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31 December, 2008

Gravely ill man goes to NHS emergency room. Not attended to until 6 hours later. Dies

Individuals don't matter in socialized medicine

A hospital trust is facing questions after a man died having waited more than six hours to be seen in an accident and emergency department. Medway NHS Foundation Trust said it was saddened to hear of the death of Stewart Fleming but said that its emergency ward was experiencing long waits because of a high number of admissions.

Mr Fleming, 37, of Rainham, Kent was taken to the Medway Maritime Hospital in Gillingham on December 12 by his wife Sarah. He had a note from his GP requesting immediate admission after a suspected viral infection failed to clear with antibiotics but, the father of two faced a reported six-hour wait before he was assessed again.

By this time his condition had deteriorated. He was eventually admitted and transferred a week later to the Harefield Hospital in West London but died last Saturday. Mrs Fleming said: "Why wait three hours for a triage when a doctor had already done it and put it in writing what was going on?"

A spokeswoman for Medway NHS Foundation Trust said: "The trust is saddened to hear of the death of Stewart Fleming. Due to patient confidentiality we are unable to discuss any details."

Source




Australian private health insurer reports that private hospital surgery includes very complex and costly cases

More than half of the surgery done in Australia is paid for by private health insurance and yet this is still a "drain" on government hospitals? Leftist logic at work again, it seems

High-end surgery in private hospitals, costing health funds $100,000-plus per case, is on the rise, fuelling concerns that it is adding to, not reducing, the strain on public hospitals. Australia's biggest health fund, Medibank Private, which has paid a record $364,859 for a bowel operation, says complex and costly operations, once the preserve of big public hospitals, are being performed increasingly in private hospitals. "Traditionally the high-end surgeries would be borne by the public system. Now we are seeing people electing to use their private health insurance for these types of procedures and enjoying the clear benefits it brings," a Medibank spokesman, Craig Bosworth, said yesterday.

But the drift of advanced cases to private hospitals is disturbing public hospitals because it adding to the difficulties they already face in finding and retaining surgeons and nursing staff. The executive director of the Australian Healthcare and Hospitals Association, Prue Power, said there was "great concern" in public hospitals about the trend to private surgery and the demand it generated for scarce medical staff. Staff shortages in public hospitals made it even more difficult to deal with waiting lists and delays in getting treatment in public hospitals, she said

Ms Power called on the Federal Government to rethink the $3.6 billion health insurance rebate and the level of premium increases for health insurance. The rebate was introduced by the Howard government, which forecast that it, along with other incentives, would boost memberships, keep premiums down and, through increased use of private hospitals, relieve pressure on public hospitals. Private hospitals do more than half the surgery performed in Australia, a plus for those with private hospital insurance, who account for less than 45 per cent of the population.

Health funds, already facing heavy increases in costs, have lodged with the Federal Health Department their applications for what are likely to be significant rises in premiums to take effect from April. Ageing of the population and increasing health-care bills and use of insurance cover by members are driving up costs well ahead of general inflation, the regulator, the Private Health Insurance Administration Council, has stated.

Ms Power said each time premiums rose, so did the cost of the rebate to the taxpayer. The growth in expensive private hospital surgery raised "a basic question of equity". "Funding going to the private sector will just exacerbate the workforce shortages in the public sector." Ms Power said she was not against growth in the private sector but it was a matter of getting the public-private balance right [Who says what is right?] and of getting better integration between the two sectors.

Mr Bosworth said that the rising number of high-cost claims paid by Medibank indicated the private health sector "is increasingly carrying the burden of an ageing population and the complex technologically intensive hospital care older people often require". The overall number of very high-cost claims had leapt in the past year, with Medibank covering 149 claims costing more than $100,000 - a rise of 73 per cent. Among the high-cost operations Medibank paid for in NSW was a neuro-surgery case costing $276,595, neonatal surgery and lengthy post-operative care for a newborn child costing $256,452, and arm nerve surgery on a 24-year-old patient costing $164,134. Mr Bosworth said many of the top claims were for people aged 54 and over, showing that private health insurance was not just for "elective surgery lumps and bumps".

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30 December, 2008

The NHS will look after you -- as long as you are not a patient

Public money totalling 1.6 million pounds has been paid out in redundancy settlements to seven senior employees following a merger of NHS trusts in Staffordshire. South Staffordshire Primary Care Trust (PCT), which took over the functions of four previous trusts, has given the money to two chief executives, three directors, a deputy director and a senior manager during the shake-up. Had the money been given to support frontline services, it would be enough to pay the wages of 50 nurses at the average NHS nursing salary of 31,600 including overtime.

Stuart Poyner, chief executive of South Staffordshire PCT, said the payouts, revealed in a Freedom of Information request, were a legal requirement. Other health organisations making big payouts to former employees including NHS West Midlands, the strategic health authority which manages a budget of 7 billion. It spent 2.2 million paying off 97 staff in the two years to August 2008.

Health chiefs are spending 360,000 of public money in an attempt to reduce the high level of sickness and absenteeism among NHS workers in Scotland, where absence rates are 60 per cent higher than in the private sector and are still on the rise. Sick leave in the NHS in Scotland currently costs the taxpayer 222 million a year. However, critics said there was no guarantee that the campaign to combat the problem would produce results, and claimed that managers should be tackling absenteeism in the normal course of their work without incurring extra costs in doing so.

Mark Wallace, of the TaxPayers' Alliance, said: "Spending even more money on the problem is not a solution. If so many staff are taking sick leave, it is a sign that either people are getting away with sickies or they are being mismanaged to the point of illness." Nicola Sturgeon, the Scottish health minister, said the funding of 360,000 from the government at Holyrood would help health boards to meet a target of reducing sickness rates to four per cent by April 2009.

Figures show that in 2007-08 there was a sickness absence rate of 5.28 per cent in the NHS in Scotland - equivalent to 12 days off a year per person - compared to a private sector average of 3.3 per cent, or seven and a half days. Low morale and overwork has been blamed for the problem, which cost the taxpayer 10m more than the previous year. The figures cover all NHS staff, from doctors and nurses to cleaners and porters.

Source




Medi mishaps blowout in the Australian State of Victoria

Crooked official statistics again

Victorian surgeons and theatre assistants mistakenly left 78 objects inside patients last year - seven times more than official records show. Hospital admission records collated for the Herald Sun show 756 objects were accidentally left in patients after surgery since 2000, far more than reported by health authorities or the State Government. The Government's "sentinel events" reports - which rely on hospitals to notify adverse incidents - show 47 instruments or other materials have been left in patients since 2002-03 that required further surgery to remove.

But figures compiled for the Herald Sun by Monash University's injury surveillance unit indicate more than 550 objects were left in patients in the same period. It is unknown how many of the objects required further surgery, but all patients required further hospital care.

Medical Error Action Group spokeswoman Lorraine Long said it was becoming a major problem. "The Government is not aware how common this is because the sentinel event data relies on people reporting it, and the last thing they are going to do is report something that will expose them to litigation," she said. "There seems to be a failure in the counting back of equipment and materials during surgery. "The consequences of leaving materials inside people can be death if it gets infected, but when patients go back to doctors and tell them they don't feel right they are not believed. "It just gets down to personal responsibility because it is not just the person doing the operation, there are another couple of sets of eyes and it gets down to being accountable, concentrating and following procedures of counting swabs and instruments."

Peter Shanahan, 60, is suing Melbourne Private Hospital after a 22cm surgical pack was allegedly left in his bowel for nine months, leading to agonising pain, the loss of a large section of his bowel and a possibly needless hernia operation after he complained of a lump in his lower abdomen. He claims the alleged mishap during routine bowel surgery ruined a year of his life. "Every time I speak to somebody in the medical field about it, they say it can't happen, that it's an impossibility. But I am proof," he said. "I don't know what the answer is, but it just shouldn't happen."

The Government's official sentinel events report listed only 11 instances where doctors reported leaving objects in their patients in 2007-08 - five involving instruments, wires or clips, five of packs or swabs and one case of a dental plate being retained. In 2006-07, the government report detailed eight retained objects, despite hospital records showing the real number was 85 in 2006 and 78 in 2007. But the biggest discrepancy occurred in 2004, when hospital admissions show 157 patients having treatment for objects left in their body. Government records from 2004-05 show just five cases, while the 2003-04 records list only eight.

Department of Human Services spokesman Bram Alexander said the sentinel events reports only dealt with "catastrophic incidents" where discovery was made after surgery was completed and requiring a new operation. He said some unreported instances may have involved items noticed missing before patients left the operating theatre, allowing surgeons to retrieve the items before recording the reason why the operation took longer on their admission records.

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29 December, 2008

Patient safety at risk as NHS repairs ignored

Patients are being put in danger because of a backlog of hundreds of millions of pounds of urgent repairs at hospitals

More than half of hospital trusts have a backlog of repairs which the NHS says need to be urgently completed to ensure patient safety. The NHS defines the work is so pressing that it "must be addressed with urgent priority in order to prevent catastrophic failure, major disruption to clinical services or deficiencies in safety liable to cause serious injury and/or prosecution". Yet despite the urgency of the work, the new figures show that the level of outstanding urgent repairs rose last year, by 11 million to 310 million pounds.

Crumbling buildings and failings in the infrastructure of hospitals have been repeatedly linked to risks to patient safety. Last year, the official investigation into Britain's deadliest outbreak of the infection Clostridium Difficile, which killed more than 90 patients at Maidstone and Tunbridge Wells hospitals cited its high maintenance backlog as a contributing factor in the spread of the disease.

The figures obtained by the Conservatives reveal that more than 120 of England's 210 hospital trusts admitted to a backlog of urgent repairs in the financial year which ended in April 2008. Imperial College Healthcare trust, which runs Hammersmith and St Marys Hospitals, had an urgent repair backlog of 27 million pounds, a figure which was almost matched by the bill at Guys and St Thomas foundation trust. Hospitals in North West London, Worthing and Southlands and Nottingham also reported an urgent backlog of more than 10 million.

Eight years ago, the Government pledged to reduce the total NHS maintenance bill, which then stood at 3.1 billion, by one quarter. The new figures show in fact the total bill has soared to more than 4 billion, including a 29 per cent increase in the last two years. The only category of repairs where the bill fell during 2007/2008 was among those defined as carrying the lowest risk to patients and services.

Shadow health secretary Andrew Lansley described the findings as "very disturbing". He said: "Over the last eight years the Government has done nothing to address this problem and things are going from bad to worse. The Government has no excuse for needlessly putting patients and NHS staff at risk like this." Mr Lansley said the Government could not pretend it was unaware of the issue, since hospitals reported their figures to the Department of Health each year.

A spokesperson for the Department of Health said hospital trusts were responsible for prioritising their investment decisions, and said the Government had invested 12bn in NHS buildings since 2000.

Source





28 December, 2008

NHS lost patient details 135 times in two years

The NHS has lost the confidential medical records and personal details of thousands of patients in a “catalogue of errors” uncovered by an investigation into how the health service handles data. A “fundamental re-examination” of how the NHS deals with personal data was demanded last night after research showed that a series of losses and thefts had potentially exposed the private details of 10,000 patients around the country. A total of 135 cases were reported, including the loss or theft of diaries, briefcases, CDs, laptops, memory sticks and, in one case, a vehicle containing patient records.

A back-up tape of an entire system was stolen from a general practice in the East of England this year. In another case, a laptop containing the records of 5,123 patients was stolen from the outpatients’ department of a hospital in the West Midlands.

The revelations will cast renewed doubt over the Government’s ability to handle personal data after a series of high-profile losses by Revenue & Customs and the ministries of Justice and Defence in the past year, and will raise further questions about the scheme to create a computerised national patient database to allow easier communication between GPs and hospitals. The Liberal Democrats, who carried out the series of Freedom of Information requests, called for the Government to scrap its plans for a national computerised database. Norman Lamb, the party’s health spokesman, has also written to Alan Johnson, the Health Secretary, with four other recommendations, including prohibiting the use of mobile devices to store patient records and publishing a set of minimum data protection standards.

Mr Lamb said: “These reports show utterly shocking lapses in security. Patients have a right to expect their personal information to be treated with the utmost care. “The degree of negligence in some cases is breathtaking, given the absolute sensitivity of patient data. There must be a fundamental re-examination of how the NHS deals with personal data. The NHS should regard lapses of standards of care as potential serious misconduct.”

The details, obtained through requests made to strategic health authorities, revealed incidents of data loss dating back as far as 2006. In some cases, private patient notes were found in public places or deserted buildings, or had been dumped in bins and skips. One loss of records was so serious that police and an NHS manager became involved. The incident occurred in January, when a district nurse took home activity sheets with patients’ names and addresses, which were stolen during a burglary.

Source




Australia: Victoria's public hospitals 'fudging' figures

A Melbourne doctor has blown the whistle on data fraud in Victorian hospitals, claiming staff routinely fudge patient figures to meet Government benchmarks for bonus payments. Andrew Buck, a senior emergency registrar with a decade's experience in the state health system, made the allegations in a submission to a Victorian parliamentary inquiry into hospital performance data earlier this month. Dr Buck said senior doctors and nurses were "shifting numbers" to make it look like hospitals were meeting targets for funding and put pressure on junior staff to follow suit. "I am regularly ordered to 'admit the patient to short stay (unit) so they don't blow their time'. This is against DHS (Department of Human Services) policy yet is routine practice in my day-to-day work, and I do it under direct orders from senior medical and nursing staff," he says in the submission.

The revelation comes after a survey of 19 Victorian emergency department directors by the Australasian College for Emergency Medicine found nearly 40 per cent of them were "admitting" patients to "short stay" and other units on computer systems when they were languishing in emergency waiting rooms or on trolleys. The doctors, who remained anonymous for fear of repercussions, said the "virtual wards" were used purely for "creative accounting" to receive funding and avoid "performance watch".

Public hospitals get bonuses for reaching State Government benchmarks, including one which requires that 80 per cent of patients be admitted within eight hours of arrival. Studies have shown that patient care is compromised by spending long periods of time in emergency departments.

When The Age published details of the survey in May, Health Minister Daniel Andrews said he would look into the doctors' claims, but then refused to launch an investigation. He said there was no evidence to suggest the alleged practices were happening. In September, the DHS warned hospitals to submit accurate data. As well, earlier this month the Auditor-General's office confirmed an investigation into the allegations.

Dr Buck said in his submission that Government benchmarks had created "perverse incentives" that put unnecessary pressure on overworked doctors in emergency departments. He expressed anger at Mr Andrews' refusal to act on the Australasian College for Emergency Medicine survey and said a "culture of fear" prevented doctors from talking about the real state of the health system. "If he won't accept hard data and admissions of guilt by emergency department directors, what hope have we got and why should I give a stuff about making the numbers look good?" he says.

Dr Buck's submission could affect the new health-care agreements between the Commonwealth and state and territory governments after federal Health Minister Nicola Roxon said in August that any evidence of fudged patient data would be of serious concern. A spokesman for Mr Andrews said this week he did not know if the minister had seen Dr Buck's submission but "anyone with an issue should raise it through the proper channels and it will be dealt with". Opposition health spokeswoman Helen Shardey said Dr Buck's submission was a "cry for help" that could not be ignored.

Source





27 December, 2008

NHS hospital apologises after baby was born on floor

A pregnant woman was left unattended for hours and had to give birth on a hospital floor despite her desperate appeals for a bed. Health board officials have apologised to Lynne Neilson, 36, whose baby started to arrive as she stood, still clothed, in a cold assessment room after hours of waiting to be admitted to the labour ward. As the head appeared, a midwife ran in just in time to put a paper mat on the floor and catch the baby, who had the umbilical cord around her neck.

Mrs Neilson and her husband, Gavin, made an official complaint to the hospital and to Nicola Sturgeon, the Health Minister, after the incident at Edinburgh Royal Infirmary. NHS Lothian announced on Christmas Eve that it had begun an investigation and had apologised.

The couple had arrived at the Simpson Memorial Maternity Pavilion early on December 5, but went home when the labour slowed. They returned at 7pm and were told to sit in the waiting room. Contractions quickened and Mr Neilson asked repeatedly for help until his wife, in pain and barely able to walk, was finally moved to an assessment room and examined by a midwife. Mrs Neilson said: “She said she’d come back in 20 minutes and that’s when it all really went wrong, because she didn’t come back. She was seeing other patients.”

Two and a half hours after they had arrived, their baby, Orla, was born. Mrs Neilson said: “The room we were in was cold. There was a narrow trolley – not a bed – which I couldn’t get up on to. I was shouting out – it was so undignified, because everybody in the waiting room would have been able to hear us. I felt a huge pressure and at that point I knew that the baby was going to be born.” A midwife arrived just in time to find Orla’s head emerging. Mrs Neilson said: “She took control and put down a disposable mat on the floor. She caught the baby – I was standing up and she was born on to the floor. I was very relieved that the midwife had come, because we were panicking.”

After the birth, Mrs Neilson was helped on to the trolley, but the family waited another hour before being transferred upstairs to a labour ward. They said they were told that the room they were placed in had been vacant throughout Mrs Neilson’s labour.

The couple have three older children, who were born in Glasgow, Hong Kong and at Edinburgh Royal, but said that this was the worst experience they have had in a maternity unit. David Farquharson, clinical director of women’s services in NHS Lothian, said: “This is not the experience we would want any mother or family to have.”

