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31 May, 2007

NHS knows how to treat war veterans

"Let the B****s die" is the underlying attitude. The fact that he paid his National Insurance contributions for all his working life means nothing to the bureaucrats. When the government is the provider, collecting what you have paid for is a very uncertain business

A 90-year-old war veteran suffering from ten complaints including bowel cancer, dementia and non-Hodgkins lymphoma has been denied NHS nursing care and told that he must pay the 600 pounds -a-week bill himself. Eric Friar, who is almost blind and can hardly walk, served as an RAF navigator in India and Africa during the Second World War. He has been categorised as having "moderate" disabilities by his NHS trust, ruling out state funding for his care.

Mr Friar has been cared for by his wife of 60 years, Norma, since he first suffered from cancer in 1992. She is now unable to care for him as she has osteoporosis. Mrs Friar, 78, has been told that the State will contribute 40 pounds a week to his care, because the couple have too much in savings. Mr Friar, of Highnam, Gloucestershire, is in hospital with pneumonia. While there he has caught MRSA and shingles has been diagnosed. He cannot eat unaided, needs a catheter and is in constant discomfort.

Mrs Friar fears she will not be able to cope when he is discharged and cannot afford the 30,000 pounds -a-year nursing home cost. She said: "How bad has he got to be? We have never asked for anything in our lives. I'm angry, really angry. It's an awful lot to for us to pay. I say to people now - spend the lot and let the Government pay for it." The NHS will contribute the weekly 40 pounds towards costs until Mr Friar's savings drop below 21,500 pounds. Then the State will provide more until his savings reduce to 13,000, when its contribution rises again.

Mr Friar's case is regarded as falling into the third of four bands: critical, substantial, moderate and low. Mrs Friar said that nursing homes that would be suitable for her husband charged about 600 a week.

Gloucestershire Primary Care Trust said that to qualify for "continuing nursing care", which is funded by the NHS, medical needs must be "complex, or intense, or unpredictable". A spokesman for the trust said that it could not comment on individual cases but was sorry to hear that Mr and Mrs Friar were unhappy with the outcome of their case. He added: "We always aim to work with a patient and their family in carrying out an assessment so we can be sure that all of the facts are available and our assessment is understood. "Every assessment is based on individual need and in cases such as these, financial support is provided as a contribution towards meeting the patient's ongoing nursing care. An appeals process is in place and this option is available if the individual or carer believes that the outcome is not the right one." [In other words, "Drop dead!"]

Source

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

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

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30 May, 2007

Mass desertion of public hospitals in Australia

So many operations and other treatments are done in private hospitals, doctor's rooms and private clinics that public hospitals can no longer train junior doctors in the skills they need. Doctors say bone surgery, gynecology, dermatology and psychiatry are areas where specialist trainees -- known as registrars, and currently trained in public hospitals -- can no longer learn the surgical and other procedures they will need to perform later in their careers. The Australasian College of Dermatologists has had to extend its training course by a year because its registrars are no longer getting enough experience in common skin conditions in public hospitals.

Figures from the Australian Institute of Health and Welfare show private hospitals conducted 45 per cent of all same-day operations in 2004-05. The national conference of the Australian Medical Association in Melbourne at the weekend heard that doctors training to be orthopedic surgeons in public hospitals were now more likely to treat complex and urgent cases such as road crash victims.

Geoffrey Metz, clinical dean and director of education at the private Epworth Hospital in Melbourne, told the conference the situation was made urgent by the planned doubling of medical student numbers, expected to soar from about 1500 graduates a year to 2900 by 2011. "If there's no increase in the number of beds in traditional teaching hospitals, trainees will be fighting each other over the same number of patients," Associate Professor Metz said. Epworth Hospital, run by the Uniting Church, already takes trainees, he said. "We need to do part of our training outside the traditional teaching hospitals."

Psychiatry registrars training in public hospitals were mainly exposed to patients with psychoses, whereas doctors in private practice saw a lot more patients with anxiety and depressive disorders, Associate Professor Metz said. In gynecology and pathology, there were also big differences between the types of cases registrars saw and the problems of private patients.

Sending trainee doctors into private hospitals might prove tricky, as one of the vaunted benefits of private hospital treatment is that it allows patients to choose their preferred doctor. Delegates at the AMA conference backed a resolution that a position statement be developed to guide registrar training in the private sector, with a stipulation that the arrangements "must respect patient choice by ensuring that all patients treated by trainees are informed about the role of trainees in their medical care, andfreely consent to this".

The federal Government has committed $60 million through the Council of Australian Governments to expand medical training into the private sector. But Associate Professor Metz said this "can't be seen as anything other than seed funding" because of the large number of extra trainees due to come through the system.

Omar Kharshid , who completed his specialist training to become a qualified orthopedic surgeon last year, told the conference trainees in public hospitals were now more experienced in treating road crash victims than patients with common complaints such as bunions.

Health Minister Tony Abbott said the Government would "do its bit" to expand training into the private sector, but details of how the $60 million would be spent had to be finalised.

Source




Australia: Kidney disease treatment shame

MORE than 200 kidney patients die needlessly every year because of Queensland's "appalling" public health system, according to a leading kidney specialist. David Johnson has revealed that a "woeful" lack of doctors, equipment and understanding of the disease means patients are not getting the treatment they need to stay alive. He said some patients with chronic kidney disease were receiving dialysis only once a week rather than the recommended three five-hour sessions. Without regular dialysis to remove toxins and excess water from the blood, there is an increased risk of complications developing such as anaemia and high blood pressure. As waste products are allowed to build up, the patients can die sooner than they might have.

The latest figures reveal 224 Queenslanders die every year while on dialysis and nine out of 10 die before they even get that treatment. About 1500 are having dialysis and 139 are waiting for a transplant. Professor Johnson spoke out as chairman of Kidney Check Australia Taskforce, a group set up to lobby governments to provide better services. He is also director of kidney treatment and chairman of medicine at the Princess Alexandra Hospital, which treats a third of the state's kidney patients.

"The situation in Queensland is appalling and far worse than the rest of Australia," he said. "We have one specialist per 150,000 patients and we should have one per 80,000. "The lack of workforce and funding is just woeful." Prof Johnson said the lack of dialysis machines also meant many patients were being sent to hospitals up to 100km away from home for treatment, and others are waiting more than a year to see a consultant.

His comments come on the eve of Kidney Awareness Week, as the charity Kidney Health Australia warns the country is losing the battle against kidney disease. Deaths from kidney failure have doubled in 20 years and Australia's health bill for treating the disease is growing by $1 million a week. In Queensland, the number of patients on dialysis is increasing by 8 per cent every year and doctors believe rising rates of obesity, diabetes and the ageing population are to blame. Kidney disease is the "silent killer" - 16 per cent of the population do not even realise they have it until their condition deteriorates.

Tim Mathew, medical director at Kidney Health Australia, is calling for an early GP screening program, targeting people considered most likely to develop the disease, such as the obese, people with diabetes, or a family history of kidney problems. "We basically need to get the Federal Government's support for some active kidney programs to chase the disease," Dr Mathew said. "We also need to educate GPs. "Generally, they don't know enough about it, or if they do they are not confident to know what to do about it."

A Queensland Health spokesman said the department was working to boost dialysis services to cope with the demand, and will be opening a new 12-chair dialysis unit at Redlands Hospital.

Source

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

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

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29 May, 2007

Private medical treatment saves British woman

Under NHS rules she would have died

Sarah Burnell was 43 when breast cancer was diagnosed in November 2005. Despite having had the all-clear after a mammogram a year earlier, she had developed 11 tumours and had to have a mastectomy and chemotherapy. Because of a family history of breast cancer – her mother had the diagnosis at 51 – she had insisted on annual mammograms from the age of 38. They probably saved her life.

Her mother had been perimenopausal when her diagnosis was made, Ms Burnell, a radiologist, said, so she would not have been screened by the NHS until she was 46. “It was only because of my work as a radiologist that I was able to get screening before this age,” she said. “This meant that I caught the cancer early, before it had a chance to spread to my lymph nodes.”

A colleague at the private Princess Grace Hospital in Central London did the mammogram, and showed Ms Burnell the results. “I only saw the largest tumour. It was only when I went for ultrasound that I found out I had 11 tumours,” she said. “Thankfully, they were all very small.”

Ms Burnell, of Battersea, had a mastectomy, reconstructive surgery and chemotherapy. A year later her aunt, 70, was told that cancer was present in both breasts, indicating an even stronger genetic link.

Ms Burnell’s daughter, Xanthe, 9, is now worried that she will develop the disease and wants to have genetic testing. “Xanthe is concerned, but we are glad at this breakthrough in research,” Ms Burnell said. “We hope it will help her decide when to start screening. If she has the gene, I think she should start being screened at the age of 25. “I would hate her to go through what I went through. It’s been a very tough time.”

Source




NHS dentistry: Splendid British bureaucratic logic at work

They only treat you if you have GOOD teeth! Don't you love it?

DENTISTS on the National Health Service are turning away people with bad teeth because they say they are only paid enough to treat patients with a good dental health record. One surgery admitted that people who have not had a dental appointment for three years will be refused treatment. Others are employing more subtle methods to reject patients.

Dentists' leaders say the NHS dental contract, introduced in April last year, has had a perverse effect because dentists earn the same for giving a patient one filling or 10. The Oakwood Dental Centre in Derby, for instance, says on Derby City Primary Care Trust's website that it "will only accept patients who have visited a dental surgery within the last three years". Aneu Sood, who runs the practice, said it had no time to treat those who "need a tremendous amount of work".

According to dentists' leaders, potentially unprofitable patients are screened out by giving preference to those patients who have recently been dropped by an NHS practice which has gone private. This sort of patient is likely to have had recent and regular treatment and therefore is unlikely to need extensive new surgery. Dentists will also take on the relatives of existing patients with healthy teeth in the expectation that family members will need little treatment as well.

Source

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

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

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28 May, 2007

Don't get mesothelioma in England

Excerpts from a doctor who was recently diagnosed as having it. It is cancer of the lungs, most usually caused by high levels of asbestos fibre inhalation

Mesothelioma is a rare form of cancer and, until recently, there was little to offer in the way of treatment. Treatments are available now, but as ever in parts of the UK the drug that is used as a frontline treatment is not available on the NHS.

This is because for each year of (quality-adjusted) life it brings it costs too much, more than 30,000 pounds. Diagnosed with a mesothelioma in Scotland, Australia and many European countries, you will receive the drug - but not in England. Nice (which should perhaps stand for the National Institute for Curtailing Expenditure rather than the National Institute for Clinical Excellence) has made a ruling on cost-effectiveness grounds that the only drug that has been shown to have effectiveness, albeit of a limited nature, will not be available.

There is nothing intrinsically wrong with limiting treatment on cost grounds, but we need to be honest and open that that is what we are doing. It might seem reasonable to limit how much might be spent but I am not at death's door yet, nor are many mesothelioma sufferers. Politicians will often come out with the old chestnut, "you cannot put a price on life", well, they do put a price on it. In my case, a year is not worth spending more than 30,000.

Patricia Hewitt, my boss, has said: "A modern health and social care system has to be completely focused on the needs of its users," and "We are trying to find out what patients need, rather than what it suits us to provide." There are many sufferers from mesothelioma out there, Mrs Hewitt, who have justifiable healthcare needs and who will not be provided with drugs which may prolong their lives because it suits you not to provide it on cost grounds. I do not think they feel completely focused on. Mind you, 30,000 is a lot of money to waste on a very sick person. You could, for example, employ for nearly a year a "senior parenting practitioner" in the London borough of Tower Hamlets.

I have gone from highly strung (for no good reason, now I think of it) consultant, father and husband into highly strung (now with a good reason) patient, father and husband. I can string a few words together when the fatigue, nausea and sleep deprivation are not so bad. I have not suffered badly from the chemo-therapy, but for some it must be like seasickness. There is a period when you think you are going to die followed by a period when you wish you were.

It is good for medics to be on the other side, you appreciate the good and spot the bad. I have liked the internet as a source of medical information for many years. It empowers patients to ask questions that encourage doctors to explain more fully. However, it cannot answer all the questions. You may not discover all that you do not know and sadly, some of the stuff you find may not be helpful.

Being a pain specialist, I looked at the pain management section of a leading university unit dealing with mesothelioma. Big mistake - I know pain is a major problem in mesothelioma and I know that resources allocated to it are inadequate. What I was not prepared for was facing the issue from the other side. By the end of my reading, I felt like looking for the weblink that would allow me for $39.99 - a special offer - to have a loaded 9mm Browning delivered to my door.

Reading one paper I felt angry that an expert had been blunt to the point of callousness. We need to care for patients, as well as treat them. Caring involves giving information in a sensitive fashion, not "click on here" to find out just how bad it can get. My esteemed colleague who, at the beginning of a presentation on mesothelioma had a slide which showed a photograph of the "shit creek paddle shop", should realise that it is accessible from the internet.

Source

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

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

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27 May, 2007

BRITISH BUCKPASSING KILLS WOMAN

Gordon Brown, the Prime Minister-in-waiting, said today that the NHS had to "be there for people when they need it" after a damning report on the death of a woman who was forced to consult eight out-of-hours GPs in four days over an Easter weekend. Penny Campbell, a 41-year-old journalist and mother, died in March 2005 from multiple organ failure. She had become infected with septicaemia during an operation for haemorrhoids but none of the doctors she spoke to or met diagnosed it. A report by a panel of independent investigators published today found that the actions of at least one of the GPs, together with problems in how the out-of-hours service was run, meant that she was not offered appropriate care.

Camidoc, a private company contracted to provide out-of-hours cover, had no procedures to ensure that notes on patients were easily available to all GPs, so that each time she rang for help they treated her as a new patient. This was a "major system failure" and was a direct factor leading to Miss Campbell’s death, the report said. Ms Campbell's partner, Angus McKinnon, said today that he was convinced that a similar tragedy could happen again. "I’ve had dozens of people contact me, cases where people had really narrow escapes," he said.

Mr Brown was asked about the case at a South London school and said that the Health Service had to "do better". "What I’ve been talking about is how we can extend the range of facilities for healthcare at the weekends and out of hours," he said. "So we need more access to doctors, we need walk-in centres, we need local healthcare centres to be more effective, we need NHS Direct to be working. "And we need pharmacies, interestingly enough, to have more ability to, for example, do blood tests and some of the basic things where you can just walk in off the street and get some of the basic tests done. And we need prescriptions to be translated to people, directly to the chemist, in a way that you don’t have to queue up at the doctor’s for a repeat prescription. "So in all these areas we need more access for patients. The health service has got to be there for people when they need it and we need to do better in the future."

But Mr Brown's intervention was scorned by the Tories. “It is odd that Gordon Brown should now realise that GP cover needs to be improved," said Andrew Lansley, the Shadow Health Secretary. “Just three years ago he allowed a new GP contract to go ahead, which doubled the costs of providing out-of-hours care and led to worsening services for patients.

Today’s report identified weaknesses in the arrangements for out-of-hours care. Responsibility for providing the care passed from individual GPs to Primary Care Trusts in 2004 when the new GPs' contract came in. The report criticises the speed at which the change was implemented, and urges the Department of Health to provide a clear definition of the role of out-of-hours care.

Ms Campbell, from Islington, North London, was diagnosed with various conditions by the GPs, including colic, flu and viral infections, an inquest heard last year. The coroner ruled that the doctors contributed to Miss Campbell’s death because they failed to recognise the seriousness of her condition. All eight doctors voluntarily stepped down from out-of-hours care while the investigation into her death was carried out - although they continue to work as GPs.

Today’s report said that six GPs provided Miss Campbell with a "reasonable standard" of care but one, named as Dr Chuah, did not adequately explore her symptoms to see if she had an acute illness. Dr Chuah failed to offer Miss Campbell a reasonable standard of care during an 11-minute call at 4.50am on Monday, March 28, the day before her death. A transcript of their conversation shows that, when she checked with him that it was "not anything serious", he replied that if it was more serious, she would be a lot more sick and "wouldn’t be talking to me like this".

It adds: "Reviewing this transcript, it is apparent that Penny Campbell was articulate and coherent. In the course of the conversation she describes her symptoms quite clearly. "It is also evident that Dr Chuah did not pick up the cues offered by her or further explore any of these symptoms to clearly and definitely exclude any serious pathology that could have accounted for these symptoms."

The investigation found that the care offered by an eighth GP, Dr Bengi Beyzade, could not be adequately assessed in retrospect. Camidoc has said the six cleared of wrongdoing will be able to work again for them following a review. Dr Beyzade and Dr Chuah would have to go through a much more rigorous process involving a performance review with their PCT if they wished to return to work, it said.

Mr MacKinnon, 40, said the fact that the two doctors may be able to work again showed a "total lack of accountability" and was indicative of a wider problem regarding the work of doctors. "To get justice where doctors have performed unprofessionally, to get justice for the victims of their incompetence, you have to sue them. That’s a broader problem within our health system," he said. "Dr Chuah should be struck off." Mr MacKinnon plans to write to the General Medical Council (GMC) about the conduct of four of the doctors. He is also pursuing civil action over the case.

Islington Primary Care Trust (PCT), which commissions Camidoc’s services, issued a statement today extending its sympathy to Ms Campbell's family and admitting failings in her care.

Today’s report says the system of "safety netting" - where Miss Campbell was told to call back if she did not recover - was "seriously flawed". Each of her calls to doctors were treated as an individual "episode", with Miss Campbell having to recount her symptoms again and again. Although Camidoc had put in place methods to transfer to a computerised records system, it failed to address existing risks and take steps to overcome the problems. The report says that Camidoc was unprepared for its shift to a major out-of-hours provider of care. It also criticises Camidoc’s lack of process for driving up standards, saying that the systems for ensuring clinical governance was in place were not fit for purpose.

The system of out-of-hours care in England has been much criticised, with a recent study from the Public Accounts Committee saying that the Government thoroughly mishandled its introduction. Prior to 2004, out-of-hours care was managed by GPs but this was handed over to PCTs as a result of the new GP contract.

Mr MacKinnon backed those criticisms today. "If Tesco can open till midnight every night, why can’t our GPs open till midnight every night?" he said. "The National Audit Office said last year that the reform of out-of-hours has been incredibly expensive - it’s massively over-budget - so if they had spent a little less money on doubling doctors’ wages they would be able to afford better night-time and weekend care." Ms Campbell had a son, Joseph, who was 6 at the time of her death.

Source




Huge public hospital cutbacks in Tasmania

They're learning from Britain's shambling NHS -- trying to disguise cutbacks as specialization

A SWEEPING shake-up of Tasmania's health services was announced yesterday -- with Health Minister Lara Giddings declaring: "We don't have a choice here." Among major changes is a move to immediately turn the Mersey Hospital at Latrobe into an elective day surgery hospital designed to cut waiting lists around the state. In other major plans, more patients will need to travel to either the Royal Hobart Hospital or Launceston General Hospital for specialist surgery or to dedicated disease-treatment units. But a significant slice of the new reforms is also aimed at keeping Tasmanians out of hospitals, with a heightened focus on the prevention of chronic diseases such as heart disease and diabetes, both linked to ageing and lifestyle.

Launching the new Future Health blueprint, Ms Giddings said Tasmania's hospitals -- and the health budget -- would be swamped unless individuals and communities made better decisions about their lifestyles and health. She said it was not acceptable that Tasmanians did not live as long as other Australians, had higher rates of illness and disease, smoked more, exercised less and waited longer for health services. More worryingly, despite the health budget increasing by 78 per cent over the past eight years to more than $1.2 billion a year, the health status of Tasmanians and health service delivery indicators have remained worse than elsewhere. "If throwing money at the problem has not solved it, we have to ask what else needs to be done," Ms Giddings said. "The health system of the past has been a victim of politicking, ad-hoc decision-making and parochialism. We must change that (even though) I recognise some Tasmanians will be upset."

The response of the State Government, following advice from highly regarded Victorian health planner Dr Heather Wellington, has been to reform the entire structure and way Tasmanians will access health services and hospitals over the next 10 to 15 years. The Mersey Hospital will lose its crisis and acute care capabilities [REDUCING capabilities is a great way to increase already-scarce services???] to become a specialist elective day surgery hospital, with some added maternity and rehabilitation services. The North-West Regional Hospital at Burnie will become the only acute and emergency surgery hospital serving the North-West and West Coast.

However, the Mersey Hospital will keep open a 24-hour emergency reception area to stabilise or resuscitate patients needing urgent attention -- such as heart attack or stroke victims from Devonport or anyone involved in a serious car crash -- before they are sent to Burnie or Launceston by ambulance.

Australian Nursing Federation state secretary Neroli Ellis welcomed the plan but said it had severe implications for nurses, especially at the Mersey Hospital. She said many nurses, who have an average age of 51, would consider early retirement rather than stay for the transition of the Mersey to Tasmania's first dedicated elective surgery centre. "Retention is going to be a huge issue," she said, adding specialist nurses at Latrobe might not want to travel to Burnie or Launceston to continue their career paths.

In other major moves, Rosebery Hospital, in the centre of the West Coast mining district, will no longer be staffed by a doctor Another great improvement???] and nurse 24 hours a day. The small rural hospital at Ouse in the Upper Derwent Valley will no longer have a permanent doctor and will be turned into an aged and respite care and community health centre.

Ms Giddings denied the reforms were all about "cutting and gutting". "We don't have a choice here; we just don't have the staff, the people to keep the system going as it is," she said. To take pressure off the three large hospitals and to better integrate health services around the state, at least four major "one-stop" Integrated Care Centres will be built in central Hobart, in Sorell or on Hobart's Eastern Shore, at Kingston and in Launceston.

These new major community medical centres will provide health services that do not require hospitalisation or emergency treatment, such as dialysis, chemotherapy, some day-surgery procedures and regular wound dressing or medical treatments. But there is no new funding for the Government's bold Future Health plan or any new staff resources.

Ms Giddings believes that with less duplication of services, better clarity of roles and more co-operation within the health system, more staff will not be needed and that the number of locums can also be reduced. Timelines for the new changes are also vague, apart from the immediate downgrading of services at the Mersey Hospital......

