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30 April, 2007

British Doctors call for health boss Hewitt to resign

Junior doctors have called for Health Secretary Patricia Hewitt and Health Minister Lord Hunt to resign over "shambolic" medical training reform. The British Medical Association's junior doctors conference called the Medical Training Application Service's problems "gross negligence". The online job application service was suspended amid fears personal details of applicants could be accessed online. The government says it is working hard to ensure the security of the system.

Earlier, the BMA called for Tony Blair to step in to avert more chaos over the online application system. BMA chairman James Johnson has written to Tony Blair warning doctors' anger will grow if the government does not address the problems with MTAS "with the level of urgency they deserve". He said the mistakes had the potential to damage patients' confidence in the proposed new database of individual health records.

The conference also criticised failures in the Modernising Medical Careers (MMC) scheme and demanded a review into the waste of public money it claims it has caused. The delegates also raised concerns that the implementation of MMC speciality training would have "grave consequences for patient care".

The issue is also mired in internal feuding, with some doctors calling on their own leadership to resign for participating in the government review. Delegate Dr Andrew Smith said there was "more anger and resentment than ever before". Despite this the BMA leadership had remained engaged in and endorsed the "fiasco that is MMC", he said.

Health Secretary Patricia Hewitt has already apologised for the "terrible anxiety" caused to junior doctors over the scheme. BMA junior doctors committee head Jo Hilborne told the conference that modernising medical careers should have brought an end to uncertainty for senior house officers. But instead, she said it had brought the fear of career stagnation, the danger of falling standards and loss of good doctors. She called the application system a "desperate failure". "The fault is with this government which has systematically ignored the people whose lives are being ruined by their ill-thought out, badly implemented policies," she said.

Conference delegates suggested the system should be scrapped and suggested two possible solutions to the MTAS problems. They said either all candidates starting posts in 2007 must be interviewed for all their choices, or all MMC training be postponed and a return made to the old system (SHO/specialist registrars) for a year while a new application process was devised. The MTAS computer system has previously been criticised for not allowing candidates to set out their experience, meaning the best candidates have not been selected for interview. But it has also been attacked for having too few jobs for the number of candidates.

Conference delegates also passed a motion calling for the National Audit Office to investigate how much public money had been spent on the computer system. And they sought guarantees that no junior doctor would be unemployed as a result of system failures.

The BMA estimates that 34,250 doctors are chasing 18,500 UK posts, due to start in August. But it has warned thousands of NHS doctors could go to work abroad because of their disgust at the process.

Lord Hunt insisted it was not a resignation issue and that all the medical organisations had called for the old system to be changed because it was not working. Earlier he told the BBC action was being taken to make the system more secure. "We have brought in over the weekend some independent experts from outside companies. They are clawing through it to make sure it is secure and we will only open it up again when we are satisfied about that."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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29 April, 2007

Universal health care's dirty little secrets

What many politicians and many other Americans fail to understand is that there's a big difference between universal health care coverage and actual access to medical care. Simply saying that people have health insurance is meaningless, say Michael Tanner, director of health and welfare studies, and Michael Cannon, director of health-policy studies at the Cato Institute.

Many countries provide universal insurance but deny critical procedures to patients who need them:

* Britain's Department of Health reported in 2006 that at any given time, nearly 900,000 Britons are waiting for admission to National Health Service hospitals, and shortages force the cancellation of more than 50,000 operations each year.

* In Sweden, the wait for heart surgery can be as long as 25 weeks, and the average wait for hip replacement surgery is more than a year.

According to Cannon and Tanner, the uninsured in the United States don't receive substandard care:

* Helen Levy of the University of Michigan's Economic Research Initiative on the Uninsured, and David Meltzer of the University of Chicago, were unable to establish a "causal relationship" between health insurance and better health.

* Similarly, a study published in the New England Journal of Medicine found that, although far too many Americans were not receiving the appropriate standard of care, "health insurance status was largely unrelated to the quality of care."

Everyone agrees that far too many Americans lack health insurance. But covering the uninsured comes about as a byproduct of getting other things right, say Tanner and Cannon. The real danger is that our national obsession with universal coverage will lead us to neglect reforms -- such as enacting a standard health-insurance deduction, expanding health-savings accounts and deregulating insurance markets -- that could truly expand coverage, improve quality and make care more affordable.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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28 April, 2007

Pensioner is refused sight drugs – until he goes blind

Socialist "compassion" at work. Elderly people can go blind for all they care

A RETIRED policeman is going blind – because a Yorkshire health trust will not pay for treatment that could save his sight. Leslie Howard, also an ex-Royal Military policeman and former prison officer, suffers from a degenerative eye condition. The drugs needed to save his sight are available on the NHS in other parts of the country. But Mr Howard, 76, has been told by health chiefs not to expect a penny of NHS treatment until he goes blind in one eye and starts losing sight in the other. He fears that after a lifetime of public service the decision by North Yorkshire and York Primary Care Trust could plunge him into total blindness and leave him and his invalid wife Mary Ann, 70, housebound.

As his case led to a new row over NHS "health rationing", Mr Howard, of Acomb, York, said: "The problem is we have lived too long and are just pieces of meat now – a nuisance. "I was advised to go private but was quoted 1,000 pounds an injection for who knows how many injections. I can't afford that kind of money. I've paid tens of thousands of pounds in taxes and to know that I will now lose my sight because I can't afford private treatment is diabolical."

Mr Howard was diagnosed with wet age-related macular degeneration (AMD) in his right eye in November. It can cause sight loss in three months. He says he was advised by the North Yorkshire and York PCT that it would only consider funding once he had gone blind in one eye and developed a similar condition in his second eye. He added: "It is more than three months since I was diagnosed and it is getting worse by the day. Has the Government lost all sense of compassion as well as economics?"

The head of campaigns at the Royal National Institute of the Blind, Steve Winyard, said: "This is a desperate situation for Mr Howard. His care trust is leaving him to go blind in one eye even though sight-saving treatments are available on the NHS. "We hear of more and more patients being forced to use retirement funds or life-savings to pay for sight-saving treatments that should be available readily on the NHS. "In cases like Mr Howard's, where people can't afford private treatment, patients face the prospect of going blind unnecessarily."

The chief executive of the Macular Disease Society, Tom Bremridge, added: "The so-called 'second-eye' policy is wholly unacceptable on ethical and practical grounds." Losing sight in one eye could affect a person's co-ordination and increase the risk of falls, while not treating the condition meant patients had a high risk of developing the problem in the second eye. Unsuccessful treatment in the second eye could then mean total blindness, Mr Bremridge said. He added: "It also makes no economic sense to deny treatment. The cost of supporting people with sight loss far outweighs the cost of treatment."

AMD sufferer and former Halifax Labour MP Alice Mahon, who took legal action against her PCT and forced a U-turn over its refusal to provide similar injections on the NHS, said: "It is an obscene policy. It's outrageous. "The whole fault is handing over all this funding to the PCTs, so it's a postcode lottery and not a national health service. I am particularly concerned there seems to be discrimination against older people who have paid into the NHS all their lives."

The North Yorkshire and York PCT said yesterday Department of Health guidelines were that, until the National Institute for Health and Clinical Excellence (NIHCE) published final guidance on new treatments, NHS bodies should continue local arrangements to manage their introduction.

There was no NIHCE guidance yet for the drugs Mr Howard wanted. So in agreement with other PCTs in the region, the trust was funding such treatments only in cases where there was evidence they would work. If any patient felt they should be considered for treatment the PCT would examine their circumstances, a spokesman added.

Source

And he's not alone:

A WIDOWED grandmother who devoted 30 years of her life to the NHS and twice fought off cancer has become the latest patient in Yorkshire to be warned she faces being denied vital treatment for a condition which causes blindness. Retired midwife Doreen Kenworthy was last week given the devastating diagnosis that she was suffering from the eye condition age-related macular degeneration.

But her shock was compounded when doctors told her the NHS would not pay for treatment until she lost the sight in her affected eye and began to lose it in the other – although further loss of sight could be prevented if she paid out thousands of pounds for private care. Her plight is similar to that of York pensioner Leslie Howard who was refused immediate NHS treatment, although a private hospital group has now stepped in to give him the care he needs. Dr Kenworthy, 56, of Stanley, Wakefield, has vowed to fight to get sight-saving treatment.

"I am not prepared to die of cancer, neither am I prepared to go blind whilst fighting it," she said. "I have never been a supporter of the private sector in my professional life. I believe in Aneurin Bevan's philosophy of free healthcare access for all at all levels. "I understand there are cutbacks, although I don't agree with the way the Labour Government has handled the NHS, but to be told 'Sorry you have to go almost blind before you get help' is dreadful."

Dr Kenworthy, who worked as a midwife and later trained midwives before retiring last year from Bradford University, said she was diagnosed with breast cancer two years ago, undergoing a year of treatment before the condition recurred in January. The eye complaint was unrelated but she had already lost some central vision in her right eye which began deteriorating a month ago. She was urgently called for tests at St James's Hospital in Leeds where specialists told her she had the eye complaint and further deterioration could be prevented only by drug injections.

She was told these were only provided by the NHS after she lost her sight in one eye and began to lose it in the other – although they were available privately at a cost of up to 1,000 each over 12-24 months. "I did not expect to be told that I couldn't be treated on the NHS but if I went into the private sector I could be treated tomorrow," she said.

Dr Kenworthy, who has twins aged 31 and four grandchildren, said the only option she had to fund the treatment was by remortgaging her home. "To have to tell your children twice you've got cancer, then to say by the way you're going blind in your right eye and can't have any treatment until it affects your other eye is very hard," she said. "It's been devastating to have cancer twice in two years, to fight it, to retire after 30 years in the NHS and then get this on top."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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27 April, 2007

HillaryCare Installment Plan

The Schip strategy for government-run health care

Any doubt that "universal" health care has returned as a dominant political issue vanished with last month's forum for Democratic Presidential candidates in Nevada. "We need a movement," Hillary Clinton declared. "We need people to make this the No. 1 voting issue in the '08 election."

She and her friends in Congress are already working on it, notably by proposing to greatly expand the State Children's Health Insurance Program. "Schip" was enacted in 1997 as Bill Clinton's health-care consolation prize after the implosion of HillaryCare. It expires in September without reauthorization, and Democrats are using the opening to turn it into another giant middle-class health-care entitlement. Call it HillaryCare on the installment plan.

Schip was conceived--or at least sold--as a way to insure children from low-income families that aren't poor enough to qualify for Medicaid. Included as part of the Balanced Budget Act of 1997, Schip began as a federal block grant of about $40 billion over 10 years. States receive an annual fixed federal contribution. Then they match the funds and design their own programs, by expanding Medicaid, creating a separate Schip program or some combination. States determine eligibility and benefits; some have premiums or co-pays, usually at negligible rates.

The Bush Administration wants to add $4.8 billion to the Schip budget, bringing it to $30 billion over the next five years. Democrats want to see that and raise by $50 billion to $60 billion. They pronounce Schip "underfunded"--and sure enough, 2007 funding already falls short of covering enrollees in 18 states by about $900 million.

But this "crisis" arose because some states have grossly exceeded Schip's mandate. They are using the program to expand government-subsidized coverage well beyond poor kids--to children from wealthier families and even to adults. And they're doing so even as some 8.3 million poor children continue to go uninsured.

The Schip legislation defines potential recipients as children in families making twice the federal poverty line, or $41,300 a year for a family of four. But states are encouraged to apply for waivers to allow for more flexibility. Now 15 states have eligibility thresholds above 200% of poverty, and nine of those are at or over 300%. In New Jersey, the figure is 350%. New York recently passed a budget raising eligibility to the highest in the nation at 400%--or $82,600 for a family of four. That's an income close to what Democrats usually define as "rich" when they're trying to raise taxes.

Some states are using Schip to create universal child health programs, regardless of need. Governor Rod Blagojevich recently expanded the Illinois Schip program to insure all children, with premiums and co-pays based on parental income. Pennsylvania's "Cover All Kids" and Tennessee's "Cover Kids" programs do the same.

As of February 2007, the Government Accountability Office found that 14 states were using Schip to cover adults: pregnant women, parents of Medicaid or Schip kids--and even childless adults. Arizona, Michigan, Minnesota and Wisconsin cover more adults than children. In 2005 Minnesota spent 92% of its grant insuring adults, and Arizona spent two-thirds the same way.

And no wonder: The Schip funding structure provides incentives for running over budget. In three-year periods, all unspent Schip allocations across the 50 states are tallied up and redistributed. A state that exceeds its allotment gets more money from a state that didn't. In the 14 states that went over budget in 2005, 55% of Schip recipients were adults.

We're all for federalism, and if states want to raise taxes to pay for government-run health care, they have every right. The problem is when they exploit federal policy loopholes to do so and thus stick taxpayers in more responsible states with a larger tab. In 2005, 28 states received an extra grant, either through redistribution or the feds picking up the check for overruns. Thus the federal government pays about 70% of total Schip outlays, despite the premise of "matching" state grants.

A bill introduced by Senator Clinton and Representative John Dingell would make all of this worse. It would index government Schip outlays to national health spending and growth in states' child population. Without "quantifiable" progress--i.e., expanded rolls--funding drops. The legislation would also create incentives for states to expand Schip to the New York level of 400% of poverty. If this keeps up, a family will soon be eligible for Schip and subject to the Alternative Minimum Tax.

In other words, what began as a hard-cap grant to cover the working poor is evolving into an open-ended entitlement to cover whatever promises states make. And all under the political cover of helping "children." Instead of debating government-run health care on its merits, Democrats are building it step by step on the sly. Or as Mrs. Clinton put it in Nevada, "Make no mistake. This will be a series of steps."

There's a lesson here for Republicans, who agreed to create Schip in a trade for Mr. Clinton's signature on their "balanced budget." Balanced budgets vanish in the blink of an election, while entitlements like Schip live on and expand as an ever-larger claim on taxpayers. Mark this down as another case in which Bill Clinton outfoxed Newt Gingrich. The least Republicans can do now is work to return Schip to its original, more modest purposes.

Source




Fake medical degrees accepted by Australian health bureaucrats

Those guys sure are good at protecting the public

A scandal over purported overseas-trained doctors in a Queensland public hospital is widening after revelations that a Russian nurse used an online medical degree from the Caribbean to get a job, while a Chinese woman used documents showing she would have just turned 14 when she went to medical college in Shanghai. Evidence obtained by Chief Health Officer Jeanette Young in an investigation into the hiring of three junior doctors, or interns, at Cairns Base Hospital has appalled officials and Queensland Health Minister Stephen Robertson, sources told The Australian yesterday.

Queensland's anti-corruption body, the Crime and Misconduct Commission, will soon join the Health Quality and Complaints Commission and the Medical Board in a wide-ranging inquiry into why the hospital bypassed checks and balances before hiring the interns on more than $60,000 a year each. One of the three recruits could not speak English and was unable to communicate with anyone on the wards. Dr Young's investigation began after The Australian revealed, two weeks ago, serious concerns about the interns' qualifications.

Since initial claims by Cairns Base Hospital managers that the recruits were observers who had no unsupervised contact with patients, Dr Young has studied the charts of more than 500 patients and discovered that in a number of cases there were unsupervised examinations, diagnoses, orders for pathology and prescriptions. "The hospital's staff took the view that they would employ the purported doctors and, eventually, the Medical Board would get around to registering them," said a senior health source in Brisbane. "It is untenable. There will bean array of investigators descending on Cairns in the coming weeks." Mr Robertson's spokesman said: "We are concerned about the information emerging. But we can't say anything until we get Dr Young's report."

Health sources said the documentation relied on by the Russian nurse and the Chinese woman to obtain employment in Cairns made the CMC's involvement essential. CMC investigators will be given the task of tracing the documentation of the Russian nurse, whose curriculum vitae was contradictory. The nurse claimed to have received a medical degree from a university in the Caribbean. However, preliminary investigations revealed it was an internet-based qualification and should not have been recognised by Australian medical authorities. "It is a rather unusual degree in that it is an online degree with the teaching done online," a source said.

Dr Young's spokesman said: "The investigation is ongoing and is a matter of priority. The Chief Health Officer is happy to advise that the investigation thus far has uncovered no evidence of patient harm." A former colleague of the Russian nurse has communicated concerns to Queensland authorities about his conduct in a previous workplace. Several Cairns colleagues of the Chinese recruit have rallied to support her as a "person of integrity", with sufficient clinical skills to do a supervised internship prior to an examination by the Australian Medical Council. She has obtained statements from former students of the university in Shanghai who have said they were also aged 14 when they began medical training.

The controversy comes as Queensland prosecutors liaise with US counterparts to extradite Jayant Patel, the surgeon who has been blamed for contributing to at least 17 deaths at the Bundaberg Base Hospital.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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26 April, 2007

Your regulators will protect you

The Food and Drug Administration has known for years about contamination problems at a Georgia peanut butter plant and on California spinach farms that led to disease outbreaks that killed three people, sickened hundreds, and forced one of the biggest product recalls in U.S. history, documents and interviews show. Overwhelmed by huge growth in the number of food processors and imports, however, the agency took only limited steps to address the problems and relied on producers to police themselves, according to agency documents. Congressional critics and consumer advocates said both episodes show that the agency is incapable of adequately protecting the safety of the food supply.

FDA officials conceded that the agency's system needs to be overhauled to meet today's demands, but contended that the agency could not have done anything to prevent either contamination episode. Last week, the FDA notified California state health officials that hogs on a farm in the state had likely eaten feed laced with melamine, an industrial chemical blamed for the deaths of dozens of pets in recent weeks. Officials are trying to determine whether the chemical's presence in the hogs represents a threat to humans. Pork from animals raised on the farm has been recalled. The FDA has said its inspectors probably would not have found the contaminated food before problems arose. The tainted additive caused a recall of more than 100 different brands of pet food.

The outbreaks point to a need to change the way the agency does business, said Robert E. Brackett, director of the FDA's food-safety arm, which is responsible for safeguarding 80 percent of the nation's food supply. "We have 60,000 to 80,000 facilities that we're responsible for in any given year," Brackett said. Explosive growth in the number of processors and the amount of imported foods means that manufacturers "have to build safety into their products rather than us chasing after them," Brackett said. "We have to get out of the 1950s paradigm."