Source





26 December, 2008

Bad Economics & Medicine

ITEM: In an article entitled "5 Myths About Our Ailing Health-Care System" in the Washington Post for November 23, 2008, Shannon Brownlee and Ezekiel Emanuel write that the United States lags behind "many developed countries on virtually every health statistic you can name. Life expectancy at birth? We rank near the bottom of countries in the Organization for Economic Cooperation and Development, just ahead of Cuba and way behind Japan, France, Italy, Sweden and Canada, countries whose governments (gasp!) pay for the lion's share of health care."

ITEM: Writing in the New York Times for December 4, MIT Professor Jonathan Gruber claims that "health care reform is good for our economy. As the country slips into what is possibly the worst downturn since the Depression, nearly all experts agree that Washington should stimulate demand with new spending. And one of the most effective ways to spend would be to give states money to enroll more people in Medicaid and the State Children's Health Insurance Plan. This would free up state money for rebuilding roads and bridges and other public works projects - spending that could create jobs." "Health care reform can be an engine of job growth in other ways, too. Most proposals call for investments in health information technology, including the computerization of patient medical records.... More immediately, it would create jobs in the technology sector."

CORRECTION: Many so-called experts may say a nation can spend itself rich, but that doesn't make it so, whether the expenditures are made in the healthcare field or in building pyramids. As with most public-spending schemes, the jobs "created" are visible; the ones lost and economic damage done are not so obvious. Government programs are funded in several ways, including taxing individuals and businesses, giving them less to spend on their own choices; borrowing money, thus increasing deficit spending and the National Debt; and running off more printing-press money, which worsens inflation and drives down the value of the currency. Professor Gruber, quoted above, is one of the "experts" who is pushing this insidious notion. The New York Times somehow forgot to tell readers that he was an economic adviser to Sen. Hillary Clinton and supported her "universal coverage" designs. His piece was called "Medicine for the Job Market," no doubt because "Selling Snake Oil to the Masses" would have been a bit longer and had the benefit of accuracy.

In the meantime, former South Dakota Senator Tom Daschle, President-elect Obama's point man on healthcare, has said the new administration's priorities in this will be "expanding insurance coverage, as well as reducing costs and improving quality." Walking on water will apparently take a bit longer. The various plans that have been advanced by the Democrats, including strategies by Obama, Daschle, and Montana Senator Max Baucus, all involve the creation of a new public entity, variously called a national board, council, or institute, that will make the decisions that otherwise might be made by doctors and those of us on the plantation who might prefer not to have such choices made by bureaucrats.

Daschle, for instance, would establish a National Health Board that would be modeled on the Federal Reserve Board. The politically appointed experts on this board would be, the senator has said, "insulated from politics." It is beyond na‹ve to expect that hundreds of billions in public expenditures are going to be spent without political considerations.

Yet, the idea that government funding can occur without government controls is still trotted out as a selling point, though it does not fit with experience or common sense. Indeed, it would be irresponsible for the government to spend such monies without oversight.

And claims that the United States needs government to fix a flawed private healthcare system ignore government's influence on the healthcare system. Socialized medicine is not just a potential route for the medical-care field in the United States: we are presently quite a way down that dangerous path. The federal government already subsidizes healthcare to a fare-thee-well. Chris Brown, a lecturer at the Australian Graduate School of Entrepreneurship at Swinburne University, has pointed out in an article for the Ludwig von Mises Institute that "government accounted for over 45% of all U.S. healthcare expenditures in 2006; it spends almost 20% of GDP on healthcare; indeed, it spends more per capita than any other" nation in the Organization for Economic Cooperation and Development (OECD), which includes "those with socialist, government-funded healthcare. In short, this is not a free market."

The infant-mortality figures cited in the Washington Post piece above are often trotted out to prove how the "free" market doesn't work as well as those economies where healthcare is socialized. The statistics are very misleading, which is no accident. Writing in National Review in 2007, Ramesh Ponnuru clarified such claims: "The advocates of national health insurance argue that America spends more than any other country on health care and that we still have a higher infant-mortality rate and a lower life expectancy than other developed nations. Both factual points are correct. But the infant-mortality rates are misleading. In this country, a premature delivery followed by death would be counted toward the infant-mortality rate; not so in some other countries. And whatever we think of our health-care system, it is not to blame for the fact that America has a lot of car wrecks and homicides. When health economists Robert Ohsfeldt and John Schneider adjusted for these factors, the U.S. had the highest life expectancy of any developed country."

David Gratzer, a Canadian-born doctor who used to believe in socialized medicine, saw its many weaknesses firsthand and has exposed them. As he noted in City Journal in its Summer 2007 issue, the United States may lag behind other countries in some "crude health outcomes." However, as Gratzer explains,

Such outcomes reflect a mosaic of factors, such as diet, lifestyle, drug use, and cultural values. It pains me as a doctor to say this, but health care is just one factor in health....

And if we measure a health-care system by how well it serves its sick citizens, American medicine excels. Five-year cancer survival rates bear this out. For leukemia, the American survival rate is almost 50 percent; the European rate is just 35 percent. Esophageal carcinoma: 12 percent in the United States, 6 percent in Europe. The survival rate for prostate cancer is 81.2 percent here, yet 61.7 percent in France and down to 44.3 percent in England - a striking variation.

Many healthcare problems here result because of government meddling, not because government hasn't intruded enough. Chris Brown lists just "a few of myriad government and other regulatory programs that keep prices high and stifle innovation: the Center for Disease Control and Prevention, the Food and Drug Administration, the American Medical Association, the United States Department of Health and Human Services, etc. One reason healthcare costs are so high is because the industry is subsidized; and one reason government intervention only grows is because you can expect more of anything that is subsidized. Doctors and physicians raise their prices on those paying privately to cover those who do not pay, i.e., those the government pays for through theft, a.k.a. taxes."

The nation's economy is in dire straits from too much spending and too much regulation. Yet that has not stopped those with ultimate chutzpah from asserting that the way to get out of a hole is to dig ourselves in deeper. One difficulty is that when healthcare spending becomes overwhelming, cost containment is going to be accomplished through rationing (although euphemisms will be used to disguise that). Current health "entitlements" are about 4 percent of Gross Domestic Product, and headed to 15 percent by 2062, according to government projections. That is unsustainable.

Medicare is already the third-largest government program in the budget, behind only Social Security and military spending. The Medicare Trustees' Annual Report released in 2008 projects Medicare's excess costs to be $85.6 trillion, a staggering figure equivalent to about six times the entire U.S. economy in 2007.

The trend is already bad, and nationalizing healthcare even more will only make matters worse. On November 20, the Wall Street Journal examined the emerging Obama health plan, pointing out:

Over the past 40 years, per capita health spending has grown an average of 2.1 percentage points faster than the economy. The dominant U.S. insurer - Medicare - has had no success in mitigating this climb, despite valiant attempts. Since the 1980s, Medicare has actually controlled the prices that physicians and hospitals are paid for thousands of billable services. In 2007, the program spent some $425 billion according to these arbitrary guesses. Because of its huge purchasing power, and because many private plans adopt its reimbursement rates, Medicare significantly shapes all health-care financing and delivery.

Now the Democrats want to double down with the public option, apparently on the theory that the bureaucracies fail only when they're too small. Even without the new program, Medicare and Medicaid costs are rising substantially both as a share of the economy and the federal budget.

And what about all those figures that seem to indicate that the U.S. system is worse than elsewhere? As we have noted, there's a good bit of chicanery about such assertions, whether they emanate from the World Heath Organization (WHO) or the OECD - particularly since those statistics are gathered in an attempt to justify even more government involvement.

Grace-Marie Turner, president of the Galen Institute, has written in the San Diego Union-Tribune that such rankings "are highly influential among policy-makers and help drive health reforms around the world. But common sense suggests that when the rankings show the United States has a health care system worse than Morocco's or Costa Rica's, it's clear that the rankings are a poor reflection of reality. An objective assessment would have listed America at - or certainly near - the top."

The criteria used by WHO and other international bodies are self-serving. As Turner observed: "Countries with tax-funded, socialized health care tend to be ranked higher simply because citizens are treated equally - even when the quality of care is extremely poor. Meanwhile, countries in which citizens have unequal access to medical care tend to be ranked lower, even when the overall quality of care is superior. By the WHO's logic, treating people equally matters more than treating people well. So theoretically, a country with a negligent health care system could improve its rankings just by neglecting everybody more equally."

Who is above the United States in such rankings? Well, the U.K., for one, scores better. This is the same nation where the government cancels up to 100,000 operations annually, in large part because there is a shortage of doctors, nurses, and facilities. That is our bleak future if we try to level the playing field by driving everyone into the ground.

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25 December, 2008

One in 20 British midwife positions unfilled

One in 20 midwife positions in NHS hospitals are unfilled despite a Government promise to would recruit 1,000 more midwives

Figures show that 583 midwife posts in NHS hospitals are vacant and 276 maternity support worker jobs are unfilled. Barking, Havering and Redbridge Hospitals NHS Trust has the higest vacancy rate, 39 per cent. If its 76 full time midwife positions, 29 posts need to be filled. One in five maternity units (22 per cent) across the country have cut midwife numbers in the past year and some have reported that their maternity unit has been cut in half. Heart of England NHS Foundation Trust has 101 full time midwives last year but this year has 47 which is a 54 per cent drop. The figures were obtained using the Freedom of Information Act by the Conservatives.

This week, Professor Cathy Warwick, general secretary of the Royal College of Midwives, said tens of millions of pounds that were meant to increase the number of midwives have not been received by hospitals. "On the very busy labour wards that are struggling to cope with the rising birth rate, midwives are having to look after sometimes two or three women in labour and that's when the woman ends up being left alone. That's not only unacceptable, that's not safe," she said.

The failure to pass on the money, part of a drive to improve maternity services, means the NHS will not be able to honour promises by ministers to give women a single dedicated midwife during pregnancy and labour. Alan Johnson, the health secretary, in February pledged 330m pounds of extra funding over the next three years to implement the Maternity Matters strategy whose guarantees include giving women the choice of whether to give birth at home instead of at hospital. He also promised that he would recruit 1,000 more midwives to the NHS by 2009.

Health Minister Ann Keen said: "Claims that midwife numbers are falling are complete and utter nonsense. "Validated figures from the latest NHS workforce census show the number of midwives has surpassed 25,000 for the first time and we know there is continuing growth towards recruiting an additional 1,000 midwives by September 2009, rising to 4,000 in 2012. There has also been a 25 % increase in the number of students entering midwifery training since 1997."

Source





24 December, 2008

Budget Office Sees Hurdles in Financing Health Plans

The Congressional Budget Office said Thursday that many of the health care proposals championed by President-elect Barack Obama and other Democrats would carry a high price tag and would generate only modest savings. The budget office, an influential voice in the work of Congress, analyzed 115 options, including proposals to expand coverage and slow the growth of health spending. Some of the options, including proposals to increase taxes on cigarettes and nondiet soft drinks, are sure to meet stiff political opposition.

One bright spot in a generally bleak picture was the estimate of potential savings from a requirement for doctors and hospitals to use health information technology, including electronic medical records, as a condition of participating in Medicare. Such a requirement could save the federal government $7 billion in the first five years and a total of $34 billion over 10 years, by reducing medical errors and avoiding unnecessary tests and procedures, the budget office said. It “would also lower health insurance premiums in the private sector,” the report said.

Without action by Congress, the report said, health costs will continue to soar, the number of people without insurance will rise by nearly one million a year, to a total of 54 million in 2019, and spending on health care will increase to 25 percent of the gross domestic product in 2025, up from 16 percent in 2007. In keeping with its duty to provide objective, impartial analysis, the budget office did not endorse any options, but it fleshed out many ideas circulating on Capitol Hill.

Democrats and many Republicans say they will make a serious effort to overhaul the health care system in 2009. Those changes are essential for economic recovery, they say. But Mr. Obama and other Democrats have not been precise about the cost of their proposals, nor have they said in detail how they would pay for them. One of the Democrats’ favorite proposals, rolling back tax cuts for high-income people, is already scheduled to occur in 2011, so, under the bookkeeping rules used by Congress, it would not produce a windfall of new revenue.

Lawmakers from both parties said they would pay close attention to the cost of new federal subsidies for health coverage because these subsidies — unlike the one-time bailouts for banks and other financial institutions — would be recurring federal obligations for years to come. Requiring employers to provide health insurance to their employees or pay a fee to the federal government would bring in $47 billion of new federal revenue in the next 10 years, the report said. A proposal to establish a national insurance pool for people who cannot obtain coverage on their own in the individual market would cost $16 billion in the next decade, it said.

Mr. Obama and many other Democrats want the government to negotiate with drug manufacturers to get lower prices for Medicare beneficiaries. The Congressional Budget Office said such negotiations “would produce small if any savings” because the government would not have enough leverage to secure significant discounts beyond those already obtained by private insurance companies that manage the Medicare drug benefit.

But the budget office said Medicare could save $110 billion in the next 10 years if Congress simply imposed a form of price controls, requiring drug makers to provide the government with a 15 percent rebate, or discount, on brand-name drugs covered by the new Part D of Medicare.

Eliminating a notorious gap in Medicare coverage of prescription drugs, known as a doughnut hole, would cost more than $130 billion over 10 years, the report said.

Research to compare the effectiveness of different drugs and treatments might help doctors and patients make better decisions. But it would not save the government much — $1.3 billion in the next decade — and it would reduce total spending on health care in those years by less than one-tenth of 1 percent, the budget office said.

The federal government could save $12 billion in the next decade if it established a procedure for approval of generic versions of expensive biotechnology drugs, the report said. It did not estimate the additional savings for consumers and employers, which could be substantial.

The report sets forth an elaborate proposal that would allow doctors and hospitals to share in the savings if they improve the quality and reduce the cost of care for people on Medicare. Under the proposal, Medicare would pay bonuses to groups of doctors who met certain performance measures. In response to such financial incentives, the report said, doctors would become more efficient and would reduce “the volume and intensity of services provided to their patients,” saving $5 billion for Medicare in the next decade.

In one particularly sobering chapter, the report notes that, under existing law, Medicare will cut fees paid to doctors by 21 percent in 2010 and by about 5 percent in each of the next few years. To avoid such cuts and freeze payment rates at their 2009 levels would cost the government $318 billion over the next decade, the report said.

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New Zealand doctors flown in to fill Australian hospital staff shortages

Where is all that wonderful socialist "planning"? Last minute patch-ups is more like it.

FLY-IN, fly-out doctors from New Zealand and interstate are filling staff shortages in [Left-run] Queensland's public hospital system, paid at a premium. At least nine of the state's public hospitals have employed NZ doctors on a fly-in, fly-out basis in the past year, mostly to fill vacancies in obstetrics and gynaecology, emergency medicine and anaesthetics. Australian Medical Association Queensland president-elect Mason Stevenson said the doctors were paid premiums of up to 50 per cent more than permanent specialists of similar experience. "This actually creates a certain discontent amongst doctors working very hard in the public hospital system when they do work side by side with the fly-in, fly-out locum doctors from overseas who are being paid substantially in excess for doing exactly the same work," he said. But he said fly-in, fly-out specialists were a necessary "Band-Aid solution" to stop Queensland public hospital waiting lists becoming intolerable.

Bundaberg Hospital has had four fly-in, fly-out doctors from NZ acting as its emergency medicine director in the past year, each working for 10 days a month. However, a permanent director will take up the position in February. The hospital has also employed a NZ anaesthetist on four occasions, for about a week at a time, in the past 12 months.

Queensland Health deputy director-general of policy, planning and resourcing, Andrew Wilson, said fly-in, fly-out doctors were only employed as temporary locums to fill staffing shortages. All were suitably registered to work in Australia. "They are employed to fill critical vacancies on a temporary basis while recruitment efforts are under way," Dr Wilson said. "Queensland Health does not have any services or facilities staffed on an ongoing fly-in, fly-out basis." Besides Bundaberg, affected hospitals include Caboolture, Redcliffe, Toowoomba, Rockhampton, Clermont, Mackay, Nambour and Caloundra.

Sylvia Andrew-Starkey, of the Australasian College for Emergency Medicine, said Queensland Health also employed interstate doctors on a fly-in, fly-out basis to fill senior emergency department positions throughout the state. "I know that Hervey Bay, Bundaberg and Rockhampton are relying on interstate people," she said. Dr Stevenson said the practice was expected to continue for another five to 10 years until recent medical graduates were able to fill specialist shortages. Queensland Health Minister Stephen Robertson could not be contacted yesterday for comment.

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23 December, 2008

Healthy pay: NHS doctor gets $500,000

A hospital doctor is earning more than 290,000 pounds from his National Health Service salary and a series of bonuses, including a 40,000 supplement to be on call. Figures obtained by The Sunday Times under the Freedom of Information Act suggest hundreds of NHS consultants earned more than 190,000 in the financial year ending in March – more than Gordon Brown – putting them in the top 1% of earners. By contrast with highly paid workers in the private sector, who now face widespread unemployment, they also enjoy full job security.

Previously NHS consultants turned to private work for extra income. The figures show they can now more than double their basic salaries by sticking with the health service, thanks to bonuses inflated by incentives to meet government targets to cut waiting lists.

