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31 October, 2007

Out-of-hours NHS care 'failing'

The NHS is failing to offer sufficient out-of-hours GP care for severely ill patients, experts have said. Existing services are "inadequate and inflexible" and there is a need for better diagnostic facilities, the Royal College of Physicians taskforce said. The group also said hospital care needed to be redesigned for those with non-life threatening life conditions that none-the-less require treatment. The government said care was improving after record investment.

The taskforce, which included a range of health professionals, looked at acute medical care. This includes the care of patients with respiratory problems or chest pains or complications linked to epilepsy or diabetes, which are not yet emergencies but could become so. The taskforce said poor standards of weekend and evening GP cover, which is now done by co-operatives of health professionals and private firms after family doctors were allowed to opt out in 2004, was forcing some patients to turn up at hospital for "reassurance".

The report recommended that local navigational hubs be set up to sign-post patients to the right services. And it called for specialist outreach clinics to be set up in the community to bring expert care out of hospitals. It said out-of-hours cover needed better access to diagnostic facilities, which includes scans and blood tests, to create a "see and treat" culture rather than the "see and greet" one that currently exists.

The experts also said hospital services needed to be redesigned to ensure "rapid streaming of patients". The experts said that all too often even patients already in hospital can find themselves moving slowly through the system seeing nurses, junior doctors and then consultants when they really need urgent help. They said acute medical units, rapid assessment, diagnosis and treatment centres which are becoming increasingly common in hospitals, need to be located near other key services such as the emergency department and critical care.

RCP president Professor Ian Gilmore said NHS professionals were facing a challenge - "to change what we do, when we do it and how we do it". He added: "For doctors, nurses, managers and all those involved with the care of acutely ill patients, this task will not be easy, but the status quo is not an option if we are to give these patients a consistently high standard of care."

Health Minister Ben Bradshaw said the government welcomed the report but was already making sure that people have access to care around the clock. "Primary Care Trusts must deliver high quality out-of-hours care, and in addition, patients have access to a range of other services that can provide urgent care out-of-hours including NHS Direct and NHS walk-in centres," he said. "We have invested record amounts in out of hours services and patients are seeing the benefits - eight our of ten patients say that they are satisfied with the service, and six out of ten rated the service as excellent or good."

Source




Australia: Another butcher doctor still operating in Queensland -- a "Professor", would you believe?

Queensland seems to specialize in "overconfident" doctors. The scum is now in private practice. Woe to Brisbane women!



A prominent member of the Brisbane medical establishment has been charged with manslaughter after he allegedly sliced open a woman's vein in a botched operation then prescribed blood-thinning drugs that hastened her death. Before the Dr Death scandal that brought about major health reforms in Queensland, Nardia Annette Cvitic, who was suffering from cervical cancer, went to Brisbane's Mater Hospital to have a hysterectomy performed by Bruce Ward. The 30-year-old collapsed in hospital three days after the operation, having lost half her blood volume. She died on February 22, 2002, despite having undergone emergency surgery, where Dr Ward's initial response of a double-dose of blood-thinning drugs was overruled by experts summoned by his worried colleagues.

Trained in Australia and Britain, Dr Ward - who maintains he is a good doctor - was working at the Mater and Royal Women's hospitals at the time of the death of the mother of two; he was a professor at the University of Queensland and remains a fellow of the Royal Australian College of Obstetricians and Gynaecologists. The Australian revealed last year that the Mater approached Cvitic's family to offer an out-of-court settlement in 2003 - eventually paying out $175,000 for her two young sons.

Dr Ward is understood to have been retrained after Cvitic's death. He has unrestricted registration through the Queensland Medical Board and was released on bail yesterday after Deputy State Coroner Christine Clements formally charged him with manslaughter. Ms Clements used the old Coroner's Act to charge Dr Ward with manslaughter, 18 months after the inquest into the death finished. In the inquest, Ms Clements heard evidence that the bloodied operating theatre at one point resembled the aftermath of the Granville train disaster in NSW in the 1970s.

While Dr Ward testified that he made reasonable, albeit incorrect, clinical decisions, Ms Clements found 13 instances where a properly instructed jury might find him criminally negligent and responsible for the death. Dr Ward declined to respond to the charge yesterday, leaving his barrister, David Tait, to continue his defence in the media, again extending his sympathies to the Cvitic family. Mr Tait said his client was devastated by her death and disappointed by Ms Clements's decision. "Over 20 years he has looked after thousands of women in Queensland for serious gynaecological cancers and, indeed, he has dedicated his life to medicine and to helping women in this position," Mr Tait told reporters, reading from a prepared statement. "Dr Ward is adamant that he has done nothing wrong, he has committed no criminal offence."

