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30 June, 2008

The latest craziness in Brtain's socialized medicine

Nurses to take charge of surgeries

The government will take on the medical profession this week by pressing ahead with reforms that will see greater power being transferred from doctors to nurses. Alan Johnson, the health secretary, is expected to follow up plans to introduce at least 150 large health centres, known as polyclinics, by announcing an expansion of surgeries run by nurses. The centres will replace lone GPs, many of whom the government believes are unable to provide evening surgeries or other modern patient services.

This is likely to escalate a row between the government and doctors over reform. Lord Darzi, the health minister in charge of a review of the National Health Service, has accused some doctors of being “laggards” and protecting their “professional boundaries”. Darzi has already said he wants to see nurses doing minor surgery in hospitals. This week he is expected to lay out proposals for more nurses to set up surgeries. They will be encouraged to establish not-for-profit firms to run the practices by being allowed to opt out of the NHS without losing pension rights.

Darzi will also outline plans to publish the death rates of hospital doctors so patients can compare their chance of survival according to who treats them. Death rates at NHS hospitals are available for heart surgery. Success rates for about 50 other conditions are expected to be published on the internet to allow patients to shop around.

Patients are also expected to be given personal health budgets and will decide how the money is spent on treating long-term conditions, such as diabetes and heart disease.

An “NHS constitution” will set out patients’ rights and responsibilities, including the right to be told why they have been denied a drug a doctor recommends.

Johnson has admitted that access to NHS drugs is a lottery and will order the National Institute for Health and Clinical Excellence (Nice), the government’s rationing watchdog, to assess drugs more quickly. He said: “What we have heard from patients is that one of their major concerns is the perceived ‘postcode lottery’ in access to drugs. “The draft constitution will address this by making it explicit that patients have the right to Nice-approved drugs and treatment if clinically appropriate. “We will also speed up the national process for appraising new drugs. If a decision is then taken not to fund a drug then your local NHS will have to explain that decision to you.”

Hamish Meldrum, chair of the British Medical Association, suggested the government’s plans for nurses to run surgeries would have limited impact because patients would choose to be treated by doctors. Meldrum said: “There are obviously certain things that only doctors can do. “It is all very well saying patients should have choice about where they are treated but there are certain treatments nurses cannot do, so there will be a limited choice. Patients usually prefer to see doctors.”

Peter Carter, general secretary of the Royal College of Nursing, said increasing numbers of nurses would run local surgeries in future. Carter added: “We never want to get into confrontations over territory. However, good progressive doctors recognise there are roles for nurses who do highly complex work.”

Source





29 June, 2008

Founding Father of Canada's Socialized Medicine Rejects the Monster He Helped Create

If we follow Canada over the edge and into the abyss of socialized medicine, it won't be because we weren't warned of the consequences:

Back in the 1960s, [Claude] Castonguay chaired a Canadian government committee studying health reform and recommended that his home province of Quebec — then the largest and most affluent in the country — adopt government-administered health care, covering all citizens through tax levies.

The government followed his advice, leading to his modern-day moniker: "the father of Quebec medicare." Even this title seems modest; Castonguay's work triggered a domino effect across the country, until eventually his ideas were implemented from coast to coast.

Four decades later, as the chairman of a government committee reviewing Quebec health care this year, Castonguay concluded that the system is in "crisis."

"We thought we could resolve the system's problems by rationing services or injecting massive amounts of new money into it," says Castonguay. But now he prescribes a radical overhaul: "We are proposing to give a greater role to the private sector so that people can exercise freedom of choice."

Castonguay has been forced to reverse his views because authoritarianism has made such a mess of healthcare in Canada, people enter lotteries to win a doctor's appointment. Fortunately Canadians are still able to cross the border to a free country, where all you have to do to get medical attention is be willing to pay for it. But if Democrats have their way, that won't be the case for much longer.

Freedom works. Socialism doesn't work. Yet socialism means more power for the authorities, so we will have to keep fighting it off, no matter how many times it has been exposed as fundamentally dysfunctional.

Source





28 June, 2008

IVF severely limited in the home of IVF

Lots of women outside Britain have 10 or more treatments to get a baby. And infertility is a very common disorder

Thousands of infertile couples are being denied IVF that should be funded by the NHS because only 9 of 151 health trusts are offering the recommended level of therapy. A total of 94 per cent of primary care trusts in England are still not providing the three free cycles of IVF that should be available under national guidelines issued in 2004, government figures have revealed.

The survey of IVF provision last year also showed that all but a few trusts have imposed tough criteria for free fertility treatment, rejecting patients who smoke or who already have children, including those from previous relationships. Most of those that offered treatment paid for one cycle, and four trusts provided none at all. The results - the first to incorporate figures from every trust in England - were published yesterday by the Department of Health. They show that a postcode lottery for IVF is flourishing despite guidance from the National Institute for Health and Clinical Excellence (NICE).

The NHS financial watchdog recommended in 2004 that three cycles should be available to infertile couples in which the woman is aged between 23 and 39. Women's chances of conceiving are considerably better when more cycles are offered, to the extent that NICE identified three cycles as cost-effective. The advice is not binding, and the Government has provided no extra funds for it to be put into effect. The Department of Health has asked trusts to provide at least one cycle, and to move towards implementing it in full.

About one in six couples is affected by infertility. Almost 45,000 cycles of IVF are performed in the UK each year, but the level of NHS provision means that more than 30,000 of these are conducted privately, at an average cost of about 2,000 pounds per cycle.

The new figures were published as doctors prepare to celebrate the 30th birthday of Louise Brown, the world's first test tube baby, who was born in Oldham on July 25, 1978. Oldham is one of the nine trusts - all in the North West of England - that provide three cycles.

Susan Seenan, of the patient support charity Infertility Network UK, said: "Thirty years after the inception of IVF treatment, in the country that pioneered IVF, and four years after the NICE guideline, it is a complete disgrace that only nine PCTs are offering three free cycles. "We are also disappointed that some PCTs are still offering no cycles at all, and that most are adding social criteria that make it difficult and unfair for patients to access the treatment they need. "There is a real need for a standard set of eligibility criteria that operate nationwide."

The survey was published on the Department of Health's website in response to a parliamentary question from Sally Keeble, the Labour MP for Northampton North. It does not include data from Scotland, Wales or Northern Ireland. It found that seven PCTs offer three cycles - Heywood, Middleton and Rochdale; Bury; East Lancashire; Stockport; Tameside & Glossop; Traf-ford; and Blackburn with Darwen. Central Lancashire offers two or three cycles, and Oldham "a maximum of three". The four PCTs that have suspended free IVF treatment were North Lincolnshire, North Staffordshire, North Yorkshire and York, and Stoke on Trent, though the latter has since resumed provision.

About two-thirds of the trusts (100) offer one cycle, while 35 offer two, and three did not provide full information. More than half (86) specify that a couple must have no children, while another 46 impose other restrictions such as no children from the current relationship, or not more than one child. The survey found that 35 trusts specify no smoking, 30 say that patients must be in a stable relationship, and 33 impose age restrictions beyond those in the NICE guidelines.

A spokeswoman for the Department of Health said: "We recognise that there are local variations in the provision of IVF and that this does cause distress to many childless couples who feel that they are not getting the treatment they need. "NICE published their guide recommendations that trusts provide up to three cycles of IVF in February 2004. But NICE and the Department of Health realised that this could not be immediately implanted and so trusts were encouraged to use this as a goal they move towards. The first step is for all PCTs to offer at least one cycle of IVF and the vast majority do so, with almost a third already offering more than one cycle."

Source




Australia: New ambulance computer system still cactus

Maybe they did not oil it enough. See my second post of the day on 23rd for background

For the second time in a week Emergency Services' $6 million computer system has crashed, forcing operators to log jobs on a "big whiteboard". The Emergency Services Computer Aided Dispatch system failed without notice at 11:30am for no apparent reason. It was back online fairly quickly - unlike last week's 90 minute outage - which was blamed on a maintenance issue.

The expensive new computer system went "live" in Brisbane on May 1 despite the concerns of fire service communications operators. Officers who contacted The Courier Mail expressed fears problems experienced in the southwest region would be repeated in the busy metropolitan area with serious consequences. The problems included delays in the system and unexplained outages, like today's crash.

Emergency Services management has previously stated its complete confidence in the escad system which was initially delayed to provide officers with extra training.

Source





27 June, 2008

NHS hospital pronounces ten-month-old girl dead -- despite her being alive

An investigation has begun into how a ten-month-old girl, feared drowned in the Thames, was wrongly pronounced dead by hospital staff. It was believed that the child had died after she fell in during an outing to feed the ducks with her mother and three-year-old sister. She was airlifted to John Radcliffe Hospital, Oxford, but after efforts to resuscitate her, doctors declared her dead. Police confirmed the tragedy at 11am, more than an hour after officers were first called to the scene on the towpath at Goring-on-Thames, Oxfordshire, yesterday morning.

A faint heartbeat was discovered later, and the girl remains in hospital in a critical condition. Neither the hospital nor the police would give details of how long it took hospital staff to discover that the child was still alive, nor could they confirm how the child got into difficulty in the water.

A spokeswoman for John Radcliffe Hospital said: “A full paediatric clinical team immediately attempted to resuscitate the child in the emergency department of the John Radcliffe. “After a lengthy period of resuscitation, a unanimous decision was made by the clinical team to stop treatment, in the best interests of the child. [It's in her best interests to be dead?????]

“Subsequently, the child showed very fragile signs of life. This does occasionally happen and the child was moved to the paediatric intensive care unit of the hospital. She remains there in an extremely serious and critical condition.”

Source




Crass Australian public hospital management kills little girl

Exhausted doctor didn't notice brain bleed. What was the hospital management thinking of to assume that a doctor did not need sleep? It's a wonder this sort of disaster does not come to light more often. The hospital manager should be sued for manslaughter

DOCTOR fatigue and the safety of bunk beds are among the issues being probed by an inquest into a girl who died hours after she was sent home from hospital. Elise Neville, then 10, struck her head in a fall from a bunk bed while on a family holiday at Caloundra, in Queensland, in January 2002. Bleeding in her brain went unnoticed by Dr Andrew Doneman, who was in the 20th hour of his 24-hour shift at Caloundra Hospital. The hospital had a policy of not admitting children and the Toowong, West Brisbane, schoolgirl was discharged.

She went to sleep on her parents' bed in Caloundra but was critically ill when her family woke at 7am. An unconscious Elise was flown to Brisbane for treatment. and died days later.

The court was told that in 2004, Dr Doneman pleaded guilty to unsatisfactory professional conduct but the issue of fatigue was raised. Health Practitioners Tribunal judge Debbie Richards said then that it seemed "extraordinary" that anyone should be working such long hours. "If this tragedy does nothing else, it should lead to the abolition of such brutally long shift hours," she said.

Queensland Health's acting director of medical workforce advice Suzanne Le Boutillier said an "alert doctors" strategy was being rolled out to help make doctors aware of fatigue. "Focusing solely on the hours of work does not make patients safe," she said. "There are a whole range of other factors that contribute to fatigue." Ms Le Boutillier said the strategy had gained support among doctors. "The great successes are where doctors drive this on the ground," she said.

The safety of bunk beds will also come under the scope of the inquest and how future deaths might be prevented.

Outside court, Elise's parents Gerard and Lorraine, said they hoped the inquest would identify and improve deficiencies in the health system. "There's been changes, that's great, but I need to see more," Mr Neville said. He said many Queenslanders lived in places removed from Brisbane and the bigger centres and they needed care too. "We were only one hour from Brisbane - one hour - and this is what happens," he said. Mrs Neville said: "I want people to see how beautiful she was and she's just always going to be a part of our lives. "We're Elise's voice and we'll see it through."

Source





26 June, 2008

What's at Stake in the Medicare Showdown

A friend recently asked me for advice on how to protect her father. He wants to stay in his own apartment as he recuperates from hip surgery. But the Medicare program that covers him requires that he head off to a costly nursing home. My friend was so desperate that she has also consulted a health-care lobbyist for advice.

At stake in the presidential election is whether we will all need to consult lobbyists to have our medical issues heard by a remote, bureaucratic Medicare program. Medicare's staff, members of Congress and Barack Obama are all moving to expand government influence over the medical choices we make. As early as today, the House will vote on legislation that aims to cut Medicare Advantage - a program that allows millions of seniors to use federal dollars to buy private health insurance.

Democrats hate Medicare Advantage and have been trying to cut it for quite some time, because they don't like health-care markets. Sen. Obama promises to cut $150 billion out of it in the coming years. The Senate has been haggling over cuts to the program for weeks. Why cut? For all the talk about finding health-care savings with painless "reforms" like better information technology or disease management, the only way to really control costs under our current health-care model is to control access to drugs, devices and services.

The crucial question is where the controls should be - with patients working through private plans or with government agencies. While private health insurance is imperfect, there's a misguided faith in Medicare's superiority that rests on flawed assumptions.

First, there's a mistaken belief that Medicare is better staffed than private plans, and can therefore make better decisions about patients' clinical circumstances and the access to new therapies they should have. Yet at any time, Medicare has about 20 doctors and 40 total clinicians (including nurses) inside the coverage office, and fewer than a dozen in the office that sets the rates that doctors are reimbursed for the care they provide. Private insurers employ thousands of doctors, nurses and pharmacists, many experts in new technologies.

Aetna has more than 140 physicians and about 3,300 nurses, pharmacists and other clinicians across its health plans. Wellpoint has 4,000 clinicians across its different businesses, including 125 doctors and 3,180 nurses. That works out to one clinician for every 9,000 people covered. United Healthcare employs about 600 doctors and 12,000 clinicians across all of its health plans and various health-care businesses.

Private plans use clinically trained people to establish access to new technologies and services, but they also consult with doctors on a case-by-case basis, determining whether a product or service should be covered. Competition for beneficiaries means private plans need to provide better access for appeals, modern services and more personal considerations than what's offered by Medicare, a monopoly supplier.

Recent data from Price Waterhouse Coopers found that private plans spend roughly four times more than Medicare on "consumer services, provider support, and marketing," which includes money spent answering the telephone to adjudicate individual issues. Smaller health plans use one clinician for every 10,000 beneficiaries. Medicare would need 4,500 clinicians to keep pace.

One place where the clinician disparity is most obvious is the delivery of cancer benefits. Medicare doesn't have a single oncologist on staff, yet since the year 2000 the program issued, by my count, 165 restrictions and directives on the use of cancer drugs and diagnostic tools.

A second common refrain is that Medicare is more efficient than private plans, spending less money per beneficiary to administer health services. But a lot of the money that private plans spend is on clinical specialists charged not only with reviewing individual cases, but also with ensuring that doctors and beneficiaries comply with plan contracts. Far from a selling point, not having these functions is one of Medicare's shortcomings.

Medicare doesn't need to hire doctors to weigh individual medical cases because it uses formulaic rules made in Washington to set broad and inflexible restrictions on medical practice. Nor does the program need to hire clinical staff to monitor compliance. It passes costs for that on to the broader health-care system by backing up its rules with the threat of costly civil and even criminal sanctions. Providers and medical product developers spend hundreds of millions of dollars on systems, personnel and paperwork to ensure compliance with Medicare's sticky morass of regulations - tasks made more expensive by the fuzziness of the program's regulations and the arbitrary way they are enforced.

This brings us back to Medicare Advantage. Many in Congress assume that private insurers are driven by greed, and only a government-run health program can ensure adequate access to services. But Medicare Advantage plans offer prevention and wellness benefits, care coordination and alternatives to hospitals at the end of life that traditional Medicare does not provide. The clinical staff of Medicare Advantage plans isn't just there to handle appeals, but to offer personalized services that reflect the care people want rather than benefits defined by remote staff at a monopoly supplier.

If Democrats have their way these plans could be in for big cuts. If Congress does nothing before July 1, doctors in Medicare will take a 10.6% cut in their pay. To stop that from happening Congress will likely raid Medicare Advantage and use the money saved by cutting that program to cushion the blow to doctors. What terrifies members is facing constituents over the July 4 break who will be upset about rising co-pays and uncertainty about their coverage. The question is how big of a bite the House and Senate will take out of Medicare Advantage. But cut they will, because Medicare Advantage plans enable competition that serves as a model for shaping Medicare into a privately run system.

Mr. Obama has been honest about his intentions. He wants to cut from Medicare Advantage to pay to expand "fee-for-service" Medicare programs. For those not yet eligible for Medicare, he also proposes to saddle private plans with new regulations and create a subsidized, Medicare-like public plan to "compete" against the private health-insurance market for the under-65 crowd. The idea is that the Medicare-like alternative would eventually displace a dwindling number of private plans, after many are driven away by costly new government rules. His endgame is to leave the government-administered Medicare program in a position to set decisions for the entire health-care system.

Will we stick with a "defined benefit," where everyone is promised the same government services? Or will we move toward a "defined contribution" system (favored by John McCain), where seniors can buy private health insurance? It's a fundamental question we are being asked in November.

In the end, my friend's father was transferred to a nursing home. Patients covered under Medicare Advantage have their own discomforts, but at least they can always change plans and appeal decisions. And they don't need to consult a lobbyist.

Source





25 June, 2008

THE CHRONIC CRISIS IN AUSTRALIAN PUBLIC MEDICINE

Three articles below from just one day!

Doctor numbers nosedive in Australia

When there are heaps of people wanting to get into medical schools this is just plain government negligence. Why is money being spent on useless "postmodern" courses when funds for medical education are so limited?

AUSTRALIA'S doctor shortage is becoming critical, with new figures revealing a plunge in the number of GPs. A report to be released today shows the number of practising GPs fell 9 per cent between 1997 and 2005.

The release of Australia's Health 2008 will reignite tensions between doctors and the Rudd Government. Health Minister Nicola Roxon said GPs should rethink their roles as medical "gatekeepers" in light of the finding. "Why, when families struggle to see their GP, when people often end up in their local hospital because they can't get frontline care from their local doctor, do we need gatekeepers?" she said.

The Australian Medical Association argues that doctors must be the gatekeepers of the health system to ensure patient safety

Source




Dud medical regulator to be sued

RAPE victims of a deviant doctor are planning to sue Victoria's peak medical watchdog for failing to act on sex assault complaints. The women have engaged Slater & Gordon to investigate suing the Medical Practitioners Board for failing to suspend dermatologist David Wee Kin Tong after two patients said he molested them. Dr Tong was jailed in March for at least 5 1/2 years for sexually assaulting 14 patients. His last victims were assaulted three years after the first complaints were made.

The women claim inaction by the profession's watchdog left Dr Tong free to abuse up to 12 more unsuspecting victims. It is believed the board, a statutory body charged with investigating complaints and protecting the public, did not hold a formal hearing into the allegations after an investigation into Dr Tong. A second complaint to the board in 2005 led to Dr Tong being reprimanded. The board is not required to pass complaints on to police.

After a victim went to police in 2007, investigators were initially refused access to the board's records on Dr Tong and were forced to serve a warrant for the material to be released. Victoria Police's sexual crimes squad raided the board's headquarters, but had to fight a legal challenge in court to use the files. The board has since apologised publicly for its handling of the complaints, but a police source says that the board's actions were tantamount to a "cover-up".

