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30 September, 2006
NHS HOSPITAL TREATS ELDERLY PATIENTS LIKE ANIMALS
And kills them!
A coroner has criticised a hospital for offering "despicable" and chaotic treatment after hearing that four elderly patients died in painful and degrading circumstances. John Pollard, who conducted inquests into all the deaths on the same day, said that he would be raising his concerns with the management of Tameside General Hospital in Ashton-under-Lyne, Lancashire. He condemned as "absolutely despicable" the treatment of Watkins Davies, an 84-year-old war veteran, who went into hospital with a fractured hip and contracted MRSA, the hospital superbug, The inquest was told that Mr Watkins, a widower, was the victim of a catalogue of failures in basic nursing care. When he fell out of his chair, while trying to wash himself, no X-ray was carried out to assess any additional injuries.
His family claim that he was left to lie in his own waste and was in severe pain for hours because of shortages in nursing staff. His meals were left up to 6ft out of his reach. Relatives told the inquest that they repeatedly had to ask a nurse to help him. Ivor Davies, his son, said: "My father did not receive adequate medical and nursing care. There was a lack of communication between nursing staff and us. "I went in one day and my dad was lying in excrement. God only knows how long he was like that. I asked whether the infection was MRSA, only to be told it wasn't. A couple of days later I was told it was MRSA after all."
Mr Pollard recorded a verdict of accidental death. He also heard that Hilda Douglas, 75, died at the hospital from a heart attack after fracturing her pelvis. The family of Mrs Douglas, a voluntary worker from Droylsden, near Manchester, said that she broke her hip when she fell from a hospital trolley without sides. There was no record of the fall. Edward Douglas, her son, said: "There was one nurse per three beds and the nurse said she could not cope." He said that medication had been left on the floor.
Recording a verdict of death by natural causes, the coroner said he found this astonishing. "What if that had been vital medication?" he asked. "It is absolutely chaotic." A third inquest heard that Raymond Lees, from Ashton-under-Lyne, who died in May, contracted MRSA after undergoing a knee replacement operation. During his time in the hospital his waist shrank by 14 inches. John Lees, his son, said that it had taken him three hours to discover that his father had not been bathed and that hospital staff did not appear to know his name. "The nurse said, `He gets himself up, dresses himself and does his own teeth'," Mr Lees said. "In fact, he was wearing the same pyjamas he had been wearing for three days. The nurse was cruel and cynical."
A fourth inquest was told that James Kelly, a pensioner from Stalybridge, Tameside, was recovering from surgery but died from pneumonia after he was left sitting in his dressing gown in a draught. Mr Pollard said: "In most of the issues, the nursing care, not the operations or the general medical staff, but the basic care of people, has been in question. I shall be contacting the chief executive and looking at all future deaths at Tameside General Hospital very carefully."
Andrew Burnham, a Health Minister, said: "I understand that the hospital trust has in place a range of measures to ensure that patients receive the high-quality nursing care they have every right to expect. These include daily rounds by matrons to check on patient care, including nutrition and hydration, all of which are reported back to the director of nursing, who has ultimate responsibility for the standard of care." A spokesman for Tameside and Glossop Acute Services NHS Trust said: "These cases are being investigated internally and the trust will act on the results of these investigations."
Source
CANADIANS NOT GOOD ENOUGH FOR THE NHS
Too white, probably. That many Canadians and Australians died for England in two world wars apparently deserves no gratitude or recognition from England's present Leftist government -- regardless of the offence that causes to Canadians and Australians
As many of you know my wife and I have recently emigrated to the UK from Edmonton, Alberta. My wife is a Canadian nurse with a first class degree in nursing from an English speaking university, and she herself is a native English speaker. In fact it is her only language, though, like many English-speaking Canadians, she does have 'cereal packet French'.
Before coming to the UK we had to travel down to Calgary, some 300km away, in order that she could sit an British Council English exam (cost $400), which is a prerequisite for 'foreign' nurses coming to work in the NHS (perhaps unsurprisingly for a native English speaker with a degree from an English-speaking university she passed the six hour ordeal - spoken English, understanding spoken English, written English and reading - with a 100% pass mark). Canadian nurses have to go through this costly ordeal in order to get professional registration with the Nursing and Midwifery Council, bizarrely EU nurses do not.
Upon getting here she understood that she would have to be retrained to 'NHS standards', which in itself is laughable due to the fact that Canadian nurses are trained to a much higher level than the average UK nurse. But still, we accepted that this was the price (300 to be precise) that we would have to pay.
The whole moving and shipping process took some time, as you can imagine, and when we arrived in the UK and phoned the Nursing and Midwifery Council (NMC) we were informed that it was not really worth her while retraining and applying to register as a nurse in the UK because the Government had just changed the rules of engagement between health sector employers and foreign nurses. Essentially employers, if they wanted to employ a foreign nurse, had to prove that there was no British or EU nurse that could fill the role. Consequently she would be unable to get a job. Tears.
Eventually, after several weeks enquiry, and in the face of ongoing and insistantly negative NMC advice, a man at the Foreign Office informed us, as we expected, that it was illegal to discriminate against anyone with a valid UK work permit (which of course we obtained when we were in Canada). The bureaucracy of the NMC (a body created by Nu Labour); their general incompetence and bad advice; added to the fact that retraining courses for foreign nurses are now very difficult to come by because foreign nurses are actively discriminated against and no longer come here, means that by the time she can get on a course and retrain she will have been out of work as a nurse for six months. And incurring retraining costs along the way.
She (we) decided not to bother. The result is that the NHS, and the country, has lost a specialist paediatric nurse, a skilled immigrant, who can work to an extremely high standard to the benefit of us all. But this is not a story of complete woe; as soon as she decided not to persue a career in the NHS she was immediately snapped up by the private sector to fulfill a paediatric training role. She now earns about the same as she would as a nurse in Canada - 40% more than a UK nurse - but the problem is that she desperately wants to nurse; it is a vocation, not just a career. And to add insult to injury there is a chronic national shotage of paediatric intensive care nurses.
The result of all this is that I have on my hands a wife who is deeply embittered about the way she has been treated by the UK Government. I regret, and she regrets, that we came back, which is a crying shame as we moved here because we love England.
Anyway, I thought I would get that off my chest. In our dealings with government organisations (mostly the NMC) during this whole saga (which would take me a week to relate to you in full) we have found them to be, almost to a man and woman, completely incompetent and unhelpful. The one redeeming organisation was a non-governmental professional body called the Royal College of Nursing, the general secretary of whom is Dr Beverley Malone.
Dr Malone is an extremely politically astute woman, a credit to her organisation, who has railed against the Government's discrimination against foreign health workers. She s, in particular, to the way the government cherry picked third world nurses from abroad, depleting those countries of their greatest natural resource, and now intends to pack them off against their wishes as soon as their work permit expires and their employers are forced to employ an EU nurse.
We have been the unfortunate victims of the Government's scramle to recruit foreign nurses and then their scramble to unemploy them in the face of criticism of falling standards, poor English, and third world cherry-picking. Wrong place. Wrong time. But our experience probably pales into insignificance compared to some poor souls.
Dr Beverley Malone now turns her attention to government discrimination against the English:
Under English law, patients in homes are entitled to state support for their nursing care but must foot the bill for "personal" care. In Scotland, by contrast, the whole bill is paid.
And there have been allegations that English patients have been subject to a "postcode lottery" caused by variations in interpretation of the rules around the country.
The Royal College of Nursing claimed the new proposals would fail to solve the problems. It called for a single national policy - and ed to plans to hand policy-making to local primary care trusts.
RCN general secretary Dr Beverley Malone,pictured, said: "It is nurses who are put in the impossible position of having to explain complicated and often unfair decisions to patients and their families.
"The RCN believes that anyone who needs nursing in a care home should get this care fully funded by the NHS. Nursing care is a fundamental part of healthcare and should be funded by the NHS.
Well said that woman. The sad fact is that we no longer have a national health service. It is, of course, beyond her remit to point out the constitutional and funding reasons why this might be so. But I have no doubt that she is aware of the facts.
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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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29 September, 2006
BUREAUCRATIC HEAVEN PROPOSED FOR THE NHS
For the past couple of days I've been wondering what it is that the rest of the world sees in Mr Brown's NHS reform that I've missed. Those people who don't confidently reply "son of the manse" when asked about Mr Brown instead say "man of substance" and cite his NHS reform plan as evidence of his sagacity. And there am I thinking that it is completely daft.
The policy of giving the Bank of England the power to set interest rates, free from political interference, has been an undoubted success. So now Mr Brown wants to extend that model to the public services, with the NHS most commonly named as the first to be reformed in this way. An independent board will be established to administer the service, with the role of politicians restricted to setting overall goals and strategy. Conservatives are sufficiently enthusiastic about the idea to claim that Mr Brown has stolen it from them. The day will come when the Tories will pretend that they had nothing whatsoever to do with it....
The NHS is not like the Bank of England. The Bank is setting the price of money. The NHS has an output not far off that of Portugal. It handles something like 10 per cent of our national income. It employs thousands and thousands of people. It is a very different animal.
There are two ways of holding such a body to account. The first is through voice - the right to protest to a political representative who depends on your vote. The alternative is exit - the right to take your custom elsewhere, with the seller dependent on your patronage in order to thrive. Mr Brown plans to remove both these forms of accountability. When he describes the new board as independent, you just have to ask: independent of what, exactly? And the answer, it turns out, is independent of you and me.
Sir Peter Lachmann, former president of the Royal College of Pathologists, felt moved to write to this newspaper that Mr Brown's new policy was "probably the best news the NHS has had in the past 30 years". I was not surprised to read this endorsement. The senior management of the service is bound to conclude that the interference of meddling politicians is nothing but a nuisance. They want to run their NHS with our money and without us pesky voters sticking our nose in the whole time.
The Chancellor is arguing that the closure of a local hospital ought to be decided by health service managers without the right of politicians to prevent it. If he isn't saying this, he is saying nothing. But is it really acceptable that such sensitive decisions be made only by a group of unelected people, accountable only to each other and without appeal to the local electorate? The model that Mr Brown intends to apply to the NHS is not really the Bank of England at all. It is, well, the model that the Tories tried to apply to the NHS in the mid-1980s.
In 1985 Norman Fowler, then the Health Secretary, appointed Victor Page as the chief executive of the NHS with the idea of relinquishing political control of administrative matters. It was perhaps with this experience in mind that another former Health Secretary yesterday told me that he thought Mr Brown's plan was "bonkers". Political pressure from voters and the media ensured that it didn't last five minutes. And neither will Mr Brown's plan.
There is an alternative. If Mr Brown truly wants to stop political interference in the day-to-day decisions made by clinical staff and local management there is something he can do. He can replace accountability by voice with accountability by exit. If a local hospital were to close because everyone was using a better service near by it might anger some residents. But no one could claim that the service providers were unaccountable.
The Chancellor has set his face against such a Blairite (actually Tory) solution. But his third way between two forms of accountability is to provide no accountability of all. His NHS board idea was intended to reinforce his image as a man of substance. I think he would have been better off with one of Doddy's wisecracks.
More here
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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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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28 September, 2006
KILLER NHS HOSPITAL
Government health inspectors are to investigate how Maidstone Hospital in Kent handled an outbreak of an infection that killed six patients and contributed to the deaths of fourteen others. The Healthcare Commission announced an inquiry yesterday into Clostridium difficile, which it said followed concerns about the rates of infection at the hospital since 2004. C. difficile is the main cause of diarrhoea infections in British hospitals, and contributes to more deaths than MRSA.
The inquiry into Maidstone and Tunbridge Wells NHS Trust will examine whether the rates of C. difficile are high, taking into account all factors. The investigation, one of only two the commission has conducted into C. difficile, will look at outbreaks of the infection and evaluate the trust's systems and procedures for controlling it. It is also likely to consider the trust's arrangements for identifying and notifying cases, the factors contributing to the rates of infection, the trust's response on the wards, and the priority given to its control.
The investigation was requested by the South East Coast Strategic Health Authority and the trust, whose three hospitals serve Maidstone and Tunbridge Wells and surrounding areas including Tonbridge, Sevenoaks and parts of East Sussex. C. difficile can cause a wide range of symptoms, from mild diarrhoea to life-threatening conditions.
Nigel Ellis, head of investigations at the Healthcare Commission, said: "Our investigation will examine how the trust identified and dealt with cases of C. difficile. "We recognise that outbreaks of infection are not always easy to control, but when they do happen they pose a very serious risk to patient safety. "We need to find out what happened, what systems the trust has in place to ensure this does not happen again and whether further improvements are needed to protect the safety of patients."
The commission, which is the independent inspection body for the NHS and the private and voluntary healthcare sectors, will publish its findings and recommendations for improvement in a report expected next year.
Maidstone is by no means the first hospital to suffer a serious outbreak of C. difficile. A total of 334 patients were infected with the bacterium and at least 33 died between October 2003 and June last year at Stoke Mandeville Hospital in Aylesbury, Buckinghamshire. In a highly critical report into that outbreak, published in July, the commission said that there had been serious and significant failings in the way in which senior hospital managers had responded to it.
According to the Office for National Statistics, in 2003 there were 1,748 mentions of C. difficile on death certificates, of which 934 noted the infection as the underlying cause of death. Between April and June, 136 patients at Maidstone Hospital were found to be infected with C. difficile, the trust said. The infection was the definite cause of death of six patients; in fourteen others it contributed to their deaths but was not the main cause, and it was unlikely to have led to the deaths of four other patients who had had the infection.
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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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27 September, 2006
HOLLOW VICTORY AGAINST THE NHS OVER HOSPITAL CLOSURE
A former nurse who won her High Court battle against hospital ward closures yesterday said that it was not a genuine victory. Pat Morris, from Altrincham, Greater Manchester, risked her home and savings on waging a campaign against Trafford Healthcare NHS Trust after it decided to cut beds at her local hospital without consulting the community. Mrs Morris, 65, resigned her nursing job to concentrate on her legal battle and faced having to pay the trust's legal costs had she lost the case.
Yesterday Mr Justice Hodge backed her view that the trust's decision in March to close 26 rehabilitation beds for older people without consultation had been illegal, and ordered that it be quashed. However, he refused to order that the two wards at Altrincham General Hospital, where Mrs Morris worked for several decades, be reopened immediately. Mrs Morris and her barrister, Anthony Eyers, who worked on her case for no charge, said that they expected NHS managers to pay lipservice to consultation but to keep the wards closed.
Mrs Morris said: "There are no winners today, only losers. They will just go through the motions only to tell us the wards will stay closed. The challenge has been made and the trust have been found wanting, but the elderly, vulnerable people of Altrincham still don't have their care close to home. "I don't have to pay thousands of pounds, but in human terms we have still lost a lot in the last few months. I have no regrets about bringing the case, except that the judge decided it was not his duty at this time to reopen the beds."
Mr Justice Hodge said that the trust would have to reach a new decision after public consultation. He added: "It cannot be right for this court in its discretion to order the reopening of the wards on the basis that there will be a public consultation which might legitimately then decide to close them again."
Mrs Morris has led the campaign against the cuts at Altrincham General since resigning from her job there in 2003 after 16 beds were cut. She was a member of the Patient and Public Involvement Group, a watchdog representing local residents, but left to fight her battle. At one stage the entire hospital was threatened with closure, but Mrs Morris, a former Tory councillor, organised a self-funded series of public rallies, letters and petitions. Hundreds of people turned up to her public meetings, but it was Mrs Morris who sought the judicial review on behalf of the group Health in Trafford. She risked an 80,000 pound bill for legal costs if the judgment had been made against her.
Trafford Healthcare NHS Trust, which is 9 million in debt, will now have to pay its own legal costs. Mrs Morris was awarded her costs, which were less than 1,000 pounds.
Mr Eyers described the ruling as a "Phyrric victory". He said: "It has ramifications for the whole country because it gives a green light to trusts that they can act first and take the legal flak later. They may have to fight, but they can act with some certainty that their decisions will not be reversed. I now expect the trust to make a series of empty promises that they won't deliver on." Mr Eyers said he had taken the case pro bono as a matter of principle: "I live in the Altrincham area and so it had some personal resonance, but NHS trusts, like any public body, should be accountable to the people they serve." He said the same principles had been behind Mrs Morris's fight: "She would have given every last penny she had if it had achieved something for the people of Altrincham."
Trafford Healthcare NHS Trust said that it had cut the beds because "it was no longer a safe place for patients to receive care. Anyone visiting the hospital would be struck by the dilapidated state of the buildings and the nursing and medical staff were no longer confident that they could provide safe services". [And whose fault would that be?] It added that four public meetings would be held next month to decide the future of in-patient wards at the 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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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26 September, 2006
NHS SEMI-PRIVATIZATION WORKING -- BUT NOT WHOLLY AS INTENDED
They are helping BritGov's battle with its public servants, but at a cost
Private health centres are being paid tens of millions of pounds by the NHS for operations that are not happening. Hardly any of the independent centres set up under generous contracts are meeting their targets, an investigation by Health Service Journal has found. But they still get paid, unlike NHS hospitals, which are paid on the basis of how many operations they do.
The 20 centres were open by March. Information gathered by the journal from public documents, freedom of information requests and parliamentary answers indicates that so far they are doing only 59 per cent of the operations for which they are contracted. The Will Adams Treatment Centre in Gillingham, Kent, is performing at the rate of 945 procedures a year, compared with the 3,954 needed to meet its targets. It carries out hernia operations and day-surgery orthopaedic, gastroenterology and urology procedures.
The Department of Health denies that there is a problem. The centres were set up with five-year contracts and a spokesman said that it was completely misleading to say that activity below 100 per cent represented a waste of money. That could be determined only at the end of the contracts, when it would be clear how many operations the centres had done.