The generosity of the NHS towards its senior staff may anger patients who have recently been deprived of modern cancer or osteoporosis treatments because they have been deemed too expensive. The consultant who earned more than 290,000 in the last financial year is a breast surgeon at University Hospitals of Morecambe Bay NHS Trust in Lancashire and Cumbria. On top of his 120,000 basic salary he is paid an annual bonus of 90,000 as a “merit award” or “clinical excellence award”. These extras, given for exceptional contributions, are paid to thousands of consultants every year. The surgeon was also paid 40,000 for overtime shifts and a 40,000 supplement for being on call.

A doctor at the Royal Devon & Exeter NHS Foundation Trust earned about 130,000 in extra payments, including 50,000-55,000 to run a regional service and 35,000-40,000 to bring down waiting lists.

Another consultant, working for Worcestershire Acute Hospitals NHS Trust, was paid a supplement of 77,000 in the last financial year for carrying out extra shifts to meet a target of giving all patients treatment within 18 weeks.

Katherine Murphy, director of the Patients Association, said: “It is unethical for the medical profession to line their pockets in this way knowing that NHS trusts are being forced to cut services. Patients are being left in pain. “Doctors are always complaining about how underpaid they are. The reverse is the case. They are being given bonuses for what should be part of their day jobs.”

A spokesman for the Morecambe Bay NHS trust said: “The consultant is highly productive and provides a high quality of care. The trust is fortunate to have his skills, knowledge and experience.”

Last month The Sunday Times reported that an NHS nurse had broken the 100,000 barrier for the first time. The nurse consultant in Rotherham, South Yorkshire, doubled her basic salary of 50,000 by working overtime to bring down waiting lists.

The health department has already been accused of awarding unduly generous new contracts to NHS employees without achieving better treatments for patients. A report by the public accounts committee found that a contract for consultants boosted their pay by 27% without any measurable improvement in productivity.

Source




Stressed Australian nurses quit public hospitals for prostitution

Exhausted and demoralised nurses would rather work as prostitutes than in Queensland's crumbling hospitals, says one former registered nurse. The mother of two with 10 years' experience as a registered nurse, who wanted to be known only as Jenna, has told how she and at least four of her colleagues have found new jobs working in brothels. "We could no longer work in such an understaffed and stressful environment," she said. "I was overworked, poorly paid and a mistake could have led to charges if I caused a death. "I came to the conclusion the nursing shortage wasn't my problem but it was my responsibility to protect myself from burning out or making a fatal mistake."

Queensland Nurses Union assistant secretary Beth Mohle said the union was aware nurses were leaving the system due to workloads and burnout, and were experiencing record levels of frustration. "A survey of nurses' attitudes undertaken last year found most nurses love nursing but hate their jobs," she said. "There's a tension there that nurses feel they can't deliver the quality of nursing they want to." She said based on population growth projections, Queensland would need an additional 16,000 nurses in the private, public and aged-care sectors by 2014. "Queensland is already behind the rest of Australia in terms of registered nurse numbers and is over-represented in the unlicensed assistant-in-nursing category," Ms Mohle said. "Of the 16,100 nursing assistants in Australia in 2006, Queensland had a massive 7300, or nearly 50 per cent. This points to a serious skill mix problem, as well as a numerical problem, within the Queensland nursing workforce." The QNU survey also found 45 per cent of nurses had experienced workplace violence, which is more prevalent in the public and aged-care sectors than in the private sector.

Jenna said violence was more of a concern in hospitals than in the sex industry. "The security (at the brothel) is wonderful. We have buzzers in our room, there are bracelets we can request if you have a client you're a bit suspicious of." Jenna said she had gone to great lengths to hide her new occupation from her family. "I wear my nurse's uniform to work, I carry my hospital ID. But when I get to work I change. There's a couple of others who do the same," she said.

Health Minister Stephen Robertson said it was disappointing some nurses were seeking alternative careers. "Queensland nurses are now among the highest paid in Australia, having benefited from a 26 per cent wage increase since 2006," he said. "This is one of the factors which has helped us to recruit an extra 5834 nurses since June 2005."

Jenna highlighted the "tiny tea-rooms" for nurses and the lack of recognition they received. "After the Bali bomb blasts, the burns unit of the Royal Brisbane and Women's Hospital treated many additional patients. At the end, the doctor was given an award. The nurses got nothing," she said. She also revealed how doctors at the RBWH referred to nurses as "Libra fleurs" - because they believed the floral tops of their uniforms resembled tampon boxes.

But Mr Robertson said the Government had created a "safe and supporting working environment for nurses". "We'll continue to work ... to ensure we have a strong nursing workforce, equipped to give Queenslanders the first-class health care they expect and deserve," he said.

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22 December, 2008

NHS bosses to limit doctors’ hours -- by hiring more bureaucrats!

This must be a high-point of socialist stupidity. They are hiring more bureaucrats in order to reduce the hours that doctors work. As if the person making up the rosters at the moment cannot simply make them up differently! It is more doctors, not more bureaucrats that are needed. So how about spending the money instead on hiring more doctors?

The NHS is appointing a new layer of managers to ensure that doctors do not work too hard. Hospitals say the bureaucrats are needed to ensure compliance with European legislation which says that, from August next year, no doctors will be allowed to work more than 48 hours a week. At the moment, junior doctors can work up to 56 hours.

Scarborough and North East Yorkshire Trust appointed a “working time directive project manager” in 2006-7. Mid Essex Hospital Services NHS Trust is advertising for one at a salary of up to 44,527 pounds. A spokeswoman said the purpose was to “redesign roles and rotas in preparation for compliance next year”.

Last week the European parliament voted to end Britain’s opt-out. Unless a compromise is reached in the European Union’s council of ministers, this will mean doctors cannot work longer hours even if they want to. The Royal College of Surgeons has issued a warning that the NHS will not be able to cope when hours are cut next year.

Source




Australia: Claims of public hospital cover-up after fall from surgery table

The NSW Health Minister has ordered an investigation into claims of a cover-up at a Sydney hospital, where a woman had part of her intestine removed without her knowledge. Rachel Hale arrived at Campbelltown Hospital on December 12 expecting routine surgery to have her appendix removed. When she woke up, she was told part of her bowel had also been removed, because "a lump" was detected. But hospital insiders allege Mrs Hale's bowel was ruptured because she fell from the operating table while under general anaesthetic just prior to the operation. They allege the fall also caused a minor head injury. The insiders claim there were no staff in the operating theatre when she fell. They allege Mrs Hale was told "a pack of lies" by hospital officials to conceal the truth.

It is alleged that once she was anaesthetised, a doctor and nurse left her unattended to work on another patient elsewhere in the hospital. When staff re-entered the room, it is alleged they found Mrs Hale hanging head first because her feet had been strapped to the table. When she hit the floor, a trocar - a hollow sharp cylinder used to introduce cannulas into blood vessels - that was inserted in her side had sliced through her bowel. A source said: "It could so easily have killed her. "They had to open her belly up, remove the section of perforated bowel then stitch her back up and rush her to intensive care." Mrs Hale spent five days in hospital.

The Sun-Herald was told an internal critical incident report was compiled hours after the surgery, which stated Mrs Hale's injuries were sustained because she was left "unattended." On December 19, the same day The Sun-Herald began making inquiries, NSW Health Minister John Della Bosca was briefed that no such report existed. The hospital then told the minister, that same day, the report had just been compiled - a week after the incident.

Mrs Hale said she was seeking legal advice. "This is absolutely not what they told me," she said. "I was there because my appendix needed removing immediately. When I woke up, they said there had been 'complications'. They said part of my bowel had been removed because they discovered a small lump. They added it had been sent to a pathologist and it came back fine. I had a bump on my head. They said I hit that on a control panel." Mrs Hale said she wanted the truth. "I need to know what the lasting implications are and how this is likely to affect the rest of my life."

Hospital insiders said they chose to speak out because Campbelltown Hospital was providing the same "sub-standard care" that in 2003 had sparked the state's largest inquiry into patient care and safety standards. "It's become routine practice to leave anaesthetised patients unattended and to cover up negligence using any means necessary," the source said. Royal Australasian College of Surgeons executive director Dr John Quinn said: "I find the episode you are recounting almost non-tenable. Patients in a hospital operating theatre, who are given a general anaesthetic, are not left unattended. It just shouldn't occur."

Australian medical experts meanwhile have cast doubt on the hospital's version of events. Cancer Institute NSW head Jim Bishop said for a complex operation involving the removal of bowel cancer, it would be "very unusual" not to gain the patient's consent first. Professor Bishop said it was common practice for doctors to first perform scans, biopsies and follow-up tests to see whether the cancer had spread and if so, how far. Director of Research at the Sydney Cancer Centre, Bruce Armstrong said: "Best practice would generally be to seek formal consent, from the patient . to inform them of what was found and to conduct further investigations."

Medical Error Action Group spokeswoman Lorraine Long said: "Doctors and nurses are swamping our hotline with stories of negligence that make you want to cry." Mr Della Bosca said the incident was being fully investigated. "If the family has concerns, we would urge them to contact the Health Care Complaints Commission. Alternatively, they can contact my office." Opposition health spokeswoman Jillian Skinner said: "This is one of the worse examples of patient care. To claim an internal report wasn't compiled until a week later is suspicious, to say the least."

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21 December, 2008

The Growing War Between Modern Medicine and the Public

The article below is a bit on the paranoid side but has some good points nonetheless

Everybody is talking about health-care reform, but true reform is clearly out of the question. Like the banks and the automobile manufacturers, the health-care system should be allowed to collapse without a government bailout. But the federal government has been bailing out the failed health-care industry all along.

Tom Daschle, the newly appointed health policy adviser to President-elect Barack Obama, and soon to be Health and Human Services secretary, says the U.S. health-care system is in need of a major overhaul, and most agree, but it appears the government will continue to expand insurance coverage for a broken health-care system, paying for more unproven and even disproven treatments.

Moreover, government intends to expand health insurance coverage for millions of Americans, which will surely increase demand for services at a time when there is a shortage of primary care doctors.

Won't expanded coverage ($2500 per uninsured American) prompt many families to drop their existing insurance plans and attempt to qualify for the new government plan, thus causing the whole program to implode with burgeoning costs? Furthermore, the federal government estimates about 40 million Americans are uninsured, but this figure is likely to grow by millions in the current economic downturn. How does government intend to rein in health-care costs and at the same time increase utilization?

Job creation is now paramount in the incoming Administration. Long term, planners are counting on the Baby Boomers getting older and sicker, thus creating new jobs in the health-care arena. Americans had better get sick on time, and develop chronic diseases that require more and more health care, so more Americans can be employed as nurses, nurse's aides, home health aides, etc.

How does a nation significantly reduce health-care costs and yet plan on increased employment in the health-care industry? This is the moral crux for American medicine. Should Americans become healthier and need less health care, there will be fewer jobs. Maybe this is why modern medicine drags its feet when it comes to preventive medicine.

According to the Bureau of Labor Statistics, among all occupations in the economy, health-care occupations are expected to make up 7 of the 20 fastest growing occupations, the largest proportion of any occupational group. These health-care occupations, in addition to exhibiting high growth rates, will add nearly 750,000 new jobs between 2006 and 2016, according to government projections. More than 3 out of every 10 new jobs created in the U.S. economy are predicted to be in either the health-care and social assistance or public and private educational services sectors. What if these jobs never materialize?

The federal government will soon be unable to meet its obligations to provide health care for retirees. The Medicare program will default on $62 trillion of care it promised to deliver to aging Baby Boomers, beginning in 2012. The only foreseeable way out of this problem is to reduce demand for care by prolonging the health span (years of healthy, unimpaired, unmedicated life) before age-related diseases set in. A delay of 7 years before the onset of age-related disease would save the Medicare program from bankruptcy.

The increased life expectancy of Americans has largely been achieved over the past century by reductions in childhood mortality. Now the focus is on reduction of mortality rates among senior Americans, adding more healthy years to the end of life.

The prospect for an anti-aging pill that can slow aging is not a pipe dream. A few years ago the Rand Corporation think-tank, addressing future technologies that may impact Medicare, added an "anti-aging" pill to the future Medicare budget. Health planners know such a technology may soon become a reality. These pills could stave off the onset of disease, even quell infections without conventional antibiotics, and may actually prevent many diseases rather than a pill for every different disease. Such a pill may not emanate from a pharmaceutical laboratory. It may come from nature.

A growing body of scientific evidence which shows that dietary supplementation with vitamin D, fish oil, and molecules found in red wine (resveratrol, quercetin, ferulic acid, etc.) and bran (whole grains), may reduce the need for medical care altogether. Dr. Bruce Ames of the University of California at Berkeley suggests the higher prevalence of disease among the poor emanates from undernutrition, a problem that could be remedied with an inexpensive multivitamin.

There is concern that with a poor economy and growing unemployment, more Americans will choose cheap, less nutrient-dense foods, which may increase the incidence of disease. This would increase the need for food fortification and dietary supplementation.

Europeans visiting America are shocked to see so many overweight Americans. Never do Americans realize, unlike other nations, they are being intentionally bred to overeat. The medical profession does little to stop this, treating all dietary-related diseases as if they are drug deficiencies. Processed foods are adulterated with taste stimulants and other ingredients that create more hunger by raising insulin resistance. Insulin that can't enter cells to produce energy, disengages satiation. This is one way food producers increase their sales, by getting Americans to eat more food.

The government is complicit in spawning the diabesity epidemic by subsidizing the production of non-nutrient-dense foods and high-fructose corn syrup, and promoting a "food pyramid" that suggests Americans consume more food, not less (17-23 servings a day), and many servings of meat, processed gains and dairy products which foster obesity.

It is obvious that modern medicine is an industry that wants more, not less, disease to treat. Patients are aware that doctors aren't interested in disease prevention. Conventional medicine is quick to dismiss any truly preventive therapies as unproven and requiring more study. A current hidden agenda is to publish pseudo-science in medical journals so nutritional approaches to disease prevention can be dismissed as not being "evidence based."

Yet, by comparison, there are very few treatments in modern medicine that are truly "evidence based." For example, statin anti-cholesterol drugs are approved by the FDA even though they don't reduce mortality rates and prevent a non-mortal heart attack in less than 1 in 100 healthy adults. Add flu shots to the list of disproven therapies. They have not been shown to reduce mortality from flu-related illness among high-risk groups (young children and older adults.) The cervical cancer vaccine has not saved one life, and may never do so, and may produce nothing more than side effects (9,749 adverse reactions and 21 reported deaths related to this vaccine in the last two years).

There are no proven cures for cancer, and radiation and chemotherapy cannot even penetrate solid tumors, which represent 70-90% of cancers, but patients are never told this. There is no way chemotherapy can work because tumor resistance is inevitable and it destroys the immune system. A published study shows chemotherapy only contributes to the 5-year survival of cancer patients 2.3% of the time. (Would you return to an automobile repair shop that only fixed your car less than 3% of the time?) Chemotherapy is approved by the FDA if it temporarily shrinks a tumor by 50%, not if it prolongs survival. Who can blame cancer patients for searching for unproven alternatives? Chemo and radiation therapy have been disproven.

It has been said that the only technologies that have been validated in modern medicine are the repair of bone fractures, the repair of teeth, and the removal and replacement of cloudy cataracts with clear lens implants.

It's no wonder a whopping 38% of American adults (12% of children) have opted for alternative medicine, says a newly released study conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. Where else can the public turn? But this statistic is thrown out as if it is evidence of a mindless public that elects to choose unproven therapies over FDA-approved drugs and devices. Yet studies show the most educated citizens utilize alternative medicine. Americans elect to choose alternatives because conventional medicine is ineffective, even hazardous, and is simply beyond affordability.

Many patients are belittled when they tell their doctors they are taking dietary supplements in lieu of problematic prescription drugs. Under the guise that dietary supplements may interfere with prescription drugs (actually, it's the other way around), the National Institutes of Health has conjured up a program to encourage patients to "confess" to their doctors that they are taking dietary supplements. The vitamin pill inquisition is underway.

Modern medicine realizes it has lost market share to alternative medicines. Americans are increasingly distrustful of prescription medicines, reading daily news reports of people dying needlessly from side effects from FDA-approved drugs. According to a Harris Poll (2005), 35% of Americans who were prescribed drugs didn't take them because they wanted to save money and another 28% left their drugs on the medicine shelf because of "frightening side effects."

More Americans are going to have to find ways to stay healthy outside of running to the doctor for everything that ails them. The health-care system, and the insurance system, won't be there for them. An unorganized self-care revolution is now in progress, which proceeds largely without doctor guidance or cooperation. More Americans are shunning problematic and overpriced prescription medications for vitamin and herbal supplements. The National Health Federation is leading that effort.

It is becoming increasingly clear that conventional medicine is working at odds against the public welfare. Yet, with the realization that American medicine is a broken system, Americans inexplicably return to the doctor's office for more of the same. Those Americans who don't learn self-care are going to suffer the most in this ongoing collapse of modern health care.

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20 December, 2008

NHS patients are cheated by 100m pounds a year extra for their dental work

Patients are being ripped off by more than 100million a year thanks to the Government's 'botched' reforms to NHS dentistry, figures suggest. Loopholes in a new contract for dentists are being exploited so that patients are effectively being charged twice for what should be one course of treatment, critics say. Dentists are accused of recalling healthy patients for checkups and splitting up courses of treatment unnecessarily. The Department of Health admits there is evidence that the tactic has become widespread since the introduction of the contract in April 2006.