The Herald Sun has learned the wealthy doctor tried to divest himself of his Toorak mansion before it could be confiscated to pay his victims' compensation. Victoria Police restrained Dr Tong's Toorak property, which he had sold for $2.35 million, only days before settlement. The proceeds of the sale were later confiscated. Already gone were antiques and paintings, many of which Dr Tong bought at Sotheby's and Christie's auctions.

Dr Tong, 40, pleaded guilty to seven counts of rape and seven counts of indecent assault involving 14 patients at clinics at Clifton Hill, Malvern, and Preston. The offences occurred between October 2001 and 2007 during examinations. He also lost his right to practise medicine. Another two women have since come forward with allegations against Dr Tong.

During a search of Dr Tong's home, police found 120 pictures of naked women -- some of them patients -- placed in small photo albums. Dr Tong told many of the women, aged between 22 and 34, they could get moles on their genitals and required a full-body examination.

Kay, who was the first victim to come forward, said although compensation was an issue, she wanted the board to change its investigation procedures to ensure the safety of others. "I was the first, but they just didn't follow up," she said. "I felt really violated and they (the board) hadn't listened to anything I said to them and took his word for it."

The MPB has since reviewed cases involving potential sex offences and apologised to victims. "Why the hell didn't they stop it back in 2004 when we complained," Kay said.

Source




Public hospital and its head surgeon facing negligence lawsuit

MELBOURNE'S The Alfred Hospital and its former head of trauma, Thomas Kossmann, are facing legal action alleging medical negligence. Law firm Slater & Gordon has told The Australian it is preparing several cases against the hospital, and possibly Professor Kossmann, for allegedly negligent surgery performed on trauma patients.

The cases come in the wake of a damning peer review into Professor Kossmann's surgical and billing practices, which were first revealed in The Australian in April. The review alleged he had exaggerated his experience on his CV, conducted risky and unnecessary surgery, and rorted government insurance agencies, including the Transport Accident Commission. It also alleged he had put lives at risk with bungled surgery that involved grave errors in more than half of the 24 cases that were examined.

Professor Kossmann has denied any wrongdoing and attributed complaints from doctors about his surgery to competitive jealousy. He condemned the peer review, led by orthopedic surgeon Bob Dickens, as a "witch-hunt", and several of his former patients have come forward to praise his surgical performance.

When the review was released last month, Jennifer Williams, the head of Bayside Health, which operates The Alfred, absolved the hospital of any legal responsibility. But Slater & Gordon medical negligence specialist Paula Shelton said her firm was preparing several cases involving allegedly unsuccessful or unnecessary surgery performed by Professor Kossmann at The Alfred. "They are all people who have got significant problems," she said. "There are certainly a couple of them that I think are serious. It's fair to say they relate to poor (surgical) outcomes." For the cases to succeed, the victim must prove at least 5 per cent physical impairment and that the surgery done was poorer than could be reasonably expected at the time. Slater & Gordon is still investigating the cases and expects to obtain the medical records from the hospital and launch action within a few months if independent advice confirms the alleged negligence.

A spokeswoman for Professor Kossmann said the surgeon was not aware of any claims against him and therefore could not comment. Ms Shelton said she was unable to give details of the cases, but The Australian has spoken with one of Professor Kossmann's patients who is not among the existing cases, but is considering joining any action against the hospital.

The patient, who declined to be named, claimed he had complications after Professor Kossmann operated on him in 2004 following a car accident. He claimed he suffered a post-operative infection following the original surgery. "At the time I found him to be very professional and thought the complications which arose both in the short term and long term just came with the territory; however, reading the reports coming out now makes me wonder about that," he said. "About a year or so later, my leg played up again so I went to a doctor to have a look at it and they found deep-vein thrombosis, which he attributed to the original injury ... X-rays showed that a titanium screw placed in my knee ... had snapped during that surgery and had been left there."

Source





24 June, 2008

British doctors dubious about new treatment protocols

Nurses doing surgery?? I think I'd be dubious too

The minister in charge of a review of the NHS has accused some doctors of being “laggards” for obstructing the introduction of new treatments. Lord Darzi, who continues to work as a surgeon, says some senior medical staff are so determined to protect “professional boundaries” that, 14 years after his own practice began using nurses to do minor surgery, others have yet to follow.

He said: “In all areas of healthcare you have innovators, people who really want to change things for the better, and you also have, in other areas of the healthcare system, people who are lagging behind and need to catch up. “They will eventually catch up once they know that, if you start thinking about what really matters to patients, how you can improve the care you provide, you get over all these different obstacles.”

Darzi, who has been in bitter conflict with doctors over the introduction of polyclinics, is backed by Sir Liam Donaldson, the chief medical officer. This weekend, Donaldson accused some surgeons of obstructing changes that would make operations safer because they objected to their “professional autonomy” being eroded. He said: “The culture of medicine has been one of clinical autonomy. Doctors are trained to take decisions, to feel they are in charge, to lead teams. They want to do what they feel is best and anything that suggests that they should standardise their practice in any way is sometimes seen as degrading of their professional ethos.”

Donaldson, who as chairman of the World Health Organisation world alliance for patient safety will this week launch an airline-style danger checklist for surgeons, added that one British doctor told him such checks would reduce consultants to “factory workers”. Donaldson said: “I was talking about a way in which standard operating procedures are used in the airline industry and he said: ‘Well, if you bring that into medicine, we might as well go and work in factories.’ “I think it is a new idea for some traditional people holding traditional attitudes in medicine and I think we need to break those down and get people thinking and learning from other industries.”

Darzi, who will publish his review on the NHS at the end of this month, also says doctors and nurses must treat patients as customers. He says that if patients don’t like the quality of care they are receiving they should go elsewhere. His report will include proposals to routinely invite patients to grade the quality of nursing care they receive during their hospital stay, including how comfortable they were made to feel on the ward and if they were treated in a kind and compassionate manner. Results of these questionnaires will be published so that patients can shop around for the hospital with the most compassionate nursing care.

Darzi, who still practises his keyhole surgery specialism two days a week at St Mary’s Hospital in London, said he recently had a patient who requested a referral to his unit from outside its catchment area. He said more details of the most advanced surgery will be made available to patients as part of his review. This will make it easier for patients to find out where the latest technology is used.

Darzi said: “Have patients been treated as customers? When you go to a restaurant you look at a website and find out exactly what people said about that restaurant. In future I want to show which hospitals, doctors and nurses are actually bringing innovation into their healthcare.” Darzi is to set up a new website featuring all the latest innovations in medicine to encourage hospitals to adopt new treatments more quickly.

Source




Not again! Another government computer system fails

And a dangerous one: The system for an Australian ambulance service. My local Yellow cabs and Pizza Hut have great computer systems for managing customers and Bill Gates sells programs that are a thousand times more elaborate. What's wrong with the bureaucratic boneheads? Nobody gives a damn. That's what's wrong. The system was "innovative", of course. Governments should only buy tried and tested systems. They bungle anything else

A $6 MILLION computer system crashed within hours of being turned on last week, leaving Emergency Services staff using pen and paper to dispatch ambulances and fire engines. The Queensland Ambulance Service computer-aided dispatch system, known as VisiCAD, went down for six hours on Wednesday and communications centre staff said patient lives were put at risk across the state.

"Once the crash occurred the computers froze . . . Many other dangerous technical difficulties then occurred," a QAS employee told The Sunday Mail yesterday. The informant said that in the chaos and confusion, two patients with non-life-threatening conditions who had requested ambulances were overlooked. "No one died, but it definitely put lives in danger," the employee said.

He said the Queensland Fire and Rescue ESCAD system crashed for 2® hours at the same time. Queensland's Emergency Services has spent millions of dollars in the past decade trying to find a suitable computer-aided dispatch system. Sources said the new model was rushed in without being properly road-tested.

A QAS spokesman played down the system crash. "The Department of Emergency Services is currently implementing one of the nation's most innovative dispatch systems, called VisiCAD," he said. "The new system will link all QFRS and QAS communications centres with a single state-of-the-art computer-aided system." He said the cause of the "outage" of about 90 minutes late on Wednesday was related to a maintenance issue ["maintenance"? How do you maintain a computer program? Do you oil it?], not the system. "There have been no reports of any significant impact on service delivery." The spokesman said senior management was unaware of any evidence to indicate lives were put at risk.

Source





23 June, 2008

Cancer pair win fight with NHS for top-up drugs

Two women suffering from cancer have won legal battles for the right to pay privately for life-prolonging drugs without having their National Health Service treatment withdrawn. Several hospital trusts have also broken ranks to allow dying patients to pay immediately for the additional drugs that their doctors have said they need.

The moves are a sign that the government’s ban on so-called co-payments is beginning to crumble. In the face of a campaign led by The Sunday Times, Alan Johnson, the health secretary, has already announced a review of the policy which is due to report in October.

Melissa Worth, a solicitor at the law firm Halliwells, who is representing eight patients fighting for the right to co-pay, said: “Many more NHS trusts are finding different ways of allowing patients to pay for cancer drugs. “The government has now publicly acknowledged there is a problem and people are realising that what is most important is that patients get the best possible care.”

Andrew Haldenby, director of the think tank Reform, which includes Doctors for Reform, a group of 1,000 doctors campaigning for change, said: “This is a victory for common sense. It has become clear that many doctors have rejected the bureaucratic rules of the NHS to act in the best interests of patients. They deserve praise for looking beyond the guidance to act in a way which shows the true values of medicine. These cases also show the government had to order a review as its position is unsustainable.”

One woman, who took legal action against Weston Area Health NHS Trust in Weston-super-Mare, Somerset, has been told she can pay for Avastin, the bowel and breast cancer drug, in the hospital’s private wing while receiving the remainder of her care on an NHS ward. The trust, which runs Weston General hospital, said: “This patient is having complete treatment on the NHS and has chosen to purchase separate treatment as well. Because the hospital has a unit for private patients on site, it has been agreed that the patient can receive Avastin on that unit.”

Another woman, who has bowel cancer and is taking legal action against the Royal Marsden NHS Foundation Trust in London, has been advised that she will also be able to pay for Avastin without being denied NHS care. The woman’s husband, who does not wish to be named, said the trust had told them it would not object, “provided we were not getting treatment in the private [wing] and on the NHS in the same episode of care, on the same visit. Effectively, we have won the right to pay.” The Royal Marsden has declined to comment on the case.

The Velindre NHS Trust in Cardiff faces a judicial review after refusing to allow a woman to buy a cancer drug.

Nottingham University Hospitals NHS Trust, ABM University NHS Trust in Bridgend and University Hospital Birmingham NHS Foundation Trust are also allowing some of their NHS patients to pay for additional drugs.

Many dying patients are still being denied the chance to spend their savings on cancer drugs, however, because their trust plans to retain the ban until the government review ends. Sue Matthews, 57, a former physiotherapist from Buckinghamshire and the wife of an NHS orthopaedic surgeon, says this could be too late for her. Matthews, a mother of two with bowel cancer, wants to be able to pay for the drugs Avastin or Erbitux without losing her NHS care. She said: “It could all be too late for me. “If the government turned round now and said, ‘We realise it has been happening in other areas of the NHS and we are prepared to accept it now’, that might be of some use to me. But he [Alan Johnson] is just trying to placate people and for those in my position it doesn’t help at all. “Some of these reviews go on for years. I will be dead by then.”

Another cancer patient, Jonathan Chapple, a retired company chairman from Kingston, southwest London, was asked by an NHS trust to pay £55,000 upfront for all of his cancer care when he asked to top up with the drugs that doctors said would give him the best chance. Like Matthews, Chapple, 69, was told by doctors that Avastin or Erbitux, which are not routinely funded by the NHS, were most likely to extend his life. His oncologist at the Royal Marsden told him that he could not continue to receive NHS care while paying for the drugs, however, and he was advised to transfer to the hospital’s private wing. Chapple said: “Having paid all my life for NHS services, to be put in this position feels immoral.” He is now travelling to a private clinic in Germany for treatment.

The Royal Marsden said: “In line with all private providers, we do ask for a deposit upfront and this is judged on the individual patient and their treatment pathway.”

Source




Australia: Dangerous public hospital blood blunders

PATIENTS' lives are being put at risk in Queensland hospitals because of an alarming level of blood-type identification errors, experts have warned. A medical conference in Brisbane last week was told that a recent study of Townsville, Royal Brisbane, Wesley and Greenslopes hospitals in Queensland revealed four patients had been given potentially fatal incorrect blood transfusions. The six-month study to December 2007 also identified a further 26 cases of blood-related errors.

The Patient Safety Symposium at the Brisbane Convention Centre was also told two patients had their blood type wrongly identified in the emergency department at Gold Coast Hospital last weekend. There were 117 "adverse blood events" found after an analysis of Queensland Health's reporting incident system since December 2006. But Queensland Blood Management Program clinical adviser Dr Simon Brown said the real problem was even worse, as these were "only the incidents being reported". Dr Brown revealed an estimated 25 patients received incorrect blood transfusions in the state's hospitals every year. Patients given the wrong blood type can suffer severe allergic reactions, respiratory distress, excessive bleeding, kidney failure and death.

Queensland Pathology transfusion expert Tony Ghent is so concerned with the problem that he has developed a barcoded armband to alleviate confusion. The armband will be trialled at Royal Brisbane and Women's Hospital and the Gold Coast Hospital in the next few weeks. Investigations into blood errors have begun because of requirements under the National Blood Agreement, signed in 2003. Part of the agreement is to develop a framework to monitor the safety and delivery of the blood supply in each state and territory.

Dr Brown said an examination of Queensland Health's reporting system in the 12 months to December last year found 90 blood "incidents" in the state's hospitals. Queensland receives 250,000 fresh blood components annually. A paper delivered by Dr Brown in October to the annual conference of the Haematology Society of Australia and NZ said blood identification errors were common during the collection and administration of fresh blood components, and result in the incorrect blood component being transfused.

Source





22 June, 2008

Doctorless Canadians

Over the four times Dawn Beharry has been stricken with the same, persistent infection since January, she has had one wish: that she could see a family doctor who would remember her. She can't find one. "I've settled on coming here to see whomever, randomly," she said, referring to the Doctor's Office walk-in clinic at Bay and Dundas Sts. she has visited over the past three years.

Beharry, 26, is one of 4.1 million Canadians aged 12 or older who are without a family doctor, according to the 2007 Canadian Community Health Survey, which questioned more than 65,000 Canadians about their health. The report was released yesterday. Among its worrying statistics: Recent immigrants, the poor and the young were all more likely than the bulk of Canadians not to have a regular doctor. Only 65 per cent of immigrants who have been in Canada for five years or less have access to a family physician, compared to 85 per cent for the whole country, according to the study.

Income level, gender and age also play a role. Of the 20 per cent of Canadians with the lowest incomes in the country, 82 per cent see a family physician. Men were nearly twice as likely as women not to see a regular doctor. And the probability of having a primary doctor increased with age.

So what do Canadians without regular physicians do when they get sick? The survey found that among those who have no regular physician, 64 per cent chose to go to walk-in clinics, 12 per cent visited a hospital emergency room, and 10 per cent visited a community health centre.

In the past year, Beharry has visited both walk-ins and even the emergency room at Mount Sinai Hospital, where it was three hours before she saw a doctor. "It just really sucks," she said. She thinks that if she had been seeing the same doctor regularly, her chronic bladder infections might have been cured by now. Beharry used to have a family doctor as a child, she said, but no more. "He's at Bayview Ave. and Sheppard Ave.," she said. "I live in the east end." To find a doctor in Canada, she reflects, "you have to go through people you know."

Sylvain Tremblay, an analyst who worked on the Statistics Canada study, was careful to note that the majority of Canadians who don't have a doctor haven't looked for one. Most of those people, he said, are also young and in good health. But the number of us who, like Beharry, have made an effort to find a family doctor and failed – 6 per cent – is statistically significant, he added.

Torontonians can consider themselves lucky: 88 per cent of us have access to a family doctor – three percentage points higher than the national estimate. The percentage of Canadians who do not have a regular doctor is slightly higher – by three points – than it was in 1996.

Source




Australia: Hospital Emergency Dept. 'like war zone'

South Australia: Flinders Medical Centre's emergency department "is frequently overwhelmed and resembles a war zone", the hospital's general manager has admitted. The comments were made in a letter of apology to a patient who had made a complaint to the department. The letter is from Flinders' general manager, Associate Professor Susan O'Neill, and apologises on behalf of Dr Di King for any distress the patient, Kathryn Gibbons, of Encounter Bay, had suffered. Dr King was one of several doctors to see Mrs Gibbons that night.

"Your comments regarding the level of overcrowding and strain on the ED at the time Dr King totally agrees with," it says. "Regrettably, the ED is frequently overwhelmed and resembles a war zone. "Staff struggle to maintain basic patient comforts and service, however patient safety is our highest priority and this was maintained." Mrs Gibbons suffers a rare and severe form of asthma, known as "brittle asthma".

In January, she went to Flinders to seek treatment for her asthma but, after a long and frustrating wait during which she felt her needs were ignored, she drove back to Victor Harbor to get treated.

In May, she wrote a letter of complaint to Flinders. On June 13, she received the letter from Associate Professor O'Neill, which goes on to assure Mrs Gibbons that she was in no danger and that her treatment was appropriate.

Southern Area Health Service chief executive Cathy Miller, speaking on behalf of Associate Professor O'Neill, said the letter was paraphrasing Mrs Gibbons' own words. She added that the emergency department was getting busier and putting additional pressure on workers. "There's no doubt the EDs are busy places and we've experienced an increase of 5 per cent from last financial year to this financial year, which is an additional 3000 patients," she said. "It is an emotive place to work and people are passionate about what they do. It can become a busy place (and) it can look quite chaotic."

Ms Miller said they were having success with new measures to improve patient flows and that the redevelopment of the department would also help. "It is the time lag between demand going up and other processes kicking in," she said.

The letter's release comes in the middle of a bitter and prolonged dispute over pay and conditions. Up to 85 per cent of the emergency specialists from the state's public hospitals have handed in their resignations, effective on Friday. FMC emergency medicine senior consultant Dr David Teubner said the doctors were resigning because the overcrowding in emergency department was risking the safety of patients. "It is impossible to practice safely in an overcrowded environment (and) the majority of the time there are more patients than there is space for them," he said. "It's undignified, it's just an awful environment in which to work. It's just soul-destroying. "To deal with (the overcrowding) we need adequate numbers of senior staff and we're unable to attract such people from interstate because of the pay."

Dr Teubner also said this year was the worst it had ever been, and that it would get even worse with winter. "The hospital is doing an enormous amount . . . to make things better but we're busier than ever and there's pressure from the Department of Health to close beds to save money," he said.

Health Minister John Hill said there was a "huge increase" in presentations at Flinders, but the State Government was working to address the issues. "We know thousands more people are going to FMC every year seeking help in the ED. Our ageing population and the shortage of GPs in the south are resulting in this huge increase in presentations," he said. "And the State Government is addressing this through the $153 million redevelopment of FMC, including building a brand new ED with increased capacity. "The expanded and redeveloped emergency department will include 21 additional treatment cubicles, to cater for an extra 14,000 people seeking treatment every year."

