Commissioning For Outcomes In Health Systems

All health systems can be measured by their success or otherwise in improving the health of the whole population they are responsible for. As resources are always finite, it is not possible to do everything for everybody, so prioritization of resources and interventions is needed. Deciding what health needs should be prioritized and how to meet those needs is the fundamental element within commissioning and leading all health systems around the World.

Commissioners are skilled managers and sometimes have clinical backgrounds. All are required to assess the needs of their population and prioritize the evidence-based interventions to secure the greatest health outcomes from within the limited resources. For over 10 years I was a Director of Commissioning in the National health service in England and one of the few that also had a clinical background. As a commissioning pharmacist I had a unique perspective, understanding both the clinical pathways and the medicines and treatments used by clinicians.

For the duration of my time as a Director of Commissioning, the NHS in England always prioritized the top causes of disease, illness and death in the population. Typically this would be cardiovascular disease, dementia, diabetes, cancer and respiratory disease. Any attempt to secure investment for conditions that were not a priority was almost impossible in a system with limited resources.

Moving to the topic of Covid, where local commissioners have been sidelined as Governments have directed policy centrally, my assessment is that our Governments and leaders have completely failed as commissioners. They have failed the populations they serve and inexcusably have caused more harm than benefit. For much of the last two years deaths associated with Covid have fallen outside the top 10 leading causes of death in the United Kingdom. The question of whether these deaths were caused by Covid or just related to a positive Covid test is now is only now getting the attention it deserves.

The UK Office for National Statistics is now reporting how many of these deaths are due to Covid (in the view of the doctor completing the death certificate) and how many are simply a death with a mention of Covid on the death certificate. Reports from autopsies across the world are demonstrating that perhaps around 10% of the patients previously recorded as dying of Covid have actually died where Covid was deemed to be the cause of death by the certificating doctor. In addition, we already know that the vast majority of patients that have died with Covid have multiple chronic diseases and the average age of death is certainly no younger than the average of all deaths. The extent to which Covid has caused deaths across the World has been greatly exaggerated, possibly using methods that will be seen to be fraudulent.

Taking this latest information into account, Covid can be rightly classified as a minor cause of death in the population. As a commissioner, it has been heartbreaking to witness the rationing of services and delays to treatments for the diseases and conditions that have always been and still are the leading causes of death in our population. We are only just beginning to understand the harm is that has been caused by these polices over the last two years.

Many studies have shown that the harms caused by lockdowns and suspending core health services outweigh the benefits of reducing Covid risks, sometime by as much as a factor of 10 to one. Consequently, I am sure that the impacts of lockdowns masks and other measures on the whole population will be seen to be extremely detrimental. In addition to the harms that have been caused, the expenditure committed in following these policies has been immense. In the United Kingdom it is not clear how much the Covid measures have cost in total, but estimates are that spending on healthcare in the UK has been certainly doubled and perhaps even tripled over the last two years. The economic costs of these failed policies will certainly result in additional harms and early deaths within our population in the years to come.

Government policy has resulted in a situation where we have invested vast additional sums into healthcare and achieved much worse outcomes for our whole population. I am sure that history will judge these policies to have been a monumental failure from a health perspective and also more widely from an economic perspective.

If I had still been a Director of Commissioning in the UK National Health Service during the last two years I would consider that I had greatly failed in my duties and brought considerable harm to the population and also significant destruction to the services in the healthcare sector. In my view the policies that have been followed in the UK and more widely across the World are nothing short of criminal and will be judged as such by society in due course.

Turning to my thoughts as a pharmacist, the management of Covid falls into two areas; the treatments that have been used to help patients with Covid and the vaccinations. Covid treatments have been very closely and unusually directed by governments. The usual course of events in health services empowers local health systems to assess new medicines and make their own decisions as to which treatments are used for individual patients. For Covid patients it has been almost impossible for most healthcare services to use existing tried and tested treatments for respiratory infections that are known to be both safe and effective. Attempts to use any of these treatments have been met with censure or worse for the clinicians involved. Data exists from studies around the world where common treatments for respiratory illnesses have been successfully used to treat Covid patients. The fact that these data have been suppressed and ignored by governments is a criminal act in my opinion.

Clinicians managing patients with a positive Covid test or who are suspected of being infected with Covid in the community are denied treatments that would be given to a patient with identical symptoms had they not tested positive for Covid. A positive Covid test for a patient with respiratory symptoms has resulted in treatment neglect and often a decline in the health of the individual which resulted in hospital admission. Once in hospital new experimental Covid treatments have been used in place of tried and tested therapies that have served us well for decades. Once again, I am sure that in the near future these policies will be demonstrated as having been extremely harmful to patients.

The second group of treatments that are being used to manage Covid of course are the vaccinations. Covid vaccinations have been introduced for whole populations under Emergency Use Authorizations, which have been greatly accelerated as, in the view of Governments, no treatments are available for Covid. The suppression of tried and tested, safe and effective treatments for respiratory disease has allowed governments to bring forward vaccinations under Emergency Use Authorizations.

As a senior pharmacist in health systems I frequently chaired drug formulary committees where new drugs were considered for use in our health services based on their safety and effectiveness data. The data for the Covid vaccines shows beyond any question that these treatments are neither effective nor are they safe. I have no hesitation in saying that if any of these vaccines had come before any committee I was chairing they would not have been approved for use for individuals at risk and certainly not for whole populations, especially in children.

Looking back on the last 12 months of the vaccination program I am filled with extreme sadness at what has happened. Data has been distorted and suppressed, the truth has been hidden and opinion and propaganda has taken centre stage. Patients and clinicians have been led astray by Governments and Pharmaceutical companies.

As I write in February 2022 there are signs that we are nearing the end of the deception as the mainstream narrative of governments is crumbling before our eyes. Society, patients and clinicians are now realizing that they have been deceived by Governments with the assistance of the mainstream, media spreading fear propaganda. But we must not celebrate a victory. This war on truth by our Governments continues and we must continue the fight.