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Health Care for Britain in Harsh Light Health Care for Britain in Harsh Light
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LONDON — Even as government’s role in health care remains deeply divisive in the United States, the National Health Service remains a beloved cornerstone of Britain’s welfare state. Polls last year showed that Britons are prouder of the health service than they are of the monarchy. They even showed off their affection for the system in the opening ceremony of the 2012 London Olympics.LONDON — Even as government’s role in health care remains deeply divisive in the United States, the National Health Service remains a beloved cornerstone of Britain’s welfare state. Polls last year showed that Britons are prouder of the health service than they are of the monarchy. They even showed off their affection for the system in the opening ceremony of the 2012 London Olympics.
Still, no Briton is ever entirely happy with the taxpayer-funded service, and now the case of a 5-year-old boy with a brain tumor has thrown a harsh light on the $170 billion-a-year system.Still, no Briton is ever entirely happy with the taxpayer-funded service, and now the case of a 5-year-old boy with a brain tumor has thrown a harsh light on the $170 billion-a-year system.
Critics are asking whether the service was justified in refusing a cancer treatment for the boy, Ashya King, sought by his desperate parents in an effort to save his life, and whether it overstepped in trying to impose its decision on his family.Critics are asking whether the service was justified in refusing a cancer treatment for the boy, Ashya King, sought by his desperate parents in an effort to save his life, and whether it overstepped in trying to impose its decision on his family.
The refusal set off a chain of events that enthralled and horrified the British public, as Ashya’s parents removed their son from University Hospital Southampton in England on Aug. 28 without the consent of British doctors, setting off a highly publicized international hunt. Concern for the child, however, turned into public outrage when the parents, Brett and Naghemeh King, were arrested and jailed in Madrid, where they had traveled to sell their holiday home so they could pay for the treatment, called proton beam therapy.The refusal set off a chain of events that enthralled and horrified the British public, as Ashya’s parents removed their son from University Hospital Southampton in England on Aug. 28 without the consent of British doctors, setting off a highly publicized international hunt. Concern for the child, however, turned into public outrage when the parents, Brett and Naghemeh King, were arrested and jailed in Madrid, where they had traveled to sell their holiday home so they could pay for the treatment, called proton beam therapy.
The outcry prompted Prime Minister David Cameron and his health secretary, Jeremy Hunt, to intervene. The British authorities soon dropped their arrest warrant; the parents were released and reunited with their son; and University Hospital Southampton finally approved the therapy that the Kings had sought. Last week, Ashya began the first of 30 treatments at the Proton Therapy Center at the University Hospital in Motol, Czech Republic. “I’m so happy,” Mr. King told reporters in Prague last week. “For one month I’ve tried to get here, and now we’ve arrived. It’s amazing.”The outcry prompted Prime Minister David Cameron and his health secretary, Jeremy Hunt, to intervene. The British authorities soon dropped their arrest warrant; the parents were released and reunited with their son; and University Hospital Southampton finally approved the therapy that the Kings had sought. Last week, Ashya began the first of 30 treatments at the Proton Therapy Center at the University Hospital in Motol, Czech Republic. “I’m so happy,” Mr. King told reporters in Prague last week. “For one month I’ve tried to get here, and now we’ve arrived. It’s amazing.”
Yet even with the turn of events, the National Health Service’s handling of the case remains under scrutiny.Yet even with the turn of events, the National Health Service’s handling of the case remains under scrutiny.
“They treated us like terrorists,” Mr. King, 51, said during an emotional news conference in Spain, where he and his wife were held for three days, separated from their critically ill son, as British authorities pursued University Hospital Southampton’s recommendation that Ashya be made a ward of the court.“They treated us like terrorists,” Mr. King, 51, said during an emotional news conference in Spain, where he and his wife were held for three days, separated from their critically ill son, as British authorities pursued University Hospital Southampton’s recommendation that Ashya be made a ward of the court.
The health service deals with more than a million patients every 36 hours, and it employs more than 1.7 million people. For the most part, its services are free to the 63.2 million residents of Britain.The health service deals with more than a million patients every 36 hours, and it employs more than 1.7 million people. For the most part, its services are free to the 63.2 million residents of Britain.
The current coalition government of Conservatives and Liberal Democrats has frozen the N.H.S. budget and last year it appointed a new director who pledged to overhaul and decentralize the service.The current coalition government of Conservatives and Liberal Democrats has frozen the N.H.S. budget and last year it appointed a new director who pledged to overhaul and decentralize the service.
There is no indication that budget concerns played a role in the Southampton hospital’s decisions about Ashya. The health service has paid for proton beam therapy abroad for other patients (it is not yet available in Britain). The treatment is said to be more precise than conventional radiotherapy, with its effects focused within two millimeters, rather than more than a centimeter with conventional methods. Precision is particularly important in treating children, because damage to adjacent healthy tissue can leave lifelong effects.There is no indication that budget concerns played a role in the Southampton hospital’s decisions about Ashya. The health service has paid for proton beam therapy abroad for other patients (it is not yet available in Britain). The treatment is said to be more precise than conventional radiotherapy, with its effects focused within two millimeters, rather than more than a centimeter with conventional methods. Precision is particularly important in treating children, because damage to adjacent healthy tissue can leave lifelong effects.
Mr. King learned of the therapy on the Internet and suggested it to Ashya’s doctors, but they told the boy’s parents that they were not convinced that it would work better than traditional radiation. According to Cancer Research UK, a charity, proton beam therapy is recommended for just 1 percent of cancer patients in the United Kingdom. Mr. King learned of the therapy on the Internet and suggested it to Ashya’s doctors, but they told the boy’s parents that they were not convinced that it would work better than traditional radiation. According to Cancer Research UK, a charity, proton beam therapy is recommended for just 1 percent of cancer patients in Britain.