Now data obtained from every primary care trust shows patients could have saved up to 109million in incorrect charges - almost a quarter of the 475million paid every year. And without the loophole, up to 6.5million appointments could have been freed up for people who currently do not have a Health Service dentist.

The Tories have calculated that the overcharging works out at an average of 7.77 pounds a year per patient, almost a quarter of the average annual charge of 33.80.

A deal drawn up by the Government means dentists can claim twice as much by spreading treatments across different appointments or calling patients back for unnecessary check-ups. NHS guidance, stating that no patients should be called back to their dentist for a check-up or have courses of treatment split up within a three-month period, appears to be being widely ignored.

Shadow Health Secretary Andrew Lansley, who obtained the figures, said: 'Labour's management of NHS dentistry has been appalling. Not only have millions been left without a dentist, but now we learn that those who do have one are often being charged more money than they should be. 'The blame here lies with Labour's botched dental contract, which incentivises dentists to increase the number of charges to patients and has led to such drastic cuts in the number of people being able to find an NHS dentist. 'The Government urgently needs to admit that the dental contract has been a monumental failure, get a grip and put an end to these practices immediately.' Dentists' leaders insist there is no evidence that anyone is playing the system.

But last week, the Government effectively admitted that its reforms have backfired when it announced an independent review of access to treatment. Health Secretary Alan Johnson appointed a team to investigate why 1.2million people have lost their NHS dentist since the changes were implemented.

Average dentists' earnings stood at just over 96,000 in the first year of the deal - a rise from 87,000 from the year before. For the top-earning dentists who own their own practice, income rose by a third to 172,494.

A decade ago, the Government pledged that all patients would have access to treatment on the Health Service within two years. But surveys suggest one in 20 patients is resorting to DIY treatment, in some cases pulling out their own teeth. And one in five says they have gone without treatment because they could not meet the cost.

Source




Quality medical care for the poor?

Not in the public hospitals of the Australian State of New South Wales

Registered nurses will be replaced by cheaper, less-qualified nurses and unqualified assistants, in the latest round of cost cutting by the State Government. The plan to substitute university-trained registered nurses with enrolled and trainee nurses contradicts a $1.2 million study commissioned by NSW Health last year, which found that increasing the proportion of less-qualified staff in hospitals caused a range of preventable complications and deaths.

Hospital managers have been ordered to save $32 million within four years by downgrading nursing cover at small and rural hospitals. The ratio of assistants-in-nursing will increase to 50 per cent of the combined registered and enrolled nurse numbers. Assistants-in-nursing have no minimum level of education and are not regulated by any nursing body. Some are students and others have a TAFE certificate in aged care. Since 1993, registered nurses have been university trained.

NSW Health says the cuts are justified because many hospitals are, in effect, working as aged-care facilities due to a shortage of nursing home places. But the lead author of the Glueing It Together study, Christine Duffield, said the plan flew "in the face of the evidence that shows the more RNs you have, the better the patient outcome". The three-year study used data from 27 NSW hospitals and found that a higher proportion of registered nurses produced lower rates of bed sores, intestinal bleeding, sepsis, shock, pulmonary failure, pneumonia and death of patients from a hospital-acquired complication. "In the mini-budget [the Government] said no frontline services will be cut, but nursing is a frontline service," said Professor Duffield, from the Centre for Health Services Management at the University of Technology, Sydney. "They're just doing it to save money."

Area health services have been identifying registered nurse positions that can be replaced since August, pre-empting the $32 million edict in the mini-budget last month. A leaked memo shows Greater Southern Area Health Service will turn 53 full-time equivalent registered nurse positions into enrolled nurse roles, each saving about $20,000 a year in salary, for a total of $800,000 by June. Karen Lenihan, the director of nursing and midwifery at Greater Southern, said most registered nurses would be lost through natural attrition, not redundancy. "It's not really about saving money; it's about being efficient."

But the president of the NSW Nurses Association, Brett Holmes, said the modelling used to devise the skill mix was "based on budget, not patient need". He had serious concerns about patient safety and nurses' workload. Less qualified nurses did not have the training to deal with critical emergencies and trauma, such as car accidents, he said. The Opposition health spokeswoman, Jillian Skinner, said the changes would put lives at risk.

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19 December, 2008

NHS Cancer patient given less than two months to live is told she must wait 25 days for drugs

A cancer patient given less than two months to live has been refused a life-prolonging drug until an NHS trust finishes a month-long investigation. Margaret Jones hopes to be treated with Revlimid for myeloma, an incurable cancer of the bone marrow. Her consultant says the drug, which costs around 4,300 pounds for each cycle, could extend the 72-year-old's life without debilitating side effects. But bosses at her primary care trust ruled they would not pay for Revlimid because it was not 'cost effective', even though other PCTs prescribe it for myeloma sufferers.

Mother-of-three Mrs Jones - backed by her family, MP, doctor and cancer charities - appealed on the grounds that another patient living nearby successfully overturned the trust's decision to block the same drug treatment in September. But on December 5 Anne Walker, chief executive of East and North Hertfordshire PCT, said her case was still being investigated and said a response would be sent 'within 25 working days' - about half of Mrs Jones's life expectancy.

The case reignites the controversy over the 'postcode lottery' for NHS care and the time taken by the Government's rationing body to approve new cancer drugs. The National Institute for Health and Clinical Excellence (Nice) ruled last month that it would deny Revlimid to patients with myeloma despite admitting that it could extend life by up to three years.

Mrs Jones, of Welwyn, Hertfordshire, was diagnosed with myeloma just before Easter 2006. She had been using the controversial drug thalidomide to fight the cancer but recently began to suffer damaging side-effects, including loss of feeling in her hands and feet, and excruciating pain elsewhere in her body. Following advice from her consultant-haematologist at the Queen Elizabeth II Hospital in Welwyn Garden City, backed by the charity Myeloma UK, she applied to the trust to use Revlimid - but was declined.

Yesterday she said: 'It seems wrong that there is a drug that can help people and yet the authorities put it beyond the reach of them. It is like being in a cage and somebody putting a piece of bread just out of reach. It is cruel.' Her son Jon Jones, 37, said: 'The concerning aspect of this case is that decisions on whether to provide a treatment are being made on the basis of total cost and do not consider the clinical effectiveness of those therapies. 'Elsewhere in the country, Revlimid is being provided. The PCT making this particular decision is located in one of the wealthiest counties in the country. The issue of a postcode lottery for health care is not going away and is still a heart-breaking issue for many people and their families.'

The 37-year-old former RAF pilot, who lives in Wiltshire, added that the PCT's decision to spend up to 25 days investigating his mother's appeal was 'upsetting'. He said: 'If you have got someone who has got a matter of weeks to live then 25 days is too long. It should become a matter of urgency. 'I am not saying that those responsible at the trust are off playing golf. I accept they are busy people. But when a decision needs making very quickly, they need to act quickly.'

Mrs Jones's Tory MP, Grant Shapps, said: 'The PCT should be utterly ashamed of itself. They have a woman's life in their hands and they should overturn their original decision immediately.'

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18 December, 2008

Pervasive NHS inadequacies

When Florence King's husband was admitted to hospital for a major brain operation, she discovered how, while the National Health Service is superb at matters of life and death, it often fails badly at the smaller touches that mean so much to patients . . . She explains: 'Over the past few months, my husband has had a major operation on the NHS and half-a-dozen follow-up stays in hospital. 'The medical treatment has been beyond reproach. He is making a good recovery and we can only express our gratitude. 'But so close and extended an experience of hospitals - not just of the one where he had his operation, but other hospitals where he underwent tests - highlighted a whole range of areas where a little thought would have improved the experience for patient and visitor alike.

'Many of the faults would cost little or nothing to remedy: it is more a matter of attitude than money. The overwhelming impression was of a system - as years of almost permanent revolution come to an end - that is expensively over-managed at the top and grievously undermanaged at the patient level. 'Most of those involved, including nurses and ancillary staff, are so wrapped up in the system that they fail to appreciate how it looks and feels to the people in their care - the people who are, after all, the whole reason the hospital is there.

'Before his operation, my husband could barely walk. He needed door-to-door transport, which meant the car. And when the hospital is out of town, a car makes visiting more flexible, which is how I encountered that most vilified of "hidden" NHS costs: parking charges. 'Now, I completely understand why hospitals in urban areas or on small sites levy charges: they don't want parking spaces that their staff need clogged up with visitors' cars and they don't want commuters squatting there for free. 'And if you have a disabled sticker, as my husband does, you do not have to pay to park. No complaints there.

'As an able-bodied visitor, though, I stuck to the rules, which meant shelling out more than 30 pounds for each of the first two weeks, until I discovered that, as a regular, you could buy a weekly season ticket for 12. 'I would not say, though, that they were exactly advertising that fact. The aggressively worded instruction boards at the car parks warned - among other things - that it was an offence not to display a valid ticket; that the machine dispensed no change; that the charge had recently gone up to 2 pounds for three hours; that charging operated 24 hours a day, seven days a week; and that there were regular checks. 'Oh yes, and they warned that thieves were about - so the patrols were about money, not security. Thanks.

'I discovered the good news about season tickets by chance, from the small print of a leaflet in the hospital coffee shop. But not before learning how more experienced visitors coped. Dozens park on surrounding roads, which creates traffic jams at visiting times. 'There was also what seemed a well established practice of passing your ticket (with its unused time) to a new arrival as you left, or leaving it on the machine for the next person to pick up. That seems fair enough. 'The 2 pounds-for-three-hours charge particularly grated because official visiting hours are two separate sessions of two hours. This means you have to pay at least 4 pounds if you visit both times.

RECEPTION

'As an arriving in-patient, my husband would have an official letter and a window of time allocated for his arrival. Invariably, there was no one manning the central reception desk or the entrance to the ward. 'Despite all the stories you hear about poor hospital security (from petty crime to stolen babies), I have entered and got lost wandering around every hospital my husband has been in. Invariably, no one has challenged me. 'Signposting is absolutely hopeless: non-existent, inconsistent; or in such impenetrable jargon that no outsider has a clue.

'Some reception desks, it turns out, are staffed only at certain times or particular days of the week, and the staffed hours bear no relation to when new patients actually arrive. For whose benefit, you ask, are they manned at all? 'Sometimes I had to winkle semi-willing staff out of adjacent side rooms where they were on a break.

'One newer hospital of my acquaintance, a positive paean to the Private Finance Initiative, has an atrium that rivals any major airport with ranks of reception desks to match, except that only the central desk is staffed - so there are muddled queues. 'It is too expensive to staff the other desk said a grumpy porter. All this public space - which has to be cleaned, heated and lit, if not actually staffed - is an extravagance. 'It is also intimidating for semi-mobile patients, who find themselves having to hobble enormous distances, even if lifts and automatic doors make it a great deal easier than in older hospitals. 'Why was the money spent on a lavish atrium rather than separate wards rather than separate bathroom facilities for men and women?

DOCTORS

'The doctors I dealt with were, without exception, informative and calming. It was almost as though they had graduated from a course in "dealing with patients and their relatives as intelligent people and how not to alarm them". Perhaps they had. 'I didn't feel at any time that the top specialists were patronising me or my husband, and they seemed to make conscious efforts to avoid using impenetrable technicalities.

'I do not doubt, though, that having doctors in the family and long familiarity with the medical minutiae of my husband's illness probably helped communication. In general, the junior doctors seemed more off-hand.

'If I have a complaint, it is the general invisibility of doctors outside the ward round. Of course, they have other places to be: in the operating theatre, seeing acute patients, lecturing. 'But they seem to inhabit a planet from which they occasionally descend, with a certain delay for effect, at the behest of ever-changing teams of nurses. The continuing, and glaring, doctor-nurse divide left me feeling that some doctors found it easier to talk to me than to the nursing staff.

VISITORS

'As visitor, you would go into the ward - sometimes you had to ring to be admitted, sometimes not - and want to announce yourself to someone. 'I felt that someone should know I was there; that it would be better not to wander around the beds looking for my husband (sometimes he was in a side ward, sometimes not); and it would be useful to know before I saw him how he was. 'No one, even at official visiting times, routinely met the visitors. Official visiting times existed, and there were rules discouraging young children and more than two visitors per patient. But hospitals seem to make a virtue of permissiveness. 'When my husband was very ill, I was grateful for the flexibility. But permissive visiting makes for a lot of coming and going. 'Not enforcing the rule about young children and multiple visitors made for more noise and bustle than my husband easily tolerated. It was, frankly, an imposition.

NURSES

'WHEN my husband was admitted to the hospital ward, I saw a notice on the wall behind the nurses' desk team saying: We operate a team nursing system." I soon discovered that this meant that no one individual was in charge - everyone was equal. 'The combination of having no one visibly in cahrge and incomprehensible shift patterns meant neither patients nor visitors had any obvious continuity.

'My husband seemed to receive his medication with punctilious regularity, and was duly recorded, along with any problems, in the handover log. 'But there were slips and times when the log was completed with a delay: "Whoops, I forgot, but I know I gave him his dose . . ." 'Every individual seemed to have a high sense of personal responsibility. Yet the fact no one demonstrably in charge left doubts. It all seemed a bit haphazard.

'I was not made to feel unwelcome. On the contrary, at mealtimes I was cheerfully called up for feeding duty. I just felt that a single, obvious contact point every day would have been desirable. The counter-argument, of course, is that everyone is too busy and hierarchies belong in the ark.

NOISE

'Thank goodness: with the introduction of individual screens, the age of the blaring TV at the end of the ward is over in many hospitals. 'But it was not only the visiting times, as my husband told me, that could be noisy. Nights were also noisy, and only partly because some patients became agitated. 'My husband's biggest complaint, though, was about the nurses and their chatter and laughter. He was on a ward for patients who'd had brain operations or suffered brain injuries. They really needed quiet. Again, who is a hospital for?

HYGIENE

Ward hygiene was good. The hand-washing and disinfectant messages have got through to the staff. I have to say, though, that I didn't like seeing nurses arrive and leave in uniform.

'I was surprised that most patients, except the very ill, were encouraged to wear their own clothes, which meant I had a pile of dirty laundry to take home a couple of times a week. I have a car and washing machine, but some relatives might not.

'What I found shocking was how often nurses seemed to prefer the patient to soil himself rather than help him to the commode. 'At one point, my husband was well enough to be detached from a catheter, but still too ill or slow to get up or reach for the urinal in time. A more considerate attitude by the nurses, not necessarily more of them, could have reduced the number of 'accidents'.

'In two hospitals, I complained several times about the lack of loo paper and general filth of the lavatory facilities for visitors. Nurses and ward staff say it is nothing to do with them and I could never find anyone who'd admit to having responsibility.

FOOD

'Meal service was separated from nursing everywhere and seemed to have a life of its own. 'The times were generally not too uncivilised, and the quality and choice were better than both of us had feared. 'My husband could also ask for toast or an ice-cream at almost any time if he had missed a meal or felt peckish. He lost a lot of weight while recovering from his operation and enjoyed these little extras.

'But, oh, the service! OK, so you don't expect restaurant standard or even charm. But I think you could expect to have the plates set down somewhere where you might be able to reach them in the order you might want to eat what is on them. 'And the amount of time allotted for eating was minimal, so the hungry patient feels pressured to gobble, and anyone who has difficulty eating simply gives up. Those who made a fuss generally got fed, but often had to wait so long that the food was cold.

'Expectations about patients' ability to eat when in bed were unrealistic. While nurses and meal staff equipped themselves with disposable plastic aprons off a big roll, patients had to make do with a tiny paper napkin. 'A disposable plastic bib or a cloak like the ones you have at the hairdresser's would be a vast improvement.

'It would also be a good idea for someone to review all the menus for ' eatability'. Roast chicken came in joints and was clearly popular, but my husband could not have begun to tackle his if I hadn't been there to cut it up; he could not even lift it! 'Anything that cannot be picked up easily by hand, fork or spoon is a nightmare. Even boneless meat, if it is in one piece or drowned in gravy, is a challenge. I especially dreaded 'pea' days - they ended up all over the bed.'

TELEPHONES

'A lot of people complain about the tariff for hospital phones. All the hospitals my husband has been in, though, allowed patients to use their mobiles, which most did with discretion. That's good.

TELEVISION

'I know that if I were in hospital and reasonably conscious, I would love to have my own TV and radio. The arrival of bedside TV and games consoles - a bit like those in passenger planes - is a great advance.

'Aha, but the NHS has news for you. It is not as simple as it seems. First of all, you need to pay, and while I would be happy to do so, the system seemed expressly designed to extract the maximum amount of money in a rather deceptive way. 'You could pay for a day, three days or a week. But the time was consecutive. So, if you had an operation on day two and were incapable of watching TV that day, you lost that day. To pay for just one day, though, was much more expensive.

'The method of payment left much to be desired. All right, you can't expect nurses to collect TV fees. But you have to buy a card at a slot machine that says it gives change and accepts notes, but doesn't, or pay by credit card on-screen. 'For me, able-bodied and equipped with a mobile phone and credit card, this was complicated, didn't work initially and necessitated two frustrated calls to the inquiry desk.

'For my husband, with fingers that didn't work well, problems with his voice and difficulties sitting up (before the operation), setting up the TV payments would have been impossible. In the week after the operation, it was even worse. 'Plus, his bed was moved first to a different ward and then to various positions in the ward. Each move meant having to re-start the TV, using a long ID number. Mostly, he gave up. 'And a head operation meant wearing a headset was not just uncomfortable but impossible, yet no earpiece was on offer.

