Ed, Quarterly admin matters to do with my business now out of the way, I turn with pleasure to perusing, and trying to do justice to your last message. However, before I do so, let me describe my experience in attending hospital for daily X-Ray treatment for prostate cancer because this is very apposite to what I will write later in reference to your piece. This treatment is being carried out on the NHS (National Health Service) that is, free. (As a brief aside, it is useful to remind ourselves that the NHS, was instituted by the Attlee's Labour Government in 1945, immediately after the war, and was negotiated with great difficulty against the fierce resistance of the medical profession by one of our greatest politicians, Nye Bevan. In order to bring the NHS about, Bevan had to compromise on many matters, particularly on the matter on the recruitment and credentialism of doctors and consultants, the restrictive practices of which were retained [even to this day] by the various medical professional bodies and colleges -- or, in other words, their trade unions. (I will continue the aside a little longer by saying that it is also apposite to say that the NHS was founded on a fallacy. This is, that once the huge investment [and it *was* huge for those days] was out of the way, and the NHS was working normally, then annual expenditures would gradually decline over a period of a decade or so to a low standing level because everybody, particularly the working class, was restored to full health and did not need much more by way of medical treatment. This notion now seems ridiculous to us but it was universally believed then. We now know that treatments for an ever expanding list of disease and handicap is growing far faster than can be afforded. How medical treatment is rationed from now onwards is becoming a very serious issue, particularly in the modern political climate when everybody thinks they have a "right" to the latest and best possible treatment for their particular complaint, no matter how expensive this may be.) After initial tests and a biopsy at a Bath Hospital I then had to attend a Bristol Hospital where I had a "planning X-Ray" (to establish all the physical parameters of my prostate, hips and so forth) and a bone scan (to establish a "background" scenario in case the cancer spreads to the bone in later months/years). The results of these were then sent back to the Physics Department at Bath Hospital where precise treatment conditions (intensity and direction of X-rays) were established for the particular X-Ray apparatus (an accelerometer) to be used at Bath Hospital. Now all these preliminary procedures from the start of my initial interview with my local doctor to establishing the conditions of treatment took five months! This involved something like 12 different consultations backwards and forwards between here (Bath) and there (Bristol -- 20 miles away) with at least five different doctors. Now I know that had an advanced cancer been suspected from the beginning and not at an early stage, as mine is, I would have had emergency treatment (probably an operation), and it doesn't really matter in my case, medically, that this stage was so prolonged. But the point is that all this so far has been incredibly inefficient and costly. If I were an ordinary working person on a hourly rate of pay, these procedures at the convenience of the consultants/NHS would have taken at least 5/7 working days -- costing me about (if I were a bricklayer, say) US$1,000. But the opportunity cost to the NHS (and to me as a tax-payer) of the repeated leisurely consultations (each one taking a fortnight to set up, etc) and so forth must be at least US$5,000. So now to the actual treatment at Bath Hospital. Fortunately, I live fairly close by and it takes about 30 minutes to get there. Although the treatment only takes about 10 minutes every day, if I lived much further out (as most cancer patients do) this would probably cost me half a day's pay each time (again, if I were a hourly-paid working man). My treatment consist of lying on a bench and am shot at with radiation from three different directions for about one minute each time. My exact position on the bench and all the other physical parameters of the apparatus are set by the two radiographers who attend me. (For safety [and legal] reasons, there have to be two. One speaks out the precise instructions laid down by the Physics Department, the other sets the position of the apparatus each time and responds to the other radiographer by repeating the conditions -- exactly the same as pilot and co-pilot do on a big airplane.) Even though the radiographers are intelligent and fully qualified people, the procedures they follow are standardised, and really could be carried out by any reliable individual of ordinary intelligence. (The point to make here is that, overall, there is a 40% shortage of qualified radiographers in England -- because of excessive credentialism and protective practices.) I'm informed that this piece of X-Ray apparatus cost well above US$2 million. It is used from 8.00am to 3.00pm for five days a week. The point to make here is that if this treatment were done by private sub-contractors (and if they were given a free hand in the recruitment of non-qualified radiographers for this rather pedestrian stage of the treatment), then such an expensive apparatus would be used for at least two daytime shifts -- morning and afternoon, say, from 8.00am to 10.00pm -- just as an engineering firm would do with an expensive machine tool. I spent 20 years in the engineering industry and am reasonably acquainted with the costs and maintenance of machine tools and other sophisticated equipment, having had responsibility for at least US$200m of such, I guess. I would say that if the X-Ray apparatus were to be made in larger numbers for private sub-contractors instead of the NHS alone then the cost could be reduced to that of a luxury car -- probably about $200,000 at the very most. (Also, at the present time, because of the small demand, the manufacturers of the apparatus are probably in a monopolistic situation and they are probably vastly overcharging the NHS.) I understand that my daily X-Ray treatment is costed out by the NHS at something like US$250. If, say, there were two or three sub-contractors in Bath competing with one another, and if they were allowed to recruit intelligent, but somewhat less qualified, radiographers, I have no doubt at all that the cost of daily treatment could be brought down to US$50. Whether this were paid by the NHS or by individuals as a private fee is beside the point. Also, anybody who has lost wages by attending between 8.00am and 3.00pm as at present could attend an evening session and lose no pay. So that's my example from my limited experience of the NHS. I have little doubt whatsoever that the total cost of the NHS, due to inefficiency, and being mainly labour-intensive, is probably two or three times more than it needs to be. I have chosen "two or three" times not only based upon my limited experience in the NHS as described above but also from what is clear from the privatisation of many state industries in the last 20 years in the UK -- and also from improvements in efficiencies within private industry (such as I experienced in engineering) -- where the cost of white collar overheads, after successive redundancies, are typically reduced to 33% of the previous. It's also apposite to mention that prostate cancer kills about 20,000 males every year in the UK. However, the NHS has made no attempt to publicise mass screening of prostate cancer among males (as they have done under pressure for breast cancer for females) even though early diagnosis produces a 95% cure rate. The NHS could not do so for cost reasons. If we had an efficient and competitive screening and treatment scenario (and sufficient publicity/advertising) then, probably, at least 15,000 lives could be saved every year (or, more correctly, death postponed!). And now, needing to take my dog for a walk and have breakfast, I'm going to delete your original message from this and reply to it separately, hopefully later today. Keith Hudson ___________________________________________________________________ Keith Hudson, General Editor, Calus <http://www.calus.org> 6 Upper Camden Place, Bath BA1 5HX, England Tel: +44 1225 312622; Fax: +44 1225 447727; mailto:[EMAIL PROTECTED] ________________________________________________________________________