Source

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

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

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26 May, 2007

Dumbing down Britain's doctors

The collapse of Britain's online Medical Training Application Service (MTAS) has been widely welcomed. The web-based system was designed to match junior doctors to specialist training posts, but following junior doctors' complaints about a lack of available posts, poorly designed recruitment forms and technical failures in the new online system, it has now been scrapped. However, the real threat to standards of medical practice - and ultimately patient care - comes from the Modernising Medical Careers programme, of which MTAS is merely one aspect.

`If one of my own children had been in that position', UK health secretary Patricia Hewitt told Channel 4 News on the day she finally suspended MTAS, she would have fully shared the distress of the parents of those affected by the series of scandals afflicting the new computerised application system for specialist medical training (1). This curious presentation of the issue from a parental perspective is echoed on the website of RemedyUK, the grassroots organisation of junior doctors that has led the revolt against MTAS, staging unprecedented mass demonstrations in March (2). The site prominently displays a colourful poster proclaiming `Mums4Medics' (with subsidiary slogans, `Dads4Medics', `Partners4Medics', `Everyone4Medics').

By the time they have completed five or six years of medical school and two years of the new post-qualification `foundation programme', the youngest of the doctors applying to MTAS is 25 and many are over 30. Yet it seems that these `junior' doctors are regarded by the health minister as children and that they even regard themselves in similar terms. The infantilisation of doctors implicit in these representations reflects the real threat to the medical profession and to the quality of medical practice posed by the current wave of `modernising' reforms.

Hewitt was quick to emphasise that, though doctors are angry about MTAS, the `underlying principles of Modernising Medical Careers' are widely accepted by both junior doctors and the professional bodies that have been closely involved in the development and implementation of this programme. Before looking more closely at Modernising Medical Careers (MMC), let's briefly look at the MTAS fiasco.

In many respects MTAS is just another National Health Service IT failure: an online system that is vastly expensive, badly designed, difficult to use and which crashes frequently. When the system made publicly available doctors' personal details, including religion, sexual orientation and criminal records, this was more than a breach of confidentiality. It raised questions over why a medical appointment scheme should require that candidates submit such information. Though it is these failures that have led to the collapse of MTAS, its defects go much deeper.

In its modernising zeal, MTAS gives priority to doctors' subjective `learning experiences' and downplays objective indicators of performance. It allocates 75 per cent of its points to 150-word vignettes of clinical cases, in which doctors display fashionable concerns about `reflexive learning', `team-working' and ethical dilemmas. According to critics this amounts to meaningless self-promotion as well as being open to plagiarism (which the system lacks the software to detect). Only 25 per cent of points are allocated to academic or research achievements. Extracurricular activities are marginalised, references sidelined and interviews rigidly standardised.

The elite Academy of Medical Sciences has condemned MTAS for its discrimination against talent and excellence, as `a threat to UK biomedical research and healthcare' (3). For the Academy, MTAS reflects `a mindset in which academic, educational and research achievement are seen as almost irrelevant to the future quality of healthcare'.

It is true that the old system of selection for specialist training posts was susceptible to nepotism, favouritism and discrimination against those from ethnic or other minorities. It is New Labour's signal achievement, in this as in many areas, to have replaced a corrupt and inefficient system with one that is potentially more corrupt and certainly more inefficient - and even more damaging to the morale and standards of the medical profession.

The spirit of political correctness that imbues MTAS has already established deep roots in the modern medical profession. These can be traced back to the adoption by the General Medical Council in 1993 of the document Tomorrow's Doctors, which outlined the `goals and objectives' of a new medical curriculum under the rubric `knowledge, skills and attitudes' (4). While `knowledge' was reduced to a `factual quantum', extensive and detailed attitudinal objectives `reflected the values of the culture of therapy and the demands of political correctness' (5). Launched in 2004, Modernising Medical Careers sought to extend the approach of Tomorrow's Doctors from the medical school into the world of post-graduate medical practice, in hospital and in primary care (6).

The first major MMC initiative was the replacement in 2005 of the traditional year doctors spent as `house officers' in hospitals immediately after qualification with a two-year `foundation programme' (part of which could be completed in General Practice). There can be no doubt that the old system had many flaws: many young doctors were exploited by absentee consultants, obliged to work excessive hours and received minimal supervision or training (to the detriment of both themselves and their patients). The foundation programme sought to replace the old `apprenticeship' model - celebrated in the surgical saying `see one, do one, teach one' - with a closely supervised programme of instruction in the attitudes and values deemed appropriate for the modernised doctor.

The new programme is `trainee-centred, competency-assessed, service-based, quality-assured, flexible, coached, structured and streamlined'; it is managed and structured, progressive, robust and seamless; it is `outcome-based' and evaluates `observed behaviour, skills and attributes'. No doubt some of this jargon conceals valuable educational and clinical activity, but it is difficult to believe that all the ticking of boxes reflects any improvement in the rigour of medical training. What remains unquantified in this system is the quality of doctors' clinical knowledge and their experience of taking responsibility in treating and caring for patients.

The 1858 Medical Act, which is established the General Medical Council, sought to establish a system of medical education that produced a doctor who, on qualification, was a `safe general practitioner'. This concept of an independent and competent general practitioner symbolised the confidence of the modern medical profession at the moment of its emergence in the nineteenth century. By contrast, the `never quite competent' doctor, one who requires continuous formal instruction and regulation, monitoring and mentoring, support and counselling, symbolises the abject state of the profession in the new millennium. While the junior hospital doctor of the past may have been used and abused, today's doctors appear to have lost all initiative or autonomy in relation to their own professional development and in relation to their patients. If tomorrow's doctors are reduced to the status of children, to be patronised by politicians and parents, as well as by their trainers and tutors, the future of the medical profession is in jeopardy.

For the Academy of Medical Sciences, MTAS is `an object lesson in what happens when we take medical education out of the hands of those who value objective academic achievement and put it in the hands of those who wish to create a uniform and biddable workforce unencumbered by the spirit of inquiry needed to challenge dogma and central directives'. The consequences of this lesson are not confined to MTAS, but go back through MMC to Tomorrow's Doctors, and the wider framework of medical education and training established over the past decade.

Source




Australia: The Melbourne medical meltdown continues

Gran dies after sent home alone

A GREAT-grandmother died alone hours after she was discharged from a Melbourne hospital and shuttled home in a taxi wearing just a nightgown. Ann Barbara Pitt, 91, died from heart disease on April 3 after she was sent packing from the Royal Melbourne Hospital where she had been admitted 12 days earlier for a tissue infection. Ms Pitt's distraught daughter Judy Liddy found her in a pool of blood on the floor of her Coburg home 15 hours after the discharge.

Ms Liddy will lodge a formal complaint with the Health Services Commissioner over the case, which comes amid rising concern about discharge quotas at the hospital. "I felt her shoulder and it was so cold I knew she'd been dead for ages," Ms Liddy said. "I'll never get over it as long as I live. "It haunts me every day and every night."

Health Minister Bronwyn Pike has been under mounting pressure since revelations the Royal Melbourne had imposed discharge quotas to achieve cash bonuses under the Government's hospital funding scheme. Documents show it aimed to discharge about 490 patients between mid-May and July to qualify for the extra cash.

Ms Liddy said the hospital had given her just one hour's notice of its decision to eject her mum at 5.30pm on April 2. "I don't believe she was well enough to be home," she said. Ms Pitt had suffered cellulitis, a condition that commonly affects the elderly or those with weak immune systems. It can be caused by infection, which medical experts say can put extra stress on the body including the heart. A coronial report cites coronary heart disease as the official cause of death. The autopsy attributes the blood loss to a fall, Ms Liddy believes.

Ms Liddy agreed to have her mother sent home by taxi - which she paid for - because she did not have enough time to make other arrangements. She hurried to meet her mother at home and found that she had been sent home without her purse. After helping her resettle, Ms Liddy set out to find the missing valuables. She returned the following day about 10.15am to find her mother dead in the hallway. "I ran out into the street screaming for help," Ms Liddy said.

She complained about the discharge, but the hospital said it could not respond because the case was before the coroner at the time. It said it could not find Ms Pitt's missing purse, but weeks later returned the item, which had been found in a stationery cupboard, Ms Liddy said.

The Health Services Commissioner is assessing Ms Liddy's complaint. Complaints to the commissioner increased eight per cent last quarter. About 62 per cent of complaints accepted for assessment relate to treatment procedures, including misdiagnosis, negligence and inadequate treatment. A Royal Melbourne Hospital spokeswoman extended condolences to the family and said patients were discharged only when clinicians deemed them ready.

Source

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

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

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25 May, 2007

Health Care's Godmother

Review of: "Who Killed Health Care?: America's $2 Trillion Medical Problem -- and the Consumer-Driven Cure" by Regina Herzlinger

Try to imagine health care as a police lineup, with the patient behind the one-way mirror, trying to pick out the suspect. The lineup includes big hospitals, employers, big insurance companies, health care academics and government. When asked which of the suspects killed health care, the patient points to all of them.

That is a good metaphor for what Regina Herzlinger does in her new book, Who Killed Health Care? The Harvard Business School Professor who is often described as the godmother of consumer-driven health care takes no prisoners in this tour-de-force of how our health care system became an unadulterated mess. In the end, Herzlinger will probably have few allies left among those who have a vested interest in the current system. Yet, should her vision become the one that guides health care reform, everyone who is a health care consumer will owe her a debt of gratitude.

Herzlinger was an early critic of "managed care," the theory that gave us insurance companies like health maintenance organizations (HMOs), which act as gatekeepers for patients' use of medical care. While many people think that HMOs are the result of private sector insurance, Who Killed Health Care? points out that they actually came to prominence due to the HMO Act of 1973. With an economy facing rising health care costs in the early 1970s, President Richard Nixon turned to HMOs to hold costs down. His HMO Act required employers who offered insurance to offer at least one managed care product. It also offered subsidies to companies that opened HMOs.

Employers liked managed care because, initially, HMOs seemed to control health insurance costs. They liked managed care so much that they narrowed the insurance choices of employees to the point that by 2005 almost all employers were offering only one type of insurance plan. Big insurers liked managed care because it meant that they would make money by not paying for medical care. Academics (most notably, systems analyst Alain Enthoven) loved managed care too. They touted the example of Kaiser Permanente as how health care should be managed. But what was best about managed care from their perspective was that it put academics at the forefront of evaluating medical treatment. Academics became dedicated to techniques such as disease management that put them in the powerful position of telling doctors how to treat patients.

Indeed, the only ones to not make out on managed care were patients and doctors. Patients loathed the restrictive nature of HMOs, to the point that eventually HMOs were replaced by managed care organizations like Preferred Provider Organizations that put fewer restrictions on patient access and choice. Under managed care, doctors are pressured to conform to managed care organizations' disease management advice. Academics frequently complain of doctors' low compliance with such advice. However, it may be that the doctors, and not the academics, know what they are doing. As Herzlinger notes, "There is no accepted evidence of the cost effectiveness of disease management." In the end, we are left us with a system of paying for Medical Care that offers few insurance choices for consumers and tries to second-guess decisions best left to patients and doctors.

The suspects are still at it. For example, big hospitals are trying to regulate specialty hospitals out of business. "The hospital industry," notes Herzlinger, "sensing correctly that this is an innovation that could really do it in, has gone to all-out war against the specialty sector." The hospital industry convinced Congress to include an 18-month ban on the opening of new specialty hospitals as part of the 2003 Medicare prescription drug bill. The true loser in this fight is the health-care consumer, as specialty hospitals often give better treatment for lower cost than traditional hospitals. Also well worth mentioning is Herzlinger's case study of how badly government has, through Medicare, mismanaged the treatment of kidney disease. It is a frightening glimpse at what a single-payer system would look like in the U.S.

Herzlinger concludes her book by outlining a compelling plan so that we can achieve the health care system that we deserve. First, we should put the tax treatment of health insurance on an equal footing so that those who do not receive their insurance through an employer also get a tax break. Second, we need to deregulate so that entrepreneurialism can flourish in the health care sector -- laws that hinder physician ownership of medical facilities are one such example. Government's role should be very limited, only helping to pay for the insurance of people who cannot afford it, and regulating health care information, much like the Securities and Exchange Commission does with financial markets. The only one of Herzlinger's suggestion that would likely prove counterproductive is her call for an individual mandate to require everyone to purchase health insurance. This is already proving problematic in Massachusetts, leading to even more government involvement in health care.

Otherwise, Who Killed Health Care? is a book that all of those who favor more freedom in our health care system should pick up. As Herzlinger notes, the importance of transforming our health care system into one run by free markets can't be overstated:

"A system controlled by the insurance companies or hospitals or government will kill us financially and medically -- it will ruin our economy, deny us the health care services we need, and undermine the importance of genomic research that can fundamentally improve the practice of medicine and control its costs."

Source




Yet more cutbacks for already-overstretched NHS maternity wards

Almost one in three maternity units in England could close because of expected cuts in doctors' working hours, the Conservative Party claims. Figures released yesterday suggest that 50 out of 176 consultant-led maternity units across the country are under threat of being downgraded or closed if guidance being used in some NHS trusts is applied nationally. Patricia Hewitt, the Health Secretary, has admitted that the number of units staffed by doctors could be cut under European rules to limit the hours doctors spend on wards.

The European Working Time Directive is set to reduce the number of hours doctors spend on wards to 48 hours a week by August 2009. The changes could lead to a reduced number of consultant-led maternity units because of a lack of staff.

Maternity units in Manchester, Teesside and other parts of the country have already been earmarked for radical overhauls, and more home births and deliveries in local units staffed by midwives are expected as a result. But the plans are proving hugely unpopular, even though they have been promoted as being in the interests of patients and NHS staff. They could mean that mothers and babies at risk of complications during delivery will have to travel farther to receive specialist care rather than transferring to the nearest hospital.

The Conservatives' estimates are based on a report issued in February by Sheila Shribman, the Government's maternity supervisor, which explained cuts to services in West Yorkshire. Two units at the Calderdale and Huddersfield NHS Foundation Trust each catered for about 2,500 births a year but, on their own, neither was big enough to justify the spend needed to retain specialist skills, she said. The average consultant-led unit currently delivers an estimated 1,800 babies a year.

The Tories suggest that if other trusts across England took Ms Shribman's recommendations as a guide, up to one in three units would close. Other guidance being circulated by NHS organisations in the East of England in turn suggests that maternity units need to deliver at least 3,000 or even 4,000 births a year to be viable.

The Tories called on the Government to delay the implementation of the European Working Time Directive in order to forestall cuts. Addressing the annual conference of the Royal College of Midwives in Brighton, Ms Hewitt said that recommendations for the potential closure of services in Manchester, for example, were "quite difficult and unpopular" but were good for babies and mothers.

Ms Shribman said yesterday that every major city and most rural communities in the country would have to consider the future of local maternity services in the light of the Working Time Directive. But she denied that there was a "one size fits all" figure for the number of births a unit had that could be applied to justify closures across England.

Source

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

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

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24 May, 2007

MEDICAID SOCIALIZES HEALTH CARE

Roughly a quarter of all taxpayer spending at the state level is now on socialized medicine in all but name. It's the largest single spending budget item in many a state capitol, says Jack Markowitz in the Pittsburgh Tribune-Review. In Texas, for example:

* Medicaid costs have doubled in the last decade and the program now covers 2.7 million people.

* The program now costs $17 billion and accounts for 26 percent of the state budget, including $6.7 billion in state funds and $10.5 billion in federal funds.

Nationally, it's not any better says Markowitz:

* In generous states, you could earn triple the poverty level, $61,332 for a family of four, and still be eligible.

* About 53 million people are covered, better than one out of six, and counting.

* Meanwhile, the total projected cost this year will be about typical, inflating another 6 percent, to $336 billion.

The program's original intent wasn't of the sort that's easy to attack. But states have tended to expand the eligibility, says Markowitz. Restricting it just to the poor lets out so many people who could use a break, elected officials figure. And ti doesn't bring in the max in matching funds from Uncle Sam, which can range as high as $3 for every $1 locally taxed.

Source




At last the NHS does something sensible

The NHS is turning its back on homoeopathy and other unproven alternative medicines in the face of a financial crisis and pressure from doctors. More than half of the primary care trusts (PCTs) in England are now refusing to pay for homoeopathy or severely restricting access a year after The Times revealed that 13 senior doctors had urged them to fund only therapies that were backed up by scientific evidence.

Figures obtained by Les Rose, one of the doctors, and The Times under the Freedom of Information Act show that at least 86 of the 147 trusts have either stopped sending patients to the four homoeopathic hospitals, or are introducing strict measures to limit referrals. Another 40 trusts have yet to provide data. More than 20 have taken action since receiving a letter organised a year ago today by Professor Michael Baum, a cancer specialist at University College London, which argued that "unproven or disproved treatments" such as homoeopathy and reflexology ought not to be available free to patients. The NHS should not be funding such therapies while it had to refuse or ration access to effective cancer drugs such as Herceptin and Velcade, the authors said. Financial issues have also contributed to the trend. The NHS overspent by œ547 million in 2005-06 and many trusts have made savings on homoeopathy to avoid cuts.

The move away from homoeopathy has been so significant that two homoeopathic hospitals are threatened with closure. West Kent PCT is consulting over plans to shut Tunbridge Wells Homoeopathic Hospital and the Royal London Homoeopathic Hospital (RLHH) has asked supporters to lobby trusts and MPs. London trusts have been particularly tough, partly as they have had to reduce some of the largest deficits in the country. Six trusts, including some of the RLHH's most important financial backers such as Barnet and Islington, have introduced referral management systems that will restrict spending. At least ten more from London and southeast England have cancelled their contracts.

Homoeopathy involves treating patients with substances that have been diluted so many times that there is often no active ingredient left. It is popular with members of the Royal Family but derided by most scientists. Research suggests that it has no benefits beyond being a placebo.

Doctors behind the original letter sent a second document to PCTs yesterday, providing a sample commissioning paper that many trusts have used to reduce homoeopathy funding. Gustav Born, Emeritus Professor of Pharmacology at King's College London, its lead author, said: "Progress has been slower than we'd like and there are still trusts that continue to use these unproven remedies through clinics and prescriptions. That is why we have written again to all the PCTs urging them to follow the commissioning example set by others."

Hilary Pickles, director of public health at Hillington PCT, said: "It isn't just that there is no evidence base for homoeopathy; it is also a question of spending priorities. Every time you decide to spend NHS money on one thing, something else is losing out. It is completely inappropriate to spend money on homoeopathy that is unproven, as it means less money for other treatments that are known to be effective."

One person who could benefit from a switch is Anne Fleming, 58, who had multiple myeloma diagnosed 2« years ago. She has been told that she will need treatment with Velcade, an anticancer drug that costs up to œ25,000 for eight cycles. Her primary care trust in South Cambridgeshire has diverted funds from homoeopathy to conventional medicine. She said that the NHS should also abandon non-essential treatments. "I feel very strongly about using public money on tattoo removal. Things on the national health should be about life or death," she said.

Source

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

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

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23 May, 2007

Allergy patients 'failed by NHS'

GPs and pharmacists do not know enough about allergies, putting patients lives at risk, campaigners say. Allergy UK said training on the subject was extremely limited and many people were going undiagnosed. And the pressure group said even when diagnoses were made, medics often had nowhere to send patients as there were limited specialist allergy clinics.

GPs agree it is an issue that needs to be addressed, but pharmacists argue they already receive enough training. Allergic reactions are caused by substances in the environment known as allergens, of which the most common are pollen from trees and grasses, house dust mites, wasps, bees and food such as milk and eggs.

The number of people suffering allergic reactions has been rising over the last 15 years with over 6,000 people a year in England admitted to hospital. A quarter of these involve anaphylaxis - a sudden, severe and potentially life-threatening reaction, which can cause dangerous swelling of the lips or face and lead to breathing problems.

After listening to the hundreds of people contacting them, Allergy UK believes doctors and pharmacists are too slow to pick up allergies, leaving people vulnerable to severe reactions. A spokeswoman said: "Doctors and other health professionals get little training about dealing with allergies. "It means patients are being put at risk."

The charity also criticised the lack of specialist allergy clinics. Many hospitals have some kind of service, but there are just six clinics in the country which deal with all types of allergy. The charity is planning to launch a website for health professionals giving information about allergies and the common symptoms. They are also offering training on allergies.

Professor Mayur Lakhani, chairman of the Royal College of GPs, said: "Allergies must be taken seriously and we would like to see a stronger emphasis on training in allergies in both undergraduate and postgraduate medical training. "At the moment we don't have the facilities to adequately investigate, manage and treat patients with allergies and we would like to see a programme of national action implemented in primary care."

But the Royal Pharmaceutical Society of Great Britain rejected the idea that pharmacists were not trained enough. A spokeswoman said: "Pharmacists receive five years education and training, a large focus of which is on allergy."

Source




Now this is REAL socialized medicine

What REALLY bad service does -- even to the patient and peacable Chinese:

Doctors and nurses at a hospital in eastern China have told its administrators they will use police truncheons and wear helmets as a protection from attacks by angry patients. Staff at No. 1 People's Hospital, in Zhenjiang, Jiangsu province, also asked for 24-hour security guards and cameras after a spate of assaults that led to injuries and a number of resignations, the Beijing Youth Daily reported yesterday. "Until effective measures are taken to ensure their protection, doctors and nurses will attend work with helmets and police truncheons for use in self-defence," the paper quoted a staff notice given to the hospital's directors as saying.

Medical staff were suffering frequent attacks at work from patients and their relatives, ranging from cursing and death threats to serious beatings. The Health Ministry recorded about 10,000 attacks on hospital staff stemming from patient disputes last year, the China Daily reported. In December doctors and nurses at Shanxia hospital, in Shenzhen, Guangdong province, were forced to wear hard hats on their rounds after being jostled and spat at for days by relatives seeking compensation over a patient's death.