Tomorrow, a House Energy and Commerce subcommittee will hold a hearing on the unprecedented spate of recalls. "This administration does not like regulation, this administration does not like spending money, and it has a hostility toward government. The poisonous result is that a program like the FDA is going to suffer at every turn of the road," said Rep. John D. Dingell (D-Mich.), chairman of the full House committee. Dingell is considering introducing legislation to boost the agency's accountability, regulatory authority and budget.

In the peanut butter case, an agency report shows that FDA inspectors checked into complaints about salmonella contamination in a ConAgra Foods factory in Georgia in 2005. But when company managers refused to provide documents the inspectors requested, the inspectors left and did not follow up. A salmonella outbreak that began last August and was traced to the plant's Peter Pan and Great Value peanut butter brands sickened more than 400 people in 44 states. The likely cause, ConAgra said, was moisture from a roof leak and a malfunctioning sprinkler system that activated dormant salmonella. The plant has since been closed.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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25 April, 2007

Today's tort system has life-threatening consequences

A diagnosis of non-Hodgkins lymphoma used to be a death sentence. Like many cancers, it was nearly untreatable and families were forced to wait out the days until a loved one died. But new methods of chemotherapy in addition to drugs, like Rituxan, changed all that. One study found that a combination of the two treatments improved survival rates among patients to 70 percent, compared with 57 percent for those on chemo alone. Similar situations exist for a wide range of diseases and treatments, from drug cocktails for AIDS to statins for high cholesterol.

But such novel treatments often do not make it to the market in the first place. For every 100 people helped by a treatment like Rituxan, there may be one patient who suffers serious side effects or even death. And sometimes the drug manufacturer can be held liable in court for those side effects, even when patients are properly warned ahead of time. These liability risks - or torts, in legal speak - add enormous costs to the development and implementation of new technologies and treatments. Fortunately for lymphoma patients, Rituxan has proven effective enough to outweigh legal risks.

But because of legal threats and the potential for debilitating tort payouts, many life-saving or risk-reducing technologies are never brought to market or even invented. Numerous lives are lost through accidental deaths that could have been prevented. According to data from a recent study by two professors at Emory University, America's current tort system was responsible for 2,700 accidental deaths in 2004. By extending calculations back through 1981, we can project that 77,419 lives were lost in accidents that could have been avoided if tort reforms had been adopted.

This loss of life affects not just the families and communities of those who have died. It also impacts the nation's economy. Let's think of this group of 77,000 individuals as a "ghost work force." Had these folks not died needlessly, they would have been alive and working today. It's impossible to predict whether one of these individuals would have discovered the cure for cancer or written the great American novel, but the economic output these individuals would have produced can be measured. The U.S. Bureau of Economic Analysis has concluded that the value of the average worker's output is $90,236. If we apply this ballpark value to each member of our ghost work force, we can calculate that the U.S. economy lost $7.51 billion worth of output.

Most costs of today's tort system are well-known. We see them in the form of higher insurance premiums, higher prices for goods and services, and even the destruction of entire businesses crippled by excessive punitive judgments. But the concept of a ghost work force emphasizes another cost to society - that of what could have been. And with the sacrifice of more than $7 billion in economic output due to tort risks, these costs are far from hypothetical.

A thriving economy depends on an efficient tort system that provides just compensation for those who are injured, which facilitates trade and commerce. But it's critical that the tort system not increase the cost of risk-reducing advances that ultimately save lives, like new drugs. The future costs of an unreformed tort system are difficult to fully calculate. But if the "ghost work force" were alive today, it would provide a boost to our nation's economy. Today's tort system takes away billions of dollars - and thousands of lives - each year. A tort system should operate to save lives, not cost lives.

That fact that the U.S. tort liability system is needlessly costing lives is stark evidence that tort reform is desperately needed. Lawsuits consume more resources than national defense, charity and federal education combined . _ Annual cost of U.S tort liability system: $865 billion. _ Annual Defense Department budget: $500 billion

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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24 April, 2007

The British hospital experience

Notes from a patient -- Prof. Brignell. He got prompt treatment only because he had private insurance but even then the NHS did not make it easy

Kafkaesque! That is the word. If you don't know what it means, make an appointment as an outpatient with the British National Health Service. An hour or two in the waiting room is enough to induce that feeling of hopelessness endured by Joseph K. In my case they had taken the trouble to write, bringing the appointment forward by half an hour, but I was still there in suspended animation an hour later than the original appointed time. About fifty assorted human beings sat glum and dispirited, some occasionally whispering to each other with a librarian reverence. In the background, people in various shades of uniform bustled through unseeing, intent on their business. Behind the reception desk women rattled computer keyboards with intense determination.

Suddenly my name was called and I found myself whisked from the large waiting room to a small waiting room. There was no silence here. A very large Irish woman was regaling the reluctant company with an account of her recent experiences as an inmate, including details of biological functions we would rather not know about. After another half hour, a woman approached me and said "The registrar has looked at your notes and has decided to let you see the consultant." Perhaps welcome news, except that it was the consultant who had asked me to come back and see him ten weeks after the first examination. People came and went. I waited.

It was quite different once I penetrated the inner sanctum. The consultant was urbane and gentlemanly, radiating that cultivated assurance that we used to expect of our medical advisors. He recommended that I have a course of intravenous antibiotics, but we would have to wait for a hospital appointment, as it should commence under observation in case there were any reactions. I mentioned that I had managed to retain sufficient medical insurance to cover hospital admission, so he left it with me to make the appointment. When I phoned BUPA there were no problems and a bed was found for me for the following weekend.

The difference! When you approach the NHS hospital, the first thing you see is a large yellow notice with ominous black capitals announcing THIS IS A WHEEL-CLAMPING ZONE. Just the thing for people in distress and pain, who have to grope around to see if they have the coins to feed the meter! It induces the same sort of anxiety as a notice I remember from almost forty years before YOU ARE NOW ENTERING THE GERMAN DEMOCRATIC REPUBLIC. The notice at the entrance of the private hospital said "Welcome" and directed you to the car park. Inside, the atmosphere was calm and kindly. What was striking was the obsessive hygiene and asepsis, from another age. Inside and outside each patient's door were dispensers for alcoholic hand rubs, which visitors were encouraged to use. Despite the occasional puncturing it was actually a pleasurable experience.

My local GP practice had volunteered to carry on the injections, so the consultant had arranged that I would pick up the antibiotics at the town pharmacy and take them in. I received a phone call to say that the pharmacy had discovered that it was not licensed to handle those particular antibiotics and would I drive back to the hospital pharmacy (a three hour round trip) to pick them up? Five days of injections went smoothly, but hanging over me was that threat of the unknown - THE WEEKEND. Don't worry, I was told, just phone one of these numbers and arrange an appointment with the out-of -hours service and we will give you the kit of parts to take with you.

Hello, is that the out-of-hours service?

Yes.

I would like to make an appointment for some intravenous injections.

How did you get this number?

I was given two numbers and the first one did not work.

This is an administration number, you are not supposed to have it.

What would happen if I had used the other number?

It would come to the same place, but that is not the point.

I would like to make an appointment for some intravenous injections.

Well you can't. The system does not work like that. You will have to phone on the day.

I went back to the local surgery and the receptionist kindly arranged the appointments for the Saturday and Sunday. Fortunately, the appointments were in nearby Shaftesbury, at a local cottage hospital of the sort that the Government is trying to close. It was charming and, above all, clean, even having a hand-rub dispenser on the waiting room wall.

The professional staff were kindly and efficient, indeed magnificent. This is not just a ritual nod of politeness. These people, fully aware that they are working in a mad system, still manage to maintain and integrity and dedication that is a wonder to behold. As the intravenous injections are a slow business, there was an opportunity for conversation, during which I elicited some interesting remarks:

Reorganisation is the norm in the NHS.

The rules change so often that nobody actually knows what they are.

The trouble with the big hospitals is that the cleaners are no longer part of the team, as they were in matron's day, and anyway they can barely communicate in English.




Some patients get no treatment at all in Tasmanian public hospitals

ONE in seven patients leaves the stretched Royal Hobart Hospital emergency department before being treated because of long waits. Between December and March, 13,058 patients presented to the department but 1821 -- an average 15 a day -- did not to wait to see a doctor. Some of the patients had been assessed as suffering "life-threatening" or "potentially life-threatening" illnesses or injuries and severe pain.

But department director Tony Lawler said the "majority" were patients who had presented to triage with "potentially serious" or "less urgent" conditions. He said there was always a "concern" that patients who did not wait would die, but stressed they were encouraged to stay or given options for medical help. "We don't put people in the waiting room and forget them," Dr Lawler said. "We try to maintain supervision." [Hard to do when they have walked out!]

RHH chief executive Craig White said the "did not wait" figures were steadily climbing but the hospital was working hard to bring them down. The figures come as the emergency department -- which moved into its new $15.4 million home last month -- comes under increasing pressure and criticism. In the past month, nurses, patients, politicians and ambulance officers have complained of long waits for medical help. Ambulances have been "ramping" or building up at the department, unable to offload patients because the hospital is full. And an elderly woman died in the emergency department last month after four days trying to get help and hours in waiting rooms.

Dr Lawler said patients were prioritised on clinical need, sometimes causing frustration. "Sometimes a patient might not appear to be very ill," he said. "It sometimes seems there's an inequitable process about who is seen first." He said some patients felt better and left or decided to see their GP, but conceded some patients who left were rated category one, two and three.

Dr White said waits had increased because more patients were presenting to emergency and beds in wards were harder to access. He said access block was "complex" but recent nursing-home closures meant aged-care patients were taking up 16 beds. Access block figures from the second half of 2006 show 29 per cent of patients admitted through the RHH emergency department wait more than eight hours for a ward bed. This compares with a 27.4 per cent national average.

Dr Lawler said the hospital had started holding daily bed management meetings to free up beds and new systems would help ease the wait. The new emergency department allows patients to be "streamed" through three paths and there is a clinic dedicated to patients in the lowest categories. This means a patient needing stitches can be "in and out" without having to wait for a cubicle. A short-stay unit will open in July for patients who require observation but don't need to be admitted. Dr Lawler said this area would act as a "pressure valve" to the department and reduce waits.

He could not compare the RHH "did not wait" figures to other hospitals but Australian Nursing Federation state secretary Neroli Ellis said they seemed "high". She attributed the figures to the closure of 1B North, a 30-bed ward closed for six months for renovations that only began last month. Ms Ellis said up to 16 patients stayed in the emergency department overnight on trolleys waiting for a bed.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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23 April, 2007

The Dr. McClellan Medicare cure

Republicans won a big victory this week, shooting down a Democratic plan for more government-run health care. The GOP victors, and free-marketeers, might send their thank-you notes to Dr. Mark McClellan. Dr. McClellan is the 43-year-old internist who, until recently, held the thankless job of running Medicare. He was handed the further thankless task of designing and implementing Congress's tepid 2003 Medicare reform. And he's the big brain who then wrung every last ounce out of that authority to create a striking new model for Medicare competition that is today not only performing beyond expectations, but is changing the political health-care debate.

High praise, yes, but borne out by this week's GOP defeat of a bill to allow the government to fix Medicare drug prices. That was a top Democratic promise this last election, as the party sought to play off public anger over health-care costs. Liberals saw it as an important step toward their all-government, health-care nirvana. Nancy Pelosi and Harry Reid also felt this was an issue on which they could once again roll Republicans, by flashing the impoverished-senior-citizens card.

Instead, Dr. McClellan's new model came online and wowed the older class. Private companies have flocked to offer a drug benefit, giving most seniors a choice of 50 innovative plans. The competitive jockeying has slashed prices from an expected $37-a-month premium to an average $22. The cost of Medicare Part D for taxpayers was 30% below expectations its first year--unheard of in government. And Medicare Advantage, which allows seniors to choose between private insurers, has grown to encompass nearly one in five beneficiaries.

This success has rebutted Democratic criticisms of the drug benefit and shown up those who tar the Bush administration as incompetent. The program's success emboldened Republicans to vote for free-market health care this week. Democrats have seen flagging public support for their program of more government and fewer drugs. While Mr. Reid held his caucus together this week, some are worried about bashing a drug benefit that has an 80% senior approval rating. "Congress only wishes it had an 80% approval rating," chuckles former Democratic Sen. John Breaux, an author of the 2003 reform. "A lot of folks campaigned last year on 'We're going to fix this program,' only to be told by seniors, 'Wait a minute, it ain't broke.'"

None of this was inevitable, but goes back to the competent Dr. McClellan. President Bush came to town pushing Medicare reform, and had a shot at an historic overhaul. The GOP could offer the carrot of a new drug benefit, in return for opening the entire decrepit program to private competition. Instead, Bush and Co. became more interested in claiming credit for an $8 trillion entitlement, and settled for meager reform.

Dr. McClellan nonetheless took this pared-down opportunity and used it to show private competition can work. His success, in particular with the drug benefit, rests in two broad ideas. The first was to design a program that immediately attracted a critical mass of private players to provide price and choice competition. At the time, nobody thought that possible. Mr. Breaux remembers Congress worrying that so few private players would participate that whole areas of the country would lack private drug plans.

Dr. McClellan's solution was a program that gave companies maximum freedom to design plans, bundle drugs and turn a profit. He was a salesman, talking up the opportunities and even traveling to New York to reassure Wall Street. It worked, and by the first days of business most seniors were being courted by anywhere from 11 to 23 plan sponsors. Those numbers have only grown, creating so much competition that sponsors are eliminating deductibles, lowering premiums, offering more drugs. It's also led to smart cost-cutting and efficiencies; an estimated 60% of Medicare prescriptions are now for generics.

Dr. McClellan's other strategy--and the flip side of the coin--was to get seniors enrolled quickly. His team designed an Internet program that allowed seniors to punch in their information and examine the best plans. His agency reached out to local organizations--church groups, community centers--and enlisted their aid in explaining details. A call center at one point handled 400,000 plan questions a day. Today, some 90% of Medicare recipients are enrolled in the benefit, numbers that have further attracted private players, further spurred competition, further lowered prices. "This is how you come in under budget, increase satisfaction," says the man himself, Dr. McClellan. He adds, humbly, "Nobody should think this is perfect yet, but it's clearly accomplishing some good things."

Good things or no, the reforms are still at risk. There was a time when Democrats believed in Medicare reform, but now most prefer it as a political stick to beat President Bush. There are also liberals--Henry Waxman, Pete Stark--who understand this is a crucial moment in the national debate over government-versus-private health care, and will do what they can to sabotage the reforms.

Expect, therefore, more votes over Medicare's right to price-fix. If a broad bill can't pass, liberal politicians will instead target individual, high-cost drugs, arguing that since Medicare foots most of the bill for these products, it should have the right to "negotiate." The real goal will be to get any foot in the price-setting door, making it harder for private companies to craft flexible drug packages, and laying the groundwork for more price-setting down the road.

Expect, too, a push to starve the competitive programs of cash. Critics know how effective this is, having siphoned dollars out of the old Medicare Advantage program in the 1990s, causing private plans to drop out, and giving the program a bad name. Dr. McClellan's reforms, and a Republican Congress, have re-energized the program, but the key to future success is in the budget. Republicans would do well to spend more time touting the competition successes of the reform, rather than the drug giveaway.

In a perfect world, the Bush administration would never have swallowed that entitlement in the first place. In our imperfect world, it at least had the wisdom to hand the reform challenge to a guy who was able to demonstrate the merits of health-care competition, and optimistically, pave the way for broader reform down the road.

Source




Incompetent British ambulance service

Patients are less likely to be treated by a paramedic in London than in Wales, government figures show. Nationally, only half of front-line ambulance staff are fully trained paramedics, according to figures released under the Freedom of Information Act. London has the lowest percentage of paramedics, at 34 per cent, and Wales the best, at 61 per cent. There are also concerns that a preoccupation with meeting the Government's target of answering life-threatening calls within eight minutes is putting lives at danger.

The ambulance service will today tell Tonight with Trevor McDonald on ITV1 that meeting the target is a higher priority than sending the appropriate staff member. Most ambulances are staffed by emergency medical technicians, who carry less specialist equipment than a paramedic.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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22 April, 2007

NHS has billions for useless computer projects but not enough money for nurses

Nurses have voted overwhelmingly to take industrial action unless ministers improve a "miserly and insulting" pay deal for health workers. The Government has offered nurses in England, Wales and Northern Ireland a 1.5 per cent pay rise this month, with another 1 per cent to come in November, in defiance of the recommendations of an independent pay review board. But delegates at the Royal College of Nursing (RCN) annual conference rejected the offer yesterday, and called on the Government to agree the recommended full 2.5 per cent pay rise immediately - as it already has in Scotland - or face the consequences.

Thousands of ambulance workers, porters and other NHS staff who are members of the GMB union have said that they are also prepared to take industrial action over a similar staged pay deal. If industrial action were taken it would be the first on a national scale by nurses. In an angry and passionate debate at the conference in Harrogate, delegates said that a strike was unlikely but that they would be prepared to take action such as working to rule, which would mean nurses working their contracted hours and no more.

Such measures are designed to minimise any impact on patients, but could mean longer waiting times for nonessential operations. The union's council will now seek an emergency meeting with Gordon Brown, the Chancellor, and Patricia Hewitt, the Health Secretary, to discuss the issue before deciding whether to ballot members next month.

Peter Carter, the RCN's general secretary, said that the staged offer was equivalent to a 1.9 per cent pay rise, which was "unacceptable and miserly", but that he did not want to proceed in a "ramshackle way". He added: "Let's be clear, we want to avoid strike action. We are hoping that Gordon Brown and Patricia Hewitt will wake up and take this seriously. But we are prepared to find ways to hurt the Government while trying to protect patients. We mean business."

Ministers at the Scottish Assembly, with elections looming next month, have agreed to award nurses a 2.5 per cent pay rise from this month. Ann Taylor-Griffiths, of the RCN's Welsh board, told the conference: "We are one nursing body, we are one NHS and deserve one nationally implemented pay award." David Harding-Price, a nurse from Nottingham, was given a standing ovation as he said: "Stand up now and tell the Government: no more rhetoric. Action, action, action now. Unison, the public sector union, is also expected to support industrial action by nurses when it meets at its conference in Brighton next week.