Mr Hill added that a GP Plus Health Care Centre at Marion and extra staff being employed by the Government would also help. Doctors and the State Government met again at the Industrial Relations Commission last night to discuss the enterprise bargaining agreement. Industrial Relations Minister Michael Wright said a new offer to the state's public doctors had been put on the negotiating table. He said talks were "progressing well", and they would possibly continue over the weekend. SA Salaried Medical Officers Association senior industrial officer Andrew Murray said there were still "significant issues" to be resolved.

Source





21 June, 2008

Australia: Doctors old, foreign and busy

This is pretty absurd. There is no shortage of people wanting to get into Australian medical schools. I sure am glad that my GP has a similar background to mine. It makes visits a lot more pleasant

MORE than half of the GPs working in Australia were born overseas, with one in seven GPs in Queensland having only arrived in the country since 2001. An analysis of data from the 2006 census shows Australia is increasingly relying on overseas-born, ageing and overworked doctors - a situation condemned by a leading health expert as "an absolute crisis" and a risk to patients' lives.

According to the census figures, more than 50 per cent of Australia's 35,000 GPs were born overseas, compared with 22 per cent of the general population. At the time of the census, one in 10 of Australia's GPs - and 15 per cent of those in Queensland - had lived in the country for less than six years. Among specialists, 41 per cent were born overseas, with about 9 per cent here for less than six years at the time of the census. Of those medicos arriving in Australia in the previous five years, one in five GPs and nearly a quarter of specialists came from India.

The figures also show Australia has more older doctors in the workforce, with 12 per cent of GPs and 14 per cent of specialists aged 60 or over. And Australia's doctors are working long hours, with city-based GPs working an average of 49 hours a week.

Founder of the Australian Health Care Reform Alliance, Professor John Dwyer, said the statistics showed the national health system was in a dire state. "At the moment, patients are being very much short-changed," he said. "Definitely lives are at risk." He said the situation was even more worrying in Queensland, with the census figures showing a shortage of doctors compared with other states. Only Western Australia has fewer GPs per head of population than Queensland and only the Northern Territory has fewer specialists per head of population. Data from the Queensland Medical Board showed more than 5000 oversea- trained doctors are registered to work in Queensland.

Incoming Australian Medical Association president Dr Mason Stevenson said many regional and remote areas were heavily reliant on foreign-trained medical officers. "You actually have some hospitals that are manned 80 per cent by overseas doctors," he said. "In fact, outside of southeast Queensland, 50 per cent of GPs are overseas-trained doctors - not just overseas-born, overseas trained. They are indispensable to fill the void."

A meeting of the National Health and Hospitals Reform Commission in Brisbane yesterday heard calls for a 100 per cent Medicare rebate for doctors in rural and remote areas. The Brisbane-based Need More GPs support group also told the commission it should be easier for overseas doctors to move into GP roles.

Source




Universal Health Coverage --- Call It Socialized Medicine

This article is from some time back but still seems applicable

One of the biggest myths being propagated today is the absurd notion that "people can't see a doctor without having insurance." The truth is office visits are relatively cheap, well within the means of most people. The problem is most people don't budget anything for their annual medical care. And, then when a problem arises, any expense greater than zero "isn't in the budget."

The other problem is that insurance really isn't insurance anymore. It is pre-paid health care. True insurance is intended to prevent financial disaster in the face of an unlikely event. Most people, however, have come to expect first dollar coverage for everything including very common and likely events like routine doctor office visits. "Covered'' employees don't realize it's their money going to pay for this "wonderful" non-bargain of first dollar coverage. It's not a "free" benefit provided by their employer as most employees believe. These costs are essentially hidden from employees. Money their employer wastes in purchasing first dollar coverage or inferior managed care coverage for the employee is money which would have been the employee's salary to spend as they choose.

The reason most people obtain their health insurance from their employer is because of tax discrimination. During World War II, our government enacted wage and price controls. Employers couldn't attract better workers by offering higher wages, but were allowed to offer health insurance as an untaxed benefit. Although World War II ended 54 years ago, this same tax discrimination policy remains in effect today.

This atrocious policy discriminates against the working poor, part-time employees, employees working for small businesses that don't offer health insurance, and the self-employed. Those who obtain their health insurance through their employer, purchase their coverage with pre-tax dollars. On the other hand, those who purchase their health insurance on their own, purchase it with after-tax dollars --- a huge difference. In fact, the uninsured actually end up paying what amounts to a tax penalty for being uninsured.(1) It is estimated that "a family in the bottom fifth of the income distribution pays about $450 more in taxes than insured families at the same income level. For families in the top fifth of the income distribution, the tax penalty is $1,780."(1) The analysis goes on to say that "on the average, uninsured families pay about $1,018 more in federal taxes each year because they do not have employer-provided insurance. Collectively, the uninsured pay about $17.1 billion in extra taxes each year because they do not receive the same tax break as insured people with similar income. If state and local taxes are included, the extra taxes paid by the uninsured exceed $19 billion per year."(1)

Where, we must ask, is the compassion for these overtaxed, hard-working people? This is clearly a government-created problem. What we don't need is more government (nationalized health care) to "fix it." What we need is to get government out of our wallets so people can have their own money needed to purchase and own their own health insurance. The other thing the pro-socialist "crisis mongers" fail to tell people is that only one-third of the uninsured are chronically uninsured.2 For the other two-thirds, it is only a short, temporary condition, "half of all uninsured spells will last less than six-months. Three-fourths of them will be insured within 12 months. Only 18 percent of all last for more than two years."(2)

Those who brandish the "crisis" of the uninsured to promote socialized medicine also often fail to tell people that uninsured doesn't necessarily mean poor. In fact, the National Center for Policy Analysis (NCPA) tells us that "a third of the uninsured households earn more than $30,000 a year and 10 percent earn more than $50,000."(2) That's at least 40 percent of the so-called "uninsured" that could well afford a $45 office visit or health insurance.(2) We need to get away from the concept that "someone else," big government or insurance, needs to take care of our every need.

The other adverse consequence of this tax discrimination is that it led to cost inflation of medical care. Everyone came to believe that we were spending "other peoples' money" (OPM). And, when you're spending OPM, the sky is the limit. Patients have been told that they are getting "free" insurance from their employer and quite naturally came to expect everything they wanted or desired, whether of marginal benefit or not, would be "fully covered." Likewise, the physician who "participated" in insurance and was paid directly by the insurance company for everything with OPM, had no disincentive to hold down costs. The patients came to view these "participating" physicians as "good" and "compassionate" because the physicians would accept their insurance and the patient would have to pay little or nothing out of pocket, not realizing that OPM was actually their money all along.

Both patient and participating physician, therefore, contributed to this disrupted market where both buyer and seller were insulated from costs thus leading to uncontrollable cost inflation. The problem of cost inflation was further compounded by the cost of government regulation. Government mandates increase the costs of health insurance tremendously, and the mandates are often for things that most people don't want or need. Yet, they are forced to pay for the "coverage." "These mandated benefits included wigs for bald-headed women (Minnesota), pastoral marital counseling (Vermont), and community sperm bank services (Massachusetts).(3) In New York state, most health insurance premiums doubled as a result of state-mandated community rating. This has made health insurance especially hard to afford for the young and healthy who are, in effect, punished by the state for being young and healthy and for not engaging in unhealthy behavior. State mandates, which were purportedly instituted to "help" people, have thus had the effect of pricing many people out of the health insurance market. This, however, is predictably what happens when we look to big government to "help" us.

Indeed, "universal coverage," nationalized health care, or socialized medicine, regardless of what you choose to call it, is not the same as medical care. All of the citizens of Canada, for instance, have "universal coverage." What they often don't have, however, is the medical care that they need when they need it. That is why we see Canadians crossing the border into the United States in droves to obtain the health care that they can't get when they need it in their own country. Their government rations access to health care and thus attempts to control costs by making MRI scans, radiation oncology, bypass surgeries and many other health services largely unavailable to their own people. Is this the egalitarian's view of compassion and social justice?

We Get More of What the Government Subsidizes

Government programs also breed highly destructive dependence. How destructive? Well, I once took care of an alcoholic patient who bragged that his government disability checks allowed him to purchase better quality whiskey than he could afford to buy when he wasn't considered disabled because of his alcoholism. The government thus subsidized his alcoholism.

During his hospital stay, I pointed out his government subsidized habit had damaged his liver, his pancreas and his brain. He was slowly but surely killing himself with alcohol, bought and paid for by the government. After much discussion with the patient, I convinced him to give up alcohol, but there was a problem. Although the patient was willing to give up alcohol, he wasn't willing to give up the government checks. You see, if he gave up alcohol, he would lose his disability status, and would have to do something drastic like work to obtain money. But, he reasoned, why work when the government will give him the money to spend doing something that he liked to do? This spontaneous "experiment" in addiction medicine proved one thing beyond a shadow of a doubt. As powerful as addiction to alcohol is, it pales in comparison to the addiction to government money.

Yes, we need health care reform, but it needs to be based upon the principles of individual freedom and individual responsibility. And, there are many options out there. Most people could purchase a high deductible indemnity insurance policy at a lower price than they would pay for monthly managed care premiums. That's right --- a much higher quality of health care at a lower price! Imagine, having the freedom to choose the doctor or hospital you want to go to, being able to go to specialists without denials, delays, and gatekeepers. And, the money saved by purchasing a high-deductible catastrophic policy could be set aside in a special savings account to pay for deductibles. The money saved by purchasing a high-deductible policy could also be used to pay for the insurance premiums.

Medical Savings Accounts (MSAs) allow people to put money aside and take a tax deduction for keeping and controlling their own money. The MSA earns interest year after year tax free and if not spent by retirement age can be converted into a pension fund. Think of all the money you and your employer have turned over to insurance companies since you started working, and how much a young worker would have accumulated after 45 years of investment in a MSA. Those in favor of nationalized health care, of course, don't want to give you control of your own money. Government elites feel that they can better spend your money for you. This is the real message that they don't want you to hear.

And, last but not least, there is charity. No hospital ever turns any patient away because of lack of funds. Hospitals and the physicians on call at those hospitals are required by law to treat all patients presenting to the emergency department irrespective of ability to pay. And we do it all the time. It's a total myth that you can't come to the hospital because you "don't have insurance" or "can't pay." Charity is something that should involve churches, not big government. What big government does, confiscating money from all, including the minimum wage earner, and redistributing it based upon some social engineering scheme, isn't charity. It's legalized plunder. True charity comes from the heart, not from forced "contributions." Most churches and charitable agencies understand the dependency trap of big government programs. They understand that it does no good in the long run to give a man fish for his dinner. This does not help him. To help a man, you must teach him to fish. The goal should be to help a man back to his feet so he can support himself and his family, not to trap them in a cycle of dependency. That is what dignity and self-esteem are all about. That is what true compassion is all about. The Amish don't have "insurance coverage," yet they have existed for centuries via a charitable tradition of voluntarily sharing others' burdens and medical expenses. This same concept has been implemented via other churches and religious organizations in conjunction with MSAs and has been proven by AAPS members like Dr. Alieta Eck and associates to be a much more affordable alternative to traditional health insurance.

I find it very sad in a country where men and women have died fighting to preserve our freedom and have died fighting off socialism and communism that some are now considering socialized medicine as a solution to improving access to health care.

Lenin once said that "medicine is the keystone in the arch of socialism,'' and I believe those who are promoting "universal coverage" via government-run and government-controlled medicine know this. What they hope is that the public won't find out the truth. There is nothing compassionate about socialism. This is why the AAPS gives a high priority to educating other physicians and the public about the truth of socialized medicine. That is why AAPS should be joined and supported by all physicians!

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20 June, 2008

NHS reviewed

I am looking at a leaflet informing the public about the creation of the National Health Service, almost 60 years ago. The celebrations for this anniversary begin at the end of this month. There will be a party at Wembley Stadium, a service of celebration at Westminster Abbey, and countrywide events, most of it organised by the Department of Health in Whitehall.

Never underestimate the desire of politicians to lay claim to the NHS. For many years it was a “Labour” achievement, its strongest stick with which to beat the Conservatives. And when the next election comes, the NHS - the fate of the local hospital or GP surgery - will still account for far more votes than any esoteric arguments about 42 days' detention, or EU or climate change treaties.

Labour will suck every piece of political capital it can from the 60th anniversary party. By chance, as I write this, I receive a voicemail from Labour HQ asking whether I plan to write about the anniversary in the next fortnight. “Health ministers are very keen to start laying out where the NHS needs to go in the next few years” and one of them would be very keen to have a few words with me... The debate on polyclinics, the press officer adds, “is one very clear dividing line on modernisation”.

Poor old health service, batted from party to party, from election to election. I turn back to that leaflet from 1948: “Your new National Health Service begins on 5th July. What is it? How do you get it? It will provide you with all medical, dental, and nursing care.” And a very clear dividing line on modernisation in 60 years' time.

All medical, dental, and nursing care... you don't even need to ask the question to know that the NHS could never claim that today. NHS dental care is patchy at best, medical care is heavily rationed, and nursing care, as anyone who has spent time in hospital will tell you, is hit and miss. In part, this is due to greater demands on the health service. Whatever it offers, we want more: more treatments, more consultations, more medicine. More care. Demand has always taken the politicians by surprise: Nye Bevan estimated the initial cost of the NHS at 176 million pounds for 1948-49. Its first full year of operation came in at 437 million.

Today we want the service to meet an ever-expanding definition of health. We want it to make us happy as well as healthy, fertile as well as fit. One day we will expect it to make us beautiful, perhaps even successful too. No wonder it is still struggling on its 90 billion annual budget.

It isn't only the fault of the patients. The officials and the politicians who run the NHS have lost sight of what they are there for. Look at the current campaigns listed on the DoH website: “know your units”, “top tips for top mums” (including “top tips from Patsy Palmer” of EastEnders), and my favourite “Catch it, Bin it, Kill it”, a campaign to encourage the public to practise “correct respiratory and hand hygiene when coughing and sneezing”. The NHS waggles its finger at us, naughty children. Put your hand in front of your nose when you sneeze! It has turned into mum.

When it doesn't admonish, it consults: yesterday the department sent hospitals tens of thousands of surveys to track patient satisfaction with the patient choice programme. And when it doesn't consult, it issues edicts: June 12, 2008 - “The NHS Resilience and Business Continuity Management Guidance 2008: interim strategic national guidance for NHS organisations.” Poor guys. No wonder the best managers in the NHS are the ones who know which Whitehall edicts to file immediately in the bin.

Time after time patients tell the politicians that what they want from the NHS is what the NHS promised at the start: access to high-quality medical care (in clean premises) as and when they need it.

Now the greatest risk to the health of the NHS is approaching: the march of the alternative health industry. This week came the publication of the “Report to Ministers from the Department of Health Steering Group on the Statutory Regulation of Practitioners of Acupuncture, Herbal Medicine, Traditional Chinese Medicine and Other Traditional Medicine Systems Practised in the UK”. Otherwise known as twaddle. What it said is that government should regulate alternative therapies from acupuncture to Ayurveda.

It's the latest step by the alternative health industry, spearheaded by the Prince of Wales, towards official recognition by the NHS. Their problem: doctors see no scientific merit whatsoever in most of the “treatments”. Research by Edzard Ernst, a professor of complementary medicine, has found the majority of alternative therapies to be clinically ineffective, and many dangerous.

Regulate the practitioners - for safety, note, not for efficacy, as that is impossible to prove - and you give them official recognition. From recognition it is but a short hop to demand and then prescription: packet of Prozac, bit of yoga and a bag of dodgy herbs for you, sir. Britons already spend billions on alternative medicine; how much more could they spend when it is public money floating down the colonic canal? Free massages and maharishi ayurveda for all!

And imagine the bonanza in work for the Whitehall bureaucracy, as the British Association of Accredited Ayurvedic Practitioners grapple for dominance over the Maharishi Ayurveda Physicians' Association (none of these is made up). Question 10 of the consultation document preceding Monday's report read: “Would it be possible for the herbal medicine traditions of Kampo and Tibetan herbal medicine to be individually represented on Council?”

The Government responded on Monday - with a three-month consultation. So join in. Write to the Health Minister Ben Bradshaw at Richmond House, 79 Whitehall, SW1A 2NS. Write, on behalf of the NHS: “What I want for my 60th birthday is... the chance to provide medical, dental, and nursing care to all. And absolutely nothing else.”

Source




Australia: Not enough medical staff to use badly-needed donated organs!

Dying Queenslanders desperate for transplants are missing out because the state's leading hospital is giving donated organs to interstate patients. At least twice this year interstate surgical teams have flown to Brisbane to retrieve organs turned away by Prince Charles Hospital. The fiasco has been blamed on staff shortages and surgeons with "large egos and voluminous hip pockets".

Queensland Health has confirmed organs donated by Queenslanders were being sent interstate because of the "unavailability of transplant service surgical staff with the appropriate specialised skills at the time of the offer". It refused to reveal whether anyone on the heart or lung waiting list had died after organs had been sent interstate. Under the national donor scheme, organs which become available in a state are meant to be offered to residents in that state first. In Queensland, two people are waiting for hearts, eight for lungs and two for heart/lung/liver transplants.

The stunning revelations have been exposed by Professor Russell Strong, the first surgeon to perform a liver transplant in Australia and medical director of Queensland Health's Queenslanders Donate. In a strongly worded letter to Queensland Health acting director-general Andrew Wilson, he argued Queenslanders had a better chance of a transplant if they lived interstate. "I wish to draw your attention to a situation that must be regarded as unacceptable and with the potential for severe repercussions," Professor Strong said in the April letter, obtained by The Courier-Mail.

He argued the hospital should be stripped of its transplant services. "It is highlighted by two events in the past three weeks (where) two young healthy males were involved in motor vehicle accidents, received traumatic brain injuries and became multi-organ donors," he wrote. "In the first case, the heart and lungs were offered to The Prince Charles Hospital (TPCH), were accepted for heart/lung bloc and two names given for a cross match. Within half an hour, TPCH rang back declining the organs due to a lack of surgeons to remove the organs and perform the transplant surgery. "The organs were offered interstate and an interstate team came to Queensland to retrieve the organs. "

Source




Australian ambulance inquiry to hear of 'bullying and intimidation'

Bureaucracy stifles paramedics who try to blow the whistle

An inquiry into the NSW Ambulance Service is expected to hear evidence of deep-rooted problems of intimidation and bullying. But the parliamentary inquiry, due to start in less than three weeks, could suffer the same fate as previous investigations, with paramedics too afraid to speak publicly, fearing retribution from their superiors. Nurses recently gave evidence behind closed doors, during the Royal North Shore Hospital and NSW Public Hospitals inquiries, scared they would later suffer harassment from management. Almost all the submissions lodged by ambulance officers are either anonymous or cannot be published.

