September's menu – food and drugs, followed by arguments about the bill – Health Policy Today, 2 September 2008

The Times today carries a new supplement – Agenda.  Within it is a chart of forthcoming political events.  In health terms, we are in for a month of political debate on food and drugs, followed by an argument about how to divide the bill.


SYMBOLS OR LABELS?

On September the 17th, the Food Standards Agency board will meet in London.  On its agenda will be a report on whether traffic lights symbols or guidance amount labels are the best way to inform health eating choices.

Last week, the Conservatives said their position was to scrap traffic light symbols and instead adopt a pan-European label, stating nutritional values.  The government vigorously defended their traffic light scheme and were backed by the BMA and others.

'behind the seemingly managerialist exterior beats a strong political heart'

In this week’s HSJ, Michael White says we live in a post-ideological, managerial political age.  That may not be entirely true: behind the seemingly managerialist exterior beats a strong political heart.  The classic political divide is, crudely, that Labour is interventionist, suggesting choices, while the Conservatives are more laissez-faire in their approach, believing that full information should be given.  

Labour believes that the green and red lights give shoppers an indication of the nutritional value without studying a complicated chart.  They give people a clear steer.  The Food Standards Agency website explains how it works.

‘So, if you see a red light on the front of the pack, you know the food is high in something we should be trying to cut down on. It's fine to have the food occasionally, or as a treat, but try to keep an eye on how often you choose these foods, or try eating them in smaller amounts.’

Back in February 2007, a survey found that the traffic light system was more popular than the labelling approach suggested by industry .  Parents said they liked the simplicity, some adding that it was good to use with their children.

The objection to the traffic lights approach is that too crude and simplistic.  Tesco argue that while ‘traffic light labelling might appear simpler at first, but the GDA approach (nutritional chart) was more likely to change customer behaviour, and encourage a switch to healthy products.’

'The Conservatives also believe people should have the information they need and make their own choice'

The Conservatives also believe people should have the information they need and make their own choice.   If people don’t understand nutritional information, they would say, the food industry and government should work to improve understanding.  Educate rather than dictate, they might say.

The Conservatives also believe that industry should play a part in the development of guidance to consumers.  They have established a partnership deal, setting up a group to explore an alternative system that provides better information.   Some fear, however, that their position is too close to business.

This view will be backed up by reports today that major “> supermarket chains are responding to the credit crunch by cutting prices.  But the products they are targeting are often unhealthy fatty and sugary foods .

‘The National Consumer Council said fatty and sugary foods now made up more than half (54%) of in-store supermarket promotions, nearly double the number recorded in the last survey in 2006.    Morrisons was the worst offender for the fourth time in a row, with 63% of its promotions featuring sugary and fatty foods, the NCC said.


ACCESS TO DRUGS CONTINUES TO BE AN ISSUE IN ENGLAND AND SPREADS NORTH OF THE BORDER

The political calendar provides plenty of events to heighten, further still, the political debate on access to drugs.  

On the 24th September, NICE will publish clinical guidelines on chronic kidney disease.  The Richards’ Review on co-payments is due on October 1st and the 17th sees the closing date for comments on the draft NHS Constitution, which will clarify the role of PCTs in allowing access to drugs.

Over the last couple of months we have heard about a number of individual cases where individuals cannot access drugs that might extend their lives.  The case being reported today is particularly sad because an error by the NHS is the likely cause of his cancer.  As The Sun put it, ‘NHS gave me big C, but won’t save me’.  The word ‘save’ is a little misleading but it is a moving story.

The Telegraph explained his liver cancer comes three years after he contracted Hepatitis C, as a result of  being given blood from the NHS that was later found to have been infected, bought in from an American firm .


ARGUMENTS ABOUT WHO PAYS THE BILL

If co-payments are permitted in the Richards Review, it will change the balance of who pays for care.  Individuals will finance a greater proportion of their care. The key question is how far this balance is allowed to grow. The NHS Confederation’s response to Review says co-payments should be allowed.  Like others, they seem to come to because they cannot justify not allowing them, not because they believe copayments to be positive. They would limit copayments to drugs that NICE have rejected. Like others, the Confederation is keen that implications of the review are confined. That may not be possible in the long term.  

The question of who pays is also relevant to the argument about food labelling.  The costs of obesity are growing - and some present nightmare scenarios of the future, if current trends continue. It is a problem taking so seriously in Japan that they have legislated maximum waist sizes and is encouraging public (local authority) and private insurers to reduce this with a range of financial penalties if this fails. The question of who pays for the cost of obesity is becoming more politically important.

Another decision with important financial implications is not included in the supplement published in the Times.  The Government is already late in publishing its proposals to amend the way that money is distributed across different Primary Care Trusts, but it will have to respond soon.

There is a pending political debate between Labour, who prefer to distribute according to indices of deprivation, and the Conservatives, who think that greater weight should be given to age.   Arguments about how this cake is divided will become more prominent.