Ministers have defended the staged offer as fair for nurses and affordable for the economy. A spokeswoman for the Department of Health said: "What we have suggested is a sensible increase that's fair for NHS staff and affordable for the economy. In fact we expect the overall average earnings of nurses to rise by 4.9 per cent next year, above the national average." Mothers and newborn babies are being put at risk because of a lack of specialist care for postnatal depression, the RCN says. The conference will be told today that suicide is the biggest killer of new mothers and that more resources are needed to support women who suffer mental illness during pregnancy or after childbirth. 6.5 hours of unpaid overtime worked on average by nurses every week Source: RCN estimate

Source




Australia: A deeply corrupt State public hospital system

Two contradictory pieces of advice about cancer treatment for Maryanne Smith* led Maryanne and her husband, Michael*, to question a doctor's competence. In the beginning, all they wanted was a straight answer. But as the Sydney South West Area Health Service obfuscated and the shutters came down on a bureaucracy used to getting its own way, it turned into so much more.

Almost 2.5 years after their initial complaint, Maryanne Smith is gravely ill and only one thing is clear: NSW has learnt little from the bitter and heartbreaking patient safety scandal at Camden and Campbelltown hospitals. A Herald investigation has found that the internal inquiry into the Smiths' complaints against Concord Hospital was conducted with little regard for fairness, key doctors were not interviewed and the results were heavily censored. A specialist who supported the Smiths was investigated in an attempt to silence him and the doctor alleged to have given the contradictory advice continues to practise.

The dispute shines a light into the often murky dealings of the state's health system. It leads along a trail of relentless and expensive legal action against doctors and through a complaints handling system that in some hospitals still seeks to silence rather than openly discuss problems. In this world, there is no resolution for anyone: not patients, and not doctors or other health professionals.

There are an estimated 8000 deaths in Australia each year as a result of medical errors, more than the annual road toll of about 1600. Hidden beneath innocuous labels such as "complications", "misadventure" and "sequela", these deaths and injuries have become an accepted part of health care, experts argue. "Harm caused by health care ranges from the mundane to the catastrophic, from a small skin tear on the arm of a frail, elderly patient being helped into bed, to quadraplegia or death," say Merrilyn Walton and colleagues Bill Runciman and Alan Merry, the authors of the recently released Safety and Ethics in Healthcare. "These problems were, for many years, viewed as part of the price to be paid for the great benefits of modern health care."

Walton, an associate professor of medical ethics at the University of Sydney who was NSW's first health care complaints commissioner, is incensed that governments have not moved faster to prevent the rising toll of serious harm and deaths from medical errors. "I am talking about system errors that are getting repeated and repeated - at some stage the governments in this country are going to have to be brave and deal with this," she says. "We have acknowledged there are a high number of adverse events, but we haven't gone the step further . that means confronting some hierarchies around the design of the system to force change."

In addition, violations of basic standards of care are tolerated daily, she warns. "Routine violations happen, for instance, around handwashing . a system that tolerates routine violations is a dysfunctional system and yet it happens regularly in every hospital because there are no consequences."

The authors say that 10 per cent of admissions to acute hospitals are associated with an adverse event. In NSW, where government figures put the annual admission rate to acute care hospitals at 1.3 million a year, that means up to 130,000 patients are being harmed or experience near misses each year.

The Smiths are waiting to hear whether the Independent Commission Against Corruption will investigate their concerns. The director-general of NSW Health, Robyn Kruk, referred the case to the watchdog just weeks before last month's state election. Since then, there has been a familiar refrain from bureaucrats and politicians: "I cannot comment on a matter that is before ICAC."

The poor advice Maryanne Smith received may not have been a medical error that resulted in death, but even small mistakes can lead to prolonged suffering, delayed treatment, more pain and unnecessary confusion.

NSW Health is fighting a war on several fronts, some official, others under the radar. Camouflaged in carefully written policies and the weasel words of bureaucratise, the state's health officials and the revolving door of ministers have sought to convince a sceptical public the NSW health system is safe. After surviving the horror years of multiple investigations into 19 patient deaths at Camden and Campbelltown hospitals, two other state-run hospitals have been called to the NSW Coroner's Court this month to explain themselves. The court is separately investigating the deaths 18-year-old Jehan Nassif, who died from meningococcal disease at Bankstown hospital last year, and Vanessa Anderson, 16, who died at Royal North Shore Hospital in November 2005, three days after being admitted for a head injury. She was treated by overtired and junior staff, after the hospital had been warned about a potential staffing crisis.

The inadequacies of our mental health system were also laid bare this week with the news that in 2001 a teenager was discharged from a psychiatric unit without treatment or medication after a suicide attempt, and then became a quadriplegic after another suicide attempt days later. He is suing the Sydney South West Area Health Service for negligence.

Add to that a steady stream of specialists leaving the public health system citing flagrant breaches of patient safety as a factor and one thing becomes abundantly clear: it is only a very thin veneer of safety and accountability that cloaks our public hospitals.

Maryanne Smith had a slow-growing tumour and was referred to a doctor then on staff at Concord Hospital in June 2003. She was advised, as a matter of urgency, to pursue a particular form of treatment. "I cannot overemphasise to you just how strongly [the doctor] advocated that I agree to submit to an urgent . treatment," Smith wrote in her first letter of complaint to Concord Hospital on November 28, 2004. "In contrast, none of my former specialists . ever spoke to me in terms of such urgency."

Alarmed at the doctor's approach, she returned to her regular doctor, who reassured her that her condition did not yet need to be treated with urgency. By April 2004 the cancer had progressed and she was again referred to the doctor at Concord. This time he gave her advice that she says contradicted his earlier recommendations. "This time he stated very definitively that [treatment] would in no way reduce the bulk of my tumours. Both my husband and myself left this second appointment somewhat confused and distressed." Again, her cancer specialists were perplexed by this advice and she was referred to a second specialist at Concord. That second specialist told her the therapy would help reduce the bulk of her tumours. After careful consideration and much angst, she had the treatment.

The doctor in question has denied many times that he gave Smith conflicting advice. When the couple complained about the inconsistencies in his advice and attitude, they were assured by senior health bureaucrats his performance had not been called into question. Yet information they obtained under freedom of information laws tells a different story. It shows multiple concerns have been raised about the doctor's performance - and that his own colleagues had complained about his clinical and professional behaviour, some as far back as 1998.

Four months after her initial complaint, the area health service wrote to Smith, rejecting her allegations and giving the doctor's interpretation of the two consultations. The cover-up had begun. Infuriated, she wrote a second letter of complaint in August 2005. She believes the doctor falsified his notes from their meeting, and one of the findings from one of the three investigations into this issue showed the doctor had not taken contemporaneous notes at his consultations, in contravention of NSW Health and hospital policy.

Beyond the doctor's treatment of Smith, there were other serious problems relating to his performance, a senior staff specialist told the Herald. "I had innumerable clinicians complain to me about what he was doing," the specialist says. The most serious complaints relate to allegations that patients had received radiotherapy unnecessarily because the doctor had mistakenly interpreted bone scans as showing the presence of cancer. The specialist wrote his first letter to a senior hospital bureaucrat in April 1998, warning that the doctor's performance had "reached a dangerous level, impacting on patient care". "I personally had to intervene to stop one such patient being treated with high-dose radiation unnecessarily," the specialist says. On another occasion, the doctor prematurely and wrongly stopped a patient's therapy, he says.

In October 2005 the doctor again denied Smith's allegations in a letter to South West Area Health Service obtained under FoI laws. "I have not 'lied' to any person or intentionally misled them. I . can only reiterate my recollection of the consultations with the support of my letters to her referring physician," he writes. "I regret [Smith] has the perception I closed the door to discussion about possible . treatment. This was not my intention."

More correspondence followed - much of it written by Michael Smith as he repeatedly laid out the initial complaints his wife made about her treatment, followed by a growing number of complaints about their treatment by the area health service's bureaucrats. In May last year the Smiths received a four-page letter from Mike Wallace, the chief executive of the newly formed Sydney South West Area Health Service, saying an investigation had been completed and 49 recommendations had been made. Despite repeated requests, Wallace would not release the recommendations or discuss the findings with the couple.

All the area health service would tell the Herald is this: "The chief executive has referred this matter to the Independent Commission Against Corruption . on 24 January 2007. It is therefore inappropriate for the area health service . to comment. In mid-2006 the AHS offered to meet with and mediate with the family through the Health Care Complaints Commission. This offer was not taken up."

A spokeswoman said the doctor whose performance was in question had "fully co-operated with the investigation into the . family's complaint. The investigation found that there was a difference of opinion about the information conveyed by [the doctor] at the two consultations with [Maryanne Smith]."

Cliff Hughes, the chief executive of the NSW Clinical Excellence Commission, is a former senior cardiac surgeon who faced his demons as a young doctor in the public system. He is a strong believer in being up-front with patients about errors, and encourages his colleagues to do the same. And despite the problems in the state's health system, he is determined that patient safety will improve under his watch. "We are at one stage along a very rapidly progressing path - in most of the areas I think NSW is leading the procession down this path," Hughes says.

Eradicating medication errors - one of the most common causes of harm - is high on the list. The introduction of a national in-patient medication chart goes a long way to ironing out common problems and mistakes, he says. Anticoagulants such as warfarin have been tagged as a major problem, mostly because until recently such drugs have usually been dispensed about 9pm, after the prescribing doctor had gone home. Modern lab techniques mean blood test results - vital for deciding whether the drug is needed and in what quantity - are now available much earlier in the day. That means the doctor who ordered the tests in the morning is still on duty when they come back in the afternoon, Hughes says, reducing the potential for communication errors between shifts.

Another project Hughes says will reduce harm to patients is the campaign to reduce the number of unnecessary blood transfusions. "Blood is a good product but it is not entirely safe, there is the risk of both minor and major infections, immune reactions and so on," he says. "The evidence that we have collected indicates that we can reduce the level of blood usage by about 10 per cent or so across the system."

The prevention of hospital-acquired infections, via a handwashing campaign and a project on intravenous lines, as well as a falls-prevention campaign, a program to reduce aspiration pneumonia in stroke patients and a clinical leadership training package are all new, positive steps.

But even Hughes admits that guidelines are not enough. There are still 400 to 500 events in NSW that cause serious harm or death to patients each year, he says. "The real change is the whole of the system wants to measure themselves regularly, that is the big change from pre-Campbelltown days . we have got a whole system, all 108,000 [health system employees], who can report [errors] and when they report, we can take action." He acknowledges some are still reluctant to throw themselves on the mercy of the system - particularly when individuals are wrongly singled out for blame in a system where errors occur mostly as part of a chain of events. "We need to recognise there are always going to be people who are frightened of what has just happened or what nearly happened, who don't quite know what they should do and are worried about retribution."

Is change happening quickly enough? "All of us . where the risks are patients lives or wellbeing, want to move faster," Hughes says. "I don't believe NSW Health is in crisis, but we have recognised the urgency of all of these programs - it can be expensive at times, it can be draining at times, it can require more personnel at times, but we must move forward."

It could have been so different for the Smiths. This dispute could have ended so many times in the past 2® years - if the hospital or the area health service had conducted a proper investigation and if the Smiths had felt their complaints had been dealt with seriously. There were many opportunities to do it right. But what began as a simple complaint about conflicting medical advice became a lesson in dealing with the dysfunctional and bullying bureaucracy of one of the state's largest area health services.

The Smiths are idealists. They believe public servants should serve the public. They are livid at what they see as the misuse of power by senior bureaucrats who backed a doctor whose clinical skills were under a cloud following the persistent complaints from his colleagues, patients and their families.

The NSW Ombudsman and the NSW Medical Board have received complaints from the Smiths, as have the Health Care Complaints Commission, Medicare, NSW Health and the NSW Health Minister. It is unclear how those complaints are progressing.

Since the multiple inquiries into patient deaths at Camden and Campbelltown hospitals, NSW Health has gone some way to addressing medical errors and how they are investigated. Clinical governance units have been established in all health services and the Government is spending $60 million over five years to implement its patient safety and clinical quality program, a spokesman says. "The NSW health system has adopted the 'open disclosure' standard . [that] aims to promote a consistent approach by all hospitals to open communication with patients . following an adverse event." Yet for all the talk about a system of open disclosure of errors, about involving patients more in the process of health care, it seems NSW public hospitals and the bureaucrats who run them have a lot to learn.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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21 April, 2007

NHS care 'left to student nurses'

Lives are being put at risk because student nurses are being left on their own with patients, a study has claimed. A poll by the Royal College of Nursing of 1,500 student nurses found nearly half had been left unattended with patients without warning. Guidelines say student nurses should always be monitored except those in their final year and even that has to be prearranged. The government said patient safety was of "paramount importance".

The survey showed 44% of student nurses had been left unattended without warning and without a doctor or qualified nurse present. Eight in 10 of those said it had happened on at least three occasions. Of the 553 first-year students questioned, 42% said they had been left on their own. And 15% said they had witnessed adverse events while left unattended. But 84% said they did not report that they were left unsupervised.

Gill Robertson, the RCN's student nurses adviser, said there were reports of students just eight weeks into their training being left alone. She said this could happen on surgical wards and other areas of a hospital where patients were extremely ill. "That is like the average person being left with a patient. It should not be happening and is a risk to patient care."

She added nurses were being stretched because of the cuts being made - the RCN estimates over 22,000 health staff posts have been lost in the last 18 months. And another survey of nurses working in 173 hospital wards revealed a third of nurses thought patient care was being compromised on each shift because of reduced staffing.

RCN general secretary Peter Carter agreed the financial problems in the NHS were to blame for the problem. "Those registered nurses left have to do ever more with even fewer resources." Mr Carter also said he was concerned by the reports of student nurses not being able to get jobs once they had qualified. "I am hearing worrying stories from nurses who qualified last September who are still unable to get jobs because trusts are freezing entry levels posts to save money."

Health Minister Lord Hunt said: "Patient safety is of paramount importance to the government and NHS staff alike. "We would expect any nurse, whether in training or in practice, to report any incident they feel has an adverse effect on patient safety." Liberal Democrat health spokesman Norman Lamb said: "This is extremely worrying - patients' lives could be at risk. "The damaging deficits in the health service not only result in job losses but have a serious impact on the remaining workforce."

Source




NHS bungles pay deal -- more pay for less work

A pay deal that gave hospital consultants [senior doctors] a salary increase of 25 per cent left them working shorter hours and treating fewer patients, the National Audit Office has found. It says that the consultants deserved more money, but it was regrettable that the public and the NHS had not seen benefits in greater productivity and better services.

The contract, agreed in 2003, cost œ715 million in the first three years - œ150 million more than the Department of Health estimated. In that time the average consultant's pay rose to œ110,000 a year while the average number of hours worked fell from 51.6 a week to 50.2. Although there was an 11.3 per cent increase in the number of consultants working in the NHS in the two years after the agreement, the amount of consultant-led activity increased by only 4 per cent. "The bottom line is that the Department of Health has increased consultants' salaries without demonstrating any extra productivity in return," said Edward Leigh, MP, chairman of the Commons Public Accounts Committee, to which the audit office reports. "This is one more example of weak financial management by the Department of Health. It drove through the new pay deal with scant regard for proper evidence and solid financial forecasting."

Sir John Bourn, the Comptroller and Auditor-General and head of the National Audit Office, said: "Consultants deserve to be paid properly for the work that they do. However, the new contract was introduced to benefit not only consultants but patients and the health service in general. "Although a new contract was needed, it is regrettable that the costs are higher than expected and that we are not yet seeing any clear evidence of improvements in productivity or services for patients."

In negotiating the contract, the department used out-of-date information on the hours that consultants actually worked. In spite of evidence that the average was between 50 and 52 hours a week, the department worked on the assumption that it was 47 hours. It then agreed a contract with the British Medical Association that was based on an average of 43 hours a week. In fact, consultants continued to work much longer hours than these, and under the new contract were paid for them. As a result, the contract cost œ150 million more than the department expected.

Lord Hunt, the Health Minister, said: "The new arrangements reward and incentivise consultants who make the biggest contribution to service delivery and improving health services. This has helped us to recruit and retain highly skilled consultants, historically a challenge for the NHS. We now have low vacancy rates - fewer than 2 per cent - and more than 10,000 more consultants working in the NHS than when the Government came to power."

Andrew Lansley, the Shadow Health Secretary, said: "This confirms that the Government simply didn't understand what consultants were doing before they made assumptions about the new contract."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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20 April, 2007

NHS knowingly used contaminated blood

Victims of the contaminated blood scandal renewed their calls for compensation yesterday, as evidence emerged that the Government was told about the dangers of using "skid row" blood products as early as 1975. At an independent public inquiry into the supply of tainted blood to haemophiliacs during the 1970s and 1980s, survivors and relatives of those who died said that questions still needed to be answered about what successive governments knew.

At least 4,500 haemophiliacs were infected with HIV and hepatitis C from contaminated plasma. A total of 1,757 have died and thousands more are terminally ill.

One letter presented to the inquiry showed that in January 1975 the Wilson Government was warned that one of the US companies it bought plasma treatments from sourced all its blood from "skid row derelicts". The letter, written by Stanford University Medical Centre to the Blood Products Laboratory at the Lister Institute, said that these clotting products, known as Factor 8, had proven to be "extremely hazardous", with recipients having a 50 to 90 per cent chance of developing hepatitis.

The inquiry, chaired by Lord Archer of Sandwell, a former Solicitor-General, heard that other products were bought from companies that acquired blood from prisoners in America.

Those giving evidence yesterday spoke of their harrowing ordeals. Sue Threakall, whose husband died in 1991, aged 47, after contracting HIV following the use of Factor 8, told the inquiry: "This terrible tragedy should never have happened; it was wholly avoidable. Warnings were ignored, lessons were not learnt and our community was lied to by the people it should have trusted most."

The Government has not confirmed whether it will allow ministers or civil servants to give evidence to the inquiry, which is scheduled to report by late summer.