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17 December, 2008

British woman driven 200 miles to give Caesarian birth to premature twins and then finds after delivery that the hospital has only one incubator available!

Vast lack of facilities. Even a Caesarian was too hard for three hospitals. And as for incubators for premmies! What do you think you are? In the 21st century? And this is in London, not on some remote island!

A new mother was sent to four different hospitals in four days to give birth only to have her premature twins separated after they were born. Angela Breeds, 30, was forced to make a 200 mile trip because surgeons were unable to perform a necessary caesarian section at the first three hospitals she was sent to. And when she finally gave birth to Suzie and Sonny, the twins were separated after just five minutes because of a lack of cots.

Ms Breeds, a self employed hairdresser from Stanford-le-Hope said: "I'm just so angry about being pushed around everywhere. "Then when I found out they had to be separated I was completely gutted."

The mother's ordeal started on December 3 when doctors at King's College Hospital in south east London told Miss Breeds she needed a caesarian section because one of the twins was not getting enough nutrition. She was transferred 31 miles away to Basildon Hospital in Essex that night for the operation. But after she arrived, she was told the hospital did not have the right facilities for the procedure so she was sent to Peterborough Hospital in Cambridgeshire, 96 miles away.

She waited in the hospital for three days before being told surgeons at the facility could not perform the operation either. So she was again transferred to Whipps Cross Hospital in east London, another 86 miles away, on Sunday December 7 where she gave birth the following day. But there were not enough incubator cots for both tots and within five minutes of giving birth, Sonny was taken away from his mother and sister to Royal London Hospital in Whitechapel.

Katrina Coulson, an NHS East of England spokeswoman said the NHS in the region was hoping to increase the number of special and intensive care cots

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16 December, 2008

10,000 Polish women get NHS abortions

Ten thousand Polish women had abortions in Britain last year, it has been reported, in procedures which are thought to have cost the NHS between 5million and 10m pounds. Thousands of the women are thought to have come to Britain specifically for the procedure, which is illegal in Poland. People coming to Britain as temporary workers are given a National Insurance number, which allows them to register with a doctor and have NHS treatment.

Britain is thought to be a particularly popular destination as terminations can be carried out as late as 24 weeks into a pregnancy. In several other EU countries, abortions can not be carried out after 12 weeks. A pill given to women under nine weeks pregnant costs the NHS about 500 pounds while an operation necessary for those further into pregnancy costs about 1,600 including after-care.

The figures were reportedly disclosed by the Polish Federation for Women and Family Planning. Aleksandra Jozefowska, a spokesman for the Federation, told The Sun: "On Polish internet sites you can find lots of information on how to obtain an abortion in Britain. And every week I have two or three phone calls from women who want to know about abortion in England."

One unnamed London doctor was reported to have told the newspaper: "As long as they get an NHS number, they haven't got a problem. They can say: 'I didn't know I was pregnant until I got here, I'm in an impossible situation and need help'."

Source




Australia: Is Victoria's ambulance service unfixable?

The complaints never seem to stop

Long delays for ambulance services are putting lives at risk, the Victorian ambulance union says. A log of 291 incidents from August to November showed dangerously slow response times, Ambulance Employees Association Victorian secretary Steve McGhie said. Ninety-six scheduled shifts failed to run on time during that period. In one case, an 89-year-old woman with severe chest pains was taken to hospital by car after waiting 23 minutes for an ambulance to arrive, Mr McGhie said.

"These figures show the ambulance service is failing the community,'' he said in a statement. "People's lives are being put at risk by slow response times and cancelled ambulances. "Paramedics are working massive hours to cover our over-stretched service, and when everyone else is with their friends and family at Christmas, this is their busiest time of the year.''

Mr McGhie said the only way to attract new people to the profession was to offer fair wages and 10-hour rest breaks. "The community needs to be extremely cautious over the holiday season, because this log shows the ambulance you need in a crisis simply may not be there.''

A spokesman for Health Minister Daniel Andrews said the State Government had committed 258 extra paramedics and provided $186 million to services during 2008.

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15 December, 2008

Gross incompetence: NHS hospitals forced to close wards as winter bug spreads

They can't even handle a predictable flu outbreak

Hospitals are facing a winter crisis as a sharp rise in cases of flu and other viruses forces some to close wards to new patients. Several hospitals are already struggling to cope with a sudden rise in admissions and the spread of a virulent winter vomiting bug. Figures from NHS Direct's telephone help line show that the number of calls about colds, flu, coughs and fever has trebled in the past three months.

The figure tends to rise as winter draws in, but in the same period last year the increase was only two-fold, not three-fold. NHS Direct received 10,512 calls between September and December this year, compared to 3,435 calls for the previous three months, while more than 25,000 people have visited NHS Direct's flu symptom checker website.

The vomiting bug norovirus - the most common gastrointestinal illness in the UK, affecting up to a million people every year - is causing particular problems, with NHS chiefs forced to warn sufferers to stay away from doctors' surgeries and hospitals for fear of spreading it further. Affected hospitals include Addenbrooke's in Cambridge, Norfolk and Norwich Hospital, Worcestershire Royal Hospital and York Hospital. Several trusts said the knock-on effect was making it difficult to meet the Government's target of admitting, or dealing with, 98 per cent of emergency patients within four hours.

One of London's three major trauma centres, St George's in Tooting, was issued a 'black alert' and closed its doors to emergencies for a number of hours on Monday after experiencing a 14 per cent surge in demand compared to the same period last year. Staff at St George's reported that up to 20 patients requiring urgent admission had to be kept on beds in A&E as wards were full. Some were diverted to neighbouring hospitals, including Mayday in Croydon, Kingston Hospital and St Helier in Sutton, all of which reported pressure on their own capacity.

The Royal Devon & Exeter Hospital closed its doors to all visitors last week after 12 of its 49 wards were infected, forcing it to postpone about 60 non-urgent operations. It faced extra pressure from emergency admissions caused by falls on ice, with nearly 100 people going into the emergency department with ice-related injuries on Monday alone.

In Carlisle, two elderly care wards at the Cumberland Infirmary were closed last week in a bid to isolate the norovirus bug. Nearby Wigton cottage hospital was closed to all admissions and non-emergency transfers for the second time in a fortnight.

Two wards at East Surrey Hospital closed, while five at the Queen Elizabeth Hospital in King's Lynn were shut or under observation.

At the University Hospital of North Staffordshire, six wards were closed, reducing the number of beds available to patients by 130. Sarah Byrom, the chief nurse, said: "While norovirus is common for this time of year, we have seen a big increase in the number of people coming into the hospital with symptoms."

Affected wards can usually be reopened after a few days, following routine disinfecting. But campaigners claim that cuts in bed capacity have left hospitals ill-equipped to cope with seasonal flu, accidents and respiratory complaints at the same time as having to close wards to cope with norovirus. Geoff Martin, head of campaigns at Health Emergency, called the situation at St George's "deeply worrying" and said: "We are calling on the Government to make cash available to open additional beds and draft in extra staff to cope with the growing crisis on the wards."

Norman Lamb MP, Liberal Democrat spokesman for health, said too many hospitals where operating at 90 to 95 per cent capacity, despite experts recommending no higher than 85 per cent in order to allow hospitals to cope with a sudden influx of patients or an emergency. He said: "There is a minority of hospitals around the country already operating under impossible pressure and when you add to that winter viruses such as norovirus you get a crisis. It has an impossible impact on staff, putting them under enormous strain, and it clearly affects patient care."

A spokesman for the Department of Health said: "Winter crises used to bedevil the NHS. Thanks to record investment and better organisation we have not had a major winter crisis for several years. However, we constantly update our contingency plans in the light of events." [Translation: Reality does not exist]

Source





14 December, 2008

Why Tie Health Insurance to a Job?

One thing we can all agree on is that portable coverage is more secure

Not many people are buying cars built 60 years ago. No one is watching TV on a set manufactured in the 1940s. Patients are not lining up to see a doctor who hasn't cracked a book since before the polio vaccine was discovered. Why, then, do millions of Americans get their health care through an employer-based system from the 1940s?

Employers didn't start offering health benefits roughly 60 years ago because they were experts in medical decisions. It was a way of circumventing the World War II wage and price controls. Barred from offering higher salaries to attract workers, employers offered health insurance instead. Aided by an IRS ruling that said workers who received health benefits did not have to pay income taxes on them, and by the fact that employers could write off the cost of the health benefits as a business related expense, this accidental arrangement became the primary way most Americans access health care.

The system worked at first, but a lot has changed in 60 years. Back then, the average soldier returning from World War II took a job with a local company where he would work for decades until he got a gold watch at a big retirement party. Today, lifetime employment is dead. By 42, the average American will change jobs 11 times.

Sixty years ago, most American companies competed only against neighboring companies for lucrative contracts. Today, most businesses are up against foreign companies that don't foot the bill for their employees' health-care costs.

Today, health-care costs are increasing at twice the rate of inflation. To stay in the black, companies are forced to raise their employees' premiums and deductibles, opt for cheaper insurance plans, or worse yet, drop health benefits altogether. Since 2000, the percentage of employers providing health insurance has declined by nearly 10%.

For too many, the employer-based system is inefficient. Each employer purchases health insurance separately. According to a recent estimate by the McKinsey Global Institute, this adds more than $75 billion in underwriting, marketing, sales, billing and other administrative costs that offer no health benefits. More than half of all American employers who offer health-care benefits don't offer their employees a choice. Consequently, most Americans don't have the option of giving their business to insurance companies that treat them well and only cover what they need. This prevents the usual market forces from holding down costs.

Workers are the ones paying for this waste. The money that employers are spending to buy health care for their employees could otherwise go to workers in the form of higher wages, empowering individuals to make their own health-care choices.

The currently available alternative to this employer-based system is even more horrifying. Individuals buying insurance don't have the same purchasing power as large businesses and end up paying much higher prices to cover administrative costs and risks. They also don't get the tax breaks that employers get for buying health insurance. In most states, insurance companies have the right to discriminate against individuals by denying coverage or charging astronomical prices to anyone with a pre-existing condition. It is no surprise that, when given the choice between the employer-based system and buying health insurance on their own, the vast majority of Americans reject the latter. (A Kaiser Health Tracking Poll this summer, for example, found that only 17% of Americans said they would prefer to buy insurance on their own.) But this is a false choice. It assumes that the current system is the only option. Why can't Americans have the best of both worlds?

Americans need some of the benefits of the employer-based system: the security of being part of a large group, of not being denied coverage because of age and pre-existing conditions, and the convenience of having experts screen qualified plans and manage enrollment. But Americans also need portable insurance -- coverage that follows them when they change jobs, lose jobs, start a business or whatever else may come. Americans need more choices and the market power to buy the health coverage that works best for them and their families and, in turn, to make insurance companies compete for their business.

Such a system could be implemented today by creating state or regional insurance exchanges that pool individuals and small groups to pay the same lower prices charged to larger employers; that certify that all insurance benefit packages meet minimum consumer protection standards; that manage the enrollment process; that collect premiums; and that require insurance companies to issue and renew coverage for anyone who applies, protecting the insurers by paying them a risk-adjusted premium that pays them more when they enroll sicker, more costly, patients.

Fundamentally, this means that insurance companies would have to change their business model to compete on the basis of quality, price and benefits, rather than by "cherry picking" the healthiest people to cover. It means spending less money on administrative costs and more money on keeping patients healthy. And it means letting everyone keep the health insurance they have if that's what they want, but giving all employers and employees more choices for their health care.

In the coming year, there will be no shortage of suggestions for fixing the nation's health-care system. But what Americans and the president-elect need to ask is whether the health-care system that was founded in the 1940s is the best health-care system for the 21st century. We believe that Americans deserve better.

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13 December, 2008

Newer breast cancer drug cuts risk of death by a fifth compared to NHS treatment, research shows

A drug for breast cancer has been found to cut the risk of dying by almost a fifth compared with the Health Service's standard treatment. The research by an international team is the first to show that women with early breast cancer taking the aromatase inhibitor (AI) Femara for five years after surgery live longer without the disease, compared with those taking tamoxifen.

AIs were approved two years ago for NHS use in postmenopausal women after studies showed they cut disease recurrence and improve survival. But patients usually take tamoxifen initially and switch to an AI drug within two to three years. The study said women using the AI drug Femara, also known as letrozole, for the entire five-year period are more likely to survive.

Risk of death was reduced by 19 per cent, according to data presented to the San Antonio Breast Cancer Symposium in the U.S. by the International Breast Cancer Study Group. The trial studied 8,000 women in 27 countries, including the UK, of whom 5,000 were assigned to either Femara or tamoxifen without being switched. For the rest, who were switched to Femara halfway through, the survival benefit was 13 per cent.

Nigel Bundred, Professor of Surgical Oncology at South Manchester University Hospitals Trust, said: 'These data represent an important milestone in the treatment of women with breast cancer. 'For the first time we are seeing suggested survival benefit with upfront aromatase inhibitor letrozole therapy for five years compared with tamoxifen for the same time period.'

Henning-T Mouridsen, professor of oncology-at Copenhagen University Hospital-and one of the trial investigators, said the drug produces an 'early and sustained reduction' in recurrence of disease in the breast and its spread into the body. Around 44,000 British women develop breast cancer a year including 33,000 after the menopause.

AI drugs shut down the body's supply of oestrogen altogether, while tamoxifen works by blocking oestrogen's effects on cancer cells. These drugs work in women only after the menopause and where breast cells are sensitive to oestrogen - up to four in five cases.

The Government's rationing watchdog has approved three aromatase inhibitors (AI) - Aromasin, Arimidex and Femara - alongside tamoxifen. Primary care trusts are expected to fund them, but the annual cost of an AI is 900 pounds, compared with less than 300 for tamoxifen. A survey last year found only a fifth of Britain's biggest breast cancer hospital units were definitely following guidance to switch patients after initial treatment with tamoxifen.

Professor Jeffrey Tobias, Professor of Cancer Medicine at University College and Middlesex School of Medicine, said the latest findings mean AI drugs should now be used in preference to tamoxifen. He added that osteoporosis sufferers may still be better off on tamoxifen as AIs cause bone problems, but tamoxifen has a fourfold higher risk of causing womb disorders

Source





12 December, 2008

Thousands of NHS patients suffer avoidable medical errors, says Healthcare Commission

Thousands of patients are the victims of medical errors that could have been avoided if safety was given a higher priority in the NHS, the health watchdog has warned. Incidents where patients were harmed or so called near-misses are not being reported meaning lessons cannot be learned and future problems avoided, the Healthcare Commission said in its annual State of Healthcare report. One in ten patients admitted to hospitals will suffer from an error and around half of these could have been avoided, it warns.

The report said only half of NHS trusts comply with all safety standards and there has been little improvement. Errors that have led to patients being harmed include incorrect diagnosis, wrong doses of medication, surgeons operating on the wrong part of the body and paperwork going missing.

The wide ranging report covers all aspects of healthcare in England and highlights a number of areas of significant improvement in the NHS, particularly around deaths from cancer and heart disease and huge reductions in waiting times.

Demand for healthcare has increased dramatically, the NHS has higher levels of funding than ever before, and the health of the nation is improving, the report said. However, the last annual report before the Healthcare Commission is subsumed by the Care Quality Commission, the report focuses on patient safety and the lack of progress in the last five years. The report said too few incidents are reported to the National Patient Safety Agency with particular problems in primary care where doctors and nurses report almost no errors although the majority of patient care is delivered by GPs.

The report said there are 'up to 600 errors a day in primary care' but this was disputed by the Department of Health and the British Medical Association as based on research in other countries. The NPSA received 959,000 incidents of errors in 2007/8 but "worryingly" the report said seven per cent of hospital trusts and 13 per cent of primary care trusts did not report any incidents.

Prof Sir Ian Kennedy, chairman of the Healthcare Commission, said: "In my view the NHS is really only just out of the starting blocks. "There is a lot more we can do before we can be confident that the care patients receive is as safe as it reasonably can be. "What must change and change quickly is that we don't know very much about how safe care is in primary care. Information about missed diagnoses and late diagnoses won't show up on anyone's register of incidents of untoward events. "Safe care is what patients expect and what they are entitled to. "The real responsibility for the safety of care lies with those who provide care locally, namely the trusts and the boards responsible for trusts." He said unless safety is "internalised in their DNA" then nothing can change.

The Healthcare Commission called for one national database of serious incidents as the recording of errors is currently spread across different organisations. And hospital trusts and primary care trusts should also be measured on their serious untoward incidents and how they learn from them.

Dr Hamish Meldrum, Chairman of Council at the British Medical Association said: "The overall picture in this report is of major improvements to standards of care. We applaud the efforts of NHS staff in reducing the amount of time patients have to wait, and improving the quality of the care they receive. "Any errors are regrettable but there are millions of contacts between the NHS and patients every day. It is inevitable that, in a very small proportion of these, care falls below the highest standards. Doctors want to get rid of unacceptable variations in quality, but we need to be careful to analyse and learn from the causes of low performance rather than jumping to conclusions or simply adopting a blame culture."

Martin Fletcher, Chief Executive at the National Patient Safety Agency, said: "Good reporting is the cornerstone of patient safety. Safety cannot be improved without a range of valid reporting, analytical and investigative tools that identify the sources and causes of risk in a way that leads to preventative action. The National Reporting and Learning System has a vital role to play in supporting NHS organisations to identify risks to safe patient care. Patient safety needs to be everyone's responsibility."

