Be still my quivering heart, I have a plan…

In Australia, defibrillators carried in ambulances are often called ‘Packer Whackers’ – they acquired this name after Kerry Packer. Following a heart attack in 1990, from which he fully recovered, Packer donated a large sum of money to ensure every ambulance from that moment on carried a defibrillator. When he died in 2005, he was one of the richest men in Australia. I mention this as defibrillators can be expensive. I don’t mean the ones you see these days in supermarkets, community centres and so on, but the proper ‘external’ defibrillators that are to be found in most hospital wards and clinical areas. These are expensive, ranging in price from around £6,500 to £10,000 each. 

The hospital where I’m a Non-Executive Director - Wrightington, Wigan and Leigh NHS Trust - has developed a programme of re-providing all the defibrillators across the Trust – which will come in at a total cost of just under £450,000. Kerry Packer did indeed have deep pockets. We are having to do this for two reasons. The main type of defibrillator we use is currently subject to an NHS Patient Safety Alert, and obtaining spare parts is becoming increasingly difficult due to US shipping sanctions. In the short term, until these pieces of equipment are replaced, and staff trained to use them, there are a range of ‘safety nets’ in place to safeguard patients.

Surprisingly, despite defibrillation having been around since 1947 when a defibrillator was first used on a person, the exact mechanism of defibrillation is not that well understood. There are ongoing studies looking at how cardiac tissue responds to electrical shock. It is used as a treatment for life-threatening cardiac dysrhythmias, although it is only appropriate in specific dysrhythmias known as ventricular fibrillation. However, when you need it, the equipment must be there and in good working order. Increasingly, I am becoming worried that this will not be the case post Brexit. And I am not alone in having these concerns.

Last week, The Nuffield Trust published their analysis of what a ‘no-deal Brexit’ might mean for the NHS. Its analysis looked at the possible price increases for medical devices, medicines and other things such as food and blankets. Their analysis estimated that the NHS would need to find another £2.3bn by 2020 – and that is just to stand still! Their estimation also suggests that this is the sum of money freed up for improvements to patient care next year and the following one. This is not intended to be a political blog. There are other better and more able commentators than me to publish such much-needed narratives. No, I mention ‘no deal’ ‘poor deal’ Brexit concerns, as they are symptomatic of the current health and social care zeitgeist.

It seems to me there is an overabundance of rhetoric and a wealth of reductionist ambition, and a lack of economic coherence and investment in the current world view of health and social care. A great example might be to look at the current chaos around this year’s flu vaccination programme. With the flu season just around the corner, many GPs are still having to turn away patients because of a lack of flu vaccine; particularly the catchily-named ‘adjuvanted trivalent flu vaccine (aTIV)’ that is recommended as the preferred vaccine for those over the age of 65 years old.

NHS England last week blamed GPs for the mess, suggesting that they should have ordered more of the drug earlier on in the year, when their advice had been published. This seems a little harsh as the manufacture Seqirus is only making supplies available on a phased basis; the last phase being towards the end of November. In Scotland, the situation is even worse, as the Scottish government failed to get enough stock and are restricting the aTIV vaccine to those aged over 75! Despite Seqirus (and NHS England) claims of increased demand this year, Public Health England’s official data show that the number of patients over the age of 65 receiving the vaccine has dropped significantly this flu season compared with last year. The same is true for the falling uptake among all at-risk groups. It feels like a mess that could have been avoided. 

More generally, the supplies of all medicines might become a lot more difficult and expensive after we leave the EU. Ash Soni, the president of the Royal Pharmaceutical Society noted earlier in the year that the UK simply does not have the manufacturing capacity to supply all the drugs that are prescribed. Many of the medications used in the UK are manufactured and supplied by pharma factories across Europe. When we consider that more than one billion items are dispensed annually, costing £17bn a year, it’s a very worrying thought as to the consequences of interruptions to this supply chain. It’s so worrying, I can feel my heart quivering… 

…hold on, a heart that quivers instead of pumping, results in a cardiac arrest – I hope we have some anti-arrhythmic drugs and a ‘Packer Whacker’ handy…