The Health Ministry last week called for police to patrol hospitals to protect staff and ensure a "harmonious" medical environment. "Harmonious society" is a catchphrase of the President, Hu Jintao, for easing tensions fuelled by corruption and a widening wealth gap.

Source




CONSTANT CUTBACKS ARE THE HALLMAREKS OF THE NHS BUT IT HAPPENS IN AUSTRALIA TOO

Two reports below from the Australian State of Victoria:

Patients booted out of Melbourne public hospital

SICK elderly patients will be among hundreds ejected from the Royal Melbourne Hospital in a management bid for government-sanctioned performance bonuses. Documents seen by the Herald Sun reveal the hospital is planning to discharge one patient from selected units by 10am each day for the next seven weeks. Up to 490 patients, including those from the acute geriatric medicine unit, will be discharged as the financial year draws to a close. Health Minister Bronwyn Pike says the practice is common in Victoria and overseas.

The documents, which describe patients as "system blockages", also reveal elderly patients are among the 65 per cent made to wait more than eight hours for admission. In an email to senior staff, the director of the hospital's division of medicine, Tony Snell, says the discharge tactic aims to secure bonus funding under a Department of Human Services performance scheme. "The aim is to get a significant amount of the available bonus pool funding," Dr Snell writes. "We seek your support in achieving these improvements in patient care (i.e., less delay in the emergency department), which will also improve our budget situation. "In order to achieve this we are targeting the key performance indicators of length of stay in the emergency department and waiting list reduction."

Ms Pike, who says she has not seen the email, backs the practice. "We want to make sure we don't have people on a bed with a suitcase packed waiting for the hospital to get the paperwork right, or that the patient has their medication with them," she says. "I fully support setting targets for the units, because it's saying to them this is best practice." Asked whether she would encourage other hospitals to set similar standards, Ms Pike says: "I know they already are and I'm very pleased. "Anyone who would suggest this is compromising patient care is insulting the doctors and nurses who work in the system."

A Royal Melbourne spokeswoman yesterday insisted patients would not be sent home before they were ready. "It's really just asking doctors to do their rounds earlier in the morning," she said. The spokeswoman said about a third of the 170 patients presented to the emergency department each day required hospital admission. The email says that in previous years, patients have had to wait 24 hours in the emergency department before admission. It says that 64 per cent of patients are admitted from the emergency department within eight hours. But last month, in the medical division, only 35 per cent were admitted within that time frame. "To improve this we need to increase morning bed capacity and move out patients more quickly from the emergency department," Dr Snell writes. "We are aiming to have at least one patient per unit discharged by 10am." Dr Snell and another staffer would also audit patients who had remained in hospital for longer than a fortnight to see where they could assist in removing blockages in the system.

A second email from a senior staffer orders that patients identified for discharge be moved to the transit lounge and vacant beds be filled immediately. The hospital's division of medicine has 10 units, which include acute geriatrics, haematology and diabetes.

Opposition health spokeswoman Helen Shardey says the Royal Melbourne had suffered a drastic bed shortage. "The funding is not coming in on a sustainable basis, so the hospitals are having to play these games all the time," Ms Shardey says. Latest figures reveal there were 2872 patients on the Royal Melbourne's elective surgery waiting list in December last year, up 100 in six months

Source




Reduced surgery in another Melbourne public hospital

SICK children and pregnant women will be denied surgery at a major Melbourne hospital next week. Monash Medical Centre has slashed its elective surgery list as the financial year draws to a close. Doctors believe the move is aimed at cutting costs but Monash insists it is part of normal scheduling.

Theatre schedules seen by the Herald Sun reveal a blackout on pediatric, obstetric and vascular surgery for the week beginning May 28. A high-level health care source said patients continued to wait for elective operations at Monash despite beds and doctors being available. "The surgeons are there with nothing to do," the source said. "It happens regularly and usually in the last quarter of the financial year. "It's because they've got their bucket of money for the year and now they're running out and it costs them money to push (patients) through."

Specialists were angered by the blackout. "It was believed to be due to the fact that it was a funding constraint," the source said. "It was implicit and it wasn't well received by the people who were affected."

A spokesman for Southern Health, which manages the Monash Medical Centre, said next week's surgery blackout was necessary due to an anaesthetists' conference. A spokesman for Health Minister Bronwyn Pike said emergency surgery would continue. "It's not related to funding," he said. There were 1767 people waiting for elective surgery at Monash at last count, in December.

The row at Monash came as Ms Pike defended Royal Melbourne Hospital's decision to discharge at least one patient from selected units each day until July. The Herald Sun yesterday revealed the directive, which was contained in an email that also described patients as "system blockages".

One patient who doesn't want an early release is Harry Tsogias, 40, who said yesterday he had been wrongly sent home once before. Rushed to Royal Melbourne's emergency department on April 14, unable to walk and in extreme pain, Mr Tsogias was diagnosed with sciatic pain in his right leg and discharged a few hours later. "I couldn't walk. It was so sore I was in tears," he said. "I was in a lot of pain and I was sent home." On May 10, he returned to the Royal Melbourne and was this time rightly diagnosed with an aggressive infection in his hip -- so advanced he needed surgery. After having parts of his infected hip bone cut out, he now faces the possibility of a hip replacement. "They gave me a very quick examination and sent me home," he said. "This could have been prevented."

Due to go home again this week, Mr Tsogias said he was not ready and accused the hospital of throwing patients on the street to free up needed beds. "I am not going anywhere," he said. "After what happened last time I don't want to go until I am 100 per cent cured."

The Royal Melbourne yesterday denied the Herald Sun access to patients in the transit lounge, where they are forced to wait. "They are kicking people out before they are ready to leave," said Mr Tsogias' sister, Anna Manidis. "Someone is not doing their job properly."

Royal Melbourne's executive director (clinical governance) Christine Kilpatrick said: "No patient is ever discharged prior to them being assessed by the medical staff and (staff) ensuring they are ready and safe." The hospital was under enormous pressure to free up beds, but there was no financial incentive to discharge one patient a day. "We don't have a dollar value on their bed," she said. "It is about making sure patients who are ready to leave prior to 10am have all their needs and services arranged."

Source

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

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

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22 May, 2007

A defender of the indefensible

The chairman of the British Medical Association, James Johnson, has resigned after a letter he wrote to The Times defending the failed medical application system caused widespread fury and led to a number of doctors resigning from the BMA in protest. Mr Johnson, a surgeon, wrote yesterday to the BMA tendering his resignation. “My letter caused an absolute furore,” he admitted. But he was unrepentant about the letter, signed jointly with Dame Carol Black, which defended the Chief Medical Officer, Sir Liam Donaldson, regarded as the chief architect of the new medical training system.

Since the letter appeared on Wednesday, in response to one from Professor Morris Brown of Cambridge University and colleagues, a wave of anger has engulfed Mr Johnson. There has been no opportunity for the Council of the BMA, which he chairs, to meet since the letter appeared but opinions expressed on medical websites and in Times Online made clear that he had lost support. On Times Online there were by early yesterday afternoon 496 reponses to the letter, universally critical of Mr Johnson and Dame Carol, who is chair of the Academy of the Medical Royal Colleges. Many called on them both to resign.

The day after the letter appeared, a meeting of the Scottish hospital consultants condemned it unanimously. Other comments on the website include one from Richard Sidebottom, a junior doctor from London, who says: “I see the BMA and the royal colleges as traitors to those they should be looking after.” Others say that the letter is “arrogant, deluded and out of touch” while Chris Twine, a junior doctor from Cardiff, says the views expressed in it are “totally at variance with those of doctors dealing with the Medical Training Application Service (MTAS) in any capacity”.

What appears to have caused the greatest offence is a sentence in which Mr Johnson and Dame Carol “restate our support for the Chief Medical Officer and his role in improving junior doctors’ training”. Yesterday Mr Johnson was unrepentant over his defence of Sir Liam. “He’s a civil servant, he can’t defend himself,” Mr Johnson said. But his view of Modernising Medical Careers (MMC), Sir Liam’s creation, is not shared by the bulk of junior doctors. Nor, apparently, is it shared by Dame Carol’s successor as President of the Royal College of Physicians, Ian Gilmore, who last week wrote an open letter to Patricia Hewitt, the Health Secretary, saying that MMC needed to be reconsidered along with the failed application system.

A member of the BMA Council said yesterday: “Jim’s position became untenable when his letter to The Timeswas published. He did not consult senior BMA colleagues before sending it, and the letter caused substantial damage to the reputation of the association.”

Mr Johnson told The Times yesterday that he had planned to give up office at this year’s Annual Delegate Meeting in Torquay next month. The council will be chaired in the meantime by Sam Everingham, the deputy chairman. A new chairman will be elected at Torquay. Mr Johnson’s is the third resignation prompted by the MTAS fiasco. Previously two officials at MMC, Professor Alan Crockard and Professor Shelley Heard, resigned in protest at how, in their view, the MMC process was being subverted by efforts to repair the damage done by the computer failure. The High Court has yet to give judgment on the case brought by RemedyUK, the junior doctors’ pressure group, against MTAS. That is expected on Wednesday.

Source




Australia: Some attack on bloated hospital bureaucracies at last

QUEENSLAND Health does not have enough money to fund over-budget hospitals requiring key staff. Director-general Uschi Schreiber has imposed a staff freeze on districts that have blown their budgets, despite admitting the personnel were needed for "effective health service delivery". A cap has been placed on theatre-booking clerks, radiology/medical imaging clerks, ward receptionists, human resources officers and indigenous liaison officers.

Ms Schreiber has told her district health managers that the freeze would remain until the end of the financial year. In a memo obtained by The Courier-Mail, Ms Schreiber said: "I would like to bring to your attention consistently strong growth in administrative staff numbers, most notably at district level. "Whilst appropriate staffing levels for both clinical and administrative employees is a key component of effective health service delivery, this must continue to be balanced with the need for budget integrity."

The correspondence said districts, area health services and divisions would be banned from hiring any more administrators if they were above "affordable levels". She said if the extra staff was for essential, day-to-day activity, approval would have to be sought from an area general manager or an executive director.

Peter Forster's Queensland Health Systems Review, which evaluated the department in the wake of the Jayant Patel scandal, found that the department was putting budgets in front of patient care. It also revealed that the department was overburdened with bureaucrats, and recommended central office be cut to 644 positions. More than 160 had been identified as surplus.

In a statement to The Courier-Mail, Ms Schreiber's office said the 644 cap was an "annualised figure and the actual number fluctuates slightly throughout the year". There were 657.65 positions in February this year. Eleven positions were child and youth health positions "transferred to corporate office pending machinery of Government changes" and 31 were special project positions with a "set life span". "Queensland Health is actively managing administrative staff numbers and maintaining a lean corporate office," the statement said. "Administrative staff positions are established only where a strong and compelling need can be demonstrated and at the district level such positions must support clinical services. "The director-general has issued a memorandum to ensure active management of administrative staff numbers continues and appointments are linked directly in the districts to the support of clinical services, rather than an increase in bureaucratic positions."

Source

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

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

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21 May, 2007

IMPERSONAL PUBLIC HOSPITALS CAN KILL

And a substandard solution is being tried in Australia

On Christmas day a few years back, Mary Webber was the doctor on duty in a short-staffed Sydney emergency department. The elderly man in the bed before her was clearly unwell: high fever, racing pulse, heavy breathing, confused and complaining of persistent pain all over his body. Webber and her colleagues checked for the usual causes, but ruled them all out. No one could figure out why the man was so ill. He'd been in a minor car accident a week earlier, but X-rays following the incident had shown no signs of fractures.

Webber tried to transfer him to a bigger tertiary hospital better equipped to handle his case, but three declined before a district hospital finally admitted him. Doctors then had to play "catch up'' trying to access various test results and information being held by at least three different hospitals. One registrar noted in the man's file that it wasn't clear who was even in charge of his case. The delays added up, probably to about four days, Webber says. Eventually the man was diagnosed with a rare infection concealed in his spine - but by then it was too late. He died shortly afterwards.

Whether or not that outcome could have been avoided is impossible to say, but Webber says if things had been handled differently he certainly would have stood a better chance. "The doctors were following the normal processes, but if there had been a doctor whose job it was to check up on the tricky patients, someone who was senior enough to crash through some of the barriers and push some of the walls down, then this might not have happened,'' she says. "Or at least it might have been picked up earlier. Everyone was working very hard, but the system itself had inherent flaws when it came to patients like him - the system works very well for `in-the-box' patients who come down established pathways, but not so well for the out-of-the-box patients.''

Now a new brand of doctor designed to help manage and co-ordinate the care of those "out of the box'' patients is being piloted by NSW Health at five public hospitals, in an effort to improve safety and quality of care, and reduce errors and adverse events in a hospital system plagued by doctor shortages. Webber, along with two of her colleagues at Ryde Hospital, doctors Michael Boyd and Ross White, have been among the first to take on this new role of "hospitalist'' - a doctor who will work in hospitals in a generalist role that crosses the divisions between medical departments and specialties. NSW Health has allocated $1.4 million over two years for the Hospitalist Pilot Project, and plans to recruit about 20 more doctors to the position in July.

Exactly what such doctors will do has some degree of flexibility. They will liaise between specialists and junior doctors, as well as with GPs in the wider community. Some will create mentoring programs for junior doctors that review difficult cases and discuss what could be improved; some will develop new systems to deal with longstanding problems, such as a database to improve the lines of communication with GPs. The goal is to provide better continuity of care in a system that has become increasingly fragmented - ideally improving quality of care for patients who are chronically ill or have complex needs, such as the elderly or people with multiple health problems that don't fit neatly into one area.

But not everyone is enthused with the idea. In January the Internal Medicine Society of Australia and New Zealand released a position statement calling the plan a "short-sighted and inappropriate response to the workforce crisis'', that may ultimately result in substandard care as lesser-trained doctors are given the responsibility traditionally charged to general physicians who have to pass the same boards and standards as sub-specialists. "We're very much in favour of someone taking a holistic view, but we think the ideal hospitalist already exists in the form of general physicians,'' says society vice-president Alasdair MacDonald, who wrote the group's position statement. "Rather than creating a whole new class of doctors who don't have the same qualifications, we should be putting our money into recruiting and training general physicians, and improving remuneration for them to restore the balance of generalists compared to sub-specialists.''

Hospitalists first emerged in the US in the 1990s, and there are now more than 10,000 there. The NSW project marks the first time the role has been formally trialled in metropolitan areas in Australia. Victoria, Queensland and WA have all informally expressed interest in the program, says Professor Katherine McGrath, the deputy director-general of health system performance, who sponsored the program at NSW Health. In rural and regional areas - where doctor shortages are more acute - hospitalist-type roles are more common, though they often happen by default. In Queensland, however, the "rural generalist program'' has taken the idea to next level, developing a specific training module for rural doctors working in hospitals, and last year had that qualification recognised.

Such formalisation is not on the cards in NSW. NSW based the new position partly on the American model, which has had some promising results. A review of hospitalist programs published in the Journal of the American Medical Association found that patients' average length of hospital stay was decreased by almost 17 per cent, hospital costs dropped by more than 13 per cent and most patients were satisfied with the care they received (2002;287:487-494).

But there are inherent differences in the way the US and Australian models are set up. Under the US model, hospitalists have considerably more power than those being piloted in NSW. For example, in the US hospitalists can admit their own patients, while here the specialist is ultimately in charge of the patient and just delegates responsibility to the hospitalist. There are also differences in training and qualifications. In the US hospitalists are internal medicine specialists; about half are general physicians and the rest tend to be specialists in intensive care. Several academic centres have now developed hospitalist-focused postgraduate training.

By contrast, NSW Health is targeting doctors who have experience working in hospitals but have chosen not to undergo further specialty training - such as a senior career medical officer, or a GP who would like to work part-time in hospital. There is no separate qualification required to become a hospitalist, and it's being seen as a pathway for career medical officers to progress in their careers rather than a specialty in its own right. Training will be in short bursts in the form of one-day workshops, much like the way continuing professional development works, as opposed to any formal course, McGrath says.

The hospitalists will be working on contracts that range from two to five years - eons compared to most junior medical officers, who rotate as frequently as every 10 weeks and registrars who rotate every six months to a year. "They know how the hospital system works and they can build a long-term relationship with the specialists," McGrath says. "The whole point is to ensure there is no slippage in standards of care - the patient remains under the care of the specialist, and the hospitalist works under the delegation of the specialist - that's where we differ from America. We've made it deliberately different to protect against any risks."

But MacDonald says that itself may be part of the problem. He claims that if anything, hospitalists should be under the supervision of general physicians because hospitalists recruited here are unlikely to have the expertise and training to take responsibility for complex patients. If that's the case specialists may not trust them to hand over responsibility to begin with. Instead they'll seek assistance from another specialist, increasing cross-referrals and further complicating matters. "The optimum hospitalists already exists and what effectively we're doing is saying, well we can't train enough of them, so let's create somebody that's not trained to the same extent, hasn't had to stand up to the same scrutiny and hasn't had to do the same exams - and employ them to do that work," he says. "And let's supervise them by people who don't necessarily have the breadth of specialist's knowledge across lots of disciplines, and by administrators who are often not from a clinical background."

Even among proponents of hospitalists, there is some concern that the goals of the NSW pilot project may not reflect the achievements hospitalists have made overseas. Bill Lancashire is a senior lecturer at the University of NSW Rural Clinical School and a critical care doctor at Port Macquarie Base Hospital. He is actively pushing to have hospitalists introduced there, and says they can help reduce demands on overburdened specialists by taking over management of some of the less complicated patients, as has occurred in the Canadian system. But as to whether it can actually diminish hospital errors, he is not so sure. "I think we need to think more about why we're doing it and what we hope to achieve. Across Australia there is a real concern about adverse events in hospitals, but this shouldn't just be a reflex response to that," Lancashire says. "We need the evidence to show that adverse events will be reduced, because overseas that hasn't been the impetus; it's been specialists being overwhelmed by patient numbers."

The review published in JAMA in 2002 found that while several studies showed hospitalists improved measures such as inpatient mortality and readmission rates, the results were inconsistent. Whether they will make a difference to safety and efficiency in Australia remains to be seen. The NSW pilot project ends in December next year.

Source




Granny suffers 82 hours of agony in an Australian public hospital



AN 81-year-old great-grandmother endured 82 hours of agony in a Perth hospital. She lay immobilised on trolleys and in "holding pens'' before finally getting urgently-needed hip surgery in Royal Perth Hospital yesterday. Rita Robins' son Peter wants WA's besieged Health Minister Jim McGinty to explain why his fragile, elderly mum experienced days of fasting and constant surgery cancellations before she could get the operation for her seriously fractured left hip. "These are the people that public hospitals should be helping,'' an angry Mr Robins told The Sunday Times, while his mum was getting the surgery. "What do these old people do? "There are more than her going through this at the moment -- this would be just a drop in the ocean. "(Mr McGinty) says there's no health crisis, but what about this?''

Mr Robins' wife Dianne said it broke her heart to see the suffering of her kind-hearted mother-in-law -- who is a great-grandmother of five, grandmother of nine and a mother of four. "I don't think you would do this to an animal,'' Mrs Robins said. She said the elderly woman fell about 7pm on Tuesday at her Northam home and had been taken to Royal Perth Hospital by 11.45pm. Her mother-in-law then spent the next 39 hours on her back -- to stop her moving her hip -- on a trolley, being wheeled to ``empty spots'', while promises of surgery on Wednesday morning fell through.

"About 1.30pm on Wednesday, they took her to what they called a `holding pen','' Mrs Robins said. "This was just stretchers again with curtains between them in just one big open room. "And because she's on her back, they had to put a catheter in for her because she can't get up to go to the toilet or anything. "I requested that if the operation wasn't going to happen, could they feed her because she had been fasting from the night before, and could they give her some of the medication she usually takes. "But the nurse just straight out said to me, `I can't find anybody to come and do what we need to do'.''

Her mother-in-law, already suffering dementia, started to stress. "She was really tired, she didn't sleep all night, she was scared and with all this stress, it made her mind wander because she also hadn't eaten,'' Mrs Robins said. But she was left in the "holding pen'' until 2.30pm on Thursday, before getting a bed. She was made to fast again for hours on Thursday and Friday only to have the surgery again cancelled. Finally, at 9.30am yesterday, she was wheeled into surgery at RPH.

"She's not got private cover because she's a pensioner. She lives in a housing commission home,'' Mrs Robins said. "She's been a widow for seven years and she's had a real tough life. So what do these people do when they need health care?''

Mrs Robins said up to a 24-hour wait might have been acceptable. "But from the time she got to the hospital, until the operation, that's about 82 hours of her lying on her back, not being able to move,'' Mrs Robins said. "So when Mr McGinty says `There's no health crisis', I'd love to phone him up and say `Come visit now', but he's too far away from what the people are doing. "She's a wonderful lady, she's done so much for so many people _ even though she never had much. "And because she's had such a tough life she's always got out of things with a smile. So when I see her like this it just breaks my heart.''

Opposition health spokesman Kim Hames said: "If Jim McGinty cannot ensure timely medical help for people like Mrs Robins and the hundreds of others who are subjected to the same lack of treatment because of his mismanagement, perhaps it is time he does the decent thing and stands down as health minister.'' Mr McGinty refused to comment. An RPH spokeswoman said the Mrs Robins had had surgery postponed on Thursday because of pre-existing conditions, which the family denied.

Source

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

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

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20 May, 2007

AUSTRALIA: A LEGAL SAFEGUARD AGAINST HOSPITAL NEGLIGENCE TO BE REMOVED

As part of the "solution" to public hospital capacity shortfalls in Queensland

PUBLIC patients whose operations are botched will lose their right to sue the State Government under a plan to reduce hospital elective surgery waiting lists. Thousands of people who will have their operations outsourced to private hospitals will also be unable to access their case notes under the Freedom of Information Act if things go wrong. Under the plan, called Surgery Connect, a broker will be paid a one-off, $8.5 million fee to find private hospitals to treat the state's long-wait public patients.

