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31 January, 2008

Don't treat the old and unhealthy, say NHS doctors

You've paid for your health insurance all your life only to be told you can't collect on it when you need it? That's a risk you take with socialism. And it's already happening to some extent in Britain

Doctors are calling for NHS treatment to be withheld from patients who are too old or who lead unhealthy lives. Smokers, heavy drinkers, the obese and the elderly should be barred from receiving some operations, according to doctors, with most saying the health service cannot afford to provide free care to everyone. Fertility treatment and "social" abortions are also on the list of procedures that many doctors say should not be funded by the state.

The findings of a survey conducted by Doctor magazine sparked a fierce row last night, with the British Medical Association and campaign groups describing the recommendations from family and hospital doctors as "out-rageous" and "disgraceful". About one in 10 hospitals already deny some surgery to obese patients and smokers, with restrictions most common in hospitals battling debt. Managers defend the policies because of the higher risk of complications on the operating table for unfit patients. But critics believe that patients are being denied care simply to save money.

The Government announced plans last week to offer fat people cash incentives to diet and exercise as part of a desperate strategy to steer Britain off a course that will otherwise see half the population dangerously overweight by 2050. Obesity costs the British taxpayer 7 billion a year. Overweight people are more likely to contract diabetes, cancer and heart disease, and to require replacement joints or stomach-stapling operations.

Meanwhile, 1.7 billion is spent treating diseases caused by smoking, such as lung cancer, bronchitis and emphysema, with a similar sum spent by the NHS on alcohol problems. Cases of cirrhosis have tripled over the past decade.

Among the survey of 870 family and hospital doctors, almost 60 per cent said the NHS could not provide full healthcare to everyone and that some individuals should pay for services. One in three said that elderly patients should not be given free treatment if it were unlikely to do them good for long. Half thought that smokers should be denied a heart bypass, while a quarter believed that the obese should be denied hip replacements. Tony Calland, chairman of the BMA's ethics committee, said it would be "outrageous" to limit care on age grounds. Age Concern called the doctors' views "disgraceful".

Gordon Brown promised this month that a new NHS constitution would set out people's "responsibilities" as well as their rights, a move interpreted as meaning restrictions on patients who bring health problems on themselves. The only sanction threatened so far, however, is to send patients to the bottom of the waiting list if they miss appointments.

The survey found that medical professionals wanted to go much further in denying care to patients who do not look after their bodies. Ninety-four per cent said that an alcoholic who refused to stop drinking should not be allowed a liver transplant, while one in five said taxpayers should not pay for "social abortions" and fertility treatment.

Paul Mason, a GP in Portland, Dorset, said there were good clinical reasons for denying surgery to some patients. "The issue is: how much responsibility do people take for their health?" he said. "If an alcoholic is going to drink themselves to death then that is really sad, but if he gets the liver transplant that is denied to someone else who could have got the chance of life then that is a tragedy." He said the case of George Best, who drank himself to death in 2005, three years after a liver transplant, had damaged the argument that drinkers deserved a second chance.

However, Roger Williams, who carried out the 2002 transplant on the former footballer, said doctors could never be sure if an alcoholic would return to drinking, although most would expect a detailed psychological assessment of patients, who would be required to abstain for six months before surgery. Prof Williams said: "Less than five per cent of alcoholics who have a transplant return to serious drinking. George was one of them. It is actually a pretty successful rate. I think the judgment these doctors are making is nothing to do with the clinical reasons for limiting such operations and purely a moral decision."

Katherine Murphy, from the Patients' Association, said it would be wrong to deny treatment because of a "lifestyle" factor. "The decision taken by the doctor has to be the best clinical one, and it has to be taken individually. It is morally wrong to deny care on any other grounds," she said.

Responding to the survey's findings on the treatment of the elderly, Dr Calland, of the BMA, said: "If a patient of 90 needs a hip operation they should get one. Yes, they might peg out any time, but it's not our job to play God."

Source




The Massachusetts mess

A further comment -- by Bob Parks

So let me get this straight.. The cost of Massachusetts' health insurance mandate will rise 85 percent, or $400 million, next year. Former Massachusetts Gov. Mitt Romney, who rammed this down all of our throats, won't have to answer for all this because the Mass healthcare plan doesn't fully go into effect until after the presidential election. How convenient. Tell everyone how great the plan, you stuck your old state with after you left office, is.

As it turns out, the same Mitt Romney who claims to be a Reagan conservative has left an already cash-strapped state with the inevitability of increased taxes to cover the additional costs of his national healthcare model. It's a shame we didn't parse his words like we did Bill Clinton. Sure, the plan didn't require a raise in taxes while he was governor. The plan wasn't in place yet. Romney said.

"I'd say each state needs to get busy on the job of getting all our citizens insured. It does not cost more money."

Nothing from Mitt about tort reform. One of the reasons healthcare costs are so high is that doctors have to carry outrageous amounts of malpractice insurance to protect themselves from people like John Edwards. That cost, along with the annual amounts of near-unfettered fraud, is always passed down to the consumer.

Also remember, there was a time when many of us didn't have health insurance. I can only remember going to the hospital or a clinic once or twice during my childhood. We didn't have helicopter moms taking us into the doctor's office as soon as our noses started running or our tummies hurt.

As a Massachusetts resident who saw the man in action, I told you Mitt Romney comes off as a phony, thus it's hard to believe anything the man says while in election mode. From a speech posted on Mitt's own website he said.

"Healthcare is not a Democrat issue. It's a Republican issue; it's a conservative issue. Democrats look at problems like this and they have one answer: government. `We need bigger government, they say, so we can manage problems like this.' That's the wrong answer. Conservative principles have the answer for health care."

He listed them off as "personal responsibility, free market dynamics, choice", and being able to do all this without a government takeover. Well, aside from throwing his conservative principles under the bus, we sure are as close as we'll ever get to a government healthcare takeover. How do we know this? Private industries seldom require tax increases.

Maybe it's just that I never knew what real conservatism was, but I was always under the impression that real conservatives were for government that didn't impose itself in our lives. I guess Mitt Romney has proven us wrong.

Source





30 January, 2008

Incredible British medical negligence again

You are just one of a herd of cattle to NHS doctors

A BOY who spent most of his life being deaf in one ear has been cured after he discovered the wayward tip of a cotton bud. After being deaf in his right ear for nine years, 11-year-old Jerome Bartens identified the cause of his ailment while playing with friends at a church hall in Haverfordwest, in Wales. The Daily Mail said Jerome heard a popping sound in his ear and, after using his finger to investigate the cause of the noise, discovered the tip of a cotton bud.

His father told the newspaper he was shocked that doctors did not discover the object after years of examinations. “It was just incredible – his hearing returned to normal in an instant,” Carsten Bartens told the newspaper. “He was cured as suddenly as he became deaf… I had always suspected Jerome had stuck something in his ear when he was little and that was causing the problem. “But the doctors and hearing specialists said it was wax and he would probably grow out of it.”

Jerome said it was strange to have his full hearing back again. “I can hear much better now and I think I’ll be happier at school now my ear does not ache all the time,” Jerome said. “It’s great that people don’t have to shout to me and that I don’t have to turn my head all the time.”

Source




British nurses leaving in droves

Thousands of nurses are leaving the NHS in search of better pay and working conditions abroad. More than 10,000 nurses and midwives left to work abroad in 2006-07, leaving the NHS just a few years from a staffing crisis, the country’s top nurse said. Nearly 35,000 nurses - enough to staff the entire health service in Wales – have emigrated in the past four years. During the past three years there has been a 75 per cent rise in the number of nurses leaving for Australia alone, data from the Nursing and Midwifery Council (NMC) suggests.

Despite an anticipated shortfall of 14,000 nurses by 2010, Clare Chapman, the Department of Health’s director-general of workforce, has said that the NHS no longer needs to increase overall numbers of nurses and doctors.

Peter Carter, general secretary of the Royal College of Nursing (RCN), told The Times that the Government was guilty of a “yo-yo approach” to workforce planning, exacerbating low morale. “We are just a few short years away from a crisis,” he added. “There is every sign that being short-staffed on overstretched wards puts patients at risk, yet an estimated 20,000 nursing posts have been cut in hospitals and surgeries across the country. “At the same time as they are offered a miserly pay deal, they are being bombarded with advertising for a better life abroad. When you are offered comparable salaries and a higher quality of life in Australia, the Cayman Islands or South Africa, is it any wonder that some might choose to kickstart their careers abroad?”

The average salary for an NHS nurse was 24,000 pounds, Dr Carter said, about 10,000 less than the average police officer or teacher, while a below-inflation pay rise of 0.6 per cent in real terms last year had been an insult.

In total, 33,513 nurses left the UK and registered to work abroad between 2003-04 and 2006-07, but this was likely to be a conservative estimate, Dr Carter said. Meanwhile, 6,144 nurses from abroad were registered to work in the UK last year, 4,624 of them from outside the EU.

Source





29 January, 2008

Massachusetts Health Costs Balloon

(Boston, Massachusetts) As always, socialized medicine means massive unanticipated costs. In Massachusetts, the mandated health plan is like a huge vacuum cleaner sucking dollars out taxpayers' wallets.

According to recent reports, the cost of Massachusetts' health insurance mandate will rise 85 percent, or $400 million, in 2009. Former Massachusetts Gov. Mitt Romney (R), meanwhile, has been on the presidential campaign trail praising the program he put into place.

According to The Boston Globe, the cost increase is largely due to an increase in the number of people signing up for state-subsidized health insurance. State and federal taxpayers are likely to shoulder the cost increase.

Mark my words, Massachusetts' premier symbol of corruption and ineptitude, The Big Dig, will be considered a bargain basement deal when compared to the dollars ultimately confiscated from the public for the state's socialized health care system.

Remember, voters, Mass. HealthCare is Mitt Romney's baby.




How dreadful! Big drug firms launch cheap versions of their pills!

What right have they??!! A big whine below emanating from haters of the drug industry. Just the phrase "Big Pharma" warns you of Leftist bias ahead

Many of Big Pharma's biggest blockbusters will soon lose their patent protection. Deloitte, a consultancy, estimates that $55 billion of products will go off patent in 2009 and will then face competition. At the same time, pharma bosses are being asked to defend patents in costly legal battles against an increasingly confident and litigious generics industry. As generics firms evolve from mere copycats into innovators in their own right, many such firms—led by Israel's Teva, India's Ranbaxy and Dr Reddy's Laboratories—are vigorously challenging patents.....

Under American laws designed to encourage generic drugs, which save money for patients, the first generic maker to win regulatory approval for its version of any given branded drug is supposed to enjoy a six-month monopoly. This promised pot of gold was designed to support small generics firms—but Big Pharma has found a loophole. It is pre-emptively launching generic versions of its own branded pills, which wipes out those six months of monopoly profits and undermines the economics of generics firms.

Merck, a big American pharmaceuticals firm, is soon expected to launch an authorised generic version of Fosamax, an osteoporosis drug that is due to lose patent protection in February. A recent survey of global branded-drugs firms by Cutting Edge Information, a consultancy, found that a third of them had launched authorised generics between 2005 and 2007—and the number will grow to 44% between 2008 and 2010. Pfizer has set up an in-house division to handle such generics.

More here




Australia: Emergency wards facing crisis

The good ol' government "planning" again. This is a government that REDUCES the number of beds when it rebuilds a hospital! Despite steady and quite foreseeable population growth

A DRAMATIC increase in the number of patients turning up at public hospital emergency departments has stretched the system to its limit, says [Queensland] State Health Minister Stephen Robertson. He has called on Queenslanders to give overworked hospital doctors and nurses a break after a survey showed 75 per cent of those who go to public emergency rooms for treatment are there because they couldn't get access to a GP or didn't want to pay doctors' fees.

The number of people who sought treatment at Queensland hospital emergency departments last year increased 8.7 per cent from 2006 - nearly five times the usual annual increase, and four times the state's population growth for the period. The flu epidemic in August boosted the figures and the state's 23 largest public hospital emergency departments treated nearly 1 million patients in 2007. "This is what we have to try and deal with . . . we can't just keep forever expanding our emergency departments to cope with ever-increasing numbers," Mr Robertson said. "We have to find ways to deal with this very challenging, increasing demand."

The survey, commissioned by Australia's health ministers, revealed that one out of every three emergency room patients thought they actually needed hospital treatment. But about two out of three went to hospitals because their doctor was not on duty, or that doctor's clinic was closed. The overload has flowed through to add months to elective surgery waiting lists, hospital staff say.

Mr Robertson said new and refurbished emergency departments would be the priority in the Government's record $5 billion capital works spending in 2007-08. "But the problem is that emergency medicine is one of those specialties where there is a worldwide shortage," he said. Mr Robertson today will release the public hospitals' performance report for the December quarter. It will reveal that 929,093 people attended emergency departments in 2007, up from 854,550 in 2006. The 82,774 December total in emergency rooms was the highest in Queensland history.

Mr Robertson said the number of doctors in Queensland had increased from 8453 in 2001 to 9352 in 2006. But the number of GPs per 100,000 people had fallen from 238 to 227, and an increase in the number of female GPs and an ageing male sector had resulted in a decrease in doctor-patient hours.

AMA Queensland president Ross Cartmill disagreed with Mr Robertson that people attending hospital did not need treatment. He estimated that less than 5 per cent should have seen a GP first. "The fundamental issues in our Accidents and Emergencies are not enough staff and a lack of beds."

Source





28 January, 2008

Cancer woman runs out of time in NHS battle

Yet another death from socialism -- and as deliberate and as heartless as anything Stalin did

A WOMAN suffering from breast cancer has run out of time to benefit from a potentially life-extending drug which the National Health Service (NHS) denied her, even though she was prepared to pay for it. Colette Mills has been told by doctors that in the four months since she asked for the drug the disease has taken such a hold in her body that the cancer will no longer respond to the treatment. She is the victim of a ruling which states that any patient who wants to pay for additional drugs not prescribed by the NHS should lose their entitlement to their basic NHS cancer care and pay for all their treatment. She was prepared to pay for the drug but not her whole treatment.

Mills, a 58-year-old former nurse, said: “I am just absolutely gutted. I just cannot believe people make these decisions about other people’s lives. “It wasn’t going to cost them. I was going to pay for it. How can they say this policy is far more important than somebody’s life? “The NHS has taken this opportunity away from me and, if they are doing it to me, they are doing it to a lot of other women as well.”

The government claims that to allow some patients to pay for additional drugs on top of their NHS treatment creates a two-tier system between those who can and cannot afford them.

Asked about her future prospects, Mills said: “They are not hopeful of halting it. They will give you no promises. I didn’t ask and he [the doctor] didn’t say. It is not something I want to know just yet.” Mills, a mother of two, launched a legal action to try to force the NHS to allow her to pay for the drug Avastin which she wanted to take alongside another medicine, Taxol, which is prescribed by the health service. But during her four-month battle with the NHS, the breast cancer has spread to other parts of her body and doctors have told Mills it is too late for her to benefit from the combination of Avastin and Taxol.

An American trial has shown that taking the drugs in combination doubles the chance of preventing the disease from spreading compared to taking Taxol on its own. Taking Avastin in addition to Taxol is also likely to keep the disease under control for almost twice as long. Leading oncologists say Avastin offers a small but significant advantage in treating breast cancer. Mills will now be prescribed an alternative medicine but does not know how successful this will be in stopping the cancer.

Several other cancer patients are also taking legal action to win the right to pay for medicines that are not available on the NHS. The patients’ lawyer, Melissa Worth, of the law firm Halliwells, said: “Colette has been told by her medical team that she may have missed her chance. If she had been given the opportunity to take the Avastin when she first contacted her medical team about it, then she would have had three months’ treatment by now. Months down the line, the policy will need to change but for those patients currently fighting their NHS trusts, it might be too late.”

Becoming an entirely private patient would have cost Mills, from near Stokesley, North Yorkshire, about 10,000 pounds a month instead of about 4,000 solely to pay for the Avastin and its administration. Although she could have tried to raise the funds such as finding a loan, she believes it is a fundamental principle that the NHS should continue to fund her basic care for which she has paid through her taxes.

The Department of Health, however, said top-up payments would “undermine” the “fundamental principle of the NHS, now supported by all the main political parties, that treatment should be free at the point of need”. Mills’s case has provoked a national debate about whether NHS patients should be allowed to pay for top-up treatments. NHS chief executives, the Patients Association, Doctors for Reform and Saga, the organisation for the over-fifties, have all backed Mills and other patients in her situation since The Sunday Times highlighted their plight last year. A group of Conservative MPs, including former shadow health minister John Baron, are campaigning for co-payments to be allowed.

Source




Australia: Big and dangerous hospital delays for ambulances in Victoria

HUNDREDS of ambulances are out of service each day -- stranded at Melbourne hospitals. Ambulances are stuck at hospitals for up to four hours despite government benchmarks that they be free to leave within 25 minutes. Paramedics are unable to respond to new emergencies because the hospitals are full, documents under Freedom Of Information laws reveal.

The Metropolitan Ambulance Service documents reveal alarming numbers of ambulances waiting at hospitals. On average, more than 29 ambulances across Melbourne wait daily at emergency departments for an hour or more. In the first six months of last year, more than 320 ambulances a day were stuck for longer than 25 minutes. The documents reveal:

AN AMBULANCE delivered its patient to the emergency department at the Austin Hospital in three minutes, but waited three hours because there was no bed.

153 AMBULANCES, almost five a day, spent an hour or longer at Royal Melbourne, Grattan St, in May last year.

40 AMBULANCES were stranded for more than an hour at Frankston Hospital in one week.

MORE than 100 ambulances were stuck for an hour or longer at The Alfred in January.

Ambulance Employees Union secretary Steve McGhie said the down time could cost lives. "The reason they're waiting so long is because they can't get their patients off the stretcher," he said. "There is no room for them at the hospitals and ambos have to wait until they find room. "Every minute they have to wait at a hospital is another minute another patient has to wait for an ambulance."

Opposition health spokeswoman Helen Shardey echoed Mr McGhie, saying the out-of-service time could mean the difference between life and death.

Source





27 January, 2008

The Collective Punishment Model

Remember how in grade school, the teacher would punish the whole class for the actions of just a few disruptive students? This is an early lesson in collective punishment, which is usually practiced during wartime or under martial law. Collective punishment has now arrived with compulsory medical insurance. Known as an "individual mandate," politicians of both major parties have supported it. Compulsory politically-defined insurance is law in Massachusetts, is up for consideration in California and Colorado, and Democratic presidential candidates endorse it nationally.

Politicians peddle compulsory insurance under the guise of "personal responsibility." The story is that the uninsured receive medical care without paying for it. Their freeloading passes costs onto the insured, which increases premium costs. Compulsory insurance, say its supporters, can remedy this problem by forcing both the insured and uninsured to purchase medical insurance - as defined by politicians.

This rationale is flawed. First, freeloading from the uninsured does not significantly increase insurance premiums. Paying the medical bills for the uninsured adds little to insurance premiums - and certainly less than Colorado's scheme for compulsory insurance. A study published in Health Affairs found that uncompensated care is "only 2.8 percent of total personal health care spending," of which our tax dollars - not increased premiums - fund at least 80 percent.

In Colorado, the Lewin Group found uncompensated care to be less than four percent of total medical spending. The portion of uncompensated care that can correspond to increased premiums is around $200 million annually. This is just $85 per privately-insured resident, or one percent of the average premium.

But the billion-dollar "cure" proposed by Colorado's Commission on Healthcare Reform would cost the insured more than $85. To encourage compliance with compulsory insurance, the Commission's plan includes tax-subsidized premiums and Medicaid expansion. Privately-insured Colorado resident, the tax increase would cost about $400.

Second, holding people responsible would mean punishing freeloaders themselves and allowing providers to prevent customers from skipping out on the bill. This is the exact opposite of compulsory insurance, which forces the innocent to purchase insurance policies determined by political interests, rather than their own needs. This is collective punishment. What if we applied the rationale for compulsory medical insurance to freeloaders who leave restaurants without paying the bill? This certainly increases prices, but forcing all citizens to purchase "diner's insurance" punishes the innocent.