About 400 patients, mostly children, have been sent abroad for proton beam therapy by the National Health Service since 2008, officials said. Matthew Watts, a spokesman for University Hospital Southampton, said that the hospital refers about five cases a year to centers in the United States.About 400 patients, mostly children, have been sent abroad for proton beam therapy by the National Health Service since 2008, officials said. Matthew Watts, a spokesman for University Hospital Southampton, said that the hospital refers about five cases a year to centers in the United States.
One beneficiary was Ross Anderton, who was found to have a rare cancer, orbital rhabdomyosarcoma, six years ago when he was 16 months old. His mother, Lesley Anderton, said she was given two choices: doctors could remove Ross’s affected eye, or he could undergo radiotherapy, with a risk of damage to his pituitary gland, his hearing and parts of his brain. His doctors did not mention proton beam therapy until Mrs. Anderton found it on the Internet and suggested it.One beneficiary was Ross Anderton, who was found to have a rare cancer, orbital rhabdomyosarcoma, six years ago when he was 16 months old. His mother, Lesley Anderton, said she was given two choices: doctors could remove Ross’s affected eye, or he could undergo radiotherapy, with a risk of damage to his pituitary gland, his hearing and parts of his brain. His doctors did not mention proton beam therapy until Mrs. Anderton found it on the Internet and suggested it.
Setting aside their initial hesitation over an unfamiliar new treatment, the doctors referred her son to a hospital in Florida, and the National Health Service covered the cost — around $325,000 for the eight-week treatment, Mrs. Anderton said — other than the travel expenses. The service has also paid for follow-up treatments for Ross, who is now 6.Setting aside their initial hesitation over an unfamiliar new treatment, the doctors referred her son to a hospital in Florida, and the National Health Service covered the cost — around $325,000 for the eight-week treatment, Mrs. Anderton said — other than the travel expenses. The service has also paid for follow-up treatments for Ross, who is now 6.
The circumstances of the Ashya King case are different. Doctors removed his tumor, called a medulloblastoma, and recommended a combination of chemotherapy and radiotherapy after surgery to maximize his chances of surviving. The Kings disagreed, arguing that conventional radiation was unsuitable for a child as young as Ashya. “The hospital wanted to kill him, turn him into a vegetable,” Mr. King said at the Madrid news conference.The circumstances of the Ashya King case are different. Doctors removed his tumor, called a medulloblastoma, and recommended a combination of chemotherapy and radiotherapy after surgery to maximize his chances of surviving. The Kings disagreed, arguing that conventional radiation was unsuitable for a child as young as Ashya. “The hospital wanted to kill him, turn him into a vegetable,” Mr. King said at the Madrid news conference.
Proton beam therapy is generally not recommended for a medulloblastoma, a highly malignant cancer that emerges in the back and the bottom of the brain, cancer experts said. Roger Taylor, oncology vice president of the Royal College of Radiologists, said conventional radiotherapy is more effective when there is a risk that cancer cells have spread, such as through the cerebrospinal fluid in the brain and spine; that kind of spreading is common with medulloblastomas.Proton beam therapy is generally not recommended for a medulloblastoma, a highly malignant cancer that emerges in the back and the bottom of the brain, cancer experts said. Roger Taylor, oncology vice president of the Royal College of Radiologists, said conventional radiotherapy is more effective when there is a risk that cancer cells have spread, such as through the cerebrospinal fluid in the brain and spine; that kind of spreading is common with medulloblastomas.
Even so, University Hospital Southampton said it agreed to supply a referral for proton-beam treatment overseas after Ashya’s family said it could pay for it privately. But a few days later, the distressed parents removed Ashya from the hospital without notifying doctors, setting off the hunt and arrest.Even so, University Hospital Southampton said it agreed to supply a referral for proton-beam treatment overseas after Ashya’s family said it could pay for it privately. But a few days later, the distressed parents removed Ashya from the hospital without notifying doctors, setting off the hunt and arrest.
And that is where the system failed, said David Hunter, a professor of health policy and management at Durham University in England. Communication between doctors and parents broke down, he said, leading to the Kings’ decision to flee and the hospital’s pursuit of them.And that is where the system failed, said David Hunter, a professor of health policy and management at Durham University in England. Communication between doctors and parents broke down, he said, leading to the Kings’ decision to flee and the hospital’s pursuit of them.
Professor Hunter also said that, because the health service is publicly accountable, doctors tend to be reluctant to recommend innovative solutions for fear of lawsuits if things go wrong.Professor Hunter also said that, because the health service is publicly accountable, doctors tend to be reluctant to recommend innovative solutions for fear of lawsuits if things go wrong.
Mrs. Anderton, too, said that, despite the excellent care her son received, the N.H.S. is not always at the cutting edge. “The only downside is that we don’t have advanced types of treatments that could be lifesaving,” she said.Mrs. Anderton, too, said that, despite the excellent care her son received, the N.H.S. is not always at the cutting edge. “The only downside is that we don’t have advanced types of treatments that could be lifesaving,” she said.
After the warrant against Mr. and Mrs. King was lifted, the trust that runs the hospital in Southampton released a statement in support.After the warrant against Mr. and Mrs. King was lifted, the trust that runs the hospital in Southampton released a statement in support.
“It is good news that Ashya’s treatment can be resumed without delay, and we are delighted for him that the situation has now been resolved,” the trust said.“It is good news that Ashya’s treatment can be resumed without delay, and we are delighted for him that the situation has now been resolved,” the trust said.
The Kings still face substantial challenges, though, including the bill for the treatment in Prague, expected to be at least $113,000. It is not clear who will pay.The Kings still face substantial challenges, though, including the bill for the treatment in Prague, expected to be at least $113,000. It is not clear who will pay.