Upper House MP Robyn Parker, who is overseeing the inquiry, said there were already common problems evident from ambos who have submitted evidence. "Anecdotally we can see there is a high suicide rate among ambulance officers," she told The Daily Telegraph. "It also appears management are using rosters and the transfer system to bully officers. I will be probing the department on both those (issues) on the first day." Low morale is plaguing the service, which has been the subject of internal and governmental investigations.

Ms Parker said: "The officers need a place where they can air their grievances and I will be demanding answers from the (health) department. "But this will also be putting the Government on notice and hopefully they will act."

The Daily Telegraph recently reported the overstretched service was relying on firefighters to respond to medical emergencies. Trucks are equipped with trauma kits and defibrilators attending to patients when ambulance crews do not cover the area. One ambulance officer said some Sydney suburbs were completely without emergency medical coverage. "Many areas in Sydney are inadequately covered by ANSW due to a deficit of stations," the submission said. "In the areas known to me there are three suburbs Carlingford, Berowra and Galston, that are at best 15 minutes from an ambulance. For a first-world country in the 21st century, that's embarrassing."

Another anonymous worker said inexperienced junior staff were attending jobs unsupervised. "I cannot remember the last shift I worked where we stayed wholly in our station area," the submission said. "We constantly move resources and become stretched to the limit and some areas end up with no coverage. The fact the NSW Fire Brigade is covering ambulance jobs is testimony to this."

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19 June, 2008

Disgraceful act by British hospital

Mother was accused of kidnapping baby as part of hospital exercise

An unsuspecting mother was accused by hospital staff taking part in a security exercise of stealing a baby from a ward as she left the building with her new daughter. Clare Bowker, 37, was confronted by staff as she got into her car outside Good Hope Hospital in Sutton Coldfield, West Midlands. She was asked to accompany them to the maternity unit with Hannah, her seven-week-old baby, and her other daughter Holly, then four, where she was told a baby had been snatched. Mrs Bowker was questioned by police and her bag searched to verify her identity.

She was recognised by her midwife who confirmed that Mrs Bowker had given birth to Hannah by caesarean section at the hospital seven weeks earlier. During the same exercise, it was arranged for another baby to be taken off the ward, with the father's consent, to make staff believe a baby had genuinely been lost.

A distressed Mrs Bowker was allowed to leave the hospital after 40 minutes, still believing the situation was real. It was only when she called the midwife a few hours later that she was informed she had been involved in a "staged" staff training event. She suffered post traumatic stress after the experience in December 2005 and underwent a year of counselling over what the hospital has called a case of "mistaken identity". The Good Hope Hospital Trust has agreed to pay her undisclosed compensation, believed to be a five-figure sum, to cover her suffering and loss of earnings.

Mrs Bowker, of Four Oaks, West Midlands, said: "It is an awful thing to be accused of and I want to make sure nobody else has to go through what I went through. "I think I am a strong person, but you can be quite vulnerable so soon after giving birth. If somebody in management had approached me on the day and asked me to take part in some kind of exercise, I probably would have done so. "Instead they targeted me and the 40 minutes felt like hours. They clearly made no risk assessment, they didn't use actors and they also put the staff members through a very stressful ordeal."

She gave up her job as a conference manager at Birmingham's Aston University and now works four hours a week as a support tutor at Sutton Coldfield College. Mrs Bowker added: "For a long time I was blaming myself for my reaction. I would burst into tears for no reason. I thought I was being silly for getting so upset. "Then I was told I had post-traumatic stress disorder."

A spokesman for Good Hope Hospital said they had apologised to Mrs Bowker for her experience. He said: "The safety of babies in our maternity unit is very important so we regularly carry out routine exercises to ensure our ward and security staff know what to do to prevent babies being unlawfully taken from the unit. "Unfortunately on one occasion in 2005, there was a case of mistaken identity in which a member of the public, Mrs Bowker, was caught up in an exercise. "A full investigation of the incident was carried out and we have apologised for this mistake and compensated Mrs Bowker for her inconvenience and embarrassment."

The Heart of England NHS Foundation Trust, which now manages the hospital, said it did not carry out such exercises and uses alternative methods to test security procedures.

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More public hospital negligence in Australia

After all the publicity about meningococcal meningitis and its drastic outcomes, it's incomprehensible that it is not looked for as a first step. One suspects another underqualified immigrant doctor. Public hospitals employ almost any doctor at all and don't look too closely at their qualifications

A FAMILY is seeking a $7 million payout after their 10-month-old son was left blind, deaf, brain-damaged and disabled by an undiagnosed bout of meningitis. Jeremy Netherway, now 8, was diagnosed with a viral infection when his worried parents rushed him to Perth's St John of God Hospital in Subiaco on May 29, 2000. But the boy's parents, Nicola and Peter Netherway, claim the hospital and a doctor, Anita Cvitanovich, failed to recognise that Jeremy had pneumococcal meningitis.

They are suing the doctor and the hospital for $7 million, saying Dr Cvitanovich failed to carry out tests to confirm meningitis and delayed giving Jeremy antibiotics to treat the illness. They also claim the hospital failed to keep the doctor fully informed of Jeremy's condition.

The damages amount has already been agreed to by all parties but the doctor and hospital have denied liability and blame each other for Jeremy's condition. The liability issue is on trial in the District Court, with judge Shauna Deane presiding over the matter, which is listed for three weeks.

Giving evidence yesterday, Mr Netherway choked back tears as he described the day his son was rushed to hospital. "He was listless, he had his eyes shut, his head was tilted back. He was very, very pale," Mr Netherway said. His wife, Nicola, earlier told the court that Jeremy had been admitted to hospital for the night after Dr Cvitanovich diagnosed him as having a viral infection, saying he needed to be rehydrated. She said the doctor had told her meningitis was a possibility but that it was unlikely. But Ms Netherway said that after sleeping for two hours, her son's condition became progressively worse. He was suffering from a fever and vomiting constantly until he was dry-retching, she said.

By the time Dr Cvitanovich returned at 8am on May 30 to check on Jeremy's condition, the baby was grunting and breathing coarsely, Ms Netherway said. It was then that the doctor placed him on intravenous antibiotics and took blood before he was rushed toPrincess Margaret Hospital for Children.

Ms Netherway told the court she saw Dr Cvitanovich a few days later in the intensive care unit, where she was informed that Jeremy may suffer paralysis from his illness. He now requires full-time care.

The court has already heard that Dr Cvitanovich did not see Jeremy after 10.30pm on May 29 but had told nurses to contact her if Jeremy was vomiting, had not urinated or his temperature had risen above 38.5C. She did not return to the hospital until 8am the next day when Jeremy's condition had worsened considerably, Ms Netherway said.

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18 June, 2008

Many NHS trusts fail to meet hygiene standards

More than a quarter of health trusts in England are failing to meet basic hygiene standards, official figures show today. The Healthcare Commission reports that no improvement has been made on a year ago. In total, 103 out of 391 trusts admitted they did not achieve the minimum requirements, brought in by the Government to help combat the hospital superbugs, MRSA and Clostridium difficile.

Patients groups and politicians said that it was "shocking" that one in four still did not meet the standards, despite ministers' pledges to tackle cleanliness.

More than 8,000 deaths were related to MRSA and C. diff. The report shows that 26 per cent of trusts failed to keep facilities clean, did not have adequate infection control or follow guidelines on decontaminating reusable equipment. Only 40 per cent of trusts claim to have met all the Governments standards, which include patient care and confidentiality as well as hygiene, a slight fall on last year.

The commission warns that even fewer trusts may be deemed to have met all the criteria by the time it finishes spot checks this year. The failings come despite a [stupid] 50 million pound "deep clean" of every hospital in England, designed to curb superbugs.

Despite the critical reaction, Ben Bradshaw, the health minister, said that he welcomed the fact that the number of trusts failing to comply with more than seven standards had fallen from 15. "This improvement is a great tribute to the hard work of NHS staff," he said. "We are also pleased that infection control is showing significant improvement."

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Australia: Outcry over intensive care shortage for babies in Victoria

The state's most fragile newborns are being sent interstate because Victoria's neonatal intensive care units are stretched to breaking point. Over the past week, Victoria's 72 neonatal intensive care cots have been full, forcing dangerously premature babies or mothers with high-risk pregnancies to be flown interstate for life-preserving care. Four acute babies or mothers with high-risk pregnancies have been flown to Canberra or Adelaide in the past fortnight.

At the same time, the Brumby Government celebrated the opening of the new $250 million Royal Women's Hospital, which has been widely criticised for being too small to cope with a rising birthrate.

The Department of Human Services yesterday revealed that 12 newborns from regional areas, who would normally be treated at Melbourne hospitals, had been flown interstate for care in the past year. This was up from just three in 2005-06 and nine in 2006-07.

The new Royal Women's is equipped with 18 neonatal intensive care cots but can accommodate an extra two when stretched -- the same as the hospital it replaced.

Newborn Emergency Transport Service state medical director Dr Michael Stewart said the system was under pressure from a surge in demand. He said no babies had been harmed by the recent journeys. "It is obviously not ideal to have to do this, but we are looking at what is the safest and most effective for the whole system at the time as well as being very cognisant of the individual baby and their families," he said. "I don't think in the ideal world it is good to move an adult, a child or a baby from one hospital to another or out of the state if they need intensive care, but the reality is that is occasionally what we need to do. "These peaks can last for a few days to a week or so, sometimes they last several months, but the tip of the peak we hope just lasts for several days because that does get very difficult to manage."

The new $1 billion Royal Children's Hospital will have an increase in its number of neonatal intensive care cots when it is completed in 2011. Monash Medical Centre and Mercy Hospital for Women are the only other Victorian hospitals with units to sustain the dangerously premature newborns who need help to breathe.

Dr Stewart said the state usually coped with less than 60 babies needing intensive care at any one time and "cot-block" had improved since 2000 when there were just 48 Victorian neonatal intensive care unit cots. But Royal Australian and New Zealand College of Obstetricians and Gynaecologists president Christine Tippett said there were simply not enough neonatal intensive care cots to meet demand. "The four units are constantly running at or near capacity and the pressure on staff and equipment is at an unsustainable level," she said.

Department of Human Services spokesman Steve Pivetta said babies in border areas were often closer to interstate hospitals and denied a lack of resources was to blame.

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17 June, 2008

Socialists retreat: Patients on NHS to be freed to use top-up drugs

Patients who pay for "top-up" drugs will no longer be denied free NHS treatment, the Government will announce next week. In a major reversal of policy, the Department of Health will review the present rules, which ministers regard as unfair and a penalty for people fighting life-threatening illnesses such as cancer.

It will announce an end to the "co-payments" system, in which those who buy drugs that the NHS has deemed too expensive are made to pay for the rest of their care. The move comes after it was disclosed that a patient who paid for a drug to treat bowel cancer died after being denied free NHS treatment. Linda O'Boyle, 64, from Essex, was told that her decision meant she was considered a private patient.

Ministers have been defending the policy for months, claiming that to scrap it would lead to a "two-tier" NHS in which the wealthy have access to better health care. But in recent weeks they are understood to have been persuaded that the NHS already contains "top ups", particularly in dentistry and in some hospitals, where patients can pay for private rooms. They also believe that the change will apply to a very small number of patients each year.

The Government is also desperate to back a popular policy in the face of recent setbacks. The announcement on the changes is expected to be made on Wednesday.

Source




More of that brilliant government "planning"

Brand new Emergency Dept. building but not enough staff to man it. An almost British level of bureaucratic incompetence

The $22 million Redcliffe Hospital emergency department revamp is struggling to cope with demand, the Redcliffe Herald has been told by patients. Just weeks after the launch of the state-of-the-art extension, the ED came under fire from a Clontarf mother, who did not want to be named, who told the Herald her feverish 14-month-old son had to wait three hours for treatment. "He was taken there by ambulance with a 39 degree temperature and was mottled looking,'' she said.

"I was told to ask for his temperature to be taken every 30 minutes. After the first time it took three hours of me hounding them before they tested him again. I was told three doctors were off sick and there were too many patients.'' She eventually took the boy home and later consulted her GP. "It's a real slap in the face when they build all these nice and flash buildings but it's the same old problems. The needs basis is there and the shiny new Emergency Department isn't fooling me."

The Herald was also told of an 18-year-old man who, last month, waited about seven hours for surgery after being badly bashed at Scarborough. While the Herald has published a litany of complaints over the past three years about the ED, it has also received many letters of support from patients.

The new, larger ED has 41 treatment areas and a new five-station triage zone. It's capacity is expected to grow from 47,000 annual patient treatments to 50,000. At its opening Health Minister Stephen Robertson acknowledged the Peninsula had an "increased demand" for hospital services but said the new ED would help responses to the demand. State Member Lillian van Litsenburg, who is travelling overseas, previously said the new ED would "improve patient flow and in turn enhance the day to day running of the hospital"...

One mother, a former nurse, who had seen the Redcliffe ED full said the service was still being clogged up with unnecessary patients. ``There are lots of people who don't need to be there, but they won't pay $60-$70 to see a GP and they go to the hospital for a snotty nose,'' she said. She knew of people from northern Brisbane suburbs who saw Redcliffe hospital as the closest option for treatment. ``They look at Redcliffe compared to the Royal Brisbane as easier to get to,'' she said. ``But they need to consider Prince Charles Hospital as an option, which has an under-utilised ED.''

Queensland Health held a community forum last night to discuss the construction of a GP super clinic at the Redcliffe Hospital. It will be a 24-hour, bulk-billing service aimed at taking the pressure off the ED, by servicing less urgent medical issues.

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16 June, 2008

NHS drugs cheaper but much less effective

The National Health Service is providing dying cancer patients with drugs that are five times less effective than those available privately and is refusing to treat them if they try to buy medicines themselves. One drug for kidney cancer, routinely available through public health systems in most European countries but not to British patients, can reduce the size of tumours in 31% of patients, compared with just 6% of those prescribed the standard NHS drug.

The growing row over “co-payments” has prompted the government to reconsider the ban. Alan Johnson, the health secretary, has promised a “fundamental rethink” of the policy. The shift comes as increasing numbers of cancer doctors defy the official Whitehall ban and allow patients to pay for drugs while still receiving NHS care. Doctors at the Royal Marsden hospital in London and consultants at the NHS trust in Swansea are offering patients NHS care while they pay to receive drugs that will prolong their lives. Last week The Sunday Times revealed that about 16 consultants in Birmingham are ignoring the government guidance.

Research presented at the American Society of Clinical Oncology found that kidney patients taking the new drug Sutent lived six months longer than those prescribed alpha interferon, the NHS treatment.

The failure of the NHS to make more effective drugs available to cancer patients has been condemned as “unethical” by leading doctors. John Wagstaff, professor of oncology at Swansea University, said: “This has created a very difficult situation for us. Having seen the latest data, I believe it is now pretty unethical to give many patients alpha interferon [rather than Sutent]. We are often forced to prescribe interferon because we do not have access to Sutent [on the NHS], but I am always upfront with the patients. I tell them what I think the most effective treatment is.”

Eight times as many patients in Germany and France receive Sutent as in Britain, according to figures held by Pfizer, the manufacturer. Sutent, which costs about 2,200 pounds a month compared with about 800 for the NHS drug, is one of a number of life-prolonging new drugs at the centre of the co-payments row.

In advanced kidney cancer, when the patient cannot be treated with any other drug, Nexavar, another medicine, can double the period when the disease is held under control. A trial of Nexavar, comparing the effect of the drug with a placebo, showed it to be so effective that the trial had to be halted early as it was considered unethical not to give it to all the patients in the test. Tumours were prevented from growing for an average of 5.5 months in patients taking Nexavar, against 2.8 months in those taking the placebo. Despite the findings, Nexavar is not routinely funded by the NHS.

Similarly, bowel cancer patients are up to four times as likely to see their tumour shrink if they pay for Erbitux than if they take irinotecan, the NHS-approved drug, alone. A study published in the New England Journal of Medicine in 2004 showed that 23% of patients experienced a reduction in the size of their tumour when they took Erbitux and irinotecan. Other studies showed that just 5% of patients have the same benefit from taking irinotecan alone. Those taking irinotecan alone had their bowel cancer under control for 4.2 months, but this rose to 8.6 months when Erbitux was added. Erbitux, costing about 3,000 pounds a month, is funded for bowel cancer in most European countries. Patients in France are 13 times, in Spain 10 times and in Germany nine times more likely to get the drug than Britons.

The drug Avastin offers similar benefits. Research presented earlier this year showed that patients who receive Avastin and routine chemotherapy before surgery are twice as likely to be alive two years later as those who receive only the chemotherapy available on the NHS.

Source




South Australian hospital crisis

Penny-pinching socialist government needs to fire some of their precious bureaucracy and put the money into medical pay

DOCTORS in retirement and on holidays could be called back to work under contingency measures to combat SA's growing public hospital crisis. Health Minister John Hill said yesterday the Government was developing a plan to try and keep the hospitals functioning if as many as 115 emergency doctors and anaesthetists follow through on resignations by the end of next week. Mr Hill said other possible measures included recruiting doctors from interstate, nurses taking on additional duties and GPs being drafted into public hospital emergency wards.

Doctors are seeking a pay rise of up to $111,000 a year while the State Government said it was offering to incease the current annual package for emergency department consultants from about $313,000 to about $356,000. The State Government's packages include on-call allowances, leave loading and salary sacrifice benefits. Mr Hill revealed the measures under consideration yesterday as:

DOCTORS warned more will quit as part of a rolling campaign.

EMERGENCY doctors gave emotional accounts of overcrowded and under-staffed hospitals.

DOCTORS revealed they were starting rescue funds to help those planning to quit pay mortgages and bills.

QUEENSLAND said it would welcome disaffected SA clinicians, who are also being targeted by agencies recruiting for other states.

Mr Hill said the Government was considering a range of options to plug holes left by the resignations in the public health system. He said patients would face "very long waits". Some emergency wards could close, with less serious cases diverted to GP services. "We have to take them seriously and we are working through contingency plans now," Mr Hill said. "We are looking at how you'd bulk up the services; in the city we'd need to keep the spine hospitals - the Royal Adelaide Hospital, Lyell McEwin and Flinders - functioning.

"I am very worried about the circumstances if they do resign. "It might be that GPs come in to the emergency department; some nurses could come in and do the minor things; people who have retired, they might want to come back to work; doctors on leave might come back early . . . or those working part-time might do more work. "Those are the kinds of options we have to look at."

The doctor resignations have been prompted by an impasse in a bitter eight-month long pay and conditions dispute and are effective two weeks from lodgement. Doctors say they want pay parity with their interstate counterparts to attract more doctors as well as equality in a system where groups of doctors in the past have negotiated separate loadings.

SA Salaried Medical Officers Association senior industrial officer Andrew Murray baulked at the Government's contingency suggestions - and accused the Government of not having a plan. "If people who deal with the most seriously sick people that go to EDs suddenly aren't there, what's the contingency for that?" he said. "Does he really expect an old, retired doctor who hasn't practised medicine in five to 10 years to deal with a major road trauma? "As a first fallback, probably the most closely related specialists in dealing with people in trauma are intensive care doctors and anaesthetists . . . hang on, didn't someone tell me the anaesthetists are quitting tomorrow? They don't have a plan."