Cvitic's elder sister, Helen Liversidge, who was in court to hear Ms Clements's findings, said she was pleased with the result. Describing her sister as "very fun-loving, happy, vivacious young lady, full of life", Ms Liversidge said she had lost the opportunity to see her children grow up. "Her eldest son is now starting his first day as a butcher," she said.

Ms Clements was supportive of the reforms undertaken at the Mater, and across the health system, since the death, but lamented the lack of closer monitoring for blood and fluid loss. "If this had been recorded and coupled with so-called standard blood tests ... the problem of blood loss might have been identified earlier," Ms Clements said.

Ms Liversidge said she believed the reforms introduced after her sister's death were already saving lives. "My sister's death has helped a lot of people," she said. Under the 2003 Coroners Act, Queensland coroners are only able to recommend that charges be laid against a person. However, because Cvitic's death occurred before the law change, Ms Clements was able to charge Dr Ward under legislation passed in 1958.

Source





30 October, 2007

Brits don't recognize Michael Moore's picture of their health system

The fourth estate has always had a bad name, but it seems to be getting worse. Journalism should be an honest and useful trade, and often still is. But now that journalism has more power than ever before, it seems to have become ever more disreputable. In recent years it has been brought lower and lower by kiss-and-tell betrayals, by "reality" TV, by shockumentaries and by liars, fantasists, hucksters and geeks of every kind, crowing and denouncing and emoting in a hideous new version of Bunyan's Vanity Fair.

Outstanding among these is Michael Moore, the American documentary maker. He specialises in searing indictments, such as Fahrenheit 9/11 and Bowling for Columbine, and has, without a doubt, a genius for it. Although his films are crude, manipulative and one-sided, he is idolised by millions of Americans and Europeans, widely seen as some sort of redneck Mr Valiant-for-truth.

Nothing could be further from the truth. His latest documentary, Sicko, was released in cinemas last week. Millions of people will see it and all too many of them will be misled.

Sicko, like all Moore's films, is about an important and emotive subject - healthcare. He contrasts the harsh and exclusive system in the US with the European ideal of universal socialised medicine, equal and free for all, and tries to demonstrate that one is wrong and the other is right. So far, so good; there are cases to be made.

Unfortunately Sicko is a dishonest film. That is not only my opinion. It is the opinion of Professor Lord Robert Winston, the consultant and advocate of the NHS. When asked on BBC Radio 4 whether he recognised the NHS as portrayed in this film, Winston replied: "No, I didn't. Most of it was filmed at my hospital [the Hammersmith in west London], which is a very good hospital but doesn't represent what the NHS is like."

I didn't recognise it either, from years of visiting NHS hospitals. Moore painted a rose-tinted vision of spotless wards, impeccable treatment, happy patients who laugh away any suggestion of waiting in casualty, and a glamorous young GP who combines his devotion to his patients with a salary of 100,000 pounds, a house worth 1m and two cars. All this, and for free. This, along with an even rosier portrait of the French welfare system, is what Moore says the state can and should provide. You would never guess from Sicko that the NHS is in deep trouble, mired in scandal and incompetence, despite the injection of billions of pounds of taxpayers' money. While there are good doctors and nurses and treatments in the NHS, there is so much that is inadequate or bad that it is dishonest to represent it as the envy of the world and a perfect blueprint for national healthcare. It isn't.

GPs' salaries - used by Moore as evidence that a state-run system does not necessarily mean low wages - is highly controversial; their huge pay rise has coincided with a loss of home visits, a serious problem in getting GP appointments and continuing very low pay for nurses and cleaners.

At least 20 NHS trusts have even worse problems with the hospital-acquired infection clostridium difficile, not least the trust in Kent where 90 people died of C diff in a scandal reported recently. Many hospitals are in crisis. Money shortages, bad management, excesses of bureaucrats and deadly Whitehall micromanagement mean they have to skimp on what matters most.

Overfilling the beds is dangerous to patients, in hygiene and in recovery times, but it goes on widely. Millions are wasted on expensive agency nurses because NHS nurses are abandoning the profession in droves. Only days ago, the 2007 nurse of the year publicly resigned in despair at the health service. There is a dangerous shortage of midwives since so many have left, and giving birth on the NHS can be a shocking experience.

Meanwhile thousands of young hospital doctors, under a daft new employment scheme, were sent randomly around the country, pretty much regardless of their qualifications or wishes. As foreign doctors are recruited from Third World countries, hundreds of the best-qualified British doctors have been left unemployed. Several have emigrated.