Source




Malnutrition in NHS patients

Patients are at risk of malnutrition because of a shortage of nursing staff to feed them properly, a survey suggests. Almost half of the 2,000 nurses questioned by the Royal College of Nursing said that they did not have enough time to make sure that patients got their meals and were able to eat them because they were too busy. The findings come six years after the Government spent 40 million to improve nutrition in hospitals.

Difficulties getting food for patients outside set mealtimes was cited as the main problem by 49 per cent of nurses. Almost as many (46 per cent) nurses blamed a lack of staff to assist those patients who needed help eating.

Campaigners from the charity Age Concern say that elderly patients in particular are regularly going without meals because they are placed out of their reach or because they are unable to eat without assistance. The survey was released at the annual congress of the college in Harrogate yesterday.

Source




NHS goes private to hit target

EMERGENCY funding totalling 160,000 pounds has been set aside so that more than 40 patients can be treated at a private hospital and waiting list targets can be achieved in East Lancashire. General surgery and orthopaedics cases being dealt with by East Lancashire Hospitals NHS Trust were in danger of exceeding 20-week in-patient treatment targets. The hospitals trust has undertaken a series of waiting list initiatives to meet the NHS goal and a number of patients had been transferred to the private sector Abbey Gisburne Park Hospital, near Clitheroe, for treatment.

But since an initial batch of patients were relocated to Gisburne Park in December, the transfer rate appears to have dried up, according to a Blackburn with Darwen Primary Care Trust report. The report adds: "East Lancashire Hospitals Trust has repeatedly been reminded, via performance meetings and e-mails, of the opportunity to transfer patients to the independent contract, if additional capacity was needed to meet the March targets. "They have however made, limited use of this, preferring to retain the patients at the hospital trust, and giving assurances that they could manage the lists internally."

Every patient on the 20-week waiting list should have been given an appointment date by February 16 and the hospital trust has been asked if any outstanding patients can still be moved to Gisburne Park. Some of the 40-plus outstanding cases, were not medically suitable for transfer to Gisburne Park, others refused to attend the hospital, and a proportion were reluctant to change their consultant mid- treatment. But in the meantime the primary care trust has also held talks with Beardwood Hospital, the privately-run facility in Preston New Road, Blackburn, about dealing with NHS patients there.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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19 April, 2007

NHS model crumbling

The NHS is unlikely to be free at the point of use within 10 years, say doctors. A British Medical Association poll of 964 young GPs and hospital doctors found 61% thought patients would have to pay for some treatment by 2017. Nearly half of all young doctors also expect to leave the NHS within 10 years, according to the survey. All three main political parties have ruled out bringing in a form of charging in the short-term.

The doctors questioned were members of the BMA's Junior Members Forum, which effectively represents the top doctors of the future as it includes those who have graduated within the last 12 years and students. The poll also revealed 94% thought the role of the private sector would continue to grow. A total of 48% of those questioned said they envisaged they would have left the NHS within 10 years, with only a third (35%) of those saying that would be through choice.

Forum chairman Dr Andrew Thomson said it was time to have a debate about the future of the NHS because of pressures from the ageing population and new, ever-more expensive drugs. "Doctors fear that current reforms are damaging the NHS beyond repair. "We seem to be selling off the service to the highest bidder without considering the legacy for future generations of patients. "Government reforms are having negative effects on both services and the morale of doctors. We need to find ways of moving the NHS towards a period of stability. At the moment it is under serious threat. "We will be the ones making the decisions in the future and implementing changes so we want to know what the public, profession and political parties think."

Various options have been put forward, including asking patients to contribute towards the cost of some minor treatments, such as varicose veins, or excluding them from NHS care altogether. There has also been suggestions that an NHS tax could be introduced to help pay for the extra demands on the health service. Dr Thomson said his members were not expressing a favour for any one option, but he suggested patients may well be ready for a change in the system.

BMA policy is still that the NHS should be free at the point of need, although the issue is likely to be discussed at the doctors' annual conference, which sets policy, later this year. But a spokeswoman for the Patients Association said: "I think it is an important principle that where care is needed it is free. "We would not be in favour of patients paying for care where doctors say it is necessary."

The Department of Health has defended NHS reforms, saying it is committed to creating "a truly patient-led service". "What will not change is our commitment to a universal, tax-funded service, with equal access for all," said a spokesman.

Source




The NHS computer meltdown continues

What's a wasted few billion among friends? Hundreds of millions are often spent on government computer projects before they are abandoned but it takes the NHS to commit waste on this scale. Think how many more doctors and nurses they could have hired with 12 billion! Once again, Britain makes Kafka look unimaginative. The whole affair is beyond rational comprehension. The one thing it shows is how unbelievably wasteful a socialist government can be with the people's money in pursuing their dreams of control

Urgent action is needed to rescue the 12 billion pound programme for upgrading the NHS computer system, the Public Accounts Committee of the House of Commons has said. Over budget and behind schedule, the National Programme for IT is "not looking good", according to a report from the committee.

Edward Leigh, the Conservative MP who chairs the committee, said: "Urgent remedial action is needed if the long-term interests of NHS patients and taxpayers are to be protected. "The electronic patient clinical record, which is central to the project, is already running two years late; the suppliers are struggling to deliver; and, four years down the line, the costs and benefits for the local NHS are unclear."

Ministers said that the criticisms were out of date and that the costs of the programme had not escalated.

Source




Tasmanian hospital worker protests over appalling care

And the only response is buck-passing

A WORKER at the coalface of the Royal Hobart Hospital has slammed conditions in Tasmania's biggest Emergency Department. Noreen Le Mottee has broken ranks to write to RHH chief Craig White, emergency boss Dr Tony Lawler, Premier Paul Lennon and political leaders about bed closures.

As a triage clerk, she works on the front line dealing with patients and distressed families. "It is disheartening to arrive at work night after night only to find the waiting room full of sick and understandably irate patients who have been waiting up to eight hours to be seen by a doctor," she wrote. "Too often these are category 3 (urgent) patients who should be seen within 30 minutes according to the national standard."

Health Minister Lara Giddings said emergency pressures had got worse and blamed Federal Government under-funding. Mrs Le Mottee's March 27 letter has been released by the State Liberals, who said they asked for a response before going public. Her concerns included:

"As I write there are 10 patients awaiting beds, the request for one submitted 10 hours ago. "My own and other staff's frustration and embarrassment ... is nothing compared to the pain and anguish suffered by the patients. "With no ED cubicles ... no option but for patients to remain on their ambulance trolleys. "Patients are waiting because the department becomes bed-blocked when other patients cannot be sent to a ward. "I feel extremely angry knowing that Ward 1BN, some 30 beds, has been closed since before Christmas ... it must be addressed urgently before the situation worsens with the onset of winter."

Mrs Le Mottee said yesterday she would not speak further and that her letter "said it all". Category 3 includes severe illness, people with head injuries but conscious, major bleeding from cuts, major fractures, persistent vomiting or dehydration.

Liberal health spokesman Brett Whiteley said Mrs Le Mottee had still not heard from anyone apart from the Liberals. Ms Giddings said the Howard Government's neglect meant Tasmanians were finding it harder to get health care and the results were showing up in all public hospitals. Australian Nursing Federation secretary Neroli Ellis said there were 34 beds closed.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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18 April, 2007

Enforcement Options Considered for Proposed California Health Insurance Mandate

California Gov. Arnold Schwarzenegger's (R) administration on Tuesday proposed using state and private databases to locate residents without health insurance, an approach that also could be used to enforce penalties against uninsured people, the Los Angeles Times reports. The plan was presented at a meeting of representatives from insurers, hospitals, physicians, business organizations and consumer advocacy groups (Rau, Los Angeles Times, 4/11).

Schwarzenegger in January announced a proposal that would require all state residents to obtain health insurance and would share the cost among employers, individuals, health care providers, health insurers and the government (Kaiser Daily Health Policy Report, 1/9). Schwarzenegger said the proposed system could be modeled after a system that the state Department of Motor Vehicles uses to track drivers without car insurance and another state system that tracks residents who do not pay child support. Under the plan, residents who lacked coverage for at least 60 days would be located through state or private databases.

The Schwarzenegger administration said that the proposal initially would be intended to notify uninsured residents that they must have insurance and help identify insurance options. Residents who do not obtain coverage after being notified would be subject to penalties. California Health and Human Services Agency Secretary Kim Belshe said the tracking system "represents one approach to enforcement," but she added that "nothing is set in stone." Other proposals under consideration would "attach the wages of people who don't buy insurance and ... increase the amount they owe in state income taxes," according to the Times. Some present at the meeting said they oppose penalties for the uninsured

Source




NHS DANGEROUS FOR SICK BABIES

Care for premature or seriously ill babies has fallen even farther below acceptable standards, the baby charity Bliss has found. In a report prepared for it by two researchers at the National Perinatal Epidemiology Unit, it finds that units are understaffed, often have to close to new admissions, and that babies often need to be driven hundreds of miles to the nearest empty intensive care cot.

The report shows that, on average, baby units are understaffed by a third and suitably qualified nurses are in particularly short supply. Two thirds of units, not wishing to turn babies away, admitted more than they could care for properly. Many babies needing the highest levels of intensive care had to be treated in units capable of providing only lower levels. Ideally, said Bliss, there should be one nurse for every baby in intensive care, a staffing figure agreed by ministers. The research for its report shows that if this target were achieved infant deaths could be reduced by 48 per cent. At present less than 4 per cent of units achieve this staffing ratio.

Andy Cole, the chief executive of Bliss, said: "The first few days after birth are absolutely critical for babies born premature or sick, and the care they receive during this period shapes not only their chances of survival but also their future health. "Bliss is concerned that the Government gives less priority to intensive care for babies than for adults and children and that it is only thanks to the goodwill and commitment of doctors and nurses that babies are being cared for in some cases. "We are calling on the Government to make one-to-one nursing care mandatory for intensive care babies, and to commit the necessary resources to get this essential service back on track."

The new report, Special Delivery or Second Class, was based on data provided by almost 80 per cent of the 224 units in hospitals for the care of newborn babies. Demand for such services is increasing. Last year 80,000 babies were admitted to the units, which are classifed into three categories: intensive-care units, high-dependency units, and special-care units. The babies needing care were born prematurely (less than 37 weeks of gestation), of low birth weight (less than 5.5lb) or had other medical problems. The number of babies who survive such an unpromising start in life is increasing, so the demand for the units is increasing.

Between 60 and 70 per cent of units said that demand for cots exceeded capacity last year across all three levels of care. As a result, some babies were being given care in inappropriate units: 1,233 were given breathing support in special-care units, for example, which are equipped to deliver such care only in the short-term.

Some transfers of babies between units are inevitable and can be justified if, for example, they need surgery. Transfers simply because units are full (called inappropriate transfers) should not exceed 10 per cent. Last year the figure was 22.6 per cent. In one in four cases twins or triplets were separated and sent to units that may be hundreds of miles apart, a traumatic experience for mothers. "It is hard to imagine having the stress of one child in an intensive care unit," Mr Cole said. "Imagine having two, split by 150 miles."

Three years ago the Department of Health committed 70 million pounds to improving the service but the money has now almost run out, and Bliss believes that at least 20 million of it disappeared into other budgets because it was not ring-fenced. It calculates that to meet the full requirement of one-to-one nursing, the present numbers need to rise from 5,863 whole-time equivalents to 8,147, an increase of almost 2,300 nurses, which would cost 75 million a year.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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17 April, 2007

Why progressives should learn to love cost-sharing in health care

An article below (excerpts) by Leftist Ezra Klein -- who sees some of the realities

It is a common complaint among Democrats that they have no success with framing. On health care, however, they've had too much success with the framing -- what George W. Bush might call catastrophic success. "Universal health care" is an ingenious phrase; it easily garners majoritiy support when polled and is almost impossible to argue against. What sort of grinch is against health care for all? The trouble is, defining the conversation in terms of universality (or a lack thereof) means implicitly defining the problem as an issue of access. Make no mistake, the fact that 45 million Americans are uninsured is a moral disgrace. But if we could achieve full coverage tomorrow, holding all other things equal, the system would collapse within a matter of decades. No one would be able to afford it.

Since 2000, health insurance premiums have shot up 87 percent. The economy has not grown by anything near a comparable amount. In 30 years, Medicare alone will be almost 8 percent of GDP. Give it a few more decades and it'll take more than 10 percent. And so we reach a tongue-in-cheek dictum known as Stein's Law: If something cannot go on forever, it will stop. Since we can't afford this sort of cost growth forever, eventually, we'll stop it. The question is how.

Progressives tend to focus, rightly, on the access question. It makes sense for a number of reasons. One is that the worst of the cost crises won't materialize for decades, while the uninsured lack health coverage now. Another is that cost control is only possible within an integrated, more centralized system, and such a system is better sold on grounds of access than on overall cost.

But how to best control costs should be considered, even if it never becomes a preeminent political talking point. It must be considered not only because the health system will collapse unless spending growth slows, but because we spend too much on health care in the United States. We spend more than we need to, first of all, because our prices are so high and our system is so inefficient. But even if we could purchase care at wholesale rates and construct the most effective delivery system in the world, we would still be spending more than we probably should. On this, the data is clear: We purchase more care than really benefits us.

The largest study of health insurance ever conducted, done over 15 years by the RAND corporation, randomly sorted individuals into different insurance plans with varying levels of generosity. Those in the most expansive plans received 40 percent more care than those in the least -- and their health outcomes were no better. The only exception was for the poor, whose health outcomes were hurt by cost-sharing and improved by more generous plans. The Dartmouth Atlas studies showed that regional variations in medical culture and doctor density led to, among other odd effects, 30 percent of seniors in Miami seeing more than 10 specialists in their last six months of life, compared to just seven percent of those in Oregon. Even with this huge variation in care, outcomes among the two populations were no different. The research is clear: Not only is more care not always better, it is sometimes worse -- and it is always more expensive.

For progressives, that's a problem, as excessive money spent on unlimited care could instead be going towards everything from more generous income supports to increased education funding to infrastructure improvements to rebates on payroll taxes. Health care is the most urgent of domestic progressive priorities, and rightly so, but it would be a better world if, in fixing the health care system, we could free up more money for other progressives priorities.....

But even though conservatives have embraced a crude, even regressive, form of cost-sharing, there's a kernel of insight to their account. In 1965, the average American received a bit under $1,000 in health care, and paid $483 out of pocket. In 2006, Americans received $6,640 in health care, and paid . $837 out of pocket. While total costs have increased by nearly 700 percent, out of pocket spending hasn't even doubled. It's not, however, as if we don't pay for that spending. It just goes through premiums, and lost wage increases, and taxes. In the end, we pay it all, we just do so in a way that encourages using ever more health care, and thus paying ever more for it.

Moving some of the spending to the front-end -- making us pay for care rather than premiums -- would certainly right some of those odd incentives. But it should be done in the context of a system-wide shift to a nationalized structure. The increased financial exposure of consumers will force better behavior from providers, but that's only half the battle. Even as you increase the perceived financial vulnerability of Americans (though their total costs will be far less), you can increase their protection against the practices and whims of providers. A major factor in our sky-high health costs is that Americans simply pay more per unit of health care than any other nation. We're getting gouged, and it has to stop. For that to happen, a new system must bring Americans into the same pool, so the government can use its massive market share to bargain down prices and advocate for their interests -- just like every other nation does.

More here




Reality: Health Care Will Cost More And Nationalization Rations & Destroys Quality

While the Left continues on its tired campaign for nationalized health care, revived by excitement over currently barely holding the majority in Congress, it has lost the core argument that it would effectively and efficiently bring access to all at lower costs and higher quality. Facts just won't comply with statist fantasy.

Some conservatives pay compliments to Ezra Klein, perhaps because he doesn't engage in Kosian vulgarity or excess, writes well, and does engage in civil discourse, certainly traits to be welcomed from the Left. However, make no mistake, Klein tactically veers from Leftist tropes while remaining faithful to its core. His latest, on health care, says we are spending far too much on health care, which will increase, and admits that, indeed as conservatives aver, more exposure of health care consumers to the cost of treatments will rein in some excessive usage.

But, Klein perseveres in the Left's theme that the only way to really and humanely expose health consumers to cost is by a sliding scale of major cost sharing within the framework of a nationalized system that imposes severe price restrictions on providers. Klein asserts that such a nationalized health care will continue to deliver the access and quality Americans expect.

Klein, and others whether conservative or liberal, fail to admit that the increased portion of our budgets that will be spent on health care is largely unavoidable, at least if we are to receive the access and quality we expect. Aging population coupled with advancing technology and the natural rise in expectations that comes with expanding national wealth will continue to increase spending on health care.

Only rationing of access and quality will reduce or seriously slow the rise in health care spending. Nationalization may do this, but more likely would not - as the revolt against overly restrictive HMO's demonstrated, and the political pressures for runaway costs of existing federal programs' demonstrates. What we'd be left with would be no way back, and a disastrous decline of health care access and quality just as demand for it increases.

Ideologues revel in "silver bullet" grand schemes, whether from the Left or Right. Conservatives' counter to the Left on health care, that more exposure to costs will make wiser consumers and restrain costs, is overstated because by its very nature health care choices - particularly in severe illnesses or accidents -- are not usually subject to informed choice, and can't be, but must rely upon informed and trained professionals whose own knowledge is in dynamic growth.

There are certainly marginal improvements that come from better information systems and from more self-responsibility and access to useful information. But, it's not a panacea. As I pointed out here, the Trojan Horse of the uninsured is overstated, to propel nationalized health care, and used to undermine the health care of 80% of Americans. The latest poll of the privately insured (consistent with many other polls), for example,

found most U.S. workers are very satisfied with their employer-provided health care benefits..At least seven in 10 workers consider their health plan to be excellent or very good at providing easy access to providers and covering a wide range of services, while two in three say their plan provides a sense of security that they will be able to afford good health care.

At the same time, contrary to conservative support for decoupling employees from employer-provided insurance, "About three in four employees would prefer to get health benefits through their employer rather than getting additional salary to buy their own."

Nationalized schemes trade on natural and legitimate anxiety of others about ability to obtain insurance, or the unwillingness of some of those who can afford insurance to pay for it. Incremental reforms, like COBRA and HIPAA and some states' small group legislations, have reduced this insecurity by providing guaranteed access to insurance. RomneyCare is the next step of incremental reform, although its details are in process of elaboration in the face of empirical analyses.