Third, government controls already punish the innocent - insured and uninsured alike - by making medical care and insurance prohibitively expensive.

The federal tax exemption for employer-provided insurance coddles insurance companies by tying employees to their employer's plans, effectively discounting insurance, and shielding insurance companies from competition. It also drives demand for more comprehensive insurance than would otherwise be purchased. Insulated from medical costs, patients behave like business travelers on a company expense account, so medical providers need not compete on price. Shall we further pamper insurance companies by forcing everyone to purchase their products?

On the state level, medical providers and disease constituencies lobby to force insurance to include benefits that many customers do not need. For example, Colorado law compels widowed wives to pay higher premiums for prostate screening, maternity, and marital therapy. These mandates increase Colorado premiums by 21 to 54 percent, which dwarfs the one percent increase attributable to the uninsured. Colorado's Chief Medical Officer states that 2,500 Coloradans lose insurance for every one percent increase in premiums. Nationally, the figure is 300,000 people. These controls also reduce wages and are responsible for up to twenty-five percent of America's uninsured.

Compulsory insurance further empowers politicians to determine what insurance is best for you. For example, the Boston Globe reports that under the Massachusetts plan, "more than 200,000 people with health insurance would have to buy additional coverage to meet proposed minimum standards under the state's new health insurance law."

When government policies increase insurance costs, the first to drop coverage are the young and healthy. Those remaining in the insurance pool are at higher risk to incur medical expenses, so premiums rise again, which again drives out the healthiest remaining customers. It takes some nerve to support policies that make insurance prohibitively expensive and then make it a crime not to purchase insurance.

Compulsory insurance is based on collective punishment, a perverted form of justice found where troops patrol the streets and spitballs go splat. It punishes both the insured and uninsured for the misdeeds of politicians. Legislators should stop scapegoating the uninsured for the mess they've perpetuated. They should repeal legislation that inhibits the free market from delivering affordable high-quality medical care.

Source





26 January, 2008

"Treat it like car insurance ."

In almost every cry for "nationalized healthcare" these days, there seem to be one of two basic mindsets advanced for such a program. One camp continues to advocate the "Medicare model," seeking to base an expansion of health insurance on this overblown and bloated methodology, which is already very near the point of bankruptcy or drastic cutback on services in order to continue to function at all. Enough has been said, both here and elsewhere, about how absurd this system is as prototype for broader "coverage."

However, even among those who recognize the serious faults in the present Medicare model, there are many who see health insurance as just another mismanaged program, which if only it were better regulated would answer all the problems it now presents. These folks point to the "automobile insurance" paradigm as something the healthcare industry should emulate. They also use the fact that mandatory auto insurance has become the rule rather than the exception, to indicate how easily health mandates could be applied across the board.

What they fail to consider is how different insuring an automobile is from the personal health and wellness realm. Herewith is an attempt to define some of those differences.

First, let's examine the "mandatory" aspects of auto insurance. Even in its most draconian implementations, this does not compel drivers to take on full coverage (including comprehensive/collision, maximum personal injury, car rental during a disabled vehicle, etc.). It only requires the driver to be insured for liability to others, at least to a minimum standard of coverage. The focus of the mandates is on your burden on innocent others, not on your personal well-being.

Second, the incidents covered by an auto insurance policy are restricted to the results of accidents and breakdowns, even under the most all-inclusive policies. There's no coverage for routine maintenance, oil changes, parts or labor for repairs, etc. All of this must be secured under a separate set of warranty coverage, none of which is mandatory in any state - nor is it likely to become so.

And finally, car insurance may currently be obtained through a much wider variety of insurance agents and companies, in many cases spanning state lines and boundaries. Although the rates themselves may be based on where you live and the actuarial statistics pertaining to that area, in most cases companies based far across the country can serve your requirements, competing with localized agencies.

Now compare all this with the health insurance model, if it mimicked the automotive one. If the only requirement was that you minimize your negative effects on others, a proper mandate might require you to avoid contact with others while afflicted with a communicable disease. During flu season, for example, one might wish to secure some policy that paid at least partial wages for time missed while staying home and recovering from a virus, rather than passing it to others by our presence in the workplace. No other coverage (except perhaps for the medicine to speed recovery?) would be then deemed mandatory, although one would be responsible for remaining isolated until the ailment had passed, at least through its communicable stages.

The limitations on personal-care coverage, even as voluntarily incurred, would also be pretty restrictive if we strictly adhered to the automotive model. Just for starters, physical exams, screenings and other supposedly "preventative" actions would not be covered by the policy; we don't object to paying out of pocket for an oil-change, or a new battery - or if we do, we've secured a repair and maintenance contract to limit those expenses beyond a certain level. (Note that one can now do something similar with healthcare, by taking out a high-deductible, catastrophic-only policy, with low premiums, while investing the remainder in a Health Savings Account to pay for those "maintenance" costs.)

Whatever the case, under this paradigm there would be no need for the massive amount of paperwork and bureaucracy we now must weather - in every doctor's office, clinic and hospital - processing all those claims and forms for routine examinations, screenings and treatments, for the mere security of detecting possible serious ailments before they become inoperable or incurable. Paying up front and at point of service would cut such administrative costs considerably, and any healer who failed to pass along those savings, with lowered fees, would not stay in business very long.

Only the big-ticket items, caused by "collisions" with other elements (in this case, chronic diseases, accidents and other catastrophic events, comparable to "other vehicles, physical barriers and tree-trunks," in the case of the autos), would be "covered" by insurance under such policies. If we chose to add "coverage" for either minor ("fender-bender"?) or health-maintenance events, we could do so, but this would not be mandatory under a consistent application of this paradigm.

Finally, if we were truly basing this process on the automotive model, we'd be offering a lot more options, and without the state-line boundaries that now exist. While some leeway among local providers does exist, there are so many mandated coverage provisions imposed by individual states, with no recourse to avoiding them in being "covered" within that state, that the cost of the policy is artificially increased just by that factor alone. Bottom line, the "car insurance model" might be a good starting point for serious healthcare reform . but only if one really means what is implied by that idea.

Source




Australia: Woman's death in government hospital was preventable

A MELBOURNE woman who died after giving birth could have survived if her medical treatment had been more timely and organised, a coroner found today. Piyanat Siriwan, 33, died at 2.15pm on April 1, 2004, at the Monash Medical Centre from massive blood loss after giving birth to a healthy baby girl at 8am that morning at the South Eastern Private Hospital in Melbourne's outer east.

Delivering her finding today into the death, Coroner Paresa Spanos said with more competent medical management, including a more timely transfer from the South Eastern Private Hospital, Mrs Siriwan "had a reasonable chance of surviving''. "In that sense I find her death was preventable,'' Ms Spanos said. Saying Mrs Siriwan's transfer between the hospitals was "a study in chaos'', Ms Spanos was critical of Mrs Siriwan's obstetrician Maurice Lichter and anaesthetist Emlyn Williams in their handling of her case on the day of her death, and ordered them to front the Medical Practitioners Board of Victoria (MPBV). She recommended the MPBV take whatever "action it deems appropriate against the two doctors''.

Ms Spanos also made an adverse comment about South Eastern Private Hospital not having made Dr Lichter or Dr Williams aware there was an emergency supply of blood available which would have been used to help Mrs Siriwan. She recommended the hospital ensure all doctors were aware of such supplies being available in future cases.

However, Ms Spanos said she did not have any adverse comment to make in relation to the Metropolitan Ambulance Service or the nurses attending Mrs Siriwan on the day, adding that their concern and frustration had been evident. A lawyer for Mrs Siriwan's husband, Harrinat Siriwan, said outside the court that he was too upset on hearing his wife's death was preventable to speak publicly.

Source





25 January, 2008

Wal-Mart Finally Wins Approval of Its Employee Health Plan: Retailer Says More Than 50 Percent of Staffers Have Signed Up for Benefits Package

Wal-Mart said this week that for the first time in its 45-year history more than half of its workers had enrolled in the company's health insurance plan, a potent milestone for a retailer long associated with unaffordable benefits. The discount retailer said that, after it introduced a revised health plan last fall, the number of workers who signed up reached 690,970, or 50.2 percent of its 1.4 million employees, the NY Times reports. The higher enrollment — which has risen from 45.5 percent of Wal-Mart's employees five years ago — is expected to help blunt criticism from unions and political groups that have focused, relentlessly, on the company's failure to insure fewer than half its workers.

After several years of research and discussion, including interviews with executives at companies known for generous healthcare, like Starbucks, Pitney Bowes and Microsoft, Wal-Mart last fall introduced what was considered its most flexible, and generous, health plan. A family can pay as little as $250 a year in premiums if it is willing to have a $4,000 deductible and be responsible for as much as $10,000 in medical bills, roughly the same plan that cost them $1,500 a few years ago, reports Times writer Michael Barbaro. "We can see that the improvements we've made are being embraced by our associates and their families," Linda Dillman, the head of benefits at Wal-Mart, which refers to its workers as associates, told the Times.

Critics still contend the plan is out of reach for many Wal-Mart workers, who earn, on average, less than $20,000 a year. But thousands of workers have enrolled. Wal-Mart said that 30,000 workers who enrolled for 2008 were previously uninsured. To date, Wal-Mart said, 92.7 percent of its workers have healthcare, it not through Wal-Mart, then through a spouses' or parents' employer, state Medicaid programs, the military or a previous job. The number of workers who are uninsured has fallen, to 7.3 percent in 2008 from 9.6 percent last year, the company said.

Dillman said Wal-Mart would commission a study to find out why those 7.3 percent of workers were not enrolled in a health plan. "We really want to understand what is the barrier preventing them from moving onto our plans," she told the Times.

In a statement, Wal-Mart Watch, a union-financed group critical of the retailer, said it was "surprised that Wal-Mart is proud to report that half its employees choose not to take Wal-Mart's health care plan, including 7.3 percent who think Wal-Mart's plan is worse than nothing at all."

Source





24 January, 2008

Dental alternatives

Recently I was having dinner at a local restaurant and bite into something hard that really shouldn’t have been there. My jaw felt sore but after a day or two it seemed fine. A few days later the pain really started. I called around the local dentists and found only one that would fit me in. He quoted a price of $160 for the appointment. With no other option I took it.

The dentist himself rarely appeared during the entire appointment. An assistant took an x-ray of my top left molars. The dentist put in a brief appearance to look at the tooth and the x-ray and tell me it was fractured. He then wanted to send me to a specialist for a root canal and then to come back to him for a crown. I have no idea what the cost would be since I didn’t have the cost of the specialist or the root canal. But just the first dentist alone, with the first visit, wanted $1,300+. Add in the root canal and this first useless visit and the cost most likely would have exceeded $2,000.

As for the severe pain the dentist suggested I buy some over the counter pain killer -- the very kind of pain killer that was already failing miserably. To be fair, I don’t blame the dentist for his refusal to prescribe a pain killer. The drug cops, in order to expand their field of operations, have been harassing doctors who dare to try to alleviate patient pain. The government wants you to suffer in order to protect you from yourself.

But what really pissed me off was that by the next day it was quite clear that they had diagnosed the wrong tooth. Originally I told them it was my left side but that it sometimes felt as if it was the top and sometimes the bottom. I couldn’t tell because the entire jaw was throbbing. But as it got worse it was more clearly the bottom jaw. Yet the tooth they diagnosed was on the top.

A conversation with someone reminded me that Tijuana is filled with dentists so I flew down that Sunday night to make an appointment on Monday morning. The dentist there fit me in his schedule a couple of hours after the call. He checked the teeth and said it looked like there was a small fracture in a lower molar. Then came my first surprise. To x-ray the tooth he used a small plastic device, which acts as the film, that was attached to his laptop. After the x-ray is taken the image appears instantly on the laptop. My U.S. dentist wasn’t this advanced.

From the x-ray it appeared that a root canal would be needed. My last experience with a root canal was very unpleasant -- lots of pain that the dentist kept telling me couldn’t be happening but was. The dentist assured me that it would be different. I went ahead with some reluctance.

The pain killer was injected and he waited and waited. He kept asking about how numb my lips were feeling. And when I told him they were numb to the center of my lip it was time to start. I can honestly say that there wasn’t any pain during the entire process. He did the root canal and packed the tooth scheduling me for a crown on Friday.

During this first session he spent over two hours working on my tooth. He was the only one who did the work. He didn’t bring in a second-stringer. There was no pain whatsoever. He warned me the jaw would be in pain when the shot wore off. It did. And when it got bad I called him and he suggested a pain killer which I can purchase over the counter -- you can’t get in the U.S.

I went back a few days later to have the crown fitted and then again the next day to have it attached. Only on the third visit did another dentist handle it because my original dentist had no appointments. This dentist constantly kept fitting the crown and filing away at it to make sure there was perfect fit. And then as a bonus I decided to have my teeth cleaned as well. That cost $30 extra.

There was nothing second rate about the care I received. I got prompt care directly from the dentist. It was accurate, pain-free and effective and it cost a fraction of what I was paying at home. Even with my flight the total cost was about half what I would have paid at home. So even the cost were relatively pain free. The most painful part of the experience was dealing with the travel Nazis at the airport and waiting in line with thousands of people trying to get permission to re-enter my own country on my way back to the airport.

Of course you can seek treatment in the United States if you wish. Or you can take a medical vacation in Mexico. What you’d save, depending on what needs to be done, can pay for the trip and still put extra money in your pocket. Of course, if you have third party payment for your care you may not worry about the costs -- and that’s one of the reasons that medical care in the U.S. is so expensive.

Source





23 January, 2008

Britain: Nurses' low pay 'fatal in rich areas'

Lives are being lost because of the central negotiation of pay rates for nurses, a study has found. Hospitals in prosperous areas such as London and the South East find it harder to recruit and retain nurses than those in areas where local wage rates are lower. This is because regional differences in nurses' pay are not as big as regional differences in the wider labour market. As a result, hospitals in prosperous areas treat fewer patients and have worse results than those in poorer areas, says a team from Bristol and London in a report for the Centre for Economic Performance and the Centre for Market and Public Organisation.

A gap of 10 per cent between nurses' pay and that of women working locally in the private sector was said to raise the death rate among people admitted to hospital after a heart attack by 5 per cent. The NHS and the Royal College of Nursing (RCN) are wedded to the idea that nurses everywhere in the UK should be paid the same. There are some regional variations, say Professor John Van Reenan, of the London School of Economics, and colleagues, but they do not fully reflect differentials in the labour market. In inner London, for example, white-collar wages for women are 60 per cent greater than those of women in the North East. Allowances are paid to nurses who work in inner London, but they amount to only about 11 per cent more than the wages of their colleagues in the North East.

The new research by Emma Hall, Carol Propper and John Van Reenen tracked changes in wage rates and changes in performance in more than 100 English hospital trusts between 1995 and 2002. Hospitals in areas where the outside labour market is strong treat fewer patients per staff member. They have higher death rates among patients who are admitted after heart attacks.None of these effects is found in private sector nursing homes. Nor do they seem to arise from financial problems faced by hospitals in high-cost areas.

There is a 15 per cent increase in death rates between hospitals where outside wage rates are in the top 10 per cent and those in the bottom 10 per cent. Productivity varies by 18 per cent between the top 10 per cent and the bottom 10 per cent. The results have important implications for regulated labour markets, and the NHS, the report concludes. "Rather than focusing on across-the-board increases in national pay, which we found not to be cost effective, relaxing the regulatory system to allow local wages to reflect local market realities would improve productivity and save lives," it says.

Peter Carter, the general secretary of the RCN, said: "In the RCN's experience, poor hospital performance tends to be related to an absence of clinical leadership, inadequate resources and staffing levels or ineffective financial management. "The modelling in this study can lead to simplistic conclusions on very complex issues."

Source




Australia: Call for inquiry into public hospital death at hands of a Saudi

Coverup?

The NSW Opposition has called for the parliamentary inquiry into Royal North Shore Hospital to be reopened to hear evidence from a senior anaesthetist who raised concerns about the hospital's practices with a coroner. Opposition health spokeswoman Jillian Skinner said she would push to reopen the inquiry after Deputy State Coroner Carl Milovanovich, who is investigating the death of teenage patient Vanessa Anderson, said it was not his role to canvass broader issues at the hospital.

Vanessa, 16, suffered a seizure and died two days after her skull was fractured by a stray golf ball in November 2005. The inquest has heard she received no anti-convulsant drugs and was prescribed Panadeine Forte and the painkiller Endone, a combination three medical experts described as inappropriate.

Mr Milovanovich was set to deliver his findings last July, but adjourned the inquest after senior anaesthetist Dr Stephen Barratt wrote to him raising concerns about Sanaa Ismail, the anaesthetics registrar who increased Vanessa's dose of Endone. As the inquest resumed yesterday, Michael Williams SC, for the Anderson family, also sought to question Dr Barratt about his wider concerns at the hospital, but Mr Milovanovich limited the doctor's evidence to matters relevant to Vanessa's treatment.

Dr Barratt told Westmead Coroner's Court that Saudi-trained Dr Ismail "unfortunately has an issue of needing to save face" and invented stories. While he backed down from his initial assertion that this was a "cultural issue", he said: "She will not admit to mistakes." Recalled as a witness, Dr Ismail - now a senior registrar at the hospital - repeated her evidence that she misread Vanessa's medication chart, not realising she was on high-strength Panadeine Forte rather than ordinary Panadeine.

Dr Barratt told the court that two incidents earlier in 2005 had triggered his concerns about Dr Ismail's performance when unsupervised. However, when cross-examined by Dr Ismail's barrister Stephen Barnes, Dr Barratt conceded there was "little or nothing" in either incident to raise safety concerns. He agreed that an internal investigation cleared her of mistakes in treating the first patient, who went into cardiac arrest while in labour.

The court heard Dr Barratt had been "impaired" by extreme anxiety when he contacted the coroner and was prescribed medication less than three weeks later. Outside court, Vanessa's father Warren Anderson said the six-month adjournment had been difficult: "We just want the truth about what happened to our daughter." Ms Skinner will move to reopen the parliamentary inquiry so Dr Barratt could testify "about all of the matters he wanted to canvass". Mr Milovanovich will hand down his findings on Thursday.

Source





22 January, 2008

Surgical competition cuts costs

Warren and Wendy Miller would never have chosen India as a tourist destination. They thought it was too hot, too poor, too dirty and the food, well, "too Indian". But as they gazed up at the Taj Mahal, that most elaborate of monuments to a perished love, they knew they had done exactly the right thing. The Millers were medical tourists, escaping Queensland's long public health waiting lists and eschewing private specialists for the same reason.

The Innisfail couple flew to India in March 2006, so Warren, 67, could have his arthritic knee replaced at the world-renowned Fortis Hospital in New Delhi. While they were in the neighbourhood, they also decided to have laser surgery on their eyes.

The Millers aren't alone. Every year, hundreds of Australians are heading overseas for sun, sand - and surgery. While exact figures aren't known, travel industry specialists estimate that most of these travellers, more than 85 per cent, are heading offshore for Botox treatment, breast enhancement or reduction, and bottom lifts. Dubbed "nip-and-tuck tourists", they are paying in Thailand, Malaysia and the Philippines a fraction of what it would cost them at home to have cosmetic surgery, with the bonus of an overseas holiday thrown in. And an alibi. While daiquiris are being sipped and beaches are being walked, wounds are healing thousands of kilometres from home and the prying eyes of friends and family. Clients are returning home refreshed, rejuvenated and retouched while friends and family are none the wiser.

Dental treatment is also booming in South-East Asia - a trend that saw Brisbane psychologist Keith Owen bound for Bangkok last year. In the luxurious surrounds of the Dr Sunil Dental Clinic, Owen had 13 teeth crowned and two badly broken ones repaired. In Australia, the dental work would have cost about $35,000 with a conditional guarantee. In Bangkok, the final bill - including air fares, accommodation and trips to see the city's highlights - came in at less than $10,000. In addition, there's a 15-year guarantee if there are any problems, regardless of who is at fault. Sunil also provides limousine transport to and from the airport and the clinic, a service which is most definitely not available in Australia.

