
Since 1.4.13, when the Health and Social Care Act 2012 took effect, the responsibility for the NHS passed from central to local government. The present crisis in A&E is therefore the responsibility of every elected councillor of every Local Authority. They should act through the new committees created for that purpose, namely their Health and Wellbeing Boards.
The chairmen of the new Clinical Commissioning Boards (CCGs) sit on this committee ex officio, and they have the power to do this, as they control about 2/3 of the NHS budget (£65 bn pa nationally, and £400 mpa locally in the city of Brighton and Hove) Councillors can solve the crisis in A&E by telling their CCGs to do what Prince Charles told the World Health Organisation conference 8 years ago (in May 2005) and integrate into the NHS the best of complementary therapy.
Polls show 3 out of 4 patients want complementary therapy (such as yoga classes) free on the NHS, and 1 out of 2 GPs suggest they try it. However, the patient has to pay, which most cannot afford. This is the cause of health inequalities. The rich get complementary therapy, and learn how to live healthily, but the poor cannot afford it, so on average suffer long term conditions 18 years before the rich, and die 9 years earlier, as found by the Marmot report in 2010.
This paper proposes a scheme in which the GPs can prescribe training courses (such as the Mindfulness Based Cognitive Therapy (MBCT) 8 week course, which is NICE-recommended for depression) in the form of a voucher. Patients can trade it for a free course where it is now provided by the third sector, and the facilitator can claim the value from the commissioners in arrears, (as pharmacists now do for drugs.)
Problem. The NHS system is broke
Aneurin Bevan’s promise that the state would look after everyone from the cradle to the grave by giving away free treatment (mainly drugs) has not worked, as public health has declined, as 1 in 4 of us (15 million) now have at least one long term condition. Last year, GPs wrote a billion monthly prescriptions, which implies that half the population are on 3 drugs continuously, the second to counteract the side effects of the first, and the third to counteract the side effects of the second. Unless in emergency patients have to wait a fortnight for an appointment to see their GP, and patients now have to wait 12 hour at A&E.
Solution. Allow GPs to prescribe courses which give patients self help tools to prevent, heal and cure their conditions.
The solution lies in the word ‘doctor’, which comes from the latin verb ‘doctare’, meaning ‘to teach.’ Doctors’ original function in society was to teach people how to live healthily, but this was hijacked by the drug companies, for whom they have become pill pushers. GPs should revert to their original function as teachers, by prescribing NICE-recommended courses which teach self help techniques to prevent, heal and cure dis-eases and long term conditions.
The Mindfulness Based Cognitive Therapy (MBCT) 8 week course is NICE-recommended for depression (CG232004, and CG123 May 2011) This is clinically indicated for one in three patients presenting with anxiety. Transport for London provide it for their sick staff, and have thereby reduced their staff absence rate by 73%. It is provided free on the NHS, but unless you are suicidal, the waiting time is excessive, so GPs cannot readily prescribe it.
Under the NHS constitution, patients have the statutory right to NICE-recommended treatments (including the MBCT course) if their doctor says it is clinically appropriate. Theoretically, the MBCT course is clinically appropriate for the 160,000 patients in Sussex who are depressed. However, the old Primary Care Trust (PCT) only commissioned about 8,000 patient places pa of MBCT courses, which means that the waiting time for a course for depressed patients s 160,000/8,000= 20 years.
To enable GPs to prescribe a MBCT course as easily as Prozac, and for the patient to obtain a course within a few weeks, the CCG should create a voucher system by which the patient could cash the prescription with and private provider of the MBCT course. There are many of these in every town, and they are providing them like evening classes for between £150 and £370 per client.
I have created a company called Social Enterprise Complementary Therapy Company (SECTCo) to provide this voucher scheme in Brighton and Hove. For further details, see www.sectco.org.uk, and www.rteginaldkapop.org sections 9.56,9.57, and 9.59, or contact John Kapp, 22, Saxon Rd Hove BN3 4LE, 01273 417997, [email protected], after 10.6.13.