These are not "silver bullets" or all-encompassing systems. They are consistent with pragmatic trial-and-error focusing on specific problems, wholly in line with the American approach to governance that blends private enterprise and flexibility with only so much legislative compulsion as necessary to impel and regulate.

Ideologues, or politicians seeking to trade on fear, will no doubt continue to propound grand schemes. Smarter ones, however, will recognize what most voting Americans do: incremental reforms that save what's best, work best.

Source




Australia: The government version of urgency



LIFE-threatening ambulance delays at overcrowded hospital emergency departments are growing longer. Emergency ambulances now take an average of 32 minutes to unload a patient. This "at hospital time" has jumped four minutes in the past six months and has stretched by eight minutes, or 33 per cent, in the past two years. A frustrated paramedic sent photographs of ambulances queueing outside the Monash Medical Centre's emergency Department to the Herald Sun. He said six emergency ambulances and two patient transfer ambulances waited for up to an hour to offload their patients last week.

Metropolitan Ambulance Service operations general manager Keith Young acknowledged growing delays were affecting emergency response times. "There are growing pressures on some hospitals that ultimately result in a delay in us unloading patients, which is a concern," Mr Young said.

The MAS aims to respond to 90 per cent of emergencies in 14 minutes. In 2005, the target was 13 minutes. A MAS survey in 2005 found a strong community preference for response targets of less than 10 minutes. In recent months the average response time to 90 per cent of emergency calls has been close to 16 minutes, a Health Department source said. "There have been several close calls where it looked like it would hit 16 minutes," the source said.

Paramedics said there was no doubt the delays would cost lives. One said hospitals continued to force ambulances to queue to avoid financial penalties imposed by the State Government on hospitals that go on full or partial bypass too often. "The system is broken and (Premier Steve) Bracks has hidden behind a lot of smoke and mirrors for a long time," the paramedic said. "The early warning and bypass system is fundamentally flawed. "It penalises a (struggling) hospital by taking money from them when they need the money to pour into (extra) staff. "The end result is patients are put at risk."

A Health Department source said overcrowding had become so dire at the Royal Melbourne Hospital that it had virtually given up telling the MAS when it was too busy to cope with more patients. Hospital emergency department staff claim they are regularly directed to ignore bypass and early warning systems designed to help ambulances avoid crowded hospitals. The practice has become common since the Herald Sun revealed last year that the Royal Melbourne had spent 102 hours on full or partial ambulance bypass last May, more time than any other hospital. Mr Young confirmed some hospitals had been spoken to about diverting ambulances when their emergency departments were full. A reference committee of MAS, department and hospital representatives was looking at new management strategies to deal with delays.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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16 April, 2007

NHS negligence kills again

A mother of four died after a “gross failure” by NHS staff to provide basic medical attention on two separate occasions, an inquest has ruled. Alison Christian, 36, died in agony from a perforated duodenal ulcer after accident and emergency doctors and a nurse answering an out-of-hours phone line failed to detect the symptoms of peritonitis.

Had Ms Christian been correctly examined by the hospital doctor or been referred to a doctor by the out-of-hours service Primecare two days later, she would have survived, the inquest ruled. Instead, she was told to take laxatives.

Mitchell Bower, her partner of 21 years, with whom she had four sons, told the inquest that Ms Christian, of Sheffield, went to the city’s Northern General hospital, complaining of pains in her chest and shoulders, and was told that she had a chest infection. She returned the next day with abdominal pain but her abdomen was not examined, said Christopher Dorries, Coroner for South Yorkshire West. Her condition deteriorated and she called an out-of-hours NHS call centre. Mr Dorries said the outcome of the call should have been a visit by a doctor within the hour.

Ms Christian died after being admitted to hospital the next day. Mr Dorries found that her hospital discharge “without appropriate examination” and the failures of the deputising service “amounted to a gross failure to provide basic medical attention” to a person who obviously needed it. Ms Christian died from “natural causes contributed to by neglect”.

Source




Private care is better for childbirth

PREGNANT women from across the world are lining up to have their babies in an acclaimed Queensland hospital. Mothers-to-be are flocking to Nambour Selangor Private Hospital on the Sunshine Coast, in search of an empowering birthing experience. They have travelled from Hong Kong, Canada, the US and the United Arab Emirates to give birth in the unit. The hospital was also recently visited by a team of maternity experts from Britain, Australia and Brazil, who wanted to learn from the hospital's model of care.

The unit is one of few in Queensland to offer water births, natural twin births, and natural births after previous caesareans. Midwives and obstetricians are matched to mothers and supported throughout their pregnancy, labour and beyond. Midwife Lynne Staff, who founded the maternity unit 10 years ago with obstetrician Ted Weaver, said it was all about giving women what they wanted. "It's bending services to meet the needs of women, rather than bending women to meet the needs of service providers," she said. "We want women to feel strong and positive. It's simple things that make the difference, such as not separating babies from mothers in caesarean births, and giving women the chance to talk about the birth afterwards."

The hospital also offers parents childbirth preparation classes, and women are able to attend workshops to help them prepare for breastfeeding. There are also classes for couples expecting twins, giving them the opportunity to explore birthing options and providing tips on how to manage their new family.

Mrs Staff said she was saddened that other Queensland hospitals didn't provide the same standards. As previously reported in The Sunday Mail, a study reveals one in three mothers is traumatised after giving birth in understaffed and overcrowded [public] hospitals. [Similar figures have been reported for Britain's NHS hospitals]

Mrs Staff said: "Part of the problem is that hospitals don't find out what is important to women. "I think it's very sad that in the 21st century women can't access positive services in hospitals."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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15 April, 2007

A free market keeps dental costs down too

DENTISTS have conceded costs in Australia are contributing to an exodus to Thailand and other countries offering dental treatment at half the price. The Australian Dental Association yesterday warned "buyer beware" in the wake of the dental tourism trend. But the ADA said that, apart from anecdotal tales of botched surgery overseas, there was insufficient evidence to advise Australians not to go.

Thailand has long enjoyed a reputation as a cheap holiday destination. It now attracts thousands of Australians who combine a holiday with a cheap trip to the dentist. More than 1.8 million foreigners visited Thailand in 2005 for medical treatment ranging from sex changes to minor cosmetic surgery. The influx, up from 630,000 in 2002, has generated a multi-million-dollar industry.

Bangkok Dental Spa is one of a growing number of specialist dental centres in the Thai capital catering mostly to foreigners. Patients pay $400 to $500 for a new crown, compared with $1500 in Australia. Implant work ranges from $2800 for surgery and a titanium prosthetic, compared with $4000 locally. Bangkok Dental Spa chief executive Lily Porncharoen said she treated hundreds of Australians each year. Treatment in Thailand was cheap with high clinical and professional standards, she said.. "Australia is a very good market for us," Dr Porncharoen said. "It's not too far and they know Thailand well. "What we (Thai dentists) need is our Government to promote us to Australian people so they understand better our standards. I think more and more Australians will come."

With only anecdotal evidence of pitfalls, the ADA's John Matthews said it was hard to challenge Dr Porncharoen's claims. "I don't think we (ADA) have enough evidence to say: don't do it," he said. Thai dentists were cheaper than Australian counterparts because of lower salaries, lower laboratory costs and a "less regulated" environment, he said.

Labor health spokeswoman Nicola Roxon said dental costs under the Howard Government had soared and more than 650,000 people were on public waiting lists for treatment.

Source




Inside a Queensland public hospital

JAYANT Patel was less of a health risk than the hospital that employed him, a new book on the rogue surgeon says. In a compelling account of working with the former Bundaberg Hospital doctor, a surgical ward nurse paints Dr Patel as an often likeable workaholic who over-rated his ability so much he "thought he was God".

The nurse's insights are penned in the book, Dancing With Dr Death, under the assumed name Virginia Kennedy because of concerns that disclosing her identity would jeopardise future job prospects. "Not all the surgery he did was bad," said Kennedy, who has revealed her real identity to The Courier-Mail. "He did a lot of good surgery. He just over-rated his ability. That's what my book is about. It's the good, the bad and the bits in between."

The 208-page account paints Dr Patel as a Jeckyll and Hyde with a scalpel who became known throughout the hospital as a surgeon to avoid. Kennedy says one nurse even used to repeatedly joke he planned to have "Back off, Patel" tattooed on his body.

But despite Dr Patel's faults, the experienced nurse-turned-author is even more scathing about the hospital's administration and management. "I believe that hospital was a disaster waiting to happen before he ever came there," Kennedy said. "He became the catalyst. He became the match that lit the flame."

She tells of "downright dangerous" workloads in a hospital with little infection control. The book reveals Bundaberg Hospital was so obsessed with saving money staff were ordered not to give patients blankets, unless they were requested, to reduce laundry costs. And a man employed as a "bed carboliser", which involves washing down and remaking beds once a patient has died or is discharged from the hospital, was told by management to cut back on his cleaning. The man, named in the book only as Steve, says he was told by management: "If the bed looks clean, I am not to wash them. I only have to make them." Steve later left the hospital to become a builder's labourer.

Kennedy said management frequently pushed patients out the door ahead of their expected length of stay, telling them to handle their own dressings at home. "We commonly saw people returning with infected wounds and even wounds infested with maggots," she writes.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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14 April, 2007

BRITISH BAN ON EXPENSIVE DRUG OVERTURNED

Health regulators have overturned a ban on two drugs that could benefit patients suffering from rare and life-threatening brain cancers. The revised guidance from the National Institute for Health and Clinical Excellence (NICE) means that up to 800 patients a year will benefit from receiving the drugs, Temodal and Gliadel, on the NHS. Doctors and campaigners have been battling for two years to get NICE to reverse its decision to bar brain specialists from prescribing the drugs. The original guidance in 2005 rejected both therapies on the basis of cost effectiveness.

Temodal was originally approved for newly diagnosed cases of brain cancer in 2001 but NICE refused to approve its use for advanced cases of the disease despite compelling evidence from trials. The decision led to anger as the drug, a tablet that patients take as oral chemotherapy, was invented by British scientists funded by Cancer Research UK, yet neurologists in this country were unable to prescribe it to patients.

Gliadel is administered in a wafer that is left at the site where a brain tumour has been removed by surgery. Trials show that the drug is highly effective at mopping up remaining cancer cells and preventing the disease recurring.

Yesterday cancer charities called on health authorities to make the drugs available immediately and not wait until the decision comes into force in June. Ella Pybus, speaking on behalf of a consortium of charities, said: "Everyone is relieved that NICE has had this change of heart. There was solid evidence that these drugs work. "Now we are looking for primary care trusts to give these drugs to all those who qualify for treatment. It will be a cruel blow if treatments for one of the most lethal of all cancers were further delayed because of lack of sufficient funding."

Source




Shocking government medicine in Tasmania

Must not get sick after hours!

A man with agonising pancreatitis said he was frightened while he waited seven hours overnight in the Royal Hobart Hospital before getting medical attention. Shane Lockley was taken by ambulance to the emergency department and put in a wheelchair with a morphine drip in his arm. Mr Lockley said it was only after he started spitting up blood that he was taken into an emergency cubicle and then only after waiting about another hour. The incident happened on a Sunday night late last month.

"My GP told me if you get symptoms to get to hospital, because this disease is potentially fatal," said Mr Lockley, of Sorell. "I had to beg the ambulance to pick me up, then at hospital they put me in front of a television in a wheelchair. "Not one person checked me. Even if something had happened to me, they wouldn't have known. "I was spitting up blood and went up to the nurse to tell them. The drip ran out and the blood was in the tube. What's going on? "I was badly treated. A doctor walked in and (said:) 'How's your friend, Mr Alcohol,' assuming I was a drinker, but I said: `I don't drink, mate.'"

Mr Lockley, 42, said he had blood tests and was sent home. He said a report was not sent to his GP and they did not check his records. He said he needed to have his gall bladder removed and attacks of pain were becoming more frequent.

Wife Terisa said the ordeal scared the family. "We were just appalled. The doctor gave pretty strict instructions he would have to go to hospital if necessary, because it can be fatal," Mrs Lockley said. RHH chief executive officer Craig White said the care provided to Mr Lockley was appropriate for his clinical circumstances. Dr White said a report was faxed to his GP on the morning he was discharged. Mr Lockley said the doctor did not have the information when he saw him later

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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13 April, 2007

Socialized Medicine in Colorado - An Open Letter to Colorado Physicians

By Paul S. Hsieh, MD (paulhsiehmd@gmail.com)

My name is Dr. Paul Hsieh, and I am a physician practicing in the south Denver metro area. I am deeply concerned that socialized medicine may be imposed on Colorado by our state legislature within the next year or so under the guise of "comprehensive health care reform". I'm morally opposed to this because I believe it would be devastating to our patients and to our medical practices, and I'd like your help in speaking out against this ominous prospect.

The political process which could lead to socialized medicine is already underway, but most working physicians I've spoken with have been unaware of it. Hence, I want to sound the alarm before it's too late. As some of you may know, in June 2006 the Colorado state legislature authorized a special 24-person Commission (called the "208 Commission" after Senate bill SB208) to generate proposals to restructure the health care system in Colorado, and submit them for legislative approval. The Commissioners were chosen by politicians from both political parties. Currently, there are only two doctors on the 208 Commission; the other 22 are representatives of various special interest groups.

The basic premise of the 208 Commission is that the government must guarantee health care for all Coloradoans. During their public meetings, a significant number of the Commissioners have expressed support for some form of socialized medicine. Although they frequently use euphemisms such as "single payer" or "universal mandatory coverage", similar language has been used in other US states and other countries to justify government-mandated socialized medicine. Simultaneously, the Colorado Medical Society (CMS) has developed an official position in which they urged that health care in Colorado should be "universal, continuous, portable, and mandatory".

On January 25, 2007, the CMS submitted those "Guiding Principles" to the 208 Commission, portraying them as the consensus of the doctors of Colorado. They have also stated that the "CMS believes, after extensive vetting and a unanimous vote at the 2006 House of Delegates, that the Guiding Principles represent a compelling consensus of Colorado physicians".

When I first learned of this, I was angered and appalled, because that position does not reflect my views or the views of many other physicians that I've spoken with. The CMS does not speak for me on this issue, and I am not part of this "compelling consensus". I completely oppose any form of socialized medicine, regardless of whether it is called "single payer", "mandatory universal coverage", or anything else, because I believe it would be bad for both patients and doctors. Years of experience in the US and other countries have shown that these programs will hurt patients and cause unnecessary patient deaths. As costs inevitably spiral upward, bureaucrats will ration medical services. Eventually, physicians will be forced to practice against their best medical judgment. This is a violation of the fundamental rights of both doctors and patients.

As a result, in states like Tennessee (which in 1994 implemented its own version of mandatory universal coverage called TennCare), many doctors find the practice climate intolerable and are either leaving the state or quitting medicine entirely. I do not want that to happen in Colorado. States like Massachusetts and California, which are also attempting to guarantee universal health care for their residents, will soon face similar problems.

Although I completely agree that there are genuine problems with the current system, more government interference in medicine can only make things worse, not better. One basic principle we all learned in medical school was, "First, do no harm". This applies as well to politics as it does to clinical practice. Most of the problems of the current system have been the result of bad government policies. Adding more government bureaucrats to the mix will only make things worse.

In my opinion, it is not the government's role to guarantee health care for all Coloradoans, any more than it is the government's job to guarantee all citizens a car, or a job, or a great haircut. It is morally wrong and economically unsustainable. It is precisely the attempts by the governments in Canada and Great Britain (or states like Tennessee) to guarantee universal "cradle-to-grave" coverage that has led to the runaway costs and inadequate health care in those places. I recognize that not everyone will agree with me here, and this is part of my point. This is a very contentious issue amongst doctors. Based on my discussions with numerous physicians, I don't think one can accurately say that there is a "compelling consensus" of the doctors of Colorado.

So if you oppose socialized medicine on the grounds of medical conscience (as I do), then please contact both the Colorado Medical Society and the 208 Commission, and let them know where you stand. The CMS is speaking in your name on this issue, so if you disagree with their position (or if you believe that their position should not be portrayed as the physician "consensus"), then they need to know. The CMS has requested feedback from doctors including those who disagree with their current position, so I urge you to take them up on this.

The 208 Commission is a public body, and has also asked for input from all citizens of Colorado. So if you want to protect your right to practice good medicine and protect your patients' best interests, they need to hear from you. As doctors, we have a lot of credibility with the public, so speaking out now is imperative, before the 208 Commission submits their proposals to the state legislature for a vote. Even a one line e-mail like, "I oppose universal, mandatory coverage or any other form of socialized medicine, because it will be bad for me and my patients", could have a tremendous impact.

For your convenience, I've included links to the e-mail addresses of the relevant parties of both the CMS and the 208 Commission. To contact the CMS, go to: http://tinyurl.com/2ez4mo. To contact the 208 Commission, go to: http://tinyurl.com/yv2o4m.

One excellent resource is the website www.WeStandFIRM.org, a non-profit group of Coloradoans devoted to freedom and individual rights in medicine. I especially recommend the article, "Health Care is Not a Right" by Dr. Leonard Peikoff. If you wish to stay informed on this topic, I also encourage you to sign up for their mailing list or read their blog. Also, please feel free to forward this open letter to any other Colorado physicians that may be interested. A copy of this letter is also available online at: http://www.WeStandFIRM.org/docs/Hsieh-01.html

Disclaimer: I am neither a Republican nor a Democrat, but an independent voter. My objections to socialized medicine go beyond party politics.

Source




Buckpassing government medicine kills

A DOCTOR told to give anti-seizure medication to a teenage patient with a fractured skull told a Sydney inquest today she did not believe the instruction was too urgent or important. Vanessa Anderson, 16, died at Sydney's Royal North Shore Hospital in November 2005 after being hit on the head by a golf ball during a tournament. Glebe Coroners' Court has been told Vanessa was not given any anti-convulsant medication before she suffered a seizure and died.

The inquest into her death today heard evidence from Dr Nicole Williams, who had been the neurosurgical senior resident at the hospital for two weeks when Vanessa died on November 8. Dr Williams told the hearing that on November 7, consultant neurosurgeon Nicholas Little had told her to give the patient the anti-convulsant drug Phenytoin. Dr Williams said Dr Little appeared to waver over the decision and she formed the opinion that "we could write some up, but it probably wasn't that urgent and wasn't that important".