Its own figures put a different gloss on the situation by including other short-term programmes launched to shift the backlog. When those are included, it says that the programme is working at 84 per cent of capacity. Independent sector treatment centres (ISTCs) are controversial because NHS traditionalists say that they take money away from health service hospitals, disrupting their finances. The first ISTCs were set up under contracts that guaranteed an income based on the number of patients they undertook to treat, regardless of whether that many were treated.
Overall, HSJ calculated that the 20 centres should be treating patients at the rate of 78,242 a year, assuming that the target numbers are averaged over the whole of the five-year contract. But in the period to March their treatment rate was 46,073 patients a year, 59 per cent of the target.
In defence of the centres, many have not been open long, and the numbers they treat have not had time to build up. The main cause of the shortfall appears to be a reluctance by doctors to refer patients to them. Attempts have been made to persuade GPs to increase referral rates, but one obstacle is that ISTCs are staffed largely by doctors from abroad who are not known personally to GPs. This may affect judgments and make it less likely that patients will choose to go there.
The centres are costing primary care trusts a lot of money. Local reports suggest, for example, that the underperformance of the Will Adams ISTC is costing Medway PCT 100,000 pounds a month. The trusts deficit in 2005-06 was 2.4 million.
A survey by HSJ of 42 NHS chief executives found considerable disquiet. More than three quarters felt that their own finances had been damaged by the centres including 7 per cent who called the effect disastrous. Almost 60 per cent doubted that the centres had added to NHS capacity, and question marks were raised about whether the NHS needed any extra capacity anyway.
The health department, and 10 Downing Street, are unlikely to be unduly alarmed by the findings. The hidden agenda behind the ISTCs was an attempt to break the power of surgeons in NHS hospitals to control waiting lists, and that seems to be succeeding. The policy to allow patients a choice as to where they are treated has had such a dramatic effect on waiting times that top advisers regret that it was not introduced much sooner.
Source
NHS fails as an insurer once again
A new drug that could transform the lives of children with a rare genetic condition might be judged too expensive for the NHS. Hunter Syndrome was in the headlines last year when Andrew Wragg, 40, a former SAS soldier, was driven to despair by the decline of his son Jacob, 10, and smothered him with a pillow. The father, from Worthing, was cleared of murder and given a suspended sentence for manslaughter with diminished responsibility.
The fatal syndrome, suffered almost exclusively by boys, is caused by a defective enzyme that is unable to break down complex sugars produced as waste products in the body. These compounds, called mucopolysaccharides, accumulate in the tissues and organs and cause worsening physical and mental health problems.
The new drug, Elaprase, developed by Shire Pharmaceuticals, has been approved in the US and is expected to be licensed in Europe by the end of the year. Given by infusion, it improves breathing and movement. Parents of some Hunter children say it has transformed them. But it will cost at least 100,000 pounds per child per year, and as much as 300,000 for older, heavier patients who need bigger doses. Although the number of Hunter children in the UK is small no more than about 100 the cost of providing it for all of them could well be prohibitive.
A patients group has been lobbying ministers to confirm that the drug will be funded under a special scheme for children with rare diseases. Christine Lavery, chief executive of The Society for Mucopolysaccharide Diseases (SMD), said: Funding for treatments for rare diseases similar to Hunter Syndrome is due to end at Christmas. We expect that to be extended. But there has been no promise that the DoH will fund the new drug for Hunter Syndrome. All our questions and requests for clarification of the position have met with a lack of response, which leads us to fear the worst.
Although not a cure the drug, which replaces the missing enzyme, may allow affected children to lead near-normal lives if the condition is picked up early. Dr Ed Wraith, a consultant at the Royal Manchester Childrens Hospital, said: With this disease, there is damage to the heart, liver, brain and other organs which invariably leads to death well before the age of 20. The treatment is a major breakthrough and it would be a tragedy if the Department of Health didnt provide the money.
The Department of Health said: No decision has yet been made on whether this expensive drug will be funded. The same is likely to be the case north of the Border, where the Scottish Medicines Consortium has refused a related drug for a girl with a similar condition.
Bob Wragg, 64, grandfather of Jacob, said: Thank God they have found a treatment at last. His wife, Anne, a nurse, said: A lot of people just dont understand the torment that Andrew went through caring for Jacob and seeing him get worse and worse. An adult sufferer of the syndrome, Colin Arrowsmith, 26, from Newcastle, has been receiving Elaprase weekly as part of a trial since February 2004. He had already defied doctors predictions that he would be dead by his early teens and until five years ago was able to live independently. He worked in the mailroom of an electricity company but was forced to give it up because his hips began to crumble. This forced him into a wheelchair and made him more reliant on his parents.
His mother, Barbara, said: He was picking up lots of infections and his liver and spleen were very large. Since he began the weekly infusions his general health is better and his liver and spleen are no longer swollen. He has a lot more energy. The treatment wont reverse the damage done but weve been told that it should prevent further damage.
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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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25 September, 2006
NHS MATERNITY DISGRACE
A couple who lost their baby after they were turned away from the nearest maternity unit have exposed a crisis of overcrowded hospitals shutting their doors to women in labour. Andrew and Rachel Canter have launched a campaign to prevent other mothers and babies being put at risk by maternity hospitals closing to new admissions for up to 30 hours at a time. The couple's son, Jake, was born dead after they were forced to drive past the maternity hospital where they had planned to be admitted and take a 20-minute detour to another unit. Rachel was in the late stages of labour and needed urgent attention.
Their case reflects a national trend for busy maternity hospitals frequently to close their doors to new admissions, even turning away women who have booked places on their wards. Evidence compiled by The Sunday Times shows:
* In one year, maternity hospitals in Greater Manchester had to close on 90 occasions, some for up to a day. One had to close 29 times. A shortage of staff has forced Greater Manchester and East Cheshire hospitals to plan cuts in the number of maternity units from 13 to 8.
* Women are frequently turned away from London's major hospitals. St Thomas's hospital is understood to have closed to new admissions three times in a fortnight but has refused to disclose details. Chelsea and Westminster hospital has closed its maternity unit four times in the past year for up to 11 hours.
* Last month a woman in labour was turned away from maternity hospitals in Hastings and Eastbourne before setting off on a 30-mile journey to Pembury, Kent.
* The Barratt maternity unit at Northampton general hospital had to close during two weekends in March, once for up to 30 hours, forcing 10 women to be redirected.
The problems have emerged as the NHS is bracing itself for the permanent closure of maternity units across the country. David Nicholson, its chief executive, recently warned that the number of maternity hospitals would need to be cut. Managers say there are not enough doctors.
Andrew Canter, who runs an advertising agency and lives in Welwyn, Hertfordshire, believes his son could have lived had Barnet maternity unit not closed to new admissions on the day his wife gave birth. He said: "This baby could have been born alive. It was an absolute disgrace that we were treated in this way. This was a classic case of underfunding and understaffing. We now want changes so that Jake didn't die in vain."
The Royal College of Midwives says a lack of doctors and midwives is responsible for the closures. Barnet and Chase Farm Hospitals NHS Trust said the maternity unit had to close on the weekend that Jake Canter was stillborn last October because it was too busy. The hospital had not been designed for the number of women who gave birth there
Source
Long delays for cancer diagnosis in Australia
Women suspected of having breast cancer are waiting longer than seven days to be diagnosed because of a national shortage of pathologists. Instead of the recommended 24-hour diagnosis, the Royal College of Pathologists of Australasia (RCPA) reports that some women are waiting more than a week to be diagnosed. The lack of pathologists also means some women wait as long as four months for autopsy results after a miscarriage.
The Sunday Telegraph revealed earlier this month that some families had been forced to wait a year to learn their loved ones' cause of death because the Westmead morgue had been unable to fill vacancies for forensic pathologists. The college has blamed the Commonwealth and state governments for failing to honour commitments to fund additional training positions to address the problem.
RCPA chief executive officer Debra Graves said the situation had reached crisis point, with patient health potentially put at risk. She said some women with breast lumps had to repeat diagnostic procedures because of the pathologists shortage. Dr Graves said it was advisable that a pathologist perform or supervise diagnostic procedures to ensure the correct cells were taken, but the unavailability of pathologists had resulted in cases where incorrect cells had been taken, forcing patients to repeat procedures. "It is best practice to have a woman with a lump diagnosed within 24 hours, but what we are seeing at the moment is women having to wait for anything up to a week because they've had to come back," she said. "That is a terribly stressful time for a woman, but it's happening everywhere and it's getting worse."
According to the RCPA, there are 70 pathologist vacancies nationally, with the shortage affecting hospitals across Australia. Figures from the college show there are 1290 practising pathologists in Australia, 20 per cent of them aged over 60. In 2003, the Australian Medical Workforce Advisory Committee recommended that an extra 100 training positions be created over the next five years. But since that meeting, only 39 new positions have been funded instead of the recommended 300. The college put forward a budget submission to the Commonwealth for an additional $13.75 million to fund an extra 40 positions. The Commonwealth agreed to fund 10. The NSW Government has provided funding for four pathologist positions.
In the most recent RCPA Path Way journal, the college cites a cancer being undiagnosed by an overworked pathologist as a worst-case scenario if the shortage is not immediately addressed. A spokeswoman for Health Minister Tony Abbott said the training of pathologists was the responsibility of state and territory governments, but added the Commonwealth had a program to train pathologists in the private sector. "In 2004-06, $3.7 million in funding was allocated," 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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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24 September, 2006
JOBS BOOM IN HEALTH
If you really want to understand what makes the U.S. economy tick these days, don't go to Silicon Valley, Wall Street, or Washington. Just take a short trip to your local hospital. Park where you don't block the ambulances, and watch the unending flow of doctors, nurses, technicians, and support personnel. You'll have a front-row seat at the health-care economy.
For years, everyone from politicians on both sides of the aisle to corporate execs to your Aunt Tilly have justifiably bemoaned American health care -- the out-of-control costs, the vast inefficiencies, the lack of access, and the often inexplicable blunders.
But the very real problems with the health-care system mask a simple fact: Without it the nation's labor market would be in a deep coma. Since 2001, 1.7 million new jobs have been added in the health-care sector, which includes related industries such as pharmaceuticals and health insurance. Meanwhile, the number of private-sector jobs outside of health care is no higher than it was five years ago.
Sure, housing has been a bonanza for homebuilders, real estate agents, and mortgage brokers. Together they have added more than 900,000 jobs since 2001. But the pressures of globalization and new technology have wreaked havoc on the rest of the labor market: Factories are still closing, retailers are shrinking, and the finance and insurance sector, outside of real estate lending and health insurers, has generated few additional jobs.
Perhaps most surprising, information technology, the great electronic promise of the 1990s, has turned into one of the biggest job-growth disappointments of all time. Despite the splashy success of companies such as Google and Yahoo!, businesses at the core of the information economy -- software, semiconductors, telecom, and the whole gamut of Web companies -- have lost more than 1.1 million jobs in the past five years. Those businesses employ fewer Americans today than they did in 1998, when the Internet frenzy kicked into high gear.
ATTITUDE SHIFT
Meanwhile, hospitaL administrators like Steven Altschuler, president of Children's Hospital of Philadelphia, are on a hiring spree. Altschuler has added the equivalent of 4,000 new full-time jobs since he took over six years ago, almost doubling the hospital's workforce. To put this in perspective, all the nonhealth-care businesses in the Philadelphia area combined added virtually no jobs over the same stretch.
Altschuler plans to add 3,000 more employees over the next five years as the hospital, one of the nation's leading pediatric centers, spends $1.7 billion to expand. Next up is a new 1.2 million-square-foot research facility that will be packed with well-paid scientists and support staff. "Health care is the major engine for the economy of the city of Philadelphia," says Altschuler.
The City of Brotherly Love is hardly alone. Across the country, state and local politicians, desperate for growth, are crafting their economic development strategies around biotech and health care. California will pour $3 billion into stem cell research over the next 10 years, and other areas are on the same path. "Our downtown business leaders and politicians have traditionally considered health care as a cost center, not as an economic engine," says Baiju R. Shah, a former McKinsey & Co. consultant who runs Cleveland's BioEnterprise, a nonprofit founded four years ago to stimulate the local health-care and bioscience industries. "But people are waking up."
What they're waking up to is the true underpinnings of the much vaunted American job machine. The U.S. unemployment rate is 4.7%, compared with 8.2% and 8.9%, respectively, in Germany and France. But the health-care systems of those two countries added very few jobs from 1997 to 2004, according to new data from the Organization for Economic Cooperation & Development, while U.S. hospitals and physician offices never stopped growing. Take away health-care hiring in the U.S., and quicker than you can say cardiac bypass, the U.S. unemployment rate would be 1 to 2 percentage points higher.
Almost invisibly, health care has become the main American job program for the 21st century, replacing, at least for the moment, all the other industries that are vanishing from the landscape. With more than $2 trillion in spending -- half public, half private -- health care is propping up local job markets in the Northeast, Midwest, and South, the regions hit hardest by globalization and the collapse of manufacturing (map).
Health care is highly labor intensive, so most of that $2 trillion ends up in the pockets of workers. And at least so far, there's little leakage abroad in terms of patient care. "Health care is all home-produced," says Princeton University economist and health-care expert Uwe Reinhardt. The good news is that if the housing market falls into a deep swoon, health care could provide enough new jobs to prevent a wider recession. In August, health-services employment rose by 35,000, double the increase in construction and far outstripping any other sector.
John Maynard Keynes would nod approvingly if he were alive. Seventy years ago, the elegant British economist proposed that in tough times the government could and should spend large sums of money to create jobs and stimulate growth. His theories are out of fashion, but substitute "health care" for "government," and that's exactly what is happening today.
Make no mistake, though: The U.S. could eventually pay a big economic price for all these jobs. Ballooning government spending on health care is a major reason why Washington is running an enormous budget deficit, since federal outlays for health care totaled more than $600 billion in 2005, or roughly one quarter of the whole federal budget. Rising prices for medical care are making it harder for the average American to afford health insurance, leaving 47 million uninsured.
Moreover, as the high cost of health care lowers the competitiveness of U.S. corporations, it may accelerate the outflow of jobs in a self-reinforcing cycle. In fact, one explanation for the huge U.S. trade deficit is that the country is borrowing from overseas to fund creation of health-care jobs.
There's another enormous long-term problem: If current trends continue, 30% to 40% of all new jobs created over the next 25 years will be in health care. That sort of lopsided job creation is not the blueprint for a well-functioning economy. One solution would be to make health care less labor-intensive by investing a lot more in information technology. "Low productivity in health is mostly a product of low investment," says Harvard University economist Dale Jorgenson.
For now, though, health-care hiring is providing a safety net in areas where manufacturing and retailing are no longer dependable sources of jobs. Take Johnstown, Pa., a town that once hummed with activity from local steel mills, coal mines, and nearby factories. As most of these businesses closed, the town emptied out, going from a population of 63,000 in 1950 to 23,000 today.
Now, Conemaugh Health System, with about 5,000 workers, is the biggest employer in town. "Everyone has a Conemaugh parking sticker on their car," says Linda D. Suter, 48, who's in her second year at the nursing school Conemaugh operates. Suter's dad worked at a factory in a nearby town, now closed, that made backyard swing sets for kids.
Frank Kosnowsky sold appliances at the Sears in Johnstown for 10 years, starting right out of high school. But he got fed up with the way the company was changing and started thinking about going to nursing school. "One day I had a disagreement with my boss, and the application went right in," says Kosnowsky, 29. "I wanted something that had a future." He worked part-time at Sears while he went to nursing school. Now, three years later, he's the first and only male nurse working at Conemaugh's neonatal intensive-care unit -- a career far different than that of his coal miner dad.
Suter and Kosnowsky live smack in the middle of the "Health Belt" that stretches from New England down through New York and Pennsylvania, across the Midwest and down through most of the South. These are areas where health care has been the major source of job growth over the past five years.
Nowhere is that truer than in Cleveland. There, Cleveland Clinic, with 29,000 employees, is the biggest employer by far. Next-largest is another hospital system, University Hospitals Health System, with 21,600 staffers. Then comes insurer Progressive Corp. and KeyCorp., each with fewer than 10,000 workers in the area. Cleveland Clinic's performance is pretty good for an outfit that started in 1921 with four docs in a building they planned to turn into a hotel if their vision didn't pay off.
Beyond its immediate employment tallies, the Clinic has a huge multiplier effect on the local economy. CEO Dr. Delos M. Cosgrove says it supports perhaps 75,000 jobs in all in the area, ranging from Clinic staffers to workers at hotels and restaurants -- which patients and their families use in more than 2.9 million patient visits per year -- to 3,000 suppliers to the Clinic.
Only a few years ago manufacturers were Cleveland's job engines. Companies such as machine-tool giant Warner & Swasey Co. don't even exist anymore. Conglomerate TRW was sold in 2002, and parts of it moved away. Fittingly, the Clinic now occupies its former headquarters, which TRW donated.
Health care has been one of the few economic bright spots in the Detroit area, too. Nancy M. Schlichting heads the sprawling Henry Ford Health System, founded by the great man himself in 1915. Schlichting is overseeing the construction of a new 300-bed hospital in West Bloomfield, Mich., a suburb of Detroit, which will eventually generate the equivalent of 1,200 full-time jobs. This expansion comes at a time when Ford Motor Co. (F ) is considering big layoffs.
Then there's North Carolina. Since 2001 it has seen a total job increase of 24,000, or 0.6%. Meager enough -- but take out the 60,000 jobs added by health care, and the state's jobs would have decreased by 36,000. Employment in manufacturing, retailing, trucking, utilities, and information all fell. And construction added only 5,000 jobs, a mere fraction of health care's contribution.