Owen's decision was reached on price alone. "It was absolutely horrendous, the cost over here, and that's why I went over there," he says. "I got treated really well... and the quality of work was really good."

The greatest potential, though, lies in the area of elective surgery. People like the Millers are exploring their surgical options because they are fed up with extensive waiting times in the public and private sectors in Australia. More and more people are getting out their passports and fetching their phrase books to have elective surgery, including heart operations and hip replacements, overseas. Singapore even offers organ transplants, including kidney and liver.

There are dozens of internet sites where potential patients can package their holidays, including flights, tours, transfers, accommodation and a trip to a specialist of their choice. Admittedly, most of these are geared to potential clients from the UK and the US, where not only are the waiting lists hellish but costs are extortionate. Many US companies now sign up employees to health insurance that stipulates all major surgery and dental work must be done outside the country.

In Australia, Thai Airways already has recognised the growing market for Australian health tourists by offering holiday packages to Thailand that include executive medical check-ups through Royal Orchid Holidays. One of the hospitals in the package is Bangkok's Bumrungrad Hospital, which The New York Times has described as having "carpeted wards, internet access, cable television, rooms with balconies and private bars". The foyer is of the standard of a five-star hotel, and there are apartments and suites with a pool and fitness facilities for post-operative recovery. Last year, the hospital catered for more than 450,000 overseas patients from almost 200 countries. Add on daily cleaning, room service meals, fluffy bathrobes and airport transfers - what's not to like about the place?

Both the Australian Medical Association and the Australian Dental Association say patients should be extremely cautious when investigating the overseas option for treatment, especially if the destination is a developing country. Infection rates, follow-up care and internet rip-off merchants preying on vulnerable people are all cited as reasons to stay at home. Recent media exposure about botched operations, especially cosmetic surgery, has made Australian travel agents offering medical tourism packages wary. At least two of the operators involved - Redcliffe-based International Medical Tours and Sabra Travel in Sydney - have had a rethink. A spokeswoman for Sabra said they'd stopped offering health tours about six months ago, while IMT is also planning to close that side of its operation.

The Millers, though, are a two-person fan club, and ready to sing the praises of their treatment option to anyone who'll sit still long enough. "The hospital itself was absolutely No. 1 - a great big multi-storey building," Miller says. He says the accommodation and treatment was first class - and there wasn't a speck of dirt in sight. And yes, they wouldn't hesitate if a second trip was in the offing. "I'd like to have my eyebrows lifted," Wendy Miller says - tongue firmly planted in her 63-year-old cheek. They even found a restaurant that served Chinese food the way they'd cook it at home themselves.

Source





21 January, 2008

NHS kills thousands -- increased funding no help

Over 17,000 deaths a year could be saved if NHS performance improved, a new study claims today. The Taxpayers' Alliance claims the 34 billion pounds of extra spending on the NHS by Labour has made no difference to mortality rates. Its claims are based on an analysis of World Health Organisation data, comparing NHS performance to its European counterparts since 1981. This took into account how many deaths could plausibly have been averted by the NHS - a measure known as mortality amenable to healthcare. The calculations compare the UK performance to that of Germany, France, the Netherlands and Spain.

The Taxpayers' Alliance says if the UK were to achieve the same level of mortality amenable to healthcare as the average of the other European countries studied, there would have been 17,157 fewer deaths in 2004. This is over five times the total number of deaths in road accidents.

The campaigning group argues its findings show the government's extra NHS spending has failed to deliver results. Report author Matthew Sinclair said: "Thousands are dying every year thanks to Britain's health service not delivering the standards people expect and receive in other European countries. "Billions of pounds have been thrown at the NHS but the additional spending has made no discernable difference to the long-term pattern of falling mortality. This is a colossal waste of lives and money. "We need to learn lessons from European countries with healthcare systems that don't suffer from political management, monopolistic provision and centralisation."

Source




How a superbug cost the NHS 5 million pounds

There is talk of a ski chalet in Verbier and they are drawing up plans to build a holiday home in Ibiza. A plot of land on the Mediterranean island has, it emerges, already been chosen. Leslie Ash and her husband Lee Chapman are certainly in a position to afford such luxuries now - even if they might not have been before.

Ever since the Chelsea and Westminster Hospital accepted liability - back in 2006 - for "shortcomings" in care that left Miss Ash, 47, battling a near-fatal superbug, the only question remaining was just how many "noughts" would be printed on her compensation cheque. The answer was finally made public on Wednesday: 5million. That's six "noughts", incidentally - and equal to the total of every payout made to every MRSA victim in Britain since 2002.

The award would pay for 250 specialist intensive care unit nurses for a year, or 70 consultants; or, indeed, any number of second homes in Switzerland or Spain, where the couple are thought to be about to buy land for their proposed new property. "We can then combine the peace and quiet over there, with the hustle and bustle of London," Miss Ash is quoted as saying.

Now, no one can begrudge former patients like Miss Ash, a mother of two teenage boys, and still best known for her role as Deborah in the 1990s sitcom Men Behaving Badly, some form of compensation, or her luxurious place in the sun. For a time she was left almost completely paralysed from the waist down. Offers of work dried up. Today, she cannot walk without a stick and is in considerable pain ("I'll always be in pain . . . my painkillers only take 50 per cent of it away," she has said.) ....

The deal signed by her lawyers is ten times the 500,000 pounds she was initially reported to have been awarded as a victim of a hospital superbug. Her injuries meant it was "unlikely she would ever be able to return to an active role as an actress", the writ stated. "The size of the payout is large because it takes into account her loss of earnings and future loss of earnings." Miss Ash has said holding the Health Service accountable - rather than making money - was the motivation behind her compensation claim. But we have learned that more than one offer to settle was made during the legal negotiations, including a substantial one in late November last year. Miss Ash insists she was at the "height of my career" when she became ill - hence the record damages. Even her most ardent fans might dispute this....

Source





20 January, 2008

Judicial Watch Finally Pries Open the Clinton Vault

Post below lifted from Suitably Flip about the health dictatorship America narrowly escaped in the 1990s

The Judicial Watch website is down at the moment (possibly due to a massive traffic flood) back up, but Captain Ed summarizes what the group found in the first collection of documents they managed to wrangle from the Clinton Library on the topic of Hillarycare circa 1993.  Specifically, some of the documents detail strategy deliberations that address how to deal with the First Lady's detractors.  And the tactics discussed (including the suggestion by a certain Democratic Senatorial elder that the Clintons "expose lifestyles, tactics and motives of lobbyists") are of a flavor that can best be described as Clintonian.

What's more, the memos seem to lay bare the fact that even the coziest Clintonistas weren't precisely bowled over by her radical plans to socialize American medicine.  More bluntly, it sounds like even Clinton campers realized the authoritarian utopia Hillary was cooking was enough to make George Orwell himself blush.

A June 18, 1993 internal Memorandum entitled, “A Critique of Our Plan,” authored by someone with the initials “P.S.,” makes the startling admission that critics of Hillary’s health care reform plan were correct: “I can think of parallels in wartime, but I have trouble coming up with a precedent in our peacetime history for such broad and centralized control over a sector of the economy…Is the public really ready for this?... none of us knows whether we can make it work well or at all…”

With the primary in high gear, this ought to shift the political discourse in interesting directions.  If the early glimpses are an indication of what's yet to come, we may have to start referring to a young Senator from Illinois as Mr. Inevitable.

Update:  I think I've cracked the cipher of the intials "P.S."

Paul Starr (born May 12, 1949) is a Pulitzer Prize-winning professor of sociology and public affairs at Princeton University.
...
In 1993, Starr was the senior advisor for President Bill Clinton's proposed health care reform plan.

As fate would have it, Starr recently wrote an article for The American Prospect (the liberal magazine he co-founded), entitled "Hillarycare Mythology: Did Hillary Threaten Democratic Senators?"  In the piece, he aims to disabuse us of the notion that the First Lady was so ominously proficient in the dark art of politics.

Writers love stories like this one because they seem to confirm a larger narrative about a public figure's inner qualities. Some stories are so good you wouldn't want to spoil them by finding out they never happened.

Well, we may be about to find out.

Update:  Judicial Watch is back up.  This is the page detailing the first round of documents and this is the memo "A Critique of Our Plan" (pdf) that I'm speculating was written by Paul Starr.

Here are a few more of his thoughts about Hillarycare.

We will inevitably be accused of creating a monstrously complicated proposal, and it will take an enormous effort to communicate the essentials in a simple way.

But the issue is not just communication.  There is more regulation in this plan that [sic] I expected to see, and I worry about the wisdom of much of it.  The spirit and some of the substance contradict the idea of flexibility for states and room for variety, innovation, and competition.
...
[T]he most heavy-handed part of the program is the budget, and we may not have any credible way of making it more palatable.

And a few more highlights from that Senate elder's smear cookbook (pdf).

Impeach the credibility of opponents:

• Avoid partisan targeting.  Demonstrate that opponents are advocates of delay or inaction, regardless of party affiliation.  Moderate Republicans must be broken from conservative ranks.



• Expose opponents as "professional lobbyists" with values and interests divorced from average Americans (document salaries, perks, ideological extremism, and provide all to the media.



• Use classic opposition research to expose their selfish and short-sighted motivations, and obstructionist tactics (collect mailings, track ad campaigns, investigate expenditures, and provide to the media).

His punctuation here is comically revealing.

Apply pressure on undecided Congressional votes with intensive message delivery through their home state or home district media outlets.
...
Result:  Three-four days of saturation local coverage in all targeted states and/or districts, tied to national events with network coverage - all featuring "real" people with "real" stories.

At one point, the author (Jay Rockefeller of West Virginia, incidentally) lays out the pros and cons of waging an avowedly partisan grassroots campaign vs. a non-partisan campaign, in order to rally public support for Hillarycare.  If the modern day Clinton machine is aptly characterized as one of meticulous scripting, triangulation, and... lets face it, ham-fisted sock puppetry, Senator Rockefeller may deserve some credit for showing them the ropes.

Non-partisan:  The National Health Policy Council is the most obvious existing organization to be expanded for this purpose.

Advantages:

• ... A high-profile announcement of the decision to take this "aggressively non-partisan approach" would be extremely helpful in building public confidence and support...



• General public would recognize this as a clear attempt to break through partisan politics and gridlock.

NOTE: Just so you understand, I have been involved with NHPC, as honorary chair, for nearly two years.  I can attest to their effectiveness and their breadth both geographically and politically.  I have considered other existing organizations, but I believe NHPC would serve you needs best, in part because I know that the people involved are prepared to do anything you would ask of them.

All the goodwill of a "non-partisan" organization with all the control and ideological reliability of group of paid staffers?  Brilliant.  I wonder if Hillary ever tried to replicate that formula.

Update:  I reached out to Professor Starr at Princeton, who acknowledges it was his memo and offers a couple of additional points.

Dear Mr. Pidot,

Two points: 1) This memo, which I wrote, was a critique of a preliminary draft, not the final draft, of the 1993 Clinton health plan, and 2) none of the provisions to which I objected are in Senator Clinton's current proposal, which shows that she has fully absorbed the concerns I was raising.

If you use any of this short email, I presume that as an honorable journalist, you will quote it in full. 

Sincerely,
Paul Starr

20 January, 2008

Surgical competition

Warren and Wendy Miller would never have chosen India as a tourist destination. They thought it was too hot, too poor, too dirty and the food, well, "too Indian". But as they gazed up at the Taj Mahal, that most elaborate of monuments to a perished love, they knew they had done exactly the right thing. The Millers were medical tourists, escaping Queensland's long public health waiting lists and eschewing private specialists for the same reason.

The Innisfail couple flew to India in March 2006, so Warren, 67, could have his arthritic knee replaced at the world-renowned Fortis Hospital in New Delhi. While they were in the neighbourhood, they also decided to have laser surgery on their eyes.

The Millers aren't alone. Every year, hundreds of Australians are heading overseas for sun, sand - and surgery. While exact figures aren't known, travel industry specialists estimate that most of these travellers, more than 85 per cent, are heading offshore for Botox treatment, breast enhancement or reduction, and bottom lifts. Dubbed "nip-and-tuck tourists", they are paying in Thailand, Malaysia and the Philippines a fraction of what it would cost them at home to have cosmetic surgery, with the bonus of an overseas holiday thrown in. And an alibi. While daiquiris are being sipped and beaches are being walked, wounds are healing thousands of kilometres from home and the prying eyes of friends and family. Clients are returning home refreshed, rejuvenated and retouched while friends and family are none the wiser.

Dental treatment is also booming in South-East Asia - a trend that saw Brisbane psychologist Keith Owen bound for Bangkok last year. In the luxurious surrounds of the Dr Sunil Dental Clinic, Owen had 13 teeth crowned and two badly broken ones repaired. In Australia, the dental work would have cost about $35,000 with a conditional guarantee. In Bangkok, the final bill - including air fares, accommodation and trips to see the city's highlights - came in at less than $10,000. In addition, there's a 15-year guarantee if there are any problems, regardless of who is at fault. Sunil also provides limousine transport to and from the airport and the clinic, a service which is most definitely not available in Australia.

Owen's decision was reached on price alone. "It was absolutely horrendous, the cost over here, and that's why I went over there," he says. "I got treated really well... and the quality of work was really good."

The greatest potential, though, lies in the area of elective surgery. People like the Millers are exploring their surgical options because they are fed up with extensive waiting times in the public and private sectors in Australia. More and more people are getting out their passports and fetching their phrase books to have elective surgery, including heart operations and hip replacements, overseas. Singapore even offers organ transplants, including kidney and liver.

There are dozens of internet sites where potential patients can package their holidays, including flights, tours, transfers, accommodation and a trip to a specialist of their choice. Admittedly, most of these are geared to potential clients from the UK and the US, where not only are the waiting lists hellish but costs are extortionate. Many US companies now sign up employees to health insurance that stipulates all major surgery and dental work must be done outside the country.

In Australia, Thai Airways already has recognised the growing market for Australian health tourists by offering holiday packages to Thailand that include executive medical check-ups through Royal Orchid Holidays. One of the hospitals in the package is Bangkok's Bumrungrad Hospital, which The New York Times has described as having "carpeted wards, internet access, cable television, rooms with balconies and private bars". The foyer is of the standard of a five-star hotel, and there are apartments and suites with a pool and fitness facilities for post-operative recovery. Last year, the hospital catered for more than 450,000 overseas patients from almost 200 countries. Add on daily cleaning, room service meals, fluffy bathrobes and airport transfers - what's not to like about the place?

Both the Australian Medical Association and the Australian Dental Association say patients should be extremely cautious when investigating the overseas option for treatment, especially if the destination is a developing country. Infection rates, follow-up care and internet rip-off merchants preying on vulnerable people are all cited as reasons to stay at home. Recent media exposure about botched operations, especially cosmetic surgery, has made Australian travel agents offering medical tourism packages wary. At least two of the operators involved - Redcliffe-based International Medical Tours and Sabra Travel in Sydney - have had a rethink. A spokeswoman for Sabra said they'd stopped offering health tours about six months ago, while IMT is also planning to close that side of its operation.

The Millers, though, are a two-person fan club, and ready to sing the praises of their treatment option to anyone who'll sit still long enough. "The hospital itself was absolutely No. 1 - a great big multi-storey building," Miller says. He says the accommodation and treatment was first class - and there wasn't a speck of dirt in sight. And yes, they wouldn't hesitate if a second trip was in the offing. "I'd like to have my eyebrows lifted," Wendy Miller says - tongue firmly planted in her 63-year-old cheek. They even found a restaurant that served Chinese food the way they'd cook it at home themselves.

Source





19 January, 2008

British cancer patients let down on fertility

Cancer patients are being denied access to NHS fertility treatment, leading specialists say today. In spite of a recommendation in 2004 that patients facing chemotherapy should be given universal access to sperm, egg and embryo storage, there is no consistency and no national policy on funding such techniques. Patients who are treated for cancer can become infertile, so storing sperm, eggs or embryos can be their only hope of becoming parents later.

A new report by experts from the Royal Colleges of Physicians, Radiologists, and Obstetricians and Gynaecologists, recommends that the NHS funds these services, including setting up research-based centres for egg and ovarian tissue storage. About 11,000 patients aged between 15 and 40 are diagnosed with cancer each year in the UK - 4 per cent of the total. A separate survey for the charity Cancerbackup highlighted the "postcode lottery" in accessing procedures.

In 2004 the National Institute for Health and Clinical Excellence (Nice) said that cancer patients should be given universal access to sperm, egg and embryo storage. The Royal Colleges' working party found this was not happening. "There is currently no national policy for funding any of the techniques which aim to preserve fertility or treat the effects of gonadal damage, demand for which will always be very limited. "The working party strongly recommends that an agreed national policy and funded nationwide equity of access to resources be available."

The report says that sperm banking should be widely available and noted the success of embryo storage. The study also called for patients to be fully informed of the risks of treatment at the time of diagnosis.

Dr Michael Williams, Vice-President of the Royal College of Radiologists, said: "It is shocking that arguments over funding still limit patients' access to fertility-preserving treatments. Sperm freezing is well established, simple and effective."

The Cancerbackup survey of 84 out of 152 primary care trusts (PCTs) revealed that access to fertility services is patchy across England. The East of England was found to have the best provision, while PCTs in the South West failed to implement many of the Nice recommendations. About a third of men questioned by Cancerbackup said they had never been offered sperm storage. The survey also revealed that only half of the PCTs funded embryo storage.

Joanne Rule, the chief executive of Cancerbackup, said: "It is unacceptable that access to fertility services for cancer patients is dependent on where you live. Some PCTs are denying patients the option to preserve their fertility. All cancer patients should be informed of the potential impact of cancer treatment on their fertility before treatment starts."

A spokesman for the Department of Health said: "There are Nice guidance documents which recommend that cancer patients should have access to appropriate trained personnel at the time of diagnosis to discuss fertility issues. Implementation of Nice guidance is a standard which the NHS is expected to achieve over time."

Source




Scotland: Great-grandmother sues over MRSA

A great-grandmother who contracted the MRSA superbug in hospital is suing NHS Greater Glasgow for 30,000 pounds, in a move that could pave the way for hundreds of other sufferers to claim millions of pounds in damages. Legal arguments began yesterday at the Court of Session in Edinburgh, where a judge is to decide whether the case brought by Elizabeth Miller, 71, should proceed to a full hearing.

Mrs Miller, who was not in court, told The Times last night that her life had been devastated by weakness and breathlessness since she acquired the infection after a heart operation in the Royal Infirmary, Glasgow, in 2001. The case is believed to be the first of its kind in Britain. Mrs Miller, from Kilsyth, near Glasgow, had MRSA diagnosed nine days after an operation to replace her aortic valve. Her legal team blames the infection on staff not washing their hands, a lack of soap and paper towels and faulty sinks and taps at the hospital. They say that a nasal swab taken from their client proves that she did not have MRSA before her operation.

Source





18 January, 2008

Fruitless attempts to create equality in a complex world can have disastrous consequences

The instant I heard how the NHS was treating Colette Mills and Debbie Hirst, the image came to me. Here we go again, I thought.... They both have cancer. They wish to benefit from a relatively new drug called Avastin, but the drug has not been approved for use by the NHS. It does do some good, but it is not regarded as cost-effective. So the two women decided that they would buy the drug themselves. Fair enough? Apparently not. The two women have been told that if they pay for the drugs, NHS treatment will be denied to them. They have to pay for all their care privately, an impossibly large sum, or receive it all through the NHS. Alan Johnson, the Health Secretary, was firm on the subject. They cannot, he argued, "be treated on the NHS and then allowed, as part of the same episode and the same treatment, to pay money for more drugs".

But the reason he gave was not a medical one - that drugs needed to be administered together by the same doctor on NHS time. Or a practical one - that it would be a bureaucratic nighmare to have some drugs for sale and some not. It wasn't a legal one either: it isn't at all clear that the law prevents this mixture of the NHS and private treatment Instead he said this of the request by these gravely ill women: "That way lies the end of the founding principles of the NHS."