Health Minister Lord Darzi said: "The NHS sees a million people every 36 hours. Unfortunately, as in any modern health service, mistakes and unforeseen incidents will happen. Only a very small number of errors put patients at serious risk. "We know there's more work to be done and are leading the way worldwide, having set up the National Patient Safety Agency and established a reporting and learning system to encourage open reporting. The introduction of quality quality accounts will refocus the attention of the boards of NHS bodies on the quality and safety."

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11 December, 2008

The Obama Health-Care Express is underway

What Democrats learned from the fall of HillaryCare

A charismatic Democratic President takes office promising to extend health insurance to all Americans. His party enjoys majorities in Congress, and the GOP is at sea. The press corps finds policy a bore and instead files stories that draw facile analogies to the heyday of FDR. Yes, all that will be true next year -- but it was also true in January 1993. Fewer than two years later, the grand health-care ambitions of Bill and Hillary Clinton were reduced to tatters. No one is more attuned to this memory than today's Democrats, who aren't about to let history repeat itself. And since the lessons they learned from the HillaryCare fiasco are political, and not substantive, they are already moving full-speed ahead.

This mentality is nicely captured by Tom Daschle, the former Senate Majority Leader who Barack Obama has tapped to run Health and Human Services. "I think that ideological differences and disputes over policy weren't really to blame," he writes of 1994 in his book "Critical," published earlier this year. Despite "a general agreement on basic reform principles," the Clintons botched the political timing by focusing on the budget, trade and other priorities before HillaryCare.

President-elect Obama will not make the same mistake. Congressional Democrats are already deep into the legislative weeds, while Mr. Daschle is organizing the interest groups and a grassroots lobbying effort. Mr. Obama may be gesturing at a more centrist direction in economics and national security, but health care is where he seems bent on pleasing the political left.

According to Mr. Daschle, because of the Clintons' hesitation, "reform opponents succeeded in confusing and even frightening Americans about what change might mean," and this time the Democrats mean to define the debate. Consider the December 2 letter to us from Senator Max Baucus, who is upset that a recent editorial on his health-care plan did not use his favorite terms of art (his style being surrealism). "It will require affordability, but premiums will not be set," he writes. So the government will merely determine "affordability" -- which might as well be the same thing.

Much as Mrs. Clinton insisted that her health bureaucracies were "alliances," Mr. Baucus says his new entitlement "will not be 'managed by the government,' but by an independent council of Presidentially appointed health-care experts." The Senate Finance Chairman wants us to believe that a government commission to determine benefits and subsidies will somehow be above politics.

Shrewder moves are being made to co-opt should-be opponents. The Clintons decided to go to war with "proponents of the status quo," as Mrs. Clinton put it in a bare-knuckled speech in May 1993. This meant vilifying business, especially insurance companies guilty of "unconscionable profiteering" and even drug makers like Merck, which Mr. Clinton had courted during his campaign. This time, Democrats are trying to seduce business with subsidies and other bribes.

They may succeed, which is no surprise given that many corporations would be only too happy to dump their health liabilities on the government. The "Divided We Fail" coalition, which advocates "universal" coverage, includes not only usual suspects like unions and AARP but also the Business Roundtable and the National Federation of Independent Business, the small-business lobby that led the charge against HillaryCare.

America's Health Insurance Plans, the industry trade group, recently said its members would accept all comers regardless of health status or previous illness -- i.e., guaranteed issue -- but only if the government requires everyone to buy insurance. The individual mandate will expand their business in the short term, but it won't be long before Congress is also regulating premiums, cost-sharing and administrative expenses. Dr. Faustus, call your internist.

Another opening for Democrats is the new director of the Congressional Budget Office, a post vacated when Peter Orszag joined the Obama Administration. CBO totes up the official cost of legislation and thus is one of those obscure Beltway outfits that frames the political argument. A "score" that is too costly make a bill harder to pass.

In the 1990s, CBO director Robert Reischauer knee-capped HillaryCare by pointing out its true costs and giving little credit to claims it would generate savings. With good reason: Putative cost "offsets" never seem to materialize when Congress tries to plan the insurance markets. Now Democrats will try to install a CBO director who can be more easily rolled.

Most disturbingly, Democrats are talking up "budget reconciliation" to pass a health overhaul. This process was created in 1974 and allows legislation dealing with government finances to be whisked through Congress on a simple majority after 20 hours of debate. In other words, it cuts out the minority by precluding a filibuster. Mr. Daschle writes that reform "is too important to be stalled by Senate protocol," and Mr. Baucus has said he's open to the option.

Any taxpayer commitment this large ought to require a social consensus reflected in large majorities, but Democrats are determined to plow ahead anyway. They know that a health-care entitlement for the middle class will never be removed once it is in place; and that government will then dominate American health-care choices for decades to come. That's all the more reason for the recumbent GOP to get its act together.

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300 babies exposed to tuberculosis in Australian public hospital

What a disgrace! The old story of imported doctors again. Government hospitals will take just about anyone as a doctor

About 75 babies under three months will be given antibiotics after they were exposed to tuberculosis by an infected doctor at an Adelaide hospital. SA Health says about 300 children in the Neo-natal Intensive Care Unit and the Special Care Baby Unit may have come into "close and prolonged contact" with the doctor between September 28 and November 28 this year. About 75 of these children are too young to diagnose, and will be treated with antibiotics to minimise the chances of infection.

The doctor was screened for TB by immigration authorities when he arrived in Australia in March this year. His chest X-ray found no trace of TB - but a routine follow-up test by SA Health last week returned a positive result. Tests for TB are ineffective in babies under three months of age. The overseas-born doctor is on sick leave, but hospital authorities expect him to return to work after he is cured.

SA Health chief medical officer Professor Paddy Phillips said the risk of transmission was low. "However, as a precautionary measure, those people identified as possible contacts are being offered screening and some are being offered preventative antibiotics," he said.

However, Professor Phillips said the risk of infection was assessed as being at the low end of the spectrum. "Those babies in the NICU will be offered a program of preventative antibiotics as a precaution until they reach three months and are able to undergo a screening test, with a further precautionary test offered at six months," he said. Other babies treated in the SCBU will be offered a screening test when they reach three and six months of age. "Doctors from the Women's and Children's Hospital have been contacting the families today."

Older children and other visitors to the hospital are not believed to be at risk of infection. There were 59 new cases of TB diagnosed in South Australia last year. About 1000 new cases are detected in Australia each year.

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10 December, 2008

How untrained NHS GPs are missing two-thirds of dementia victims

Hundreds of thousands of dementia sufferers remain undiagnosed - largely because of a lack of GP training, it can be revealed. Research shows two-thirds of victims have not been identified by the NHS - meaning they get no drugs, home help or other vital assistance. And a separate survey of family doctors found that their inadequate training, and a shortage of support services for sufferers, is mostly to blame for the health service's failings.

There are at least 700,000 people living with Alzheimer's or a related condition in Britain, with 575,000 of those in England, according to Government-recognised research. GPs are expected to compile lists of all those diagnosed. But according to an analysis of those lists in England by the Liberal Democrats and the Alzheimer's Society, only 220,000 are registered. It means around 355,000 - 62 per cent - of dementia sufferers live without any support from the NHS.

Meanwhile, in the survey of GPs by the Daily Mail, 29 per cent admit they have not had enough training to diagnose and manage dementia. Some 60 per cent said there was a reluctance to diagnose because of a lack of support services, while 40 per cent felt hesitant to make a diagnosis because of the dearth of drug treatments. Worryingly, 10 per cent feel nothing can be done for victims, so do not bother to diagnose at all. Overall, more than two-thirds said funding shortages were to blame for care failures.

Neil Hunt, chief executive of the Alzheimer's Society, said: 'Without a diagnosis, people can't understand frightening symptoms and can't make plans for the future or access support. 'GPs get very little time and we hear cases of people being told they are stupid and sent away. 'Others have a five minute session and are basically told, "good luck, I don't envy you but there's nothing we can do". 'It's no wonder people give in to depression and give up. But the evidence is many can have a reasonable quality of life if the disease is diagnosed early enough.'

The LibDem research into undiagnosed sufferers found 95 per cent of PCTs have fewer than half the registered dementia patients expected. It also unveils a postcode lottery, with some health trusts having far fewer registered patients than others. The worst is Heart of Birmingham PCT, which covers the centre of the city. An estimated 82 per cent of sufferers there are undiagnosed. The best is Islington in North London. But even there, some 32 per cent go undiagnosed.

LibDem health spokesman Norman Lamb said: 'These findings beg the question - why are so many going without the help their GP can offer? 'Too often people assume nothing can be done and it is a part of ageing. 'We must challenge this view, because a great deal can be done to delay the onset and progression of the condition. 'The NHS must do more to ensure people are encouraged to seek early help and that they have access to care from their GP, specialist assessment and accurate diagnosis. 'But the problems go wider with a social care sector under massive pressure. 'The Government has been slow to acknowledge these problems and there's a risk that urgently-required reform will be knocked in the long grass as economic problems grab attention.'

But Care Services Minister Phil Hope promised investment into dementia research will 'continue to grow'. He added: 'We recognise that the key to improving the diagnosis rates is firstly to increase public and professional awareness. 'Secondly, we must ensure professionals involved in diagnosis have the skills and knowledge to do so effectively.'

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9 December, 2008

Individual Insurance Mandate Comes into Play

Many political leaders - and now some leading insurance companies - are arguing that the government should require all Americans to have health insurance. Sen. Max Baucus (D-MT) advocates a federal mandate on individuals in his health overhaul blueprint. America's Health Insurance Plans and the Blue Cross and Blue Shield Association, two insurance trade groups, came out this week in favor of a mandate.

They argue a very valid point: If you guarantee that insurers must sell policies to anyone who wants to buy one, many people will wait until they get sick to buy it. That means there wouldn't be enough money in the insurance pool to pay for care, because healthy people wouldn't be paying in. It wouldn't really even be actual "insurance," as that is understood, where people pay premiums over time to protect against the risk of very expensive medical bills.

Since guaranteed issue is a popular proposal in a new health care regime, insurance companies know they have to prevent devolving to a lopsided pool where everyone who has "insurance" is sick. So they're saying they support an individual mandate, which would require everyone to purchase insurance by some yet-to-be-specified date to avoid this adverse selection problem. This would result in major losses of freedom for consumers. First of all, they would be compelled to pay for insurance or be fined for non-compliance.

New York Times reporter Robert Pear wrote Nov. 19: "Insurers did not say how the government should enforce an individual mandate : whether through fines, tax penalties or other means. Politicians have also been reluctant to specify details of enforcement, which could prove highly unpopular."

Another glaring detail, to which Pear alluded, is that if everyone is required to buy health insurance, no politician is going to let the insurance companies decide how much it should cost.

President-elect Obama's plan calls for regulation of private insurance to see that its prices are "fair" and comparable to that of his proposed government insurance program. This could mean that younger, healthier people would be charged more for their mandatory insurance so older, sicker people don't have to pay so much. Ultimately, these policies would be the death knell for the private insurance industry - and consumer choice.

It is in consumers' best interest to retain private insurance as an option, rather than yielding that function to the federal government. And most people understand this: A recent study noted that Gallup polls over the years show Americans prefer a private system to a government-run one.

Source




Australia: Absurd salaries for health bureaucrats

Western Australian nurses are demanding a better deal after Premier Colin Barnett defended salaries of $400,000 or more for 11 of the state's health bureaucrats. It was revealed in today's The Sunday Times that four Health Department bosses were on contracts that enabled them to earn $480,000 a year, while seven more could earn up to $420,000. Health director-general Peter Flett earns $540,000 after being appointed to the top job in October, $90,000 less than his predecessor Neale Fong.

Dr Fong, Australia's highest-paid public servant, resigned in January after the Corruption and Crime Commission found he had engaged in serious misconduct with disgraced former Labor premier turned lobbyist Brian Burke.

While in opposition, the current government pledged to cut excessive public service salaries once it took office. But Mr Barnett said the government had to pay high salaries to attract good administrators. "They are high salaries, but if you're talking about leading clinicians in the health sector that's the sort of salary level that prevails,'' he said today. "If we want top-quality people working within government, whether it's in health, education or legal areas, you're going to have to pay competitive salaries. That is a reality.''

WA Nurses Federation secretary Mark Olson said he was surprised at the number of health administrators on $400,000-plus salaries in WA. He said Mr Barnett was mistaken to claim that the wages of the state's top paid health bureaucrats were commensurate with similar jobs in the private sector. "It's just a fallacy. The previous government ran the same line,'' Mr Olson said. "When they paid that excessive salary to Dr Fong they said they had to pay him that money to get him from the private sector. "It turned out that he had been on about $330,000 a year and got more than a 200,000 pay lift when he went from St Johns (private) Hospital to the public sector.''

Mr Olson said Mr Barnett had also appeared to indicate that only doctors or people with a medical background could be appointed to top-level management positions in the health sector. "They don't have to be clinicians to move into these areas,'' Mr Olson said. "People who don't have medical qualifications are running very large health organisations around the country and around the globe.''

He said the current level of salaries was sending the wrong message to the people working ``on the floor'' in the state's health system. "It's a pure and simple equation - we are short of doctors on the floor, we are short of nurses on the floor,'' Mr Olson said. "I'd like to see the money going in that direction rather than to bureaucrats. There's no shortage of bureaucrats, there never has been.''

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8 December, 2008

Cancer patients die after mistaken all-clear from NHS

Two patients have died and three more are seriously ill after being mistakenly given the all-clear by two doctors drafted in from overseas to help cut NHS waiting lists. An undisclosed number of colonoscopy procedures, an operation where a camera is inserted into the bowel to check for malignancies, have had to be reviewed after a specialist found cancer in an unidentified patient in January this year. The total number who may be terminally ill is still unknown.

Steve Davies, 47, a father of three died in September last year after having previously been told he was healthy following a colonoscopy at Shepton Mallet treatment centre in Somerset, a private hospital which contracts with the local NHS to provide waiting list surgery and diagnostic procedures. A second man died in January. Another man seen by the second doctor involved has come forward because of local publicity and discovered he has advanced cancer.Two more missed diagnosis have been identified by the review, carried out by a team of independent experts drafted in by the Department of Health.

The surgeon at the centre of the investigation is Ben Mak, a Dutchman who has spent much of his career operating on landmine and bullet-wound injuries for the Red Cross in Afghanistan, Sierra Leone and Angola. As a result of concerns Mak was suspended and resigned in May. 1,828 colonoscopies performed by him between his arrival in Shepton in October 2005 and March 2008 have been reviewed by a team of independent experts drafted in by the Department of Health. 97 of them were considered sufficiently worrying to require patients to undergo immediate re-investigation for possible malignancy. Of the remainder, most have either been told to consult their GP as soon as possible, or to ensure they are rechecked within five years. Only 480 have been told there is nothing to worry about.

Colonoscopies carried out by another surgeon, have also been reviewed. Hospital authorities at Shepton Mallet insisted there was no evidence of misdiagnosis in this doctor's work, but Stuart Bromley, an Exeter solicitor, says he has a client now gravely ill with cancer, who was told by the doctor in September last year there was no evidence of a tumour.

Colon cancer is one of the most common forms of the disease. It affects 23,000 people annually, of whom 16,000 die. Experts say such tumours are normally slow-growing and can be detected on a colonoscopy up to four years before they become fatal.

Edwin Scarbrick, vice-president of the British Society of Gastroenterology, said NHS units and most private centres are now signed up to a national accreditation programme overseen by four of the medical Royal Colleges. This ensures colonoscopy diagnoses are regularly audited and reviewed. It is not clear what audit system was used at Shepton Mallet, but the hospital's annual report for the year to March 2008, reported no problems. "There has been a lot of debate about the involvement of the independent sector in this work," said Scarbrick.

Steve Davies' widow Tracey, said there was ample evidence he was seriously ill. Davies, a painter and decorator from Westbury-sub-Mendip, had suffered severe bleeding and agonising pain but was apparently told his condition was not malignant when Mak scanned him twice the previous January. He has left a daughter aged 20 and sons aged 15 and 17. "We are devastated" she said. I can't believe how this was allowed to happen."

Allan Fairhurst, 61, from Frome, is among those waiting to hear if previously undetected growths he had removed last month, are malignant. "I won't get the results until next week. Holding on to be told whether you have cancer after all, is very worrying."

The Shepton Mallet review will re-open debate about the safety of independent treatment centres which contract with the NHS to keep routine waiting lists down. Most rely on overseas staff, and there have been concerns over the ability to check clinician's credentials.

There is also concern that the General Medical Council (GMC), which monitors performance of UK doctors, has no jurisdiction over foreign clinicians. Channels for ensuring the GMC is notified of problem overseas doctors identified through overseas medical registries are also unreliable. A GMC spokesman said the amount of information relayed in either direction, depended purely on whether the GMC had a relationship with a country's medical regulators.

Neither Mak nor the other doctor responded to messages or emails. Caroline Gamlin, director of public health for Somerset, said patients could be assured that the work of the two surgeons now performing colonoscopies at Shepton Mallet has been investigated and is entirely satisfactory. She said the centre is currently going through the Royal Colleges audit accreditation process.