Oddly enough, the retirement meccas of Florida and Arizona are among the least dependent on health-care jobs for growth. Over the past five years the two states have gotten only 10% and 15%, respectively, of their new jobs from health-care services -- hospitals, doctor's offices, and nursing homes. Phoenix showed a job gain of 240,000, but only 30,000 were in health care. That's partly because the influx of elderly has been balanced by a rise in younger workers, too.
Is the health-care economy a good deal for workers? It is for Patricia A. McDonald, a second-year student nurse at Conemaugh. Before going to nursing school, McDonald, 46, sold insurance door-to-door, often driving close to 1,000 miles a week in rural areas to make cold calls. Her take in sales commissions was $35,000 to $40,000 a year, but that was before deducting expenses. Registered nurses in the Johnstown area, by comparison, are paid an average of almost $43,000 -- with no traveling. "This will be much better," says McDonald.
Unlike many other industries, health care offers a full range of jobs, from home health aides making very low wages through technicians and nurses making middle-class salaries up to well-paid doctors. On average, annual pay in private health services is $43,700, slightly above the private-sector average of $42,600.
RIPPLE EFFECT
Even more promising, health care has taken over the role manufacturing used to play in providing opportunities for less skilled workers to move up. Jeffrey Lites started as a part-time cashier in the cafeteria at Philadelphia's Children's Hospital in 1996 after being laid off as a computer operator. "I never envisioned working in a hospital," say Lites. But now, close to finishing his degree in early childhood education from Temple University, Lites works as a child-life assistant, providing recreation and activities for young patients who may stay for weeks or even months. "I have the best job in the entire hospital," says Lites, who moonlights as a musician on weekends.
The expansion of health care is also spinning off related jobs. Cleveland Clinic Innovations, a unit that funds startups, has already created 19 companies in its five years of existence. Together they employ about 186 people, including more than 50 in the Cleveland area. One, Cleveland BioLabs Inc. (CBLI ), went public in July and trades on NASDAQ. "We like to say that the New Economy is alive and well in the 40 blocks of the Cleveland Clinic," says Christopher Coburn, executive director of Cleveland Clinic Innovations.
James A. Martin is pursuing the same pot of gold in Shawnee, Kan., a city of almost 60,000 located just outside Kansas City. Martin, executive director of the Shawnee Economic Development Council, is helping the city set up a biosciences development district, the first in the state. He's hoping to build on the jobs already there, including the animal-health division of Bayer HealthCare (BAY ). "The high growth potential of biosciences jumped out at us," says Martin. "We got the bug."
Scott Becker, CEO of Conemaugh, is leading the effort to develop a technology park in a prime in the center of Johnstown, where a mammoth dairy used to be. Potential biotech and info tech tenants include a company dealing with electronic medical records and another that's involved with drug trials. "The goal is to bring a new, younger workforce back to town," says Becker.
UNBALANCED
Shah of Cleveland's BioEnterprise cautions that biotech may not be the right economic development strategy for many places. For one, it's hard to develop a local biotech industry from scratch. "I've seen a lot of regions that take a swing at that," says Shah. Besides, he says, biotech mainly provides jobs for a small number of highly paid workers. For many communities, Shah favors a broader strategy of encouraging health-care delivery and medical equipment and supplies.
Still, using health-care spending to create the vast majority of new jobs, while beneficial in the short run, is not desirable over the long run. A well-balanced economy needs to provide a wide variety of jobs, not just positions for doctors, nurses, and medical technicians.
The biggest worry is that demand for health care will absorb too much of the workforce and squeeze out other types of jobs. If medical spending rises to 25% of gross domestic product by 2030, as many economists expect, health care's share of jobs could grow to 15% or 16% of the labor market from today's 12%, based on historical patterns.
Such a shift in employment would require health care to be the single biggest creator of jobs in the economy for the foreseeable future. And while the U.S. could in theory afford to spend 25% of GDP on health care, it's hard to imagine a world in which our children have to choose between working for the local hospital or the local health insurer.
The real question, then, is whether it is possible to restructure the health-care system to provide equally good care with fewer workers. The answer is yes, say some experts. "What we have consistently found is that the supply of physicians, except at the low end, has rather little influence on patient outcomes," says David Goodman, a professor at Dartmouth Medical School who started his career as a pediatrician in a rural county in Northern New Hampshire. Jonathan Weiner, a professor at Johns Hopkins University's Bloomberg School of Public Health, agrees: "I am absolutely certain that we can provide quality health care with fewer doctors."
These assertions miss the point, says Richard Cooper, a professor at the University of Pennsylvania School of Medicine. Cooper, a former dean at the Medical College of Wisconsin, argues that the health-care workforce grows along with real incomes and GDP. "When you get richer, you aren't going to triple your food expenditures," says Cooper. "But there's much more that can be done to improve health." Princeton economist Reinhardt concurs, noting that "if you did geriatric health properly, you'd need a lot more geriatricians."
But both sides can agree that more spending on information technology could reduce the need for so many health-care workers. It's a truism in economics that investment boosts productivity, and the U.S. lags behind other countries in this area. One reason: "Every other country has the payers paying for IT," says Johns Hopkins' Gerard Anderson, an expert on the economics of health care. "In the U.S. we're asking the providers to pay for IT" -- and they're not the ones who benefit.
Breakthroughs in technology offer other enticing possibilities for making health care less labor-intensive over the long run. Hakon Hakonarson just moved from Iceland to start up the new Center for Applied Genomics at Children's Hospital of Philadelphia. Hakonarson's group is using cutting-edge automated technology to analyze hundreds of DNA samples from hospital patients and their parents per day, something that wasn't possible until recently. His aim is to collect enough data within a short period of time to understand the genetic causes of childhood diseases and determine which children will respond best to which drugs. "If we go at this pace," says Hakonarson, "we will have something very powerful to analyze before yearend." The eventual result could be better, cheaper treatments, with fewer expensive side effects.
Meanwhile, Hakonarson employs 10 people in his lab as well as five nurses and medical assistants in the field who do nothing but ask families to participate in the study. For now, the health-care economy marches on
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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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23 September, 2006
The great wait
Governor Schwarzenegger plans to veto legislation creating a government-run, single-payer health care system in California. It's the right decision. Californians are understandably frustrated with the current health care system. Costs are rising rapidly, straining both businesses and workers. Doctors are burdened with paperwork and the limitations of managed care. Roughly 19 percent of Californians lack health insurance altogether. That's 6.5 million people. While many of the uninsured are covered by Medicaid and other government programs, California still has the nation's fifth highest number of uninsured in the country.
But simply saying that you are going to give every Californian "free" health insurance will do nothing to fix those problems. In fact, it may well make things much worse. The one common characteristic of all single-payer health care systems is that they ration care. Sometimes they ration it explicitly, denying certain types of treatment altogether. More often, they ration it indirectly, imposing global budgets or other cost constraints that limit the availability of high-tech medical equipment or imposes long waits on patients seeking treatment. For example, at any given time, one million Britons are waiting for admission to National Health Service hospitals and shortages force the NHS to cancel as many as 100,000 operations each year. Roughly 90,000 New Zealanders are facing similar waits. In Sweden, the wait for heart surgery can be as long as 25 weeks, while the average wait for hip replacement surgery is more than a year.
In Canada more than 800,000 patients are currently on waiting lists for medical procedures. As the Canadian Supreme Court noted in striking down the part of Canada's single-payer law that prohibited private payment for health care, "Access to a waiting list is not access to health care." The court went on to note that "in some cases patients die as a result of waiting lists for public health care" and "many patients on non-urgent waiting lists are in pain and cannot fully enjoy any real quality of life."
Not only would a single-payer system limit the availability of quality health care, it would add enormously to California's tax burden. "Free" health care is anything but free. The plan would be paid for by a 3 percent increase in the state income tax as well as a job-killing 8 percent payroll tax hike. For an already overtaxed state like California, these enormous hikes would be the kiss of death.
The first rule of health care reform should be taken from the Hippocratic Oath: First do no harm. We should not forget that for all its flaws, America offers the highest quality health care in the world. Many of the world's top doctors, hospitals, and research facilities are located in California. The University of California's San Francisco Medical Center, for example, is widely respected and attracts thousands of patients from around the world every year. The same is true of the Stanford University and UCLA medical centers, among others.
Eighteen of the last 25 winners of the Nobel Prize in Medicine are either citizens or residents of the United Statesfive in California. U.S. companies have developed half of all the major new medicines introduced worldwide over the past 20 years. In fact, Americans have played a key role in 80 percent of the most important medical advances of the past 30 years. By almost any measure, if you are diagnosed with a serious illness, the United States is the place you want to be. Do Californians really want to exchange all this for a centrally-planned health care system run by the state equivalent of FEMA?
We can make our health care system better, and we can lower costs and improve quality by giving health care consumers more choices. Health Savings Accounts, deregulation, and reforms to Medicare and Medicaid would be a good start toward making health care more accessible and affordable. Health care is literally a matter of life and death, so Californians should be very wary of entrusting it to a costly, government-run single-payer 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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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22 September, 2006
ONLY A 2 HOUR WAIT? THAT WOULD BE PROMPT IN A BRITISH OR AUSTRALIAN PUBLIC HOSPITAL
You can be having a heart attack in Australia and they won't even let you in the door. See here
The July death of a Waukegan woman who waited nearly two hours in a hospital waiting room was ruled a homicide today during a Lake County coroner's inquest. Though the immediate cause of Beatrice Vance's death in the early morning hours of July 29 was a heart attack, she also died 'as a result of gross deviations from the standard of care that a reasonable person would have exercised in this situation,' said Lake County Coroner Richard Keller, reading from the jury's verdict.
Members of Vance's family were present at the hearing, but declined to comment after the verdict was reached. Monique Vance Beatrice Vance's daughter who was with her mother in the waiting room of Vista Medical Center East has previously said she believes her mother died because she was made to wait too long.
'It's a staggering result,' said Allen N. Schwartz, a Chicago attorney retained by the family. Schwartz declined to comment further, saying he had not yet seen hospital records of Vance's hours at the hospital.
At the hearing in the county administration building in downtown Waukegan, Deputy Coroner Robert Barrett testified that he subpoenaed the records after noticing discrepancies in the hospital's version of events after Vance arrived at the emergency room at 10:15 p.m. July 28. Vance was seen by a triage nurse at 10:28 p.m. According to hospital records, she complained of nausea, sweating and chest pain of a level she rated as a '10, with one being the lowest and 10 being the highest,' Barrett testified. 'The triage nurse classified her condition as 'semi-emergent,'' he said. At 12:25 a.m., an emergency room nurse went to the waiting room and called for Vance, but got no response, he said. Vance was leaning on her side on a waiting room seat, unconscious and without a pulse.
Doctors rushed her into the emergency room, administered CPR and put Vance on intravenous blood thinners, Barrett said. At about 12:55 a.m., doctors were able to generate a weak pulse. About 10 minutes later, the pulse stopped and doctors restarted CPR. Vance was pronounced dead at 2 a.m.
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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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21 September, 2006
NHS FLOUNDERING
Patricia Hewitt, the Health Secretary, admitted yesterday that the NHS no longer knows where it is going. Where will we be in five years, ten years, fifteen years time? she asked. She gave no answer, other than it lay in the hands of local NHS organisations and the Governments reforms were designed to empower them to discover it.
In a speech peppered with such admissions, Ms Hewitt said that it was hard for anyone to understand that after years of unprecedented investment, the service was dealing with financial problems. After years of more staff, there are now job losses, she acknowledged a fact she has hithero denied by arguing that posts, and not jobs, were being lost. But she went insisted that reforms were the way to sustain the values of the NHS and that the Government would not undermine those values. The changes and reforms we are making are not only compatible with our traditional values: they are essential if we are to protect those values in a fast-changing world, she told an audience in London.
Speaking to the Institute for Public Policy Research, Ms Hewitt said that the NHS was a 1940s system operating in a 21st century world, and where patient care was improving it was despite the system, not because of it. Calling for an end to the old top-down system, Ms Hewitt emphasised the need for strong local commissioning of services, underpinned by national standards and targets. On the issue of private service providers, she said: If independent providers can help the NHS provide even better care and value for patients, we should use them.
Source
The usual government approach to "child welfare"
No Australian State is free from such gross official negligence
A baby suffered serious electrical burns, witnessed repeated acts of domestic violence and lived in horrific conditions for 22 months before Victorian welfare authorities finally took her away from her drug-addicted mother. The state's Department of Human Services was first notified of concerns for the girl in March 2001, when the child was three months old. Despite the mother's first child being removed from her care in 1999, the second child was not removed by the department until January 2003.
The full horror of the girl's first two years of life have been detailed in a judgment handed down by the Victorian Civil and Administrative Tribunal. A non-government child welfare worker, who made repeated visits to the mother's Melbourne home between August 2002 and January 2003, detailed the appalling conditions the child was forced to endure. On her first visit, the worker found the child, then 19 months old, wearing only a sodden nappy that had leaked on a three-seater couch. It left a pool of urine that the mother made no attempt to acknowledge or clean up.
The girl was also eating yoghurt with hands that were covered in urine. Asked by the worker to take away the yoghurt, bath her daughter and change her nappy, the Aboriginal mother, who was 21 years old when she gave birth, said: "I'll do it after I finish my smoke and coffee." Despite the electrical burns suffered eight months earlier, the worker - on the next visit - saw the girl playing with electrical cords plugged into the wall. On September 13, 2002, the worker found the mother and girl lying together on a filthy mattress. A male friend was present and said he and the mother had been drinking the previous night. An open beer bottle was at his feet. It was 9.30am.
The girl, who was unclean and naked, picked up an empty baby bottle that she pushed against her vagina and then placed in her mouth. The worker noticed a large bruise and graze on the girl's knee. Five days later, the worker returned and saw a bump "the size of a walnut" on the girl's head. The mother said her daughter had fallen over. Asked if the girl had seen a doctor, the mother said "she didn't need to because she was OK". The next day the worker returned to find the bump on the girl's head was "still large and now (had) a large dark blue bruise surrounding it". She suggested the mother take her to a doctor as she could have a concussion. The mother said "she could not because she had access today and then had to go shopping".
The mother subsequently took the child to a parenting group. The girl became extremely distressed, screaming and banging her head against the floor. The mother ignored her and only picked her up after urging by a welfare worker. The department was first notified about the child when she was nearly three months old. Seven months later, in October 2001, the department received a second notification. In January 2002, three days after her first birthday, the girl received serious electrical burns to her foot requiring skin grafts.
A supervision order was made in the Children's Court of Victoria in March 2002. But the mother repeatedly breached it, turning up to the department high on drugs and with the girl. On November 14, 2002, the mother said her daughter had been vomiting and had suffered diarrhoea for two days. The welfare worker suggested she take her to a doctor but the mother said the girl was "alright (and) was getting better". "The (worker) noticed piles of cat faeces in the bedroom that appeared to have been there for many days," the VCAT summary said. "(The mother) said her toilet was blocked and that she was using a bucket to urinate in and tipping it out around the back of the flat". The worker returned with a social work student to clean up the flat. "The smell of faeces in the flat was overpowering," she said. "There was six empty methadone bottles on the lounge room floor and on the mantle that were easily accessible."
On January 2003, the mother brought her daughter to a welfare agency, the Caroline Chisolm Society. After smelling the girl's dirty nappy, the worker saw patches of raw skin on her bottom and noticed a rash and thrush halfway down her leg. The mother said she had been drinking vodka and had forgotten to take the girl to the doctor. Evidence from another welfare worker outlined how the girl picked up a used syringe. The mother appeared unconcerned.
The girl was removed from the mother's care after a report to the department from the Royal Children's Hospital in January 2003. The mother was subsequently found to have a history since early childhood of severe domestic violence, substance abuse, neglect and deprivation. When the mother was three, her older sister had been murdered. She was placed in foster care but had suffered repeated sexual abuse there. She lived on the street from the age of 14 and had convictions for theft and robbery from the age of 15. She also took heroin. The mother now sees her child, supervised, for two hours every three weeks. Senior VCAT member Robert Davis rejected her bid for shared guardianship. He said the girl, now five, appeared to be well settled and "thriving" with her foster parents, their two children and her sister.
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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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20 September, 2006
NHS patients left waiting on operating tables by computer failures
Hospital operations and consultations are being delayed across England because the new NHS computer system suffers almost one “major incident” failure every day. Patients have been left waiting on operating tables and others have had appointments cancelled because of problems with the £12.4 billion system. The scale of the failures has prompted calls for the Government to rethink the future of the world’s largest non-military computer system amid fears about the impact on patient safety.More than 110 major incidents have been reported by hospitals and GPs over the past four months, Computer Weekly magazine reports today. The scale of the problems at such an early stage will come as a blow to the National Programme for IT, which is at the heart of Tony Blair’s efforts to modernise the NHS. Over the next ten years the system is due to link more than 30,000 GPs in England to almost 300 hospitals. Connecting for Health, the body that oversees the programme, said, however, that the new computer system was much more reliable than those that it is replacing.
Reported problems include failures of the system used by surgeons to see X-ray pictures on a computer screen in wards and operating theatres. On some occasions the system has crashed during an operation, forcing the surgeon to suspend the procedure while a hard copy of the X-ray is found. Hospitals have also lost access to their patient administration systems, which hold records on appointments and planned treatments, so that they do not know who is due to have consultations or treatments.
Experts are concerned at the level of failures so early in the use of the system. Patients will be at even greater risk if the failures continue when the system is expanded across the country to prescribe drugs, order test results and store 50 million medical records. More than 20 of the major incidents reported over the past four months have affected multiple NHS sites. In July a data centre in Maidstone, Kent, crashed, causing the loss of central services and systems to 80 NHS trusts.