Many of the operations will be complex, including shoulder surgery, hip and knee-replacements, prostatectomies and treatment of aortic aneurisms (swelling and weakness in the wall of the aorta). But, under the Surgery Connect model, the broker will be liable if an operation goes wrong. The tender closed on May 9.

The Queensland branch of the Australian Medical Association said it did not tender because the cost of insurance was too high. Queensland Health last night rejected claims it had washed its hands of public patients, saying they could sue the broker if problems arose. A department spokeswoman said patient notes would remain the property of private providers, but patients could access records under the Federal Privacy Act. However, legal advice obtained by The Courier-Mail said that, in regard to some matters, it could be harder to obtain information under the Federal Act.

AMAQ spokeswoman president Zelle Hodge said she was unsure who would be willing to take on the inherent risk associated with the model. "I think patients should be extremely worried not only as an individual but the bigger picture is this is just another way to run down the public hospital system," Dr Hodge said.

In a statement, Queensland Health said the rights of public patients would not be eroded: "The broker is required to indemnify Queensland Health and to maintain appropriate levels of insurance in respect of medical negligence claims," the statement said. "The broker is then responsible for ensuring the health providers it engages are appropriately credentialled and insured for such claims. "These measures are designed to provide a safety net for patients who may have suffered adverse consequences of medical treatment they have received from the private provider. "It would be remiss of Queensland Health if it did not ensure that such contractual requirements were imposed on private providers. It is also important to keep in mind that the broker and private providers are providing health services to these patients so it is expected that, legally, they would bear the risk."

The AMAQ last year held talks with the Government about outsourcing some public elective surgery but, under its plan, patients would be treated in public hospitals and, where possible, public doctors would operate in private hospitals. President-elect Dr Ross Cartmill said the arrangement included Queensland Health providing indemnity insurance.

Federal Health Minister Tony Abbott said contracts entered into by the Queensland Government and Queensland Health were issues for those bodies. "The outsourcing of elective surgery is an admission of defeat and an admission by Labor that the private health sector is an essential part of our health system."

Source

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

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

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19 May, 2007

What Healthcare and Higher Education Have in Common

Healthcare is notorious for runaway prices, which are due, in part, to this financing scheme: multiple payers. And these multiple payers have assured streams of revenue, which include:

* Employer-provided health insurance

* Health insurance purchased by the individual to comply with government mandates (as in Massachusetts' new healthcare system)

* Direct government grants (Medicaid)

* Dedicated taxes (Medicare)

If one payer doesn't pay a patient's tab entirely, then the provider just bills the other payers for the remainder. Out-of-pocket payments by patients get put on top of these other payments. A patient can have his medical bills paid by 3 or more parties. With multiple payers providing assured payments the market is subverted -- there is no pricing discipline. This leads inexorably to price inflation, which in the case of healthcare outruns the overall inflation rate big-time. Another enterprise that depends on multiple payers, assured payment, and heavy government involvement is higher education. And it, too, has raging inflation.

Assured payment results in waste and fraud. It has caused an explosion in medically unnecessary tests and procedures. It is why universities can provide their professors with cushy sinecures for precious little work. (How else could the University of Colorado afford a 6-digit compensation package for the likes of a Ward Churchill?) The hospitals and universities don't have to economize and prioritize; they can have it all. The money will be there for them.

Despite healthcare's soaring inflation rate, healthcare reformers want to throw yet more money at it. How are you going to get prices under control by pouring even more money into those assured streams of revenue? The reformers think that by eliminating paperwork and through other administrative efficiencies that they can reduce costs. (If so, what's the need for more money?) But the healthcare industry would respond to any increased cash flows by simply raising their fees, just as higher education does.

In 10 years, healthcare spending is projected to top $4 trillion, double what it is today, and much more than all federal spending today. Healthcare's share of GDP will increase from 15% to 20%.

The cure for healthcare inflation-and a great many other things, for that matter-is competition. And the way to get competition is by withholding funds, not assuring them. That's why Health Savings Accounts are so attractive. HSAs keep money out of the healthcare pipeline until you need it. And HSAs are also a fine incentive to improve your health by changing your lifestyle and habits, so that you won't have to tap into your own money.

The solution to the problem of multiple-payers in healthcare is not "single-payer", the "universal" system preferred by some reformists. Not if it means another government-run monopoly. (Government hates monopolies, except, of course, for government monopolies.)

Speaking of "universal": Congress should enact a nationwide law that allows all workers to divert their share of their company's health insurance budget into HSAs. That way if a company goes bust, like Enron, or stops providing health insurance to its employees, employees who have chosen this opt-out will at least have some healthcare money set aside. And because they would be universal, such HSAs would be portable, making it easier to change jobs, thereby making for a more dynamic economy.

America has not had a real market in healthcare since the 1940s. If we really want to reform our healthcare system, let's start by reintroducing healthcare to the market.

Source




More deadly NHS negligence

Simple procedures that could save the lives of thousands of hospital patients every year are still not routine in Britain. More than 12,500 patients a year die in hospitals from venous thromboembolism (VTE), blood clots that form in the veins of the legs or pelvis and travel to the heart or lungs. David Fitzmaurice, of the University of Birmingham, says that the condition kills at least ten times as many hospital patients as MRSA but gets far less publicity. Nationally – counting cases both in and out of hospital – at least 25,000 people die in Britain every year from VTE. “The number of deaths from VTE in the UK each year is five times greater than the combined total number of deaths from breast cancer, Aids and road traffic accidents,” Professor Fitzmaurice says in today’s British Medical Journal.

In hospitals, about 10 per cent of all deaths are caused by VTE, and many of these could be prevented. Drugs can reduce the rate by about 65 per cent, but an investigation by the Commons Health Select Committee found that as few as 20 per cent of patients were being treated appropriately. “A combination of factors may be responsible,” Professor Fitzmaurice says. “As a result of poor education, health professionals lack awareness of this condition. Venous thromboembolism is often a silent disease and often occurs after discharge from hospital.” He adds that the cost of the drugs may also be a barrier, although this is not clear.

The National Institute for Health and Clinical Excellence (NICE) published guidance last month that all patients undergoing major surgery should be assessed to identify their risk of developing blood clots. The formation of clots, known as deep vein thrombosis (DVT), occurs in more than 20 per cent of surgical patients and more than 40 per cent of patients undergoing major orthopaedic surgery. But it is also common in medical patients. Most of these thromboses are minor and cause no symptoms, but if the blood clot becomes loose it can travel to the lungs and cause VTE.

NICE’s suggestions for preventing blood clots include offering patients compression stockings, inflatable “boots” during operations and the use of blood-thinning medication. Professor Fitzmaurice says that NICE’s emphasis on compression stockings rather than drugs is controversial. It was not supported by a report of the Health Select Committee two years ago, which he says provided an opportunity to change practice. “Meanwhile, more than 25,000 may have died needlessly each year because of the failure to implement simple thromboprophylaxis in UK hospitals,” he concludes.

Source

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

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

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18 May, 2007

Customer Health Care

It's Friday evening and you suspect that your child might have strep throat or a worsening ear infection. Do you bundle him up and wait half the night in an emergency room? Or do you suffer through the weekend and hope that you can get an appointment with your pediatrician on Monday -- taking time off your job to drive across town for another wait in the doctor's office?

Every parent has faced this dilemma. But now there are new options, courtesy of the competitive marketplace. You might instead be able to take a quick trip on Friday night to a RediClinic in the nearby Wal-Mart or a MinuteClinic at CVS, where you will be seen by a nurse practitioner within 15 minutes, most likely getting a prescription that you can have filled right there. Cost of the visit? Generally between $40 and $60.

These new retail health clinics are opening in big box stores and local pharmacies around the country to treat common maladies at prices lower than a typical doctor's visit and much lower than the emergency room. No appointment necessary. Open daytime, evenings and weekends. Most take insurance.

Much like the response to Hurricane Katrina, private companies are far ahead of the government in answering Americans' needs, this time for more accessible and more affordable health care. Political leaders across the country seeking to expand government's role in health care should take note.

Thousands of free-standing primary care clinics have been operating for years in malls and main streets around the country, often staffed by physicians and many offering a broad range of health services. The retail health clinics are creating a new model with more limited services at lower prices and almost always staffed by nurses. The Convenient Care Association estimates there are about 325 of these retail clinics operating nationwide today. Seventy-six of them are in Wal-Marts in 12 states, but the company announced last month it will expand to 400 clinics by the end of the decade and 2,000 in five to seven years. They will be run by outside firms, including for-profit ventures like RediClinic as well as local and regional health plans and hospitals.

The industry is rapidly expanding. You can find a MinuteClinic in the CVS on the Strip in Las Vegas. But you also will find many locally-run clinics in pharmacies and food stores across America, such as the Express Clinic in Miami, MediMin in Phoenix, and Curaquick in Sioux City, whose motto is "Get well soon."

Prices vary for services from flu shots ($15-$30), to care for allergies, poison ivy and pink eye ($50-$60), and tests for cholesterol, diabetes and pregnancy (less than $50). Competition already is starting to drive prices down.

Of all patients who have visited the clinics, almost half went there for a vaccination, and one-third received treatment for ear infections, colds, strep throat, skin rashes or sinus infections. Ninety percent said they were satisfied with the care they received. The nurses staffing the clinics are under physician supervision and follow strict protocols to refer patients to physicians or emergency rooms if problems are more serious.

Internists and family doctors are watching. Some see the clinics as useful in providing efficient care for a limited number of uncomplicated ailments, freeing physicians and hospitals to deal with more complex cases. But others are worried about lost business, fragmentation of care, and the quality of care if the clinics miss something serious.

Rick Kellerman, president of the American Academy of Family Physicians, concedes, "The retail clinics are sending physicians a message that our current model of care is not always easy to access." The threat of competition from the in-store clinics means some doctors are keeping their practices open later and on Saturdays and holding an hour open for same-day appointments. Competition works.

And competition also worked to force prescription drug prices down: When Wal-Mart announced last year that it was dropping the price of several hundred generic medicines to $4 for a month's supply, other pharmacies, from Target to corner drug stores, followed suit. Wal-Mart now says that a third of all prescriptions filled at its pharmacies are for the $4 generics, and 30% of them are filled by people without insurance.

Take note, Congress: The market is providing cheaper medicines, more affordable care -- and it is also helping the uninsured. A Harris Interactive poll conducted in March for The Wall Street Journal said that 22% of those visiting the clinics were uninsured. Wal-Mart says that half of its clinic visitors are uninsured.

Retail clinics are particularly attractive to 4.5 million people with Health Savings Accounts who have health insurance with higher deductibles and want an affordable option for some of their routine care.

And the clinics are working to solve another problem that is vexing Washington -- creation of electronic medical records. Most retail clinics create computerized patient records, with the goal of making the records accessible throughout the chain. The records also can be emailed to a hospital or to the patient's regular doctor -- or sent by fax if necessary.

Critics of engaging private competition in the health sector will argue that the vast majority of health-care dollars are spent on a relatively small percentage of patients with serious illness, especially those with multiple chronic conditions.

But even coordination of care for those with chronic illnesses lends itself to patient-friendly solutions. The City of Asheville, North Carolina, cut its costs in half for employees with diabetes by teaming up with local pharmacists who did routine exams and got patients to their doctors or hospitals more quickly when they needed intervention. Employees received their medicines for free if they kept appointments, and their health improved.

Because health care is largely regulated and licensed at the state level, some states are more friendly than others at having non-physicians deliver care. California requires that clinics be a medical corporation owned by a physician. In Arizona, each site must be licensed, but in most other states, a single license will serve multiple clinics. Illinois is considering legislation to limit the number of nurses a doctor could supervise to two and restrict the clinics' right to advertise.

This industry is in its infancy and will hardly register in our nation's $2 trillion-plus health care bill. But just as Nucor overturned the steelmaking industry with a faster-better-cheaper way of making low-end rebar, these limited service clinics could be the disruptive innovator in our health-care system. Package pricing for more complex treatments, like knee replacement surgery, may not be far behind.

Government can get in the way, of course, with protectionist policies that throw up more regulatory barriers to entry. But retail clinics could be just the beginning of consumer-friendly innovations, if Congress were to change tax policies in a way that would allow people to have more control over their health spending, as President Bush has proposed.

The linchpin is giving people the same tax benefits whether they get their health insurance at work or on their own, or buy coverage through groups like churches, labor unions and professional or trade associations. Allowing people to buy health insurance across state lines would inject another dose of healthy competition into the system.

With many congressional leaders hostile to free-market solutions, these policy changes are unlikely in the next two years. But as consumers get a taste of what consumer-friendly health care is like, they may well demand that the top-down, centralized health-care delivery of the 20th century give way to a system more in tune with the demands of 21st-century consumers seeking greater value and efficiency.

Source




Massive closure of NHS emergency rooms in sight

Up to half of all hospital accident and emergency departments face cuts or closure under plans to improve patient care, presenting Gordon Brown with a massive dilemma as he takes over as Prime Minister. Ninety-two out of 204 A&E departments are under threat if guidance attributed to the Department of Health by NHS trusts is followed, the Conservatives claimed last night. Some NHS organisations are already using the guidance, which calls for A&E departments to serve a minimum population of 450,000 patients, to justify closures in smaller catchment areas. The average A&E unit currently serves just under 250,000 people.

But the plans are proving hugely unpopular, even though they have been promoted as in the interests of patients and NHS staff. Mr Brown, aware that the closures would come into force around the time of the next election, said last Friday that he would meet front-line NHS staff and patients to discuss health policy. It was clear last night that the Chancellor will not now face a leadership challenge as he prepares to succeed Tony Blair, having gathered a decisive 308th supporter among Labour's 353 MPs.

Last Sunday Mr Brown accepted that people were worried about the potential closure of A&E facilities and maternity services close to their homes, raising speculation that he was pondering a rethink. If so it is increasingly likely that he will move Patricia Hewitt, the Health Secretary, from her post to pave the way for changes.

The Conservative estimate of 92 nationwide cuts was based on figures in a report circulated to NHS trusts in Surrey. It states: "Current Department of Health and strategic health authority guidance suggests that, to be viable in terms of patient need, patient safety, staffing numbers and clinical training requirements, a full A&E department in the future would need to be supported by a catchment population of between 450,000 and 500,000 people." A staff briefing by Surrey Primary Care Trust in March repeated the figures, suggesting that such a catchment population was "national guidance".

Closures could mean seriously ill patients, such as those with heart problems or head injuries, having to travel longer distances to receive care in specialist treatment centres. Patients with minor injuries are expected to be treated in walk-in clinics or smaller A&E units. Such a scenario was supported by two reports published by the Government last year. These suggested that specialist high-tech centres could save 500 lives of people suffering heart attacks and result in 1,000 more stroke victims avoiding death and disability each year.

The changes are broadly supported by doctors' leaders but are fiercely opposed by patients' groups and MPs. Cuts to local NHS services have also been opposed by several senior Labour politicians in their own constituencies. The move to close A&Es comes just as demands on their facilities are rising. The number of attendances at A&E has risen by more than a million in the past three years and the average number of attendances at each is now 67,000.

A report published last year by the Royal College of Surgeons recommended that the minimum catchment population of a fully resourced A&E department should be at least 300,000. But there is debate about whether catchment areas alone should be used to allocate NHS services. Local geography, healthcare needs and staffing levels may have to be taken into account.

A Department of Health spokesman said there was no such official guidance from his department. "It is absolute rubbish to suggest that we are demanding the closure of A&E departments. "Any decisions about the shape of A&E services are taken locally so that services reflect the needs of the local population. Where local health authorities believe that patients can be better served by changing the way services should be delivered, it is right that they make those changes, and they will consult locally on any proposals."

But he admitted that the recommendations were taken from a report by the Royal College of Surgeons supported by Sir George Alberti, the former director of emergency care. He recently recommended the closure of an A&E department in North London. The remaining two A&Es serving the area will be left with catchment populations of 450,000 each.

The Tories claimed that this was evidence of central targets to close units based on the number of patients they served. Andrew Lansley, the Shadow Health Secretary, said: "Access to accident and emergency services is a vital component of the quality of NHS services. The public know that not every A&E department can provide every emergency service. But there is no clinical evidence which would justify shutting down A&E departments simply because they don't serve a catchment population in excess of 450,000. Yet that is the basis on which the Department of Health is seeking now to justify closures."

Source

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

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

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17 April, 2007

Moore lines up US health system



He won an Oscar after taking aim at US gun culture in Bowling for Columbine and earned the Palme D'Or for giving the Bush administration both barrels in Fahrenheit 9/11. But as Michael Moore puts the US health system in the crosshairs for his latest, take-no-prisoners documentary - Sicko - the firebrand director is himself in the firing line. Not only are US Treasury officials investigating him for possibly breaking a trade embargo against Cuba during the making of the movie, which premieres at the Cannes film festival, but Moore has faced renewed scrutiny of his methods.

Manufacturing Dissent, a recent film about Moore's work, shows him twisting the truth and using footage out of context. Ironically the film was made by two admirers of the director, Canadians Rick Caine and Debbie Melnyk. "We agreed with his politics," said Caine, adding that they had initially set out to make a film that celebrated Moore. But they soon discovered a trail of broken promises to colleagues, exaggerations of facts, and footage used out of context.

Among the most startling revelations of the documentary is the claim that the central premise of Moore's seminal Roger and Me - that the boss of then-General Motors chairman Rogers Smith refused him an interview - is false.

Moore would not be interviewed for Manufacturing Dissent but may find it hard to evade questions at Cannes as he promotes Sicko, "a comedy about 45 million people with no health care in the richest country on Earth." Buzz around the film is guaranteed to be intense after news of the US Treasury probe, which was sparked by Moore's decision to take rescue workers from the site of 9/11's Ground Zero to Cuba for medical treatment.

The development has handed Moore a public relations bonanza on a platter as he attempts to rev up interest in the film. "The government going after Michael Moore is like Paris Hilton going to the clink: It's a brand extension," PR expert Eric Dezenhall said. "It can only help his career. It validates his shtick that he's the little guy being silenced by a large and sinister voice."

While a spokeswoman for Moore dismissed the US Treasury probe as politically motivated, Sicko's backers have already recruited a high-powered team of spin doctors to counter an expected offensive from the health industry. The Weinstein Co, which is handling Sicko, have hired political strategist Chris Lehane, a former press secretary to Al Gore and a White House spokesman during Bill Clinton's presidency, to manage the film's press campaign. The services of high-powered New York public relations consultant, Ken Sunshine, have also been retained. "If the HMOs (health-care providers) strike, I'm going to need two guys who can strike back," Harvey Weinstein told Daily Variety.

However, in a possible foretaste of things to come, the US health industry has already gone on the attack, questioning Moore's objectivity. The Pharmaceutical Research and Manufacturers of America issued a statement attacking Moore's record. "A review of America's health care system should be balanced, thoughtful and well-researched," the statement said. "You won't get that from Michael Moore. "Michael Moore is a political activist with a track record for sensationalism. He has no intention of being fair and balanced."

Source




Another big NHS shortfall

A key target in the Government's health reforms - to have thousands of community nurses treating the most seriously ill patients outside hospital - has been missed, with fewer than half the promised numbers in place. A pledge made three years ago to have 3,000 experienced nurses in post by March this year has been delayed, with social workers and less qualified staff having to make up the numbers looking after patients with chronic illnesses. Cost-cutting and a recruitment freeze in the NHS have forced ministers to revise the deadline back one year in order to benefit from record funding increases in 2007-08.

The retreat has emerged as Patricia Hewitt, the Health Secretary, prepares to outline today how œ8 billion of extra NHS funding will be spent this financial year. It is the last planned annual increase, and many NHS chiefs are already preparing for a subsequent period of drastic budgeting. There are more than 17.5 million people living with chronic conditions such as diabetes, arthritis and heart failure. The Department of Health has claimed that cuts to local hospital services could be justified by having experienced senior nurses treating these patients in or close to their homes.

But The Times has learnt that unqualified social workers, physiotherapists and less experienced staff are being used to boost the total number of "case managers" who care for the most chronically ill patients outside hospital. The department's latest estimate is that there were 1,470 community matrons working in the NHS in December, with an official NHS workforce survey suggesting that fewer than 100 were recruited last year.

The target, set by John Reid, the former Health Secretary, during Labour's "Big Conversation" in 2004, aimed to respond to patients' calls for more care nearer to their homes. Ministers claimed that the 500 million pounds community matrons' policy would soon pay for itself by saving 400 million a year through reduced hospital stays.

But Mrs Hewitt admitted yesterday that community care remained poor in some areas. Treating patients with long-term chronic conditions was the "really big challenge" facing the NHS, she said, but she made no direct admission that the target had been missed. "By March next year, 220,000 of the most needy patients will be getting support and care in their homes from 3,000 community matrons and other case managers," she added.

Josie Irwin, head of employment relations at the Royal College of Nursing, said that the figures amounted to a "spectacular failure" of a government policy.

Source

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

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

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16 May, 2007

The political limits of "universal" health care

"Universal" government health care has once again returned as a political cause, with many Democrats believing it's the key to White House victory in 2008. They might want to study last week's news from Illinois, where Democratic Governor Rod Blagojevich's tax increase to finance health care became the political rout of the year. The Democratic House in Springfield killed the proposal, 107-0, after Mr. Blagojevich came out against his own idea when it became clear he was going to be humiliated. Only a month earlier he had said he was prepared to wage "the fight of the century" in defense of his plan to impose a $7.6 billion "gross receipts tax" on Illinois businesses.

Easily re-elected in November, the Governor used every trick in the "progressive" political playbook to sell his proposal. Instead of a general tax increase, he claimed it would be "targeted" for universal health care and education. Instead of raising individual taxes, he aimed at business and even built in an exemption for smaller firms. "These corporate guys, they can't avoid this tax," declared the Governor, sounding one of the "populist" themes that liberal columnists are now recommending for national Democrats.

Mr. Blagojevich also pitched his plan as a moral imperative, unveiling it while standing in the Fourth Presbyterian Church in Chicago and saying it was necessary to force businesses to pay their "fair" share of the tax burden. He wanted to force most employers to offer health insurance or pay a 3% payroll tax. Liberal special interest groups--including the state AFL-CIO and the Illinois Education Association--initially supported him.