Mr Murray said the emergency doctors who had quit represented about 75 per cent of those available in the state, not 50 per cent as reported this week. RAH emergency consultant Dr Tony Eliseo said it would be "impossible" for the Government to replace their level of expertise at short notice. Yesterday, more doctors said they would quit over the industrial dispute - including the Women's and Children's Hospital's head of general medicine, Dr Christopher Pearson.

Dr Pearson, who started at the WCH in 1971, said his resignation was "for the future of health in SA". "Without a sufficient package, it will not be possible to attract the bright young minds who will become the senior consultants of the future," he said.

Dr Jane Edwards and Dr Terry Donald, forensic pediatricans in child protection at the WCH, also said they would hand in their resignations tomorrow. Dr Edwards said the pay inequality across specialties in SA was leaving doctors disenchanted. "By giving deals to small groups of doctors, the Government has introduced a cancer to the whole of the health system," she said. "It's festering and pitting doctors against each other; people become jealous and feel they are not worthy." Dr. Edwards also said the hospital was struggling to fill two positions in child protection because they could not compete with other states.

Another 70 anaesthetists also planned to resign tomorrow, but Mr. Hill said a child-protection expert earning a salary package between $198,000-$215,000 would go up to $324,000 under the Government's offer. He also said there were no vacancies in general medicine. Mr Hill said doctors needed to be consistent in their claims, as "the problem we are having is different pockets of people with different goals". "They say they need extra money to recruit and retain doctors; the offer we made would help us with that," he said. "Then they say they want extra money to put them (in line) with `intensivists'. "We had to put extra money into intensivists, that's what the market dictated. It's a different market in other areas."

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15 June, 2008

NHS reforms deliver no significant patient benefit

Rhetoric not matched by results

Almost 1 billion pounds spent increasing choice and competition in the health service has not delivered any significant benefits for patients, an official report published today says. Changes intended to introduce "market style" reforms in the NHS have delivered some improvements, the Audit Commission and Healthcare Commission concluded. But there was still "some way to go before patients see any significant benefits", said Ian Kennedy, the chairman of the Healthcare Commission, who co-authored the report. Around half of patients are still not being offered a choice about where they would like to be treated, the report found

The changes have also failed to increase the number of patients being treated outside hospital, one of the key aims of the reforms. Although there have been "significant improvements" in some areas, the report concluded that progress was "behind" what it might have been.

The reforms, brought in at different points since 2000, include allowing patients more choice about which hospital they visit, increased use of the private sector and paying hospitals a set rate for each procedure, encouraging them to treat more patients more efficiently. But they were introduced with no clear "vision", the report found, and no system was set up to monitor or evaluate if they were working.

In 2006 ministers announced that patients would be allowed to choose between a limited number of hospitals for their care, a policy extended to all hospitals earlier this year. However, the report found that only 50 per cent of patients were being offered any choice at all, well short of the government's target of 80 per cent. The health service also does not collect enough information to allow patients a true choice, the report found. Most patients want details on the quality of care provided by different hospitals but that data is not being collected by the Department of Health.

The report also shows that outpatient appointment numbers remained generally static across the country, despite a stated aim to treat more people in the community instead of in hospital. And only 16 per cent of GPs believe that a new system which gives them more control over money spent by their surgery had actually helped patients.

However, the report's authors said that the reforms could deliver benefit to patients in the future. "Conceptually the measures should work and we should look to the start of improvement. In the next couple of years we will know whether the idea was correct," Michael O'Higgins, chairman of the Audit Commission, who co-authored the document, said.

The Tories accused ministers of missing "a golden opportunity" to make a real difference to standards in the NHS. Andrew Lansley, the shadow health secretary, said: "They have spent a lot but achieved far too little. "The Government has said many of the right things about reforming the NHS but when it comes to actually delivering them, it has dithered and delayed. Giving GPs responsibility for budgets for their patients should have been one of the strongest drivers of change but Labour hasn't implemented it. "Too much money that could have been spent on improving care for patients has been wasted."

Norman Lamb, Liberal Democrat health spokesman, said: "This is a depressing verdict on 11 years of endless, contradictory reform in the NHS which have cost taxpayers a lot of money and delivered little benefit to patient care. "Choice in the NHS must be made to work for everyone. Without information and support for all patients, choice will succeed in only improving care for the well informed - leaving more disadvantaged groups behind."

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14 June, 2008

"Busy" NHS hospital lets woman bleed to death

A teenager died a fortnight after having an abortion because of delays in giving her a vital blood transfusion, an inquest in Bristol has heard. A-level student Manon Jones, 18, from Caernarfon, Gwynedd began to bleed after the operation and admitted herself to hospital, where she died. A doctor told the inquest the Southmead Hospital ward in Bristol had been busy and "things could have been different". Miss Jones died in 2005. The coroner recorded a narrative verdict....

Two weeks after the procedure she went on holiday, against medical advice. She cut short her break after feeling ill and returned to Bristol, where she was a student, and admitted herself to Southmead Hospital. Initial blood tests taken at the hospital failed to alert medics to any serious condition, the coroner heard. But more tests showed she needed a blood transfusion.

However she was left waiting for the blood when another emergency broke out on the ward and her condition deteriorated, resulting in her needing life support. Post-mortem tests showed she died of low haemoglobin levels and shock caused by "retained products of conception" - that is the embryo.

Dr Lucy Jackson, who treated her at the hospital, said the results of an initial blood test did not immediately lead her to consider low haemoglobin levels. She said Miss Jones talked coherently when she arrived and bleeding was minimal.

Following a second blood test, Dr Jackson decided a blood transfusion was immediately required but Miss Jones was stable enough to "wait for the blood to arrive". The doctor was pulled away from Miss Jones when an emergency broke out elsewhere on the ward.

An emotional Dr Jackson told the inquest: "If we hadn't been so busy, particularly with the other emergency, we would have had more time and things could have been different."

The inquest heard from Dr Richard Porter, an obstetrician at Royal United Hospital, in Bath. He did not treat Miss Jones, but said it had been "wholly inadequate" to leave her waiting for a blood transfusion for more than four hours. But, the doctor said, it was "hard not to conclude" that Miss Jones would have survived had she not gone on holiday and had she attended hospital earlier.

The coroner said the death was not due to natural causes and a verdict of misadventure would have been inappropriate. He said the narrative verdict was because Miss Jones died as a result of retained products of conception following the termination of a pregnancy.

The coroner discussed the issue of neglect and said he did have concerns. He said an earlier transfusion of blood would have been likely to have saved her life. He also said that it was unsatisfactory that scans had gone missing.

More here





13 June, 2008

Overdue FDA reform to come?

The recent news that Sen. Ted Kennedy has brain cancer sharply focuses national attention on the tragedy of all forms of cancer. The senator has a malignant glioma so difficult to treat that half of those diagnosed with it die within a year, and nearly all are dead within two years.

There are many promising new cancer treatments in the pipeline, but under current Food and Drug Administration (FDA) regulations, almost no one gains access to them, no matter how dire the need or how compelling the evidence that the drugs work.

Most people receiving a terminal cancer diagnosis die before the most promising treatments in the pipeline reach them. Why? Because those tragic events occur on the wrong side of the magical moment when someone at the FDA puts an approval letter on a fax machine declaring the drug they needed - and never got - is "safe and effective."

Congress now has an opportunity to address this problem thanks to Sen. Sam Brownback (R., Kan.) and Rep. Diane Watson (D., Calif.), who recently introduced the Access, Compassion, Care, and Ethics for Seriously Ill Patients Act. The Access Act, said Mr. Brownback at a press conference introducing the bill, provides that "terminally ill patients whose medical needs are unmet by currently available options would be granted access to promising, investigational treatments."

As Ms. Watson observed at the same press conference, "The activism of the AIDS community in the 1990s expedited the marketing to the general public of promising antiretroviral drugs. Today it is my understanding that many AIDS drugs do not have to go through the controversial and questionable Phase III testing with placebo controls. Sadly, the expedited approval of promising new drugs for cancer patients and patients with other life-threatening diseases does not receive the same attention or expedited approval."

We know from personal experience - having received similar diagnoses for our spouses - what Mr. Kennedy and his family face, and it is our hope that he be given access to any promising treatment that can give him the best chance of extending his life. We support that access even if he gets it only because of who he is, a Kennedy and a U.S. senator. Our national shame is that humane access to effective drugs is not available to all with terminal illnesses.

Among the promising new therapies that should be available to Mr. Kennedy is a vaccine being developed at Duke University. The vaccine trains the body's immune system to kill malignant tumor cells, but to leave healthy cells alone. It is safe and effective, increasing average survival for patients with malignant gliomas like Mr. Kennedy's from 14 months to 33 months, based on the results of clinical trials presented in Chicago at a conference on cancer recently. Although the number of patients treated so far is small, the magnitude of the estimated survival difference and the strength of the underlying science makes it very unlikely that the positive effect is due to chance.

But the vaccine faces additional years of randomized trials in which a few hundred patients will get, or not get, the vaccine before the FDA considers approving it. Given what we know about the vaccine, the ethical problems with such trials are obvious, but the FDA will rigidly demand them.

In the meantime, the thousands who won't get into the trials will die waiting. What will we learn? That the survival advantage is a month or two less, or more, than the 19 months already estimated. That's it.

Mr. Kennedy's situation, identical from a regulatory standpoint to the plight of hundreds of thousands of other Americans, shouts to the heavens the humane necessity of urgent reform in the drug approval process to make it work better for people who have serious and terminal diseases.

The Access Act creates a new approval mechanism called Compassionate Investigational Access (CIA) for patients who can't wait. Patients receiving a CIA drug must suffer from a serious or life-threatening disease, be out of approved options and unable to gain access to a clinical trial, provide informed consent, and allow the collection of clinical data from their experience with the drug so we will all know more about the safety and efficacy of new therapies before they are approved for wider use.

The Access Act also improves the FDA's accelerated approval mechanism that has helped to preserve the lives of HIV/AIDS sufferers, but has never been adequately applied to other serious diseases like cancer.

Before his diagnosis, Mr. Kennedy was working on legislation to reinvigorate the war on cancer. The Access Act belongs in that package. Some of his friends in the Senate, including Democrat Bob Casey and Republican Arlen Specter of Pennsylvania, co-sponsors of the Access Act, will support him.

The unavoidable reality for people with a terminal disease is that good cancer drugs are held up behind a one-size-fits-all regulatory wall. The Access Act offers Congress, and Mr. Kennedy, a way to help break the regulatory logjam for all of us.

Source




What is wrong with Britain's proposed new polyclinics? Try the death of GP care

Britain may get more opening hours and new equipment but the doctor-patient relationship will suffer

Those mourning the absence of the English football team from Euro 2008 have a new spectator sport to distract them: the battle between health ministers and the medical profession over polyclinics, the Department of Health's brave new vision for healthcare. Doctors argue that the Government is adopting a Steve McClaren approach, with ill-conceived tactics that will end in tears; while politicians accuse the medics of acting like prima donnas - interested only in themselves, while currying favour with patients by kissing the NHS club badge.

The debate boils down to this. Last year's review by Lord Darzi of Denham into healthcare in London suggested the development of new facilities to increase the range of services for patients - polyclinics. The Government is mightily impressed with this idea and wants to run with it the length and breadth of England. The medical profession isn't, and wants to trip it up. Shiny new facilities, extended opening hours, multiple services under one roof? What's not to like?

Quite a lot, in fact. Open-all-hours surgeries may appeal to time-pressed, worried-well commuters. But to the most needy users - young families, the chronically sick, the elderly - geographical convenience is more important. Centralised services may make impressive buildings and economic sense, but are little use to Zimmer-frame-hampered patients.

Another disadvantage is the loss of continuity. It may be difficult to establish doctor-patient rapport in a polyclinic, given the number of staff, their shift patterns and the facelessness of the service. Cynics say that continuity is less sacred than the medical profession would have you believe - and, if the worst of a patient's problems is an ingrowing toenail, they may have a point. But for patients with multipathology - and, in our ageing society, that is a significant constituency - continuity is key. With it, patients have a clear point of reference, someone with his finger on the physical and metaphorical pulse; without it, there is a real risk of duplication, omission and disintegrated care.

"Care" is a killer word in the polyclinic debate. A clear message from countless patient-satisfaction surveys is that, while GPs may not always be able to cure, they do care. Whether this key facet of general practice will be retained in the new era remains to be seen. There are certainly concerns that the threat of privatisation - which many believe goes hand in hand with polyclinics - could make staff and managers focus more on income than illness.

Of course, ministers have ready answers to these objections. To a degree, they have a point: the new plans might work well for some people in some areas. They would argue that much of the opposition is simply the reflex rant of a profession notorious for its resistance to change - although this is not surprising if the change involves being coerced into new working patterns or environments, or seeing your lovingly nurtured patient list swallowed up by the corporate clinic down the road.

But the Department of Health might do well to look behind the rhetoric to ask why we medics - backed by the BMA, the Royal College of General Practitioners, the King's Fund and many patients - are quite so sceptical. Partly, it's change fatigue. Doctors emerge from one set of time-consuming reforms to find that another pile has landed on their desks - each reinventing the wheel and distracting from patient care. Then there is the feeling that we are being bullied. GPs are still licking their wounds from the fight with the Government over extended opening, in which they were given a choice between a slap round the face and a doing-over with a baseball bat.

These latest changes feel as if they are being imposed from above. Then there is a nagging suspicion that the polyclinic is just another bright idea. One which, like NHS Direct, walk-in centres, choose and book, computerised records, smacks of expensive, focus-group-driven initiatives, pandering to those with plenty of health wants but few genuine health needs.

Most of all, though, the medical profession's fire is fuelled by anxiety that the precious fundamentals of traditional healthcare - personalised care, continuity and patient advocacy - are in jeopardy. The polyclinic is perceived as a threat to the heart and soul of general practice.

A brief scroll down the GP forums confirms this - "One-to-one GP care will be lost forever", "The structure of family medicine in this country is being destroyed" and "This is the death knell for general practice". This depth of feeling won't be appeased by any semantic re-jigging of the concept - politicians should be less fixated on gratuitous innovation and more appreciative of what they have already. Otherwise, they will score an own goal that will relegate traditional general practice to the status of the English football team: talented, sorely missed and criminally redundant.

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12 June, 2008

Australia: Wealthy get faster access to surgery even in public hospitals

Rather surprising that rich people go to public hospitals at all. Over 40% of all Australians have private health insurance and Australian private hospitals are generally first-class. The rich go public mainly because they or their doctor "knows someone", I suspect. Bureaucracies are particularly susceptible to that. If you are "in favour" in a bureaucracy, they will throw the rule-book right out the window for you on occasions. I have seen some remarkable examples of that in my own circle

Rich people have the shortest waiting times for elective surgery while middle income earners wait the longest, a new report on public hospital waiting lists shows. The Australian Institute of Health and Welfare study shows middle income earners wait an average of 31 days for elective surgery while the rich wait just 24 days. The poorest Australians wait 30 days for surgery.

And living in a big city doesn't guarantee faster access to a public hospital operating table -- those living in inner regional areas get into hospital faster, waiting an average of only 27 days for surgery, while those in big cities wait 29 days.

Private health insurance membership has nothing to do with the rich getting faster access to hospital. AIHW spokeswoman Jenny Hargreaves says the waiting-time figures applied only to public hospitals and had no connection to a person's insurance status. And she could give no explanation for the finding that rich people had shorter waiting times than others.

The report shows private hospitals are now carrying out 61 per cent of the 1.6 million elective surgery procedures every year while public hospitals perform just 39 per cent. The rich were more likely to use private hospitals, with the report finding 261,358 of them went private for elective surgery. But over 73,000 wealthy people used a public hospital when they had elective surgery.

More middle income earners used private hospitals than public for elective surgery, with 127,596 going public and 184,617 going private. Only the poorest Australians relied more on public hospitals than private, but 149,571 still used the private system.

The report found the waiting times varied a great deal depending on the patients diagnosis, with cancer patients waiting on average 15 fewer days before surgery. The longest waiting times were for knee and hip replacements. Those with gonarthrosis of the knee had an average waiting time of 119 days, and one in five waited longer than a year for surgery. Patients with senile cataracts waited much longer for access to surgery than other cataract removal patients.

More than 87,910 patients had an adverse event connected with their elective surgery. Over 23,000 had complications with the hip and knee replacements or other implants inserted during surgery.

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NHS in England spends 400 pounds less per patient than Scotland as 'health apartheid' widens

Scots have 400 pounds more of taxpayers' money per head for health and social care than the English. Official figures showed yesterday that the difference between NHS and social spending on the two sides of the border means everyone in Scotland has 20 per cent extra. This means Scots have more hospital beds, a higher ratio of GPs to patients and more qualified clinical staff in their health service.

The report from the Office for National Statistics said that total expenditure on health and personal social services during 2006-07 in England was 1,915 pounds for each person. In Scotland the figure was 2,313. Scots also have on average 16 per cent more to spend per head on NHS drugs than the English. The cost of their prescription drugs is on average 191.40 a year compared with 164.40 in England.

This form of 'health apartheid' means Scots are routinely prescribed drugs on the NHS that are not available free across the border.

The illustration of the scale of the gap in health spending between England and Scotland was set out in a volume of health statistics published by the Government yesterday. It comes amid growing tension over the way public money is directed towards Scotland. Tory leader David Cameron has promised to tackle the 'West Lothian question', the system that allows Scots MPs to have a say on NHS and social spending in England while English MPs have no equivalent input on Scottish affairs.

Concern has centred on the way that key NHS drugs - to treat conditions such as Alzheimer's and lung cancer - are available on the NHS in Scotland but not in England. The number of hospital beds available for Scottish and English patients is also affected. There were 3.5 daily hospital beds for every 1,000 people in England in 2006, the analysis showed, but 5.6 in Scotland.

The ONS warned that 'comparisons between countries have to be treated with caution because of differences in the classification of services'. However officials confirmed that health and social spending in England in 2006-07 was lower than in Scotland, Wales, or Northern Ireland.

The publication of the figures triggered calls to correct the imbalance in spending between England and Scotland and for a revision of the Barnett formula. The Barnett formula was the system developed in the 1970s under which Scots received 1,500 pounds a year more each of taxpayers' money to compensate for not getting devolution.

Jill Kirby, of the think-tank Centre for Policy Studies, said: 'These figures confirm that we have a two-tier health system and that the English are on the wrong side of the bargain.

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11 June, 2008

Another victim of NHS pennypinching: 'I was told I was too young for a smear test but now I am dying of cervical cancer at just 24'

Twice Katie asked for a smear test, but was told she was 'too young' to need one. Now 24, she is dying from cervical cancer, one of many young women who have fallen victim to a scandalous change in health policy.

One year ago Katie Hilliard was a typical 20-something - working in the City, going out with friends from university and generally just having fun. But the 24-year-old now has cervical cancer and despite a hysterectomy, chemotherapy and radiotherapy, the disease has spread to her lymph nodes and lungs. Doctors have given Katie at best two years; at worst 11 months. 'They have not been very positive about the future,' she says simply.