The Nuffield Orthopaedic Centre NHS Trust in Oxford said this year that it had identified “major issues of patient safety” when patients were lost in the system after being dropped from waiting lists or were not being called for important treatment.
Richard Bacon, a Tory member of the Commons Public Accounts Committee, said that the Government needed to reconsider the scheme. “This is the latest evidence that there are serious and growing problems with the whole National Programme for IT in the health service,” he said. “In many respects the NHS IT programme is making things worse, not better, while sowing distrust and disillusionment across the health service.”
Richard Vautrey, a member of the GPs’ joint IT committee of the British Medial Association and the Royal College of General Practitioners, said: “Any system in healthcare has to be available to clinicians and any downtime, however short, can have significant implications. If it is not possible to access the information during the consultation that can make the consultation particularly difficult.”
A Connecting for Health spokesman said that what constituted a major incident was open to interpretation and often problems were reported when systems were simply running slowly. “Connecting for Health is operating systems 24 hours a day, seven days a week in hundreds of s across England,” he said. “In that context, what is being quoted represents a very small service interruption and we expect performance to compare favourably with any large-scale organisation that uses IT, especially in the first year of operations.”
Source
The good old generous taxpayer again
The Queensland Government will subsidise the travel of public-sector doctors to attend an extravagant medical conference in Beijing later this month, despite running a cash-starved health system that has lurched from crisis to crisis. The annual conference of the Queensland branch of the Australian Medical Association, the lobby group that was particularly vocal during the recent election campaign in which health was a key issue, will be held over five days in the Chinese capital. But delegates will have to attend only four morning sessions over the week and will hear from two keynote speakers - both of whom are based in Brisbane. All afternoons are taken up with leisure activities or sightseeing, with the only evening commitment the "conference farewell dinner".
Senior public health professionals who choose to attend can pay for it from the $20,000 they receive each year for professional development, an allowance secured by the AMAQ during salary negotiations held earlier this year. The Australian understands that senior government officials are disappointed by the AMAQ's choice of , particularly when the enterprise bargaining agreement requires the allowance to be paid without restrictions.
The middle day of the conference, which will be held from September 25 to 29, begins with a breakfast on the Great Wall followed by a visit to the Summer Palace and Lake Kunming. "Comfortable rubber-soled hiking boots are strongly recommended," the conference itinerary states. Lunch is included. On the other four days, delegates will only have to attend programs on medical issues for a few hours each morning. Queensland AMA president Zelle Hodge said while she would not be attending the conference, it was a chance for doctors and other health professionals to network and share information. "This is an opportunity for people to develop some continuing professional development and it's not going to make any difference to the crumbling health system," Dr Hodge said. "It is not uncommon to share speakers across countries and understanding the complexities of healthcare across different countries."
A spokeswoman for Queensland Health said yesterday it was unclear how many public-system officials would attend the conference because it was organised on a "district by district" basis. The AMAQ was also unable to provide information about how many health professionals would be attending. State Health Minister Stephen Robertson could not be reached for comment. The AMAQ held its conference last year in St Petersburg, Russia.
While most health professionals attending the conference would be working in Queensland's private health sector, senior medical officers and superintendents working in the public system receive $20,000 each year to spend on continuing education programs. Dr Hodge said it was a matter of personal choice how public-sector officials chose to spend their salaries. "That money is part of their salary package which they utilise however they see fit and any travel they do for professional development is part of that package," she said. "This is part of their salary package, and it's not as if that money would not come out of that salary package and patients in Queensland are actually going to be adversely affected."
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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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19 September, 2006
TWINS FORBIDDEN
Authoritarian medicine in Britain
Women may be prevented from having twins through IVF treatment because so many are being born that they are swamping intensive-care units. Would-be mothers will be allowed to have only one embryo implanted at a time, under proposals drawn up by a group of leading doctors. The change could reduce women's chances of having a successful pregnancy but the group says the move is needed to halt the sharp rise in IVF twins, who are blocking neonatal intensive-care beds.
At present women are allowed to have two embryos implanted to increase their chances of success, but this has contributed to a near doubling in twin births to 9,500 a year since the late 1970s. Mothers of twins are six times more likely to suffer from pre-eclampsia - high blood pressure during pregnancy - and three times more likely to die in childbirth. Twins are four times more likely to die within 28 days of birth and five times more likely to have cerebral palsy than single babies.
Professor Peter Braude, who chairs the expert group for the Human Fertilisation and Embryology Authority (HFEA), said twins were "a complication, not a bonus. "The public does not realise that twins are a health risk. The need to tackle the problem is unequivocal. Neonatal units are stretched to the extent that you cannot always get your baby into one. "If you deliver your baby in London, you find the baby is being shipped off to Northampton. We need to separate mother and baby or one twin from another. If we could lower the multiple pregnancy rate, we would have more cots available. It is stopping other babies getting into neonatal units."
His group is expected to recommend that only one embryo is implanted at a time in women under 35, while remaining embryos are to be frozen for transplanting if the first attempt at pregnancy fails. Those having IVF privately would also be affected because the HFEA licenses all clinics, not just those on the National Health Service. About 30,000 couples have IVF each year. The group is expected to say that, for NHS patients, the state should fund the implantation of another frozen embryo if the first attempt fails.
Source
Public protests achieve what useless "regulators" would not
The story below appeared in the Gold Coast Bulletin of 18 Sept. 2006
The [Qld.] State Government will close a legal loophole that allows convicted rapists to work as doctors. Work is already under way on new laws to stop doctors convicted of certain offences from continuing to treat patients in Queensland's health system. A spokesman for Premier Peter Beattie yesterday confirmed processes to create the new legislation were set in motion soon after the Government swept back to power on September 9. "There has already been an exchange of letters and we will be liaising with stakeholders about what needs to be done," he said. "We want to make sure any legislation is effective."
The move comes in the wake of public outrage after the Queensland Medical Board re-registered convicted rapist and known drug addict James Samuel Manwaring in July. After pleading guilty in 2002 to a vicious attack against his then wife, Manwaring was told by District Court judge Brian Hoath that nothing could 'excuse your involvement in these offences'. However, the Health Practitioner's Tribunal last July allowed him to immediately apply for re-registration after he had met a stipulation to submit hair for drug testing. He passed the drug test and was registered to work within days. The tribunal imposed a further 24 conditions on his registration which would be strictly monitored.
The board said its hands were tied by laws which forced them to allow Manwaring to re-register if he met the tribunal's criteria. At the time Mr Beattie vowed to investigate closing the loophole, ordering a report from the Medical Board into the laws and any potential effects.
Manwaring's victim Pat Gillespie, who has agreed to be identified, said there was no way Manwaring should be allowed to treat patients. She welcomed Mr Beattie's announcement, saying it would protect all Queenslanders. "I welcome what the Premier is doing for the patients of Queensland," she said. "This loophole needed to be closed and I am just really pleased and relieved that this is going to happen."
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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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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18 September, 2006
NHS RELUCTANT TO ADOPT EVEN THE MOST BENEFICIAL NEW TECHNOLOGY
The National Health Service could save at least 500 million pounds a year by adopting techniques that could halve the recovery time of patients after surgery. A new trial at the Freeman Hospital in Newcastle upon Tyne has shown that bowel surgery patients were ready to be discharged in just 7 days, rather than 14. The surgeons told a conference in Lisbon yesterday that better preparation and education of patients, greater use of keyhole surgery and a technique for improving fluid balance and blood circulation during and after surgery could greatly reduce the recovery period. The trial was the latest evidence of the effectiveness of CardioQ, a blood monitoring device developed by a British company, Deltex Medical.
If repeated across the country, the savings to the health service would exceed last years NHS deficit of 500 million pounds. However, the device was used in fewer than 5 per cent of possible NHS procedures, reflecting the difficulty of getting new devices used by the service. Alan Horgan, consultant colorectal surgeon at the Freeman Hospital and leader of the study, said: These results are remarkable. Everyone involved in surgery and NHS management should read this study. Fluid-balance during and after surgery is incredibly important to patient wellbeing. Our surgical recovery programme means the Freeman Hospital is already a leader in recovery times, but the CardioQ has allowed us to get even better. We have proven that it is possible to save the NHS both time and money, while also enhancing patient care.
CardioQ works by monitoring how much blood the heart is pumping. Blood lost during operations is topped up by using a colloidal solution that mimics the behaviour of blood. Getting the volume exactly right is critical to ensuring that sufficient oxygen is delivered to the organs. Too little can lead to organ failure and even death. But too much can cause heart failure, so doctors have had to tread a fine line between the two. CardioQ monitors blood volume using an ultrasound probe inserted down the throat. The probe measures blood flow by bouncing ultrasound waves off blood cells flowing through the aorta, the main blood vessel.
The trial covered 108 patients. Half were given fluid at the discretion of the anaesthetist, while the other half had their fluid levels monitored by CardioQ. The national average recovery time for bowel surgery is 14 days, but at the Freeman, discharge took an average of only 7 days. The largest part of the improvement was the result of the recovery programme, which included the use of keyhole surgery. But CardioQ also contributed another two days, and patients treated with it also had far fewer post-operative complications 2 per cent rather than 15 per cent. None needed an unplanned admission to the critical care unit, compared with 11 per cent of patients not treated using CardioQ.
Every day in a general or surgical ward costs 400 pounds per patient. The CardioQ monitor costs 7,000 pounds and the probes used in the trial 55 pounds each, meaning that the monitor could pay for itself in days. It could be used for a range of operations, not just those on the bowel. The National Institute for Health and Clinical Excellence described CardioQ as standard clinical practice. Yet such is the reluctance of the NHS to adopt new approaches that it is used in fewer than one in twenty operations in which it could provide benefits. Ewan Phillips, managing director of Deltex Medical, said: Embracing this technology should be a no-brainer.
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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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17 September, 2006
Britain: Stupid new government rules on sperm donors have the predicted effect
Hundreds of infertile couples could miss the chance to have a baby because of a nationwide shortage of sperm donors. More than two thirds of British fertility clinics have been unable to recruit donors or have had great difficulty in buying supplies, since the Government lifted donors lifelong anonymity last year, research shows.
BBC News found that 50 of the 74 clinics and sperm banks that responded to its survey are not recruiting new donors. There are 84 licensed centres for sperm donation in Britain. Those that can find men to donate have only 169 approved donors on their books and 90 per cent of these serve just ten clinics. There is only one registered donor in Scotland, and none in Northern Ireland.
This compares with a peak of 459 in the 1990s, when men could donate sperm knowing that any offspring would not have the right to trace them. This provision was removed in April last year, despite warnings from fertility doctors that it would lead to a collapse in supply. The Government argued that children conceived from donated sperm or eggs had a right to know the identity of their biological parents. Allan Pacey, head of andrology at Sheffield University and Secretary of the British Fertility Society, said: If there arent enough men who are willing to donate and be identified to the donor-conceived offspring later in life, and if we dont have the ability to import sperm from other countries because the regulations are too tough, then we are not going to be able to treat patients that require donor sperm treatments. Sadly some will go without. I think we are certainly in a crisis at the moment. Most of the clinics are finding it very difficult to get enough sperm to treat their patients.
He said that many patients who needed donated sperm to conceive were considering travelling abroad. It leaves patients in a desperate situation. If they are unable to get treatment in their local clinic, then they are looking to other sources. Some are getting flights to other European countries. Others may turn to internet sites that provide sperm for home insemination. These are signs of desperation and I thoroughly understand them.
Zoe and Colin Veal, whose only possibility of conceiving is by using donated sperm or an IVF technique called ICSI (intra-cytoplasmic sperm injection), were told by their Bristol clinic that there was no sperm available. Mrs Veal said: I think it was a huge shock as for the first time we realised that we werent going to be able to access treatment. You then have to start thinking about where you go from here and then you have to start thinking about risks that you might have to take, such as buying fresh sperm over the internet or whether you just move on and become a childless couple permanently. Without sperm you cant have a baby, and so that is the end of the line.
Mark Hamilton, chairman of the British Fertility Society, said: The British Fertility Society is well aware of the difficulties many patients throughout the country are experiencing in accessing gamete donation services, in particular donor insemination treatment. Provision of such services requires significant resources to attract, recruit, screen, and counsel prospective donors. The survey reinforces our own findings that many clinics are now finding it impossible to provide these 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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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16 September, 2006
BRITISH PUBLIC HOSPITALS ARE POLITICAL FOOTBALLS
A secret meeting has been held by ministers and Labour Party officials to work out ways of closing hospitals without jeopardising key marginal seats, The Times can reveal. Concerns about the political impact of planned hospital closures and other cuts to the NHS, which had a deficit last year of more than 500 million pounds, prompted ministers to organise the closed-door discussion. Details of the meeting, revealed in e-mails passed to The Times, show that it included Hazel Blears, the Labour chairman, political advisers from No 10 and even at the request of Ms Blears a Labour Party representative.
Opposition politicians said yesterday it was deeply inappropriate that party officials should have had an influence over plans drawn up by civil servants for changes in services on medical grounds. They also expressed concerns that hospitals in Tory constituencies were more vulnerable.
The e-mails show that Patricia Hewitt, the Health Secretary, called for those at the meeting to be provided with heat maps, showing marginal Labour seats where closures or reconfigurations of health services could cost votes. She also asked for lists showing hospitals where the European Working Time Directive is likely to hit hardest, making 24-hour rotas hard to sustain. Ministers have always insisted that the directive will not affect hospitals, but the e-mails suggest otherwise. Ms Hewitt may have been seeking to blunt the impact of the loss of 24-hour care by reconfiguring services to conceal it.
David Nicholson, the new NHS Chief Executive, gave warning this week that closures and reconfigurations were imminent. He expected there would be about 60 such changes, affecting every strategic health authority (SHA) and focusing particularly on maternity and accident and emergency services. The leaked e-mails make it plain that such changes have been considered since at least May. The first, from Alison Smith, a Department of Health official, refers to a May 12 submission about supply-side reconfiguration. The second, from Ms Hewitts private secretary, says that the Health Secretary asked for a political meeting to discuss the submission. She wants the health ministers Lord Warner and Andy Burnham to attend with their advisers, Ms Blears and her two advisers, and John McTernan and Paul Corrigan from No 10. A further e-mail from Ms Hewitts diary secretary says that Ms Blears has asked for a party representative to be included. The meeting took place on July 3 at the Department of Health.
Andrew Lansley, the Tory health spokesman, said: There is a secret political debate going on to try to minimise damage to the Labour Party. A spokesman for Ms Blears confirmed that the meeting had taken place but said that because it was political there was no record of who was present. It wouldnt be unusual for Labour Party press officers to attend meetings with ministers, he said. And as Minister without Portfolio, Ms Blears has the responsibility of providing policy advice to the Prime Minister across all departments, so she had a second reason for being there.
Ministers are worried that the changes planned by Mr Nicholson may have the same effect as the removal of an A&E unit from Kidderminster Hospital in 2001, which led to the Independent candidate Richard Taylor ousting the Labour MP. After Mr Nicholsons interview appeared, the Department of Health said his remarks did not mean wholesale closures of hospitals but rather that the NHS needed to work with local communities to decide how best to organise services.
One of the first strategic health authorities to make a move is the East of England SHA, whose board met yesterday to discuss a review of acute services. There are 19 district general hospitals in the region and reports suggest that as many as nine will be downgraded. Mr Lansley said it was no coincidence that the hospital top of the list for changes, and the only one specifically targeted in the board papers, for yesterdays meeting, was Hinchingbrooke which happens to be in one of the two safest Conservative seats in the country.
Source
Good proposal from the Australian Left for partial privatization of public hospital care
Perhaps one day ALL government hospitals wil be seen as a bad idea
Private hospital beds will be bought to slash waiting lists for public hospitals under a new ALP policy designed to shake up the health sector. The federal Opposition also plans to ease pressure on doctors by handing more of their roles to nurses and allied health professionals. Opposition Leader Kim Beazley will reveal his plans today in a speech to the Macquarie Graduate School of Management in Sydney. It will offer the first glimpse into a potential Beazley government's approach to health, starting with a strong repudiation of the Howard Government's long-running accusation that Labor is ideologically opposed to private sector involvement.
Mr Beazley will warn that cost-shifting and duplication are crippling the health system at a time of massive increases in demand for services. He will accuse the Government of squandering reform opportunities and promise to use the next commonwealth-state health agreement, which starts in 2008 and will run for five years, as a springboard for change. "We need to tap into the full potential of the private hospital sector," Mr Beazley says, in a speech obtained by The Australian last night. "Private hospitals are an invaluable national health resource and more needs to be done to integrate them with the public system."
Labor will also shake up medical training by paying private hospitals to provide clinical training for medical students and other specialist trainees. The proposal is designed to meet complaints that the Government has dramatically increased the size of university medical and nursing schools without extracting guarantees that state-run public hospitals would be able to provide hands-on training. "Integration and co-operation will define health care in the future," Mr Beazley will say. "All hospitals are in the health business. They have a vested interest in working together."
Mr Beazley will also promise stronger action to deal with medical workforce shortages by realigning roles of doctors, nurses and allied health professionals, using a Productivity Commission recommendation as his template. Mr Beazley will frame his health policies in an economic context, arguing better health would lift workforce capacity. Labor sources said Mr Beazley's attempt to link social policy with economic policy would set a trend for his bid for victory in next year's election. They said Labor's defeat in the 2004 poll came because voters were convinced by the Government that Labor was not serious about the economy.
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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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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15 September, 2006
Subsidy Economics 101
To hear the political advocates talk about it, you'd think the economy had a sadistic grudge against twenty-somethings, torturing them with spiking college prices, burning housing markets, and crushing health care costs. We've got "the worst of all worlds" for young adults, declared the moderator at a recent New America Foundation forum. "Problems in the labor market, enormous problems with paying for education, and a level of economic risk that previous generations really didn't encounter."....