Now Mr Johnson is a compassionate man and an intelligent one, too. He's not, in my experience, generally dogmatic. So what on earth possesses him to deny cancer treatment to these terribly sick patients? Where could such an idea come from? Sootynomics.

Last year was the 50th anniversary of Tony Crosland's book, The Future of Socialism. While re-reading what was, when it was published, one of the most important books of social democratic thinking, I was struck by how dated it had become. Crosland spent half the book in earnest dispute with people advancing ideas that are, to the modern eye, completely ridiculous. He patiently explains, for instance, over an entire chapter, why guild socialism - a barely comprehensible scheme in which trade groups control industry - wouldn't be a bright idea.

What has changed over the past 50 years is this: we now appreciate, or at least have some inkling, how big and how complicated the world is. When there are staff employed in the occupational therapy unit of the IT centre of the people who make the dye that colours sliced bread packaging, how exactly does guild socialism work? The idea of a fully planned economy, painstakingly criticised by Crosland, now needs little effort to refute. It has simply fallen away.

Yet there remains an extraordinary amount of public policy confidently advanced without any idea of the massive contrast between the size and complexity of the world and the puny measure being proposed, without any understanding that the world rages on like the sea - unstoppable, uncontrollable. The absurd idea, for instance, that you can tackle obesity by banning food advertisements on children's television (an apt example of Sootynomics, come to think of it) or stop climate change by using fewer carrier bags at the supermarket. I remember one of my colleagues calling for a boycott of Tesco because it was killing the high street. The last time I looked, Tesco was still trading.

Alan Johnson's NHS ruling is a perfect example of the same syndrome. What is the fundamental principle whose end he fears? Not that care should be free at the point of use, since he already believes that to use Avastin, you must pay for it. No, the principle to which he clings is that all patients should receive the same care. There should be equality. Do you see what I mean when I say it would be comic if it wasn't a tragedy? Mr Johnson looks at the world with its vast disparities in wealth, with its teeming masses and its warzones and its starving slums and its clipped suburbs and thinks he can make the world more equal by preventing a couple of women buying Avastin.

Actually, never mind the starving slums and the warzones, there isn't even equality inside the NHS. There are cancer drugs you can have prescribed in Scotland that you can't have prescribed in England. You can pay for some dental services while receiving others on the NHS. You can receive two different but related treatments and pay for one of them as long as you don't have the treatments together in one place as one episode.

Alan Johnson is trying to hold a line that cannot be held. As more expensive drugs become available and are deemed "not cost-effective" the Mills and Hirsts will multiply. The offence against their rights will be seen increasingly as unacceptable and the pursuit of an elusive equality ever more obviously futile. You may as well stop planing down the tree now, Mr Johnson.

Source

A good comment on the above from a "Times" reader:

This long-standing NHS policy is symbolic of the vicious logic of Britain's socialism. It is the politics of Iago: "If Cassio remain/ He hath a daily beauty in his life/ Which makes me ugly." Like the nasty kid in the playground, we will attack anyone who is better than us.

It is also tribal. The NHS treatment is "us". You are either with us, or outcast. It reminds me of the provincial museum official who denied entry to a public school group. "They're not us. They can't use our facilities." Thankfully that nasty piece of tribal nonsense was over-ruled by Tony Blair. In this more tragic case and many like it, the vicious 'if I can't have it, neither can you' policy of tribal doctrinaire socialist equality will continue.




British medical education bungle good for Australia

A BLUNDER in a jobs recruitment program in the UK will result in relief 19,000km away with hundreds of doctors set to migrate to Australia to help fill staff shortages in our ailing public hospitals system. More than 5000 British medics have found themselves unemployed after failing to get a training post at hospitals in the UK. Two years ago, with critical shortfalls in the number of doctors, the British government lifted the number of places available at training schools and centralised the recruitment system. But it failed to take into account how many places there were available in hospitals to provide internships or hands-on training for the medicos to complete their training.

The British Medical Association said yesterday the only winner would be Australia, with hundreds of young doctors applying to complete their training and fill critical staff shortages. Most of the doctors have applied to work in NSW and Queensland hospitals but a BMA spokesman said hospitals across all states could expect British applicants in the next few months when the true number of training posts available became clear. "It's just a ridiculous situation," a spokesman said. "They increased the medical school places but gave us a situation now where there are only between 8000 and 9000 places (in the UK) but about three times as many applicants. "Not being able to complete their training means they have to put their careers on hold, take a non-training job or practice abroad. The loss to the UK is a gain for countries like Australia and we know a number who are planning to head there."

Dr Robert Thomas spent a year at a NSW Central Coast hospital but was one of the few to find a place in the UK to complete his training. "I was lucky but a lot of my friends are still planning to travel to Australia to work in hospital accident and emergency wards," he said. "I think you will find most will go there for training but will stay there for good. The life is so much better."

An official inquiry into how thousands of doctors missed out on UK places last week concluded the government and Department of Health should be stripped of responsibility for the recruitment system.

Source





17 January, 2008

AUSTRALIA'S MEDI-MESS -- CONTINUED

Four new reports below

Rudd flailing at the air over health

State health ministers have been ordered to design ways to admit fewer people [That's a great start!] to hospital and release patients only when they are ready to leave, in exchange for incentive payments to be rolled out by the Rudd Government. Federal Health Minister Nicola Roxon is preparing for a meeting with her state counterparts on January 31 in Melbourne to discuss how to implement the Government's $2 billion plan to fix the problems in the nation's health system over the next four years. The Rudd Government has warned it will consider a commonwealth takeover of public hospitals [Do the Feds REALLY want that monkey on their backs?] if the states have not begun implementing reforms by the middle of next year.

Ms Roxon's move came as retired appeals court judge Geoff Davies - who headed the 2005 commission of inquiry into Queensland health, prompted by the Jayant Patel malpractice scandal - called on governments to consider rationing services or restricting access to ensure safety and quality.

After health ministers and treasurers met in Brisbane on Monday to discuss the distribution of $150 million for an elective surgery blitz - a tiny proportion of Australia's $80billion-plus annual health spending - Mr Davies has used the opinion pages of The Australian today to criticise previous reform efforts. "It is possible that, in the end, the only realistic choice may be between, on the one hand, a system which can provide free hospital care and treatment of all kinds to all people, but only inadequately, seriously risking patient health and safety; and, on the other, one which can provide a safe and adequate system but not to all categories of people or not of all services presently promised," he writes. "But the possibility of that choice is one which politicians have, so far, refused to confront ... because they have assured us that we are all entitled to free healthcare, whatever that may mean."

Australian Health Policy Institute director Stephen Leeder questioned whether Mr Davies had been exposed to the "dark side of health" for too long, saying most patients were satisfied with the level and quality of care received in public hospitals. Professor Leeder said the public system had for more than a decade struggled to provide more essential operations with less funding, "relatively speaking", and that it was time for governments to respond. He said surveys had shown Australians were willing to pay more to improve the system, although not in the form of co-payments or direct funding, but "the people reluctant to do anything about it are the politicians".

But Jeremy Sammut, from the Centre for Independent Studies, said health costs would continue to rise and governments should look at more radical funding options. "If we shift to a self-funded model, we'll have more chance of having a sustainable health system in the long-term," Dr Sammut said. He said such models should go beyond the private health insurance reforms embraced by the Howard government and instead replicate the superannuation reforms of the early 1990s.

But Australian Healthcare Reform Alliance chair John Dwyer said he did not believe the public health system was unsustainable. "I do believe that a quality public health service, in which people will get quality of care in a timely manner based on need, not their own personal situation, is entirely achievable," he said.

Ms Roxon told The Australian there was an awareness that change was required. "We do understand that there is a legitimate claim for more money for hospital services, but we also need to be much smarter about how we provide a range of other services that could keep people out of hospital, that could make their transition in and out of hospital better." She said there was "a significant amount of sifting going on" of good ideas, not just within the federal Health Department and the states. "I'm asking the states and territories to give us some ideas. I'm absolutely adamant that we have to get both the entry and the exit end of the hospital working properly. "So we have to look at managing inappropriate and preventable hospital presentations and admissions, and we have to look at having proper discharge processes so that people who are frail or chronically ill don't leave hospital with everybody knowing they'll be back in two weeks."

Source

Patients risk death in Australia's sick hospitals

We've all heard about the worrying inadequacies of our public hospitals. Shortages of hospital beds, shortages of doctors and shortages of experienced nurses are among the most serious. At least in one hospital, Bundaberg, these inadequacies have caused serious injury and death. Their revelation has caused public outrage. But such inadequacies are by no means confined to one hospital, or even to one state. On the contrary, there is convincing evidence that they are widespread throughout Australia. Public hospitals, generally, are not delivering all of the services promised by governments to all of the people to whom they are promised, at a level that ensures adequate patient health and safety.

Until recently, the solution of this problem has been mired in political point scoring and mutual criticism between the commonwealth and state governments. Because direct responsibility for health has been that of the states, the commonwealth health minister chose simply to blame the states for these inadequacies; and state leaders responded by blaming the commonwealth for failing to fund the education and training of sufficient doctors and, more generally, for failing to provide sufficient funds to enable the states to deliver adequate patient health and safety to all of those who sought it free of charge.

So it was heartening that then-Opposition leader Kevin Rudd not so long ago acknowledged - the first time by a commonwealth leader - that public health is not just a state problem, but one that must be solved co-operatively by the commonwealth and the states. And that acknowledgement has now resulted in commonwealth funding to ease elective surgery waiting lists. But it is one thing to recognise this; it is quite another to recognise and acknowledge the nature and extent of the problem; and yet another to solve it.

In consequence of the report of my commission of inquiry into Bundaberg and other public hospitals in Queensland, the Queensland Government acted promptly to attempt to remedy the inadequacies disclosed in that report. But it was hampered in what it could achieve by the terms of the Australian healthcare agreement, which it had made with the commonwealth, as had all other states.

By that agreement, the state was committed to continue to provide, at no cost to all who sought them, all of the services which it promised at the commencement of the agreement, whether or not it was capable of providing them adequately. And when the then premier, Peter Beattie, raised the possibility of co-payments for some services, the health minister, Tony Abbott, threatened legal action for breach of the agreement. The result was, and remains, that states, endeavouring to improve the quality of free hospital care, are confined to do that within the existing framework, whether or not that framework is capable of delivering adequate patient health and safety to all who seek it free of charge.

The Australian healthcare agreements are based on the assumption that all Australians, irrespective of their wealth, are entitled to free hospital care and treatment, including operative treatment; not just emergency care and treatment, but also elective procedures. What has not been considered, and what politicians have so far been reluctant to consider, is whether that assumption is a realistic one.

Can Australia afford to provide all of those services, free, to all Australians while maintaining an adequate standard of medical and hospital care and safety? For if there is one thing that we should never compromise, but unfortunately have, it is an adequate standard of care and safety. Unless that standard is achieved, there remains a serious risk that patients will continue to suffer both delay in treatment and inadequate treatment, either of which substantially increases the risk of injury or even death.

It is possible that, in the end, the only realistic choice may be between, on the one hand, a system that can provide free hospital care and treatment of all kinds to all people, but only inadequately, seriously risking patient health and safety; and, on the other, one which can provide a safe and adequate system but not to all categories of people or not of all services presently promised. But the possibility of that choice is one that politicians have, so far, refused to confront. Politicians have refused to confront this possibility because they have assured us that we are all entitled to free health care, whatever that may mean. To admit that they cannot provide, safely and adequately to all Australians, all of the services presently promised might risk public disapproval, even anger.

But Australian governments must together consider whether, in order to deliver a safe and adequate free public hospital system within realistic budget constraints, they must make a choice: either limit the services presently promised by that system or limit the categories of persons to whom they are presently promised.

Two realities compel this consideration. The first is that, without either such limitation, governments have consistently failed to provide a safe and adequate free public hospital system. And the second is that Australia's national real healthcare spending has been growing faster than the Australian economy every year since 1990. Taken together, these show that the possibility of public hospitals providing all of the services promised to all of the people to whom they are promised, at no cost and at a safe and adequate level, is becoming increasingly remote. Thus the first challenge for co-operative federalism in health: what kind of free hospital system can Australia realistically deliver without, in any way, compromising patient health or safety?

There is a second challenge. Who should deliver that system? Should it be delivered solely by public hospitals or should some part of it be delivered by the private sector under contract with government? The latter is already occurring in some states. And if universities in this country commence providing specialist surgical training, and to that end establish teaching hospitals, greater surgical expertise may, in the future, at least in some specialties, exist in those hospitals than in public hospitals.

Consequently, better quality surgical care and treatment may be obtained in some areas by using the private sector, funded by government, to provide it, rather than by providing it within government-run hospitals.

I do not presume to know the answers to these questions. My concern is to ensure that any reconsideration of the provision of free health care in Australia is not confined by the way in which it has been delivered so far. For if there is one certainty about the existing system, it is that it remains inadequate. A little safer now than it was, but still worryingly inadequate.

Source

Ambulance absurdities in Victoria

Surprise! Something that is "free" will be abused

MELBOURNE'S $16 million-a-year ambulance dispatch system is forcing paramedics to race through streets to treat nose bleeds, apply sticking plaster and tend to compulsive hand-washers. Ambulance officers say a computer dispatch program that fails to distinguish between a heart attack and a stubbed toe sends them on thousands of unnecessary high-speed runs each year.

Ambulances have been sent to people with in-grown toenails and sprained ankles - at $860 a trip. Call-outs have jumped more than 25,000 in the past year but paramedics say that up to half of the code one jobs - the highest priority response - are for cuts and scratches, or less. Their union says ambulances are sent to most jobs to eliminate the risk of litigation. "I can't tell you how many Band-Aids I've put on this year," one paramedic said. "It's costing a massive amount of resources. "We can't get the response times down because we're going to everything."

Another said: "Everything's an emergency. Some of them are things that, when I was a kid, your mum would look after." Other "emergency" jobs include: a patient whose lip had been cut on a pizza crust, a man with a paper cut and a boy with a grazed knee.

Ambulance Employees Union secretary Steve McGhie said paramedics did not need the burden of treating minor complaints. "It is an American system based on (fear of) being sued. It's causing huge concerns for paramedics," Mr McGhie said. "It will get worse before it gets better."

MAS chief executive officer Greg Sassella said the same dispatch system was used around Australia and the world. Mr Sassella said it was "conservative" in rating the degree of emergency, but there was no better system. Victoria had tried to improve the system by introducing referrals to doctors or nurses, he said, weeding out more than 26,000 calls last year. Mr Sassella said referrals, which cost $61, will be expanded in coming years. "We've done more than any other service in Australia to reduce over-response," he said.

Paramedics believe some people call ambulances to avoid waiting at medical clinics. "They think they'll be seen quicker at a hospital (arriving by ambulance). There's a percentage ... who know how to play the game," Mr McGhie said.

The MAS annual report says the "community's expectation of ready access to health care" is a reason for a 9 per cent rise in call-outs in the past year. But one officer said the figure was misleading. "I can tell you, the number of sick people in Melbourne has not gone up 9 per cent in the past year," he said. "There is a proportion of society which uses us as a taxi service ... every day, you do an inappropriate job. We are being flogged, absolutely flogged." The officer said Victoria should run a public awareness campaign on when it was appropriate to seek emergency help, similar to one in the UK.

The MAS report said the increasing number of call-outs was partly due to reduced access to medical services and patients discharged early from hospital. An ageing population, greater rates of complex and chronic illness and more people living alone are also cited as factors. Ms Sassella said ambulance resuscitation rates for cardiac arrest had risen from 5 per cent to 55 per cent in the past decade.

Source

Ambulance absurdities in Queensland

Surprise! Something that is "free" will be abused

The State Government will consider on-the-spot fines for Queenslanders misusing the Ambulance Service as paramedics become fed up with frivolous call-outs. Emergency Services Minister Neil Roberts will meet with his department next week to consider the introduction of infringement notices as the Ambulance Service shoulders a call-out rate 30 per cent above the national average. Paramedics have told The Courier-Mail of instances in which "patients" have faked injury to ensure a free ride to hospitals including:

* A man who faked an ankle injury to receive transport to the Gold Coast Hospital, where he was later seen walking freely. He then admitted to paramedics he had needed a lift to see his girlfriend in the maternity ward.

* A man complained of back pain but when the ambulance arrived he said he did not have money for a taxi and wanted a lift to a methadone clinic.

* A Gold Coast woman claimed she was sick and needed transport to hospital. When she arrived, she left the ambulance and headed for the shops. A paramedic said there was nothing they could do to stop the woman. "That happens all the time," the paramedic said. "They basically say we pay our ambulance community cover so shut up and take us. "We're absolutely flogged and everybody's sick of it. "Most of us are ready to give it away."

The ambulance service receives funding from an annual levy on Queenslanders of $97.99, collected through electricity bills. An audit into the service, ordered by Premier Anna Bligh, last month recommended the scrapping of the levy and reintroduction of the old subscriber/user pays system, or a retention of the levy and a new user co-payment regime. But Ms Bligh said a levy and co-payment system was "untenable" and the subscription system had previously resulted in people making a financial decision not to call an ambulance.

There is a provision in the Ambulance Service Act for fines of $3750 for people making "false calls" but acting Emergency Services Minister Andrew Fraser said "these offences must be dealt with summarily through the court and it has been rarely used". "The Government will examine enforcement and consider the introduction of infringement notices," Mr Fraser said. Queensland Ambulance Union State Organiser Jason Dutton said the union welcomed the fines and other steps being taken by the Government.

Source





16 January, 2008

AUSTRALIA'S MEDI-MESS

Four more recent reports below

Cash boost no health cure

ABOUT 4000 people on Queensland's elective surgery waiting lists will have their treatment fast-tracked by a Rudd Government cash injection. But it could be weeks before anyone determines who will benefit from the extra money, the first tranche in the delivery of Federal Labor's election campaign health pledges. Under the plan thrashed out between the federal and state governments in Brisbane yesterday, Queensland will receive the $27.6 million it asked for to help shift its backlog of 35,000 patients waiting for elective surgery.

State Health Minister Stephen Robertson said the first of the extra surgeries would begin within a month and include ear, nose and throat, neurological, ophthamological, orthopedic, urological and vascular procedures. But the Australian Medical Association cautioned there were 8600 people waiting longer than they should.

The funding to tackle Queensland's notoriously stubborn surgery waiting lists is part of $150 million offered by Treasurer Wayne Swan yesterday as a downpayment on the Rudd Government's four-year, $600 million health funding plan. It is also the fifth attempt since November 2005 to clear waiting lists by injecting extra funds into the public hospitals system.

But Federal Health Minister Nicola Roxon said "fruitful negotiations" yesterday provided new hope and she was "very confident, if today is any sign, that we will be able to work well for the benefit of all of the country"....

Queensland Treasurer Andrew Fraser said the funding would be used to target those patients waiting longer than clinically recommended for their elective surgery. The latest quarterly public hospitals performance report shows 35,061 patients sitting idle on elective surgery waiting lists.

AMA Queensland president Dr Ross Cartmill cautiously welcomed the announcement. "It is more expensive to treat people in the private sector, so fewer people will be able to be treated," Dr Cartmill said. "It is good news that there is the potential to treat around 4000 people but we should bear in mind we are still talking about a small number."

Source

Nurses offered cash to come back

No word about improving their absurdly overstretched working conditions

QUALIFIED nurses no longer working in the health system will be given financial incentives in a bid to lure them back to work, Prime Minister Kevin Rudd has said. The $87 million scheme aims to attract 7750 of the 30,000 nurses across Australia not currently working back to the profession within five years. Under the plan, cash bonuses of $6000 will be available to nurses who return to the health workforce after being out for more than a year. They will be paid an extra $3000 after six months back on the hospital ward and a further $3000 after 18 months. Hospitals will also receive a contribution of $1000 for each nurse to assist with retraining costs.