A spokesman for Shepton Mallet hospital said: "It is important to stress that patients with suspected cancer are not referred to Shepton Mallet NHS Treatment Centre for colonoscopies. Patients with suspected cancer are referred to specialist cancer treatment centres, while the Shepton Mallet NHS Treatment Centre performs routine colonoscopies."

"The results of the independent review show 1,593 patients need take no further action and do not have cancer:197 patients will require a follow up investigation over the next four years as part of their routine surveillance, but are classified as being at low risk of cancer. Sadly, four patients have been found to have developed cancer, however, the independent review of the DVDs of their procedures did not show any evidence of misdiagnosis. In addition, a further 34 patients were correctly fast tracked for specialist cancer treatment. No patient wants to be told that a previous procedure needs to be repeated. For the majority of patients, this is not the case, but we would once again like to offer our sincere apologies to patients whose colonoscopies were reviewed as part of this investigation."

"Shepton Mallet Treatment Centre has to meet national standards set by the Department of Health and it does so. This year, for the first time, Independent Treatment Centres like Shepton Mallet can apply for accreditation by the Joint Advisory Group on GI Endoscopy. We are one of the first to be going through the process of getting that accreditation because we are committed to providing patients with the highest possible standards of care." "[The other doctor] is not an SMTC employee but an agency doctor whose work is subject to clinical audit. The clinical audit of his colonoscopies has shown his work to be satisfactory and he is on the GMC's specialist register."

Source




Notorious Australian public hospital does invasive cancer operation against advice

They knew the woman did not have cancer but operated anyway

A Mackay woman who claims she had an unnecessary operation to remove lymph nodes after being incorrectly told her she had breast cancer, is suing for compensation. The operation to remove 11 lymph nodes went ahead despite a pathologist advising against it because a biopsy did not reveal any cancer, the claim alleges.

Jacqueline Hampson was 48 and nursing at Mackay Base Hospital at the time she had the operation in 2006. She says she was told a year later she had never had cancer. "I was just so shocked," Mrs Hampson, 51, said. The lymph nodes that were removed showed no tumours, her claim says.

Her claim against Mackay Health Service District, filed by Shine Lawyers, says that medical staff failed to properly diagnose or investigate her condition or perform surgery in an appropriate manner. She now has lymphodema, a condition that causes retention of fluids, and a limited range of movement in her left arm. She suffers pain, swelling and psychological problems and has lost employment. "I can no longer nurse. I miss it so much," Mrs Hampson said.

On December 13, 2005, Mrs Hampson had a mammogram at BreastScreen Queensland's Mackay clinic. It revealed a cluster of micro-calcifications in Mrs Hampson's breast and she underwent a core biopsy. She says BreastScreen Queensland told her the biopsy revealed an infiltrating ductal carcinoma -- a form of breast cancer. But a pathologist who later reviewed the biopsy told the hospital that there was no cancer and advised against performing a lymph node operation, the claim says.

Mrs Hampson claims she went to hospital on January 10, 2006, for a further biopsy and was only told she was to have lymph nodes removed when she was on the operating table. A lumpectomy and testing of a larger sample from her breast revealed no carcinoma but the lymph node surgery went ahead. "This is a sad case of a woman having to undergo radical surgery which she didn't need," Jodie Willey of Shine Lawyers said.

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7 December, 2008

British doctor who carried out unnecessary hysterectomies still fine to work in the NHS

A doctor who left two women unable to have children after carrying out unnecessary operations "for research" has been allowed to continue working. Dr Martin Quinn, a consultant gynaecologist, was found guilty of misconduct by the General Medical Council (GMC) which ruled he should not have carried out hysterectomies on both women. He was suspended from working for six months but will be allowed to practise after that time.

One of the women involved said that she was "bewildered" that a consultant who had "terrified" her into believing that radical surgery was her only option would still be allowed to work in the NHS. The GMC found that Dr Quinn had failed to act in the best interests of both women. The panel found him guilty of misconduct and that his fitness to practise was impaired.

Dr George Lodge, chairman of the panel, told Dr Quinn that his actions represented "misconduct so serious as to call into question whether you should continue as a registered doctor, either with restrictions on registration or at all." He added that the panel was concerned that he had allowed his research interests to "intrude unacceptably" into his care of patients. But the panel suspended Dr Quinn for six months, saying they were satisfied there was no evidence of a general lack of competence and no previous evidence of misconduct.

Dr Quinn, who has been a doctor for 25 years, was suspended from his 80,000 pounds a year role with Hope Hospital in Salford, Greater Manchester in April 2005 and his employment terminated in May last year. In recent months he has been working at St George's Hospital in London. A spokesman for St George's said: "Martin Quinn has been working at St George's as an unpaid honorary clinical fellow since June this year. In this role, he has been supervised at all times when in contact with patients."

David Dalton, chief executive of Salford Royal, the trust which runs Hope Hospital, said: "We have always and will continue to put the needs of patients first." All 600 patients who were treated by Dr Quinn at Hope Hospital between September 2002 and April 2005 have had their cases reviewed and a number have been offered extra support by the hospital.

One of the women who had an unnecessary operation spoke of the pain the surgery had caused her family. The 32-year-old mother-of-two from Salford told Dr Quinn that she and her husband wanted to try for another child but he convinced her that she needed a hysterectomy. She was "bewildered" that he had not been banned from practising medicine, she said. The woman, who did not want to be named, said: "He took my fertility and prevented my partner and I from having another baby. "He terrified me into thinking a hysterectomy was the only safe option." She added: "I just wanted justice and the reassurance of knowing he will not be able to work in gynaecology in the future and mess up other people's lives."

Source




Australia: Public hospital bed shortage forces vulnerable women into wards with men

QUEENSLAND'S public hospital bed crisis is now so acute that women, including some with breast cancer, have been put into wards with men. Gail Ramsay said she was horrified when she was admitted to the Princess Alexandra Hospital in Brisbane last week and was taken to a ward containing three men. Ms Ramsay, who is undergoing chemotherapy, has lost her hair and wears a prosthetic breast and a wig. "At night-time when you go to bed, you take all that off," she said.

"I said to the nurse: 'Look, it's embarrassing.' "She said: 'Keep your curtain pulled. If you want to be treated, you've got to be prepared to share with men. That's common practice now. That's what happens.' " Ms Ramsay, from the Ipswich suburb of Riverview, said she was only moved to a women's ward after she complained and "ran out of the room".

The 52-year-old, who was in hospital for three days after doctors found a blood clot near her heart, said she met other women there who had been treated in men's wards. "They didn't like it either," she said.

Australian Medical Association Queensland president Chris Davis said the practice was common in most public hospitals throughout the state because of the lack of beds. "I think this is another one of the examples where we've actually gone backwards with our hospitals over the past 20 years by not being able to offer people gender-specific wards," Dr Davis said.

He said he had been told by a colleague this week that beds at the Rockhampton Hospital had been set up in staff offices to accommodate patients. "When the system is running under that sort of pressure, people will have to accept a bed wherever and hope that their privacy and dignity is maintained," he said. "It's not a comfortable situation for a lot of people, very understandably."

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6 December, 2008

Private-Sector Health Care Leads the Way

It is easy to criticize the US healthcare system, but we should be clear on one thing: it is not "free market" or "private" healthcare. A free market in healthcare would be more efficient and innovative, and offer better quality products and services, with lower prices than is currently the case. In addition to the US government's obvious socialist interventions with programs such as Medicare and Medicaid, there are a multitude of other measures that hinder innovation in healthcare — and we can expect only increased involvement under ObamaCare.

While socialists point to the "failures" of the US healthcare system and, by some magical feat of legerdemain that merely exposes their (economic) ignorance, attribute it to the "free market," it is crucial for Austrolibertarians to point out the absurdity of this false reasoning. For example, the US government accounted for over 45% of all US healthcare expenditures in 2006; it spends almost 20% of GDP on healthcare; indeed, it spends more per capita than any other OECD country (see Figure 1), including those with socialist, government-funded healthcare. In short, this is not a free market.

We can quickly list a few of the myriad government and other regulatory programs that keep prices high and stifle innovation: the Center for Disease Control and Prevention, the Food and Drug Administration, the American Medical Association, the United States Department of Health and Human Services, etc. One reason healthcare costs are so high is because the industry is subsidized; and one reason government intervention only grows is because you can expect more of anything that is subsidized. Doctors and physicians raise their prices on those paying privately to cover those who do not pay, i.e., those the government pays for through theft, a.k.a. taxes. Government is a poor individual's (and everyone's) worst enemy, or at least should be when recognized for what it is and does. Fortunately, there are entrepreneurs who compete in the healthcare industry, despite government's attempts to hinder competition.

Private companies that are allowed to do business without government intervention (and without being granted a government-sanctioned monopoly) must offer better-quality services or lower prices to continue to attract customers. One example of a company that consistently offers both better-quality products and services and lower prices is Wal-Mart. Even Wal-Mart's critics typically agree that it is always about low prices. Indeed, many governments have issued antitrust cases against Wal-Mart for charging too low a price (so-called "predatory pricing"). Because of the threat of antitrust prosecution — and especially given that antitrust laws are so vaguely defined — businesses are more fearful of taking on risk, and less efficient in serving the consumer.

Fortunately, however, Wal-Mart has continued to grow and has recently ventured into the healthcare market.[1] While the US government adds more bureaucracy and money to the healthcare situation, private companies such as Wal-Mart are innovating and bringing the blessings of healthcare to many. Wal-Mart has given access to lower-priced, affordable products to "poor" and millions of uninsured individuals. They are the world's largest (private) employer, with over two million employees serving over 200 million customers a year. Sam Walton should receive a Nobel Peace Prize for his efforts, which have lifted millions out of poverty, and continue to do so.

Wal-Mart now offers walk-in, inexpensive healthcare services by leasing store space to private health clinics. This service, combined with an in-store pharmacy that offers $4 prescriptions, will offer these services to millions of people, and there is no requirement to have health insurance. Consider this: Wal-Mart's $4 prescription program has saved customers over $1 billion dollars since its inception. Prices are a flat fee of around $45 per visit, and are well advertised, i.e., there is no guess work, and price transparency exists. Contrast this with a typical doctor's visit where you might not know what you are paying until three months later. From Wal-Mart's website, we read the following:

Our retail clinics are an especially valuable resource for individuals without health insurance. Nearly half of all clinic patients report that they are uninsured. Many visitors have said that if it were not for our clinics, they wouldn't have gotten care — or they would've had to go to an emergency room. By visiting one of our clinics, patients receive the care they need and at the same time reduce overcrowding in emergency rooms and eliminate the costs of unnecessary hospital visits.

There are significant effects and benefits that can be attributed to Wal-Mart's innovation in healthcare services. For example, Wal-Mart offers faster service and treats common illnesses, fostering a greater specialization and division of labor. This will allow doctors to specialize in more complex problems; and yet some physicians are (correctly) worried since they will have to struggle to compete with Wal-Mart's healthcare. Most physicians earn their revenue from "quick" visits — the "simpler" the illness, the quicker the visit — which means more customers, and more revenue. Wal-Mart will now be treating those patients and receiving revenue from customers, which formerly would have gone to physicians.

Similarly, the AMA cartel could receive a "prescription" from Wal-Mart on learning how to foster innovation, as opposed to stagnation, to maintain relevance. Other organizations, such as the American Academy of Pediatrics, instead of attempting to compete, intransigently and stubbornly cling to their antediluvian practices by merely writing position papers opposing retail clinics such as Wal-Mart.

Indeed, almost any healthcare service will have to lower its prices to compete with Wal-Mart. Competition will likely increase and there will be more healthcare and retail clinics that offer similar services at competitive prices. The more profits that Wal-Mart obtains through this service, the more competition there will likely be to strive for a portion of consumer's money — thus we see the important function of profits in the economy. Typical public opinion has the causal link exactly backwards: the more profits a company earns (in a free market), the better it is serving its consumers, i.e., the more they are demanding its services. They should be exalted for their efforts (and profits), not condemned.

In the spirit of competition, self-interested entrepreneurs will strive to serve the consumer better than their rivals. This will result in more affordable healthcare for more people — something the government could never achieve, regardless of any mixture of force, money, and bureaucracy; in fact, any government intervention will only stifle this "healthy" process.

The market, to the extent it is able to work freely, would lower healthcare prices while increasing quality; to the extent that government is involved, expect higher-priced and lower-quality services — and more bureaucracy. Wal-Mart and other retail clinics have raised the bar for competitors by lowering costs and innovating. In a world where government power is growing and seizing — and ceasing — liberty, and suppressing innovation that takes place in a free market, private companies such as Wal-Mart that continue to take risks and innovate provide hope for the future.

Source




Australia: Incompetent ambulance phone operator kills man

A man suffered a heart attack and died while an ambulance called for him went to the wrong address, the Opposition has told State Parliament. State Opposition Leader Lawrence Springborg today highlighted the case of 62-year-old Bob Silman, who suffered a heart attack on November 2 near Mackay. His wife Lorraine called an ambulance to their Pleystowe address, just 10 minutes from the local ambulance station. But Mr Silman died during a 40-minute wait for paramedics, who were dispatched to number 2, instead of the Silman's address at number 20. Mr Springborg said the tragic case brought to attention a substandard ambulance response service.

Health Minister Stephen Robertson said the case was a sad one but call centre staff were professionals who were trained to deal with stressed callers. "There have been instances where, because of the distressed nature of the caller, it has been difficult to identify the precise address," he said. Mr Robertson said initial advice suggested the delay at the Silmans' home was due to an inaccurate address being provided to the responding crew. "I am not placing any blame on any individual, but that is the advice I have received on that matter," he said.

But the triple-0 call log shows Mrs Silman repeatedly tried to clarify her address with the confused operator. Mr Springborg told reporters the dispatch system was wrong - not Mrs Silman - and the Government should apologise. "She went through the most extraordinary and excruciating painful process in trying to convince the call centre that they had the information on her property address wrong," he told reporters. "Despite this Government taxing Queenslanders more and more in the boom times, they have managed to get it wrong today and it has actually ended in tragic circumstances."

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5 December, 2008

Improving the Individual Health Insurance Market

People purchasing health insurance in the individual market face double-jeopardy: Unless they are eligible for the self-employment tax deduction, they must pay for coverage with after-tax dollars, and they also face the full plethora of state insurance mandates and regulations. Despite these encumbrances, the individual market functions much better than conventional wisdom assumes. Lifting burdens on the individual market - rather than adding new ones - could enable it to become an important base for expanded health coverage.

Policy changes that are needed include allowing the purchase of health insurance across state lines to create a more competitive market, strengthened guaranteed renewal protections, and new purchasing arrangements to help those with pre-existing conditions obtain coverage. In addition, new tax subsidies to help the uninsured buy coverage could, if properly structured, power-boost the purchase of more affordable, portable coverage.

A reality test: Before policymakers attempt to fix the individual health insurance market, it is important to get a clearer picture of what is actually happening in this sector where an estimated six percent of privately-insured people obtain coverage. Prevailing wisdom holds that "there is agreement that the market for buying health insurance as an individual doesn't work well," and some argue that this market is hopelessly expensive and dysfunctional.

However, actual research demonstrates otherwise. Mark Pauly and Brad Herring1 looked not just at hypotheticals, as some surveys have done, but at actual people shopping for and purchasing insurance in the individual market. They find there is more pooling of risk in the individual market than commonly believed: "Analysis of new data.shows that actual premiums paid for individual insurance are much less than proportional to risk, and risk levels have a small effect on obtaining coverage." They also found that the premiums that higher-risk people actually paid were only, on average, about 1.6 times those of lower-risk people.

Caution ahead: Policymakers should be very cautious about adding more regulatory burdens to this market. We can look at the evidence in states that have tried various levels of regulation of their health insurance markets, especially with community rating and guaranteed issue, to see the impact. Efforts by state legislators to "fix" the individual market often backfire.

Community rating, for example, means that lower-risk purchasers pay a higher price for insurance than people with greater risks. This is a formula for adverse selection, especially in a guaranteed issue environment. People have an incentive to wait to purchase health insurance until they need medical services rather than pay an artificially high price for continuous coverage they may not use. This leads to an increase in the number of people without health insurance, the opposite of the desired result. Pauly finds that, "The effects of adverse selection in nongroup markets are most severe in states with community rating and guaranteed-issue rules for the individual market." Others argue that these problems could be mitigated if an individual mandate for purchasing health insurance were to be imposed, but that would be a very heavy political lift in the current environment.

Three recommendations to improve the individual health insurance market:

A national market for health insurance: Giving people more options to purchase coverage across state lines would generate a much more competitive market so people are not trapped by the expensive mandates and regulations in their states.

University of Minnesota economist Steve Parente and colleagues showed2 that opening up competition among the states for health insurance would mean an additional 12 million people could get health insurance without any new spending by the federal government (an important consideration in the current fiscal climate). This would allow people trapped in states with community rating, guaranteed issue, and excessive mandates to shop for policies in other states where premiums are more affordable and policy options are more flexible. Some may select a high-deductible plan, but people should have a range of options to find the ones that best suit their needs.

Critics charge, however, that this would open up the Wild West of unregulated health insurance where people would be faced with policies that don't cover even the most basic medical needs. But every state regulates its health insurance markets to assure, not only the solvency of companies offering the coverage, but that the policies actually offer responsible insurance coverage.