Finally, there is the famously skyrocketing cost of health care. Its cause is no mystery. According to the Centers for Medicare and Medicaid Services, in 2002 nearly 46 percent of personal health care expenditures were covered by the government, and after insurance only about 14 percent were covered directly by patients. That's right: the people demanding the treatments picked up only 14 cents of every dollar spent on them. So long, economizing!
Generation X and Y spokespersons probably understand what's going on: when government subsidizes purchases, prices go up. So why do they insist on blaming the economy for young adults' woes rather than the government policies -- and the baby boomer parents -- that created them? Because twenty- and thirty-somethings want the same subsidies their parents got.
Unfortunately, politicians are hungry for new constituents, and they seem prepared to meet the demands of the young. Indeed, only a few weeks ago the Democratic Leadership Council introduced the American Dream Initiative, proposing that the federal government spend $150 billion over ten years to entice states to keep college prices down (read: dump their costs onto state taxpayers), and create a $3,000 tax credit for post-secondary training. The initiative also promises universal health care for children -- a boon for young parents -- and lower patient costs for pre ion drugs.
Twenty-something activists, of course, want all of these benefits. But to get them, they have to blame the economy, not the government, for their troubles. Otherwise, at the very least they'd eventually have to explain to their own children why they knowingly saddled them with burdens even bigger than their own.
Source
NATIONAL HEALTH GP SURGERIES SUBSTANDARD TOO
One in seven GP surgeries is "not fit for purpose", a survey has suggested. The problem is getting worse and putting key policies such as moving care into the community in jeopardy, the GP magazine, Pulse, said. Some 1,092 premises out of more than 7,000 across the UK were below minimum standards, its survey found.
The government said premises were getting better as 1 billion pounds was being invested in upgrading GP surgeries and health centres. Three out of five of the 175 primary care organisations which oversee GP practices said at least one of their GP premises was inadequate.
London was by far the worst affected area in the UK, with 522 premises deemed unfit by the capital's 31 primary care trusts. In some areas, such as Bromley, Lewisham and Havering, almost all premises were not fit for purpose. In England, Birmingham, Bristol and Bradford were also badly affected and in Scotland, Grampian and Ayrshire and Arran were the worst hit.
The results are nearly double official figures which show 600 premises are unfit. Pulse said if its figures were extrapolated to all primary care organisations in the UK, the real total would be nearer 1,500 of 10,300 GP premises. The magazine said doctors had said they could raise the capital required to build new premises, but NHS bodies could not afford the rent on them.
Jo Haynes, editor of Pulse, said: "GPs want to take on more work from hospitals and to provide more services for patients from their surgeries. "But they are being prevented from doing so because the government refuses to invest the comparatively small amount of money to enable primary care organisations to fund new premises."
Dr Peter Holden, of the British Medical Association's GPs' committee, said the results were further evidence that the Department of Health was "spending peanuts on premises". "This means GPs cannot take on the broader role that is possible in primary care, delivering services at a fraction of the cost of secondary care. "It's complete short-termism, as usual."
Health Minister Lord Warner said premises were getting better as 1 billion pounds was being invested in GP surgeries and health centres under the Lift programme, a public-private partnership. He also said the government was helping the NHS open 125 new health centres - a rate of expansion that "rivals Tesco". He added: "We will go on investing in better premises for primary care and community services, but in ways that benefit patients."
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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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14 September, 2006
BRITISH UNIONS ATTACK LIMITED NHS PRIVATIZATION
Hospitals and GPs' surgeries could be hit by widespread disruption in the first national strike in the NHS for 18 years after workers who buy and distribute vital supplies voted to walk out. The proposed strike by workers in NHS Logistics could delay operations and treatment if hospitals run out of key supplies such as syringes, hand-cleansing gel, latex gloves, disposable bedpans and hand towels, according to Unison, the public service union. NHS Logistics handles 51,000 products, including vaccines, but not general drugs, and delivers supplies to hospitals.
The action will hit hospitals and GPs' surgeries across England in the first national action since midwives went on strike. The strike - which was backed by three to one in the ballot - is in protest at the Government's plans to outsource the logistics work to DHL, the parcels group, in one of the biggest privatisations of health service work. NHS Logistics, which has 1,400 employees, serves 600 hospitals in England and nearly 9,000 GPs' surgeries. Dave Prentis, the general secretary of Unison, said: "These are not troublemakers, not hardliners, but workers who care deeply about the NHS. "NHS Logistics is an award-winning service and it makes no sense to sell it off."
Unison will decide on Friday whether it will mount one lengthy strike or a series of one-day strikes. Its action could come before the Labour Party conference in two weeks' time. Nigel Edwards, the director of policy at the NHS Confederation, which represents more than 90 per cent of NHS organisations, said: "Many hospitals do not hold large volumes of the medical supplies provided by NHS Logistics. Therefore those trusts that use NHS Logistics - which is not all of them - will now be looking at contingency arrangements to ensure they have adequate medical supplies. "We hope that NHS Logistics will be working with individual trusts to make sure that contingency arrangements can be put in place so that patient care is not adversely affected. We would also hope that strike action does not place patient care in jeopardy."
Unison is taking the Government to court to seek a judicial review of the way the contract was awarded after its value was suddenly changed from 700 million pounds to 1.6 billion. A spokesman for the Department of Health said: "The NHS uses about 500,000 different products such as catering supplies, office equipment and medical supplies, but only around 51,000 of these products are provided by NHS Logistics. The majority of hospitals have their own local supply and delivery arrangements."
The announcement of the strike ballot came as health unions and medical associations began a joint campaign to fight the Government's reforms and further involvement of the private sector in the NHS. Stephen Campion, the general secretary of the Association of Hospital Consultants and Specialists, told a meeting of campaign leaders that the Government's relationships with the health unions was "one of the most divisive and fragmented relationships since those bad old days of the 1980s". Mr Prentis told the TUC's annual conference that despite Labour's large investment in the NHS since it came to power, this year it was "in crisis, threatened as never before".
More here
When is the stupidity of vastly overworked public hospital doctors going to stop?
It is bad for the patients and bad for the young doctors
On Saturday March 11, as the city [Melbourne] preened itself for the Commonwealth Games, a young man, loved for his warmth and generosity, walked for the last time into The Alfred hospital, where he was a trainee surgeon. Chanh Thaow had come a long way since his Hobart childhood. The pride of his parents, leading members of Tasmania's Hmong community, Chanh had clocked up 14 years of training. To achieve his dream of being a surgeon, he needed only to pass one more exam. His teachers believe he would have passed the test, had he lived to take it. But on that day in March, Chanh walked to the registrars' room and closed the door. He then intravenously administered to himself a lethal dose of anaesthetic drugs - enough to end his life. He was 32.
In an interview with The Age, Chanh's father, Vue Thaow, has spoken for the first time of his concerns that his son was overworked and alienated by the surgical culture at The Alfred. Mr Thaow said his son was told to stop recording his level of tiredness during marathon shifts.
Chanh's death, which is being investigated by the State Coroner, is the second suicide of a young doctor in the past nine months. On December 16, Lachlan McIntyre, 29, an intensive care registrar at St Vincent's, died of an injected drug cocktail in his North Melbourne bedroom. He was found with a suicide note nearby.
These young men were struggling with private demons and no one will ever know what tipped them over. Their deaths shocked Melbourne's medical fraternity and sparked a wave of introspection and questioning about support for young doctors and the culture of overworking trainees. A working party of doctors from across the medical colleges, headed by North Carlton GP Raymond Martyres, has requested a meeting with the coroner investigating Chanh's suicide to raise concerns about the treatment and emotional health of young doctors. The coroner's workplace unit is also aware of the details of the death. "These unexpected suicides have focused our attention," the head of the Victorian Doctors Health Program, Dr Naham (Jack) Warhaft, told The Age. "They are particularly tragic because they are usually the really good ones. They are competent clinically, they are high achievers." Dr Warhaft has called on the medical profession to openly discuss and address the problem of "unexpected suicides". The doctors involved asked for no help and felt an "acute hopelessness", but had no outward signs of depression.
The call comes as the Australian Medical Association prepares to release its "safe hours" survey of trainees working in hospitals, nine years after its first campaign to stamp out shabby treatment of young doctors. The results, to be released next month, are still being analysed, but AMA president Mukesh Haikerwal told The Age there had been only minor improvement since the last survey in 2001, which found many young doctors were working long shifts. (Studies have shown the performance of doctors after more than 18 hours awake is the same as having a blood-alcohol reading of more than .05). Dr Haikerwal said the survey had found that long and unsafe shifts were still too common. "If hospitals think they can get away with it, they will try," he said.
There are no official figures on how many trainee doctors commit suicide, although it is estimated to be at least one or two each year in Victoria. Doctors are twice as likely to commit suicide as the rest of the population, and female doctors are five times more likely than the average person.
Mr Thaow said his son's death came "out of the blue", but Chanh had been exhausted. "My son told me it was an environment where you would have to go on a 24 or 36-hour shift and never say that you were tired." Chanh told his father that "snobbish and selfish" senior surgeons pressured young doctors so they felt they could not speak up about their concerns. "No matter how hard he had to work, he would have to bear it and then do the same thing to the people who followed him."
The Alfred hospital refused to allow its senior medical staff to be interviewed for this report and would not say whether it had investigated Chanh's death. Instead, it issued a short statement that declared the health of young doctors a "priority" and detailed a mentoring scheme and career support for trainees. Spokeswoman Tracey Ellis refused to answer questions about average working hours for surgical trainees and the surgical culture. If the coroner decides to hold an inquest on Chanh's death, The Alfred will probably be called on to justify its roster system for young doctors.
Dr Warhaft said some hospitals supported their young doctors, but there was still "a long way to go for all of us". The profession needed to work on its emotional intelligence and provide a more supportive environment - particularly when doctors were under personal stress - where admissions of despair and suicidal thoughts were better accepted. "There are extraordinary pressures on young doctors," Dr Warhaft said. "They are trying to make huge advances in their career, they have their clinical load, their studies, often a new relationship and a few young kids, and they are working perhaps up to a 100-hour week."
Dr Deborah Amott, chairwoman of the Royal Australasian College of Surgeons' trainees' association, said that although working hours for some young doctors were improving, the culture had to change. "There is this awful culture around medicine which involves the complete bastardisation of junior staff. There is this hyper-masculine, balls-to-the-wall culture in surgery of cure at all costs - both to the patient and doctors. It is quite a struggle to turn that around."
Professor John Collins, the dean of education at the college of surgeons, denied there was a general problem with the culture of senior surgeons, but said some hospitals were more demanding than others. "It is a huge thing for a major international college to lose one of its trainees," he said. "We try to do everything we can to prevent this." As part of the college's accreditation of training hospitals, trainees could reveal confidentially any concerns, he said. The college had recently reprimanded a Victorian hospital for unsafe working practices for young doctors, but he would not say which one.
After Chanh's death, the college is looking to strengthen the criteria around safe and healthy working conditions it requires of hospitals to keep their accreditation as training institutions. "We are committed to the safety and wellbeing of these young people, but at the end of the day we have no power over the hospitals," he said. "All we can ask for is some evidence that the rosters and work schedules take the AMA's code of practice on safe hours into account."
Professor Collins often hosted Chanh and his study group at his Carlton home as they prepared for exams. He remembers him as an old-fashioned gentleman, loyal and considerate of the young doctors behind him, and someone who always arrived at the door with a gift, chocolates or soft drinks in hand. "It was a sombre occasion at the (Alfred) debrief," said Professor Collins, who said he was devastated by Chanh's death. "Watching the young doctors and their reactions to this - I mean, they loved him."
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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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13 September, 2006
Australia: Your regulators will protect you
The abortion doctor Suman Sood, who continued to practise in NSW despite more than 30 complaints against her, was refused registration as a doctor by three other states and territories, the Medical Tribunal has heard. More than 18 months after starting proceedings against the doctor, who was last month convicted of performing an illegal abortion, the tribunal opened its hearing into 11 complaints yesterday. In a statement, the Indian-trained doctor yesterday admitted she was guilty of unsatisfactory professional conduct and professional misconduct and declined to contest the hearing.
The complaints, by the Health Care Complaints Commission, cover the treatment of five patients, including the woman at the centre of the abortion case. The cases of three other patients, who cannot be named, were highlighted by the Herald under the names Louise, Nadia and Christine early this month. The commission also alleges Sood was not of good character, was dishonest, deliberately misled the NSW Medical Board at an earlier hearing, breached undertakings given in bankruptcy proceedings, made false medical notes and practised while suspended. Anna Katzmann, SC, for the commission, said all the complaints were so severe, the commission sought to prevent her from re-registering as a doctor "for a long period of time". "No other order is appropriate in order to protect the public," she said.
Sood had voluntarily withdrawn her registration at the end of last month, days after she was found guilty of illegally procuring a miscarriage and after the Herald revealed the litany of complaints against her.
The commission also alleges Sood misrepresented her standing before the District Court after being convicted of Medicare fraud, leading Judge Anthony Blackmore to talk of her "previous good record". "She clearly is a skilled practitioner whose services the community can ill afford to be without," Judge Blackmore had said. Sood is awaiting a retrial on these charges. The tribunal also heard Sood had applied for, and been denied, registration by the Medical Boards of Queensland, Western Australia and the Northern Territory.
It was unclear last night when or why she was rejected. A spokeswoman for the Queensland Medical Board only said Sood was refused registration "after action taken in NSW". The tribunal also heard Sydney Adventist Hospital contacted the medical board advising of three "incidents" with Sood, when she worked for the hospital in late 2003 and early 2004. The complaints by patients include two patients suffering a ruptured uterus, the illegal abortion, poor post-operative care, and a patient falsely told she had cancer.
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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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12 September, 2006
WILL MANDATORY HEALTH INSURANCE WORK?
Should we require individuals to buy health insurance? Sounds like a good solution to the problem of growing numbers of people who are uninsured: If people won't buy health insurance voluntarily, pass a law mandating that they buy it anyway. Problem solved.
Well, not quite, says Greg Scandlen, president of Consumers for Health Care Choices. How do we know mandatory coverage will work? How do we know it will succeed in getting people who do not currently have health insurance to buy it? Policymakers can get an idea of how well mandatory health insurance would work to reduce the number of uninsured by looking at another type of mandated coverage: auto finance.
* All but three states mandate automobile insurance, but 14.6 percent of America's drivers remained uninsured in 2004, according to the Insurance Research Council.
* No state mandates health insurance, but 17.2 percent of the population lacked health coverage in 2004, according to the Employee Benefit Research Institute.
* In 17 states, the uninsured rate for auto is higher than for health.
This is a remarkable finding considering that driving is a voluntary activity and enforcement is relatively easy -- making people show proof of insurance when they register their cars, says Scandlen. Further, auto coverage is relatively inexpensive, especially since the only part of the coverage mandated in most states is the damage you might do to other people and their property. You are not required to insure for the damage you do to yourself or your own car.
There are no easy solutions to America's health insurance problem. The current notion that a state legislature can solve the problem through mandatory coverage is naive at best and a distraction from the hard work of finding real solutions, says Scandlen.
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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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11 September, 2006
EMERGENCY ROOM BLUNDERING IN THE NHS
Patients admitted to accident and emergency departments with serious injuries are treated routinely with untested therapies that may kill them, one of Britain's leading public health experts said yesterday. Hardly any treatments used in emergency trauma care have been subjected to proper clinical trials, according to Ian Roberts, Professor of Public Health at the London School of Hygiene and Tropical Medicine.
Professor Roberts led the first important study in the specialty, which has shown that drugs commonly used for 30 years to treat head injuries actually increase the chances of death and disability. An "evidential black hole" means that doctors have no way of knowing whether other therapies are similarly dangerous.
Though injury is among the biggest causes of death, it receives a fraction of the research funding given to other killers, such as cancer and heart disease. This is because pharmaceutical companies have no interest in evaluating the effectiveness of widely used but untested drugs, and because injury disproportionately affects the poor, Professor Roberts said. "It is a worrying fact that injury is a major cause of death worldwide, but most of the treatments used in its management are untested," he told the festival conference in Norwich. In the UK, injuries account for 6.6 per cent of the burden of disease, but less than 1 per cent of research spending. This compares with 27 per cent for cancer, 16 per cent for neurology, 12 per cent for infectious disease and 9 per cent for cardiovascular disease.
The biggest random controlled trial of a trauma treatment - the Crash study into corticosteroids for head injury - was stopped early in 2004 after finding that the drugs raised the risk of death by 3 per cent. The Lancet, the medical journal, estimated that at least 10,000 patients had died from the untested drugs. "I very much hope these treatments do more good than harm, but we don't know and I think we should," Professor Roberts said.
Soldiers also suffer from the lack of research, he said, and the Ministry of Defence should devote more funding to trials for treating trauma. "You would have thought the MoD has a duty of care towards soldiers," he said. "Not at all. I think they should show a little interest in evaluating treatment of trauma."
More here
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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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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10 September, 2006
The accidental drug trafficker
Three years ago, federal prosecutors likened McLean, Virginia, pain doctor William Hurwitz to "a street-corner crack dealer." But it turned out there were a few differences. Unlike a street-corner crack dealer, Hurwitz did not sell drugs. Instead, he prescribed narcotics to patients, the vast majority of them undisputedly legitimate, in an attempt to relieve severe chronic pain. The small minority of patients who used the pills to get high or sold them on the black market also claimed to be suffering unrelieved pain, and Hurwitz said he believed them.
Prosecutors said none of this matterednot because Hurwitz was lying (although they suggested he was) but because, even if he was completely on the level, even if he was making a conscientious effort to treat pain, he was still guilty of drug trafficking. A federal appeals court recently rejected this astonishing assertion, dealing a blow to prosecutions that seek to punish mistakes in medical judgment with prison terms.