But a funny thing happened on this road to Canadian health care. The state's more rational Democrats revolted, arguing it would drive businesses out of Illinois. Chicago Mayor Richard Daley was an early opponent, and Democratic Lieutenant Governor Patrick Quinn was cool to it. House Speaker Michael Madigan very publicly withheld his support and last week came out against the tax hike.

As tax increases go, this was one of the worst. A "gross receipts tax" is popular with politicians because it applies to every dollar of company revenue, not merely on profits, or on final sales the way a retail sales tax does. But this means the tax tends to hit hardest those small and medium-sized businesses that have healthy sales volumes but narrow profit margins. The tax is a huge revenue-raiser but can also be a job killer.

Mr. Blagojevich tried to soften this impact by creating an exemption for business with annual revenues of less than $5 million. But even with that exemption, retailers would feel the squeeze from the higher cost of goods. And because the tax applies to all business transactions, it creates what economists call a "pyramiding" effect that has a damaging overall economic impact.

The Tax Foundation estimated that Mr. Blagojevich's proposal would have been the largest state tax hike in the last decade, as a share of state general fund revenue--at 27% nearly double the next closest, which was Nevada's 14% increase in 2004. In per capita terms, the tax hike would average about $550 per Illinois resident.

All of this piled on top of the $1.5 billion in new taxes and fees that the Governor imposed in his first term. State revenue has been rising at a respectable 5% annual pace, but spending is rising faster. Jonathan Williams of the Tax Foundation says the Governor's proposed budget this year calls for a 13.2% spending increase, which comes on top of a near double digit increase a year ago. The cumulative impact of this rising tax and spending burden has been to drive businesses out of the state.

"To describe every major CEO in Illinois as fat cats is a mistake," said Chicago Mayor Daley. "They don't have to be here. They can go to Wisconsin. They can go to Indiana. They can go to India. They can go to China. So if you want to beat up businesses, go beat 'em up, and when they leave, just wave to 'em and they're going to wave back to you." Even Jesse Jackson disowned the Governor's plan, noting that "We all want health care. But business closer is not good health."

One lesson here is that it is far easier to talk about "progressive" political causes than to pay for them without doing larger economic harm. In today's global economy, the margin for policy mistakes is smaller, even for individual states. Mr. Daley may appreciate this better than Mr. Blagojevich because he knows the consequences of bad policy will harm Chicago long after the Governor retires to private equity, or some other "fat cat" job.

As for national Democrats, Presidential candidate John Edwards has already proposed a huge tax increase to pay for national health care. At least he's honest about what such promises require, but we doubt it will help his Presidential prospects. Illinois Senator Barack Obama has been silent on his Governor's tax implosion, but someone should get him on the record. And Hillary Clinton, well, we can't wait to see how "universal" her promises will be.

Source




Empowering patients: New Labour's unhealthiest idea?

Everyone slates Blair for Iraq while praising his health reforms. Yet his interventions in the NHS have alienated patients and degraded doctors

After Tony Blair's lip-trembling resignation speech, commentators were inclined to give him credit for his public sector reforms while questioning his judgement over Iraq. But New Labour's widely approved `patient-centred' reforms are a real threat to the quality of healthcare in Britain.

When, a week earlier, Blair visited the offices of the King's Fund, New Labour's favourite health policy think tank, to give a speech commemorating a decade of National Health Service reforms, he received a generally positive response from the assembled ranks of health experts and professionals (1). King's Fund chief executive Niall Dickson set the tone in his congratulations to the prime minister on the eve of his departure for providing `unprecedented levels of funding' and `significant improvements in key areas'. Though there were some reservations about disruptive reorganisations, there was general agreement that New Labour reforms have succeeded in their key objective of making the NHS more responsive to patients. While the soundbites about `patient-centred' healthcare may appear merely banal, they reflect the corrosive cynicism of New Labour that is Tony Blair's true legacy to the NHS.

Speaking to the King's Fund conference immediately before the prime minister, David Pink, chief executive of the Long Term Medical Conditions Alliance, a consortium of more than 100 patient organisations, welcomed the government's commitment to a `patient-centred' NHS. As Pink acknowledged, the very presence on such a distinguished platform of somebody speaking from the perspective of patients was a potent symbol of the transformation of health policy under Blair. He enthusiastically endorsed a number of initiatives that, while purporting to advance patient interests, reveal the destructive consequences of the government's attempts to reform healthcare according to the rhetoric of choice and empowerment.

While many commentators have criticised the Quality and Outcomes Framework (QOF) as a crude target-driven payment-by-results system imposed on general practice, Pink welcomed `a major national programme that has turned the NHS's attention to helping people monitor and maintain their own health'. In practice, QOF operates as a financial lever to shift medical practice away from the diagnosis and treatment of disease towards intrusive and moralising interventions in patients' personal lives, justified by the dogma that this improves health and prevents disease. Far from benefiting those with chronic conditions, this shift is depriving them of continuity of care while doctors' energies are consumed with medicalising the worried well. The provision of an incentive bonus to GPs for recording patients' preferences about where they would like to die - a choice over which neither patient nor doctor is in practice able to exert much influence - aptly symbolises QOF's contribution to patient empowerment (2).

Another New Labour health initiative approved by David Pink is the Expert Patient Programme, a series of formal training sessions through which people learn to manage their own chronic illnesses. (As, according to the Long Term Medical Conditions Alliance, there are some 17million people with such conditions in Britain, at least one in four of the population is deemed eligible for this programme - though only 23,000 have so far participated.) For Pink, `the great significance of this programme is that it is an acknowledgement of the vital role that patients and their families have in improving their own health' - and he welcomed the support of the British Medical Association for the programme.

Though the Expert Patient Programme (EPP) has a commonsensical appeal, it is imbued with bad faith: it offers an illusory empowerment to patients with chronic illness and an illusory relief from the burden of caring for patients with chronic illness to doctors (3). If the EPP was widely taken up, it would affirm an identity as sufferer from chronic illness for a growing proportion of the population while imposing an increasing burden of responsibility for their own care on those with chronic disease. While patronising patients, EPP implicitly degrades doctors, devaluing medical science and professional expertise. Who benefits? Not patients, not doctors, not society; perhaps a few politicians and health policy bureaucrats.

David Pink is also a staunch advocate of `patient and public involvement' in the NHS, another of the favoured slogans of New Labour. Given the `democratic deficit' resulting from the decline in popular participation in political parties, local councils and elections, the government has sought to increase public involvement in many areas of public life, from the arts to schools to hospitals. Such initiatives inevitably have an artificial and bureaucratic character, particularly in the sphere of healthcare, which people - at least in the past - sought to avoid when they were well and to keep to a minimum when they were sick.

New Labour's promotion of `patient and public involvement' has led to the cultivation of the professional patient (together with the professional carer) who purports to express the interests of patients (and carers) in general. Of course, members of the public who are able and willing to assume these roles are inevitably unrepresentative of patients and carers in general - and, unlike local councillors and MPs, are not subject even to the episodic recall of the ballot box and hence are under no obligation or even pressure to reflect the interests of those they purport to represent.

In his enthusiasm for `patient and public involvement' David Pink personifies the defects of these initiatives. While he speaks on behalf of people with chronic illnesses to top politicians and policymakers, he was not elected by people with chronic illnesses and he is in no way answerable or accountable to them. Indeed, as the chief executive of a meta-quango, which strictly represents a number of organisations (also unrepresentative and unaccountable) rather than individuals with chronic illnesses, he is as remote from such individuals as any politician (and vastly more remote than the average GP). In fact, what emerges is that his status at the King's Fund assembly of health policymakers is conferred by government endorsement of his position rather than by any democratic mandate.

It is thus perhaps not surprising to find that, of all the assembled dignitaries, he provides the perfect warm-up man for Tony Blair on his tenth anniversary celebrations.

Source

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

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

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15 May, 2007

NHS RADIOTHERAPY FAILURE

Cancer patients are being systematically let down by the radiotherapy services in England, a damning government report concludes. Lengthy waits and huge variations in service from place to place mean that tens of thousands of patients every year are receiving substandard service, reducing their chances of survival. The report to ministers from a top-level committee, whose broad conclusions were first revealed in The Times last month, calls for urgent action. "Unless action is taken without delay, the Government will lose the opportunity to save lives, and services in this country will fall further behind those of other comparable countries" the National Radiotherapy Advisory Group says.

The NHS delivers 1.5 million courses of treatment every year, when the optimum would be 2.5 million, the report says. Variations between areas are said to be "unacceptable", with the best-served areas delivering two and a half times as many courses as the worst. But it does not specify which areas are bad and which less bad.

Karol Sikora, a cancer specialist, said: "The report shows how bad things really are, but disguises just how bad the local gaps in services are. These areas which have fallen behind must be named too in order to target improvements." Since 1997 the Government has invested more money in radiotherapy, but even this increase has fallen far short. The problems arise from miscalculations made 15 to 20 years ago, when the need for radiotherapy was significantly underestimated.

It was wrongly believed that radiotherapy would not have a key role to play in future cancer treatments and that demand for it would fall. This was a gross misjudgment, as demand has increased and will continue to increase as the population ages. Radiation treatments involve large doses given by linear accelerators, given in a series of smaller doses to reduce injury to healthy tissue. Typically, an entire course might comprise 15 to 40 treatments. The most productive centres deliver more than 10,000 courses per linear accelerator (linac) per year, the least productive only about 5,000.

The report calls for a target of at least 8,000 courses a year immediately, and 8,300 a year by 2010-11. Linacs should be kept running nine hours a day on average, with some running for as long as 11.5 hours a day. They should be operated year-round, including Bank Holidays (with the exception of Christmas Day, Boxing Day, and one day at Easter), and include some treatments on Saturdays. But the report rules out seven-day working because there are insufficient staff and patients may be reluctant.

Michael Williams, Vice-President of the Royal College of Radiologists, and co-chair-man of the advisory group, said: "Radiotherapy is one of the most effective cancer treatments available, but the UK has fallen short in its provision. "This is the main finding of a second report published in the current issue of the journal Clinical Oncology. The research confirms that substantially less radiotherapy is given in the UK than is standard practice elsewhere in Europe and the USA."

Professor Janet Husband, president of the college, said, "The report will be extremely valuable in determining future development and in building on the substantial investment in modern equipment achieved as part of the Cancer Plan."

Source




NHS DOCTOR-TRAINING MELTDOWN CONTINUES

An emergency review of the appointments system for junior doctors is being dominated by government apparatchiks, leading doctors claim in a letter to The Times today. The system and attempts to rescue it are a fiasco, write Morris Brown, Professor of Clinical Pharmacology at Cambridge, and more than a dozen leading specialists, as doctors prepare to challenge the outcome of the review in court. The hearing, which begins on Wednesday, will seek to have the computer-based Medical Training Application System (MTAS) declared so unfair as to be an abuse of power. It is expected to take two days. Victory for the doctors would leave the Department of Health, which has apologised for the debacle, in confusion.

In their letter to The Times, Professor Brown and colleagues say that MTAS has so far failed every task, and the review set up to rescue it “has become top-heavy with DoH apparatchiks”. The issue, in the Times letter and later today in court, is whether it is fair to allow doctors in England, who have already spent ten years training, a single interview to determine their futures. There are about 32,000 junior doctors applying for about 20,000 posts, which they will take up in August. Nobody knows the exact figures, nor how many of the applicants come from outside the UK. The doctors are mostly in their mid to late20s, and are applying for “run-through” training posts lasting five years, which would end with them ready to apply for jobs as consultants. Hospitals that pick the wrong applicants will be stuck with them for five years, so finding the right ones is crucial.

Applicants who fail to get a run-through post will not necessarily be unemployed but their careers will stall. To get a doctor to this stage costs the state 250,000 pounds in education and training costs. The potential losses would easily exceed 1 billion if, say, 5,000 UK-trained applicants gave up medicine or decided to go abroad. One official, who did wish to be named, blamed the department for a failure to match the expansion of medical schools to an equivalent growth in training posts.

This year, the difficulties are compounded by a failed attempt by the department to exclude foreign graduates. Under European law it cannot exclude EU graduates, but relatively few of them apply. The key is graduates from outside the EU, traditionally one of the mainstays of the NHS. The department attempted to cut off these applicants by saying they would need work permits. A challenge in court by the British Association of Physicians of Indian Origin (BAPIO) was rejected, but leave to appeal was granted. Pending the result of that appeal, the department was forced to allow nonEU doctors to apply in the first round of selection.

Thousands more found another way round, by joining the “highly skilled migrant” programme. They qualified for that by virtue of already working in the NHS as, for example, senior house officers. As a result, it is estimated that between 10,000 and 11,000 of the applicants for the 20,000 posts originate from outside the UK and Europe, maybe half of them through the highly skilled migrants programme. Nobody knows quite how many, nor do the application forms enable hospitals to distinguish home from foreign applicants.

So who is in charge? “Nobody is,” said the official who spoke to The Times. “The system was developed in isolation from workforce planning. So it was impossible to find any one person who would ask: ‘Will this work?’ .” RemedyUK, the pressure group bringing the action, hopes the court will say the process is unlawful, but expects a solution to require negotiation.

Source

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

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

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14 May, 2007

NHS 'failing on mixed-sex wards'

The NHS is failing to ensure all non-emergency hospital patients are kept in single-sex accommodation, the government has admitted. Campaigners say mixed-sex accommodation denies patients the chance of treatment with "privacy, respect and dignity".

Ministers were insisting as recently as November that 99% of patients were being seen in single-sex wards. But the government has now announced that 28 NHS trusts - 15% of the total - need more help achieving this. The promise to end mixed-sex accommodation was first made in the 1997 general election manifesto after Tony Blair attacked the Conservatives for failing to have "the wit" to end the practice. A target was introduced in 2000 that within two years 95% of patients would be in single-sex accommodation.

The government's definition includes separate wards or bays divided by fixed partitions, which campaigners say is not enough. Patients also needed access to single-sex toilet facilities. Departments such as intensive care and A&E do not have to fully comply for practical reasons, although they are expected to make an effort.

Last year, ministers said NHS managers had reported just 1% of patients were seen in mixed wards. But the government launched an inquiry after reports from patients and a survey by the Healthcare Commission cast doubt on the claim.

Chief nursing officer Christine Beasley, who conducted the inquiry, has now concluded the NHS had to do more to keep male and female patients separate. Her report called on all hospitals to review their practices and said 28 trusts were receiving support to change their practices because they were falling a long-way short. It did not identify how many patients were staying in mixed accommodation, although campaigners said it ran into many thousands. The report also failed to explain why NHS managers had given ministers what turned out to be incorrect information.

Professor Beasley said: "I am asking the NHS to do more to ensure that when there is no choice but to mix patients, that more safeguards are taken to ensure that privacy is maintained."

Health Secretary Patricia Hewitt said: "The NHS overall has an excellent record of treating people with dignity and respect. "However, this report shows there is clearly still more work for the NHS to do to meet our commitment to eliminate mixed-sex accommodation wherever possible."

Katherine Murphy, of the Patients Association, said: "Patients have a right to be treated in a safe environment with privacy, respect and dignity. "Patients continue to complain and for years politicians have promised to rectify this problem. "After more than 10 years of promises broken by a succession of ministers, it is time for action."

The Patient Forums organisation said a survey it carried out of 2,500 patients in March this year found 25% had shared a ward or bay with members of the opposite sex. Chair Jacquie Pearce-Gervis said: "We would like to see an eradication of mixed sex wards in order for all patients to spend their time in hospital recovering and not worrying that their dignity or privacy could be compromised."

Shadow health secretary Andrew Lansley accused the government of trying to bury bad news by publishing the report on the day Tony Blair was expected to announce his resignation. "Labour will never learn that the public are fed up with their style of government instead of dealing with the problems being faced by patients."

Source




Cancer, and good and bad arguments against socialized medicine

Post lifted from Tiger Hawk . See the original for links

Captain Ed declared today that "US healthcare saves more lives than socialized medicine." Maybe it does, and maybe it doesn't. I'm quite sure, though, that Ed's evidence -- a recent study that shows a correlation between the availability of certain anti-cancer drugs and survival rates in more than 60 countries -- does not necessarily support the proposition in the title of Ed's post. The Anchoress, bless her soul, is no closer to the target with her headline: "US Cancer Care 10X better than socialized UK."

There are a number of obvious objections to these post titles and the underlying claims made for them, but the most devestating one is this: It hardly matters if cancer cure rates are higher in the United States if we also have higher rates of advanced stage cancer because of other aspects in our health care system, such as infrequent or non-existent screening for an unfortunately large proportion of the population. Sure, we may cure more cancers than those parlor pinks in Europe, but perhaps we have more cancers to cure because we do a poorer job of detecting precancerous changes when they can be treated without drugs. Now, I don't know that any of the foregoing is true -- although I suspect it is -- but one cannot determine from Ed's post or the underlying links whether it isn't true. The conclusion in the post heading is therefore a leap of faith rather than a bankable conclusion.

That said, there are versions of socialized medicine that raise troubling questions that are quite independent from "collective" public health outcomes. First, better collective results do not necessarily make for a more just system. A socialized single-payer system might, for example, decide that it was wasting money on too-frequent screening of women for cervical cancer at the cost of, say, insufficient "well baby" care. A bureaucratic decision to shift resources from the first to the second might save the lives of more children than the lives lost to undetected cervical cancer, and so result in a "better" public health outcome. That collective victory, however, would be cold comfort to the dying woman who would have elected more frequent Pap smears but was not allowed even to pay for them out of her own pocket (for fear of creating an alternative private system for "the rich"). A rigid single-payer system does not allow for different appetites for risk -- those judgments become "social," rather than individual. That forced substitution of bureaucratic decision for individual choice is itself dehumanizing, whether socialists admit it or not.

Second, the supporters of hard single-payer systems completely ignore the rights -- yes, I mean the rights -- of physicians and other healthcare providers. Extra: TigerHawk points to the first reader who identifies the author and context of this quotation:

"I quit when medicine was placed under State control, some years ago," said Dr. Hendricks. "Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected tot he privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything -- except the desires of the doctors. Men considered only the 'welfare' of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, only 'to serve.' That a man who's willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards -- never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind -- yet what is it that they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it -- and still less safe, if he is the sort who doesn't."

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

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

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13 May, 2007

Canadian Drugs, Eh?: Washington fights over an unwanted program

Listen to Maine Sen. Olympia Snowe discuss importing drugs from Canada, and you'll hear endless happy talk about "more competitive prices," "substantial savings" and how "crucial" reimportation is to "the American consumer." What you won't hear Ms. Snowe mention much is the drug-import program of Portland, Maine.

Interesting that, since Portland was one of those cities that gained notoriety a few years back for defying federal law and setting up a Canada import program that it promised would save its thousands of city employees and their dependents a bundle on drugs. Three years in, it has attracted all of 350 participants.

That was also the flame-out fate of a statewide plan by Gov. John Baldacci to empower the Penobscot Indian Nation to build a distribution center to import price-controlled Canadian drugs for some 325,000 uninsured and underinsured Mainers. The tribe in February unceremoniously closed the program (which never got its hands on Canadian drugs, but morphed into a domestic mail-order business), having attracted just 3,000 Medicaid recipients.

Ditto, all across America. Three years ago, grandstanding governors and mayors vowed to break federal law and set up state-run drug import programs, giving millions of citizens the "opportunity" to buy cheap Canadian drugs. The media showered these souls with headlines, praised them for being on the side of poor, strapped U.S. consumers--then forgot all about it. Today, most state-import programs are on life support, while some have closed completely. Never mind all Washington's hifalutin arguments about intellectual property, free trade and safety; the overwhelming majority of Americans appear to have little use for import programs that offer few drugs at long wait times, under suspect safety conditions and with minimal savings.

All of which helps explain this week's bizarre, and highly cynical, Senate votes on drug imports. Many of the very senators who supported or co-sponsored Ms. Snowe's amendment to change federal law and allow Canadian imports hail from states that have seen their own high-profile programs wither or die. That includes Wisconsin's Herb Kohl and Russ Feingold, Missouri's Claire McCaskill and Dick Durbin of Illinois.

These folks know firsthand that Canadian imports aren't really that popular and won't save much, if any, money. But they do like what this debate offers, namely the chance to bash U.S. pharma companies and to stand with "overcharged" U.S. consumers. The votes are more a sideshow, and it explains why some senators, who publicly support the easing of drug-import laws, also voted for a poison pill that gutted Ms. Snowe's amendment on safety concerns. It isn't as if masses of Canadian drug fans will come storming down their doors.

If anything, Portland is a success compared to the more high-profile state programs that got rolling in 2004. When Illinois Gov. Rod Blagojevich introduced his I-Save-RX program, which was initially joined by neighboring Wisconsin, he dramatically declared that "the nearly 13 million people who live in Illinois and the more than five million people who live in Wisconsin will have the opportunity to save hundreds--and in some cases even thousands--of dollars each year on the high cost of their medicine." Mr. Blagoevich spent nearly $1 million in taxpayer dollars developing it, including some 500 state workers from two dozen agencies who spent 5,600 hours flacking the program.

All this caused Illinois Auditor General William Holland to get curious about just how much benefit this wonder program was producing, and last fall he issued a stunning report. Over 19 months of operation, a grand total of 3,689 Illinois residents had used the program, which equals approximately 0.02% of the population. Results from the four other participating states were even more laughably dismal. Wisconsin had 321 people use the program; Kansas 267; Missouri 460; and Vermont 217. Mr. Holland also noted that the program was, er, illegal, and that the state had failed to implement quality control.

Things haven't been much rosier for Minnesota Gov. Tim Pawlenty, a Republican who felt it expedient to throw over the U.S. drug industry in favor of a few populist headlines. Mr. Pawlenty promised in 2003 that his Minnesota RxConnect program would serve some 700,000 people. A representative from Minnesota's department of human services explained to me this week that the state (conveniently) does not break out the number of people who use its program. But according to its latest statistics, Minnesota RxConnect last month filled a total of 138 prescriptions. That's for the whole state. Programs like those in Springfield, Mass., have simply closed.