Allowing interstate commerce in health insurance would lead to larger pools and more competition among companies offering coverage, spreading risk and reducing costs. Health insurance companies are worried about disrupting their current books of business if healthy individuals can opt out of their current pools to find more affordable coverage elsewhere. But bringing millions more people into the market will expand their pools. Further, new programs to give those with higher-health risks better options for coverage will further stabilize the market.

Guaranteed renewal protections: After the initial purchase, almost all individual insurance is "guaranteed renewable" at class-average rates. That means that insurers cannot increase premiums differentially based on health risk for people seeking to renew their policies. Pauly and others have shown that people in individual markets are largely protected against future reclassification risk. Guaranteed renewability stabilizes markets by providing an incentive for people to purchase health insurance when they are healthy and to maintain continuous coverage. This HIPAA protection should remain in force and be strengthened where necessary.

Expanding access: At least two groups have developed plans that would enable people with pre-existing conditions to enter the insurance market and obtain coverage at affordable rates. America's Health Insurance Plans3 and the National Association of Health Underwriters4 have developed plans that would allow more people to obtain private insurance by cross-sharing risk among companies participating in a specified market. In addition, federal funds could supplement state funds to create more functional high risk pools in the states. When properly structured, these risk pools, coupled with a mechanism for guaranteed access to insurance, could produce a more stable health insurance market.

Some people will need special assistance because their health risks are above normal, their incomes are low, or both. A guaranteed access program also could be a mechanism to provide additional subsidies to them.

The individual market for health insurance is more functional than commonly believed. The challenge for policymakers is not to repeat the mistakes of states that have been overly aggressive in regulating their individual insurance markets. Rather, they should allow more flexibility, more competition, and sensible protections. This means allowing people to buy coverage across state lines, allowing all policies to be guaranteed renewable at reasonable rates, and creating new guaranteed access programs. Combine this with new subsidies to individuals for the purchase of health insurance in the form of refundable tax credits and we could open a new interstate highway to expand access to health insurance in the individual market.

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Complacency over wrongly-dosed children at an Australian public hospital

Health officials and the State Government have again been forced to admit potentially harmful mistakes in the treatment of patients - this time involving children. Eleven children suffering cancer were overdosed with chemotherapy, a failure caused by human and computer error and perpetuated for at least three years. The fault was only picked up by a "nervous" new staff member who double checked a reading at the Women's and Children's Hospital.

The systematic failure is the second of its kind revealed this year, and comes amid doctors' claims that South Australia's health system is dangerously overburdened and understaffed.

The latest bungle, discovered in October, was only revealed yesterday, the day after State Parliament rose for the year, raising questions of a cover-up. Eleven of 72 patients treated at the WCH since 1998 received too much of the chemotherapy drug etoposide phosphate. The children were aged from one to 15 years, and the average overdose was 13.6 per cent. One child has since died from cancer and one family is yet to be contacted about the overdose.

'An independent review by Sydney Children's Hospital paediatric oncologist Associate Professor Marcus Vowels found that although it was "unlikely", it was an "open question" whether the overdose could increase the risk of secondary cancers.

In an incident earlier this year, 869 Royal Adelaide Hospital cancer patients were underdosed with radiotherapy, which could have cut five lives short. Staffing problems were found to be the main contributing factor to that calibration error. The latest mistake has prompted Opposition calls for State Health Minister John Hill to be sacked.

Etoposide phosphate is an alternative form of the more common etoposide. When it was first used at the WCH in 1998, a computer program adjusted the dosage to take into account the fact it was a slightly different drug. In 2005, manual adjustments were introduced as well, so the dose was adjusted twice, giving a higher-than-planned dose.

"Over the . . . years from 1998 (to) 2004, `corporate knowledge' in the Oncology Unit was lost, with three senior members of staff leaving senior roles," Professor Vowels reported. "Oncology staff continued using etoposide phosphate and dose calculations were made by the oncologists in the clinic, not being aware that a computer program was already performing this task."

WCH chief executive officer Gail Mondy said a "very novice staff member" who was "very nervous about the system" double checked the calculations at the end of October. Ms Mondy was notified on November 17 and an investigation began on November 25. SA Health chief executive officer Tony Sherbon said the error would have been discovered anyway "in due course", and the fact that it was discovered in a random check showed the system was working. He said the mistake was "a team error".

Cancer Voices SA executive Ashleigh Moore was one of the people who was underdosed at the RAH. He said the system must be fixed "so this never, never happens again". "You expect to get what your clinician has planned. You don't expect to get less or more than that," he said.

Opposition health spokeswoman Vickie Chapman said Mr Hill and Mr Sherbon should be sacked for covering up a major scandal. "It is disgraceful an investigation into the incorrect treatment of 11 children in a public hospital was conducted while the Parliament was sitting and the Government failed to inform South Australians," she said. "Children receiving incorrect treatment at the WCH is bad enough. "To then conceal the matter is unforgivable."

Mr Hill said that when he heard about the mistake two weeks ago, he ordered an investigation and review. He has now referred the matter to the SA Safety and Quality Council. "We have an excellent health care system in SA. It's one of the best in the world," he said. "We've seen two errors . . . one in relation to radiotherapy and one in relation to chemotherapy. They're not related in any way at all. "The only thing that makes them noticeable is that awareness of the errors occurred within a few months, but that demonstrates a system that is open about it. We've made no attempt to hide it." He said telling the public about the investigation before it was complete would have panicked many and "would have been an appalling thing to do".

Mr Hill, Mr Sherbon, and Ms Mondy said no parents should be concerned, but if anyone wanted further information they should phone the WCH Chemotherapy Info Line on 8161 6180.

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4 December, 2008

Critically ill patient shuffled from one Australian State to another: NSW to Queensland

Another failure of the NSW public hospital system. And Queensland is pretty bad too -- as shown by the fact that it was only a private hospital that could take the patient

A woman critically injured in a car crash had to be flown to Queensland for treatment as not one NSW hospital could treat her. Georgie Batterson endured a 400km helicopter flight to Southport on the Gold Coast for emergency surgery after Saturday's crash on the Pacific Highway near Kempsey. She was refused admission to every hospital in Sydney and Newcastle as the entire NSW hospital system was on "code red", meaning no space could be found for her.

The 56-year-old Kempsey woman's shocking story emerged as her husband Ian, also injured in the accident, finally tracked down where his wife had been taken. Mrs Batterson is now in an induced coma in a private hospital on the Gold Coast - with broken ribs, a collapsed lung, broken pelvis, broken leg and a shattered ankle.

The Daily Telegraph can reveal that a trauma doctor with the Westpac Rescue helicopter spent two hours on Saturday night calling hospitals in Sydney as well as Newcastle's John Hunter "begging" them to take her as she lay strapped to a trolley, critically injured and crying in pain. He was told not one of the 400 intensive care beds in NSW was free. It was then that rescue helicopter pilots made the decision to fly Mrs Batterson to Queensland.

Mr Batterson yesterday told The Daily Telegraph he was traumatised by what his wife had to endure. "As far as nurses and emergency staff at Kempsey, they were perfect . . . absolutely 150 per cent," he said. "There is something seriously wrong when you can't get treated in your home state. The pilot was desperately asking them where he was going. The trauma bloke said, 'Bugger it, we'll go to Queensland'."

NSW Nationals leader Andrew Stoner said the Battersons' story was a "disgrace". "This State Government has become so dysfunctional it can't meet its basic responsibilities," he said.

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3 December, 2008

How NHS betrayed Alzheimer's patients: A third of services are slashed

The scandal of widespread cutbacks in NHS care affecting thousands of Alzheimer's patients is exposed today. Almost one in three health trusts admits axing vital services such as district nurses and day centres, leaving desperate families to struggle alone. Fewer than half are running clinics to spot early signs of Alzheimer's despite soaring numbers of patients. And, most damningly, two in five trusts fail to provide any dementia services at all.

The disturbing findings are unveiled as the Daily Mail launches Action on Alzheimer's, our Christmas appeal to raise funds for those with this devastating disease and other dementia conditions. Celebrities including Sir Cliff Richard and broadcaster Angela Rippon have given their heartfelt support to the campaign.

The findings on NHS care, from a survey carried out for the Alzheimer's Society, shows that help has never been more needed. Around 700,000 people have dementia in Britain, costing the nation 17billion pounds a year. This number is on course to reach a million by 2025 as the population ages, according to official estimates.

Best-selling author Terry Pratchett, who was diagnosed with a rare form of dementia last year, recently warned Prime Minister Gordon Brown that Britain faces a 'tsunami of Alzheimer's' unless more funding for a cure is found.

Given the scale of the emergency, 98 per cent of primary care trusts insist dementia is one of their top priorities. Yet the survey carried out for the Alzheimer's Society by GP magazine lays bare the reality for thousands of sufferers and their families. It shows services may be getting worse - not better - despite the NHS budget doubling to almost 100billion a year and a new dementia strategy for healthcare staff.

Results from Freedom of Information requests found 30 per cent of primary care trusts have closed or downgraded dementia services in the past three years. This includes slashing the number of district nurses providing support for those with the disease, or closing day centres for Alzheimer's sufferers. An astonishing 40 per cent of trusts admitted they did not provide any specific dementia service at all. Forty-one per cent said they had no early detection services or clinics. The figures could be far worse because only 57 out of England's 152 primary care trusts responded to the survey. Campaigners fear those who did not reply had even worse services.

Neil Hunt, chief executive of the Alzheimer's Society, said: 'The NHS is completely failing to face to the fact that we have a serious issue here, not just in terms of numbers but in terms of the terrible impact of dementia on an increasing number of sufferers or their families. 'If we were talking about cuts to services for another disease, such as cancer, there would be a national outcry, and the NHS would not be able to get away with it.

'What we need the NHS to do is to detect the signs of dementia, diagnose it early, break the news properly and offer sources of help. That is not happening. 'Patients have told us that early diagnosis helps them make plans and get support in place before things get really bad. 'Services have always been patchy across the NHS but to hear PCTs are cutting them back is too much.'

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2 December, 2008

NICE to rethink its ban on life-extending kidney cancer drugs

Great to have bureaucrats deciding whether you will live or die!

The NHS rationing watchdog could be forced into a humiliating U-turn over its ban on life-extending kidney cancer drugs within weeks, it emerged yesterday. The National Institute for Health and Clinical Excellence is expected to give the green light to at least two medicines previously rated as "too expensive" early in the New Year. The climb down will be a major victory for patients and cancer doctors and could extend the lives of up to 3,600 people with advanced kidney cancer.

Nice provoked a massive row in August when it unveiled plans to ban four drugs for advanced kidney cancer on the NHS - Sutent, Nexavar, Avastin and Torisel. Although the drugs are widely available in other countries including France, Germany, Spain, Mexico, Argentina and South Korea, Nice ruled that their cost - around 70,000 pounds a year per patient - made them too expensive for the NHS.

Cancer specialists say Sutent is the most important breakthrough in kidney cancer in the last three decades and can extend patient's lives by up to two years. They described Nice's previous decision to ban the drugs on cost grounds as "unfair and inhumane" and warned that patients would be condemned to an early death.

Yesterday Nice confirmed that it was looking again at the drugs in the light of new evidence about their effectiveness. A meeting in January will draw up new guidance on all four treatments. Nice is also under pressure to be more flexible in weighing up the cost effectiveness of drugs that don't cure patients - but which can give extend their life. A meeting in January will draw up new guidance on all four treatments. The final decision is likely to hinge on whether the price of one or more of the drugs can be reduced - or on drugs companies comping up with a "risk sharing" scheme in which they partly subsidise the final.

However there is growing optimism among senior cancer specialists and charities that at least two of the four drugs could get a reprieve. Pat Hanlon of the charity Kidney Cancer UK, said: "No decision has been made by Nice and we are still campaigning for the ban to be lifted, but we have reason to be hopeful."

Since Nice banned the drugs in August, research from America found that Sutent was more effective than previously thought. The reappraisal was also prompoted by a Government review into the way drugs for terminally ill patients are assessed by Nice. Under its current rules, Nice rarely approves drugs that cost more than 30,000 per patient per year even if they extend lives. The review will look at raising this figure - which many doctors claim has been plucked out of thin air. "These drugs are available all over the world and the UK is lagging behind other countries," said Mr Hanlon.

The drugs are expensive because advanced kidney cancer is not a common disease. That means the huge cost of researching and developing the drugs has to be covered by a relatively low level of sales. Over the last few weeks Pfizer and Roche, which make Sutent and Avastin, have been in talks with the Department of Health about the cost of the drugs. Pfizer is understood to have offered to cut its price by five per cent.

Nice said its appraisals committee was looking again at its draft guidance for kidney cancer drugs because new evidence had emerged - but that the decision had not been made. "We will publish a next draft within four weeks of the committee's meeting in January and issue final guidance in March 2009," a spokesman said.

Around 7,000 people are diagnosed with kidney cancer in Britain each year. The disease progresses to the advanced stage in around 1,700 cases annually. Around 3,600 patients in Britain would benefit from Sutent. Without the new drugs, patients are left with one other medicine on the NHS - Interferon. The drug does not work for all patients.

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1 December, 2008

Insane NHS bureaucracy

Paying government employees more seems to be their main aim in life. Too bad about getting anything for the increased pay

An NHS nurse has broken the 100,000 pounds sterling ($200,000) barrier for the first time as health staff cash in on generous incentive schemes. The nurse consultant in Rotherham, South Yorkshire, has doubled her basic salary of 50,000 by working overtime under an NHS initiative to bring down waiting lists. On this rate she would be hit by the tax raid launched by Alistair Darling against high earners - a startling indication of how public-sector workers have prospered under Labour.

Figures obtained by The Sunday Times under the Freedom of Information Act suggest dozens of NHS nurses now earn more than 60,000 a year. The incomes of hospital doctors have also rocketed, with many consultants' NHS earnings exceeding 200,000. One consultant at the Royal Devon and Exeter NHS Foundation Trust was paid between 225,000 and 229,000 in the last financial year. A consultant at Tameside Hospital NHS Foundation Trust in Ashton-under-Lyne, Greater Manchester, earned 228,000.

Consultants' basic salaries are being boosted by bonuses, or clinical excellence awards, and by payments to bring down waiting lists. One doctor at Gateshead Health NHS Foundation Trust was paid an extra 50,000 in the last financial year to help cut waiting times. Labour has promised to meet a waiting-times target of 18 weeks by the end of December. There are no set national overtime rates. They are negotiated between trusts and their nurses and doctors, and are not publicly available.

The generous payments are controversial at a time of economic hardship. The health department has already been accused of awarding unduly generous new contracts to NHS employees without achieving better treatment for patients. A recent report by the Commons public accounts committee found that a new contract for hospital consultants boosted their pay by 27% without any measurable improvements in productivity.

The disclosure of nurses' true incomes challenges the perception that they are all poorly paid. Last month the Royal College of Nursing, a nurses' union, claimed members were struggling to make ends meet. An appeal was launched last year to ask Premier League foot-ballers to donate a day's pay to a fund for impoverished nurses.

The nurse who earned between 100,000 and 105,000 in the last financial year is a "nurse consultant", one of the top grades of the profession, employed by the Rotherham NHS Foundation Trust. The NHS employs more than 800 nurse consultants in England. Their roles can range from running clinic sessions advising patients on how to manage conditions such as diabetes, to performing minor surgery to remove cysts and moles. They also carry out research.

A newsletter published by the Rotherham trust last year said it had four nurses on this grade. It featured one nurse consultant, Julie D'Silva, who carries out endoscopies - internal examinations often inside the stomach. In another issue D'Silva spoke about her contribution to cutting down the waiting list: "We have put in a great deal of effort to deliver the best service we can to the people of Rotherham. However, we don't want to stop there and we hope that in time we will manage to get waiting times down even more."

This weekend the trust said that for reasons of privacy neither it nor D'Silva would confirm whether she was the nurse who had earned in excess of 100,000. A spokesman defended the extra payments: "The trust is very clear that these payments represent good value for money with real and tangible benefits to patients."

A full-time nurse consultant normally works about 37.5 hours per week. Under the European working time directive, nurses should not do more than 48 hours a week. The trust declined to disclose how many extra hours the nurse was working for her additional 50,000.

The FOI returns show many nurses have annual incomes in excess of 60,000. A nurse at Buckinghamshire Hospitals NHS Trust had an income of 71,000, while a nurse at Sandwell and West Birmingham Hospitals NHS Trust earned 61,000. Official figures for September 2008 show NHS nurses had an average annual income, including overtime, of 31,600, while the average consultant salary was 119,200.

The British Medical Association, the doctors' union, advises members they can maximise extra NHS payments if there is no competition from private firms in the area. Consultants are estimated to be paid 600-900 for four-hour shifts to cut waiting lists.

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Tasmanian public hospital waiting lists continue to grow

It's a problem in the public hospital systems of all Australian States -- though NSW and Queensland seem to be the worst

The waiting list for elective surgery in Tasmania increased by almost 10 per cent in the three months to the end of September, compared with the same period last year. New figures from the Health and Human Services Department show that at the end of last September, the number of patients waiting for elective surgery was 8,600. That's a jump of 9.9 per cent from the end of September 2007, when about 7,800 people were waiting.

The department's Progress Chart, which has just been released, says the waiting list will continue to grow because of Tasmania's ageing population and increasing rates of chronic disease.

Other figures show the number of women screened for breast cancer in the September quarter dropped by 9 per cent, compared to the same quarter in 2006.

The number of adults getting dental treatment increased by 15 per cent.

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