After Vanessa's family raised concerns that she could be allergic to Phenytoin, Dr Williams asked a more senior doctor, neurosurgical registrar Azizi Bakar, whether the drug should be administered. Dr Bakar nodded "to acknowledge what I said and made a comment like `it's OK'," she told the court. Dr Williams said she believed Dr Bakar was experienced enough to decide whether Vanessa should be given the drug or an alternative medication. It was the end of her shift and she thought the matter had become Dr Bakar's responsibility, she told the court.

Asked whether she thought she no longer had a role to play regarding the anti-convulsant medication, Dr Williams said: "That's the way I saw it."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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12 April, 2007

REALITY DAWNS IN CONNECTICUT

In a year when legislators pledged to cure the state's health care ills, the most ambitious plan of all would have the state fund coverage for everyone in Connecticut under age 65. But a staggering price tag - as much as $18 billion - left the plan on life support Monday, and legislators are virtually certain to pull the plug. The cost is slightly more than the entire state budget proposed by the governor. Without a cost affixed to it, the so-called single-payer plan was approved 12-7 by the legislature's insurance committee last month. It is awaiting action by the House of Representatives and the Senate.

The legislature's nonpartisan Office of Fiscal Analysis estimated the costs at $11.8 billion to $17.7 billion, depending on variables. Gov. M. Jodi Rell has proposed a state budget of $17.5 billion. The estimate sent shock waves through the state Capitol Monday, prompting key legislators to say that passing universal health care this year is unrealistic. "There are reality checks when you put a fiscal note to a bill," said House Speaker James Amann, a Milford Democrat. "There are some ideas that are so unattainable, so far out of reach, that you have to have a reality check."

Amann Monday evening said lawmakers would have to scale back plans to a level that is affordable over a sustained period. There is only "a very slim hope" that all of those currently without health insurance could be covered by the legislature this session, he said. Instead, Amann said he would work to improve access for children who have not been signed up for the state's HUSKY health insurance program. While the estimates vary, state officials say there are thousands of children who are eligible for the program and have not yet been signed up by their parents.

Among health care watchers in Connecticut, the estimate for providing health coverage for nearly 3 million people was the biggest topic of the day. The cost would be $17.7 billion if annual health insurance premiums were $6,000 per person; $11.8 billion if annual premiums were $4,000 per person. "Even we were quite shocked [by] the enormity of the cost. ... A lot of people are just scratching their heads and saying, `Wow!,'" said Eric George, associate counsel of the Connecticut Business and Industry Association, the state's largest business lobby.

The Republican governor does not support the "single-payer" option, saying that 94 percent of Connecticut residents are currently covered by programs such as Medicaid, Medicare, and employer-subsidized insurance. "Why would we spend $17 billion when the target we need to hit [the uninsured] is 6 percent of the population?" asked Christopher Cooper, Rell's spokesman. "The price tag is unrealistic. I'm sure that's going to have a chilling effect on the next committee to look at it - appropriations." The budget-writing appropriations committee is still crafting its formal response to the budget proposal Rell unveiled two months ago. The committee planned to finish its work this week with a wide variety of recommendations on spending - including health care.

Senate President Pro Tem Donald Williams, the highest-ranking senator, said he expects the committee to offer improved access to the HUSKY program for children, which many legislators believe is underused because eligible families have failed to sign up. Williams also expects to see more money for Medicaid reimbursements for doctors and hospitals, along with money for community health centers and school-based clinics. "On the one hand, $17 billion seems staggering, and it is," Williams said in the Capitol press room. "At the same time, the Connecticut Business Policy Council estimated that in Connecticut we spend $22 billion on health care costs each year - and that was in 2004 - for 3.5 million people." Williams conceded that the legislature will be unable to resolve all the issues by the time the legislative session ends at midnight on June 6. "No state has done what I would like to see us do, which is to have a Medicare-for-all type system," Williams said. "It will be difficult to get it all done this year."

Based on predictions made late last year, health care was supposed to be the predominant issue in this year's legislative session. But Rell has largely stolen the spotlight from the Democrats by offering a $3.4 billion, five-year education plan. She would fund it with a 10 percent increase in the state income tax, retroactive to Jan. 1. She dominated the news again by calling for a 3 percent spending cap on municipal budgets, with certain exceptions, to ensure that the increased state aid for schools would lead to property tax relief. Regarding HUSKY, Rell has said the number of children enrolled increased for eight consecutive months as nearly 9,000 children enrolled for the first time between July 2006 and March. Overall, more than 223,000 children are covered by the program. Cooper added that the state needs to focus on helping those who have not been placed in any state programs. "If 6 percent of the people need health insurance, the program should be focused on those 6 percent," Cooper said.

Source




Australia: Arrogant government ambulance service

The Victorian ambulance service has been the target of frequent complaints but, despite government huffing and puffing, it never seems to improve

PARAMEDICS have been accused of refusing to take a woman with a life-threatening brain aneurism to hospital because they believed she was drug-affected. The Metropolitan Ambulance Service is now examining a number of allegations that seriously ill patients have been refused transport. Premier Steve Bracks has called for an investigation. Others complaints involve a teenager with bile leaking behind her liver, a man with a burst stomach ulcer and a cancer patient who died. The MAS said human error or a failure to follow proper processes were probably the cause of any problems.

On November 26 last year, a 6mm aneurism burst in the front of Greensborough mother Melinda Fort's brain. Paramedics allegedly diagnosed her as drug-affected and refused to transport her. Her terrified 14-year-old daughter called a second ambulance five hours later. Ms Fort spent five weeks in intensive care. "All I want is those two drivers to come to my house, look me in the eye and apologise," Ms Fort said. "Even if I was a druggie I still wasn't well, so why wasn't I taken?"

Jade Olsen, 18, of Wantirna said she was denied an ambulance last Saturday when a paramedic told her by phone that the pain she was suffering after a gall bladder operation was not life-threatening. Her mother drove her to Knox Private Hospital, where she had emergency surgery to remove 500ml of toxic bile that had leaked behind her liver. "I'm pretty angry about it. It could have been somebody else with a much more serious matter that could have led to death," Ms Olsen said.

On March 20, Greta Galley called an ambulance for her terminally ill husband John, 72. But she said she was told his pain had to be assessed by a triage nurse first. She drove him to Frankston Hospital, where he died five days later. "It's not as if you call an ambulance for nothing," she said.

Mr Bracks urged the MAS to examine the cases, saying its resources were adequate. "If there are instances where triaging has not worked effectively . . . that will be investigated, and I have urged the MAS to (do so)," he said. MAS general manager of operations Keith Young said an investigation of Ms Olsen's complaint had begun and the others would be examined. "We certainly take these matters seriously. . . but . . . we receive a very small number of complaints. Many times, it is often a misunderstanding or not substantiated," he said.

Liberal health spokeswoman Helen Shardey said she'd be shocked if paramedics were trying to perform triage by phone rather than in person

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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11 April, 2007

WOOLLY WOOLHANDLER STRIKES AGAIN

The woolly one works in that temple of political impartiality: Harvard university. She keeps doing "research" which leads to support for socialized medicine. Her most famous statement was that socialized medicine would REDUCE bureaucracy! -- despite the fact that, in mature examples of such systems (such as Queensland and Britain), only about 1 in 4 employees of such systems are actual medical personnel! And even the doctors and nurses spend a large part of their time on bureaucratic tasks! She does tend to "overlook" rather a lot. In this case one thing she overlooks is that many if not most men are impacted by women's medical costs -- if they are married to or otherwise in partnership with a woman. Her assumptions and omissions may tell you something about Dr. Woolhandler. Post below lifted from Taranto:

Here's an Associated Press story on a new "study" that purports to argue against free-market health-care policies:

High-deductible health insurance plans favored by many employers often wind up being an unfair burden to women, a new study says, largely because women need many routine medical exams that quickly add up. The median expense for men under 45 in these plans was less than $500, but for women it was more than $1,200, according to a study by Harvard Medical School researchers.

They also found that only a third of insured men in that age group spent more than $1,050 in annual medical costs, while 55 percent of women did. "High-deductible plans punish women for having breasts and uteruses and having babies," said Dr. Steffie Woolhandler, the study's lead author.

"When an employer switches all his employees into a consumer-driven health plan, it's the same as giving all the women a $1,000 pay cut, on average, because women on average have $1,000 more in health costs than men," she said. Women's costs are higher because women need mammograms, cervical cancer vaccine, Pap tests, birth control and pregnancy-related services that men do not, said Woolhandler, who also is a co-founder of a physicians' group that advocates for a single-payer national health insurance system.

Wait a minute now. Wouldn't it be just as accurate to say that traditional, low-deductible plans and socialized medicine schemes pose an unfair burden to men, punishing us for lacking breasts and uteruses and not having babies?

Actually, that would be simplistic too. Really, it's single men who bear the brunt of women's health-care costs under these systems. After all, if we were married, our wife would most likely sign up for our employer-provided health-insurance plan, and we would have an interest in its generosity vis-…-vis women's medical needs.

We're particularly amused by Dr. Woolhander's comment that women are punished for "having babies." Usually when that happens, there's a man involved too.




Your bureaucrats will protect you -- again

A PURPORTED doctor working in a Queensland regional hospital will be sacked by health authorities after investigations found she was not medically qualified. Another person from the same intake of foreign workers has already been dismissed for failing to properly understand English. The credentials and background of the two were not checked by hospital or regulatory managers before they were employed, stunning the Queensland Medical Board and senior Queensland Health officials 18 months after the devastating scandal over foreign-trained surgeon Jayant Patel.

The two wore stethoscopes, conducted physical examinations and were held out to patients as doctors. Their work was meant to have been as observers under full-time supervision, but sources say this was not always the case because of busy periods and a shortage of staff.

One of the employees, who remains suspended from Cairns Base Hospital pending the exhaustion of rights of appeal, had used a public health qualification from a Shanghai college to pass herself off as a clinically trained junior doctor in her final year of training. She was paid more than $1200 a week as a doctor intern and student observer, watching and dealing with patients over several months, until March. The woman could not demonstrate knowledge of medical or clinical care, sources told The Australian yesterday.

The other employee hired during the Beattie Government's continuing campaign to overcome a chronic medical manpower shortage is believed to have had clinical training, but could not communicate in English to an acceptable standard.

Their status was discovered after a reminder was sent to hospital bosses to ensure staff were properly vetted and registered. The hospital's deputy director of medical services, Ric Streathfield, has admitted he "dropped the ball" when he bypassed the medical board to employ the two on salaries of more than $61,000 a year.

A Queensland Health spokesman said they had performed no procedures and had limited contact with patients. "At no time were any patients in danger," he said. "Their employment is a localised human resources matter, not a clinical matter, and the fact it has been dealt with shows the processes of Queensland Health and the medical board are working."

The two, who worked for several months until it was realised they had not been vetted by the medical board, were employed along with two other foreign interns, one of whom remains on suspension pending further clarification of credentials. The fourth has been registered. "These characters were not let loose to do brain surgery, but they were medically examining people even though at least one had no medical training," a government source told The Australian yesterday. "The slippage of standards and the failure of checks and balances that allowed this to happen so soon after a major public inquiry into the health system is worrying. It amounts to a neglect of medical administrative duties and it has directly impacted on patients."

The Beattie Government promised a $9.7 billion funding boost and a new era of openness and transparency in the aftermath of the public inquiries arising from the damage wreaked by Indian- and US-trained surgeon Dr Patel. His deadly incompetence in the US had resulted in Dr Patel being barred from performing surgery, but neither the Medical Board nor Queensland Health checked his background before he became Bundaberg Hospital's director of surgery. Dr Patel is to be extradited from his US home in Portland, Oregon, to Queensland to face multiple charges of manslaughter, grievous bodily harm and fraud arising from his two years at Bundaberg Hospital.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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10 April, 2007

NHS radiotherapy machines 'lie idle'



State of the art radiotherapy machines are lying idle in NHS hospitals, a BBC investigation has found. A report by the Royal College of Radiologists, commissioned by Five Live, found 10% of machines in the 60 UK centres were not being used. The total cost of the machines is £150m, with some of the funding coming from lottery money. The college said the survey findings were "no surprise". The government acknowledged there were problems.

The survey found Maidstone Hospital had two brand new machines that did not work for a year. The manufacturer, Varian, said this was happening across the country, with some hospitals taking 18 months to switch their machines on. This delay is vital as the machines only have a 10-year life. It also found that over 60% of the machines were not using new software that allows doctors to focus on the tumours and not damage healthy tissue. Ipswich Hospital uses this new software IMRT on all its head and neck cancer cases.

Dot West, has been treated using IMRT and says it had a dramatic effect. She said: "I feel very lucky to have this treatment and I think it should be more widespread." "If I have this treatment there is far less chance of me losing my right eye and also further brain damage."

The findings of the investigation came as no surprise to the Royal College of Radiologists. The college's vice president Michael Williams said services have improved, but that they still are not up to scratch. "The present radiotherapy service is inadequate. People are reluctant to admit how bad the situation is because they say it's a lot better than it was," he said.

The Department of Health acknowledges there are problems with radiotherapy waiting times and ministers are currently studying recommendations from the national radiotherapy advisory group on the future development of radiotherapy.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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9 April, 2007

More on Britain's maternity meltdown

Steadily regressing to the primitive where untrained family members have to deliver the baby

At first Annette Armstrong wasn't planning to have her mother present at her baby's birth. But she came round to the idea - after all it would be nice to hold her hand during the labour. It turned out to be the 'best decision' of Annette's life. For it was her mother who ended up having to deliver the baby - without her, says Annette, there is a chance her baby could have died.

Annette's ordeal began after her waters broke and she was admitted to a large maternity hospital near her home in Birmingham. When the 28-year-old went into labour, she experienced the alarming consequences of the chronic midwife shortages in Britain's maternity wards. "There were ten women, all at various stages of pregnancy and labour - five who had already given birth and one inconsolable woman who had just had a stillbirth - but only two midwives to look after us all. "The midwives were rushed off their feet and clearly couldn't meet the needs of all their patients. I got the feeling I was just a number, an item on a conveyor belt.

"After I was admitted I saw the midwife just once over the next three hours when she popped her head round the door to check on me." Three hours later, a different midwife started her shift. "After a quick check she told me I wasn't progressing that quickly and it could be a while yet," says Annette. "Before I could ask any questions she was gone."

With Annette screaming and the midwife absent, Annette's husband Daniel, 29, had to find an anaesthetist to give Annette an epidural - a form of pain relief that numbs the lower half of the body. But the injection was put in the wrong place, leaving Annette still able to feel every contraction. When the midwife finally reappeared, Annette told her she was ready to push the baby out. "But the midwife told me there was no way my baby was coming yet and I should try to stay calm. She didn't even check how dilated I was.

"I'll leave my assistant with you," she said, and a girl who looked no more than 20 appeared at the door. "She's a trainee, but she can come and get me if you really need me," the midwife said. "I'm just popping out, but I'll be straight back after that."" The trainee was unable to check how dilated Annette was because she wasn't sure if she'd enough experience to tell.

With Annette screaming that she was about to give birth, her mother had no choice but to roll up her sleeves and deliver the baby herself. "My mum is not a midwife and I couldn't believe she was about to deliver my baby. Daniel shouted at the trainee to get help, but she just stood in the corner looking petrified. "Twenty minutes after the midwife had left, the baby was crowning - the top of its head had appeared. My mum said: "This is your little girl and we have to get her out safely. There is no one else here to do this, so you have to trust me. Now start pushing." "When the head was out, she told me not to push so hard till each shoulder was out so that I didn't tear - she remembered being told this when she she was having me and my siblings." Minutes later, Harriet was born weighing 8lb 9oz and in good health.

"My mum and I burst into tears. She had helped me at a time when I needed her most, but I couldn't believe the NHS staff had put us in that position. "Were it not for my mum's advice and calm attitude, my child could have been starved of oxygen or had a whole host of other complications from not being delivered in time - she might even have died."

Annette is one of thousands of women each year whose care during childbirth is being put at risk by the current crisis in NHS maternity services. A shortage of midwives, coupled with budget cuts, means that overstretched units are struggling to cope, let alone provide the personal care pregnant women want and need. It makes the Government's promise that all women will have continuous care by 2009 seem, at best, wildly optimistic.

Only last week a study revealed that thousands of women find themselves isolated and frightened during labour because they do not get the care they need. Over half were left alone at times during labour. Just 19 per cent had one midwife providing continuity of care during their labour and while giving birth, with over half of firsttime mums having a stream of three or more midwives see them through the experience. The poll - funded by the Department of Health - also uncovered complaints about unsympathetic staff, who were too busy to give women the care they need.

Campaigners say that poor care during childbirth is leaving 30 per cent of women traumatised - that's around 200,000 women a year, says Maureen Treadwell of the Birth Trauma Association. She describes one alarming case where a woman who arrived on a maternity ward was asked to remove her underwear for an internal examination in the corridor - in front of cleaners. In another, cleaners were sent to clean up a room where a woman had been left naked.

More worryingly, there is the potential risk to health. Experts warned that many of the 60,000 reported maternity ward errors between 2003 and 2006 were due to staff shortages, inadequate experience, lack of consultant involvement and equipment problems. While deaths linked to pregnancy are rare, the latest figures show the number or women dying from pregnancy-related problems is rising, despite advances in medicine.

Two thirds of the 261 women who died from pregnancy complications between 200 and 2002 (the latest figures available) had 'some form of sub-optimal clinical care'. (In the previous three years, 242 were reported). Medical experts are concerned that the next report on maternal and child health, released at the end of the year, will show a further increase in maternal deaths.

Maureen Treadwell said: "Women's experiences on maternity wards vary from utterly superb to appalling and unacceptable. The appalling end is leaving hundreds of thousands of women suffering from some kind of trauma."

At the heart of this national problem is a severe shortage of midwives. According to the Royal College of Midwives, 10,000 more are required to ensure women get the care they need throughout childbirth. The shortage is due to an increasing number of midwives reaching retirement age and cuts in government funding for maternity units, meaning that newly-qualified midwives find it harder to get jobs. At present midwives have to work longer hours under greater stress, causing more of them to leave the profession.