Ask program administrators why so few people use Canadian imports, and they'll give you a frank, and long, list. Many consumers are wary about safety issues. They like having a relationship with a local pharmacist, and like knowing their drugs have undergone a U.S. quality check. Many drugs aren't available: that includes anything that needs to be taken immediately (antibiotics, for instance), or specialty drugs (such as injections for diabetics, which are hard to ship). It's also the case that many chronic diseases are today managed with generics, which remain cheaper in the U.S. Those that do use import programs tend to be a very small population that take maintenance drugs, say for high blood pressure, or cholesterol.

Perhaps an even bigger point is that huge numbers of Americans don't even pay for their drugs, but rather farm out their bills to an insurer. That's even more the case now that seniors are getting their drugs through Medicare. Joseph Bruno, the former Republican minority leader in Maine's legislature and now full-time CEO of a chain of pharmacies in that state, points out that 94.5% of his customers get prescriptions paid by a third party and so aren't price-sensitive.

"This is nothing but political posturing," he says of the U.S. Senate debate. He also notes that many of the infamous "bus trips" from Maine to Canada were in fact ginned up by labor unions that wanted to elevate drug prices into a political issue, and that successfully left the false impression that Americans were falling all over themselves for Canadian meds. "If you look at the numbers, that's just not the case." Still, don't expect the political caterwauling over imports to go away any time soon. There's still too much political upside to talking up a program that few Americans really want to use.

Source




NHS Specialist stroke care 'lottery'

A third of stroke patients are still not treated in a specialist unit despite improvements in access, a national audit has shown. And fewer than half of patients receive brain imaging within 24 hours, a figure experts said was "unacceptably low". Welsh patients fare the worst with only nine specialist units in the country, the Royal College of Physicians found.

The government said it would publish a National Stroke Strategy this summer to "accelerate" the rate of improvement. Patients who receive care in a specialist unit have a 50% reduced risk of death and better long-term recovery. National guidelines published in 2001 recommend all patients are treated in a specialist unit but similar guidelines were not introduced in Wales until 2006.

The College said there had been significant improvements but some hospitals had failed to recognise that stroke patients needed "21st century care". The audit, funded by the Healthcare Commission, found the number of eligible hospitals in England with stroke units increased from 82% in 2004 to 97% in 2006. But only 28% of patients in Wales were treated in a stroke unit compared with 64% in England and 73% in Northern Ireland. Only 15% of patients are admitted to a stroke unit on the day they arrive at hospital. And although brain scans are needed to determine treatment, patients admitted on a weekend often have to wait until the next working day. Those with minor strokes who are in hospital for less than two days are least likely to have access to specialist services.

Dr Tony Rudd, chair of the Intercollegiate Stroke Network, said more than 90% of patients should be treated in stroke units. "And not to have done imaging by 24 hours is not really good enough. We need to differentiate between bleeds and blocked arteries."

He added: "The failure of the majority of hospitals in Wales to offer stroke unit care is scandalous and needs urgent action" Dr Rudd, who is also consultant in stroke medicine at St Thomas' Hospital in London, said the National Service Framework in the UK had successfully increased the number of specialist units but there still wasn't the capacity to deal with every patient.

Dr Jonathan Boyce, head of clinical audit at the Healthcare Commission, said the study showed welcome improvements. "But there is still too much variation, too many places and regions that are not responding as well as they could to minimise the harm done by this serious and common condition. "They now need to get their house in order."

Joe Korner, director of communications for The Stroke Association, added: "Stroke units can halve your chance of dying from a stroke, so it is a scandal that getting treated on one is a matter of luck or your postcode."

A spokesperson for Health and Social Services at the Welsh Assembly said the report showed stroke services in Wales needed improvement but there was a strategy in place. "Over the last year, NHS organisations in Wales have been required to develop more appropriate models of care for patients suffering with strokes. "Officials at the Welsh Assembly Government will work with the NHS to develop clear national priorities for action."

Professor Roger Boyle, national clinical director for stroke and heart disease, said the pace of improvement needed to accelerate. He said a national stroke strategy would be published for consultation this summer which will include a toolkit to help hospitals commission stroke services. He added: "I would also urge the NHS to use this report as a tool to examine how their stroke services."

Source

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

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

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12 May, 2007

US Cancer Care 10X better than socialized UK

Post lifted from The Anchoress . See the original for links

Gaius tells it:

"Seriously, do you really think socialized medicine is a good idea? Do you really believe that the code phrase "Universal Health Care" is anything but socialized medicine? Read this article from the Telegraph before you answer. Read it all the way through because the really important information is buried toward the end. Because it matters."

Gaius highlights a bit: "British cancer patients are substantially more likely to die of the disease than those in other western European countries because of poor access to the latest drugs, according to an authoritative report to be published today."

[...]

The proportion of colorectal cancer patients with access to the drug Avastin was 10 times higher in the US than it was in Europe, with the UK having a lower uptake than the European average."

It seems very strange to me that while Canada, Britain, France and the other countries with socialized health care systems find those systems in steady decline, the Democrats keep telling us that socialized medicine is the way to go. It's certainly the way to put an enormous amount of money and citizen control within the power of the Government.but will it save you're life? Not if there's a waiting list, and not if - as I suspect - availability of treatment will only be sanctioned by the government if you have lived your life by their standards. `Smith!' screamed the shrewish voice from the telescreen. `6079 Smith W.! Yes, you! Bend lower, please!

Money and power.I can't think of any other rational reason why the Democrats want to push us toward a health care system that clearly does not work.

The other thing that worries me about socialized medicine is that there is no incentive there for the best-and-the-brightest to undertake the arduous work (and heavy cost) of obtaining medical degrees, so that they can be under the power of the Government, rather than allowed to strike out on their own. Then who will be our next doctors? The second tier students? The third? Socialism too often is a showcase for mediocrity. It doesn't work. The private sector is imperfect, and there are certainly issues within our health care system that need addressing, particularly for the un-insured, but throwing us into this fresh hell is not the answer.

Maybe the answer is to help uninsured people, especially those with children, to buy into the same health insurance plan (or a reduced one, with reduced premiums) that our government employees tap into. Would that work?

Seems to me with all the big plans out there, already in existence, there should be a way for un-insured folks to participate for a manageable fee. People don't need to be "given" things - all that does is strip them of their dignity and their sense of self-pride [See comments section for an expansion of that thought - admin]. But there must be a way to include them in some sort of discounted participation. We need some new people in government, with new ideas. These tired, old ones need to be put to bed.

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

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

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11 May, 2007

NHS holds up cancer drugs

The UK has one of the worst records over access to cancer drugs as stark inequalities exist across the world, a Swedish study says. Researchers ranked the UK in the bottom group for its "slow and low" uptake of drugs after analysing the sales of 67 treatments in 25 countries. The US, Austria, France and Switzerland were the best, the Karolinska Institute and Stockholm School of Economics said. But the UK government said it had speeded up the drug approval process.

The researchers said getting new treatments to patients quickly and in large numbers was reflected in the survival rates. France had the highest five-year survival rate in Europe at 71% for women and 53% for men, compared to 53% and 43% in the UK respectively. The research was funded by drugs firm Roche, but independent experts said that did not invalidate the findings.

The greatest differences in uptake, measured by the proportion of patients given the drugs and how quickly they came on to the individual markets after being produced, was seen in bowel and lung cancer drugs. The US's uptake of bowel cancer treatment bevacizumab was 10 times the European average, the researchers said. In Europe the likes of France and German had higher than average use, compared to "very low" in Italy and the UK.

For lung cancer, uptake of erlotinib was 10 times higher than the European avearge in the US and three times higher in Germany. Uptake in Australia, the UK, Norway and Poland was slow.

In the UK, the first sale of breast cancer drug trastuzumab was in autumn 2000, nearly two years after it hit the market in the US and a full 12 months after it was given in Switzerland and France. Along with the UK, New Zealand, Poland, Czech Republic and South Africa were ranked at the bottom of the overall league.

Lead researcher Dr Bengt Jonsson said: "It is our hope that this report will inspire policy-makers and decision-makers to take action to address these imbalances so that access to new innovative cancer drugs does not become dependent on the patient's couintry of residence. "Cancer research continues to grow, with many new drugs and treatments expected to be introduced in the coming years. "Countries need to address urgently how they are going to accommodate newer drugs into health care systems and pay for them."

In the NHS, the National Institute for Health and Clinical Excellence (NICE) has responsibility for recommending if new drug treatments should be provided by the health service. The system has been heavily criticised because of a backlog in assessing treatments and for restricting access to them. But a Department of Health spokesman said NICE was essential in ensuring that the NHS used the most effective treatments. And he said measures had been taken to speed up the approval process for key drugs. "We are making good progress in ensuring cancer patients have access to the drugs they need. "For example draft guidance was available within two weeks of Herceptin for early breast cancer being licensed." [And the guidance was not to use it generally!]

Source

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

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

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10 May, 2007

Rethinking research funding

Dr. Jerry Avorn, a professor of medicine at Harvard Medical School, shows in his article below how full of anger at drug companies he is. Perhaps he thinks they have not given him all the presents he is entitled to. He is, however, bereft of ideas about how to improve on the present system.

He notes that, in spite of huge research efforts, new drug approvals have dropped off. He does not for a moment consider that the huge and ever-rising costs of getting a drug through the FDA approval process might have something to do with that. Leftists don't criticize bureaucracy. They LOVE bureaucracy! His solution to the problems he sees? Take money off the companies that produce the drugs -- thus making it HARDER for them to get new drugs approved!

His proposals (if we can call them that) are extremely fuzzy but he seems to think that governments can do it all! I wonder what he has in mind as an example of something that governments do well? His proposal is a simple Leftist kneejerk, untroubled by any evidence for its efficacy. It is true that governments already fund a lot of research but actually doing the research is a different matter entirely. Government business enterprises have been sold off worldwide in recent decades but dinosaur Avorn seems to want to create new ones!

THE BIOTECHNOLOGY Industry Organization is holding its annual mega meeting in Boston this week at a pivotal time in the industry's history. Medically, biotech is at the growing edge of therapeutics. Most older, conventional drug companies have become massive marketing engines with a dulled innovative edge -- only 18 new drugs were approved by the FDA in all of 2006. By contrast, many biotech companies retain their roots as research-based operations where the scientists' agenda can still compete with that of the sales department. Some of the most exciting new treatments for cancer, autoimmune diseases, and even vision loss are emerging from this creative new sector.

But amid the breakthrough findings, lavish entertainment, and self-congratulation that will fill the convention attendees' schedules this week, some important worries may not get the attention they merit. The first relates to costs. Not the cost of the luxury harbor tours and exorbitant meals that participants will enjoy in the coming days; I'm referring to what patients (or taxpayers) have to pay to get access to these wondrous discoveries.

Regimens that can cost tens of thousands of dollars a year per patient can cloud the moral judgment of those who purvey them. For example, a confluence of interests among biotech giant Amgen, for-profit dialysis centers, and kidney disease consultants seems to have led to substantial over prescribing of the company's flagship blood-building product, erythropoietin -- a lucrative practice that probably increases the risk of side effects and even death. Another dilemma: A new biotech product, Lucentis, can reverse the vision loss caused by macular degeneration, a devastating cause of blindness. But the drug costs $2,000 for each monthly injection. Many ophthalmologists are convinced that equally miraculous results could be provided to far more patients with use of a very similar biotech product, Avastin, at only $50 per dose. Yet Genentech, which makes Avastin, has not agreed to sponsor a clinical trial to study this possibility, which could also save Medicare hundreds of millions of dollars in the coming years. That's probably because Genentech makes both Lucentis and Avastin, and use of the more affordable drug would cut into the more expensive drug's expected profits.

Biotech has brought to market a number of important new cancer treatments. But pricing a lifesaving cancer regimen at over $50,000 is guaranteed to put that treatment beyond the reach of many patients. It doesn't cost anywhere near that much to produce these drugs. Rather, the industry argues that these sky-high prices are justified to fuel the expensive research it performs. But many biotech advances are heavily based on publicly funded research supported by the National Institutes of Health and by foundations. Current policies allow companies to charge whatever they want for a new drug, with no payback required for most of the indispensable, taxpayer-supported basic research that made it possible. With the federal deficit threatening to flatline the NIH budget for the first time in a generation, and venture capital speculators increasingly preferring to fund safer "late-stage" companies with nearly marketable products, savvy conventioneers this week must be worried about where the next decade's miracle cures will come from -- as we all should be.

The breathtaking five-figure prices that some biotech drugs command per course of therapy warrant a rethinking of this "trickle-down" approach to supporting science -- a strategy that amounts to the growing privatization of medical research. The example of biotech's older, flabbier siblings is not encouraging: Only about 14 cents of every dollar paid for Big Pharma's products makes its way back into research and development, according to the companies' own figures.

A safer course for the nation would be to take some of the billions the nation is paying for these expensive products and use it to rev up NIH funding, protecting the flow of scientific innovation on which new biotech products depend. The companies could then come in and do the hard work needed to bring those discoveries to market. They should be rewarded fairly, even handsomely for that important work -- but not at levels that will pauper the rest of us or the federal treasury. And we need a better way to provide reasonable compensation for the taxpayer-supported research on which breakthrough products are based. Public funding of university-based research, not extortionate drug prices, is the safest way to guarantee "the miracle cures of tomorrow." It might make for fewer luxury harbor cruises at future BIO conventions, but we can live with that.

Source




Yet another proposal about how to fix the unfixable

The NHS should be run outside politics by a board appointed by Parliament, the British Medical Association says. The NHS should have its own constitution and make clear that it cannot provide everything possible, focusing instead on core services that meet the needs of the great majority of patients most of the time, it says. These changes would prevent day-to-day political meddling and let patients know what they could expect, the BMA says in a discussion paper.

The plans arise from dissatisfaction among the medical community about the Government's reforms, James Johnson, chairman of the BMA Council said. There was "intense unhappiness" in the entire workforce, with reforms that lacked logic or coherence. Professionals had been marginalised by changes over 15-20 years, and the "constant dabbling" by politicians was dividing managers from clinicians, he said.

The recommendations envisage the NHS as an organisation that is a cross between the BBC and an old-style nationalised industry: run by a board, reporting to Parliament, and governed by a constitution that would set out principles, rights, and responsibilities. Patient input would be strengthened by greater local involvement, the division between purchasers and providers eroded if not abolished, and clinical leadership given greater priority.

Mr Johnson, a surgeon, said that the current reforms were "probably just about as unpopular as you can get. They lack cohesion; they are contradictory. "It is absolutely right the politicians set the guidelines, but day-to-day dabbling when a particular topic becomes headlines is not good for the service," he said. For the Secretary of State to have to react to every local eventuality "can't be the best use of Cabinet ministers' time. We think the way forward is for the service to be vested in a board of governors. The Government would set the amount of money and the general direction of travel for the NHS without any further interference." The board of governors would ensure compliance with the NHS constitution. It would appoint an executive management board, to include the NHS Chief Executive and Chief Medical Officer.

Some rationing of services appeared inescapable, Mr Johnson said, as treatments became more costly and the population aged. The list of services provided should be decided through debate between politicians, professionals and the public. Hamish Meldrum, chairman of the BMA's GPs committee, said that this did not mean the association favoured rationing. "We will continue to press for all necessary resources, but we do believe rationing may be inevitable. What we are recommending, if rationing is to take place, is that it's done in an open manner."

Andy Burnham, the Health Minister, said: "We resist any call to make the NHS a slimmed-down, emergency service, because that's what it would become if we started rationing care. The NHS should continue to be comprehensive and universal. Further independence within the NHS should be considered only if it improves services. We are already devolving decision-making. "

Andrew Lansley, the Shadow Health Secretary, thought the BMA was too pessimistic, and that bureaucratisation and demoralisation could be reversed. "I endorse some of the principles - taking politicians out of the day-to-day running of the NHS; reengaging professionals and focusing the Secretary of State and department on public health challenges," he said.

Nigel Edwards, of the NHS Confederation, which represents most NHS organisations, said that producing a written constitution would be extremely difficult. "The NHS exists in a cash-limited system and has a multitude of competing priorities," he said. "It is extremely difficult to reach a consensus on expensive drugs and treatments that pleases everyone. "We need to confront the reality that if the public do not want cost to be a factor in NHS decisions, they may have to prepared to pay more. "The confederation agrees that the NHS should be more independent of central government control. However, the structure of this is less important than ensuring devolution of power to local trust level."

Source

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

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

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9 May, 2007

Drug for Scots only?

Nutty British health bureaucrats disagree with one-another -- too bad for patients in England

A cancer drug has been approved for prescription in Scotland that is unlikely to be obtainable for patients who live south of the Border. The Scottish Medicines Consortium (SMC) said that Sprycel was cost-effective for use in the chronic phase of myeloid leukaemia, providing a lifeline for patients who have developed resistance to the “wonder-drug” Glivec. But the National Institute for Health and Clinical Excellence (NICE), which performs the same value-for-money assessment for England and Wales, does not have Sprycel on its list of forthcoming appraisals.

That is likely to mean that English and Welsh patients will find it difficult to get the drug on the NHS. Technically, doctors can prescribe any drug that is licensed, as Sprycel is, but in practice, primary care trusts are reluctant to pay for any that lack the imprimatur of NICE. In recent months the Scottish consortium has proved more ready to approve cancer drugs than NICE. Among these are Alimta for mesothelioma, Erbitux for head and neck cancers, Tarceva for lung cancer and Velcade for myeloma in patients who have failed on at least two prior therapies.

Sprycel, from Bristol-Myers Squibb, inhibits the growth of leukaemia cells, enabling adults with some types of leukaemia to control the disease over a sustained period. It is the first option for patients with chronic myeloid leukaemia who have developed resistance to Glivec, the drug that transformed treatment of the disease. After some time, a proportion of patients find that Glivec can no longer control the disease. Sprycel gives these patients an option. It is also useful in treating patients with some types of acute lymphoblastic leukaemia. Introduced last December, it has been reviewed by SMC, and declared cost-effective.

The number of patients who could benefit potentially is small, perhaps no more than a few hundred a year. That may enable primary care trusts to take a more lenient view, especially as patients will already have been on Glivec and Sprycel is costed at about the same price.

Tessa Holyoake, honorary consultant haematologist at Glasgow Royal Infirmary, said: “Today’s announcement is an important step forward in the management of chronic myeloid leukaemia (CML). “Dasatinib [Sprycel] offers a new option for patients in the chronic phase of the disease who have developed resistance or intolerance to prior treatment including imatinib [Glivec], who previously had a very poor prognosis due to the lack of effective alternatives.” Tony Gavin, of Leukaemia CARE, said: “We are keen to see equal and fair access to treatment for patients throughout the UK. While the SMC decision is obviously great news for Scottish CML patients, we are very concerned that patients living in other parts of the UK may be denied access because of funding constraints.”

Welcoming the announcement, Frank Pasqualone, managing director of Bristol-Myers Squibb Pharmaceuticals, said: “We are delighted with the SMC’s decision and hope that CML patients in the chronic phase with resistance or intolerance to imatinib have been given renewed optimism in their fight against this rare but life-threatening disease. “Recommendations such as this make medicines more accessible to the patients who need them. Sprycel builds on our company’s long legacy of providing innovative oncology medicines to patients.”

CML, although relatively rare, is a devastating condition that accounts for about 15 per cent of all leukaemias. About 2,600 people are currently affected by it in the whole of Britain. In Scotland, about 60 new cases are diagnosed each year.

Source



Australia: State government hospitals cannot accomodate difficult twin birth



A PREGNANT mother has been shunted between three hospitals up to 200km from her Sydney home because doctors can't find enough neo-natal beds for her premature twins. NSW Health was last night desperately searching for two specialised cots – which cost $1 million each – in Sydney to house April Mackey ahead of the impending arrival of her twins. The mother-of-three is 29 weeks pregnant and has spent the past two days at John Hunter Hospital, in Newcastle, despite living at Badgery's Creek in western Sydney. Doctors have been unable to find two neo-natal intensive beds at a Sydney hospital, despite 124 being in use across the state.

Mrs Mackey told The Daily Telegraph last night she was not sure if she could have her babies, due any day, at the hospital, which did have two available neo-natal cots. "They are telling me the beds are no longer available so I have no idea where I will be sent to next," Mrs Mackey said. "This is supposed to be a joyous occasion and yet I am stressed out worrying about where I am going to be. I've got no one here with me because all of my family is in Sydney."

Mrs Mackey, 32, went into labour last week when the water around one of her twins broke. When she visited Nepean Hospital she was told there were no beds and she was sent to Royal Women's Hospital at Randwick. From there she was transported by ambulance to Newcastle but during the journey she was transferred from one ambulance to another. Her husband Colin has had to remain in Sydney to care for their three other children. "I just want to get back to Sydney to be there for my children," she said.

Health Minister Reba Meagher said it was impossible to have the intensive care cots at every hospital. "It is not possible to have these very intensive cots at every hospital because of the cost and the care involved," she said. "There has been some communication breakdown with the family. I've asked NSW Health to address that promptly and I've asked appropriate accommodation be found for her and her family." Opposition health spokeswoman Jillian Skinner said it was a sad indictment on the health system.

Source

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

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

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8 May, 2007

Doctors admit: NHS treatments must be rationed

Fertility, multiple sclerosis and migraine therapies at risk

British doctors will take the historic step of admitting for the first time that many health treatments will be rationed in the future because the NHS cannot cope with spiralling demand from patients. In a major report that will embarrass the government, the British Medical Association will say fertility treatment, plastic surgery and operations for varicose veins and minor childhood ailments, such as glue ear, are among a long list of procedures in jeopardy.

James Johnson, the BMA chairman, will warn that patients face a bleak future because they will increasingly be denied treatments. He will urge the NHS to be much more explicit about what it can realistically afford to do and ask political leaders to engage in an open, honest debate about rationing. The BMA proposes the drawing up of a new patients' charter specifying those health services to which every citizen across England should be entitled, regardless of the local health authority's financial situation. They also want to see a second list of all the treatments which the sick will get only if their primary care trust has the money, and if doctors decide they are clinically worthwhile.