As for consultants, the men in Whitehall didn't believe what they said about the hours they worked, beyond their duties, and issued new contracts forcing them to work less. You could hardly make it up.

None of these problems mean we should abandon the idea of a universal shared system of healthcare. It's clear we would not want the American model, even if it isn't quite as bad as portrayed by Moore. It's clear our British private medical insurance provision is a rip-off. I believe we should as a society share burdens of ill health and its treatment. The only question is how best to do that and it seems to me the state-run, micromanaged NHS has failed to answer it.

By ignoring these problems, and similar ones in France's even more generous and expensive health service, Moore is lying about the answer to that question. I wonder whether the grotesquely fat film-maker is aware of the delicious irony that in our state-run system, the government and the NHS have been having serious public discussion about the necessity of refusing to treat people who are extremely obese.

One can only wonder why Sicko is so dishonestly biased. It must be partly down to Moore's personal vainglory; he has cast himself as a high priest of righteous indignation, the people's prophet, and he has an almost religious following. He's a sort of docu-evangelist, dressed like a parody of the American man of the people, with jutting jaw, infantile questions and aggressively aligned baseball cap.

However, behind the pleasures of righteous indignation for him and his audience, there is something more sinister. There's money in indignation, big money. It is just one of the many extreme sensations that are lucrative for journalists to whip up, along with prurience, disgust and envy. Michael Moore is not Mr Valiant-for-truth. He is Mr Worldly-wiseman, laughing behind his hand at all the gawping suckers in Vanity Fair. Don't go to his show.

Source





29 October, 2007

Australia: THE QUEENSLAND PUBLIC HOSPITAL SYSTEM IS STILL STAGGERING

It's not only the State of NSW that has big problems. Three reports below


Public hospital negligence destroys a baby's future

How would YOU like to send your baby to hospital with diarrhoea and get him back with a damaged brain? It didn't happen to me. When my son developed gastro problems in his early childhood, he was taken to a top private hospital and immediately put on a drip. He was not released until he was well again. He is now a 6' tall healthy wealthy and happy mathematician. Working hard and saving your money really helps. Spending it as you get it is negligent because trusting your children to the government is negligent -- as negligence is all you can reliably expect from any government system. Negligence works in its own way too -- a very sad way, as we see below:

A year ago baby Ryan Mason was a happy, healthy newborn, delighting his young parents with his smiles. But at just 11 weeks Ryan developed severe brain damage after being sent home from Caboolture Hospital while allegedly still dehydrated and suffering gastroenteritis. A few hours after arriving home the baby turned blue, stopped breathing and suffered cardiorespiratory arrest while his parents rushed him back to hospital. Ryan was flown to Royal Brisbane Hospital, where his 22-year-old parents, Teisha-Lee and Tim Mason of Toorbul, north of Brisbane, were told he had brain damage. Ryan, now 13 months, developed cerebral palsy, cannot hold his head up or control his arms and may have vision problems.

A claim for damages for personal injuries has been served on Queensland Health, along with an expert's report, by Quinn and Scattini Lawyers. Dr John Raftos, a senior Sydney emergency medicine specialist, said in the report it was his opinion that if hospital staff "had properly assessed and treated Ryan's gastroenteritis and dehydration he would not, on balance of probabilities, have developed hypovolaemic shock and permanent brain damage".

Ryan had been having bouts of diarrhoea when Mrs Mason first took him to Caboolture Hospital on December 10 last year. He was diagnosed with gastroenteritis and sent home, but the next day he was admitted and treated with intravenous fluids for dehydration. Mrs Mason said that during his second night Ryan had diarrhoea every 20 minutes from midnight until 5am on December 13 and was screaming.

Medical records showed that a pediatric team ordered that Ryan and his wet nappies be weighed four times a day to check on his rehydration. Dr Raftos said in his report this was not done and in his opinion Ryan was discharged home while still dehydrated. Lawyer Damian Scattini said Ryan's case was "another preventable tragedy brought about by systems failure within a Queensland public hospital".

A Queensland Health spokeswoman said the department could not comment on legal proceedings.

Source




State government caves in on one hospital

With a "fudge" that would do the British proud. A "British fudge" is a bit hard to define but it is basically a partial retreat or concession that is disguised as not being a retreat or a concession

The crisis at Brisbane's Princess Alexandra Hospital has been solved, with all beds to be reopened and surgery restored after cancellations. A budget blowout had forced the hospital to turn away the sick last week, with 60 beds closed and 20 per cent of operating theatre procedures cancelled. But Premier Anna Bligh stepped in yesterday and ordered the impasse be resolved. She eased the squeeze on hospital budget constraints - giving the PA an extra year to balance the books - and hinted that extra funds would be handed over in December.