Melanie Every, of the Royal College of Midwives, said: "Maternity care has become more involved, more invasive and the expectations of mothers are much greater than they were ten or 20 years ago. We have also seen a rise in the birth rate by around 50,000. "Women should have one-to-one care during labour." She added that one midwife should have a caseload of 28 to 35 mothers, depending on the kind of care the woman needs. However, there are hospital trusts where there is just one midwife for every 41 mothers. She says: "Shortages could jeopardise the standard of care in some services, but that doesn't mean every maternity unit is a dangerous place to be. The UK is still a very safe place to have a baby."

The crisis in maternity care is being exacerbated by falling numbers of experienced senior doctors, again due to funding cuts. The Royal College of Obstetricians and Gynaecologists estimates there needs to be a 5 per cent annual increase in the number of consultant obstetricians to meet the demands of maternity units. Yet since 2004, there has been a 17 per cent fall in the number of consultants being employed. This means that maternity units are routinely left without a senior doctor on the wards in the evenings and at weekends to deal with complications. Some 64 per cent of average-sized maternity units (ones where 3,000 to 4,000 babies are born a year) have a consultant on the wards only between 9am and 5pm, Monday to Friday. At other times, units are forced to rely on senior doctors who are on call from home.

The Royal College of Obstetricians and Gynaecologists has set a target that all units of this size should have consultant cover from 9am to 9pm on weekdays by 2009. Professor Shaughn O'Brien, vicepresident of the Royal College of Obstetricians and Gynaecologists, said: "Maternity care is very safe but it could be safer if there was one-to-one midwifery care available and there was consultant presence on the labour ward. "But the Government has never provided the funding for significant numbers of consultants to give this level of round-the-clock care on maternity wards, as there is in Europe. "If we could prevent one medical legal case for brain damage - which would receive a payout of around 3.5 million pounds - it would pay for one consultant obstetrician for the whole of his obstetric career."

Ministers desperate to limit the political furore sparked by the maternity crisis insist that services will improve. By 2009, they are promising that all women will be able to choose whether they want to give birth at home, in a midwife-led unit or in hospital, and will have access to continuous care during childbirth. To achieve this, the Government is planning to 'reconfigure' maternity services, merging some hospitals to make 'super-units', while opening a number of smaller midwifery-led units. However, critics claim the restructuring process means 43 existing maternity units have closed or are under threat - a move which they say will restrict women's choices. They also point out that continuity of care is less likely in big regional birth centres as opposed to smaller local centres.

Any improvements in maternity care will come too late for Annette, who has been left to reflect on her ordeal last April. She feels the NHS failed her and her baby because there weren't enough staff on the maternity ward and the midwives who were assigned to her didn't give her enough attention. "Were it not for my mother, I dread to think what would have happened," she says. "Harriet is a happy, healthy little girl, but it could have been so different. "What worries me is that many women won't be lucky enough to have their mums by their sides and will be left at the mercy of medical professionals who don't have the time or the inclination to look after them properly. "The Government needs to increase funding for midwives or I will certainly not be the last woman to have a terrible experience of birth."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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8 April, 2007

NHS encouraging midwives rather than obstetricians because they are cheaper?

A full range of birthing choices, huh? If only one could simply giggle and chuck the glossy Maternity Matters document in the bin along with Patricia Hewitt. We know the NHS will never be able to provide every mother with her own named midwife to hold her hand throughout what James Naughtie hilariously referred to on the Today programme yesterday as her "confinement" (where do they find these male presenters born so many, many generations ago?).

We know it, because we know about NHS rotas and staff attitudes and the way the patients are made to fit around them. We know pregnant women are not all going to have their own midwife on call, unless that means call back after 9.30am and speak to the answerphone.

Yet we must do more than chuckle, for Maternity Matters is no joke. It is the next stage in a midwife-led campaign to limit the choice available to women giving birth. You only need to read the introduction to see this. "It also emphasises the need for all women to be supported and encouraged to have as normal a pregnancy and birth as possible," writes Ms Hewitt. Her junior "Minister for Care Services", Ivan Lewis, adds: "I believe individualised care offered by a midwife, specialist support provided to those most at risk and normal birth without medical intervention will become a more realistic option for every parent."

A "normal" birth . . . birth without medical intervention: why? Why should we? This is an extraordinary conspiracy against women, a sort of quasi-religious belief in the virtue of pain, which Ms Hewitt is bafflingly encouraging. The more that modern medicine offers, in terms of pain relief and convenience, the more urgent the insistence of this weird sorority that a woman has to give birth "naturally".

Again, why? We are no longer expected these days to die naturally, without the operation that would remove the cancer or the pain relief to help us on our way. We are not expected to have our hips fixed naturally. We are not even expected to endure a mild headache without a paracetamol. Yet somehow the deeply painful and, for some, traumatic experience of giving birth is forced upon woman after woman in the name of some Earth Mother concept.

As a woman interviewed on the radio yesterday said, the worst part of her otherwise excellent treatment on the labour ward was the moment when the midwife gave her "quite a lot of grief" because she chose to have an epidural. She only had the strength to insist upon it because her father, sister and husband were all doctors and she trusted their advice. These midwives trained to help women give birth are for some reason trained only to help them give birth naturally. They are the chief conspirators against us. Please, let us have fewer of them, not more, Ms Hewitt.

I remember when I told my very nice and until then helpful midwife that I was going to have a Caesarean (I, fortunately, had a choice). I might as well have said that after careful thought I had decided I would feed my baby heroin. When she had recovered sufficiently from the shock, Maureen, a large, broad-hipped woman and mother of about eight, suggested I might have been swayed by Posh Spice: "A lot of women want to follow their favourite celebrity." Then she asked whether I was doing it at my husband's request to keep myself perfect for him "down there". There was no way she was going to understand that for me a predictable, pain-free birth (yes, I wanted it in the diary; anything wrong with that?) with a surgeon I had met and trusted, accompanied by lots and lots of drugs, was my choice.

Too many women in their late thirties have too many horror stories of agonising labours followed by emergency Caesareans under general anaesthetic so that, after all that, they miss the actual birth. For the rest of their lives they must live with terrible scars from being slashed wildly across the stomach by the cack-handed doctor on call, and remember the first weeks of their child's life in only a blur of exhausted depression and trauma. Does maternity not "matter" for them, too? Ask a woman who has had a planned Caesarean: awake, calm, pain-free. And no risk of the "down there" issues that Maureen referred to, either.

Yet the whole thrust of government policy is towards making that - the best choice for many - less and less available. They are closing smaller consultant-led maternity units and encouraging women towards natural home births or midwife-led units (no Caesareans), while hoping to use the specialist consultant-led birth centres only for the few expecting complicated births; minimal medical intervention, maximum embrace of the "natural". Ouch!

Perhaps the most insidious effect of these official attitudes is the guilt they can engender in the poor woman who tries and feels she has "failed" to have a "normal" birth as eulogised by NHS midwifery and the equally messianic National Childbirth Trust, progenitors of so many doomed "birth plans". One writer in The Times has been describing the feelings of disappointment and failure she felt after an emergency Caesarean: "Right from the start I felt I had let [the baby, Charlotte] down, not to mention me and my family." So irritated were many "pull yourself together, girl" readers, that she felt compelled to respond, this time less traumatised, a year after the birth (you can see the whole debate on the Alphamummy blog): "In the months leading up to the birth of Charlotte, like any very excited first-time mum, I read lots of books and attended a `natural birthing yoga' class on a weekly basis. In all my teachings I was told over and over again that the best way is the natural drug-free way. I was told that drugs slowed down the labour and could affect the baby. Nowhere was I told the benefits of drugs. I was brainwashed into thinking that natural is right and drugs were wrong."

Quite. It is shocking that a feminist Secretary of State for Health in the 21st century should be colluding with the pious missionaries campaigning to keep women's birth experiences in the 19th. We are modern now. And we are not in the Third World. We do not need to get behind a bush and squat. Let those who want to go natural, choose natural. But let those who don't, choose drugs. Choose a Caesarean. Choose life - any way they want it.

Source




NHS might not even be able to supply a midwife!

Fury at Hewitt's plan to water down promise of one-to-one midwife care for pregnant women

A government pledge to give every mother the right of one-to-one care from a midwife during labour has been watered down to allow hospitals to use lower-paid attendants with fewer skills. Midwives' leaders call the move 'scandalous', arguing that it will increase the risks for those women and babies not supported by a qualified midwife.

The policy shift will be in the government's maternity strategy, due to be announced by Health Secretary Patricia Hewitt this week. The government has come under increasing pressure over the state of maternity wards due to a recent spate of reports showing that standards in Britain are falling, with thousands of women not receiving good antenatal care or enough support during the birth. In its election manifesto in May 2005, Labour promised that by 2009 women would be cared for by a named midwife throughout pregnancy and would receive continuous care throughout the delivery. Instead they could now find themselves in the care of a maternity support worker, a new category of staff without a nursing or midwifery degree who may not be able to deliver a baby safely.

However, Health Minister Ivan Lewis is adamant they would not jeopardise safety. He told The Observer: 'By the end of 2009, we want to see trusts at least giving a commitment to the fact that a skilled professional is present throughout the birth. That could be a midwife or it could be a maternity support worker.' He defended the use of lower-skilled staff: 'What matters is that the mother feels confident that she is well cared for. There are many maternity support workers who are providing an excellent service.'

Lewis also criticised the 'rhetoric and scare-mongering' of recent media reports that have highlighted problems on maternity wards. 'A lot of the media reporting has been very irresponsible because it scares women. There have been two million births over the past three years, and 50 women died in that time due to obstetric complications that could have been dealt with better. One death is too many - but that number doesn't suggest a crisis in terms of safety.'

The Royal College of Midwives is furious that hospital trusts will be able to claim they offer continuous care during labour when they have replaced trained midwives with maternity care assistants, who are paid around 12,000 pounds a year and are not subject to the same regulation. They were originally introduced to help with lighter duties on maternity wards, such as feeding and washing, but many believe hospital trusts see them as a cheap workforce.

RCM adviser Sue Jacob said: 'This change has been quietly slipped in and is nothing short of scandalous. Do we really see childbirth as so unimportant that you de-skill the very people who will be delivering children? Women want nothing less than a midwife by their side when they are in labour. We know from all the research that's been done that continuous care from an experienced professional makes a huge difference to the safety of both the mother and the child.'

Belinda Phipps, chief executive of the National Childbirth Trust, said: 'We would like to see the gold standard being met, which is a qualified midwife being with a woman throughout labour. We know that 10 per cent of women are being left alone during labour, and they don't like it. It's just down to not having enough staff, and the financial situation in the NHS has made that worse.' Phipps pointed out that in Scotland the target of offering continuous care from a midwife is already being met. 'It has to be asked why the rest of the country can't achieve this goal, given that it is so very important for women when they go into labour,' she said.

Under the new strategy, called 'Maternity Matters', from 2009 women will also be offered a choice of whether to receive their antenatal care from a midwife or a GP. They will be able to choose whether to give birth at home, in a midwife-led unit or in a hospital.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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7 April, 2007

British hospital phone-call ripoff

Patientline, the company that provides telephones at hospital bedsides, is to increase its prices by up to 160 per cent. Charges for outgoing calls will rise from 10p a minute to 26p. This compares with about 3p a minute for the basic BT rate. Incoming calls to patients cost 39p per minute off-peak and 49p a minute at peak times.

Yesterday the company said that it was not wholly responsible for the hike in charges; delays to the Health Service IT project were also to blame. Patientline told The Times that it had invested 160 million pounds in installing 75,000 bedside consoles in more than 150 hospitals. In 2005, Patientline was investigated by regulators over its high charges, but was cleared of any wrongdoing.

Seven years ago the company won contracts with NHS hospitals to provide the consoles, which, at the Government’s recommendation, provided for doctors to access the proposed electronic patient record system and for electronic prescribing and ordering of X-rays, as well as telephone and entertainment services. The additional services were intended to be integrated into the National Programme for IT, with Patientline being paid for electronic record and prescribing schemes as NHS trusts used them. After years of delays to the 6.2 billion project, such systems are not yet online, and Patientline and other companies say that they have been forced to recoup their costs through charging patients to make calls.

Patientline has admitted that it is 80 million in debt and that it currently has money left to operate only for the next 12 months. The NHS does not subsidise or receive money from calls. Colin Printer, the company’s marketing manager, said “As a private sector company, we’ve put millions of pounds worth of equipment into these hospitals and that’s a massive investment for us. Each bedside system cost 1,700 pounds to install, and across the country they were maintained and supervised by 800 staff, Mr Printer said. “They are significant pieces of kit, designed not only to provide phone, television and radio services but also the internet, and electronic medical care. “It is not possible to attach a specific figure to revenues that may have been anticipated from delivering other services for which Patientline equipment is designed, such as electronic patient records and electronic meal-ordering, but it is fair to say Patientline anticipated a greater rollout of these services. “It looks like the patient’s being asked to pay for the cost of everything, which was not the original intention.”

To date, only one hospital has implemented the electronic patient record system and only a few have adopted meal-ordering, according to Patientline. It says that while call charges will increase, the cost of the complete bedside “package” will fall from 3.50 a day to 2.90. Charlotte Brown, the company’s commercial director said: “We’ve realigned our prices to bring the price of TV, which the majority of people watch, to a much lower level.” The price of packages for people staying for longer than a few days would fall, and such patients would be able to get free games and internet services, she added.

The Government has maintained that these services are a luxury and should not be funded by taxpayers. However, the Patients Association says that patients often have no choice but to use Patientline because many hospitals no longer have public pay phones. Mobile phone use has previously been restricted or banned, although some hospitals are relaxing the rules in accordance with recent government guidancesubject to the discretion of ward managers.

Michael Summers, of the association, said that the cost of incoming calls was already high and that the latest increase would lead to more complaints. “These people are ill, often recovering from operations, and the hike from 10p to 26p to phone out is really too much. People are going to be really upset with this,” he said. The Department of Health said: “Arrangements with providers of bedside entertainment systems are agreed locally, and Patientline should be discussing any proposed pricing restructuring with NHS trusts.”

Source




Government operating theatres shut down in Australia despite high-demand

A STRING of hospitals has been forced to close operating theatres over the Easter holiday break, according to the State Opposition. Opposition health spokesman Helen Shardey said yesterday the stoppage at several regional and two metropolitan hospitals reflected the Bracks Government's failure to adequately fund the hospitals. Kyneton District Health Service, Kilmore Hospital, Bairnsdale Regional Health Service, Casey Hospital and Monash Medical Centre will each close its theatres for a fortnight. Echuca Regional Health will stop elective surgery for three weeks, after a two-week shutdown over Christmas.

But the hospitals and the State Government deny any funding shortfall, saying the routine closures were largely to allow staff to have time off over the holiday period. Ms Shardey said the hospitals were "feeling obliged to say that". "There are concerns that they are running short of funds and are being forced into this action," she said. Ms Shardey said it was inappropriate for the theatres to close for routine surgery while more than 36,000 patients remained on Victoria's waiting lists. "These latest closures are enough to cause further delays in waiting times for essential surgery when patients have already waited long enough," Ms Shardey said.

But Bairnsdale Regional Health Service CEO Gary Gray denied his hospital in East Gippsland was closing surgery for financial reasons. "We are actually operating at a surplus at the moment," Mr Gray said. "We work our closures around Christmas and Easter as part of our leave management strategy; obviously that is when we get the most requests for leave from our staff. "No one is going to have to wait longer for surgery," he said.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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6 April, 2007

NHS dentistry



Reforms to NHS dentistry are failing, the British Dental Association said yesterday as thousands of would-be patients besieged a practice near Portsmouth offering NHS care. In scenes more typical of the January sales, patients arrived at first light at a new practice in Titchfield Common, Hampshire. Before the doors had opened, 2,000 people had registered online and over the phone. Hundreds more arrived in an attempt to grab the 1,000 remaining places. By the time the surgery opened at 10am, the queue stretched around the block. Manori Ambrose, who set up the surgery, said: “There are a lot of people who need a dentist who are not even on the waiting list.”

The British Dental Association (BDA) wrote to Barry Cockroft, the Chief Dental Officer of England, yesterday and called for changes to the dental contract, which has been in force for a year. The letter, from Lester Ellman, chairman of the BDA general dental practice committee, said: “The strength of the evidence means I must now write to you to urge you to reconsider the current dental contract. Our concerns go beyond the significant transitional difficulties experienced over the past year and we can now demonstrate that the new system is in need of fundamental reform.”

He called for three key changes: the abandonment of units of dental activity as the only way of measuring performance; more money to be paid directly to primary care trusts for dental services; and for dentists to be given the option to transfer their NHS contracts to new owners. Dr Ellman called on the Government to look again at an alternative model, called personal dental services, which was piloted over a seven-year period.

Near the front of the queue in Titchfield Common was Chris Rills, 49, who said: “I have been without an NHS dentist for three years.”

Last year the Government introduced a new contract to attract dentists back to the NHS. It claims that the move is succeeding, but a BDA survey has found that 85 per cent of dentists thought that it had not improved access to NHS care.

An NHS dentist took her own life after succumbing to the pressures of work, an inquest in Pickering was told. Ingrid Gill, 46, of Thornton Dale, North Yorkshire, took an overdose of antidepressants and whisky after taking on a huge list as the only NHS dentist at the practice, and then being asked by one of the owners to resign from the NHS list because of ill health. She also later had breast cancer diagnosed. Verdict: suicide.

Source




Creeping privatization of government healthcare in Australia's oldest "free" hospital system

It's a process already well underway in Britain

AROUND 10,000 Queensland public hospital patients waiting for elective surgery will now be able to access private health care as the government throws its waiting lists open to tender. Health Minister Stephen Robertson today confirmed a Courier-Mail report that the state was spending $8.5 million to have the patients treated sooner in the private sector through a brokerage service. "Queenslanders who have been identified as waiting too long for their elective surgery will be offered to this brokerage service, who will then go around private hospitals to see who is prepared to take that patient," Mr Robertson told ABC radio today. "They will obviously be paid for taking that particular patient. "That means we will be able to make some real inroads into those numbers of Queenslanders who are waiting outside of the time that it is clinically appropriate for them to be seen for their elective surgery."