Mr Rudd outlined the scheme at Sydney's Royal Prince Alfred Hospital today, saying the move would go some way towards assisting the predicted shortfall of 19,000 nurses across Australia by 2010. "This will not be the end of our announcements on this matter but is a solid start in dealing with what is an impending shortfall in the overall supply of nurses," Mr Rudd said. He said the Federal Government would now write to state and territory governments and hospital representatives to outline the administrative arrangements for the plan. He said the government was committed to a similar scheme for nurses in residential aged care facilities.

Source

Pass all nurse trainees, teachers told

LECTURERS at a Brisbane nursing college were instructed to pass all of their students regardless of their performance. The investigation by the Queensland Nursing Council into Shafston College last year found that the college's Head of School of Nursing, Gay Carran, gave a directive to teachers that "no student should fail".

One witness, who was a senior nursing lecturer at Shafston from January 2004 to June 2006, told David Price, who undertook the investigation for the council, that students who had failed an occupational health and safety exam were allowed to re-sit the test two more times. She said in one re-sit exam, she and a colleague were told by Ms Carran to "mark students' work on the spot, immediately return unsatisfactory papers to students, and coach them until they obtained correct answers".

Ms Carran, who was also interviewed by Professor Price, denied she had given the directives but was reported as saying: "You always have to err on the side of ... let's be fair to the student. Ms Kemp (a Shafston nursing teacher) used to be black and white. If a student didn't pass, they were failed. We spoke to Ms Kemp about this as 'you can't do this because students are paying good money for the course'."

Five other former teaching staff at the college who were interviewed as part of the investigation supported the existence of the "no-fail" directive from the college management. Professor Price's investigation also found the college allowed some incompetent students with poor English to graduate with a nursing diploma last year, qualifying them to become enrolled nurses.

The college came under scrutiny after a graduate told a former Shafston lecturer she felt "unsafe" as an enrolled nurse at Brisbane's Prince Charles Hospital. Details of the investigation were submitted to the Queensland Supreme Court as part of the case brought by Shafston Nursing against the Queensland Nursing Council.

The council has not renewed the college's accreditation, which expired on December 31. The council has also placed restrictions on the activities of graduates from Shafston College. Shafston has since cancelled its nursing course, which was scheduled to begin in three weeks, and has suspended teaching for continuing students, some weeks away from graduating. About 500 students - of whom about half are from overseas - are being directed to a similar course offered by a South Australian private educator or to nursing programs at TAFE.

Professor Price's investigation was conducted in July last year and involved interviews with five former teaching staff, current senior staff and an inspection of the Shafston Nursing campus at Brisbane's Spring Hill. Students were charged up to $16,000 for the 55-week course. In its defence, Shafston claimed in documents submitted to the court that the witness statements were flawed because the former staff did not necessarily understand exam re-sit requirements. The college also rejected the idea it had allowed incompetent students or those with poor English skills to pass. The QNC has imposed strict restrictions on Shafston students who graduated in the last trimester of last year. Shafston and two of its graduates have separately taken the QNC to the Supreme Court in an attempt to have the restrictions lifted.

Source

Ambulance patients waiting too long in NSW

CRITICALLY ill patients are being forced to wait a combined 718 days a year on trolleys outside hospital emergency departments, figures from the NSW Ambulance Service show. The statistics, for P1 category patients such as road accident, stroke and stabbing victims, monitor the time those rushed to hospital by ambulance have to wait before being admitted. Across the state's public hospital one million minutes - or 718 days - were lost to the delays in 2006-07, News Ltd says. Gosford, Royal Prince Alfred, Wollongong, Royal North Shore and Liverpool Hospitals were the worst offenders.

Dr Sally McCarthy, vice-president of the Royal Australian College of Emergency Medicine, blamed the blockages on a lack of emergency beds. "This reveals the true problem about what is wrong with our health system and how the State Government is refusing to listen," she said. An unnamed ambulance officer said "people on death's door" were waiting for treatment.

Source








15 January, 2008

California confusion

Arnold Schwarzenegger said in an address this week that California must end its "binge and purge" budget process -- his way of kicking off a binge worthy of Imperial Rome in its decadent late period. Yep: As his state reels from one of its recurrent fiscal crises, the Governor is making some headway on his "universal" health-care plan. California is carrying a $14 billion budget deficit and Mr. Schwarzenegger is suggesting across-the-board spending cuts. So perhaps it's unwise to introduce a new government entitlement that costs north of $14.4 billion a year. But then, you have to understand the Kremlinology of liberal health-care reform: This effort has as much to do with politics as public policy.

Mr. Schwarzenegger devoted more than a year to health feuding with Sacramento. He strafed his own party for opposing tax increases. Meanwhile, many Democrats (and most labor unions) fought the Governor's agenda because the subsidies weren't extravagant enough. Desperate, the Governor brokered a last-minute bargain with Assembly Speaker Fabian Nunez in December.

Thus Mr. Schwarzenegger's ambitions didn't die -- but for now, maybe call them the living dead. The negotiators rushed to patch together a policy framework before 2007 ended, but they didn't have the votes to actually pay for it. A two-thirds majority in the state legislature is required for tax increases, and Mr. Schwarzenegger alienated the Republicans he needed. So if this scheme is to become reality, new taxes on tobacco, hospitals and business must be ratified by voters in a November ballot initiative.

Assuming that the bill reaches Mr. Schwarzenegger's desk at all. His plan may hit a wall in the state Senate, where President Pro Tem Don Perata, a Democrat, has qualms about the plan's cost in the midst of a budget meltdown. Apparently, Mr. Perata is one of the few adults in Sacramento. Mr. Schwarzenegger and his collaborators insist their proposal is revenue neutral and requires no new spending after the start-up costs. But the numbers are flimsy. When the bill moved out of the Assembly hopper, the financing fine print remained unresolved and legislators were practically working off the back of an envelope. Mr. Perata is leery of potential consequences for the state's general fund.

With good reason -- these health plans are always more expensive than predicted. But that's what happens with governance via political ego. Having invested himself so fully in the congratulations for "doing something" about health care, Mr. Schwarzenegger wanted a plan, anything to claim victory. He's spinning it as "post-partisan" pragmatism. At least he's not calling it a "free market" solution, as did Mitt Romney after he pioneered a similar plan.

Like Massachusetts, Mr. Schwarzenegger's program is built around the "individual mandate," which requires that everyone acquire insurance or else pay penalties. While bumping up subsidies for the uninsured, California would also lay down more severe insurance regulations, instituting price controls and compelling companies to offer policies to all applicants without regard to age or health condition. Such mandates have all but devastated the insurance markets in every other state where they've been tried, but then all this is the triumph of politics over experience anyway.

In addition to hiking state levies on cigarettes to $1.75 a pack and imposing a 4% tax on hospital revenues, there are new taxes on business. Companies must either spend a certain amount on covering their employees or pay a tax sliding between 1% and 6.5%, depending on the size of the payroll. If Mr. Perata is watching out for his state's bottom line, such taxes may drive businesses to Nevada or Arizona -- or simply lead them to dump their health-care liabilities on the state and pay the 6.5%.

None of this is what California's cooling economy needs -- to say nothing of the damage that such a plan would do to the insurance markets, or the national precedent it would set. Mr. Perata supports comprehensive health reform but seems to be leaning toward prioritizing the budget deficit. If Mr. Schwarzenegger's stunt collapses only because of fiscal reality, that's good enough.

Source




400,000 people 'still waiting more than a year for NHS treatment'

Almost 400,000 patients are still waiting more than a year for NHS treatment, a think tank claimed today. Government figures showed a rise in the number of patients being admitted for treatment within the 18-week target from referral. The latest figures, for October 2007, showed 60 per cent were treated in that timeframe, up from 57 per cent the previous month.

But right-wing think-tank Civitas warned the figures were concealing a high number forced to wait far longer. It said 713,513 (or 18 per cent) of patients needing elective treatment were waiting longer than 36 weeks, with 387,152 (10 per cent) of those having waited over a year. Despite improvements, current rates are not enough to ensure the Government hits its target for all patients to be treated within 18 weeks by the end of the year.

Civitas also warned of a postcode lottery, with 33 per cent of patients at Hastings and Rother Primary Care Trust (PCT) treated within 18 weeks, compared with 82% in Blackpool PCT and Telford and Wrekin PCT. James Gubb, director of the health unit at Civitas, said: "Instead of political targets, performance should be driven by choice and competition - a self-sustaining and much more positive mechanism for change. "If this means more patients choosing to have their treatment in the independent sector or the better NHS hospitals, then these should be allowed to expand in response. "As is the case elsewhere, it is the ability of patients to compliment, complain and ultimately take their business elsewhere that will drive providers in the NHS to improve. "GPs must be in the driving seat, offering patients real choice and ensuring this mechanism is available."

Source





14 January, 2008

A Different 'Right to Life' -- one being denied

Today the Supreme Court will consider a petition to hear a case raising profound issues regarding the right of individuals to make their own health-care decisions. The case is Abigail Alliance for Better Access to Developmental Drugs v. von Eschenbach. The suit claims that FDA violates the due process rights of terminally-ill patients, who have exhausted all approved options and are unable to enter a clinical trial, by prohibiting access to promising investigational drugs.

Consider the plight of such patients. They search for clinical trials of new drugs that might extend their lives. Nearly all are ineligible. Of the few who do qualify, many learn the trial is fully enrolled and closed, or too far away. Others face a 50-50 chance of getting a placebo (a sugar pill) under blinded conditions (meaning neither they nor their doctors know what they are getting). Many are allowed to die without being told about or offered the active drug.

The FDA commonly insists on statistically comparing the timing and severity of the deaths of untreated (placebo) patients with those of patients who receive the potentially effective drug. This renders the FDA's vaunted "science" for drugs intended to treat terminal illnesses little more than a crude measurement of the height and accrual rate of two piles of bodies. There are better, less ethically challenged trial methods available to test drugs, but the FDA has consistently refused to accept them.

The FDA has ignored our Citizen's Petition for more than four and a half years. This petition is the FDA's administrative mechanism for public challenges of its decisions and policies. It is little more than a cruel joke for the sick. The agency is required to respond to a petition within six months but rarely does, and often never responds at all. One's only recourse is to sue and then fight the inevitable FDA motion for dismissal claiming the plaintiff hasn't exhausted all administrative options -- meaning the FDA hasn't yet acted on the Citizen's Petition.

If the suit survives, the plaintiffs find that lower courts have so rarely allowed a patient to challenge an FDA decision or policy that they have no legal basis to get to trial -- as was recently learned by a group of cancer patients challenging the FDA's mishandling of a new therapeutic vaccine called Provenge for terminal prostate cancer. The federal judge in that case dismissed all parts of the suit directed at FDA's decision to delay the drug for years because patients had no "right" to challenge a decision the FDA claimed was not yet "final." The judge's decision will be lethally final for thousands of men with prostate cancer.

No terminal patient has the time needed to wrestle with the FDA in court if they first have to establish a right to do so. Consider that the Abigail Alliance case was filed in 2003. Over the ensuing years, it has carried the names of three defendants, tracking the musical-chairs nature of the highly-politicized job of FDA commissioner. At every turn the FDA stalled, then claimed we had lost our standing because the patients named in the original suit had died. The appeals court didn't buy that cruel argument, but it took months to resolve. During this slow dance choreographed by the FDA, more than 2.4 million Americans have died from cancer alone.

The majority opinion of the appeals court suggested that this is an issue for Congress to solve. A great idea if one has a full lifetime to work on it. In the last session, a bill called the Access Act designed to fix some of the problems was introduced in Congress with multiple sponsors, but any significant reform takes years to enact. The stopgap FDA reform bill passed last year contained none of the Access Act provisions, addressing only the more politically expedient and high-profile issues swirling around FDA's handling of drug safety. The omission was in part the result of the difficulty faced by terminal patients when they try to get the attention of Congress. They simply don't live long enough to connect and organize into a political force.

No matter one's judicial philosophy, it is inconceivable that the framers of the U.S. Constitution intended unelected, tenured career bureaucrats to hold absolute power over American lives without prospect of challenge in the courts. The framers understood that the pursuit of life is an inalienable right that should not be abridged without due process of law. The FDA and a majority of the D.C. Circuit Court of Appeals think terminally-ill Americans are excluded from the fundamental right to pursue life. The Supreme Court now has the opportunity to take this case and correct those egregious misjudgments.

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British dentistry meltdown

The crisis in NHS dentistry is rapidly worsening because dentists are switching thousands of patients to private treatment, figures show. NHS treatment is in free fall with a 16 per cent collapse in the proportion of dentist's earnings made from the NHS from the years 1999-2000 to 2005-06. The figures, published by the NHS Information Centre, highlight the challenge facing the NHS after a survey, disclosed in The Independent yesterday, revealed that dentistry in England was the most expensive in Europe. The fall in NHS earnings has accelerated in the past two years and is most pronounced among young dentists who are the future of the profession.

NHS incomes fell by over 20 per cent in a single year from 2004-05 to 2005-06, as a proportion of total earnings, among dentists aged under 35. Young dentists now earn on average only just over a third of their income (36 per cent) from the NHS.

Patients' organisations said the decline in NHS dentistry was alarming and could lead to the eventual collapse of the NHS dental service. Surveys show patients are having increasing difficulty in finding an NHS dentist and the Government admitted last year that two million patients who wanted access to an NHS dentist had failed to get it. Anthony Halperin, chairman of the Patients Association and a practising dentist in London, said: "There is no question that dentists are switching patients to private treatment where they can because they feel it is the long-term future for them. They don't want to do run of the mill work, they want to do quality work and that is very difficult under the NHS."

The NHS Information Centre's report into dentists' pay showed that dentists in multi-partner practices who own their surgeries earned 114,000 pounds on average in 2005-6 from NHS and private work. Single-handed practitioners with their own practices earned 94,000. Dentists earned 58.2 per cent of their income from the NHS in 1999-2000 but that fell to 41.9 per cent in 2005-06. Among those under 35, the proportion of earnings from the NHS fell from 63.8 per cent to 36 per cent in the same period, a decline of more than a quarter in six years.

Dr Halperin said the new dental contract introduced in April 2006 had made matters worse. The contract replaced the fee-for-item payment system with three payment bands to encourage a preventive approach. "Dentists are really unhappy about the new contract. They are worried they are going to be asked to do more work for less money. If the contract turns out to be uneconomic, they will switch more patients to private work because it is a safer option and if that happens it will lead to the collapse of NHS dentistry."

The British Dental Association said the decline in NHS incomes reflected a wider malaise in the profession. Peter Ward, chief executive, said: "The dental workforce as a whole is looking to a future in which they feel less and less able to rely on the NHS and are adjusting the balance of their work accordingly." Implementation of the new contract had resulted in up to 1,000 dentists leaving the NHS and 266,000 fewer patients accessing NHS dentistry, the association said. Mr Ward said: "These statistics offer further evidence that the Government's reforms to NHS dentistry aren't achieving their stated aims. This contract has failed to improve access for patients and failed to allow dentists to deliver the kind of modern, preventive care they believe their patients deserve."

The Department of Health rejected suggestions that NHS dentistry was in decline. A spokesman said: "It would be wrong to take this shift in the share of income as evidence that dentists are turning their backs on the NHS. It simply reflects the ever-increasing demand for purely cosmetic dental work which, quite rightly, is not provided on the NHS." He added: "Access to dentistry has remained broadly stable in the past two years and we are doing all we can to make further improvements."

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13 January, 2008

Boston mayor says the only good medicine is government medicine

I'm betting that he does not line up in emergency rooms very often

Mayor Thomas M. Menino embarked on a highly public campaign yesterday to block CVS Corp. and other retailers from opening medical clinics inside their stores, an effort that exposed a rift between Menino and the state's public health commissioner, a longtime ally. Menino blasted state regulators for paving the way Wednesday for the in-store clinics, which are designed to provide treatment for sore throats, poison ivy, and other minor illnesses.

The decision by the state Public Health Council, "jeopardizes patient safety," Menino said in a written statement. "Limited service medical clinics run by merchants in for-profit corporations will seriously compromise quality of care and hygiene. Allowing retailers to make money off of sick people is wrong."

In a separate letter, Menino urged members of the city's Public Health Commission to consider barring the clinics from Boston. CVS executives said they plan to open 25 to 30 MinuteClinics in Greater Boston before the end of the year, although they have not specified how many of those will be within the city's limits.

The Boston Public Health Commission spent nearly an hour discussing the impending arrival of the clinics and ways they could potentially be stopped. The panel took no action, but instructed the health agency's attorney to investigate whether it could adopt regulations forbidding stores with clinics from selling tobacco products, forcing them to make an untenable financial choice. The city says 31 CVS stores and 56 other pharmacies in Boston have city-issued licenses to sell tobacco.

In a statement issued last night, executives of MinuteClinics said they "would be happy to talk to Mayor Menino about any of his concerns." "We at MinuteClinic are committed to providing convenient, affordable access to quality health care," the statement said.

By issuing a broadside against the clinics and the state's approval of them, Menino placed himself squarely in opposition to a former longtime deputy, John Auerbach. Before becoming the state's public health commissioner last year, Auerbach spent nine years as executive director of the Boston Public Health Commission.

Auerbach's state agency yesterday released a statement defending its decision on the clincs: "The members of the Public Health Council were deliberative and thoughtful in their review of the limited service clinic regulation. We believe these types of clinics, operated either as part of a retail operation or in a nonprofit setting, can provide the public access to safe, convenient, and quality care for minor health issues."

The clinics are not designed to treat chronic diseases such as cancer or diabetes or serious emergencies. The facilities will be staffed with nurse-practitioners who are trained to spot patients with more severe illnesses or in need of specialized care and send them to a doctor or an emergency room. The regulations apply to any retail company, hospital, or community health center that wants to open a limited-service clinic outside traditional settings.

Members of the Public Health Commission acknowledged many of the mayor's concerns yesterday, but they also said a solution needs to be found for patients who can't get easy access to primary-care doctors or who spend hours waiting to have routine illnesses treated in emergency rooms. Commission member Hortensia Amaro, a Northeastern University professor, said her own experience trying to make an appointment illustrates the crisis. "It's almost impossible to get a primary-care doctor in Boston," she said. "I've waited nine months to get an appointment, and I have great insurance."

Still, members of the commission said clinics inside retail stores might only exacerbate long-standing problems in the healthcare system. Dr. Paula Johnson, a board member and physician at Brigham and Women's Hospital, said episodic visits to a drug store clinic could defeat efforts to provide patients with a reliable continuum of care. "We could be setting ourselves up for some real problems," she said.

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NHS 'now four different systems'

There are now four different NHS systems operating in the UK since devolution, according to health chiefs. As the NHS enters its 60th year, NHS Confederation boss Gill Morgan has told the BBC the health service is now in a unique position in its history. Ms Morgan said while the underlying principles of free health care still stand, patients in the UK's four nations are getting different services. Patient groups said the situation was breeding envy.

Ms Morgan, whose organisation represents NHS trusts and health boards, said there was no longer a universal system across the UK, as there had been when it was set up by the Atlee government in the summer of 1948.

England - NHS market created whereby hospitals and community services have to compete with the private sector for patients, resulting in big falls in waiting times

Scotland - Doctors have much more of a say in services, with limited involvement from the private sector. Meanwhile, patients enjoy free personal care, unlike the means-tested systems elsewhere

Wales - Close working relationship between the NHS and local government, which has meant more innovation on public health, but less emphasis on waiting times

Northern Ireland - Somewhat hamstrung by political situation, but re-organisation of trusts pushed through and good integration between social care and NHS

She told the BBC News website: "We basically have four different systems albeit with the same set of values. "This period [since devolution] has been unique in the history of the NHS as it was essentially the same across the UK before devolution. "We have had a complete split in philosophy. "The model in England is about contestability and choice driving service improvements. Outside organisations have been brought in and patients can shop around. "That model has been rejected by the other three."

In Scotland, where people have been given free personal care - unlike the means-tested systems elsewhere - Ms Morgan said there has been much more consensus. She described the approach as the "collectivist model". "They have very little contestability. "They have been slower to improve waiting than England, but much less tension between doctors and managers. "In Northern Ireland there has been very big structural change and more integration between health and social care." And in Wales, which has received praise in England for introducing free prescriptions, she said the close working relationship between local government and the NHS had had an impact on public health.