The situation had been in deadlock with PA management and the Australian Medical Association Queensland accusing the Queensland Government of under-funding one of the state's biggest public hospitals. Ms Bligh had refused extra money for the hospital, saying it had to manage on a record $33 million budget increase this year. An eight-hour "bypass" on Wednesday, when all new patients were redirected to another hospital, made the emergency worse.

But Ms Bligh - as she did with the Caboolture Hospital ER crisis two years ago - brokered a peace deal with the AMAQ and hospital managers. There was no initial new money, but sources said the PA Hospital would be well compensated by the Government at the mid-year Budget review. Ms Bligh told The Sunday Mail the agreement would see the projected budget over-run of $18 million progressively reduced over the next 18 months rather than in the current financial year.

She said PA chief executive officer Dr David Theile would introduce efficiency measures, including replacing nursing agency staff with Queensland Health-employed nurses. "This agreement, achieved after constructive talks between the Government, hospital managers and the AMAQ today, is good news for patients," Ms Bligh said. "The PA Hospital will progressively reopen beds and restore theatre lists. This will enable the hospital to return to full activity within a few weeks. "I have restated my commitment to reviewing the need for any increase in the PA Hospital's budget, along with all other public hospitals, in the mid-year Budget review. "Further, the Government will review funding needs for the whole public health system for 2008-09 and following years, as part of the Budget process early next year."

Ms Bligh and Dr Theile had clashed last week, with the Premier saying taxpayers were "entitled to see strong management ensuring that budgets are maintained". She denied a Government backflip on the issue yesterday after sending in her Director-General Ken Smith to negotiate with hospital management and the AMAQ. Ms Bligh said the Government would work with the hospital to manage its budget to ensure clinical standards were maintained, beds were reopened and theatre lists restored.

Leading PA visiting medical officer and AMAQ president Ross Cartmill welcomed the agreement and said the resolution was in the best interest of patients. "The Government's commitments today give me the confidence the PA Hospital can continue to provide top-quality service to our patients now and into the future," he said.

Source




Hospital pen-pusher jobs on increase

ALMOST two-thirds of new appointments in Queensland public hospitals are non-medical, latest figures reveal. From May 2005-2006, Queensland Health boasted, clinical staff increased by 1200, but official figures show that 3196 extra staff were employed. A report stated that Queensland Health spent 82 per cent more on administration than any other state. [Because it is Australia's oldest "free" hospital system (started in 1944) and the cancer of bureaucracy has had longer to grow]

Liberal leader Bruce Flegg said money was being wasted on pen pushers: "Patients should not have to suffer because the numbers aren't right in the budget. Cuts should have been made from non-clinical areas." The Australian Medical Association said no cuts had been made to administration staff at the PA, but patients' operations had been cancelled.

Queensland AMA president Dr Ross Cartmill, who works at the PA, urged QH to investigate how many non-clinical staff were employed. "There are two types of non-clinical staff - the clinical support staff who work with the clinicians to make their life easier, and then there are the other group which is those who are employed purely in an administration role. We do believe too many of those . . . have been employed."

Representatives of QH and Health Minister Stephen Robertson refused to reveal how many non-clinical staff QH or the PA employed in the last year.

Source





28 October, 2007

Another attempt at socialized medicine in the USA

The House passed a revised children's health proposal Thursday, but not by the two-thirds margin that supporters will need if President Bush vetoes the measure as promised. The 265-142 vote was a victory for Bush and his allies, who urged House Republicans to reject Democrats' claims that changes to the legislation had met their chief concerns. If the same vote occurs on a veto override attempt, Bush will prevail, as he did earlier this month when he vetoed a similar bill. The tally was seven votes short of a two-thirds majority. Several House members were absent.

Liberal groups continue to run attack ads against Republicans siding with Bush on the issue, which many Democrats consider a winner for their party. Democratic leaders said changes to the bill, which would add $35 billion to the State Children's Health Insurance Program, had addressed critics' concerns about participation by adults, illegal immigrants and families able to afford health insurance. But GOP leaders called the changes insignificant and politically motivated.

The decade-old health program is aimed at families that do not qualify for Medicaid but are too poor to afford medical insurance. As with the bill Bush vetoed, the revised measure would add would $35 billion over five years, financed by a 61-cent increase in the federal excise tax on a pack of cigarettes. Under the revisions, the program would exclude families earning more than three times the federal poverty rate. Low-income childless adults, which some states cover, would be phased out in one year. And states would have to be more rigorous in checking the validity of applicants' Social Security numbers, an effort to exclude illegal immigrants.