The case against Hurwitz, who was convicted of 50 drug trafficking charges in December 2004 and sentenced to 25 years in federal prison the following April, encouraged doctors who already thought twice before helping patients in pain to think three or four times. Prosecutors argued that a physician who writes pre ions in good faith can nevertheless be convicted of drug trafficking, and the judge instructed the jurors accordingly.
Consider for a moment what this position would mean if it were applied to other crimes. If you mistakenly picked up someone else's suitcase at the airport, you could be convicted of theft. If a child climbed into your cart at the supermarket, you could be convicted of kidnapping. If you accidentally killed a pedestrian who darted in front of your car, you could be convicted of murder.
Fortunately for Hurwitz, other doctors who treat pain, and the millions of patients who depend on them, a three-judge panel of the U.S. Court of Appeals for the 4th Circuit unanimously repudiated the Justice Department's concept of accidental drug trafficking. "A doctor's good faith in treating patients is relevant to the jury's determination of whether the doctor acted beyond the bounds of legitimate medical practice," the court ruled, vacating Hurwitz's conviction and ordering a new trial.
The government argued that even if the judge's instructions to the jury were incorrect, the error was "harmless" because it did not affect the trial's outcome. Yet Hurwitz's intent was the focus of his defense, and comments by the jury foreman after the trial indicated the jurors thought he was guilty of negligence at worst. "Good faith was at the heart of Hurwitz's defense," the 4th Circuit noted. "By concluding that good faith was not applicable...and affirmatively instructing the jury that good faith was not relevant...the district court effectively deprived the jury of the opportunity to consider Hurwitz's defense."
The appeals court muddied the waters a bit by insisting on an " ive rather than a subjective standard for measuring Hurwitz's good faith." It's not clear exactly what that means. Since a jury cannot see Hurwitz's thoughts, it obviously must rely on ive evidence of his good faith: Did he take medical histories and perform exams before prescribing painkillers? Did he consult with other doctors and make an effort to keep up on the latest developments in pain treatment? Did patients who were faking or exaggerating pain feel a need to lie and conceal?
The answer to all those questions is yes, strongly suggesting that Hurwitz prescribed painkillers in good faith. But if the " ive" standard demands moreif it requires not only that a doctor believe he is practicing good medicine but that he is in fact practicing good medicine--it treats malpractice as a felony rather than a regulatory violation or a tort. Doctors who err on the side of trusting their patients already risk their licenses and their livelihoods. They should not have to risk their freedom as well.
Source
FASCIST DEA BUREAUCRATS RELENT A LITTLE
The Drug Enforcement Administration yesterday overturned a two-year-old policy that many pain specialists said was limiting their ability to properly treat chronically ill patients in need of powerful, morphine-based painkillers. While defending its efforts to aggressively investigate doctors who officials conclude are writing painkiller pre ions for no "legitimate medical purpose," the agency agreed with the protesting experts that it had gone too far in limiting how doctors prescribe the widely used medications.
The unusual turnaround was welcomed by relieved doctors, who said it will help restore "balance" in government policy between the needs of pain patients and the effort to control pre ion drug abuse and diversion.
Specifically, the DEA proposed a formal rule that would allow doctors with patients who need a constant supply of morphine-based painkillers to write multiple pre ions in a single office visit. Under the new rule, a doctor can write three 30-day pre ions at a time -- two of them future-dated -- to be filled a month apart. Two years ago, the agency clamped down on the common practice of writing such multi-month pre ions, which it said were probably illegal and were contributing to the growing abuse of pre ion painkillers. As a result of the DEA's position, many doctors began requiring patients to come in each month for a new pre ion -- office visits many doctors considered medically unnecessary but essential to keep them out of trouble with the DEA.
Yesterday, DEA Administrator Karen Tandy said the agency had been wrong in limiting the multiple pre ions and had made the tough decision to reverse course. She said the DEA received more than 600 comments from doctors, patients and others about its policies on narcotic painkillers, many of them strongly opposed to the agency's position on limiting refills. "Think about how hard it is for anybody to go out publicly and say, 'We think this is probably prohibited by law,' " she said, referring to the earlier decision to prohibit multiple refills. "And then you listen to people and then you say, 'You know what? You're right,' and we're going to propose a rule that interprets this correctly. And that's what we've done."
When the DEA issued its restrictive 2004 drug refill guidelines, many pain specialists saw it as a sign that relations between their profession and the agency had deteriorated badly. They also complained that DEA arrests and prosecutions of doctors treating pain were creating a "chill" on medical practice and denying patients drugs they needed.
Agency officials had earlier worked for two years with pain and hospice experts on a "frequently asked questions" guideline to advise doctors on how to prescribe controlled drugs in a way that would not get them into trouble with law enforcement. The agency briefly posted the guidelines on its Web site in 2004 but then pulled them down and disavowed them. One of the doctors involved with writing the guidelines -- who became a critic of the DEA when they were abruptly discarded -- called Tandy's actions yesterday "a very positive step forward in restoring that necessary cooperation between practicing physicians and the DEA."
Howard Heit, a Fairfax County pain and addiction specialist, also said the new policy will help patients get better care by allowing doctors more flexibility in prescribing controlled drugs.
But Siobhan Reynolds, who created the Pain Relief Network several years ago to help defend pain doctors who she said were being unfairly arrested and prosecuted, disagreed and said the new DEA policy has changed little. "Ms. Tandy states here, as she has on many occasions, that doctors need not fear criminal prosecution as long as they practice medicine in conformity with what these drug cops think is 'appropriate,' " Reynolds said. "If that isn't a threat, it will certainly pass for one within the thoroughly intimidated medical community."
The use of pre ion narcotics rose sharply over the past decade as knowledge grew on how to control intractable pain and specialists found what they considered better ways to help patients. That growing use, however, has led to abuse as well, and to scores of deaths and injuries associated with pre ion narcotics.
In addition to publishing its new policy statement and rulemaking yesterday, the DEA began posting extensive information on its Web site about doctors who have been arrested and prosecuted for their prescribing practices. Tandy said that she hopes doctors will review the cases so they will see that only "egregious" offenders are being prosecuted.
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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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9 September, 2006
SOCIALIZED MEDICINE FOR CALIFORNIA VETOED
Gov. Arnold Schwarzenegger confirmed Tuesday that he plans to veto a bill allowing the state to provide health insurance for all Californians, saying he is opposed to "government-run health care."
Senate Bill 840 would establish a single-payer system in which the state would take over the role that private insurance companies now play. Private medical groups and hospitals would continue to provide care as usual but would be paid through the state system. In theory, payroll taxes and individual income taxes would replace the premiums that individuals and businesses now pay to insurers, though the bill does not actually allocate funding for the new system.
The Republican governor has said repeatedly that he opposes single-payer health care, but until Tuesday had not commented specifically on the bill that the Democrat-controlled Legislature approved during the last days of the lawmaking session last week. Tuesday, he outlined his intention to veto the measure in an opinion piece that appeared in the San Diego Union-Tribune. "Socialized medicine is not the solution to our state's health care problems," he wrote. Schwarzenegger has said health-care is a priority for his administration. But he has said he will not propose a solution until next year if he is re-elected in November.
The author of SB 840, Sen. Sheila Kuehl, D-Santa Monica, said the bill does not establish socialized medicine or government-run health care because medical providers would continue to operate privately. "I think this is one indicator of the real Arnold," she said. "No matter what he says for election purposes, in his heart he supports the insurance companies and nibbling around the edges of the health-care crisis."
Despite Democratic support for the measure, Schwarzenegger's Democratic opponent in the gubernatorial race, state Treasurer Phil Angelides, has not taken a position on the bill.
Source
Australia: Public hospital bureaucracy fails mothers
Six years of lazy bureaucrats sitting on their hands
Ten birthing tubs in the Royal Brisbane and Women's Hospital's main maternity unit that were meant to provide the option of soothing warm water baths for labouring women continue to lie empty and unused after six years. The tubs were installed in the unit's birthing suites during the multimillion-dollar refurbishment of Queensland's flagship medical facility. But a spokeswoman for the hospital said yesterday there were still no plans to trial use of the tubs "until they were deemed safe". "An ergonomic assessment of the tubs has revealed (they) are not safe for use," the spokeswoman said. "RBWH is reviewing various options to improve their safety."
Two years ago, Queensland Health's RBWH district manager, Professor Richard Olley, said the tubs would not be used until a "multi-centre randomised control trial" was held to assess the safety of the tubs being used for immersion during labour. That decision ignored the 2003 findings of an in-house hospital committee which found the use of water in labour and birth in the hospital's separate birth centre - available only to a few women - had achieved "good outcomes for both mothers and babies".
The tubs' on-going closure as a result of workplace health and safety issues or medical safety issues means about 4230 women annually who give birth in the hospital's main maternity unit are denied the option of a warm bath for pain relief during labour. Maternity Coalition Queensland vice-president, Melissa Fox, said access to a bath for labouring mothers was a standard option in many other maternity services around Queensland, Australia and the world. "It should be for Brisbane women too," she said. The lack of access had been an ongoing disappointment to mothers.
"A range of reasons have been proposed for this and it's about time the problems were clarified and dealt with so women can have a access to a reasonable range of choices," Ms Fox said. "Many women, including myself, find a warm bath soothing and relaxing, easing the pain of the contractions so you are less likely to feel the need for pharmacological pain relief."
About 620 women each year apply through a ballot system to give birth in the hospital's birthing centre. In the birthing centre about 50 per cent of the women use that facility's birthing pools for pain relief during labour. Ten women each month in the birthing centre have water births.
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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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8 September, 2006
Competition works for Medicare Part D
A study of the Medicare Pre ion Drug Coverage Program, also known as Part D, reveals free-market competition is keeping drug prices down more effectively than price controls in Medicare's other segments. According to "Secretary's Progress Report IV on the Medicare Pre ion Drug Benefit," by U.S. Health and Human Services Secretary Mike Leavitt, released June 14, allowing seniors to choose from a variety of coverage plans has kept costs 40 percent lower than the Bush administration expected after the president signed the Medicare Modernization Act into law in December 2003. This could save taxpayers billions of dollars over the next decade.
"[E]xperts estimated that the average [individual's] monthly premium would be around $37," Leavitt wrote. "Our analysis of actual enrollment finds that the average 2006 Part D premium is less than $24. This represents strong competition plus informed beneficiary choices. "The overall 2006 cost to the taxpayer has dropped about 20 percent from the July 2005 estimate, and estimates for the net total cost to Medicare for the 10-year period from 2006 to 2015 have been cut by $180 billion," Leavitt continued. "State phase-down contributions over the same period are now projected to be $39 billion less."
Model Program?
Some free-market advocates believe Part D's competitive success could lead to price controls being removed throughout the entire Medicare program in the future. "The early evidence with the Part D program shows that competition can work in Medicare," said Grace-Marie Turner, president of the Galen Institute, a policy research group in Alexandria, Virginia. "Drug plans competed to encourage seniors to sign up, by offering more attractive benefits and lower premium prices, and seniors responded by picking plans that offered the best value. The reason the drug plans were able to offer lower prices is that they were able to negotiate with pharmaceutical companies for lower drug prices. "This is the market working to provide better value for beneficiaries and lower costs for taxpayers," Turner said. "We finally can see that the health sector can respond to the forces of competition and be better for it!"
Mixed Views
Other free-market advocates were skeptical of Leavitt's report. Twila Brase, president of the Citizens Council on Health Care in Minnesota, interpreted the findings cautiously. "The 40-year history of Medicare shows that government programs start out with a bang, and once everyone is a captive participant, prices increase and access declines," Brase explained. "In addition, despite the unanticipated drop in estimated cost to taxpayers, the drop is not a saving. The cost to taxpayers is still $746 billion over the next 10 years. That's $75 billion a year taxpayers didn't have to pay before Medicare Part D became law."
Mike Cannon, director of health policy studies at the Cato Institute, a libertarian think tank in Washington, DC, said Leavitt's optimism is shortsighted. "Medicare Part D dumped more weight on an already sinking ship. Now Congress and the Bush administration are saying, 'See, it's not sinking that much faster.' This is success?" Cannon asked. "What Republicans see as short-term savings will quickly disappear as seniors, drug manufacturers, and politicians learn to game the system. "Everyone from conservative Republicans to left-wing Democrats are already lining up with legislation that would increase the cost of this program. Part D is a disaster of epic proportions," Cannon said.
Source
More surgery cancellations in Queensland public hospitals
The State Government has cancelled elective surgery for up to 500 patients who would have had their operations after the election. The Royal Brisbane and Women's Hospital cancellations span 151 surgical sessions - up to 500 operations - over five weeks. Premier Peter Beattie said the cancellations were planned months ahead.
But Liberal leader Bruce Flegg said yesterday surgeons were only advised on Wednesday and patients would not be told until Monday - two days after the election. Dr Flegg said it was a slap in the face for patients, some of whom would vote for Labor. He produced leaked documents with the subject heading, "rolling cancellations", which showed that more surgery could be postponed. The documents reveal general, vascular, orthopedics and urology surgery will be suspended.
The memo from the hospital's surgical team to "interested parties" said that from September 25 to October 6, upgrades were scheduled for the surgical day care unit and the sterile processing centre. However, it does not reveal why operations need to be cancelled from Monday.
"These massive surgery cancellations are right across the board, from category one to category three," Dr Flegg said. "There is no doubt that cancelling people's operations in urgent cases put people's lives at risk. "Again we have hundreds and hundreds of Queenslanders getting a little slip in the mail saying, 'Don't come in on Monday, we have cancelled your operation'. "This is a Premier who stood with his heart and said, 'We're getting more doctors and nurses. We're fixing health'."
Mr Beattie accused Dr Flegg of "political mischief" and said very few surgeries would be cancelled. But Dr Flegg said Mr Beattie's blase excuses were a reason why visiting medical officers, who were among the backbone of public hospitals, were leaving the system. "Constant cancellations are exactly why the number of visiting specialists in Queensland has almost halved under the Beattie Government."
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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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7 September, 2006
WHY MEDICAL CARE IS SO EXPENSIVE
Medical expenses are rising faster than the costs of any other service. They are climbing at rates that exceed not only those of inflation and dollar depreciation but even the Federal government itself. In fact, they are consuming an ever larger share of personal and national incomes. Some 40 years ago, American medical spending was estimated at 5 percent of national income; today it is calculated at some 16.5 percent and rising continually. Several reform proposals in Congress would boost the share ever higher.
Many observers offer lucid explanations of the medical-spending explosion. Some are convinced that the present generation of Americans, which enjoys a level of income and living standard higher than that of its forebears, is more mindful of health and wholesome living and, therefore, is spending a larger share of income on health care. But critics prefer to point to the ever growing number of Americans who are overweight or even obese, which may breed physical disorders and afflictions and finally acquire medical attention. Other observers hold the endless stream of medical innovations responsible for rapidly rising health-care costs, such as new drugs and delicate tools for microsurgery. They lay most of the expense explosion at the feet of technology. But these writers never explain why new drugs and new tools should raise medical costs threefold and consume an ever larger share of national income. Technical innovations usually lower the costs of production.
A few writers believe that the primary reason for rapidly rising costs of health care is a massive expansion of medical insurance, which foots doctors and hospital bills. They like to use an inordinate terminology that diverts the reader from the actual causes. They broaden the concept of insurance to encompass Medicare and Medicaid, which are government programs providing medical care for the aged and needy, and then hint at insurance as the driving cost factor. In reality, the number of Americans with health insurance is actually declining; rising health-care costs and a declining number of employer-sponsored benefits are steadily reducing the number of insured Americans. At the present, some 47 million Americans are bereft of any coverage.
Few observers dare to state that spiraling health-care costs are the inevitable consequence of a 1965 Social Security amendment molding Medicare and Medicaid. It provided a basic welfare program that covers most persons aged 65 and older as well as all needy individuals. Soon after its passage some four million patients rushed to seek treatment and some 18 million Americans registered to have 80 percent of doctor and surgeon bills paid by the new system. By now, in 2006, Medicare provides health benefits for 41 million elderly and disabled persons, and Medicaid, a joint federal-state program, serves some 50 million poor beneficiaries. It is the fastest-growing item in most state budgets and accounts for some 20 percent of total state spending.
The program has undoubtedly saved lives as it has enabled elderly and poor people to receive medical treatment they were not able to afford on their own. It has raised the quality of living for many. But its sponsors completely ignore some undesirable consequences such as the soaring costs and the rising number of people who therefore choose to forego any health insurance coverage. Surely, it has saved some lives but also may have cost some. It has doubled, tripled, and quadrupled many phases of the health-care industry but also kept other service industries smaller than they would have been in a free service economy. It has helped administrators of hospitals and extended-care facilities to embark upon substantial expansion and has stimulated development of many home-care services. But there cannot be any doubt that the massive injection of political funds and the growing role of legislators and regulators have radically changed the very nature and structure of the health-care industry.
Medicare and Medicaid are political handiwork forged by legislators and regulators, fashioned by politicians who recast it in every national election. It is a very popular political issue passed and argued about without ever being settled. Politicians representing the beneficiaries are demanding ever more outlays, others speaking and acting for the people who are forced to cover the deficits are opposing the charges. Facing ever rising costs, some want to reduce the cost-of living increases in benefits, others plan to increase the wage subject to payroll taxation. In 2005, the benefit-politicians raised the maximum earnings subject to Social Security tax exactions to $90,000 with the tax rate at 12.4 percent, borne equally by employer and employee. In 2006, they raised the maximum to $94,200; in coming years they will boost it to $100,000 and more.