Senior BMA sources say their report recognises the reality that despite record investment in the NHS, 'postcode lotteries' are rife. Primary care trusts, the local NHS organisations that commission and pay for care from hospitals on behalf of patients, are increasingly rejecting requests to pay for procedures or drugs because they are not perceived to be the best use of funds.

Some PCTs have been bitterly criticised for refusing to pay for expensive new cancer drugs; treatment to prevent older people going blind through age-related eye degeneration and operations to help obese patients lose weight through stomach-stapling. Each trust already has a committee of medical experts that takes decisions on whether to fund medication for complaints which are not covered in their basic contract with the Department of Health. These include treatments such as growth hormone for adults, neuro-stimulation for migraines, breast reduction and enlargement, treatments for incontinence and even some care for multiple sclerosis.

Johnson will use the launch on Tuesday of a BMA discussion paper on the future of the NHS in England to spell out his belief that Britain's ageing population will put ever greater pressures on local NHS organisations to decide how best to use their resources, and that the public's reluctance to put significant extra funding into the NHS means rationing will become increasingly common.

Dr Michael Wilks, one of the BMA's senior office holders, revealed the organisation's radical thinking in a recent letter to its 139,000 members updating them on the progress of the BMA working group, headed by Johnson, which has drawn up the document. He told them the group had concluded that 'while the service should remain universal, the challenges raise questions about how comprehensive the service can continue to be. This will depend on whether politicians and the taxpayer are prepared to contemplate either increasing expenditure or explicit rationing. 'Rationing of health care in one form or another has always existed but has not been discussed. While agreeing that an open and honest debate on rationing is needed, the nature of that debate needs to be clarified. It might, for instance, address whether current inequities in care caused by pressures to balance the financial books are preferable to one alternative, which is to set a limit on the availability of some procedures.'

Health Minister Andy Burnham last night welcomed the report as a useful contribution to the debate about the NHS's future. He defended the NHS as 'the right model for Britain's future'. '[It is] a system which makes the most modern treatments and medicines available and that is envied by other governments around the world as a fair and cost-effective way of providing high-quality health care to a whole population based on need alone. 'I would resist any call to make the NHS a slimmed-down, emergency service, because that's what it would become if we started saying "you can have this" and "you can't have that". It should continue to be comprehensive and universal.'

Source

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

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

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7 May, 2007

French government hospitals worse than NHS

The groaning from the naked elderly woman in the bed next to me was coming in rasping bursts. I was unable to move and in agonising pain but she was clearly dying. The one doctor in the admissions ward of the hospital had been called out to assist an ambulance crew with an emergency some distance away and nobody else came to tend to her for a very long time. Was this Bangladesh, Albania or even Luton? No, it was France, a country we are told has a well-funded, state-of-the-art health service.

But while it has skilfully marketed healthcare tourism to Brits seeking cheaper and quicker access to hip replacements, cataract surgery and even heart bypasses, the luxury treatment packages conceal a very different reality for the run-of-the-mill medical emergency like me. Hospitals are being shut to save money; bed numbers are being cut in those that remain; waiting for treatment is common, even when you have a booked appointment; and given the famous French "pudeur" [modesty], there is an extraordinary lack of concern for patients' privacy and dignity.

I was rushed into hospital in the middle of the night with a suspected life-threatening blood clot in my right leg. I was warned that it could move to my lungs at any moment, cutting off the supply of oxygenated blood within seconds, causing rapid death. The pain was excruciating - as if car battery acid were being infused into my veins. The leg was paralysed, and the merest touch caused me to scream with pain. The ambulance arrived at my remote home with impressive speed, however, and quickly rattled off on the 12-mile journey to hospital. While I swore at every rut and turn, the ambulanceman chatted as if we were on a church outing. Was there a rural ambulance service in England, he asked. I told him there was, but that the French health service was generally considered superior.

It is not. I have spent more than a decade covering health issues for this newspaper. I have been in hundreds of hospitals around the world, and interviewed numerous enthusiastic British patients tucking into red wine and steak and chips as they recover from planned surgery in splendid privacy at immaculate French hospitals. But when I was taken into the state-run hospital at Vire in the western Normandy d‚partement of Calvados, not far from Mont St Michel, two weeks ago, I did not realise that there was no vacancy among the 630 beds shared between the town's private and public hospitals. Although I was being treated, I nevertheless lay stuck to a narrow plastic trolley for some 17 hours as the sun blazed down outside, and the temperature climbed above 30C.

I put on a brave face as my family came to visit and quickly left, aware they were in the way and invading the privacy of other stricken patients. I learnt a great deal about the medical history and personal circumstances of three patients who shared my narrow space during my hours on the trolley. I also got an opportunity for close monitoring of their bedpan use, vomit and other bodily effusions.

The sparrow-like naked woman was the last of them. As we lay alone together, she wondered if they had forgotten us and apologetically begged me to help her. I explained I couldn't move but shouted for a nurse, realising she was dying. The room was suddenly full of people. As they fought to save her she not only lost control of all bodily functions, but was reduced to helpless panic as she struggled vainly for breath. I should not have been there.

In a surreal moment, a healthcare assistant slid through the melee to admonish me for refusing the offer of an evening meal. I persuaded staff to wheel me into the cool peace of the corridor only by pointing out they would have more space to treat my roommate. Minutes later the stench from the room followed me out, as a binful of soiled bedding was unceremoniously dumped next to my head.

I was finally wheeled off to the cardiology unit, where all patients have private rooms. A week of intensive treatment, infusions, blood-thinning drugs and tests followed. The treatment was fine, but all the nurses spoke of the relentless pressure on beds.

French doctors have been denied the 35-hour working week offered to other public sector workers. Hospital administrators told me that most of them do 48-50 hours - for about half the average 110,000 pounds paid to their NHS counterparts.

I was told that patients sometimes complained about the lack of privacy, but with little effect. One nurse said that after the director of the hospital was treated in a six-bed unit and had to perform his ablutions while the other patients looked on, opaque screens were introduced between the beds, but only in that unit. "I've seen on television those curtains you have round beds in English hospitals," she said. "I don't think it occurs to the managers here, and if people complain about the lack of privacy for patients not in rooms by themselves, the first objection is that doing anything will cost more money."

I was discharged and sent for more investigations in other centres and clinics. In the town's other, privately run, hospital, I was kept waiting for 90 minutes. Nobody apologised or explained. An MRI scan performed at a stand-alone private diagnostic centre in another town finally detected a rare abnormality of the joint lubricating fluid that in my case had caused a slow-growing, nonmalignant tumour which had ruptured into my knee. I was then referred to a rheumatologist and readmitted, this time to Caen University hospital.

In Caen it was clear that the intention was to keep me over a second weekend to prevent the bed being taken by a tiresome emergency case. Only when I remonstrated was I told that the "unorthodox" decision would be taken to puncture my knee and draw off the fluid causing the swelling, on a Friday afternoon. The next day I was reluctantly released.

French voters go to the polls today to decide on their new president. Healthcare provision was scarcely mentioned in the election campaigns of any of the contenders - maybe because of a mistaken belief that it is not a problem. The system faces identical problems to the NHS, and ones that are threatening healthcare provision across the developed world. The population is ageing, and demand for hospital treatment in Vire is increasing at a rate of 5% a year.

Ordinary French patients pay for their care with a mixture of state funding and private insurance. For those without private insurance, treatment for costly or rare conditions may be limited. There is not enough capacity in the system because of the classic problem of "bed blocking" that is just as familiar in Britain - old people who can't be discharged from hospital because intermediate care or convalescent homes no longer exist.

British people have been infected with the welcome American attitude to competition and customer service. If something isn't good enough, they complain. In Europe and especially France, people still meekly put up with being sold bad food and bad consumer products and services. Despite France's claim to one of the best healthcare services in the world, the only appreciable difference with the NHS appeared to be cleanliness. Instead of the mute mop-draggers, there were armies of cheery diligent cleaners everywhere.

It is not too ridiculous to suggest that while French hospital managers could certainly teach their NHS counterparts about managing a cleaning service, healthcare managers here could teach them a thing or two about concepts of consumer rights. It might help them to treat all their patients with a bit more humanity.

Source




Australia: ambulance service in critical condition

The Queensland Ambulance Service has plunged into crisis, with frontline paramedics pleading for more staff and emergency vehicles before it's too late. The Government admits recent ambulance response times have worsened alarmingly and staff morale is poor as many paramedics continue to work up to 14 hours straight - shifts their own Minister described as "killers". In a further blow to the QAS, new Assistant Commissioner Stephen Gough - recruited with much fanfare from Victoria less than a year ago - is on indefinite sick leave.

Last week The Sunday Mail revealed that faulty defibrillators used by paramedics had been linked to the death of a Queensland man, two years after the QAS was ordered to replace cables in similar equipment after the deaths of two other men.

Emergency Services Minister Pat Purcell said last week all the money raised through the ambulance levy (minus administration costs) was distributed to the QAS via the Government's Consolidated Revenue account. But an examination of the QAS annual budget reveals the introduction of the compulsory community tax has not significantly increased funding to the service. In the year before the levy was introduced on July 1, 2003, the ambulance budget was $248 million. In its first year the $88 annual fee, which replaced the voluntary ambulance subscription system and was added to electricity bills, raised more than $96 million - but the QAS budget increased by just $27 million.

The levy, increasing with the Consumer Price Index each year and now $95, is expected to contribute more than $120 million to State Budget coffers this year. The annual budget for the QAS in 2006-07 is $355.7 million. Premier Peter Beattie, when introducing the levy, said the money would not be used for other purposes. "We are not going to take one cent out of this," he said.

But Mr Purcell said it was never intended that the levy would provide additional funds for the QAS. "At no stage was the levy ever intended to increase the Queensland Ambulance Service budget," he said. "The levy instead took the place of other sources of funding like the QAS subscription scheme and user charges." He said the levy funded only a portion of the QAS budget - about 32 per cent for 2006-07. The rest was allocated from the State Budget.

But paramedics, angry over the state of the service and lack of improvement since the levy was introduced, said last week the public should be demanding answers from the Government. "They are being ripped off. The levy is being used to pay for management junkets . . . what is left is used to replace the many frontline troops who have left and ambulances that have broken down," one ambo said yesterday. In a letter to The Sunday Mail, another officer described the state of QAS operations in Brisbane as "disgraceful" and claimed patient lives were at risk. The officers cannot be named because they have been threatened with fines and sacking if they speak out.

Source

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

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

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6 May, 2007

More NHS superbug deaths

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

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

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

A statement from the James Paget University Hospitals NHS Trust said: “At the beginning of December 2006 we became increasingly concerned about a rise in our normally low background rate of C.diff. “Our concerns were heightened by the increasing severity of illness which led us to believe that a new strain was present in the hospital. “We immediately responded to these changes in the patterns of patients’ illness by putting in place a wide range of additional infection-control measures.”

Precautions include putting patients suspected of having the bug in isolation rooms, revising antibiotic prescribing policy, upgrading cleaning procedures and introducing new deep-cleaning techniques, involving the recruitment of 15 new staff. Visitors to the hospital are being asked to wash their hands with soap and water as an extra precaution as the usual alcohol gel is not a protection against the bug.

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

Source




Australia: Victorian hospitals still in trouble

Every single State government health system in Australia keeps producing tales of woe

The number of patients waiting for surgery has grown again. In more bad news for Health Minister Bronwyn Pike, the latest hospital report shows a blow-out in the elective surgery waiting lists to 37,197 Victorians. The state's hospitals failed half their performance benchmarks, meaning tens of thousands of patients were not given medical attention in the required periods.

The six-month update into the performance of hospitals shows the Government has failed to rein in the ballooning surgery waiting lists, despite a 2006 funding blitz designed to reduce the list ahead of last November's state election. Ms Pike released the report yesterday, a month late -- a day after she was attacked in State Parliament by Liberal health spokeswoman Helen Shardey, who accused her of hiding the results. "Our hospitals have performed 914,653 operations for people on elective surgery waiting lists since 1999," Ms Pike said yesterday. But there was little good news in the report, which showed that between July and December last year:

* 800 more patients than last year were now on the elective surgery waiting list, despite a $52 million pre-election spending spree by the Government.

* A THIRD of emergency patients waited more than eight hours for a bed.

* MORE than 70 per cent of urgent patients suffering blood loss or vomiting received treatment within 30 minutes, below the required minimum of 80 per cent.

* HOSPITALS were too slow moving non-admitted patients out of emergency departments, with 76 per cent staying less than four hours, compared with the required 80 per cent.

The state's hospitals did achieve their targets for the number of times an ambulance was sent away to another hospital -- but the 1.8 per cent bypass rate was still higher than the previous six-month rate of 1.3 per cent. All 3765 emergency patients requiring immediate treatment for heart failure, life-threatening injuries and drug overdoses were seen immediately. The benchmark requiring 80 per cent of emergency patients with bone fractures or breathing problems to be seen within 10 minutes was also met. The hospitals met their benchmarks for providing elective surgery for patients whose cases are deemed to be urgent.

Ms Pike said the targets were ambitious. "There are people that wait too long, we know that, but that number as a proportion will come down because we are increasing the volume of people who are getting their surgery overall," she said. Ms Shardey said Ms Pike was incapable of managing Victorian hospitals. "It's the job of government to forecast demand, and it's a failure to manage the system more than anything else," Ms Shardey said.

Source

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

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

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5 May, 2007

Publicity forces some humanity onto the NHS

There's nothing like those "caring" socialists to look after you. You can go blind for all they care. The fact that you have paid for your government health insurance does not at all mean that you will get the cover you have paid for

An elderly couple who faced having to choose which of them should go blind because they could not both afford sight-saving drugs have finally been saved by the NHS. Olive Roberts, 79, and her husband, Ron, 81, both suffer from wet age-related macular degeneration (AMD), the most common form of blindness in Britain. They were told that the only way to treat their condition quickly enough was to go private. However, the treatment would have cost them more than 14,000 pounds each. They could afford only one course and decided that Mrs Roberts should have it as her sight was deteriorating faster.

Yesterday Wiltshire Primary Care Trust announced that it would fund Mrs Roberts’s treatment. The trust denied accusations of a U-turn, but was criticised by campaigners for allowing the couple’s condition to deteriorate by taking more than two months to decide. The couple are among tens of thousands of people with AMD who urgently need sight-saving treatment but who say that they have been let down by local health authorities refusing to fund new and effective drugs to treat the condition.

The Royal National Institute for the Blind, which supported the couple’s case, said that four out of five NHS trusts were denying patients prompt treatment with sight-saving drugs.

Mr and Mrs Roberts had AMD diagnosed after sudden onsets of blindness last year. Mr Roberts, a retired civil servant who served with the RAF and the Royal Navy during the Second World War, was disappointed that the trust had not contacted them directly with the news. “While we are delighted that Olive can receive the treatment she needs, we have been through hell in the past three months, and this highlights the fact that many other people are not getting the help they need.”

AMD damages the part of the retina responsible for precise vision. Treatments are approved for use on the NHS in only a quarter of cases and can merely slow the disease’s onset. The Roberts were advised that only prompt treatment with the drug Lucentis could prevent blindness. However, it is not approved for widespread use on the NHS. Mr and Mrs Roberts, of Malmesbury, asked Wiltshire Primary Care Trust to fund the treatment, but were told that they would have to wait up to three months for a decision.

Advised to undergo treatment within that time, the couple decided to buy Mrs Roberts a course of the bowel cancer drug Avastin, a cheaper alternative. However, clinical trials have not proved its safety and efficacy in AMD. Paul Jakeman, medical director for Wiltshire trust, said that the NHS would fund Mrs Roberts’s treatment with Lucentis. Mr Roberts said that he could now afford to pay for Avastin for himself. “It seems that only those who shout loudest will get this treatment,” he said.

Source




Now it's Western Australia: Health Minister admits overcrowing in public hospitals

Western Australia's Health Minister, Jim McGinty, has conceded that overcrowding is causing problems in hospital emergency departments but says beds are being opened to deal with the problem. Mr McGinty says there's been a peak in demand at Sir Charles Gairdner Hospital but more beds are being progressively opened to alleviate the pressure. "We're creating an extra 150 beds in the hospital to improve the patient flow, to make sure that patients can be seen a lot more quickly and that we minimise the log jam that's currently occurring," he said.

The State Opposition has accused Mr McGinty of burying his head in the sand about the state of overcrowding in public hospitals when he criticised the Australian Medical Association yesterday for raising the issue.

Mr McGinty accused the Australian Medical Association's Doctor David Mountain of not telling the truth when he described Perth's hospital emergency departments as being in a state of "general mayhem" since Sunday. Only a few hours later, overcrowding caused Sir Charles Gairdner Hospital to activate a code yellow alert. Doctor Mountain says a code yellow means patient care is compromised by overcrowding.

The Opposition's Health spokesman, Kim Hames has accused Mr McGinty of shooting the messenger. " It seems that every time that someone sticks their hand up and complains about conditions in the hospital the Minister virtually goes for their throat, and he's done it yet again," he said.

Source

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

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

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4 May, 2007

The crisis in NHS maternity wards

Killing babies through being too busy is accepted as normal and many mothers are treated worse than farm animals



When my daughter was born, I did not think she was alive. She came out of her mother with a chest striped blue and purple, and failed to move. She lay motionless on the mat in the delivery room and the blue disappeared, rapidly replaced by more purple. Then the purple darkened and contracted as fast as the pupil of an eye. Now, at the ripe old age of ten seconds, my baby was white as a sheet with dark blotches. And still not moving.

My wife Rachel had tapped me on the shoulder barely two hours before. We were in bed. The clock radio blinked 1.30. In the dark, she had told me: "I think I'm in labour." It was all more rapid than I could ever have imagined. Zooming down dark London backstreets, I thought the baby was about to be born in the footwell of our car. And by the time we reached the nearest maternity unit, the poor child was trying to get a glimpse of the corridor. We were shown to a room. Midwife and baby emerged simultaneously.

Now, looking at my daughter lying there on the blue plastic mat, I remember two things clearly: assuming something terrible might have gone wrong, but deciding not to panic unless the staff did. I looked to the midwife for reassurance. "Show me your notes," she said - not shouting, but urgent all the same. "Hold up your wife's notes." I was grabbing at the file. "Last-but-one page." Everything had happened so fast, she had not been able even to glance them over. "Are you Rhesus Negative?" she asked Rachel. "I don't know, don't think so," my wife replied. I was still staring at the little scrap on the floor. Baby motionless; midwife worried.

Then a miracle happened. Our NHS angel, the midwife, took a towel and rubbed the lifeless baby to get the circulation flowing, and suddenly the white and the purple disappeared and the skin shone with glorious red, like a farmer's cheeks on harvest day. Then she started bawling her eyes out - the noise might have tried our patience in the weeks since, but that morning it was as welcome as wedding bells.

The midwife, a sparky fortysomething whom I shall not embarrass by naming, had been about to go off shift when we arrived. She had stayed on from a sense of duty, thank goodness, and congratulated us heartily. "Blimey, I thought she was a goner," I confessed over the sound of my newborn screaming. "I even thought you thought she was." "My rule," said the midwife, "is never panic in the first minute."

I wrote my anxiety down to new-father nerves and inexperience. But had I known what I now know - thanks to working on Panorama's undercover investigation of other maternity units - I might have approached the day of my daughter's birth with rather more trepidation. We sent a reporter, Hayley Cutts, to work as an unpaid volunteer in maternity wards at hospitals in Barnet and Manchester. Some of the footage she came back with was truly frightening.

In one excerpt, filmed in January at Barnet Hospital, Hayley watched as a midwife was called away to a crisis elsewhere. That left an astonishing 24 women in the care of just two qualified midwives and one student. Picture the scene. As Hayley's camera whirrs, concealed in her blouse, the phone goes. It's a call from the delivery suite, where mothers actually give birth. They're saying they're full - they have to send a patient over to the maternity ward.

Hayley passes the news on to her more experienced colleagues. "There's a woman coming over in two minutes." "For what?" asks one. Hayley explains, "She's from the delivery suite." "She's here and there's no beds," murmurs a midwife ruefully. When, seconds later, the labouring woman appears, your first impression is of a terrible misjudgment: how can a woman so deep into labour be sent packing from the unit where she is supposed to be having her baby? The nearest midwife tells her to sit in the corridor.

The scene is awkward enough watching it on tape - it must have been a dozen times worse for the mother-to-be herself, labouring on a hard plastic chair in full view of janitors and any passing visitor. When Hayley points out to the midwife in charge that the woman is crying, she replies: "Tell her to get a life." We showed the tape to Mavis Kirkham, professor of midwifery at Sheffield Hallam University, who was shocked. "I think that's really tragic, that poor woman in strong labour in a public corridor," she said. "These are Third World conditions. No farmer would let an animal they valued labour with that degree of stress and anxiety in a tense public place."

After 50 minutes in the corridor, the woman was eventually taken to a bay in the ward, but when she got there, there was no bed for her. So she had to wait again on a plastic chair. The hospital authorities later informed us the staff's 'mistake' was not to have shifted the woman to another hospital. But the nearest alternative maternity unit was six miles away, and the poor woman was about to give birth.

I wish I could say that the overload on the ward was a one-off. But often the wards at Barnet are so choc-a-bloc they have to close temporarily. It happened eight times in the four weeks Hayley was there. When she asked a midwife why the doors were shut to new arrivals, she got the reply: 'We're dangerous at that stage. It gets to the point we've got so many women and not enough staff to look after them that we could miss things.' If that is not a warning sign to expectant mothers, what is?

At one point the Barnet staff are caught in conversation about how things won't change unless something terrible happens. 'I tell you what it's going to take,' one midwife says, 'a baby dying.' Another disagrees, saying it 'needs a mother' to die. The exchange happens casually, across an admissions desk. It is all the more shocking for that. 'We've killed off babies before now, deaths you can push under the carpet,' says a midwife on our tape. 'To kill a baby is cheap, but to damage a baby is more expensive. To kill the mother - that will actually give us the results we need, but God help the poor midwife involved in that.'