She said it was too early to say which was more successful and in the coming years the differences would become even "greater". "All we can say is that patients are experiencing different systems, each one has its advantages and we will have to wait to see what happens."

But Joyce Robins of Patient Concern said the differences were "breeding envy". "Patients are increasingly looking across national borders and wondering why they are not getting the care others are getting. "I am not sure that is good for the NHS."

Michael Summers, vice chair of the Patients Association, said England was lagging behind the rest of the UK. "England - for some reason - seems to have been the poor relation." And Professor Chris Ham, a former government adviser and Birmingham University heath expert, said the NHS had proved an important battleground since devolution. "Health is the most important service devolved governments have power over."

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12 January, 2008

NHS patients told to treat themselves

Millions of people with arthritis, asthma and even heart failure will be urged to treat themselves as part of a Government plan to save billions of pounds from the NHS budget. Instead of going to hospital or consulting a doctor, patients will be encouraged to carry out "self care" as the Department of Health (DoH) tries to meet Treasury targets to curb spending. The guidelines could mean people with chronic conditions:

* Monitoring their own heart activity, blood pressure and lung capacity using equipment installed in the home

* Reporting medical information to doctors remotely by telephone or computer

* Administering their own drugs and other treatment to "manage pain" and assessing the significance of changes in their condition

* Using relaxation techniques to relieve stress and avoid "panic" visits to emergency wards.

Gordon Brown hinted at the new policy in a message to NHS staff yesterday, promising a service that "gives all of those with long-term or chronic conditions the choice of greater support, information and advice, allowing them to play a far more active role in managing their own condition". The Prime Minister claimed the self-care agenda was about increasing patient choice and "personalised" services. But an internal Government document seen by The Daily Telegraph makes clear that the policy is a money-saving measure, a key plank of DoH plans to cut costs.

Critics claimed the plan would provide doctors with an excuse for ignoring the elderly or those with debilitating, but not life-threatening long-term conditions, and would not work without significant investment in community health services. The Arthritis Research Campaign said it risked providing health managers with "an excuse for neglecting elderly patients". Jane Tadman, a spokesman for the charity, said: "Arthritis is already too low down the priority list and the fact that this is being mooted as a money-saving measure is very worrying. "Some GPs don't take arthritis seriously enough, and the result of this could be to give them another excuse to tell arthritis patients just to go away and take their tablets."

The Patients' Association welcomed more moves to empower patients, but warned against using self-care systems to save money. "We are all for better-informed patients," said Katherine Murphy, a spokesman. "But it is a concern that financial pressures will take precedence over clinical needs."

Peter Weissberg, the medical director of the British Heart Foundation, said: "People affected by heart disease need specialist care. Whilst we support changes that empower people to look after their own health, we would be very concerned if they led to any reduction in the availability or quality of expert care for those who need it."

After years of record spending, the health service is facing a sharp slow-down as Mr Brown tries to curb soaring government borrowing. In the Comprehensive Spending Review last year, it was announced that the health budget will grow by four per cent a year over the next three years, down from the seven per cent annual growth rate between 2002 and 2007.

The Treasury also demanded that the DoH achieves three per cent "efficiency savings" over the next three years, equivalent to o8.2 billion. The department's "Value for Money Delivery Agreement" - an internal document drawn up with the Treasury and circulated to NHS trusts over the Christmas holiday - sets out how the NHS will meet the savings target. In a section on chronic conditions, it says the key to greater efficiency in the management of patients with long-term illnesses is a reduction in the need for "expensive" interventions by the NHS. "Reductions in the use of NHS (GP consultations, outpatient appointments, inpatient admissions, length of stay, emergency care and prescribing) can be achieved through increased support for self care (for example through education and skills training, information prescriptions, or self care devices)," it says.

The DoH has told the Treasury that NHS officials are drawing up "good practice guidance on care planning including support for self care". The advice is expected to be published next month. The emphasis on self care was inspired by the success of the Expert Patients Programme, an NHS pilot scheme that offers a six-week training course for people with chronic or long-term conditions. About 30,000 people have completed the course and reduced their hospital attendances by up to 16 per cent, a result NHS managers hope to repeat across the service.

Health budgets face pressure from the cost of caring for people with chronic conditions, including 8.5 million with arthritis, 3.4 million with asthma, 1.5 million diabetics and 500,000 with heart failure. Opposition politicians questioned whether the Government could save money without reducing services. But an Asthma UK spokesman said: "Our focus is on the clinical benefits of self-management. "If the Government implements procedures to ensure more self management and save money, we would support that."

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Australia: Another deadly government hospital

One of the main reasons for putting people in these hospitals is to keep them safe -- from themselves and others!

A 22-year-old woman has been found dead in her room at the controversial mental health facility Ward 1E at the Launceston General Hospital. The death came just a day after an independent reviewer commented that the ward was overcoming a "very negative" culture which included bullying and harassment.

Director of Mental Health Services Associate Professor Des Graham said attempts by staff to resuscitate the woman on Wednesday night were unsuccessful. "The death of a client in an acute mental health facility is a rare and tragic occurrence and in line with Mental Health protocols it will be investigated," he said. Health Minister Lara Giddings said the case would be investigated and action taken if shortcomings in the treatment were found.

The woman's family was notified and met with senior staff. Her body was found about 7.20pm. Detective-Inspector Mike Otley said there were no suspicious circumstances. The woman from Launceston is believed to have been in the facility for a couple of days.

Prof Graham said an interstate team would be called in to head a serious incident investigation. "It is normal practice with serious incidents of this nature for a panel to be established to review the treatment and care provided," he said. The investigation would be in addition to an inquiry by a coroner. Investigations would include an analysis of whether the skill mix and number of staff was adequate and what the documentation about the client's mental state said. Prof Graham said family, staff and other patients on the ward have been offered counselling.

The recently concluded Santangelo inquiry also found that allegations of sexual assault were sometimes ignored because of perceptions about the mental state of complainants. An investigation by the Health Complaints Commission released in 2005 found three cases of sexual assault. Ms Giddings said the death was tragic and distressing. "I extend my sincere condolences to her family," she said.

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11 January, 2008

Shocking NHS figures show mothers and babies are at risk due to chronic shortage of midwives

Mothers and babies are being put at risk in NHS hospitals because midwives are so overstretched, shocking new figures show. Midwives are being forced to oversee more births than they were six years ago, meaning they can not give women the support they need to ensure they stay safe.

In some parts of the country midwives are in charge of 25 per cent more births as they were in 2001, according to the official figures obtained by the Liberal Democrats. The average midwife is now overseeing 33 births a year - well in excess of the guidelines which state they should deal with no more than 28 births. The desperate shortage means thousands of women are giving birth terrified and alone in NHS maternity units, while many are being forced to have children in filthy wards.

Over Christmas two women died at the same hospital from the same infection - raising fresh concerns about hygiene standards in the NHS. The Royal College of Midwives said last night that the figures proved that NHS maternity services were "crumbling", with many units are under threat.

Liberal Democrat health spokesman Norman Lamb said: "These figures show that our maternity services are under huge strain around the country. "There simply aren't enough midwives to deliver on the Government's promises of one-to-one maternity care. "With the birth rate rising and many midwives set to retire over the next decade, the situation is set to get worse. "A chronic shortage of midwives could also force the closure of small childbirth centres across the country. "The Government needs to stop burying its head in the sand and launch a national review of capacity in maternity services."

Official guidelines, published in 2006 by the Royal College of Obstetricians and Gynaecologists, say that midwives should oversee no more than 28 births a year. The figures, revealed following a parliamentary question, show that across England in 2001, the average midwife oversaw 31 births. By 2006 that had risen to 33 - a rise of seven per cent. ....

Experts say fewer midwives per birth leads to increasing risks for mothers and babies. Belinda Phipps of the National Childbirth Trust said: "As the number of birth per midwives rise, the risk of a woman being in labour without a midwife by her side rises. "This is not just a 'nice to have' but is clinically important and makes a difference to a woman's labour and birth. "You would not expect to go into hospital for an operation and have the hospital tell you your anaesthetist will be running between three patients in different operating theatres. "It is not acceptable for women in labour to be expected to have their midwife running between several women also in labour.

"At the moment the only way you can be sure to have a midwife with you throughout your labour is to have your baby at home. "Women who choose to give birth in hospital also need to be assured they will have a midwife with them throughout their labour. "Using a hospital's emergency facilities to rescue women who have not had the full attention of a midwife is not acceptable practice."

Louise Silverton, deputy general secretary of the Royal College of Midwives, said: "While we support the Government's plans for maternity services, we have real concerns about their ability to deliver because there are simply not enough midwives. We need 5,000 more full-time midwives by 2009. "The birth rate is rising, midwife numbers are dropping, but the maternity services budget is falling and the maternity service is crumbling. "Ultimately it will be women and their babies who suffer a poor maternity service, and midwives will be left underresourced and overstretched. "Women report to us that because the midwives are so busy, they do not ask questions for extra support. "Women are being short changed by the shortage of midwives."

The increasing ratios have occurred because the Government has not employed increasing numbers of staff to keep pace with rising birth rates. Since 2001 the birthrate has shot up by 12.5 per cent, from 564,871 babies born to 635,679 in 2006 - a bigger rise than Government actuaries had expected. Midwife numbers have increased by just 5 per cent since Labour came to power in 1997, from 18,053 to 18,862 in 2006 - with 2006 seeing a drop in numbers on the previous year.

Fewer new midwives are being trained every year - down 16 per cent in the last two years; and newly-qualified midwives are struggling to find jobs because many trusts still have financial problems. And the RCM warns the problem could get worse, with half of midwives planning to retire within the next decade.

The amount being spent on maternity services has fallen from 1.7 billion in 2005/06 to 1.6 billion pounds last year. The shortage of midwives will make it all the more difficult for the Government to meet its pledge that by the end of 2009, all women will be supported by one named midwife throughout her pregnancy and afterwards. The Conservatives claim that more than 30 maternity units across the country are under threat of closure.

A spokesman for the Department of Health said: "England remains one of the safest places to have a baby either in hospital or at home. "The number of midwives is increasing. Between 1997 and 2006, the (headcount) number of midwives employed in the NHS has increased by 2,084 (9 per cent), which represents a whole time equivalent (WTE) increase of 809 (5 per cent). "There has also been a 20 per cent increase in the number of students entering training to become a midwife. "Through increased investment in training staff and finding ways for midwives to come back to work in the NHS, we expect to see further increases in the midwifery workforce. But we are not stopping there. "In some parts of the country, we must and will do more, like developing more training places, bringing in flexible working and finding innovative ways to fill hard to fill vacancies."

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NHS negligence kills young mother

A woman died while giving birth after a clerical error left her without specialist medical care, despite both her mother and her aunt having been killed by the same rare condition at exactly the same age, an inquest was told yesterday.

Kelly Hutchings, 22, of Fareham, Hampshire, suffered a brain haemorrhage during the birth of her daughter, Nikita, on November 16, 2005. When Ms Hutchings became pregnant for the first time that spring, no appointment was made for her to see a consultant obstetrician despite her family's "significant medical history" and referrals by her doctor and a midwife. Her need for specialist care was then overlooked by midwives and doctors on up to six further occasions, the inquest in Southampton was told.

Keith Wiseman, the coroner, said that it was "incredible" that a case like hers had slipped through the net, describing it as "like going through six or seven red lights and not realising".

The inquest was told that Ms Hutchings's mother, Shirley, had died at the age of 22 while giving birth to Kelly's brother, Mark, who is now 20. Her aunt, Sue Hickmott, had died in 1982, at the same age and from the same condition, known as deep cerebral venous thrombosis, which causes brain haemorrhage during childbirth.

However, an administrative error by Portsmouth Hospitals NHS Trust meant that an appointment for Ms Hutchings to see Marwan Salloum, a consultant obstetrician, never happened. She was seen finally by a specialist was when she fell seriously ill towards the end of her pregnancy. She was admitted to Southampton General Hospital complaining of dizziness and headaches, but her condition deteriorated and, just over 30 weeks into her pregnancy, she went into labour.

Ms Hutchings, who also suffered from cerebral palsy, was kept alive on a life-support machine while Nikita was delivered by Caesarean section. Her daughter, who has severe disabilities including blindness, cerebral palsy and brain damage, is being raised by her partner, Lee Blyth.

Donna Ockenden, head midwife for Portsmouth Hospitals NHS Trust, explained that Dr Peter Smith, Ms Hutchings's GP, had first made a referral for an appointment with a consultant. But this was "overridden" and downgraded to a midwife appointment because he had not provided any reason for the request.

A request with details of the family history, was made by June Brown, Ms Hutchings's midwife. It was approved by Mr Salloum, but Mrs Ockenden said that a "clerical error" meant the appointment was not made because the interview with the midwife was already in place. She added: "Although the history was clearly visible on the front of Kelly's notes, it was not picked up that it was a high-risk issue." Mrs Ockenden said that procedures at the trust had since been changed.

Mr Salloum told the inquest that he considered Ms Hutchings a high-risk case. "The referral that came to my attention had a box that said Kelly was anxious that her mother and her aunt both died in childbirth from a brain haemorrhage. I would like to at least discuss that with the patient."

Dr Smith said that Ms Hutchings had made no reference to her family history when she came to see him. Her stepmother, Merissa Hutchings, 41, said that she was not a "forceful girl" who would have raised concerns on her own behalf.

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10 January, 2008

Cancer patients fight to stop NHS withholding care

CANCER patients have launched a legal action to prevent the NHS from withdrawing care if they seek to improve their chances of recovery by paying privately for an additional drug. The patients say the NHS will be breaching their human rights if it withdraws the treatment they are receiving. Two of the patients, Colette Mills, 58, a former nurse from near Stokesley, North Yorkshire, and Debbie Hirst, 56, from St Ives, Cornwall, who both have breast cancer, have been told they will be made to foot the entire 10,000 pound monthly bill for their care if they attempt to pay privately for an additional drug, Avastin.

Ministers claim that to allow patients to pay for top-up drugs would be unfair to those who cannot afford them and lead to a two-tier NHS. The health department has issued guidance to NHS trusts warning that such co-payments are not allowed. However, the patients' solicitor, Melissa Worth of the Manchester law firm Halliwells, said NHS trusts would be breaching several articles of the 1998 Human Rights Act if they withdrew chemotherapy treatment. Worth also argued that in withdrawing treatment NHS trusts would undermine the National Health Service Act of 1977. She said: "In light of the indisputable obligations of the trusts to provide life-sustaining treatment when there is a known, real and immediate risk to life, there is no legal justification for the trust threatening to withdraw all free treatment should our clients wish to maximise their chances of survival by complementing the treatment they are receiving by receiving Avastin."

NHS chief executives, the Patients Association, Doctors for Reform and Saga, the organisation for the overfifties, have all backed Mills and Hirst since The Sunday Times highlighted their plight last month. This weekend they were joined by one of Britain's leading breast cancer consultants. Professor Ian Smith, head of the breast cancer unit at the Royal Marsden NHS Foundation Trust, said: "I am very sympathetic to the case of these patients. We are looking after patients with life-threatening diseases and it is difficult enough telling them they cannot get the drug on the NHS without needing to then say: `Even if you are prepared to pay for it, you still cannot have it.' This creates a very emotionally fraught situation and seems very harsh."

Politicians have also pledged to campaign for a change in policy. John Baron, a Conservative MP and former shadow health minister, said: "It is absolutely wrong for the NHS not to allow tax-paying patients to top up their treatment if they so wish. Why shouldn't patients make that extra payment for a drug that could be life-saving? This is unfair and the government should be ashamed."

The health department said: "It is a fundamental principle of the NHS, supported by all the main political parties, that treatment should be free at the point of need. Co-payments would undermine this."

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HillaryCare v. Obama: The Left's health-care spat

Once Hillary Clinton got roughed up in Iowa, she was bound to strike back against Barack Obama. Her first line of attack debuted at the Democratic debate over the weekend, and a big part of it concerns health care. Their differences are more political than substantive, but the debate does tell us something about current policy ambitions on the American left.

"Universal" health care is of course a major Democratic issue, and Mr. Obama laid out a proposal in May, Mrs. Clinton in September. Both plans create a public insurance option managed by the government. Both plans impose more stringent regulations on insurance companies, and both institute new taxes on business.

The main substantive difference is that Mrs. Clinton's plan would dictate that everyone have health insurance, while Mr. Obama's would only require the coverage of children. This so-called "individual mandate" has become the preferred liberal health policy tool after Mitt Romney introduced it in Massachusetts. In theory, such a law would force everyone to sign up for health insurance--either through their employers, a private plan or a government option--or otherwise pay penalties.

That Mr. Obama's mandate is limited to kids has led to a primary catfight that runs back several months, and Mrs. Clinton is pressing the issue especially hard now to attract liberals who think Mr. Obama is the better bet for "change." She said on Saturday that Mr. Obama "proposed a health-care plan that doesn't cover everybody." Mr. Obama counters that the reason many people aren't insured is because they can't afford it. Supposedly he is "echoing right-wing talking points," but he is more accurately echoing reality.

Massachusetts has exempted almost 20% of uninsured adults who don't qualify for subsidies from mandated coverage because it is too expensive. (No thanks to the state's health-care regulations, which Mr. Romney now prefers not to mention.) The logic of the individual mandate is that welfare programs will be necessary to achieve truly universal coverage. Thus it is in practice less an individual, and more a government, mandate.

In any case, these health-care plans aren't worth the white papers they're printed on, because Congress would carve them up along the way. Rather, they speak to aspirations. For "progressives," Mr. Obama's lack of a mandate is a kind of betrayal. Their political goal is to use incremental steps to gradually achieve a government-run health-care system--and Mr. Obama's steps aren't grand enough.

At least by comparison to Mrs. Clinton. Her attacks are intended to appeal to liberals because they highlight one of the few cases where her triangulating produced a policy position more ambitious, and more leftward, than Mr. Obama's. They also highlight her history as an agent of "change," if you consider Mrs. Clinton's calamitous 1994 failure with HillaryCare to be helpful experience. She's betting that Democratic primary voters will give her credit for having tried.

The new liberal consensus is that her 1994 effort got the policy right but botched the politics. Now a progressive agenda will only be ushered in by "confronting" Republicans. That's why Mrs. Clinton--and John Edwards--posits insurance and pharmaceutical companies as villains who must be vanquished for liberal reform to prevail. By contrast, Mr. Obama says a genuine health-care overhaul must be negotiated at a "big table" including industry. Such feints toward bipartisanship and reconciliation don't appeal to today's angry left.

However it turns out, this less than Grand Guignol ought to provide a warning to Republicans. Whatever the minor policy differences among Democrats, their major domestic ambition this campaign season is the government takeover of the health-care market. The Republican nominee will need a free-market alternative, and a way of explaining it that is more concise and compelling than we've heard so far.

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9 January, 2008

Ninth Circuit to Upend Nation's Healthcare?

In what may be the most momentous judicial decision since Roe vs Wade or One-Man-One-Vote, and possibly directly affecting far more Americans, the US Ninth Circuit may be heading toward greasing the legal skids toward nationalized healthcare. The case involves the employer mandate fees included in San Francisco's universal care scheme. As I discussed here, "Such a fee upon employers violates the 1974 ERISA law which ensures employer choice as to whether and how to provide healthcare benefits." Not a single court has decided against ERISA's preemption of such schemes. (More about ERISA here.)

Most recently, both Maryland and Suffolk County, NY decided not to appeal court decisions against their universal schemes' employer mandates, because they violate ERISA. Nonetheless, a three-judge panel of the Ninth Circuit appears to be heading toward ignoring ERISA, what a close observer likens to "jury nullification."

Federal district judge White, consistent with every other precedent in the country, decided the San Francisco employer mandate violated ERISA. San Francisco's appeal appears to have found friendly ears in the Ninth Circuit Appeals Court, from three judges with a history of extremely liberal decisions, often overturned by the Supreme Court. They have not yet issued their formal decision, but if it follows from their opinions expressed during the hearing it may seek to ignore ERISA's prohibition.