House Minority Leader John Boehner, R-Ohio, likened the revisions to "window-dressing rather than substantive changes." However, House Speaker Nancy Pelosi, D-Calif., said the legislation "has the support of the American people." Before Thursday's vote, the White House announced that Bush would veto the revised bill because it does too little to enroll low-income families ahead of those somewhat better off, and because it would cost more than the earlier bill. Democrats said it would cost more because it would cover more low-income children, the program's chief goal. The program now covers 6 million children, and the bill would enroll another 4 million if it becomes law.

On Oct. 18 the House voted 273-156 to override Bush's veto, 13 votes short of a two-thirds majority. Forty-four Republicans joined 229 Democrats in voting to override. Democrats and their GOP allies this week targeted 38 House Republicans who voted to sustain Bush's veto and later outlined their concerns in a letter. The revised bill addressed those concerns, Pelosi said. But Republicans were angry that Pelosi insisted on a vote Thursday, rather than giving lawmakers more time to study the bill and seek GOP converts. "Bringing the bill up today, with no time to even read it, is either a terrible mistake or an intentional partisan maneuver," said Rep. Heather Wilson, R-N.M., who supported the vetoed bill.

Pelosi said the House needed to act this week "because this fits into our legislative calendar." If Republicans support the health program's expansion, she said, "they won't be looking for an excuse to oppose this bill." Democrats said Thursday's vote was not the final test. Senate Majority Leader Harry Reid, D-Nev., said the Senate will vote on the bill next week, when passage by a veto-proof margin is considered likely. If Bush then vetoes the measure, the House could again seek a two-thirds majority to override. But Wilson and others said Republicans will be loathe to vote against Bush on the override question if they voted against the bill this week.

Both parties accused the other of turning the debate over children's health insurance into a political game. "It's unfortunate that even after a week of meetings and adjustments to the bill at the Republicans' request, that they would still apparently prefer to play politics instead of reauthorizing a program the vast majority of the country supports," said Democratic Caucus Chairman Rahm Emanuel of Illinois. Boehner said in a floor speech: "This bill is not going to become law." "If you're tired of the political games," he said, "if you're tired of Congress' approval rating being at these ridiculous levels, let's all just vote no."

Source





27 October, 2007

THE AUSTRALIAN PUBLIC HOSPITAL DRAMAS CONTINUE

We have been hearing mostly about disasters in the NSW hospitals lately but the Qld. hospitals are still worthy contenders for the booby prize. Three current articles below.


Hospital expert gets sarcastic with Qld. State government

FORMER health commissioner Tony Morris, QC, has lampooned the Bligh Government's health reforms for setting up the boss of the besieged Princess Alexandra Hospital to fail. The attack came as Premier Anna Bligh yesterday refused to say whether the management at the Brisbane hospital was pressured to clear waiting list backlogs.

Mr Morris said senior doctors such as PA clinical chief executive David Theile still did not have enough funds to cope with huge workloads. The Courier-Mail reported this week that the PA's overspending by 2.1 per cent had actually achieved a 7.8 per cent increase in clinical services. The budget blowout in the first quarter, which was initially blamed on management, forced the closure of 60 beds and resulted in a 10 per cent cut in waiting lists.

Mr Morris headed the 2005 Bundaberg Hospital Commission of Inquiry, one of two inquiries that resulted in sweeping reforms including having doctors in charge of public hospitals instead of bureaucrats. "Theile's appointment has proved to be the complete disaster that the Charlotte St mandarins (at Queensland Health) would have predicted: A doctor (who) is likely to focus on trivia such as reducing waiting lists, increasing surgical throughput," Mr Morris said. "And while he is enmeshed in such trifles, who is going to concentrate on the really important issues, like whether or not . . . to send the administrative director to a conference in Acapulco? "Dr Theile was set up to fail. They put a man in charge who didn't have enough funding in the right area of clinical services."

His comments came as Ms Bligh refused to deny accusations from the Australian Medical Association that the Government pressured management to clear waiting lists more quickly without realising the extra costs involved. "I can only repeat what I have already said on this: The PA is one of our great hospitals," Ms Bligh said. "We're seeing some really terrific things happening at this hospital."

But Opposition health spokesman John-Paul Langbroek called for the Premier to immediately reopen all available hospital beds at the PA. "Hospitals are meant to treat sick people," Mr Langbroek said. "If the Bligh Government is going to make cuts to public hospitals they should focus on the non-patient areas." [i.e. the bureaucracy]

Source




Major Queensland hospital is "broke"

As time goes by the hospital's service gets worse and worse -- as the ever-growing cancer of bureaucracy strangles it. Money to pay clerks and "administrators" MUST be found. Their pay packets never miss a beat. Too bad about the patients who have insufficient doctors and nurses to see to them

A LACK of money has forced Princess Alexandra Hospital to turn away sick people for only the third time in more than half a century - and more waiting list cancellations are on the way. The eight-hour "bypass" at the major Brisbane public hospital on Wednesday night was on the agenda at a heated meeting between furious senior management last night.