What makes her story even more tragic is that cervical cancer, if detected early, is a preventable disease. In fact, Katie had actually requested a smear test - used to detect the pre-cancerous cell changes linked to the disease - twice in the four years before her diagnosis. Yet each time she was refused, because she was 'too young'. Too young to be eligible for a smear test, though not too young to contract cervical cancer.

She says: 'If I'd had a smear test when I was 21, all of this could have been avoided.' Instead, Katie is now undergoing more chemotherapy and is desperately researching alternative ways of fighting the cancer. She is in a lot of pain and has trouble walking. 'I feel old before my time, but I want to live. I'm not going to give up,' she says. 'I wanted to have children and buy a house, but getting a mortgage is now impossible,' says the insurance broker from Haywards Heath, West Sussex.

She and her fiance still plan to marry this October, and she has had her eggs saved in the hope that she goes into remission. 'Some days I'm really hopeful, other days I don't know how I'm going to do this. This should never have happened. I am too young to be dealing with this. 'It is something that a simple smear test should have sorted out.'

Like Katie, Claire Everett, 22, a married mother-of-one, is terminally ill with cervical cancer. She has no doubt that a smear test 'would have made all the difference'. An otherwise healthy young woman, when she developed worrying symptoms (an unusual discharge) last year she immediately went to the doctor; the cancer was diagnosed and initially chemotherapy and radiation were thought to have been successful. Yet last summer, two months after the treatment finished, Claire was told the disease had spread through her pelvis and the cancer was now incurable.

'My mum was crying her eyes out,' she recalls. 'She asked if the cancer was terminal and I walked out of the room. Sometimes I think that if I ignore bad news, it's not happening. 'My initial thought was not for me, but for Alex, my little boy, who's two. The thought that I might not see him grow up broke my heart.'



Both Katie and Claire had fallen foul of a recent change in government health policy. Until a few years ago, all women in the UK were offered regular screening for cervical cancer from the age of 20; then in 2004 the screening age in England was raised to 25 (it remains at 20 in Scotland and Wales). This was because the risk of cervical cancer in younger women was thought to be negligible. But experts believe this change in policy means the condition could go undiagnosed while it is still highly treatable. It was 'a very poor decision', says Professor John Shepherd, surgeon and gynaecological oncologist at The Royal Marsden Hospital in London. 'Approximately 10 per cent of patients diagnosed with invasive cervical cancer are women aged 30 or younger, and these numbers are likely to increase.' ...

Screening at 25 is far too late, says Professor Shepherd. He believes women should ideally have their first smear test as soon as they become sexually active and certainly no later than the age of 20. This is in line with America, where screening begins at 20 or within three years of first sexual contact - whichever comes earlier. In other countries, such as Australia, screening begins at 18.

'I think it is inappropriate in 2008 that the NHS screening programme in England does not acknowledge and thus protect young women who are sexually active before they reach the age of 25,' says Pamela Morton, director of the cervical cancer charity Jo's Trust. 'Frankly, it's disgraceful.' ...

Quite what impact the decision to postpone the screening age to 25 has on cervical cancer rates won't be known until the figures become available around 2010. But Professor Shepherd is clear: 'I appreciate that there is a health economics issue here - it will cost money to screen younger women - but I still think it should be a priority. 'Cervical cancer is a preventable disease and catching it early will save lives.'

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Health decisions with an eye to the bottom line

The savings could be huge, according to lawmakers and researchers, if patients can be pressed into the best, most cost-effective treatments. Of course, that's a big if. But it sounds reasonable as long as it is kept optional

Medical researchers and politicians are tiptoeing into an area of healthcare that makes some Americans uncomfortable, even angry, and it has nothing to do with such hot-button issues as cloning and stem cell research. This time, the controversial idea is to press doctors and patients to use particular drugs and treatments in order to save money.

On the surface, it seems simple enough: Billions of dollars could be saved if everyone adopted the regimens that research showed were best and most cost-effective -- which, experts say, happens far less than most patients think. The problem is that any push for doctors and patients to make a particular choice collides with the cherished American belief that medical decisions are nobody's business but the patient's and the doctor's. Least of all the government's. Also, since the research is based on statistical analysis and almost all medical choices involve trade-offs, the "best practice" is sometimes arguable.

Yet scientists, medical policy specialists and leading politicians are starting to embrace the idea of using cost-effectiveness research to drive individual medical decisions. They call it "comparative effectiveness" research, sidestepping a direct reference to costs.

Democratic presidential candidate Sen. Barack Obama of Illinois is calling for substantial investment in the idea. And GOP candidate Sen. John McCain is interested. Sens. Max Baucus (D-Mont.) and Kent Conrad (D-N.D.) are to introduce legislation to create a government institute for such research. Baucus heads the finance committee, which oversees Medicare and Medicaid, and Conrad heads the budget committee.

Americans are expected to spend $2.4 trillion on healthcare in 2008. Within a decade, the figure is expected to surpass $4 trillion a year and account for 20% of the gross domestic product, the prime measure of economic output.

"Learning how to spend smarter is one of the three or four critical things that needs to happen in our healthcare system," says Gail Wilensky, a leading Republican health policy expert and former Medicare administrator. "Not only is it something the Democrats have been interested in, but a number of Republicans think this is the kind of information that is consistent with market strategies [to reform healthcare] that help doctors and patients make better decisions."

Obama's plan to control costs and make insurance more affordable includes an institute to study cost-effective treatment options. McCain's healthcare advisor says a greater role for cost-benefit studies is "imperative."

The candidates say their sole purpose is to generate information to help doctors and patients make better decisions -- not to steer insurance coverage. But experts say that's exactly where the process leads: First, researchers would identify "best practices," then Medicare and private insurers would come under pressure to penalize those who rejected the guidance.

Initially, research would probably focus on treatments that have not yet been widely adopted. But common treatments debated within the medical community -- such as surgery versus physical therapy for bad backs -- could also get scrutiny.

In the future, some experts say, approved medical tests and treatments could be handled the same way prescriptions drugs are: Patients would pay little or nothing for generic drugs or "high value" procedures and higher co-payments for treatments judged to be of "low value."

Medicare does not explicitly take costs into account. It bases coverage decisions on whether a new treatment is "reasonable and necessary." Supporters of adding cost considerations to the equation -- using "comparative effectiveness" research -- say the goal is to develop a knowledge base that government programs and private insurers can rely on to guide decisions.

"People have pointed out that a lot of the care in our system is inefficient, wasteful or inappropriate -- maybe 20% or 30%. The problem is, it doesn't come tagged," said Sean Tunis, Medicare's former chief physician. "So any efforts to restrain spending on unnecessary care are going to involve difficult decisions depriving people of things they need, or think they might need. We haven't been very honest about it, and we haven't figured out a good way to do it."

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10 June, 2008

British attack on family doctors

Doctors’ leaders who oppose the creation of GP “super-surgeries” are echoing their predecessors who likened the establishment of the NHS to Nazi Germany, Alan Johnson says today. The Health Secretary launches an attack on the British Medical Association and the Conservative Party, accusing them of reprising their “infamous double act” when they opposed the health service 60 years ago.

In an interview with The Times Mr Johnson indicated that he is preparing to change funding rules this month to make it harder for single-handed GP practices to survive. He accuses David Cameron of a political gaffe in siding with GPs’ leaders against reforms that, he says, will improve access to doctors, particularly in poorer areas, and allow them to provide better care.

The Government is braced for a battle with both the BMA and the Tories, who say that 1,700 GP surgeries may have to close as a result of the drive to group family doctors into new super-surgeries. The BMA will intensify efforts this week to mobilise patients to oppose the changes with a planned march on Parliament. Critics say that the centres, some of which will be run by companies, may be more expensive, less efficient and force patients to travel farther. But Mr Johnson justifies the reforms, saying that they would reduce health inequalities and increase the ability of the NHS to screen for disease, as well as increase patients’ choice and access while reducing pressure on hospitals.

“This is all additional capacity, it’s additional money, it’s not closing a single GP surgery anywhere in the country. We will not be railroading patients to go to these centres,” he insists. He says there is confusion between polyclinics - health centres designed to bring a wide range of hospital services closer to communities - and GP-led health centres, or super-surgeries. The former were recommended by Lord Darzi of Denham in his review of London healthcare. Mr Johnson said he welcomed a report by the King’s Fund, the health think-tank, that said the polyclinic model should not be imposed in the rest of the country. The imposition of super-surgeries is a direct threat to existing services, particularly single-handed practices, however. And while Mr Johnson insists GPs are still in control he confirms he is preparing to remove a payment - the minimum practice income guarantee (MPIG) - designed to protect GPs operating alone. “MPIG is a barrier to all sorts of things we want to do,” Mr Johnson says.

He accuses his opponents of scare-mongering when they suggest that it could lead to mass closures. “The ludicrous misrepresentation of this policy by the BMA and the Conservative Party is a faint echo of their infamous double act 60 years ago when they opposed the creation of the NHS itself,” he will say in a speech today. Speaking before his address to the IPPR think-tank, Mr Johnson says that he is struck by the similarity of some of the criticisms, particularly the charge that the Attlee Government wanted to make all doctors employees of the state. “There’s a quote from the then leader of the BMA who said: ‘I’ve looked at this very carefully and it reminds me of national socialism as practised in Germany.’”

In an interview with The Times in April Mr Cameron accused the Government of trying to abolish “the family doctor service”. “Communities which have lost their post office, their local shops and their local police station, are now going to lose their doctor,” he said. But Mr Johnson says that the Tory leader has made a “huge political gaffe” in siding with the “producer interest”. “We’ve got world-class primary care but the levels of patients who express concerns about access is large and is growing all the time.”

Laurence Buckman, chairman of the BMA’s GP committee, said that he “did not want to rise” to some of Mr Johnson’s direct criticisms of the BMA, but added: “This Government has thrown away the goodwill and trust of 45,000 doctors, which now they will never get back.” He said that the association was not against phasing out the MPIG in principle, but gave warning that as many as one in ten practices could close if the Government did not provide alternative funding arrangements. “Just over 90 per cent of practices receive some income from the MPIG, and their dependency varies, but without it about 10 per cent of practices will be financially nonviable,” he said. “There’s a fairly even distribution of these, which doesn’t just affect one particular group of doctors or patients, so practices will close in rather arbitrary fashion all over the country.”

Dr Buckman added that it was likely that “a few hundred” small practices would have to close as a result of having to merge into or compete with larger polyclinics or health centres. “No one but the Government has pushed for these reforms, which have puzzled patients and GPs alike,” he added. “It will destabilise the system unnecessarily and seems to be an enormous waste of taxpayers’ money.”

Nick Goodwin, from the King’s Fund think-tank, said: “Primary care trusts must ensure contracts are water-tight and ensure no patient groups or conditions become excluded in the drive for profits. If we are going to bring in private companies, regulation and accreditation needs to be spot on, otherwise they will take us to the cleaners.”

Source




Australia: More bureaucratic bullying of health workers

Must not blow the whistle on health propblems

A DISPUTE over a memo has cost Queensland taxpayers more than $120,000 in legal fees, and patients the services of a veteran therapist. Senior speech pathologist Quaneta Greenwood, was suspended, with pay, 13 months ago after she wrote a memo exposing a staffing problem that threatened federal funding for a state nursing home. Fraser Coast health district manager Kerry Winsor said the memo portrayed Queensland Health in a bad light, and she banned Ms Greenwood from seeing patients, gagged her from speaking to the media and accused her of misconduct.

As a result, taxpayers are stuck with a growing legal tab and are paying Ms Greenwood not to treat patients. Records show the bill for Queensland Health's lawyers, Minter Ellison, totalled $120,000 by September. Health Minister Stephen Robertson recently denied health workers were still being bullied by health bureaucrats. Yet Supreme Court documents filed by lawyers for Ms Greenwood include bullying and harassment among the claims. A Queensland Health spokeswoman said: "Since this is a matter between the employee and the department, it is inappropriate to comment while the process is ongoing."

The case hinges on a single-page memo, dated April 17, 2007, written by Ms Greenwood and a co-worker to five colleagues about speech pathology services to Yaralla Place nursing home. The memo said the district did not have enough staff to meet extra speech-therapy services requested by federal inspectors who found the home deficient. "To attend to these (referrals) we would be spending much of the day, every day at Yaralla Place, which is simply not possible," Ms Greenwood wrote. "Our department is not resourced to provide such services."

In a memo a month later, Ms Winsor accused Ms Greenwood of suspending nursing-home services without authorisation and demanded she turn in her work keys and stop treating patients. Ms Greenwood, who had spent 23 years treating cancer and stoke victims with speech and swallowing problems, was devastated by the accusations. In a court affidavit, she said she exposed the problems to help the health system and the public. "It is wrongly asserted I withdrew services. In fact I worked over the Easter holidays to provide patient services to those I had objectively assessed as needing a rapid response. I was simply doing my part to try and see to it that accreditation would go ahead. "The Aged Care Accreditation team were threatening sanctions if the dietetics and speech-therapy-patient backlog was not dealt with."

Barrister Stephen Keim, SC, is representing Ms Greenwood, who is seeking to have Ms Winsor stopped from taking further disciplinary action. Mr Keim argued that the bureaucrat could not be impartial in determining misconduct because she had shown bias against Ms Greenwood. But Justice John Byrne dismissed the application, which is being appealed at a further cost to taxpayers

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9 June, 2008

British doctors' anger at socialist cruelty to very ill patients

THE medical establishment is in revolt against Labour’s policy of denying National Health Service treatment to patients who pay privately for cancer medicines. The outcry from eminent consultants and doctors’ leaders came as news emerged of two more patients whose NHS care was removed while they were dying of cancer.

Alan Johnson, the health secretary, faces opposition from the presidents of the Royal Society of Medicine and the Royal College of Surgeons, as well as British Medical Association consultants. Baroness Ilora Finlay, president of the Royal Society of Medicine, said the issue went to the heart of the purpose of the health service. “Can we justify spending billions of pounds on the relief of relatively minor conditions and deny patients with life-threatening disease the support of the NHS when they want to bridge the costs themselves?” she said.

Finlay’s intervention, in an article for The Sunday Times, comes after it emerged that a man dying of kidney cancer had to battle for NHS care because his family followed doctors’ advice to pay privately for a drug. John Burrell, a retired financial adviser from the Isle of Wight, died last month aged 63. His daughter, Kate Tasquier, said: “The consultant told my dad he would be billed for all of his treatment such as blood tests and scans. My dad was so worried.” Although she said the NHS eventually compromised on the fees, “he ended up being so scared that he was going to be billed for his care that he was scared to go into hospital and he delayed starting the treatment”.

It also emerged that Sandra Baker, a bowel cancer victim, died last year after being denied NHS treatment in her final months. When she paid 9,500 pounds privately for drugs, she was hit with an extra bill of 16,000 pounds for her treatment. Last week The Sunday Times revealed the case of Linda O’Boyle who died of cancer aged 64 after being denied NHS treatment because she paid for a drug.

Bernard Ribeiro, president of the Royal College of Surgeons, and the annual consultants’ conference of the British Medical Association have also attacked the government’s block on NHS patients paying for additional drugs.

While Johnson insists cancer patients should not be allowed to pay for superior drugs because this would create a two-tier NHS, opposition parties have edged closer to supporting co-payments. Norman Lamb, the Liberal Democrat health spokesman who is developing a new party policy on the issue, said: “When a clinician recommends a proposed treatment as having therapeutic value to the patient, it seems cruel and perverse to withdraw all NHS treatment if the patient follows that advice.”

Doctors are concerned that more and more patients will become victims of the policy. Ribeiro said: “I would strongly oppose the denial of life-saving operations to patients based on decisions they had made about how they supplement their NHS care.”

Cancer specialists at one of the country’s largest hospitals have found a way around the ban. About 16 oncologists at University Hospital Birmingham NHS Foundation Trust write prescriptions for their patients to receive private cancer drugs at home. Professor Nick James, one of the doctors, said: “There is no question of us turning away these patients. I believe that to do so is punitive and vindictive. We remain responsible for the NHS care of these patients.”

Source




Australia: Corrupt health boss revelations

QUEENSLAND Health is again fighting corruption claims over the expenses of one of its most senior executives, information chief Mr Paul Summergreene. State corruption fighters are investigating the monthly corporate credit card invoices of Mr Summergreene, the chief information officer. These have allegedly reached up to $25,000 - leaving the taxpayer to pick up the tab for limousine hire and expensive entertainment bills.

Queensland Health acting director-general Andrew Wilson, who was made aware of the allegations against Mr Summergreene, inferred The Courier-Mail could face legal action if it revealed the details. The complaint was referred to the Crime and Misconduct Commission by Queensland Health, as required by law.

Some staff, who have transferred out of the department or quit, have also raised concerns about the amount of alcohol consumption on the premises. It is alleged a private company contracted to Queensland Health is paying for some of the alcohol.

Staff have also questioned why IT companies have helped pay for or arranged for Mr Summergreene, a former policeman, to attend the Australian Open, Grand Prix and State of Origin. For the past three years the CMC has spent thousands of dollars investigating Queensland Health and former health minister Gordon Nuttall. Investigations are still ongoing.

Mr Summergreene is the first bureaucrat during the Bligh Government to face probes into alleged financial misconduct. In a statement Dr Wilson refused to reveal whether or not Mr Summergreene had been stood down. "Queensland Health does not routinely confirm nor deny that Ethical Standards Unit inquiries are under way," he said. "This is done in the interests of fairness and any internal inquiries should be allowed to run their course without being played out in the public arena.

"Queensland Health abides by its statutory obligation to refer any matters of suspected official misconduct to the CMC. "Allegations such as those you raise are extremely serious and publication of speculative material could prove to be defamatory." Mr Summergreene worked for Queensland Transport before he took up his new position with Queensland Health last year.

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8 June, 2008

Australia: Public hospital patients being treated by a mad killer psychiatrist

It sounds like a pulp novel but it's actually happening in a NSW government hospital



NINE years after he shot and killed his wife, George Sliwinski was back in his job as a psychiatrist, treating mentally ill patients in public hospitals. Dr Sliwinski himself had a history of mental illness. This led him to either leave or be dismissed from four medical facilities in the 1980s. In 1987, after a decade of chronic drug and alcohol abuse, he shot his former wife, Alice, four times, a month after their divorce. One of the shots, to her head, killed her.

But Dr Sliwinski was released on parole in 1990. And he was employed as a resident medical officer at the Central Coast Mental Health Service in July 1994, shortly after successfully appealing to the Medical Tribunal of NSW to be re-registered. The Australian Medical Association publicly opposed the re-registration. Dr Sliwinski was employed as a psychiatric registrar at Gosford and Wyong hospitals in 1996, and continues in this role. But, to this day, many of his patients are unaware of his past - and there is no obligation for DrSliwinski or authorities to tell them.