What happens next? An appeal to the entire Ninth Circuit panel and/or to the Supreme Court. That will take time. Meantime, San Francisco and California, and other states, may rush to enact similar employer mandates as part of universal care schemes. The result may be a fait accompli of a major step toward nationalized healthcare, along with hugely increased government budget deficits requiring additional taxes upon all. (Massachusetts' is already running deeply in the red, and California's proposed system is likely to double the already $14-billion+ deficit's drain upon taxpayers.)

The private healthcare market in which most Americans are enrolled, and which polls of patients consistenly shows 70-90% satisfaction, would be so severely disrupted as to not be able to recover or be seriously weakened, leaving a government-run program as the default option. That is exactly what the proponents of nationalized healthcare desire, and what is at stake in this case.

Don't think judges matter, or that presidential appointments of judges don't matter? Think again, and look closely at what presidential aspiirants have done in their past and how reliable their promises may be now.

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Colossal British stupidity: 3 times more doctors educated than Britain can employ

JUNIOR doctors will face even tougher competition for jobs this year with close to three applications expected for each position, National Health Service managers have warned. NHS Employers, the agency responsible for staffing the health service, has warned that a Court of Appeal ruling means doctors trained in Britain will need to compete for posts to train as consultants alongside doctors from around the world who want to practise in the UK. If the juniors do not obtain a training post, they will not be able to become hospital consultants or GPs.

Sian Thomas of NHS Employers said: "There are about 9,000 posts for around 23,000 estimated applicants - that's what the Department of Health has told us. "One could argue that the more competition you have, the better quality you will get. It is a good thing for patients that there is competition for jobs - it should mean they get the best doctors wherever they live." She admitted, however, that taxpayers' money would be wasted if junior doctors trained in Britain decide to take consultant posts overseas.

The British Medical Association blames the health department for continuing to recruit medics from overseas at the same time as increasing the number of medical graduates from British universities.

Meanwhile, patients are suffering from a postcode lottery of drug prescription eight years after the government set up a body to get rid of the problem, a report by a parliamentary committee will say this week. The health select committee is expected to say that the National Institute for Health and Clinical Excellence (Nice) has failed to ensure that medicines available in one area are not denied in neighbouring districts.

An inquiry by the committee of MPs is also expected to say that the NHS, which spends about o90 billion a year, should not need to withhold life-saving medicines. It is likely to say that restrictions on drugs to treat cancer or Alzheimer's could be avoided. The MPs are expected to recommend that Nice gets greater powers to force NHS trusts to make drugs it has approved available to all patients

Source

Follow-up: ANOTHER bureaucracy!

The running of doctors' training must be taken out of the hands of the Department of Health after its chaotic mismanagement of funding and job applications, an influential report will say today. The report by Sir John Tooke, ordered last year after thousands of highly qualified junior doctors were left without training posts, recommends that the Government be stripped of control of postgraduate medical training. Instead, it recommends that the cash needed to train the next generation of specialists should be ring-fenced to prevent the NHS from spending it on something else, and managed by a new body, to be called NHS Medical Education England.

The recommendations, seen by The Times, are expected to be made today by the inquiry, which was set up by the department last year after a series of failures. Incidents included thousands more doctors applying for posts than were available, and problems with a computer system designed to shortlist applicants, which resulted in severely underqualified doctors turning up for job interviews.

Sir John Tooke, Dean of the Peninsula School of Medicine in Plymouth, was asked to chair an inquiry into what to do next. His interim report was published in October, and has been overwhelmingly backed by doctors. His final report, out today, is a stunning vote of no confidence in the department. Last year's crisis "could and should" have been predicted, he told The Times yesterday. The appointments system that failed was "rushed and poorly planned".

There are two important changes to the interim report's recommendations. One is the formation of NHS Medical Education England, which Sir John and his colleagues say will be able to articulate the principles of postgraduate training and implement it successfully - something that the department "is in no way capable of doing", he said. The report also gives warning that training could suffer when the European Working Time Directive comes fully into force next year.

The limit on doctors' working hours will mean that there is not enough time to train them to the skill levels needed, he cautioned. A way needs to be found in which doctors can continue to work legally more than 48 hours a week - perhaps by separating work on the wards from training time. But the most urgent problem is one that Sir John cannot solve - making sure that last year's debacle over training appointments, when 30,000 junior doctors applied for 20,000 posts, is not repeated. The evidence is that the pressure on places will be more intense this year, with about three applicants for every training place, and 20 to 1 in the more popular specialties.

Sir John said that the Government had failed to reconcile two of its policies: expanding medical school places in Britain and the "open door" policy towards graduates from overseas. Unless further training places were made available this year, he said, British graduates would be disadvantaged compared with those of earlier years. There will be a bulge in applications for higher training, caused by a growing number of British graduates, applications from those who won only a one-year post last year, and the uncontrolled number of applicants from abroad.

Last week, the British Medical Association gave warning that the process could go as badly as it did last year. Applications opened on Saturday for training posts in England that start in August this year. Ram Moorthy, chairman of the BMA junior doctors committee, said: "Our concern is that without adequate planning, the levels of competition could result in a lottery."

Sir John said that unless changes were made to protect the rights of British-trained doctors to at least one year of postgraduate training, a situation could arise in which students graduate from medical school but could not practise as doctors because they had not completed their year in hospital.

Source





8 January, 2008

Patients left to starve on NHS wards

The number of NHS patients suffering from malnourishment as they leave hospital has nearly doubled, new figures show. Around 140,000 patients were discharged after being inadequately fed on NHS wards last year, statistics obtained by the Conservatives reveal. The number released from hospital suffering from malnutrition, nutritional anaemia, or other nutritional deficiencies has risen by 84 per cent in the decade since Labour came to power, from 74,431 in 1997 to 139,127.

The vast majority arrived in hospital suffering from these conditions. But the Department of Health figures also show the nutritional condition of at least 8,500 patients actually worsened while they were in hospital in the last year. National Institute for Health and Clinical Excellence guidelines say all patients should be screened for signs of malnutrition on admission to hospital and treated accordingly. Campaigners complain that elderly people in particular are not given enough help to eat in hospital.

There has also been a rise in the number of patients being admitted to hospital suffering from malnutrition to 130,594, up from 70,658 a decade ago. The figure rose by 12 per cent in the last year alone. The shadow health minister Stephen O'Brien, who obtained the statistics, described them as a "scandal". He said: "Malnourished patients are more prone to infections, have more complications after surgery, and have higher mortality rates - yet the Government allows more than 130,000 patients to enter hospital in the state. "If patients are at risk of malnutrition, then they should be offered extra support before going into hospital, and they should be cared for better whilst they are in hospital. Nurses need to be given the time and equipment to get on with the job of caring for our most vulnerable patients. "It is a scandal that in 21st-century Britain, we allow vulnerable patients to be let out of hospital in a malnourished state, and it is even worse that we allow thousands of patients to get more poorly while they are in hospital."

The worst area in the country for malnutrition was the Pennine Acute Hospitals Trust in Greater Manchester, where 4,947 patients were discharged suffering malnourishment, followed by the University Hospitals of Leicester NHS Trust, with 2,771, and the Newcastle upon Tyne Hospitals NHS Foundation Trust. They were among nearly 50 hospital trusts around the country that discharged more than 1,000 malnourished patients last year.

Meanwhile, it is estimated that the poor quality of hospital food is putting patients off to the extent that 13 million meals are thrown away each year, at an average cost of 2.65 pounds each.

Last year, the health minister Ivan Lewis admitted patients were being starved on wards, with some elderly people given little more than a scoop of mashed potato for lunch. Others were "tortured" by having meal trays placed out of reach, which they were too weak to pull towards them. Age Concern has protested that elderly people are often given non-pureed food, which they cannot chew or swallow. Michael Summers of the Patients' Association said: "Families tell us that when visiting elderly relatives in hospital in particular they noticed how malnourished they are. "Nurses are so rushed off their feet that it is no surprise that patients end up malnourished. "We have heard stories of elderly people who haven't had a meal all day because they have just been overlooked. The food is just taken away when the patient hasn't been able to eat any of it. "It is a scandal in the 21st century - it ought never to happen."

Source




Deaths of two new mothers at same hospital WERE probably linked, says expert

Two mothers have died from an identical infection after giving birth at the same hospital on the same day. An expert said it was "extremely unlikely" that their deaths were not linked. Amy Kimmance, 39, and Jasmine Pickett, 29, had their babies at the Royal Hampshire County Hospital in Winchester on December 21. Within 72 hours they had both died from complications linked to streptococcus A infection - known as Strep A - which normally causes sore throats.

Winchester and Eastleigh Healthcare NHS Trust insisted investigations so far showed their deaths were coincidental. A spokeswoman said Mrs Kimmance developed fatal toxic shock syndrome as a result of a group A streptococcal infection while Mrs Pickett died from a sudden onset of severe pneumonia, likely to have been caused by a group A streptococcal infection.

However, Mark Enright, professor of molecular epidemiology at Imperial College, London, said: "It's extremely unlikely in my view that they are not linked." Professor Enright said he believed a member of staff had been carrying the infection in their throat, got it on to their hands and passed it on. He said he would be interested to see the results of laboratory tests on the women to see if the identity of the bacteria was the same.

The deaths raised fresh concern over hygiene and infection control practices in Health Service hospitals. Earlier this week David Cameron said hospitals would face hefty fines for each patient who catches a superbug if the Conservatives win power, saying infection levels of MRSA and C.diff, which cause several thousand deaths a year, were "unacceptable".

Mrs Kimmance, a teacher at St Swithun's independent school for girls in Winchester, went home with her new daughter Tess to husband David and their two other children on the day she gave birth. Her condition suddenly deteriorated and she was readmitted to hospital on December 23 where she died of fatal toxic shock syndrome triggered by Strep A infection.

A day later, on Christmas Eve, Mrs Pickett died after suddenly developing severe pneumonia, almost certainly caused by the same infection. She had given birth to her first child, a boy named Christopher. Both babies survived....

Streptococcus A is not a superbug, which means if an individual has a sore throat it can be eradicated with antibiotics. But it can cause aggressive infections if it gets into the bloodstream. There are about 1,200 bloodstream infections linked to Strep A reported to the Health Protection Agency each year, some of which lead to death. The trust spokesman said that the maternity unit had remained open as there had been no results directly linking it or the staff with the cause of the fatalities.

But she added that extensive swabbing of staff and the unit had been carried out as a precaution. She refused to confirm whether antibiotics had been given to staff and the families of the dead women, which would eradicate the infection. She added that a full investigation was taking place. The Royal Hampshire County Hospital missed its target for reducing MRSA last year and had 191 cases of the potentially deadly stomach bug C.diff between April 2006 and March. Its kitchens were severely criticised last year and as a result it now has to submit to six-monthly inspections.

Around 100 mothers die in the UK each year giving birth or shortly afterwards, about two a week.

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7 January, 2008

Britain: That marvellous government "planning" shows its worth

Nil worth. Closing hospitals just when lots of people are getting ill is something only a government plan could lead to

A fifth of the country's hospitals have wards that have been shut as the winter vomiting virus strikes staff and patients. Cases of the virulent nororvirus bug are expected to peak at about 200,000 a week over the next month. The disease, which causes two or three days of violent vomiting and diarrhoea, is at its highest level for five years. Doctors have warned patients to stay at home to avoid spreading the bug. Hospitals are especially vulnerable and anyone who has been ill with the bug recently is asked not to visit relatives for fear of taking the highly contagious infection on to wards.

A survey by The Daily Telegraph found that 30 hospital trusts in England had closed wards to new patients as staff struggled to contain the bug and many other hospitals had recently suffered outbreaks. The reporting system is voluntary so the number of closures could be higher.

NHS Direct reported yesterday that 1.2 million people asked its staff for advice over the extended Christmas period. Vomiting was the second most common complaint after dental pain. Norovirus is the most common cause of infectious stomach upset and although extremely unpleasant it is not normally dangerous, although it can lead to complications in vulnerable, elderly or very young patients. Hospitals in the North West and South West have been hit hard in this winter's norovirus season.

One of the hospitals worst affected is the Royal Oldham Hospital in Greater Manchester, where 66 cases were reported. Fin McNicol, the hospital's spokesman, said that strict infection control measures and a ban on all but essential family visits had brought infection numbers down to 40 and bed closures down from 40 to 26 yesterday. "Everyone knows someone that's poorly just now," he said. "In terms of the virus's effects on the hospital, it does appear to be more than normal but we have tried and tested prevention measures in place."

The Royal United Hospital in Bath has seven wards closed. Francesca Thompson, director of nursing at the hospital, said: "We do have a significant number of wards closed and are taking the situation very seriously. "We want to keep these wards closed for the time it takes to get rid of the infection and we will only reopen when it is safe to do so." She added: "We want to encourage anyone with symptoms of vomiting and diarrhoea to seek advice from their GP first. "People are still turning up at the hospital which could cause serious capacity issues. "We need sufficient beds to cope with serious cases and would like to ask the public to offer us their continued support."

Some regions appear to have avoided ward closures including the East Midlands, London and the North East. A spokesman for the Health Protection Agency said: "It is not unusual to see outbreaks occurring in hospitals, as the virus quickly spreads in confined environments. "Taking action early in an outbreak by closing a ward to new admissions can help control outbreaks."

Source




Australia: Nurses turned off by disorganized government hospitals

A third of the experienced nurses lured back to NSW public hospitals under a Government program have left again. Three days after Premier Morris Iemma bragged about the recruitment of a record 1618 new registered nurses, internal government figures show Nursing Reconnect, which was designed to address a lack of experience, is floundering. The figures, obtained by the NSW Opposition under freedom of information laws, show 1647 nurses had returned to the public hospital system under the program since it began in 2002. But 479 of them subsequently left, for other employment or to take time out.

Opposition health spokeswoman Jillian Skinner said the Government had spent more than $6.5 million on Nursing Reconnect, meaning each returning nurse cost more than $4000 in refresher training and administration. "The Government spent $1.9 million recruiting people who subsequently left," Ms Skinner said. "Only 107 nurses have been recruited this year, compared to 807 in 2002. "The cost of Labor's recruitment program is rising while the number of nurses signing up is falling. Nurses won't want to come back to work while [Health Minister] Reba Meagher and the Iemma Government continue to mismanage our hospitals."

On Thursday, Ms Meagher announced the new recruits, saying that Nursing Reconnect had "attracted 1650 nurses back into the profession". But she failed to mention the high attrition rate. Yesterday Ms Meagher said the most common reasons why nurses had left were family commitments and to work elsewhere as nurses. The majority who had rejoined had stayed, she said.

NSW Nurses Association professional officer Annie Butler said improvements to conditions and pay were essential to retain nurses. Their workload had increased as ancillary positions were cut, and the frustration of seemingly minor challenges, like finding enough pillows, was immense.

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6 January, 2008

China Saves the World's Public Health Systems

A rather amazing story from China

Here in Suzhou there are at least 500 Indian and Pakistani students studying medicine. They study in English but learn a little survival Chinese as well. They are amongst 10,000 such students studying medicine in China.

At first there was a guarante their credentials would be recognised in India but it appears the Indian government may have reneged on that assurance. In place is a system of further examination, once they return, which will admit them to practice in Australia, the US or the UK. Just another hurdle.

In discussion with these students, I was rather negative about their opportunities for work in Australia. The AMA used to have extremely high standards for doctors and if you did not graduate from an Australian medical school, you were subject to a battery of examinations which replicated those standards.

But of course I was out of date. The advent of free health services in Australia massively increased the demand for medical services which the Australian schools were not able to handle without lowering standards.

The demand was especially high in public hospitals where the working conditions and pay were unattractice to doctors who had studied for nearly six years and who where the cream of the academic crop. As a result the Australian government has turned to 'foreign' doctors - mostly from the Subcontinent who have similar training regimes. They still require would-be doctors to sit for an admission exam to ensure quality but it has become manifest that they have become the mainstay of our public hospital system.

The recent failed London bombings had a sideshow in Australia where a relative of two of the bombers, a doctor in a Gold Coast hospital, was arrested and investigated under terrorism laws. Despite the bombers having a phone chip from the good doctor, a list of strange phone calls from India, and his attempt to leave Australia without notice to his employers with a one-way ticket to India, he was eventually returned to India and effectively absolved of any guilt in the plot.

The new government in Australia has declared they would not oppose his return. His old employers have said he would be welcome back although it is thought unlikely he will return there. This sideshow highlighted how dependent public hospitals are on imported third-world doctors and that, rather than be bemused at China's opportunism in offering medical training to so many aspiring doctors, we should be grateful for providing a source of cheap doctors to keep our public health system affordable.

Source




Human rights vanish in NHS

IF you need evidence that the NHS has badly lost its way, look no further than the treatment meted out to 58-year-old Colette Mills. The former nurse, from Stokesley, in North Yorkshire, has been diagnosed with breast cancer that has spread to the rest of her body. Her best chance of survival is to take the new "wonder drug", Avastin. But, because of waste and bureaucratic incompetence, the South Tees Hospitals NHS Trust says it can't afford to give her the life-saving drug. That fact alone helps explain why UK cancer survival rates lag so far behind our European neighbours - despite record amounts of taxpayers' cash being poured into the health service.

But it gets worse. Mrs Mills offered to pay the o4,000-a-month cost of Avastin out of her own savings. Fine, said the NHS, but if you do, you will be treated as a private patient and will be charged the full cost of all your treatment - about o15,000 a month, which Mrs Mills cannot afford.

So, Mrs Mills is trapped in a Kafkaesque nightmare - the NHS won't give her the drug for free, but it won't let her pay for it either. That's what you get when you allow a centralised, Soviet-style bureaucracy to run healthcare - an inflexible, lumpen, one-size-fits-all, style of treatment, not driven by patient need or any notion of fairness, but motivated by the sort of rigid, outdated ideology that should have been buried under the rubble of the Berlin Wall.

Patient choice, anyone? It is not as though allowing Mrs Mills to pay for the drugs would disadvantage anybody else. And the argument put forward by the Department of Health, that allowing patients to combine NHS care with private "top-ups" would create a "two-tier health service", is nonsense on stilts. There always has been a two-tier health service. I can't help thinking that a government minister's spouse would get Avastin in the blink of an eye if they were unlucky enough to be diagnosed with cancer.

And isn't it decidedly odd that when a normal taxpayer is discriminated against and bullied in this manner, there's not a peep from the usually vociferous human rights lobby. Don't ordinary people have human rights, too?

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5 January, 2008

A government impost that started out small in order to get it into law soon becomes much bigger -- surprise!

Penalties for Massachusetts residents who can afford health insurance but do not purchase it in 2008 could quadruple compared with the maximum penalty in 2007, according to draft regulations released by the Department of Revenue yesterday. The maximum penalty for those who flout the law and do not buy health insurance would be $912 a year, compared to $219 in 2007. The higher penalty is intended to get those who are on the fence to buy health insurance. For those wavering, it could make more sense to pay for insurance than to pay the penalty.

The proposed penalties also drive home the full impact of the health reform law's personal mandate principle. This approach makes buying health insurance a responsibility of all residents, similar to the way drivers are required to purchase auto insurance. The penalty was enacted to spur residents to purchase insurance rather than rely on the care hospitals are still required to provide to patients regardless of coverage or ability to pay. "We have worked hard to craft these penalties in a manner that is straightforward and easy to understand," said revenue commissioner Henry Dormitzer in a statement. "We hope they will encourage people who can afford health insurance to buy it."

In a statement explaining the penalties, the revenue department said, "These penalties apply only to adults who are deemed able to afford health insurance." Residents who cannot afford insurance, based on state standards, won't be penalized. Residents who face penalties can appeal.

Residents can comment on the proposed penalties until Jan. 15. The regulations will be finalized early this year. Residents won't face the proposed penalties until early 2009, when they file their tax returns for 2008.