Clinical chief executive officer David Theile was yesterday forced to cancel another 17 operating theatre waiting lists from next week, taking the total cut to 20 per cent of the hospital's roster with as many as six people on each list. About 30 of the 60 beds that were closed earlier this week are expected to reopen from the weekend. PA visiting medical officer Dr Ross Cartmill yesterday said the closure of the emergency department, linked to the cutbacks, was only the third time since 1956. The PA, one of the state's biggest public hospitals, normally handles overflow from other nearby hospitals. "We can't get patients into the beds because the beds just aren't there," Dr Cartmill said.

While Queensland Health has claimed demand has "diminished" this week, hospital sources say that is only relative to peak work levels at the weekend. Premier Anna Bligh has refused extra funding for the hospital, saying it should be able to manage on a record $33 million boost this year. The Courier-Mail reported this week that while the hospital was 2.1 per cent over budget for the first quarter, it had performed 7.8 per cent more work.

Dr Cartmill yesterday said the only meaning of a hospital being efficient and over budget was that it was underfunded. "We clinicians believe we should be service-orientated - not budget-driven," said Dr Cartmill, who is also the Queensland president of the Australian Medical Association.

Acting Health Minister Rod Welford denied the bypass was linked to the bed cutbacks, saying "it can happen regardless of cutbacks". "This was utterly exceptional circumstances (on the southside, with the Mater Hospital also on bypass) and the hospitals do co-operate so if they go bypass the people are moved to another hospital," Mr Welford said.

But the State Opposition is demanding the Bligh Government reach into to its budget surpluses and find some money. Opposition Leader Jeff Seeney called for extra financial support to stop the situation getting worse. "Closing beds in a hospital that has achieved that sort of result seems incomprehensible to me," Mr Seeney said. "It is an intolerable situation."

Source




Crazy government hospital provision in all Australian States

With the unbelievable cutbacks in available beds, it is no wonder that waiting lists are so long. As the bureaucracy has ballooned, the number of available beds has drastically shrunk: Socialism at work. Quite insane.

PUBLIC hospitals throughout the country are failing to achieve essential performance standards, the Australian Medical Association (AMA) says. AMA president Rosanna Capalingua, who will release a report card comparing the performance of public hospitals, says there has been a persistent deterioration in the ability of public hospitals to cope with demand.

"Their capacity has gone down," Dr Capalingua said on ABC radio today. "In fact, would you believe that we have a statistic that there are 67 per cent fewer beds in public hospitals across Australia compared to 20 years ago, remembering the increase in population and increase in age of population we've had in that time in Australia, for the increase in demand."

Dr Capalingua said all jurisdictions had serious problems. "Across the board, all states and territories failed to come up to the benchmarks and standards that we would expect public hospitals to deliver to the Australian public," she said. "In the Australian Healthcare Agreements, we need a top-up of $2 to $3 billion to start off with and then we need an indexation increase."

Source





26 October, 2007

The de-moralisation of health care

By Melanie Phillips, writing from Britain

How in God's name have we come to this? In three hospitals in Kent, at least 90 patients have died from a superbug infection caused by filthy conditions with unwashed bedpans, staff `too busy' to clean their hands and - most appalling of all - nurses telling patients with diarrhoea to `go in their beds'. This unspeakable situation reveals not just callousness towards suffering and indifference to human dignity but a breakdown of some of our most basic civilised values.

Nor is this an isolated scandal. Last October, an internal memo warned the Government that virtually every NHS trust was reporting superbug infection. The health service, in other words, is institutionally polluted. The Government's response? To ignore this crisis, and then belatedly to bring forth Gordon Brown's pathetic commitment to a sporadic hospital `deep clean'. What has happened to the duty of care in our flagship public service? What has happened, indeed, to our sense of common humanity?

Two things have combined to cause this awful situation. The first is the Government's Stalinist control of the NHS which directly conflicts with patient care. The Kent hospitals focused on meeting waiting time targets to the exclusion of just about everything else; and the NHS management's byzantine structure ensures an almost total absence of accountability.

But that is far from the full explanation. Much more important is what has happened to the nursing profession, where there has simply been a collapse of that ethic of caring first promulgated by the inventor of modern nursing, Florence Nightingale. Of course, it must be said that there are still many dedicated and caring nurses of whom Nightingale would be proud. But in general, her ethic has been all but destroyed.