Medicare and Medicaid stand in the center of attention in every national election as both parties may seek to outbid each other in promising more benefits. In 2003, Congress was persuaded to add pre ion drug coverage to Medicare, starting in 2006. Most of its costs, estimated at some $700 billion over the next 10 years, are to be paid by taxpayers. But soaring costs are the least portentous consequences of the transformation of the health-care industry. This academic observer is dismayed and disheartened by the role played by politics in such an important industry.
In a free and unhampered economy, businessmen always seek to adjust their production to anticipated consumer demand; the wishes and choices of consumers are paramount. When government takes special interest in an industry, political judgments and motives take preference to the people's choices. When government on all its levels enters health care, the industry has to adjust to every dollar spent and every order given. Surely, there are pains of readjustment but no particular economic crises. People readily accommodate. While they are not free to choose in the market place, they may plead and supplicate in the halls of politics. Some courageous observers may even point to needless expenditures and waste as every health-care administrator may want to expand and improve his facilities. After all, they no longer are limited by market orders but only by political considerations and favors.
Politics is likely to shape the future of medical care as far as the eye can see. It builds upon popular political ideas, on old habits and predispositions, even resentment and envy. It inflicts pain without end.
Source
Got cancer? Too bad!
Cancer patients are being forced to travel interstate to seek life-saving treatment which Queensland Health deems too costly. Public hospital patients with brain tumours and prostate cancers are flying to Melbourne and Sydney - some at their own expense - to get the specialised radiation treatment. The treatment, known as intensity modulated radiation therapy, is available in most other states and gives cancer sufferers a higher radiation dose but minimises the side effects. The revelations come after The Courier-Mail reported yesterday that Queensland cancer sufferers are waiting up to four times longer than recommended for essential radiation therapy.
In 2005, Queensland Health said IMRT could help save lives but was expensive. "IMRT offers improved patient outcomes, yet due to competing demands (and) time constraints, introduction of these labour-intensive procedures is difficult and costly," it said in an internal report.
A Medical Radiation Professionals Group spokesman yesterday said patients would be spending up to seven weeks interstate to get the treatment. The spokesman for the group, which is made up of Queensland Health employees, said the treatment could be available with an upgrade of existing equipment. "Queensland has the equipment capable of offering the treatment but not the staff," he said.
Coalition health spokesman Bruce Flegg said the Government's response to cancer was "hopelessly inadequate". "That technology should be available to public patients as it is to private patients," he said. "It shouldn't be the case that people have to travel interstate."
However, Health Minister Stephen Robertson said intensity modulator radiation therapy was "high end" medical treatment needed by only a very small number of cancer sufferers. "At present in Queensland, a very small number of public cancer patients require intensity modulator radiation therapy each year," he said. "Treatment is provided in Sydney - Queensland Health pays the cost for the handful of people needing this specialised care." Mr Robertson said the Government was keen to provide the therapy and a submission by the state's clinical oncology network was under way. The Government today will announce plans to spend $9 million on new cancer equipment at the Mater and Princess Alexandra hospitals. Mr Robertson said the funds would cut waiting times and allow both hospitals to treat more cancer patients. "It represents a significant expansion of cancer services and shows the Beattie Government is getting on with the job of improving the health system," 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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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6 September, 2006
Dire prognosis for Britain's health software revamp
Lorenzo, the long-promised patient record system at the heart of Britain's 10 billion pound ($25 billion) National Health Service IT upgrade, has been exposed as foilware, with iSoft having "no believable plan" for completing development. The Lorenzo system was initially scheduled for release in March 2004, but there has been a series of delays and no British hospital trust is yet using the new software. ISoft Australia is supplying the same products for state health projects, including Victoria's $323 million HealthSmart.
The latest delivery date is 2008, but a review in February by CSC and Accenture - iSoft's partners in three NHS regional rollouts - found the date to be far too optimistic. Further, a scathing report, seen by The Australian, warns that Lorenzo may not achieve the performance necessary to support a system used by about 600,000 NHS healthcare staff and 30 million patients. "No evidence was seen for the development or testing of technical procedures that would be required for operation and maintenance of the live system," the report says. "This is the main risk to the successful delivery of a fit-for-purpose system based on the Lorenzo framework and products to the local service providers. "Technical requirements and development processes have only been considered from the bottom up," the report says. "There has been no holistic view of the behaviour of a complete system built upon Lorenzo."
The report says it's likely that large amounts of development already completed will need to be reworked during testing, "and it's anticipated other significant performance and operating issues will be encountered".
ISoft's share price has been in freefall since the start of the year, when the NHS began applying pressure over delays, and reports of accounting irregularities emerged. The meltdown wiped 90 per cent off the company's value, and was only arrested when its bankers agreed to a brief reprieve. ISoft announced a shock loss of almost 400 million, and now faces investigation by financial regulators. Last week, Accenture was reportedly trying to negotiate an exit from the NHS's Connecting for Health program, while CSC has agreed to take over management of Lorenzo, with an option to take direct control "in the event iSoft is unable to meet its obligations".
While iSoft has been spruiking Lorenzo's capabilities for years, its latest annual report reveals that product rollout is currently limited to early adopter sites in Germany and Singapore. "We expect to see the start of Lorenzo user functionality in Britain from late 2007 onwards," iSoft says. "Our activities in Britain remain dominated by the provision of services around a strong installed base of existing clients. "Work under the NHS is building up, with the initial delivery of existing products such as iPatient Manager (iPM) and iClinical Manager (iCM) into many NHS health trusts. Isoft says existing systems are being packaged with core elements of Lorenzo technology, enabling those systems to communicate with the new national network. "Existing applications will be upgraded to Lorenzo functionality from late 2007. This will provide customers with a phased, low-risk migration of their systems," iSoft says.
British Conservative MP Richard Bacon says iSoft's system is way behind schedule, has major flaws and there are serious doubts that it can be made to work before the program is due to be completed in 2010. Bacon describes iPM and iCM as antiquated, and says recent installations by hospital trusts "in the expectation that a working Lorenzo system will be delivered" may be a massive waste of money and effort. "Why are iPM and iCM being installed instead of the Lorenzo system promised and demonstrated three years ago," Bacon says. "They seem very unstable, and there is a new horror story every week. "We could end up with very poor systems installed and no upgrade path."
Similar questions are also being asked here. Victorian Health Minister Bronwyn Pike recently told the public accounts and estimates committee that Victoria was contracted for the iPM product only, although the contract "requires iSoft to make new developments and product releases available for no additional cost". "This will include the new Lorenzo product it is currently developing, within the bounds of the patient and client management functionality," she says. Department secretary Patricia Faulkner told the committee: "we have obviously been aware that iSoft is struggling with its partners in Britain to deliver its products". "They are beyond the range of what we have contracted for".
Shadow health minister Helen Shardey says the problems with iSoft's capacity to deliver were known when the contract was awarded. David More, an independent consultant and e-health blogger (aushealthit.blogspot.com), says iSoft's failure appears inevitable. "In November last year I had the opportunity to review, in detail, the hospital information system being offered to an international client for a 300-bed tertiary hospital," More says on his blog. "It was clear at the time that the Lorenzo suite was little more than foilware. The system was a concocted blend of old and new components, was obviously unintegrated and lacked any common utility in its user interface. "Needless to say, I recommended no further engagement be had with iSoft and that alternative providers should be considered."
More says NSW Health should not rely on its escrow arrangements with iSoft to protect the rollout of patient administration systems in three area health services this year. "There is no point holding obsolete software code in escrow," he says. "All that does is provide a false sense of security that something can be done when iSoft fails. "Well, maybe it can be used to fix the occasional critical bug while buying time to identify new software to replace the doomed system."
More says organisations in NSW and Victoria that purchased iSoft on the basis of future promises "have clearly let their respective health systems down very badly". ISoft Australia shrugs off the problems engulfing its parent company. Local communications chief Laurie Giles says the local position is "fundamentally unchanged". A three-day iSoft Healthcare Forum will take place as planned at Sanctuary Cove, Queensland, later this month.
Meanwhile, an industry insider says the real risk for Australia lies in the efforts and focus iSoft will have to invest in the NHS project. "So they will be less focused on projects in Australia, which represent only 10 per cent of their total revenues," he says. "They are also under a lot of pressure to cut costs, and it's hard to develop new products when you're cutting costs."
Source
Deadly public hospital delays
Queensland cancer sufferers are being forced to wait more than four times longer than recommended for life-saving treatment. A damning Queensland Health document has exposed the potentially deadly delays that many public hospital patients and their families must endure. The fresh health scandal is a significant blow to Premier Peter Beattie only four days from Saturday's election.
The internal memorandum, obtained by The Courier-Mail, reveals priority two patients with aggressive tumours, bleeding or pain are waiting up to 34 days for radiation treatment. The recommended maximum wait time for such patients is 14 days. Priority three patients with breast or prostate cancers are waiting up to 89 days while 21 days is the recommended maximum.
A Medical Radiation Professionals Group spokesman said yesterday that a shortage of radiation therapists was mostly to blame and wait times would blow out further as more therapists quit Queensland Health. "It seems the Health Minister has mistakenly chosen to focus only on doctors and nurses and unfortunately the Queensland public is paying the price," he said. Health Minister Stephen Robertson played down the waiting time figures, saying that the Government was addressing the problem. "Timeframes will fluctuate from week to week," he said.
The August 29 memorandum, with the subject heading "Delay in Treatment", gives a breakdown of the waiting times for the four public hospitals which conduct radiation treatment. Townsville Hospital priority two and three cancer patients wait up to 34 and 89 days respectively. Princess Alexandra Hospital cancer patients are waiting 50 days for treatment on priority three cancers and 36 days for priority two. Cancer patients of the Mater Hospital and Royal Brisbane and Women's Hospital also face significant waits beyond what is recommended.
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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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5 September, 2006
EYE DRUG DENIED TO NHS PATIENTS
They don't care if you go blind!
In an ideal world the drug industry identifies a disease, develops a cure through research and markets it to a ripple of applause. In the real world things are often a lot messier. But seldom are they quite as confused as they are in age-related macular degeneration, the most common cause of blindness in the UK. A new treatment exists that is eminently affordable, apparently safe and backed by a growing body of evidence that it works. But the drug company that owns the rights in the UK cannot even talk about it, and for commercial reasons the US company that originally developed it will not be promoting it. Nor is it being taken up by the NHS. As a result, thousands of people who develop the wet form of age-related macular degeneration (AMD) are being denied access to a promising treatment. Yet nobody, really, is behaving improperly. There are no villains in this story, just a lot of patients who may feel that the system is short-changing them.
The problem is real and urgent. Half a million people in the UK suffer from the condition, according to the Macular Disease Society. For most those with the dry form of the disease there are no treatments and no prospect of any. But for the 10 to 15 per cent who suffer from the wet form, which progresses more quickly and damages sight more profoundly, there are hopes.
AMD is caused by damage to the macula, the part of the retina responsible for precise vision. In the wet form, abnormal blood vessels grow behind the macula, leaking fluid and blood and causing rapid damage. Wet AMD is responsible for only 15 per cent of cases but it causes 90 per cent of the blindness. There is one treatment for wet AMD; Visudyne, licensed and approved for use in the NHS by the National Institute for Health and Clinical Excellence (Nice). It is not hugely effective and certainly not a cure, but it can help to slow the disease.
Typically for a new medicine in the NHS, Visudyne was slow to reach any patients at all. And although there are now 50 specialist centres set up to provide the treatment, by last November a survey found that only half of the new patients were getting to the clinics in time to save their sight. Visudyne is marketed by Novartis, which has also bought the UK rights to what appears to be a better treatment, Lucentis, developed in the US by Genentech. Lucentis works in the same way as some of the latest cancer drugs, by preventing the growth of the new blood vessels that cause the problem in wet AMD. Lucentis is not yet licensed in the UK, but even when it is it will be expensive, and Nice approval will be needed before the NHS will agree to pay for it. The same applies to another new treatment, Macugen, which does have a UK licence. On past history, the price of both is likely to prove a major obstacle: Lucentis is expected to cost more than 1,000 a treatment and Macugen 4,000 pounds a year per patient.
So far, so familiar; but there is another dimension to the story. Genentech is also responsible for a colon cancer drug, Avastin, which uses the same mechanism as Lucentis but is far cheaper. A few eye surgeons, first in the US and now here, have been using it to treat wet AMD. The results, they say, are excellent. Shirley Davis, a retired NHS radiographer from Huddersfield, is one of the patients treated with Avastin in the UK. Wet AMD developed in her left eye five years ago and she was told then that nothing could be done. Recently her right eye began to deteriorate, too, and she faced the prospect of going blind. She is being treated privately at the Yorkshire Eye Hospital in Apperley Bridge, West Yorkshire. So far she has had one treatment from a surgeon, Shafiq Rehman, who was delighted with the results.
I was very impressed, he says. Ordinarily, after AMD treatment you dont see any effects when you look into the eye. But I am seeing real changes, less swelling and bleeding, the normal signs of wet AMD. Ive treated only a handful of patients but 30 to 40 per cent have shown vision improvements. And so far, based on US experience, Avastin is safe. Thats important, and it works very well.Maybe Lucentis will turn out to be the gold standard but my guess is that Avastin is not far behind.
Shirley Davis is unsure whether her sight has improved and is less excited than Mr Rehman. He was jumping up and down, she says. It cheered me up. Maybe I was expecting too much, I was hoping for a miracle. But she is encouraged enough to go back for further treatments and her main complaint is that after a lifetime of work for the NHS, she is having to pay for it privately. I worked for the NHS and now they wont treat me, she says. That makes me cross.
Several other eye surgeons are using Avastin, all privately. Michael Lavin, consultant ophthalmologist at Manchester Royal Eye Hospital, calculates that the savings are huge. Avastin, he says, is 150 times cheaper than Lucentis: Avastin is as effective as Lucentis and at least as safe, with safety data on almost 8,000 Avastin injections into the eye compared with Lucentis data on less than 800. It is highly effective, prevents blindness and is much cheaper and more effective than existing NHS treatment. Richard Gregson, consultant ophthalmologist at Queens Medical Centre in Nottingham, agrees that it is just as good as Lucentis. But it is never going to be licensed for use in the eye, because that would need expensive clinical trials. It wouldnt be in Genentechs interest to conduct such trials and nobody else will do it, he says.
The NHS used to conduct trials but its impossible now. The NHS has almost abolished clinical research of this kind by bureaucratic obstacles and lack of funding. It has always been backward-looking, having to be dragged kicking and screaming to introduce new treatments. Theres a culture of dont do it.
Source
Medical training funds spent on bureaucracy
Medical schools have accused the states of diverting money meant to fund clinical training of medical students into general hospital coffers. They want the commonwealth to hand control of training funds to universities, warning that inadequate clinical training could threaten the standards of Australian medicine. But the Australian Medical Association has accused universities of siphoning training money into their general administration.
The accusations come amid intensifying concern that public hospitals are not equipped to provide clinical training to the growing number of students of medicine and other health professions such as nursing. The Australian revealed yesterday that Education Minister Julie Bishop was reviewing funding mechanisms in response to complaints that students in allied health professions were being denied clinical training. This followed news that up to 200 physiotherapists might be unable to graduate from universities this year because, while meeting academic requirements, they will not have had adequate hands-on training.
Committee of Deans of Australian Medical Schools chairman Lindon Wing told The Weekend Australian yesterday that public hospitals were under such funding pressure that they were using money previously set aside for training to boost resources for medical treatment. "They are not able to allocate the funds as they might have before," Professor Wing said. "Education is not their focus." Professor Wing said people assumed hospitals had to spend a certain percentage of their funding on clinical training. In fact, hospital budgets had no line item for training.
He said resources were limited and that the situation would worsen because university medical graduate numbers were expected to increase to about 3000 a year in coming years - up from 1250 in 1998. He said CDAMS wanted the federal Government to increase the per-student grant paid to universities for medicine - now about $16,000 a year - or to boost the loading that augmented funding for medical students' clinical training.
However, AMA federal vice-president Choong-Siew Yong said some universities diverted up to half of commonwealth medical student grants into general administration. "The universities must stop using medicine as a cash cow," he said. Federal Health Minister Tony Abbott would not comment.
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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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4 September, 2006
ARROGANT NHS DOCTORS FAILING TO LEARN
The fact that there is no effective penalty for mistakes in the NHS is background you need to understand fully the article below
Arrogance and complacency among doctors could lead to another medical disaster on the scale of the Bristol babies scandal, the Royal College of Surgeons has warned. Five years on, patients are dying on operating tables because some doctors are still failing to act on the lessons of the scandal that led to the deaths of 30 babies, the college says.
This weekend leading surgeons compared the operational failings causing surgical blunders in NHS theatres to the institutional deficiencies that contributed to Nasa's 1986 Challenger and 2003 Columbia space shuttle disasters. Tony Giddings, a member of the college's council and a former consultant surgeon, says the NHS has not changed its practices significantly since poor operating techniques led to the scandal at Bristol. "Do we need to have a second Bristol before we can actually make the cultural changes that are needed?" said Giddings. "We have continued to have avoidable deaths in surgery because the lessons that were so clearly set out in Sir Ian Kennedy's report [into the scandal] have not been acted upon."
Last weekend The Sunday Times disclosed that more than 300 babies a year were being left with brain damage because of oxygen starvation caused by lack of proper care at birth. A government watchdog also warned that more than 2,000 people died last year because of blunders by NHS staff.
Giddings says although most surgeons are now aware of their own limitations, some are still putting patients' lives at risk because they believe they are infallible. "There are some surgeons who have a seriously flawed opinion of their own capabilities," he said. "If you are a surgeon and doing dangerous work you need to have a degree of self-assurance and confidence but it can turn into arrogance. "Surgeons can become too familiar with the dangers of the operating theatre and lose that capacity to be properly respectful of those dangers. "After the first shuttle disaster, although the astronauts changed a few practices, their attitudes and beliefs did not really change and they still thought they were masters of their situation. Nasa had a second disaster and then they really had to change."