The health reform law, signed by former governor Mitt Romney in April 2006, states that the penalty for 2007 would be the loss of an individual's personal income tax exemption. This will cost residents who didn't get coverage $219 when they file their 2007 state income tax return. Under the law, penalties for 2008 and beyond would be tied to the lowest-cost option of insurance coverage. But it was up to the revenue department to determine the precise formula. Under the formula issued yesterday, the amount an uninsured resident pays for 2008 varies by income and how long the resident goes without insurance. For instance, those 26 and younger who earn too much to qualify for low-cost insurance and who go the whole year without coverage would pay a $672 penalty. Those 27 and older would pay $912, the maximum. Those who have coverage for part of the year would pay a corresponding amount of the penalty. In addition, those who earn less than 150 percent of the federal poverty level, or $15,324 for an individual, won't face penalty.

The fees are based on half the cost of the least expensive insurance plan available to each resident but are capped to avoid excessive fees. Thus, a 60-year-old resident of Boston, who would pay more than $4,600 a year for health insurance provided by the state, could have been hit with a $2,300 penalty. But the maximum possible penalty is $912 for all residents. The draft regulations are available at the revenue department's website at mass.gov/dor.

It is still unknown how many residents will have to pay the $219 penalty for 2007, according to the Department of Revenue and the Massachusetts Health Insurance Connector Authority, which administers the new law. A spokesman for the Department of Revenue, said it would measure how many pay the penalty when 2007 tax returns are filed this spring.

The connector authority has said that about 290,000 residents have signed up for health insurance since the personal mandate went into effect July 1. That includes 160,000 residents who qualify for subsidized coverage, 70,000 who qualify for Medicaid, the government health plan for the poor, and 60,000 who purchased full-cost coverage through the state or their employers. The tally will be updated Jan. 10. Before the health law was implemented, the state estimated that about 400,000 residents lacked health insurance while the US census estimated the number of uninsured was 657,000.

John E. McDonough, executive director of Health Care for All, an advocacy group that helped craft the health insurance law, said he was pleased with the proposed penalties. The department "really listened, and we see a lot of our concerns reflected in this schedule," said McDonough. "It's fair, simple, and sensitive to the needs of residents."

Source

Some context for the above -- and a warning about where it is headed

Take the example of Social Security:

Franklin Roosevelt, a Democrat, introduced the Social Security (FICA) Program. He promised:

1.) That participation in the Program would be Completely voluntary,

2.) That the participants would only have to pay 1% of the first $1,400 of their annual incomes into the Program,

3.) That the money the participants elected to put into the Program would be deductible from their income for tax purposes each year,

4.) That the money the participants put into the independent "Trust Fund" rather than into the General Operating Fund, and therefore, would only be used to fund the Social Security Retirement Program, and no other government program, and,

5.) That the annuity payments to the retirees would never be taxed as income!

Since many of us have paid into FICA for years and are now receiving a Social Security check every month -- and then finding that we are getting taxed on 85% of the money we paid to the Federal Government to "put & lt away"

You may also be interested in the following:

Q: Which Political Party took Social Security from the independent "Trust Fund" and put it into the General Fund so that Congress could spend it?

A: It was Lyndon Johnson and the democrat Controlled House and Senate.

Q: Which Political Party eliminated the income tax deduction for Social Security (FICA) withholding?

A: The Democrat Party.

Q: Which Political Party started taxing Social Security annuities?

A: The Democrat Party, with Al Gore casting the "tie-breaking" deciding vote as President of the Senate, while he was Vice President of the U S

Q: Which Political Party decided to start giving annuity payments to immigrants?

A: MY FAVORITE: That's right! Jimmy Carter and the Democrat Party. Immigrants moved into this country, and at age 65, began to receive Social Security payments! The Democrat Party gave these payments to them, even though they never paid a dime into it!

Then, after violating the original contract (FICA), the Democrats turn around and tell you that the Republicans want to take your Social Security away! And the worst part about it is, uninformed citizens believe it! Actions speak louder than bumper stickers




In just one year in one Australian State 4200 nurses quit

What happens when you overwork nurses in order to employ more and more of those lovely bureaucrats

NURSES are leaving public hospitals faster than the Government can replace them despite a record 2368 graduates starting this year. The NSW health system is haemorrhaging nurses at a rate of 10 per cent - 4200 positions - a year, leaving existing staff overworked. Premier Morris Iemma yesterday admitted, while visiting Royal North Shore Hospital, that it was difficult to recruit and retain nurses.

However, embarrassingly for the Government, Mr Iemma also conceded in front of his embattled Health Minister Reba Meagher that Royal North Shore Hospital needed to return "to the forefront". Ms Meagher has been under siege over the hospital's performance, since staff and patients revealed a series of horror stories about the hospital's performance last year. Continually forced to defend the hospital, Ms Meagher yesterday looked on as Mr Iemma did the talking.

"I have taken a number of small steps to address the issue here at Royal North Shore Hospital," he said. ". . . to restore the reputation of the hospital as well as continue to improve the health services. "There are challenges, as there are in any hospital. "We are taking extra measures to address that." The hospital will be allocated 128 nurses at the end of this month, one of the largest intakes in the state. However, it still needs another 22 experienced nurses to fill the hospital's current shortfall. But difficulties remain as bullying and harassment of nurses has tainted RNSH. Long-serving staff have complained publicly of being intimidated by senior management.

Trying to soothe the hospital's bruised reputation, Mr Iemma assured new recruits: "I can promise the graduates that anyone who intimidates . . . will be dealt with, and dealt with very strongly. "I guarantee these graduates there is no place for bullying."

Despite the Government's recruitment push, a global shortage of nurses is placing strain on hospitals. NSW Nurses Association acting president Judith Kiejda said an ageing work force was having an impact on the health sector. "Some (nurses) do leave for overseas, career changes but a lot of the losses come down to retirement," she said. "There are a lot of nurses who are coming up to retirement far more than we are bring in the new ones."

New graduate, Emma Bowen, 20, said she was not put off by the negativity surrounding RNSH. "I did my practice here (at Royal North Shore) and really enjoyed it," she said. "I had excellent support."

Source





4 January, 2008

Revolt as 200,000 people demand to opt out of new NHS database scheme

Intimate details of the first 100,000 patients have been uploaded to the controversial new NHS database despite a mounting revolt by doctors and campaign groups. Around 20 GP surgeries have added 110,000 individual records to the scheme, which will contain details on patients' medical history, current medication and allergies. But the Daily Mail has learned more than 200,000 people have requested documents that allow them to demand their personal medical records are excluded from the system, which will "go live" in January.

There is growing concern about the security of the o12bn IT programme - the biggest civilian computer project in the world - which will ultimately contain the details of 50 million people. A poll showed that more than three-quarters of doctors are either "not confident" that data will be safe or "very worried" that it will leak once the system is up and running. Some senior medics are now encouraging a campaign of disobedience against the database by supporting a campaign to urge patients to opt out.

Activists in the British Medical Association (BMA) have produced a letter that people can send to their GP to stop their records going onto the database. The letter can be downloaded from the website of the Big Opt Out campaign, nhsconfidentiality.org. Critics fear patient records could be misused if they can be accessed by NHS staff across the country.

Campaigners also highlighted the Government's "appalling" record on data security, which saw the personal and banking details of 25 million child benefit claimants lost last year. Nine NHS trusts were forced to admit losing hundreds of thousands of health records.

So far, more than 550,000 patients in Bolton, Bury, Dorset, south Birmingham and Bradford and Airedale have been asked to register with the new NHS IT scheme. It will be rolled out across the country later this year, once the pilot sites have been evaluated. Patients were initially told they would have no choice over whether their information would be included on the database. But ministers were forced to offer concessions because of concerns over privacy and security.

Patients can now choose to opt out altogether - though they are warned this could compromise their NHS care. Alternatively, patients can choose only to allow access to NHS staff who have their explicit consent.

But NHS manager Helen Wilkinson, who is masterminding the opt out campaign, said patients were not being told of their rights. She launched her campaign in 2006 after discovering that she had been wrongly labelled an alcoholic after seeing a consultant about routine surgery. She has now forced the Health Department to wipe all of her records from NHS files. "My concern is that patients' records are being uploaded without their consent," she said. "The Government says every patient should be getting a leaflet setting out their options. But the reality we are finding is that many are not. "Even when they do, we are not satisfied that the literature is clear about the risks associated with this database. "The Government has demonstrated only too clearly that it cannot be trusted with this sort of personal information. "Its record on keeping data secure is frankly appalling."

Joyce Robins, of the campaign group Patient Concern, said: "Our main problem is that they are doing it on an opt-out basis - we think they should ask for consent before records go up." Dr Paul Cundy, chairman of the BMA's general practitioners IT committee, who helped compose the protest letter, said: "Some doctors are actively encouraging their patients to rebel. "This letter is an easy way for patients to express the rights that the BMA feels they ought to have by default."

Ministers insist that the current NHS records system, which relies predominantly on paper files, can lead to unnecessary delays and risks. Marlene Winfield, head of public engagement for the NHS IT programme, said: "Patients are always surprised that their records aren't already available in other parts of the NHS - they say we thought the NHS has been doing this for years. "Patients have to go through a security process before they can set up the record. "The NHS has always had a confidentiality culture as patient information is regarded by everyone as sensitive - it's in everyone's training and contracts." But a poll carried out by the Doctors.net.uk website showed that only a fifth of doctors believe the system will be secure.

Source




Australia: Public hospital negligence leads to tragedy again

A Traralgon couple is planning to sue the local hospital because their baby was born with severe brain damage after allegedly being deprived of oxygen. Tobias Vizard was not breathing at birth, but was resuscitated in a Latrobe Regional Hospital birthing room and spent two weeks on life support. His life expectancy is short, and his disabilities include cerebral palsy and possibly quadriplegia. Mum Julia Williams said she and her family pleaded for an emergency caesarean as her son's heart rate plummeted and he could not be pushed through the birth canal during labour on August 17 last year.

It was more than two hours after her waters broke that Tobias was delivered naturally but with a hypoxic brain injury, believed to be caused by a lack of oxygen. The pregnancy was in its 40th week and contractions started on Tobias's expected birth date, a fortnight after ultrasounds indicated there was nothing wrong. He is now living with brain damage more severe than that experienced by many very premature babies.

Tobias's father, Brian Vizard, is deaf and cannot hear his son struggling for air at night to know when his airways need to be cleared. However Ms Williams said they were determined to make the most of each day together. "He was dead when he was born. He was dolphin blue, and I didn't understand what was going on until I saw them resuscitating him in front of us," she said. "We don't ever wish this to happen to anyone. You don't know what it is like to have a newborn and they are saying he is not going to make it. "But he is beautiful to look at. He doesn't look handicapped, apart from the cerebral palsy in his hand."

The distressed parents are seeking legal advice from Maurice Blackburn lawyers. Latrobe Regional Hospital spokeswoman Jan Rees confirmed the hospital investigated the birth, but said she could not comment because legal action had started. The matter has also been referred to the Health Services Commissioner, but details of the investigation remain confidential. The commissioner can enforce a compensation payout following conciliation, provided that litigation does not proceed. The Royal Children's Hospital, which treated Tobias in the weeks after his birth, declined to comment because it did not want to influence potential legal action.

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3 January, 2008

Socialized medicine leads to dictatorship over your personal life

The endpoint of all socialism -- as Hegel gleefully foresaw

Patients could be required to stop smoking, take exercise or lose weight before they can be treated on the National Health Service, Gordon Brown has suggested. In a New Year message to NHS staff, the Prime Minister indicates people may have to fulfil new "responsibilities" in order to establish their entitlement to care. The new conditions could be set out in a formal NHS "constitution", Mr Brown says.

In his open letter to doctors, nurses and other health workers, the Prime Minister promises to press on with Tony Blair's reforms of the NHS, pledging more personalised care for all patients. He adds: "We will also examine how all these changes can be enshrined in a new constitution of the NHS, setting out for the first time the rights and responsibilities associated with an entitlement to NHS care."

Creating formal conditions for treatment would build on recent controversial developments in health policy. Despite the NHS commitment to provide free universal care, it is already common for doctors to set conditions on patients seeking treatment. The National Institute for Health and Clinical Excellence already considers so-called self-induced illnesses in setting the criteria that determine which patients should qualify for new or expensive health treatments. And this year Leicester City Primary Care Trust was given Government approval to ask smokers to quit before they are given places on waiting lists for operations such as hip replacements and heart surgery.

Obese people also face more conditions from doctors who say being very overweight unnecessarily complicates many procedures. For example, fertility doctors have argued that very obese women should be denied access to IVF treatment.

Mr Brown has promised more "personalised" services from the NHS. He makes clear that his reforms will rest on people being more accountable for their own health, too. "We will describe how we will achieve our shared ambition of an NHS which is more personal and responsive to individual needs," the Prime Minister writes. "Personalised not just because patients can get the treatment that they need when and where they want, but because from an early stage we are all given the information and advice to take greater responsibility for our own health."

Katherine Murphy, a spokesman for the Patients Association, raised fears about the spread of conditions in the NHS. She said: "We would have concerns about this. Patients do have a right to access to care and we would be very concerned if people were to be denied access to care. "Is this being done for the patient, or is it just another way of saving money?"

Since becoming Prime Minister, critics say Mr Brown has sent mixed messages about his plans for NHS reform. But Mr Brown makes clear the NHS must change to respond more quickly and directly to the wishes and needs of its patients, just as businesses respond to their customers. "I believe these are steps vital to securing the health of the NHS for the next 60 years," Mr Brown says. "They will require a broadening and a deepening of reform to ensure that the NHS as a whole attaches the same priority to a personal and -preventative service as many of you already reflect in your own day-to-day decisions."

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2 January, 2008

Government attack on improved medical care

In Bethesda, Md., in a squat building off a suburban parkway, sits a small federal agency called the Office for Human Research Protections. Its aim is to protect people. But lately you have to wonder. Consider this recent case. A year ago, researchers at Johns Hopkins University published the results of a program that instituted in nearly every intensive care unit in Michigan a simple five-step checklist designed to prevent certain hospital infections. It reminds doctors to make sure, for example, that before putting large intravenous lines into patients, they actually wash their hands and don a sterile gown and gloves.

The results were stunning. Within three months, the rate of bloodstream infections from these I.V. lines fell by two-thirds. The average I.C.U. cut its infection rate from 4 percent to zero. Over 18 months, the program saved more than 1,500 lives and nearly $200 million.

Yet this past month, the Office for Human Research Protections shut the program down. The agency issued notice to the researchers and the Michigan Health and Hospital Association that, by introducing a checklist and tracking the results without written, informed consent from each patient and health-care provider, they had violated scientific ethics regulations. Johns Hopkins had to halt not only the program in Michigan but also its plans to extend it to hospitals in New Jersey and Rhode Island.

The government's decision was bizarre and dangerous. But there was a certain blinkered logic to it, which went like this: A checklist is an alteration in medical care no less than an experimental drug is. Studying an experimental drug in people without federal monitoring and explicit written permission from each patient is unethical and illegal. Therefore it is no less unethical and illegal to do the same with a checklist. Indeed, a checklist may require even more stringent oversight, the administration ruled, because the data gathered in testing it could put not only the patients but also the doctors at risk - by exposing how poorly some of them follow basic infection-prevention procedures.

The need for safeguards in medical experimentation has been evident since before the Nazi physician trials at Nuremberg. Testing a checklist for infection prevention, however, is not the same as testing an experimental drug - and neither are like-minded efforts now under way to reduce pneumonia in hospitals, improve the consistency of stroke and heart attack treatment and increase flu vaccination rates. Such organizational research work, new to medicine, aims to cement minimum standards and ensure they are followed, not to discover new therapies. This work is different from drug testing not merely because it poses lower risks, but because a failure to carry it out poses a vastly greater risk to people's lives.

A large body of evidence gathered in recent years has revealed a profound failure by health-care professionals to follow basic steps proven to stop infection and other major complications. We now know that hundreds of thousands of Americans suffer serious complications or die as a result. It's not for lack of effort. People in health care work long, hard hours. They are struggling, however, to provide increasingly complex care in the absence of effective systematization. Excellent clinical care is no longer possible without doctors and nurses routinely using checklists and other organizational strategies and studying their results. There need to be as few barriers to such efforts as possible. Instead, the endeavor itself is treated as the danger.

If the government's ruling were applied more widely, whole swaths of critical work to ensure safe and effective care would either halt or shrink: efforts by the Centers for Disease Control and Prevention to examine responses to outbreaks of infectious disease; the military's program to track the care of wounded soldiers; the Five Million Lives campaign, by the nonprofit Institute for Healthcare Improvement, to reduce avoidable complications in 3,700 hospitals nationwide.

I work with the World Health Organization on a new effort to introduce surgical safety checklists worldwide. It aims to ensure that a dozen basic safety steps are actually followed in operating rooms here and abroad - that the operating team gives an antibiotic before making an incision, for example, and reviews how much blood loss to prepare for. A critical component of the program involves tracking successes and failures and learning from them. If each of the hundreds of hospitals we're trying to draw into the program were required to obtain permissions for this, even just from research regulators, few could join.

Scientific research regulations had previously exempted efforts to improve medical quality and public health - because they hadn't been scientific. Now that the work is becoming more systematic (and effective), the authorities have stepped in. And they're in danger of putting ethics bureaucracy in the way of actual ethical medical care. The agency should allow this research to continue unencumbered. If it won't, then Congress will have to.

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1 January, 2008

Arizona Health Program in Jeopardy

(Phoenix, Arizona) The state-run Arizona Healthcare Group subsidizes the health care costs of tens of thousands of people with large infusions of taxpayer funds despite its intended goal of being self-sustaining on premium payments.

The program insures everyone for similar costs regardless of any pre-existing conditions. As a result, the number of seriously sick people signing up far outnumber the healthy people and costs have soared. Jeez, imagine that.

From AZCentral:

"I think the intention was noble," said Rep. Kirk Adams, R-Mesa, who co-chairs a legislative committee investigating problems with the program. Adams wants to scrap Healthcare Group in favor of a program for the state's sickest, uninsurable residents. "What they were trying to accomplish was correct, but it failed."

Interestingly, the comment thread accompanying the article largely blames anchor babies and the Iraq war for the failure of the government-run health care program. Obviously, the commenters have issues.

However, the reason the Healthcare Group is failing to achieve its goal is simple. In every socialized medical scheme where the government promises to give everything to everybody, sooner or later it's realized that the government has only a finite capacity to give whereas the capacity to want is infinite.

So, the government depletes its resources to give while the people continue to want and the net result is rationing, typically by extraordinary waiting times or the blanket denial of selected health services. In the case of Arizona, it appears that the Healthcare Group scheme is to be scrapped for a new and improved scheme.




Wait for a hearing aid can be more than two years in Britain

Some hard-of-hearing patients in England are having to wait more than two years for an NHS hearing aid. The Royal National Institute for Deaf People (RNID) used the Freedom of Information Act to discover just how long the waits were. It found that ten trusts were not treating patients within a year, in spite of the Government’s target being 18 weeks. The worst offender was Kingston upon Thames, southwest London, where patients had to wait 125 weeks for an aid after first seeing their GP.

The average wait was 22 weeks in the 99 primary care trusts (PCTs) across the country that responded to the request. Another 53 failed to reply. The shortest wait was four weeks; 66 of the 99 trusts provided treatment within 18 weeks. The longest waits - all more than a year – were in Suffolk (78 weeks), Gloucestershire (72), Tyne and Wear: Washington Health Centre (68), Ealing (67), Havering (64), Tyne & Wear: Sunderland Royal Hospital (62), Shepway (58), Mid Essex (56) and South Tees (54).

The RNID said that 39 per cent of new patients in England wait for more than a year to get their hearing aids. Brian Lamb, for the institure, said: “If you struggle to pick up every word, hearing aids are a lifeline to work, friends and family. “Despite government assurances, an 18-week target is a distant dream for thousands of people waiting over a year for their first hearing aid, who are battling isolation and depression because of their hearing loss.

A Department of Health spokes-woman said: “We acknowledge that audiology waiting times in parts of the country are too high, and that is why we recently published a national framework which sets out the tools the local NHS needs to transform this service.”

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