Mr Robertson said about 160 of the most urgent category one patients were waiting longer than 30 days. There were between 3,000 and 3,300 patients rated as category two and around 6,000 to 6,600 in the least urgent category three. The service, called Surgery Connect, will target elective surgery for procedures such as hip and knee replacements, hysterectomies and corrective eye surgery. Mr Robertson said private sector doctors already performed elective surgery at the federal government's Department of Veteran Affairs (DVA) rate of payment and there was no reason why they should not do the same surgery on public hospital patients for the same money. Private hospitals had also said they were willing to take the patients.

"Not all private hospitals are working flat out and from my meetings with them, they tell me on a regular basis they would be keen to see more public patients come through their doors, so this is us testing that market," Mr Robertson said.

But AMA Queensland (AMAQ) president-elect Ross Cartmill said morale in the public hospital system would suffer under the new system. "We feel very strongly that it's the doctors working in the public sector who should be doing any of the surgery," Dr Cartmill said. "Secondly, we've made it very clear that they are training the trainees - the doctors of tomorrow. "If you want to undermine the morale of the public hospital system, that's the way to do it."

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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5 April, 2007

NHS to ration IVF?

False economy again

IVF treatment could be rationed under new rules to be considered by the fertility treatment regulator. The Human Fertility and Embryology Authority (HFEA) is set to start a public consultation about whether only one embryo, rather than two, should be implanted in patients. The authority believes that it will cut the number of multiple births and protect the health of mothers and babies.

Fertility specialists say that it will severely reduce the odds of successful conception. About 30,000 women each year in the UK turn to IVF after failing to conceive naturally. In most cases two embryos are implanted with each cycle of treatment to increase the chances of pregnancy. But a report by an independent group published last year suggested that the huge rise in multiple births put the health of mothers and babies at far greater risk.

One key proposal of the One Child at a Time report was to set criteria for selecting first-time IVF patients who would be offered single embryo transfers only. These would be the youngest, healthiest patients at highest risk of multiple pregnancies. Such pregnancies carry much higher risks of miscarriage, preeclampsia and birth complications, while twins, triplets and other babies who have shared a womb together are more likely to be born prematurely.

Unlike natural conception, where the chance of a multiple birth is relatively low (1 delivery in 80 is of twins), the latest figures suggest that almost a quarter of IVF pregnancies result in multiple births, accounting for half of the 10,000 such births each year in the UK. Women who undergo IVF treatment are currently limited to two embryos under rules introduced by the HFEA in 2003. Since then, the incidence of triplets is thought to have more than halved. But cutting the number of embryos implanted in each IVF patient also reduces the already low chances of the treatment working at all, meaning that a woman may need more or repeated cycles. Last year's report said research had found that implanting only one fresh embryo in the first IVF cycle for women under 34 cut pregnancy rates to 38 per cent from about 75 per cent when two were implanted at the same time.

It has been suggested that under the revised rules, doctors should still be able to use their clinical judgment to decide if a woman should get two embryos, but that clinics will be told to reduce the number of multiple births through IVF from 25 per cent to 5 to 10 per cent. This could be achieved only if half or more women were limited to one embryo. The HFEA said yesterday that a decision was not expected to be taken until the autumn

Source




Australian Labor party embraces private health care

Recognizing reality in a country where 40% of the population have already abandoned the "free" government health system

LABOR will dump its opposition to higher health insurance rebates paid to the over-65s as the party prepares to drop its traditional antagonism to private health care. It comes as the ALP national conference later this month will move to excise from its platform a provision opposing growth in private care at the expense of the public system. The Opposition's health spokeswoman, Nicola Roxon, is today expected to tell private health funds that Labor accepts the role of a strong private health sector and supports higher rebates for older health fund members.

The move is an acknowledgement of the growth in health insurance in recent years and is in line with the strategy of the Opposition Leader, Kevin Rudd, of removing targets vulnerable to Government attack, including the private schools hit list and the pledge to reinstate workers sacked under the Government's looser unfair dismissal laws.

Labor has opposed the higher rebates - 35 per cent for the over 65s and 40 per cent for those over 70 - since they were introduced two years ago, giving the Government ammunition to raise doubts about Labor's commitment to the existing 30 per cent rebate which benefits about 10 million people. Since the introduction of the perks for older members, health fund membership for the over-60s has climbed sharply to more than 1.5 million in that age group. Labor has previously argued that the higher rebates would not be necessary because of its now aborted Medicare Gold plan to give free treatment to the elderly.

Ms Roxon said that clearly there were many people, particularly the elderly, who relied on the rebate to afford health insurance. "We don't believe we should add to their pressures by taking these away. I think this is a sign about Labor being able to move with the times. It is definitely an acceptance that private services are playing a more important role in health." She said it was important for the party "to concentrate on the issues we think the community wants us to deal with" and not on "outmoded debates that do not accept the community is changing".

Federal Labor has already signalled it is prepared for an even greater role for the private sectors in public health care, including investigating the training of doctors in private hospitals. Ms Roxon said she did not expect problems in getting the more private-friendly platform through the national conference. That was so long as the conference appreciated that Labor intended to invest in public health care to ensure the best quality service "and not some sort of safety net that the Government wants to turn it into".

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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4 April, 2007

NHS hopeless with cancer

You could literally die waiting

More than half of all cancer patients needing lifesaving radiotherapy are waiting longer than the Government's "maximum acceptable delay" for treatment, according to a damning report. The Times has been told that the paper shows huge variations in the delivery of treatments around the country, with many "black holes" where services are extremely poor.

The study, by the National Radiotherapy Advisory Group, has not been published and ministers have not indicated that it will be. But Professor Karol Sikora, a cancer specialist, said that it should provoke "an outcry for better provision". It mirrors a survey by the Royal College of Radiologists which concludes that radiotherapy waiting times are "unacceptable" and delays "reduce the chance of a cure and worsen outcomes in some patients".

There has been an outcry over the availability of new cancer drugs but radiotherapy is often forgotten. "It's the unsexy part of cancer treatment," Professor Sikora said. "It's as good as the drugs but isn't thought of as being as exciting." The college's audit shows that only a minority of patients are treated within even the targets set by the Government. In 2005, only 47 per cent of patients needing postoperative radiotherapy got it within the "maximum acceptable delay" of four weeks. In Wales the figure was a mere 26 per cent.

The audit followed earlier ones, in 1998 and 2003, and shows that waiting times have become longer since 1998, when around a third of patients waited for more than four weeks. The delays worsened considerably between 1998 and 2003 and have improved slightly since then. The audit concludes: "It is imperative that waits for radiotherapy are reduced for all patients to maximise their chance of a cure." The authors, led by Michael Williams, of Addenbrooke's Hospital in Cambridge, added that "achieving this will require a planned programme of investment in staff, training and equipment."

Professor Sikora, who has been clinical director of cancer services at Hammersmith Hospital and chief of the World Health Organisation's cancer programme, said: "Systematic delays abound. Three months' waiting time for radiotherapy is common."

Yet cancer is seen by the Government as one of its successes. Cancer mortality in people under 75 fell by 16 per cent between 1996 and 2004 and an extra 639 million pounds was invested in the three years up to 2004. "The year-on-year increase in funding has been staggering," Professor Sikora said, adding that far more is needed.

Professor Sikora has recently set up CancerPartnersUK, which is talking to hospitals about building a chain of privately-funded cancer care units with the aim of reducing the distance patients must travel. Maps based on population density and existing services show where the need is greatest. "Black spots" for cancer treatment (above) where people have to travel long distances, abound around the M25, the South Coast, in the North West and North East of England.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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3 April, 2007

More superbug deaths in Britain

A virulent strain of the Clostridium difficile superbug has been linked to the recent deaths of 17 elderly patients at a hospital. A further eleven who have the bug are being treated and five more sufferers have had bowel surgery at the James Paget University Hospital in Gorleston, Norfolk. Health experts at the hospital said yesterday that they had not identified the source of the 027 strain of Clostridium difficile, commonly known as C.diff, and could not say whether patients contracted it in the hospital or in the outside community.

The bug was a contributory factor in the deaths of the patients between December 1 and March 28 and not the actual cause of death, experts said. Of the 17 patients who died, the majority were over 65 and some in their 80s. Of the five who had surgery to alleviate the worst symptoms, several are said to have recovered and left the hospital.

Medics said that the fit and healthy had little to fear from the bug but those patients in hospital or outside who had been taking antibiotics were at risk because of imbalances in the gut brought on by taking the drugs. To prevent more cases developing, different antibiotics were being given to patients in the hospital and the outside community. The hospital has also spent 400,000 pounds on new health precautions.

A statement from the James Paget University Hospitals NHS Trust said: “At the beginning of December 2006 we became increasingly concerned about a rise in our normally low background rate of C.diff. “Our concerns were heightened by the increasing severity of illness which led us to believe that a new strain was present in the hospital. “We immediately responded to these changes in the patterns of patients’ illness by putting in place a wide range of additional infection-control measures.” [Hooray! Asepsis rediscovered] Precautions include putting patients suspected of having the bug in isolation rooms, revising antibiotic prescribing policy, upgrading cleaning procedures and introducing new deep-cleaning techniques, involving the recruitment of 15 new staff. Visitors to the hospital are being asked to wash their hands with soap and water as an extra precaution as the usual alcohol gel is not a protection against the bug.

Mr Nick Coveney, director of nursing and patient services at the hospital, said: “This strain of C.diff is much more virulent than any strain we have experienced previously.” It was not yet possible to say whether all the patients who died had the 027 strain of the bug as more tests were being carried out. In the two years prior to December 2006 the hospital had 11 patients who had experienced C.diff complications that had contributed to their deaths.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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2 April, 2007

Dangerous ambulance service lies in Britain

Ambulance staff in Wiltshire routinely and systematically altered data to make it look as if the service was meeting targets. A report from the Audit Commission found that in less than 15 months between April 2005 and July 2006 staff altered the timing of 594 emergency calls to make it appear that ambulances had reached callers within the target of eight minutes. Staff also altered the details of 89 lower-priority calls, which are supposed to be reached in 19 minutes. Many changes were made to call categories to make results look better.

Despite these changes, Wiltshire Ambulance Service (now amalgamated into Great Western Ambulance Service) failed to meet the targets for either the “immediately life-threatening” category A calls or the “serious” category B calls. Three quarters of category A calls are supposed to be reached within eight minutes, and 95 per cent of category B calls within 19 minutes. In 2005-06, Wiltshire Ambulance Trust scored 71.2 per cent and 91.4 per cent respectively.

Richard Lott, the auditor, said: “The key performance indicator for ambulance trusts is how quickly the ambulance arrives. It is crucially important that the public has confidence in the integrity of the data.” Last August the Department of Health admitted widespread altering of ambulance figures. A report showed that six out of 31 trusts had misreported response times. Wiltshire was not among them.

Source




Fatal ambulance delay in Australia

A young Australian soldier is heartbroken following the death of his fiancee and unborn baby, after a wait of more than 20 minutes for an ambulance. Trooper Sean Graham, who has seen active service for his country overseas, says his cherished partner and baby might still be alive if paramedics reached them more quickly. Mikaela Meagher, 22, died in Austin Hospital on March 21 after losing consciousness two days earlier during an epileptic seizure in the bath at her sister's home in the central Victorian town of Maryborough.

Mikaela was pregnant with Cohen Thomas Graham, who was due to have been born on the day of her seizure. Mr Graham, 23, told how he and Mikaela were looking after her sister's three children on the evening of March 19 when the double tragedy unfolded. "Mikaela's nephew went into the bathroom to tell her to hurry up because he wanted to play with his frisbee, then ran out saying she was playing under the water," Mr Graham said. He found Mikaela unconscious, began performing CPR and phoned the emergency services.

"They kept saying 'It's not going to be long, not long now'," he said. It was at least 20 minutes between the call being made and the first paramedics arriving, he said. According to Mr Graham, paramedics had to leave a man who had suffered a heart attack with a doctor in Dunolly and travelled the 22km distance to the Maryborough emergency at 160km/h.

Paramedics said Maryborough and the surrounding towns had one vehicle on duty. Sources said the team, when called to the Dunolly job, warned the Rural Ambulance Victoria control centre in Ballarat to find cover in case of another emergency, but that no action was taken. "If the paramedics had been able to get there within five minutes they were confident the outcome could have been different," one ambulance officer said. Cohen was pronounced dead when Mikaela reached Maryborough Hospital.

Mikaela, whose heart had been revived, was flown to the Austin, but with minuscule activity in her brain, her life-support machine was switched off on March 21. Many of her organs were donated to help save others.

Mr Graham has called for an investigation into resourcing and management procedures relating to the tragedy and a wider probe of the service. "If they had been there in just a few minutes I believe it might have been different," he said. "The paramedics were fantastic, but the ambulance service needs more resources. "I cannot bring Mikaela and Cohen back, but I don't want anything like this to happen to anyone else," Mr Graham said.

The RAV was restructured this year after being plagued by claims of inadequate resourcing, mismanagement, bullying, sexual harassment and cronyism. Though the target for metropolitan ambulances is to attend within nine minutes for most cases, there is no target response time for rural ambulances.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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1 April, 2007

British doctor-training fiasco

The head of a controversial scheme for training doctors was ejected from office yesterday by the sheer weight of medical opinion. Professor Alan Crockard resigned as national director of Modernising Medical Careers (MMC) over the failure of the system for selecting junior doctors for training jobs. Critics say that the system is so unreliable that excellent doctors will be rejected and poor doctors appointed, damaging the quality of care and risking patients’ lives. Junior doctors and consultants have condemned the Medical Training and Application Service (MTAS) as unfair and incompetent. The recommendations of a review panel set up to rescue the process were rejected by junior doctors.

Professor Crockard has resigned with immediate effect. Lord Hunt of Kings Heath, the Health Minister, said: “I would like to thank Alan for his enormous contribution to Modernising Medical Careers. “Alan’s work led to the successful establishment of the Foundation Programme for the early years of postgraduate medical training, which has been widely acknowledged to be a success. I appreciate that it has been a difficult time for junior doctors and would like to reassure them that we are listening to their concerns and working with their representatives to find a fair solution to this complex issue. “I would like to reconfirm our commitment to MMC which aims to recruit and train the best doctors to provide the best possible patient care.”

Professor Crockard, a neuro-surgeon, was recruited in 2004 to run MMC, a system for revamping medical training. This turned the old system upside down, replacing what amounted to an apprenticeship with a scheme designed to teach and measure competencies in all branches of medicine. While many doctors have doubts about MMC, believing that it is narrower and less flexible than the old scheme, it was the failures of the computer-based MTAS — a small part of the system — that brought Professor Crockard down. Last year, when the first doctors to be trained under MMC graduated, there was a huge row about the failures of the computer system to place them reliably into junior doctor posts, known in the MMC jargon as F1 and F2 posts.

But the problems were as nothing compared with those that occurred this year, when the task was to place junior doctors in training posts that would lead eventually to consultant positions. More than 30,000 were competing for 22,000 places. Success would put them on course to become consultants, failure could mean a blighted career. The computer could not cope with the volume of applications, limited the applications the junior doctors could make and failed to produce adequate shortlists for interviews. Many outstanding candidates failed to get any interviews in the first round because the application forms failed to recognise academic excellence adequately. Others were shortlisted despite not being qualified for the jobs.

The Department of Health appointed a panel to try to rescue the process, but its recommendations have not found favour with junior doctors. Dr Matthew Jamieson-Evans of Remedy UK, the body that organised mass medical protests in London and Glasgow over MTAS, said: “Resigning is the honorable thing for Professor Crockard to do. We bear no personal ill-will to him, but it is right that somebody should take responsibility. “This is only the first chapter. Very very few doctors are happy with the recommendations of the review panel.”

Source



Big Australian public hospital in trouble

THE Royal North Shore Hospital is lurching towards another crisis, with a senior doctor resigning over serious problems with trauma surgery as the troubled hospital struggles to rein in its budget and maintain services. His resignation comes as the hospital's ability to manage elective surgery was again called into question by revelations yesterday that a woman booked to have fibroids removed had her operation cancelled twice on the day of surgery.

Over the past 10 years the surgeon, who does not want to be named, has written letter after letter, detailing a litany of complaints and cover-ups at the hospital, which he says has failed to properly investigate any of the incidents. "The system allows multiple problems to occur," his resignation letter says. "There is no one person who takes ownership of the problem and has the ability to affect any change for the good of those individual patients who are being harmed by the system." Obsessed by process at the expense of health care, the hospital gave medical and surgical units "untenable service goals with limited resources", he said. "We are exposed to a rotating door of middle managers who are servants to a paperwork process that hides the problem."

The final straw came when a patient arrived at the emergency department with a severe fracture and other complications but was refused access to theatre - and only received surgery five days later.

The resignation comes just two months after the Herald revealed that the hospital was facing another significant budget overrun, with an audit finding that $30 million of essential equipment needed to be bought. "North Shore is over-budget," admitted Phillipa Blakey, the director of clinical operations of Northern Sydney Central Coast Health. "It is not as over-budget as it has been in the past . and in terms of the area, we will break even at the financial year." She pointed to a fall in the rate of cancellations on the day of surgery from 18 per cent last July to 5 per cent last month, as well as a reduction in the number of people waiting longer than 12 months for surgery from 61 to seven in the past year. "It is a very busy hospital and it is getting busier by the day . And despite that the performance has improved a lot."

The chairman of the Royal Australasian College of Surgeons in NSW, Phil Truskett, said: "It is no different throughout metropolitan hospitals in NSW and if you want to get into rural and remote NSW it is much worse." A lack of infrastructure and funding was hampering access to operating theatres for acute cases, affecting the patients involved and those waiting for elective surgery, Dr Truskett said. "Acute surgery is done in the middle of the night when it should not be done - we need an appropriate process and method of managing acute care during the day."

The president of the Australian Medical Association in NSW, Andrew Keegan, said patient care was suffering because the system was being run to make the numbers look better. "If someone senior doesn't take responsibility for that patient then the quality of care is at risk," he said.

Source

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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