Nursing is not a job but a vocation. That means it is governed by a sense of moral duty to the patient rather than by the self-interest of the nurse. That sense of vocation lay at the heart of Nightingale's vision. It was no accident that in her seminal Notes On Nursing, published in 1860, she wrote that `the greater part of nursing consists in preserving cleanliness'. It was not just that cleanliness was essential for recovery and health. Keeping both hospital and patients clean meant the nurse needed to have the most elevated of motives to put the care and dignity of her patients first.

Accordingly, lowly functions such as washing, dressing and administering bedpans - where dignity was most fragile - were the functions that in nursing were invested with the highest possible significance. Simply, these were moral acts. Accordingly, wrote Nightingale, if a nurse declined to do these kinds of things for her patient because she was so concerned about her own status, nursing was not her calling. `Women who wait for the housemaid to do this, or for the charwoman to do that, when their patients are suffering, have not the making of a nurse in them.'

Florence Nightingale belongs in the first rank of pioneering Victorian feminists. But the tragedy is that modern feminism has all but destroyed what she stood for. In the 1980s, nursing underwent a revolution. Under the influence of feminist thinking, its leaders decided that nurses were treated like skivvies by doctors, who were mostly men. To achieve equality for women, therefore, nursing had to gain equal status with medicine. So nurse training was taken away from the hospitals and turned into an academic subject taught in universities.

This directly contradicted an explicit warning given by Florence Nightingale herself, that her 'sisters' should steer clear of the `jargon' about the `rights' of women, `which urges women to do all that men do, including the medical and other professions, merely because men do it, and without regard to whether this is the best that women can do.' That, however, was exactly what the nursing establishment proceeded to do. Since caring for patients was demeaning to women, it could no longer be the cardinal principle of nursing. Instead, the primary goal became to realise the potential of the nurse, to deliver equality with the male-dominated medical profession.

In her book The Project 2000 Nurse, Ann Bradshaw, a specialist in palliative care, described how this agenda removed caring, kindness, compassion and dedication from nurse training. Student nurses now studied courses such as sociology, gender studies, politics, psychology, microbiology and management. They were assessed for their communication, management, problem- solving and analytical skills. `Specific clinical nursing skills were not mentioned,' she wrote. In short, nursing ditched its core vocation to care.

I wouldn't have believed this possible had I not been forced to witness how my own mother was treated in a London teaching hospital a few years ago. She suffered under a wretched double burden of multiple sclerosis and Parkinson's disease. In that pitiable condition, which meant she could barely walk, she broke her hip and was admitted for surgery to a fracture ward. If I hadn't been on hand every day, she would have starved. After surgery, she was unable to move at all in her bed. Yet the nurses made no attempt to help her to eat; nor did they even deign to move her pillow to make her more comfortable. Yet when I protested, I was told by the senior nurse on duty the bare-faced lie that an hour previously my mother had been 'skipping round the ward'.

It was then that I realised that all the excuses about NHS failure being caused by lack of money were a lie. It was then that I understood that there was, instead, a lack of something infinitely more profound - conscience, kindness, a sense of duty to others - and that the image of the NHS as the embodiment of altruism was a grotesque illusion. If you were old and incapable, it was an encounter to be feared. The memory of my mother's terrible experience still makes me cry; and I weep also for all those poor souls who have died at the hands of the NHS in Kent, and all those other frail and powerless patients who are being treated so abominably in hospitals up and down the country.

What's happened in our hospitals surely reflects a still wider social breakdown. Our society seems to have turned into a Darwinian nightmare in which the fittest prosper mightily while the old and weak are tossed aside as of no value. That's why we starve and dehydrate some elderly people to death. That's why we turn a blind eye to the dreadful conditions in so many old people's homes. And that's why nurses become managers, and preen themselves as expert professionals in meetings and seminars and conferences and away- days while patients in their hospitals are left to die in their own filth.

And what about the Labour Party, for which the NHS is the ultimate symbol of its own superior social conscience? Are Labour MPs agitating about the filth in our hospitals and the deaths it is causing? Dream on. Labour MPs are currently wholly occupied with inspecting their own navel and analysing who is up or down in the Gordon Brown/David Cameron circus. And as for the Health Secretary, while patients are dying as the direct result of the system over which he presides, he appears to think that the biggest threat to the future of the very planet is that people are too fat.

Our NHS is now the symbol of a society that has lost its moral compass along with its heart and soul.