The case of Dr Sliwinski raises difficult issues of a patient's right to know the record and background of their doctor and the ability of someone to redeem themselves and begin a new life. In 1994 the Medical Tribunal said it had "some difficulty" deciding whether he was fit to be a doctor. But it concluded he was suitable because he did not intend to kill his wife, had no history of violence and was supported strongly by three psychiatrists who gave evidence that he had been fully rehabilitated and was very unlikely to relapse.

And yet questions remain unanswered. The Health Department will not reveal how it monitored Dr Sliwinski to ensure he met strict conditions imposed by the tribunal, such as regular urine and/or blood tests, psychiatric treatment and constant supervision. The tribunal also appeared to be unaware that Dr Sliwinski's wife alleged he had a history of violence against her. It found the killing was an "isolated occasion", despite her allegations, set out in an Apprehended Violence Order summons issued in the year before her death.

The Royal Australian and New Zealand College of Psychiatrists - which is responsible for ensuring the suitability of psychiatrists - has refused to comment on what processes it undertook to assess him. And in the 1990s the NSW Medical Board was not required to independently notify employers of a doctor's restrictions. A spokeswoman for the board, Edwina Light, said it was prohibited from revealing why DrSliwinski's strict conditions were lifted in 1999.

Doctors are not legally obliged to tell patients they are working under conditions or have been deregistered in the past, and the Health Department has no policy requiring disclosure.

Dr Sliwinski went on trial in the Supreme Court for the murder of Alice on October 1, 1987, a month after they divorced. He pleaded guilty to manslaughter on the fourth day of his trial, in 1988, and was sentenced to a maximum of eight years' jail. He had shot Alice four times but said he could not recall the incident and successfully argued diminished responsibility because of his intoxicated state. In sentencing him, Justice Ray Loveday said there was no motive for the killing and described it as "quite bizarre".

According to the tribunal's 1994 judgment, he had been abusing alcohol and a cocktail of prescription drugs, mostly tranquillisers, for almost a decade and had sought psychiatric help several times from 1979, including stays at psychiatric hospitals in 1985 and 1987. He feared "dying and going mad". His drinking dated back to the late 1960s, when he drank on the job as a medical trainee because he found attending cancer wards difficult. His father died of bone cancer when Dr Sliwinski was 11 and his mother had schizophrenia.

The drug addiction began in 1977 after his first wife, Barbara, left him with their children and a doctor gave him Serepax after he was unable to administer anaesthesia due to a panic attack at Moree Hospital.

However, in its judgment in 1994 the tribunal concluded that Dr Sliwinski was not an intrinsically violent person. "[The shooting] does not indicate a tendency to vice or violence or any lack of probity. It has neither connection with nor significance for any professional function. There is no evidence that the appellant [previously] committed acts of violence towards his ex-wife or any other person ." the tribunal said.

However, a summons was issued to Dr Sliwinski over an allegation that he assaulted her by attempting to choke her in August 1986. The AVO application, seen by the Herald, alleged that Dr Sliwinski, who had been drinking heavily, said to his wife, "If I hear you have done anything to foul up my career I will kill you", and had assaulted her three or four times during their five-year marriage. The AVO was withdrawn by his wife.

Three years before the killing, he was twice told to take sick leave from his job as a psychiatric registrar at Morriset Hospital due to his depressed mental state and concerns that he was suicidal.

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7 June, 2008

NHS dentistry becoming less and less accessible

Far fewer people see an NHS dentist than before a large-scale reorganisation of dentistry service, according to official figures. Data released yesterday by the NHS Information Centre showed that a total of 27.3 million patients — equivalent to 53.7 per cent of the population — saw an NHS dentist in the two years to December 2007. This compares with 28.1 million (55.8 per cent of the population) in the two years to April 2006, when the Government’s new dental contract was implemented. The contract’s aim was to increase access and simplify dental charges.

The report also showed wide variations across England in who gets access to an NHS dentist, with greater disparities among adults than children. Among adults, the proportion who had seen a dentist in the 24 months up to December 2007 ranged from 38.9 per cent in the South Central Strategic Health Authority area to 58.3 per cent in the North East. There was also a wide variation in the number of children who have access to dental services, with 73.4 per cent seeing a dentist over the same period in the North East compared with 64.8 per cent in London.

Recent surveys have suggested that scores of patients are being forced to pay for private dental treatment because of a lack of practitioners willing to carry out NHS work.

Current guidelines from the National Institute for Health and Clinical Excellence (NICE) suggest that people should see their dentist either every six months or at intervals of up to two years, as the practice sees fit.

The British Dental Association said the figures offered fresh evidence that ministers had failed to achieve their stated aims with the contract. Peter Ward, its chief executive, said: “They have failed to improve access to care for patients and failed to allow dentists to provide the modern, preventive care they want to deliver. “Instead, this contract encourages sporadic, episodic treatment rather than the long-term, continuing relationships that dentists and their patients value. “The Government must heed these statistics and work with patients and dentists to find constructive solutions to the problems with the reforms behind this decline.”

Experts said that patients who did not have regular check-ups could be storing up health problems. Ben Atkins, of Rocky Lane dental practice in Manchester, said: “If people are not going to the dentist regularly, they are not going to pick up warning signs and the small problems that can develop into serious problems such as tooth loss, abscesses and even cancer. Holes can develop in dental enamel in as little as a few months. They can be easily corrected with a filling, but if not checked early, they can cause greater decay down to the nerves.”

Conservatives said the figures suggested that 338,000 people lost NHS dentistry in the past three months of 2007 — equivalent to 3,674 a day. The information centre confirmed that the number of patients seing an NHS dentist “had been falling consistently over the past few years” and that this fall had been greatest between September and December last year. Mike Penning, the Conservatives’ health spokesman, said: “These figures are yet another damning indictment of Labour’s appalling management of NHS dentistry. The fact that over 300,000 people lost their dentist in three months alone shows just how bad things are getting.”

A survey of 5,000 patients and 700 dentists last year concluded that the quality of care patients had received since the introduction of the contracts has worsened. Among dentists, 45 per cent said they were not accepting any more NHS patients while nearly three quarters said that they were aware of patients declining treatment because of the cost. However, 93 per cent of patients receiving NHS dentistry said that they were were happy with the treatment provided.

Norman Lamb, Liberal Democrat health spokesman, said that the dental contract had been an “abject failure”. He added: “We need an urgent review into why reforms undertaken just two years ago have completely failed to improve access.”

Barry Cockcroft, the Chief Dental Officer, said: “Since the dental reforms, we have made expanding NHS dentistry a national priority and have invested an extra 200 million this year to help strengthen local services and open more practices. “The information centre access figures do not reflect the new services that are opening all the time. Rather, the figures are retrospective and include the temporary decrease in access which occurred following the transition to the new system in 2006.”

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6 June, 2008

Australia: Scared nurses' secret evidence of intimidation from public hospital bureaucrats

The bullying of nurses by hospital management is so rife that about a third who gave evidence at the State Government's inquiry into hospitals chose to do so in secret, fearing retribution if they publicly revealed their stories. Some nurses were too afraid even to be seen seated at the Special Commission of Inquiry into Acute Care Services in NSW Public Hospitals, said Bob Whyburn, a lawyer employed by the NSW Nurses Association support nurses who gave evidence.

The nurses union was so concerned about nurses refusing to come forward due to fears of intimidation by management that it employed Mr Whyburn to attend every one of the 34 sitting days. "Roughly a third gave evidence in closed session and it's likely that a lot of them did because of fear of retribution, because that was expressed by the others in open hearings," Mr Whyburn told the Herald. "In some hospitals we went to the nurses were so concerned about what might occur if they did give evidence that they didn't even come along and listen to any evidence that was given. They were frightened to be even seen near the commission." Mr Whyburn said at one hearing at Westmead Hospital, three senior managers reserved the front row and stared down witnesses during their evidence. "The three of them stayed there all day and scowled."

Marguerite Cullen, who has been a nursing unit manager for almost 30 years, told the inquiry at Westmead on April 10 that nurses who spoke up inevitably experienced "payback". Some nurses cried because of the way they were treated by managers and felt "totally demoralised", she told the inquiry. She also told the inquiry some nurses were too afraid to attend. "They said, 'It's not worth my job. It's not worth it. The repercussions if I went down there would be too much,"' she said. "They are too intimidated. I find that quite distressing."

Besides bullying and poor morale, nurses complained of poor workplace conditions - heavy workloads, double shifts and wards staffed by too many junior nurses. Some cried while giving evidence. They also complained about a lack of consultation when NSW Health issued directives that affected their work practices.

The Nurses Association's submission to the inquiry reported widespread frustration and fatigue. Nurses described their hospitals like a "war zone" or being "in the trenches". "When people become nurses they know it is hard work . but they don't know it is unsafe, that you don't get a break and you are not supported," one nurse said. "Some shifts feel out of control."

The submission recommended an overhaul of policies to prevent and resolve bullying and harassment, saying NSW Health had failed to address a "culture of fear and intimidation embedded throughout the public health sector".

The Minister for Health, Reba Meagher, has been forced in Parliament to defend the Health Department's response to bullying, particularly at Royal North Shore Hospital. A study conducted by the University of Sydney on behalf of unions for the inquiry showed that 60 per cent of nurses said they were exhausted at work and, within the previous 12 months, 60 per cent had seriously considered leaving. The inquiry has concluded and the commissioner, Peter Garling, SC, is due give his recommendations by July 31.

Source




Australia: Ambulance bureaucrats block use of heart-saving system

Sadly, it's just the sort of thing you expect from socialized medicine. Paperwork trumps people every time

When John Plant felt his chest tighten on the drive to work two months ago, he thought his life was over. Less than 70 minutes later, the storeman was in an intensive care unit with a stent in his heart. He was lucky. The ambulance that responded to his emergency in Minchinbury was one of hundreds in Sydney fitted with a system called ETAMI, or early triage for acute myocardial infarction. It allows patients to be taken directly to one of two major hospitals, bypassing all smaller facilities, and getting vital treatment more than an hour earlier, saving lives and limiting damage to the heart muscle.

But more than 70 per cent of Sydneysiders are missing out because the NSW Ambulance Service has instructed most of its staff not to use ETAMI. It believes 12-lead electrocardiogram (ECG) machines, used to diagnose patients, should be operated only by highly trained paramedics and that junior staff should not be required to manage cardiac arrest patients for the additional time it takes to transport them to one of the major hospitals.

The instructions have angered cardiologists. "We know that the quicker a person is treated, the higher their chance of survival," the director of cardiac services at Westmead Hospital, Pramesh Kovoor, said. "But not everyone who calls an ambulance will get the same treatment and that's unfortunate because I don't believe it requires a paramedic to operate it."

For an ETAMI trial carried out between 2004 and 2007, 20 ambulances were fitted with 12-lead ECG machines capable of sending results by mobile phone to the emergency departments at Westmead or Royal North Shore hospitals. The study, in the European Heart Journal, found about 1500 patients were delivered directly to Westmead's coronary care unit during that time, with 73 per cent on the operating table within 60 minutes and 66 per cent having angioplasty within 90 minutes, compared with 2 per cent of people taken to community hospitals.

A spokeswoman for NSW Health said the results of the trial were still being analysed and the NSW Ambulance Service would issue a statement on the matter within weeks. For Mr Plant, 58, from Sadleir, in Sydney's south-west, the quick treatment meant only five days in hospital and a second chance at life.

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5 June, 2008

Private healthcare managers could be sent to turn round failing NHS hospitals

Private managers could be brought in to run failing hospitals under measures to tackle poor performance in the health service. Alan Johnson, the Health Secretary, is to announce rigorous standards of quality, safety, cleanliness and financial management for all hospital trusts, making it easier for inadequate managers or chairmen to be dismissed without large payoffs, The Times has learnt. Under the controversial plan, which has strong backing from Gordon Brown, managers could be brought in from the private sector or from elsewhere in the NHS.

Ben Bradshaw, the Health Minister, told Channel 4 News last night: “What we’ve never done before is to allow the private sector to take over the running of a whole hospital in the form of a franchise, which is one of the options that would be included in this performance regime. What we know from our experience of involvement in other parts of the health service is that the private sector can bring different skills, different management skills, different techniques.”

Doctors, politicians and unions gave warning last night that the measures risked undermining the fundamental principles of the NHS. Ian Gibson, Labour MP for Norwich North and former chairman of the Commons’ Science committee, said: “The privatisation of the NHS is becoming less than subtle. This is a blatant snub to the health service.” A spokesman for the British Medical Association, the doctors’ union, said it would have “grave concerns if the private sector took over [NHS] management”. “There is already an immense amount of talent within the NHS – in leadership and management – and this should be nurtured to ensure NHS trusts do not find themselves in a position of failure in the first place.”

A key new performance measure will be levels of Clostridium difficile or MRSA infections. There are 20 trusts that are classified as “weak” in the Government’s ratings and they will come under early and tough scrutiny.

The plan has been adopted enthusiastically by the Prime Minister, who hopes to show that he will be as radical on public service reform as Tony Blair. During the Blair years Mr Brown was often accused of being an obstacle to change, and prevented Alan Milburn giving independence on borrowing to foundation hospitals.

Government sources said last night that Mr Johnson’s move would be the first of a series from Cabinet ministers aimed at improving public services. They promised stringent minimum standards “and real consequences for those who fail to meet them”. Managers and trust chairmen will have their contracts drawn to relate to their performance against the new standards. They face dismissal – without payoffs – if they are placed on a performance improvement plan and then fail to meet the deadlines set within it.

At the moment 30 trusts, out of 290, including mental health trusts, are responsible for 46 per cent of the cases of MRSA infection and 57 per cent of patients having to wait more than 18 weeks for their operation. A total of 20 trusts were rated as “weak” for both quality of services and use of resources in October, while there are also 16 trusts that are considered “financially challenged” because of long-term budget deficits.

A government source said last night: “We can proceed with the next stage of public sector reform only if we have tackled the failing hospitals and eliminated unfair variations in local services. But we can only do that if we have a stringent set of minimum standards and enforce them.”

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A flawed system of specialist credentialling in Australia

I have just failed my final examination before being deemed a medical specialist, along with half the people who sat the exam. This is despite each and every candidate being of the highest calibre, then working in the field for several years and undertaking backbreaking preparation for several months. A large proportion of the candidates had never failed anything academic before this final hurdle. A considerable number were sitting for the third or fourth time. Each had to pay several thousand dollars for the privilege.

Welcome to the college system of training doctors. It is a system grounded in traditions and old-school philosophies, much of it a throwback to the English guilds of previous centuries. Until recently, the results of these exams were handed to the candidates in the hallowed halls of college buildings. A door would then open for those who passed, who were offered a glass of sherry or soft drink, while those who failed were given directions to the nearest taxi rank.

There are few professional equivalents as archaic. The closest would possibly be the bar association for barristers, but even they have examination pass rates of up to 80 per cent. The market is then free to value their services accordingly. If a university course were run where half the students failed, the course would quickly be modified, dropped or there would be an urgent review of the selection processes. If a business undertook training of staff for a particular task and later found half to be incapable of doing so, the business would be highly dissatisfied and undertake immediate measures to ensure the vast majority were ready. They would have every incentive to do so.

The colleges have absolutely no incentive to pass anyone. Each and every person who passes represents a new competitor with access to the total pool of fees from specialist services. The same doctors deemed unqualified to practise independently are often doing the work of the specialists within the public hospital system while their bosses are running lucrative private practices.

The system is a reflection of the many inefficiencies and difficulties of our health system - rule by committees which are unable to respond to consumer needs and changing trends, little "outcomes measurement" and a disabling level of bureaucracy and duplication.

Last month, just before the 2020 Summit, Dr Bill Glasson, an ophthalmologist and former president of the Australian Medical Association, called for a greater range of health professionals to address the hopeless shortage of workers that our system suffers. This kind of statement would have been a heresy during his days as the AMA boss. But it is a reflection that our current system of training health workers simply does not meet the needs of consumers. Nowhere is this more true than with doctors, where it takes a decade and a half to produce independent practitioners who are then grossly overqualified for the relatively routine presentations they deal with each day. And when you consider that despite this and the gross shortage of doctors, that colleges do their best to keep the numbers as low as possible, it is a travesty.

The Australian Competition and Consumer Commission has already had multiple dealings with some colleges, particularly the surgeons, who have been forced to amend many of their practices as a result. And this year there has been a submission to the ACCC by a group representing training psychiatrists. If that is not enough, the Productivity Commission is investigating the low pass rates in several colleges.

As monopolies go, one feels that the number is almost up for this one. Macquarie University is attempting to set up an alternative path for training surgeons, despite huge disapproval from specialist bodies such as the AMA. In Britain, the system has been overturned, for many of the reasons stated above. While it has been implemented poorly and caused initial chaos, there is widespread agreement in Britain that doctors' training will be shorter, more streamlined and better equipped to deal with the public's needs.

Any changes here will take time. Meanwhile, I remember what a silver-haired eminent cardiologist said in my final year of university. After a casual teaching session, he gave me a stern look and said: "Son, now that you're almost finished the course, my advice to you is to get out as soon as you can. Things are going from bad to worse and it will be very difficult for you lot. Get out while you can." While I shrugged off the comments back then, now that I am demoralised and heavy with resentment, trapped within a public hospital system that utterly devalues me, I feel he was right. I regret not taking his advice.

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4 June, 2008

NHS turns away women about to give birth in Manchester

UNDER-pressure maternity units are being forced to close their doors almost three times a week - because they cannot cope with the numbers of expectant mothers. Health bosses say turning pregnant women away is a `last resort', but the M.E.N. has learned there were 150 closures in Greater Manchester last year. This was due to severe staff shortages and because all their beds were full. Staff also had to divert pregnant women to other hospitals because they were trying to cope with complex births, including a woman having triplets.

Figures show St Mary's hospital, in Manchester city centre, was worst affected, shutting its doors to admissions 54 times for up to 33 hours at a time. Senior doctors are `disappointed' with the high number of closures, but hope a plan to reorganise maternity units from 13 to eight sites, called Making it Better, will reduce them. Consultant obstetrician Mike Maresh told of their disappointment and said they were `upset' that mums are not delivering where they planned. He said: "Mums should have their baby at their planned hospital, and the Making it Better changes will help make sure this happens. "We are confident that having fewer, bigger, maternity units will resolve the problem of unplanned closures by concentrating staff and expertise.

The National Childbirth Trust (NCT) branded the closure figures as *unacceptable'. Belinda Phipps, chief executive of the leading charity, for parents, which offers advice and support to both pregnant women and new mums, others, said: “It is simply appalling to close a maternity unit. I know that hospitals do it for safety reasons, but babies do not wait. “Hospitals also know in advance when babies are expected and know how many women are due to give birth. To get into this situation is not acceptable.”

Mrs Phipps said midwives were leaving leaving the profession in *droves' because they were unhappy with conditions and NHS changes. to maternity provision. She added: “They like to work in small midwife-led units, not ever-bigger and bigger units.” Sarah Davies, a midwifery lecturer at Salford University, said: “The gold standard is one midwife to one woman – and this is not happening.”