The college wants the government to make it mandatory for all surgeons to be trained in skills such as communication and teamwork. In 2001 Sir Ian Kennedy, the chairman of the Bristol inquiry, recommended national procedures whereby surgical teams - including the consultant, anaesthetist, and theatre nurses - should meet routinely to review their performance. This has not happened, according to the college, and, until it does, avoidable deaths will continue.
The college insists that the actual number of avoidable deaths are up to 10 times higher than the 2,159 patient deaths recorded by the National Patient Safety Agency, since only a fraction are reported. Research published in 2004 put the annual number of patient deaths due to medical error at 40,000.
In one notable case, Marc de Leval, a professor of paediatric surgery at Great Ormond Street Hospital for Children, admitted that mistakes he made in surgery resulted in babies' deaths. He volunteered to retrain in the early 1990s after seven babies he performed heart surgery on died. Another surgeon, a consultant urologist from southwest London, admitted this weekend that one of his patients died after he removed the wrong kidney. The patient later died of complications. The surgeon, who did not wish to be named, said it was essential that junior staff were free to speak up if they suspected a mistake. "There are surgeons who are fairly intimidating and people would feel it is difficult to challenge their views," he said.
Source
Californias latest drug deal hurts minority health
If you want to know why there are health disparities between different racial groups, the recent drug deal between the Democrats in the California legislature and Gov. Arnold Schwarzenegger is Exhibit A. The proposal to extort lower drug prices by removing or restricting new medicines that dont meet a state-set price will only hurt those depending on the government for health care or pre ion drugs. Thats par for the course for the states Medicaid patients, who are already subject to rationing of medicines, restrictive access to newer medicines, and delays in obtaining drugs that, while more expensive, can often be more cost effective, more convenient to use, and have fewer side effects. Not that the governor and his health director Kim Belshe are unaware of this negative impact on the health of the Golden States minority population. Several years ago, I was part of a group of health-care researchers that presented Belshe with data demonstrating that restricting access to new medicines based on price actually made people sicker and drove up total cost. One of my colleagues, Dr. Susan Horn, conducted a study showing that more regulations of the type now being proposed by the governor were correlated with an increase in patients use of more expensive medical services, treatment in emergency rooms and hospitals, and visits to doctors offices. Such government impositions not only place the poor at particular risk, but also increase the total cost of their medical care.
The use of drug therapy to treat mental illnessa large proportion of the states drug budget provides a case in point regarding the dangers of limiting access to a variety of pre ion drugs. Selective serotonin reuptake inhibitors (SSRIs) are used to treat depression and a variety of affect disorders. There are more than a dozen existing SSRIs. Yet, under Californias proposed price-control plan, Medicaid patients suffering from depression and related disorders are already limited to the cheapest drugs. If new ones came on the market that were demonstrably more effective, they would not be available unless they were discounted to a huge swath of the states population. The same would go for any type of new drug that came to market. As Loretta Jones of the Los Angeles-based Healthy African American Families notes, the gap between cutting-edge care and the needs of the poor would grow wider each year. Belshe knows better than to let this happenand so does the governor who inveighed against price controls less than a year ago.
Indeed, because California is a $2 billion market and growing, its price-control regime would make it the last place in the nation to obtain access to new medicines. In Europe, the imposition of price controls and protracted price negotiations delays access to new medicines by up to 3 years. Studies have showparticularly in the treatment of cancer, Alzheimers, diabetes and heart diseasethat the delay in the launch of new medicines translates into more death, higher health-care costs, and a lower quality of life. The Schwarzenegger-Democrat proposal would erect the same sort or rationing and it would harm Medicaid patients the most. Ironically, such a price-control regimewith its threat to cut 40 percent of the price of new medicinesundermines and wastes Californias investment in stem-cell research. For once the money is spent confirming basic science, which company will want to pursue development in a state that punishes profit?
The proposal actually rewards those who are uninsured but can afford to buy coverage, particularly those making $70,000 a year or more. (It also encourages health insurers to dump pre ion-drug coverage. Why provide it when the state will force deep discounts down the throats of drug and biotech firms?)
For example, while the bill covers drug expenses that exceed 10 percent of income, it turns out that, according to the California Health Care Foundation, the average Californian spends more a year going to restaurants ($3,500) and entertainment ($2,800) than on out-of-pocket health expenses ($2,500). By that logic, the state should negotiate discounts at Spagos and Disneyland, too. And since hospitals cost more than medicine, maybe the governor should start denying the poor access to surgery until hospitals provide a 40 percent discount to middle class people who dont want to buy health insurance.
If the governor and the Democrats were serious about health care, they could promote low-cost insurance coverage instead of protecting the wasteful benefits package negotiated by the unions. Instead, they are promising to provide another middle-class entitlement by sticking it to the poor and deepening the health disparities between the races. This is about as disgusting as it gets in politics and in public health.
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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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3 September, 2006
What uninsured crisis?
Post lifted from the Locker Room
A slide from the Duke University Center for Health Policy unintentionally offers some perspective on this week's Census report that 15.9% of Americans are without health insurance, the highest level since 1998 when 16.3% were uninsured. Nina Owcharenko thinks the best way to deal with the problem is to eliminate barriers in the individual market.
AMERICAN HEALTH CARE GIVES VALUE
Despite exploding costs, most Americans got sizable life-extending bang for their medical bucks over recent decades, says one of the most sweeping studies ever of health-care value. That might come as a surprise to anyone who has ever shuddered over a medical bill, and the report itself raises doubts over how quickly costs have escalated. However, the study calculated that Americans of all ages spent an average of $19,900 on medical care for each extra year of life expectancy gained over the last four decades of the 20th century. And that cost is worth it, the study authors say. "On average, the return is very high," concludes study leader David Cutler, a Harvard University health economist. "But it's getting worse for ... in particular, the elderly."
The federally funded study by researchers at Harvard and the University of Michigan was being published Thursday in the New England Journal of Medicine. The researchers measured value by the cost of care that extends the average person's life by one year. The $19,900 spent for each extra year of life - when averaged over 40 years - would be widely considered a reasonable value. Many public and private insurers routinely pay for treatments that cost up to roughly $100,000 for each additional year of life. The researchers attribute this this relatively low cost for longer lifespan to things like cheap blood-pressure drugs that prevent heart attacks.
However, the study also outlines disquieting trends. It finds that inflation-adjusted costs from birth rose fivefold between the 1970s and 1990s, when the cost of an additional year of life span peaked at $36,300. That means each health care dollar of the 1990s, when expensive drugs made modest impact on cancer, bought a fifth as much real value as 20 years before, when cheaper medicines saved many lives.
Values deteriorated seriously for older people, the study finds. By the 1990s, 65-year-olds paid $145,000 for each additional year of life gained - a value that would be challenged for many individual treatments. These higher costs presumably come largely from end-of-life care that doesn't extend life very much.
Health policy chief Kathleen Stoll, of the advocacy group Families USA, said she believes the study suggests real value anyway. "Each increment of gain is more expensive now, but certainly very valuable to the person involved and their family," she said.
Others were troubled. "The fact that someone is writing this paper shows how desperate the health care system is to justify these out-of-control increases in health spending," said consumer advocate Dr. Sidney Wolfe, who heads health research at Public Citizen.
The researchers admit their calculations give only a partial picture of value. They started by calculating average changes in both medical spending and life expectancy for various age groups in each decade. Then they divided changes in spending by changes in life expectancy, yielding the cost per year of life gained. But many factors extend life apart from medical care, like not smoking or keeping extra weight off. So the researchers turned to previous studies suggesting that about half of all gains in lifetime stem from medical care - and adjusted their findings accordingly.
Even the researchers acknowledge this adjustment could be off. Others familiar with their findings said their calculations - while potentially useful for the big picture - had to overlook other important factors, like the impact of care on quality of life and the amount of waste in the medical system. "It really doesn't tell you whether we are spending too much on what doesn't matter and too little on what does," said Dr. Harlan Krumholz, a cost-effectiveness expert at Yale University. Others worried about future costs, though the study makes no projections. "The growth in medical spending is unsustainable over time - both in terms of absolute dollars and the benefit it yields," said health care analyst Steven Findlay at Consumers Union.
Source
A negligent Australian public hospital
This time in the State of New South Wales
A father who lost his son to meningococcal disease is suing a South Coast hospital after it allegedly twice sent him home with his sick child. Nicholas Constantini, 5, died 48 hours after his father first took him to the Shoalhaven Memorial District Hospital in January last year. Yesterday his father, Roy Constantini, of Nowra, sued in the NSW District Court, claiming damages for psychiatric injury he has suffered since his son's death.
In a statement of claim filed with the court, he alleges the hospital was negligent in its treatment of his son, and in the advice given to him about his son's symptoms. Among its alleged failures were a failure to follow public health and NSW guidelines for the early treatment of meningococcal disease, a failure to administer intravenous antibiotics and failure to conduct appropriate tests. "Had Nick been provided with adequate treatment he would have survived," said Mr Constantini's solicitor, Stephen Thornton.
Speaking from his home yesterday, Mr Constantini said he and his sister had first taken Nicholas to the hospital about 10am on a Thursday. He said the hospital administered some tests, and gave him Panadol. They were told they could all go home about 3pm.
Mr Constantini said after leaving hospital his son began to vomit, so he returned to the hospital at 6pm, and was told the boy had an allergy. By the next morning he said his son had difficulty breathing and walking. He took him back to the hospital at 10am where, not long after, he convulsed and went into a coma from which he did not wake.
Mr Constantini said his son was flown to Sydney that night but died on Saturday morning. "I was angry. I was in shock. I had a sick child and I trusted the doctors, too. I believed them," he said. "I want everybody to know about this. I don't want it to happen to another child."
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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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2 September, 2006
LYING COVERUP OF NHS NEGLIGENCE
Their "count-out" was so casual that nobody even bothered to fill out the form. But again no penalty whatever for killing a patient
A man aged 79 slowly starved to death after hospital staff accidentally left an 18in cotton pad in his intestine at the end of an operation. In the ten following months, the forgotten swab - used to soak up blood and other fluids - blocked the natural absorption of nutrients, an inquest was told.
The swab should have been ticked off a list of items to be removed from Robert Twycross at the end of the procedure at Royal Hampshire County Hospital, Winchester. But Chaudhary Usmani, the surgical registrar, admitted that the check sheet that was normally used had not been filled in by the nurses, although he claimed the check had been carried out. "The check was done, it had not been ticked but it was done," he said. "I would never, ever close an abdomen without checking. Never ever. "Accidents can happen but swabs have to be checked. I have been in surgery for long enough, I've never done an operation when the swab check was not done."
Christian Wakefield, a consultant general surgeon who performed the operation jointly, said that the hundreds of swabs, along with other surgical instrument, were counted immediately before the operation, when they were used, and again when removed from the patient. Yet despite three checks by the two surgeons and two nurses present, the swab had been left inside the pensioner's digestive system.
Human error was to blame for the mistake, Mr Wakefield acknowledged. "The most likely cause for the oversight was that a nurse had miscounted the swabs when they were taken out after the operation," he said. "This could have happened by two swabs getting stuck together, because they can shrink in size when full of blood. "It was a case of miscounting and human error is the likely explanation."
The inquest, at Winchester, was told that Mr Twycross, of Acre Court, Hampshire, was readmitted to the hospital suffering from abdominal pains, diarrhoea, malnutrition and dehydration on February 28 last year, ten months after the surgery in April 2004. He underwent further emergency surgery, performed again by Mr Wakefield, which revealed the infected swab. Numerous check-ups after the first operation had failed to detect the swab, despite a visible lump under Mr Twycross's skin.
The pensioner was subsequently moved to a nursing home and made frequent trips to the hospital until his death on October 4 last year. The pathologist's report described the death as "unnatural" and concluded that the error had contributed to, but was not the sole cause of, his death.
In his verdict, given on Wednesday, Grahame Short, the Central Hampshire Coroner, said: "I've found that the retention of a swab was accidental. It was not the sole cause of death. Robert Twycross died as a result of malnutrition due to a retained surgical pack. He also suffered from ischaemic heart disease and jejunal diverticulosis."
Mr Wakefield agreed, conceding: "I believe he could have healed, although it would have been a very long process and if the swab had been found earlier it would have improved his recovery." An internal investigation was carried out at the hospital but no disciplinary action was taken. The hospital has implemented an extra count of swabs and instruments after surgery to ensure that nothing is left behind.
Source
Yet another negligent Australian public hospital doctor
Here's guessing it's another "overseas trained" doctor. The Leftist Qld State government and its appointees is most uncritical about the character and qualifications of such doctors -- usually from the Indian subcontinent and Muslim lands
A senior Queensland Health doctor was suspended last night and faces at least two investigations over allegations his slow response to an emergency contributed to a patient's death. The unnamed doctor, at Murgon Hospital, 226km northeast of Brisbane, has been accused of being too far away from the hospital for a timely response to gravely ill patients while on call. It's understood the doctor, who eventually attended the emergency but was too late, has been disciplined by Murgon Hospital in the past.
Last night Queensland Health refused to reveal the name of the doctor, why it allegedly took him so long to attend to the emergency, or how the patient died. The doctor's actions have been referred to the Crime and Misconduct Commission and the death will be investigated by State Coroner Michael Barnes. The revelations could not come at a worse time for Queensland Health and Premier Peter Beattie, who this week denied the health system was still in the grip of a crisis.
Sources said the male patient died in Murgon Hospital, but it was being asked why the doctor had only been suspended last night. In a statement last night, a Queensland Health spokesman said: "Concerns raised with the department about patient safety are taken very seriously. "Accordingly, the department has referred the death of a patient at Murgon Hospital to the state coroner. "Further, Queensland Health has also asked the Crime and Misconduct Commission to review some aspects of the matter. "A doctor at the hospital has been suspended immediately, pending the outcome of the CMC review, (and) medical services at the Murgon Hospital will not be affected by the suspension."
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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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1 September, 2006
MORE PRIVATIZATION OF THE NHS
A 200 million pound government deal that will mean a big expansion of private sector involvement in the health service could provoke a confrontation with the unions and the Labour Left, The Times has learnt. The contracts with 14 independent companies, concluded last week by the Department of Health without any fanfare, will provide for an additional 150,000 elective procedures a year to be carried out for the health service by private firms.
The 14 companies will be added to the Department of Healths extended choice network, which at present consists of foundation trusts and some independent treatment centres. Under the policy, patients awaiting elective care can choose from the list where they will be treated. Details of the deal are revealed in this weeks Health Service Journal.
Seven of the biggest private healthcare companies have won a large proportion of the work, with BMI Healthcare the big victor having 44 contracts across the country. Other winners include BUPA, Nuffield, Capio, Centres for Clinical Excellence, Mercury Health and Nations Healthcare. Each contract will run for five years and the private companies will provide NHS patients with a range of elective care services including general surgery, endoscopy, ophthalmology, plastic surgery and neurology. The health department has opted for centralised bulk buying to give the NHS more advantageous terms.
The contracts were not announced last week by the Health Department, prompting suspicions among health service professionals that the Government did not wish to highlight the move before the TUC and Labour conferences, where private sector provision remains controversial. But the department suggested yesterday that there was nothing unusual about an announcement not having been made. A spokesman said: This is not a new procurement but part of the second wave of procurement from the independent sector which was launched in May last year.
Source
Unending public hospital woes in Australia
Having a heart attack? You too have to wait!
This the anguished face of Queensland's health system. A woman waits with her elderly dad in an ambulance in a car park because he can't be admitted to the overflowing emergency department. At least five other patients wait in other ambulances. A year after the health inquiry and just a day after Premier Peter Beattie denied there was a crisis in the health system, Cairns Base Hospital yesterday was a scene of agony. As politicians from all sides of politics pledge to fix the problems in health, 70-year-old Ken Freckelton waited nearly two hours to be admitted to the hospital suffering chest pains.
His worried daughter Emma Freckelton-Bowden watched helplessly as paramedics were told there were no spare beds. After finally being admitted he was returned to the ambulance because there were no spare doctors. "Nobody would come and talk to us to tell us what was happening. They were talking to the paramedics telling them there were no beds," Ms Freckelton-Bowden said.
The gridlock was revealed as Coalition deputy leader Bruce Flegg stood outside the hospital unveiling a plan to expand cardiac services. Dr Flegg said the situation was a "disgrace" and left just after his press conference as media crews spoke to distraught relatives.
Cairns Health Service District Acting Manager Brett Grosser blamed the situation on an influx of patients needing beds with cardiac-monitoring equipment. "(That) meant some patients had to wait in the ambulances until these monitored beds became available," Mr Grosser said. He said this week had been particularly busy for the hospital's Emergency Department (ED). "We can't predict when ambulances will need to wait," he said. A spokesman for the Liquor, Hospitality and Miscellaneous Union, which includes ambulance officers, said backlogs at the hospital potentially led to delays in responding to other cases.
Australian Medical Association Queensland president Zelle Hodge said the hospital's emergency department was not big enough and had too few beds to cope with the demand. She said the problem of bed numbers in Queensland hospitals was compounded in the mid-1990s under the then Goss Government when Mr Beattie was Health Minister. Dr Hodge said instead of increasing bed numbers or maintaining them, they were cut. "The health economists at the time were saying: 'You're not going to need as many hospital beds because basically people are going to be in for a shorter stay'," she said. "But the doctors were saying: 'People are getting older, the population is getting bigger. Even though people are in for a shorter time, you're still going to need those bed numbers'." Dr Hodge said she was at a meeting last year when the Premier admitted he had thought those doctors were "empire building" and realised now he was wrong not to trust them
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?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
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