Sunday, 27 June 2010

Time For Soccerball

Its the soccerball foot world kick championships or something taking place apparently there's been some dreadful adverts cynically exploiting support in order to sell fatty snacks and appalling beer.

In marketing world, it seems, the only thing they know about football fan's is that they are passionate and loyal, loyal and passionate and if only their product could tap into that. Except they don't, instead some annoying character pastiche is created who doesn't represent anyone I've ever met and is exclusively male. Presumably all the women are only interested in handbags and Sex and the City 2. This marketing mentality permeates through to the administrators of the game hence daft ideas like the 39th game appear and the only records are Premier League or Champions League ones as if the game magically appeared in 1992 and no records were kept before.

A recent report indicated that many consumers couldn't tell who was a sponsor of the World Cup (I absolutely refuse to prefix it with FIFA which seems to have caught on, in some cases presumably as a contractual obligation but others should really know better) and who wasn't. Presumably makes you wander what they are getting for their money and if it could be better spent.

Tuesday, 8 June 2010

Breast Surgery and the NHS

A woman who is of transsexual history (AC) has lost her case challenging the refusal of her health authority (Berkshire West Primary Care Trust) to fund her breast surgery. Here are my notes from the judgement.

The hormones which she is taking have not in her opinion produced adequate growth. Claimant has not, "at any rate so far, sought to have such surgery (GRS) carried out" which the PCT considers a core service in the treatment of GID.

Her treating clinician stated in written evidence that any attempts to help are not going to be as effective as a surgical solution and that AC has become more fixated on achieving this aim.

NHS authorities have a duty to balance the budget every year they therefore have to find the best use of their finite resources.

The judge appears to be following a line of decisions that state that they would rather the decision is left up to the various medical boards and accession panels. Quoting Lord Bingham in R v Cambridge Health Authority ex parte B [1995] 1 WLR 898.

"...Difficult and agonising judgements have to be made as to how a limited budget is best allocated to the maximum advantage of the maximum number of patients. That is not a judgement which the court can make. In my judgement, it is not something that a health authority such as this authority can be fairly criticised for not advancing before the court."

In other words health authorities have to decide what gives the biggest bang for their bucks, giving priority to grave illnesses.

With regard where transsexuals stand in the priorities the case of North West Lancashire Health Authority v A & Ors ([1999] EWCA Civ 2022) was referred to by the judgement. Glancing at the case they appeal court judges seemed slightly dismissive of the human rights angle, however since then the Human Rights Act has come into force since then as has the judiciaries willingness to apply the act along with the Goodwin judgement.However he agrees that there is no human right to surgery under article 8.

No consensus as to the psychological benefit BA surgery gives to MtF transsexuals or natal females, the case the complainant uses of Ms X, a natal female who received BA support was distinguished by the fact she was suffering severe psychological damage and even then the decision in favour was probably borderline.

It was  advanced that the exceptional circumstances requirement amounted to a blanket ban with regard transsexuals (and therefore discriminatory), the judge didn't agree saying it was psychological need (as in the case of Ms X's greater distress) that was the deciding factor.

The judge therefore dismissed claims that their policy discriminated between natal women and transsexual historied women.


Given the fact her lawyers had to prove some sort of irrationality to succeed I had my doubts it would be successful and so it turned out as Mr Justice Bean dismissed every argument. 

Its simple economics that even the best funded healthcare system does not have infinite resources and the NHS is no exception. Tough choices do inevitably have to be made sadly leading to someone losing out. I hope these considerations are made by rigorous evidence based panels rather than the populist whim of a national newspaper for the foreseeable future. Sadly for most, if not all, MtF women, the process of transition requires very deep pockets to cover what is core to them. I wish AC the best of luck finding the means to fund the surgery in the future.

Elsewhere: Court rules that NHS was right to reject transsexual's breast enlargement claim (via