The chief executive of Barnet And Chase Farm Hospital Trust, Averil Dongworth, was suitably appalled by this conversation on her premises. But when she blamed the midwives I wondered if she had missed the point: staff shortages, missing equipment and rota chaos are surely not their fault.

So what has the Government promised? In 2004, there was a pledge that every woman in full-blown labour should have access to 'a designated midwife 100 per cent of the time'. And only last month, Health Secretary Patricia Hewitt promised every mother would have the right to opt for a home birth, overseen by a midwife. Yet the Royal College Of Midwives says the system is 3,000 midwives short and one-third of maternity units had their budgets cut last year.

All of this while Britain's birth-rate goes up. Small wonder that a report from Oxford University into maternity care in Britain found that two-thirds of mothers said they felt they had been abandoned too soon after giving birth.

If only the scenes we'd witnessed at Barnet Hospital were an exception. But they were not. North, south, east and west we found all manner of horror stories about the pressure on maternity services. I went to see Ben Harman and Katie McKay at their swish terrace home in Battersea - young, professionals with loving families and lots of friends. Eight months ago, when her labour began, Katie was told by Chelsea & Westminster Hospital that their maternity unit was too busy to take them at present and she should 'have another bath' while her labour progressed. So she did. This was her first child; why argue with the experts? After the bath she rang back - the unit was still full and there was no space at any other hospital. 'I freaked out,' Katie told me. Still they told her to hang on. After two hours Ben drove her to Chelsea & Westminster, but still the staff were too busy for her. 'It was only after my waters had broken, one hour and ten minutes after I'd actually been on the ward that I was given my first internal examination,' she told me.

The baby was lying the wrong way round, in the breech position, and in distress. Instead of an emergency caesarean they tried to deliver the baby normally. She was starved of oxygen and baby Ella died five days later. 'From our point of view,' Katie said, 'It was just too many red lights. If you go through one red light you might get away with it. If you go through five you're going to have an accident. 'The first red light we went through was when the position of the baby wasn't picked up, the second red light was the hospital being closed to admissions, the third red light, not being examined for an hour-and-a-half. Unfortunately, for us it resulted in our baby's death.'

This was the wisest single thing anybody told us in the course of filming. How terrible that Katie had to find it out through her own personal tragedy. Sitting in their front room, I leafed through their photograph album. Picture after picture showed Ella being hugged, so cherished by her mum and dad in those five short days of life. Her parents found the explanation that midwives weren't available to provide better care because of a "change of shift" was little short of an insult.

Our reporter, Hayley, also did work experience at St Mary's hospital in Manchester, inside the city's biggest maternity unit. Secretly recording there for weeks, she kept hearing stories from stressed-out midwives and mums who said the care they received was unsatisfactory. Hayley was at the bedside of Lili, who was 16 days overdue but had not been induced because of a lack of beds in the delivery unit. Finally, staff did induce her. But then they turfed her out of the delivery ward because they said they needed the room for someone else. With no access to any pain relief beyond gas and air, she begged to be examined. When it turned out she was in the late stages of labour, Lili was rushed to delivery to have her baby. Then, in one of the film's most chaotic scenes, Hayley is sent to fetch a CTG, the monitor which picks up a baby's heartbeat when pressed to the mother's stomach.

From ward to ward she goes. Here is a sample of the exchanges: Hayley: "Hiya, I was wondering if we could borrow a CTG monitor." Staff member: "Oh - er - that'll be a matter of finding one." Staff member two: "I doubt it. The place is full." Ward clerk: "I can't actually find one anywhere, love." Hayley: "Really? Do you know when one will be available or not?" Staff member: "I couldn't say, no. Unless they might have one over there. Have you tried over on MDU, maybe." Hayley: "OK, I'll go and ask - thanks." And the reply from the next unit when she asks if they've got a precious CTG? "We haven't. They're all in use." Such scenes would be comic if they were happening anywhere but in a hospital.

And when Hayley - who is totally upfront about her lack of training - is asked to monitor a baby's heartbeat by a midwife too busy to do it herself, you realise just how disturbing the problems on Britain's maternity wards have become. It brought me back to those chaotic moments in December when our Anna was born - which was, after all, a normal if somewhat rapid delivery. In those precious moments you realise a life is in the balance; and the whole future of your family. You don't want to leave the hospital counting yourself lucky that a midwife turned up for the birth.

Source




An Australian government denies its hospitals are in crisis

The Queensland Government has denied the state's health system is in crisis despite finding that four unregistered foreign-trained interns were undertaking the work of doctors at Cairns Base Hospital. The scandal comes two years after Indian-trained surgeon Jayant Patel was blamed for contributing to the deaths of 17 people at Bundaberg hospital, which led to a radical shake-up of the health system.

Queensland chief medical officer Jeanette Young filed a report to the Government yesterday which said that not only had four overseas-trained interns been doing the work of doctors at Cairns Base Hospital earlier this year, but two medical supervisors had allowed them to do such work even though they knew the four were not registered doctors. Two of the four interns have been dismissed and one is in the process of being dismissed. Another has been registered and is now practising as a doctor at the hospital.

Two medical supervisors at Cairns Base Hospital, acting executive director of medical services Wayne McDonald and deputy medical superintendent Ric Streatfield, face an ongoing examination of their actions by Queensland Health's Ethical Standards Unit as well as the Queensland Medical Board, which is responsible for the registration of doctors in the state. The investigations will look at not only their actions in allowing the interns to perform the work of doctors but also reports they gave to Queensland Health that indicated the interns were being supervised and had no direct contact with patients. The initial reports to the Government were that the four had always been under supervision but Health Minister Stephen Robertson sent Dr Young to Cairns to investigate patients' files.

Dr McDonald has already resigned from Queensland Health, but the medical board has the power to ban him from practising medicine in Queensland. Dr Streatfield could face a range of disciplinary actions, including being sacked.

Mr Robertson and Dr Young yesterday denied that the incident showed a system-wide problem in Queensland Health, and said the problem had come about because the hospital did not follow guidelines. "This is not a system in crisis; this is a system under pressure," Mr Robertson said. "This is not Bundaberg; the circumstances are quite different." Mr Robertson said that, although the Government had outlined clearly what guidelines needed to be followed, that had not happened in this case. "The guidelines are very clear: you don't employ doctors that are not registered by the medical board," Mr Robertson said. "I also want to stress this was a mistake made by one local hospital; it is not a whole-of-system flaw."

Three of the interns are Alex Burgansky, who did much of his secondary schooling in Ukraine and is under investigation, and Lulu Meng and Juan He, both from China, who have been sacked. The fourth, who is now a practising doctor, has not been identified. Cairns Base Hospital takes 18 interns most years, but with a shortage of doctors in regional Queensland, the intake was increased to 24 interns this year. All 24 places were filled with graduates from Australia, but when four dropped out, the hospital was forced to look overseas for replacements.

Source

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

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

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3 May, 2007

US health executive offered top NHS role

British politicians are getting desperate to fix the NHS

An American executive with a lifetime's experience of paying for care in the US health system has been offered the job of commercial director at the Department of Health, overseeing the purchase of care for NHS patients. But the appointment of R. Channing Wheeler, who is in the final stage of negotiations ahead of an expected announcement this week, is likely to be controversial as he has been caught up in the scandal of backdated stock options in the US.

The appointment of a US big-hitter with extensive healthcare purchasing experience is seen within the department as a clear signal of its continued commitment to market-based reforms and to the use of the private sector to treat and commission care for NHS patients. His selection has been approved by Tony Blair, the prime minister, from a short list that included other experienced US candidates. The department has been encouraged by their apparent belief that there is a job worth doing in the NHS.

Mr Wheeler, 55, was an executive vice-president of UnitedHealth Group, which is still being investigated by the US Securities and Exchange Commission over the alleged granting of backdated share options. The scandal has brought down William McGuire, the former longstanding chairman and chief executive of UnitedHealth, one of the largest US managed-care providers. Mr McGuire resigned after it was discovered that he and other executives had repeatedly received stock options, meant to incentivise future performance, that were granted at or near the lowest point of the share price in each year they received them.

Mr Wheeler, who until 2004 was chief executive of Uniprise, the UnitedHealth subsidiary that deals with some of the biggest US companies, is alleged to have received grants of more than 409,000 options on similar dates to Mr McGuire between 1998 and 2002, according to court papers filed in the US. A civil action has been filed by public sector union shareholders in UnitedHealth seeking $5.5m in damages from him over the share options.

The UK's health department is understood to have done due diligence on the appointment and accepted that Mr Wheeler was unaware at the time that the way the options were granted was questionable. Mr Wheeler held executive positions with US health plans, while running UnitedHealth's north-east region, before becoming chief executive of Uniprise in 1998. and 2004.

Karen Jennings, head of health for Unison, said: "The American health system is riddled with fraud and we must protect our NHS from that sort of corruptioon. "UnitedHealth is trying to infiltrate the NHS, and it is worrying that someone from that organisation is being favoured over an NHS or civil service appointee." Mr Wheeler did not return calls to his listed home address.

Source

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

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

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2 May, 2007

Maine system misses its goals by a mile

When Maine became the first state in years to enact a law intended to provide universal health care, one of its goals was to cover the estimated 130,000 residents who had no insurance by 2009, starting with 31,000 of them by the end of 2005, the program's first year. So far, it has not come close to that goal. Only 18,800 people have signed up for the state's coverage and many of them already had insurance. "I think when we first started, in terms of making estimates, we really were kind of groping in the dark," said Gov. John E. Baldacci, who this month proposed a host of adjustments.

The story of Maine's health program - which tries to control hospital costs, improve the quality of health care and offer subsidized insurance to low-income people - harbors lessons for the country, as covering the uninsured takes center stage. States, including California, Massachusetts and Pennsylvania, have unveiled programs of their own, seeking to balance the needs and interests of individuals, employers, insurers and health care providers.

But as Maine tries to reform its reforms, it faces some particular challenges: It has large rural, poor and elderly populations with significant health needs. It has many mom-and-pop businesses and part-time or seasonal workers, and few employers large enough to voluntarily offer employees insurance. And most insurers here no longer find it profitable to sell individual coverage, leaving one carrier, Anthem Blue Cross Blue Shield, with a majority of the market, a landscape that some economists said could make it harder to provide broad choices and competitive prices.

Some parts of the state's current program - named Dirigo after the state motto, which means "I lead" in Latin - are seen as promising. These include the creation of a state watchdog group to promote better health care, and an effort to control costs by asking hospitals to rein in price increases and spending, although experts and advocates said those cuts needed to be greater. But a financing formula dependent on sizable payments from private insurers has angered businesses and is being challenged in court.

And while some people have benefited from the subsidized insurance, which provides unusually comprehensive coverage, others have found it too expensive. And premiums have increased, not become more affordable, because some of those who signed up needed significant medical care, and there are not enough enrollees, especially healthy people unlikely to use many benefits. "It was broad-based reform that just never got off the ground," said Laura Tobler, a health policy analyst with the National Conference of State Legislatures. "The way that they funded the program became controversial. And getting insurance was voluntary and it wasn't that cheap."

Governor Baldacci said in an interview that when the Legislature enacted the Dirigo Health Reform Act in 2003, it gave him less money and more compromises than he had wanted. He said his administration had now learned more about what works and what does not. His new proposals include requiring people to have insurance and employers to offer it and penalizing them financially if they do not; making the subsidized insurance plan, DirigoChoice, more affordable for small businesses; creating a separate insurance pool for high-risk patients; instituting more Medicaid cost controls; and having the state administer DirigoChoice, which is now sold by Anthem Blue Cross. "We've got a reform package that takes Dirigo to the next level," Mr. Baldacci said. "It takes the training wheels off."

The proposed overhaul seems to include something each of Maine's constituencies can embrace and something each opposes, so there is no guarantee which changes will be adopted by the Legislature. "It's very hard politically to deal with the underlying costs of the system," said Andrew Coburn, director of the Institute for Health Policy at the Muskie School of Public Service in Portland. "And Maine is just not wealthy enough to cobble together enough resources to fully cover the uninsured."

The state's current program, which has added 5,000 people to Medicaid and enrolled 13,800 people in DirigoChoice, has made progress. Even though the enrollment goal has not been met, the insurance plan has grown faster than any in Maine's history, the governor said. And although about 60 percent of its enrollees were previously insured, some were paying what state officials deemed was too high a percentage of their income, said Trish Riley, director of the Governor's Office of Health Policy and Finance.

The DirigoChoice benefits are impressive, said Hilary K. Schneider, policy director for Consumers for Affordable Health Care, a Maine advocacy group. The program completely covers preventive care, subsidizes premiums and deductibles, and unlike most insurance plans, covers treatment for mental illness and does not exclude people for pre-existing medical conditions. Such coverage has caused critics to say DirigoChoice would be more affordable if it scaled back benefits. "It's a Cadillac policy, and we ought to be trying to fund a Ford Escort policy," said Jim McGregor, executive vice president of the Maine Merchants Association.

One of DirigoChoice's success stories, Jacquie Murphy, 63, of Westbrook, said, "It absolutely saved my life." Ms. Murphy said she has fibromyalgia, chronic fatigue syndrome, back problems, an autoimmune disease and memory problems from a childhood brain injury. She said that a few years ago, when she left an abusive marriage and gave up her husband's coverage, the fear of being unable to afford insurance that would accept someone with her illnesses "caused me to become clinically depressed." With DirigoChoice, which costs her just over $100 a month with the state paying a subsidy of about $250, she now has a walker, sees orthopedic surgeons for shoulder and ankle fractures, and takes medication for memory, cholesterol and thyroid problems. The relief of being insured lifted her depression, she said, and now, in her home with its Asian-themed pebbled backyard, she works as a career and life coach.

For others, like Leah Deragon, 34, DirigoChoice is too costly. Ms. Deragon, who runs a Portland nonprofit center that helps low-income families with new babies, said that although she and her husband, an engineering student, qualified for a subsidy, they could not afford the roughly $300 out-of-pocket cost each month. She remains uninsured, forgoing annual checkups and using student loan money when she needed dental work. "For us it was very frustrating," said Ms. Deragon, who shops at Goodwill and lives in her mother's home in Gorham to save money. "We earned, I think, $16,000 last year. We can't do $200 or $300 a month and still put gas in our car. Come the end of the month, we would be forced to hitchhike."

And there is John Henderson, 42, of Auburn, who enrolled in DirigoChoice in 2006 for about $90 a month while working at an L. L. Bean warehouse, a job he kept to 20 hours a week so his income would qualify him for such a low rate. But he dropped the plan this year when rates increased by 13.4 percent on average. Mr. Henderson, who has diabetes and is currently jobless, said he had stopped once-regular doctor's appointments and some medications that "I have just no hope of affording." Ms. Schneider's group is suing the state insurance commissioner for approving the rate increase.

An Anthem spokesman, Mark Ishkanian, said the increase was necessary because medical claims of DirigoChoice customers were "substantially higher" than anticipated [How surprising!], about double those of non-Dirigo plans. One reason for the higher expense was "pent-up demand" by enrollees who had been deferring visits to doctors while they were uninsured, Mr. Ishkanian said. Another was the richness of the coverage, which enrollees used for treating long-held conditions or mental illness, he said.

Ms. Riley said the state was surprised that more than half of DirigoChoice enrollees qualified for the highest subsidy, 80 percent, which meant the program has been more expensive for the state. She said Maine also expected more small businesses to enroll in DirigoChoice. But many businesses found that the program requirements of enrolling 75 percent of a firm's employees and paying 60 percent of the cost were too expensive. "If they weren't able to afford insurance before, they're unlikely to be able to afford Dirigo," said Kristine Ossenfort, senior governmental affairs specialist of the Maine State Chamber of Commerce.

Some health care advocates have accused Anthem of not marketing DirigoChoice enough to prospective customers, which Anthem denies. Especially controversial was Maine's financing formula for its program, which assumed that there would be savings because an increase in insured people would mean less charity care from hospitals, and that the cost-cutting measures would mean lower costs to insurers. The state said it would charge insurers for those savings, rather than let insurers take the savings as profit. But when the state tried to charge insurers $43.7 million in 2005 and $34.3 million in 2006, the insurance industry and the chamber of commerce sued, saying the insurers owed much less. A judge ruled for the state, but the case is being appealed. The governor's new proposal would phase out this financing structure and impose lower-cost surcharges instead.

Among the state program's biggest fans is Joan M. Donahue, 40, who was uninsured when she started a home care agency in Warren three years ago. She now has DirigoChoice for herself and her 17-year-old son, and three employees are enrolled. She also has two employees who cannot afford it and have not enrolled. "I will absolutely stick with Dirigo," said Ms. Donahue, who does not qualify for the subsidy. "This program needs healthy people who don't get subsidized so it can prosper."

The Dirigo program has already made one change that could attract people like Malvina Gregory, 31, a Spanish interpreter in Portland, who could not afford the subsidized insurance but may reconsider. Ms. Gregory was originally put off because it demanded full payment up front, and rebated the subsidy later; she went instead to a Portland program giving nearly free care, but is now afraid her income "will bump me over the limit" for that program.

DirigoChoice will now allow individuals to pay only their part up front. "The concept of Dirigo, I think, is phenomenal," Ms. Gregory said. "I hope they are able to lower the premiums. There are a lot of folks like me that are in that bind."

Source




"Universal" healthcare not so universal

A ban on smokers and the obese getting certain NHS treatments in some parts of the country was defended by Health Secretary Patricia Hewitt today. She said it was "perfectly legitimate" for primary care trusts (PCTs) to set a collective policy to deny operations to certain patients. Ms Hewitt was responding to a Sky News survey which found nine PCTs refused joint replacements to obese patients and four blocked orthopaedic surgery for smokers.

The areas concerned cover six million people, but Ms Hewitt said it was common practice in individual cases in other parts of the country. Ms Hewitt told Sky's Sunday Live: "Primary care trusts are absolutely entitled to get together with their doctors on any particular area of clinical judgment and say `these are the guidelines we are putting in place for this particular kind of treatment'. "Those decisions are being made by individual doctors all over the country. In a few places doctors have come together collectively through the primary care trusts to put in place guidelines for all of their patients. "This isn't a matter for managers or indeed Government ministers to decide who gets what operation - it's a matter for doctors and always has been.

"The NHS will treat you with help to stop smoking if the doctor's advice is that you shouldn't have the operation until you've stopped smoking. "That is a perfectly legitimate clinical decision. I support doctors making clinical decisions in the interests of their patients."

Ms Hewitt - who will tomorrow appear alongside Prime Minister Tony Blair to celebrate 10 years of the Government's NHS policies - has faced a turbulent few weeks. Junior doctors yesterday backed a call for her to quit over botched training reforms and major industrial action is in the pipeline over moves to stagger a pay rise. But she insisted surveys of patients proved reforms were working.

Source

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

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

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1 May, 2007

NHS dentists in trouble

Crazy rules

Dentists may have to pay back millions of pounds to the NHS because they have failed to reach their targets in the first year of a new contract. Some dentists face repayments of tens of thousands of pounds, and in a few cases more than 100,000 pounds. The impact on dental practices will be even greater because their income next year will be reduced, and it is feared that the problems may lead to even more dentists leaving the NHS.

The problem is the latest to hit the troubled NHS dental contract, which rewards dentists for the “units of dental activity” (UDAs) that they complete. Many dentists – nobody yet knows how many – have failed to achieve the UDA targets that were set by primary care trusts, and for which they have already been paid. One dentist said that the contract had turned him into “a UDA factory”, working flat-out to achieve the targets. Others said that the only way to reach the targets was to take on quick jobs such as extracting teeth, rather than root-canal surgery to save the tooth, which earns the same UDA score.

A survey by the British Dental Association (BDA) found that 61 per cent of practices expected to miss their targets. There are about 20,000 NHS dentists, so as many as 12,000 could face financial penalties. In practice the number is likely to be smaller, because as long as a dentist achieves 96 per cent or more of the target, the money owing can be paid off in the next year.

The BDA fgures are backed by a smaller survey by Denplan, a company that provides dental payment plans. This found that 53 per cent of the 122 dentists that it approached expected to miss their targets by enough for their PCTs to insist on “clawing back” money, and that they would receive a smaller contract next year. Another 13 per cent said that they expected to be asked to return money, but to be given the same contract. At least one dentist who spoke to Denplan said that he had been served a “notice of intent” by his PCT to reclaim 100,000 pounds for underdelivered UDAs. The dentist was still in negotiations with the PCT over the amount.

Susie Sanderson, chairman of the BDA executive board, said that the final figures would not be collated until the end of June. “It throws a real threat on the viability of many practices,” she said. “Dentists own their practices and have to invest very heavily in them. They need a high standard of equipment, and good training for their staff. They’ve invested the money in the practice, and they are pretty resentful.” Stephen Gates, managing director of Denplan, said: “Many dentists are beginning to think very carefully about their future. They have looked at the contract and said, ‘We can’t run a business on this basis’.”

David McBride, a dentist in Norfolk, said that he knew dentists who had not managed well under the new system. “Perhaps I shouldn’t say this,” he said, “but I think if you haven’t done the work, you shouldn’t be paid for it.” He agreed, however, that the UDA system was defective. “If a patient comes in and needs more than two crowns, it costs me more to do the work than I get paid,” he said. “So there is a temptation not to do things that need doing. There is a huge potential for supervised neglect.”

The BDA has told the Government that alternative ways of monitoring dental contracts must be found. “UDAs are fundamentally unfit for purpose,” Lester Ellman, chairman of the BDA general dental practice committee, said in a letter to the chief dental officer for England, Barry Cockroft.

A spokeswoman for the Department of Health said: “Practices have up to two months after the end of the year to finish reporting courses of treatment, so PCTs and practices will not yet know the final position. But if a practice has not carried out the agreed level of patient care, the PCT will have to discuss why this has happened and, if appropriate, adjust the amount paid to the practice to reflect the level of service delivered."

Source

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

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

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