Figures obtained under Freedom of Information laws show that Wythenshawe Hospital had the next-highest number of closures with 28. Other hospital closures in the year were Tameside General (5), Royal Oldham (19), Rochdale Infirmary (6), Fairfield in Bury (26), Salford Royal (4), Royal Bolton (2) and Stockport (4). There was only one at both the North Manchester General and Trafford General hospitals and none at the Wigan's Royal Albert Edward Infirmary.

A St Mary's spokesman said they were spending 900,000 pounds on extra delivery rooms and staff. And Pennine Acute Trust, which runs hospitals in Rochdale, north Manchester, Bury and Oldham, said closing units was due to 'high levels of clinical activity at a particular time' and *diverts' were a last resort.

Source




Envisaging a World Without the FDA

Incentives matter in all areas of human endeavor. When people gather to develop and deploy new medicines, for example, they are more incentized by the prospect of personal gains - reputation, profit, feeling good by doing good, and so forth - than by the benefits brought to people they have never met. This is simple, hardwired human behavior. Exceptions are few and far between.

That we instinctively work to improve our own lot first is why progress for all happens so much faster in free, open marketplaces under the rule of law. There, everyone can trade to make themselves better off: specialization and comparative advantage means that trade benefits both sides. Trade is not zero-sum; we grow the whole pie by specializing and trading the results of our work. You go off and work to make the medicine I want, and many people like myself give some our our resources to purchase the end result. Both sides benefit, exchanging - what is for them - lesser value to receive greater value.

There is no open marketplace for medical technology in the developed world, however. Instead, we see a very different set of incentives dominating the state of research and development. Regulatory bodies like the FDA have every incentive to stop the release of new medicine: the government employees involved suffer far more from bad press for an approved medical technology than they do from the largely unexamined consequences of heavy regulation.

These consequences go far beyond the obvious and announced disapproval of specific medical technologies: the far greater cost lies in all the research, innovation and development that was never undertaken because regulatory burdens ensure there would be no profit for the developer. Personal gain for the regulator is thus to destroy the gains of people they will never meet, the exact opposite of what occurs in an open marketplace.

An article that looks at one small part of the destruction caused by the FDA caught my attention, and particularly these snippets:

Since 2005 the FDA has approved 18 new cancer drugs, many of them breakthrough products. But the pipeline contains hundreds more that will never get to market because corporate developers aren't able, or willing, to come up with the money, time, and patients necessary to establish acceptable data....

The clinical trial process now is a three-part, years-long effort that effectively kills off all but a handful of once-promising drugs....

It would have been the first new drug for prostate cancer in 20 years

Twenty years! Just stop a moment and think about how far and fast biotechnology and medical science has moved in the past twenty years. Think about what the far less regulated computing industry has achieved in the same timeframe. We live in the early years of the biotechnology revolution, with something amazing and new demonstrated in laboratories every week. Yet the dominant regulatory body for one of the most advanced regions of the world has managed to stop the clock at 1988 for a major disease, the subject of research in a hundred laboratories worldwide.

This sitation exists in every field of medicine, and all participants labor under the crushing burdens imposed by regulators incentivized to stop progress from happening. The same will be true of the future of longevity medicine, unless we do something about it.

The insanity of this all is quite staggering - that people largely accept and defend the need for regulation that achieves this sort of result, that is. I have heard it said that the failure of libertarianism, of the urge to freedom and personal responsibility, is a failure of imagination on the part of those who have been brought up knowing nothing other than government and regulation on a massive scale. The majority cannot make the leap to see an unregulated marketplace for medical development that works in the same way as the unregulated marketplace for computers - enormous choice, low barriers to innovation, efficiency and low cost, competing review organizations, accountable sellers, rapid progress and responsiveness to customers driven by fierce competition, and so forth.

What is, is, and to propose another way is already an uphill battle regardless of merits. That is also hardwired into the human condition. But the present dismal state of affairs must be changed if we are to see the defeat of degenerative aging in our lifetime - nothing short of a revolution is called for, given just how far in the hole we find ourselves. The technologies needed to repair aging will take only a few decades to develop, and indeed some already exist in prototype, but the present regulatory burden placed upon medical technology will ensure we are all dead and buried, that wondrous potential squandered.

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3 June, 2008

The Florida Revelation . . .

Republicans in Congress may be out of gas, but that doesn't mean conservative ideas aren't percolating elsewhere, and even on the supposedly Democratic stronghold of health care. Take the news from Florida, where GOP Governor Charlie Crist succeeded last week in moving an innovative reform through the state legislature.

The Sunshine State has about 3.8 million people without insurance, or about 21% of the population, the fourth-highest rate in the country. The "Cover Florida" plan hopes to improve those numbers by offering access to more affordable policies. As even Barack Obama says, the main reason people are uninsured isn't because they don't want to be; it's because coverage is too expensive.

But the Florida reform, which both houses of the legislature approved unanimously, renounces Mr. Obama's favored remedy: It nudges the government out of the health-care marketplace. Insurance companies will be permitted to sell stripped-down, no-frills policies exempted from the more than 50 mandates that Florida otherwise imposes, including for acupuncture and chiropractics. The new plans will be designed to cost as little as $150 a month, or less.

Mr. Crist observed that state regulations increase the cost of health coverage, and thus rightly decided to do away with at least some of them. It's hard to believe, but this qualifies as a revelation in the policy world of health insurance. The new benefit packages will be introduced sometime next year and include minimum coverage for primary care and catastrophic expenses for major illness.

Critics are already saying that, without mandates, the plan won't guarantee quality of care. That's purportedly why the states have imposed more than 1,900 specific-coverage obligations. But invariably mandates are the product of special-interest lobbying. Health-care providers - not consumers - are always asking for tighter regulation, because they profit from making everyone subsidize generous plans that cover, say, podiatry or infertility treatment. Given the choice, consumers might choose policies that cover some services but not others.

These government rules are imposed without regard for how much they will cost and who will bear the burden. In practice, the costs are disproportionately carried by lower- and middle-income workers, who already on average have more limited insurance coverage as part of their compensation, or none at all. When prices rise because of mandates, the less affluent are often forced to make an all-or-nothing choice between "Cadillac coverage," which involves just about everything, or going uninsured. In other words, they're prohibited from buying the lower-cost options that might be better suited to their needs.

Governor Crist is to be credited for removing this artificial, regressive floor on plans. It's a simple matter of equity. And though the plan will only enroll those who have gone without coverage for six months, it also creates a clearinghouse that will let small businesses that can't afford coverage offer their employees a variety of similar policies.

Despite his often populist brand of politics (such as on hurricane insurance), Mr. Crist also avoided the typical liberal health-care response of expanding public programs. Mitt Romney should have taken this route in Massachusetts, but fell instead for the siren song of "universal coverage," even if provided by the government. Florida is already having a tough fiscal year, but such state-level expansions are often pushed anyway.

Some 13 states currently offer bare-bones policies on a full or trial-run basis. While not a cure-all, they're movement in the right direction - especially as the states can't do anything about the continuing tax bias for employer-provided health insurance. That kind of much-needed change can only come from Washington, as John McCain is proposing.

The Florida success also shows the political benefits when Republicans talk seriously about health care. Mr. Crist has made increasing consumer choice a signature issue. When Mr. McCain talked up his health-care reforms earlier this spring, he did so in Tampa. He chose the right state.

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Vindicating Vioxx

Texas and New Jersey may have different political cultures, but appeals courts in both states this week delivered a one-two punch to the liability suits against Merck for its Vioxx painkiller. In Texas, a court overturned a $26 million 2005 jury verdict against the drug company, while New Jersey's court whittled down an earlier verdict to exonerate Merck from a finding of consumer fraud and eliminate punitive damages.

The rulings are evidence that some sanity still exists in the tort system - at least at the appellate level. In Texas, the court's Chief Justice Adele Hedges said there was "no evidence" that the patient had suffered a cardiovascular event as the result of a blood clot or that Vioxx was in any way related to the death. Those are strong words for a case that the trial bar had celebrated as the start of a huge payday.

At the beginning of the Vioxx hysteria, some analysts predicted Merck's liability could spiral as high as $30 billion, threatening the company itself. Last year, Merck settled most of the cases for $4.85 billion. But since Vioxx was taken off the market in 2004, only three of the 20 suits that have gone to juries have ended favorably for plaintiffs. There were other reality checks along the way: Vioxx plaintiffs were denied class-action status in a federal court in 2006, and by the New Jersey Supreme Court last year.

This week's verdicts are especially important in the message they send regarding federal pre-emption, the topic of a pending case at the U.S. Supreme Court. In the New Jersey Merck case, the court ruled that the plaintiffs were not eligible to receive punitive damages under state law against a drug that had been approved by the Food and Drug Administration. A state court, in other words, cannot extend its reach to trump the federal drug approvals.

Without pre-emption, the danger exists of wholesale looting of the drug industry, a source of global U.S. economic advantage. For drug makers to have to submit both to the long and expensive FDA approval process and tort suits after approval amounts to a kind of business double jeopardy. The Supreme Court upheld federal pre-emption in a medical device case earlier this year. While state courts and lawsuits look only at drug safety, the Court wrote, the FDA is obliged by law to balance a product's safety against its health benefits.

Merck's decision to pull Vioxx from the shelves in 2004 may have been self-protective corporate strategy, but it wasn't a medical indictment of the drug. Cardiovascular risks have been shown to emerge only after a year and a half of constant use. Many patients with joint pain and other orthopedic ailments can be helped by Vioxx and other Cox-2 inhibitors, which aren't as rough on the stomach as high doses of ibuprofen, a frequent substitute.

Plenty of patients and doctors would like to see Vioxx back on the shelf as an option to ease otherwise intractable pain. All drugs have risks, and the danger in the Vioxx case was that a tort frenzy would destroy an industry that provides jobs and vital therapies to millions of people. We're glad the courts are allowing reason to prevail.

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2 June, 2008

Grassley's War on Cancer Patients



The news did not make it to the front pages, but on Feb. 28 a powerful member of the U.S. Senate launched an attack on the Food and Drug Administration, the drug companies and the desperate cancer patients they treat.

Charles Grassley (R., Iowa), ranking member of the Senate Finance Committee, requested that the Government Accountability Office launch an inquiry into whether the FDA behaved appropriately in granting the "accelerated approval" of Avastin, a drug for treating women with metastatic breast cancer. Mr. Grassley's action will have a catastrophic effect on America's ability to develop new drugs.

At issue is the concept of "surrogate endpoints" and the FDA's "accelerated approval" regulations. In the 1980s, at the height of the AIDS epidemic, AIDS activists were livid at the slow pace of development of new drugs to fight HIV. They lobbied heavily for changes in the law to allow an expedited pathway for the approval of new drugs for any disease deemed serious or life-threatening. The historic results were new laws and regulations that created an accelerated approval mechanism by which a drug could be allowed on the market if it showed early evidence of an effect on a surrogate endpoint.

For cancer, examples of surrogate endpoints are tumor shrinkage or a delay in the disease's progression. This kind of measurement - as opposed to an assessment of a drug's impact on a patient's overall survival - has dramatically increased the pace of cancer clinical trials. It also has won near-universal acceptance within the cancer community. The FDA does require follow-on studies to assure that a surrogate finding shows clinical benefit. But if all cancer clinical trials were required to show a survival benefit from the get-go, progress in cancer-drug development would slow to an absolute crawl.

Enter Mr. Grassley. It seems not a week goes by without him making a public accusation of evil doings within the drug industry or the FDA. Yes, Mr. Grassley did some good after the Vioxx episode, by focusing on the woeful manner in which postmarketing drug safety is managed and regulated by the FDA. But he and his staff should have kept their eyes on the ball. In the case of Avastin, the senator implied in his GAO request that something sinister occurred during the FDA's premarket deliberations, and that surrogate endpoints were the new bogeyman. Nothing could be further from the truth.

In February, the FDA approved Avastin despite a 5-4 vote by its Oncology Drugs Advisory Committee (ODAC) not to recommend approval. Meetings of this advisory committee address the most vexing issues that exist in cancer-drug development. The advice is usually helpful but never binding. Everyone who works at the FDA knows that the public only sees a fraction of what FDA insiders consider when they make their final decisions on products.

In the case of Avastin, additional data emerged late in the review process, after the ODAC meeting, that strongly supported accelerated approval. It became clear that Avastin had an enormous impact on the surrogate endpoint known as "progression-free survival." PFS is such a powerful measure that it is actually used as the basis for full approval in many cancer indications.

As part of the accelerated approval letter, the FDA also placed some of the most stringent postmarketing requirements in history for the drug's sponsor to gain full approval. No standards were lowered, and many women may now live much longer without their disease progressing.

The damage done by Mr. Grassley's decision to make an issue of this decision cannot be understated. Having served at the FDA during the Congressional hearings over the Imclone/Martha Stewart insider trading scandal, I can attest to how an action like this GAO inquiry will resonate within the halls of FDA. An extremely cautious and protective bureaucracy will respond to such intimidation by being even more protective.

The senator is demanding a full-scale review of each and every product ever approved, and is asking for a rejudgment by GAO "to ensure that drugs approved on surrogate endpoints are both safe and effective."

You can bet these bully tactics will have an effect. Look for greater demands by the FDA for cancer programs to not use the accelerated approval pathway. Just a few weeks ago, Medarex Inc. announced that the FDA will renege on a commitment to grant accelerated approval of a new product for skin cancer if its clinical trial showed benefit using the PFS endpoint.

The FDA ordered a change toward the much stricter endpoint of overall survival, adding years to the time it will take to evaluate the drug's efficacy.

U.S. cancer-drug development stands on a precipice overlooking a new dark age in which each new product's development is longer and costlier than the last. Companies may decide it is not financially viable to even bother developing new drugs, and the pipeline for new products to treat cancer could slow even more. Mr. Grassley's legacy could be thousands of additional cancer deaths.

Advocates for all patients affected by Mr. Grassley's antidrug company demagoguery - including cancer patients, Alzheimer's patients, AIDS patients - must make their voices heard.

Source




Australia: Public hospital emergency patients in mass walkout

Long waits can be very difficult for seriously ill people

Almost 100,000 patients walked out of NSW emergency departments last year, without being examined by a medical professional. The number of fed-up patients is revealed in a new Federal Government report that exposes the full extent of NSW's public hospitals crisis. It's the highest number of walk-outs on record, dwarfing all other states and territories and representing a 25 per cent rise in just two years. It means more than one in every 20 non-admitted emergency patients went home, rather than wait for treatment. "Patients have no faith in the health system, when they are not even prepared to wait to see a medical professional," shadow health spokesperson Jillian Skinner said.

Frustrated by long waits, 97,956 patients "did not wait to be attended by a health care professional" in 2006-07, the Australian Institute of Health and Welfare reported. Incredibly, 11,085 were "emergency" or "urgent" cases. A further 25,919 people abandoned emergency departments after an initial examination, but before further treatment was complete.

Last week NSW Treasurer Michael Costa warned that Rudd Government changes to private health insurance would only increase pressure on the public health system. Mr Costa said Budget changes to the Medicare levy surcharge would send privately-insured patients flooding into the stretched public system.

Father-of-two Brad Roberts, 38, was sent home from Nepean Hospital emergency department last year after complaining of severe chest pains. His wife took him to a private hospital, where he was told he had suffered a heart attack and had surgery within an hour of admission.

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1 June, 2008

NHS computer project troubled by more delays

The multibillion-pound national programme to overhaul the NHS's computer systems is likely to suffer further delays and turmoil after a contract with a key supplier was terminated. The National Programme for IT, parts of which are running four years late, aims to create a single electronic records system for 50 million patients in England, as well as to enable electronic prescriptions and other electronic services. But negotiations have broken down with Fujitsu, which had been due to implement the plan in the South of England from Kent to Cornwall.

The company, one of three regional contractors in control of the project, is the second big "local service provider" to withdraw from the project in three years, after the departure of the consultancy firm Accenture in 2006.

Negotiations to "reset" the company's œ896 million, ten-year contract have been under way since last July, and although the cost of the contract had escalated to more than œ1 billion, a deal had seemed likely as recently as last week. But NHS officials believe that the Japanese board of Fujitsu intervened, fearing that its potential losses could be much greater than its directors had forecast.

Connecting for Health, the agency that oversees the programme, said that it would issue a termination notice to Fujitsu, a move that could cost the Japanese-owned services company an estimated 340 million pounds.

The project, now in its sixth year, has come in for repeated criticism over delays and fears for the security of patient information. But tough contracts have so far kept it broadly within its estimated budget of œ12.7 billion. However, contractors will be paid only when services are delivered and working.

Fujitsu earned 256 million pounds in 2006-07 for its work on the project, but it was the provider with the most outstanding payments due to it, and in some cases had not been paid more than 12 months after systems had been delivered.

The company is understood to have wanted either more money to provide additional local services or a return to the original, more limited, contract obligations. The Department of Health said yesterday that it terminated Fujitsu's involvement "with regret" because it had not been possible to reach an agreement over this.

In a statement, Fujitsu said that it had withdrawn from negotiations as it did not feel that there was any prospect of an acceptable conclusion.

Stephen O'Brien, the Conservative health spokesman, said that the Government's attempts to "ram through a top-down, centralised, one-size-fits-all NHS computer system" had come "crashing down around its ears".

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Australia: Too bad if you need "elective" surgery

Almost 2700 Queenslanders who had elective surgery at a public hospital last financial year waited more than a year before they had their operation. And those patients needing surgery for painful hip, knee and varicose vein conditions had among the longest delays, a report from the Australian Institute of Health and Welfare says. The new data follows the release of the State Government's own figures this month indicating its elective surgery waiting lists have blown out by 15 per cent in less than three years.

Doctors recently warned the already long queues to get into operating theatres could worsen soon, with Queensland Health now forcing some of the state's top surgeons to take their backlog of holidays. And Health Minister Stephen Robertson was under pressure again earlier this week after revelations cancer patients were waiting up to three times longer for life-saving treatment than they should be at some of the state's biggest hospitals.

But the AIHW report, to be released on Friday, May 30, revealed Queensland had among the shortest waiting times in the country for elective surgery at a public hospital in the 2006-07 financial year. The report found half of the state's 108,000 public hospital elective surgery patients that year waited 25 days or less for their operation - a better result than any other state. Only 10 per cent of Queensland patients still had not been seen by a surgeon after 142 days. Nationally, half of all elective surgery patients waited 32 days or longer and another 10 per cent had yet to be admitted for surgery after 226 days.

The AIHW report found the surgery delays varied widely depending on the type of operation. In Queensland, public hospital patients needing treatment for varicose veins faced the longest queues, with only half getting their operation within 77 days and 10 per cent still waiting after two years and 40 days. There also were backlogs for Queenslanders needing knee replacements - with half of those patients waiting 74 days or longer and 10 per cent still not seen after 343 days.

Patients wanting hip replacements in the state's public hospitals also fared badly, with only half of those patients going to hospital within two months and 10 per cent still waiting after 245 days. Nationally, orthopaedic and ear, nose and throat surgery were the specialties with the highest proportion of patients facing delays of more than a year for surgery. There were 7.6 million hospital admissions for the year.

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