Source




One unfixable Australian public hospital

Despite huge pressures on the politicians, it is still a disaster zone

WHEN young mother Sara Claridge received a third phone call from Royal North Shore Hospital relaying the news that her urgent surgery had been postponed yet again, she broke down in tears. The 26-year-old was in line to have cervical surgery to remove pre-cancerous cells and relieve crippling pain from a gynaecological condition, but was told the hospital's theatres were closed. Ms Claridge - whose mother had a similar condition and had a hysterectomy at the age of 27 - had already had her operation cancelled once before she was moved up the priority list for surgery in October.

The incident is the latest in a string of alarming cases emerging from Royal North Shore Hospital following the case of 32-year-old Jana Horska, who miscarried in the hospital toilets last month. Following Mrs Horska's miscarriage tragedy, Associate Professor Bill Sears, a neurosurgeon at the hospital, spoke out, revealing operations are cancelled frequently at the last minute because of theatre closures.

Ms Claridge's setbacks now, sadly, catapult her into being a new symbol for Premier Morris Iemma's Government's failure to cope with the state's growing hospital crisis - a crisis that Health Minister Reba Meagher appears reluctant to admit, address or provide policy responses for. This latest case will increase pressure on the Government to explain how it intends to turnaround health care in NSW - it is another example of ordinary people being let down.

"But then she called and said the theatre was closed and we'd had to reschedule again to November. I was in tears, I just couldn't handle it any more," Ms Claridge said. "The pain knocks me sideways. Some days I can't get out of bed and I don't want to leave the house. "I'm 26, I shouldn't have to worry that when I have a shower my hair falls out in clumps. "I should be able to take my daughter to the park, or even be able to get up and make her breakfast without feeling like I have to go back to bed for the rest of the day."

An RNSH spokeswoman said the postponement of Ms Claridge's surgery was the decision of the doctor, who already had 21 patients on his waiting list. "(The) hospital has contacted Mrs Claridge and is investigating the possibility of an earlier date for surgery by transferring her care to another surgeon," the spokeswoman said.

Opposition health spokeswoman Jillian Skinner said yesterday it was a standard State Government defence to blame the doctors. "It is another example of the minister being at odds with doctors and their clinical decisions," she said. "She is in discomfort and she has a toddler to care for - it is cruel to delay the surgery."

Source





25 October, 2007

So health care for the poor is better in England and Canada? Guess again

Post below lifted from Chris Reed. See the original for links

From a new study by Princeton scholars:

This paper reexamines differences found between income gradients in American and English children's health, in results originally published by Case, Lubotsky and Paxson (2002) for the US, and by Currie, Shields and Wheatley Price (2007) for England. We find that, when the English sample is expanded by adding three years of data, and is compared to American data from the same time period, the income gradient in children's health increases with age by the same amount in the two countries.

In addition, we find that Currie, Shields and Wheatley Price's measures of chronic conditions from the Health Survey of England were incorrectly coded. Using correctly coded data, we find that the effects of chronic conditions on health status are larger in the English sample than in the American sample, and that income plays a larger role in buffering children's health from the effects of chronic conditions in England.

We find no evidence that the British National Health Service, with its focus on free services and equal access, prevents the association between health and income from becoming more pronounced as children grow older.

Got that? Poor kids fare better in the U.S. system, with all its flaws, than in England with its single-payer system. Oh, but that's England! Canada is what we want to be like! Michael Moore says so! It must be true. Guess again. Here's the summary of a new study by Baruch College scholars:

Does Canada's publicly funded, single payer health care system deliver better health outcomes and distribute health resources more equitably than the multi-payer heavily private U.S. system? We show that the efficacy of health care systems cannot be usefully evaluated by comparisons of infant mortality and life expectancy. We analyze several alternative measures of health status using JCUSH (The Joint Canada/U.S. Survey of Health) and other surveys.

We find a somewhat higher incidence of chronic health conditions in the U.S. than in Canada but somewhat greater U.S. access to treatment for these conditions. Moreover, a significantly higher percentage of U.S. women and men are screened for major forms of cancer. Although health status, measured in various ways is similar in both countries, mortality/incidence ratios for various cancers tend to be higher in Canada. The need to ration resources in Canada, where care is delivered "free", ultimately leads to long waits. In the U.S., costs are more often a source of unmet needs.

We also find that Canada has no more abolished the tendency for health status to improve with income than have other countries. Indeed, the health-income gradient is slightly steeper in Canada than it is in the U.S.

Got that? Poor people fare slightly better in the U.S. health system than they do in the Canadian system. On a scale of 0 to 100, relevance of these studies to the U.S. health debate: 100.

On a scale of 0 to 100, the likelihood they ever will become part of the U.S. health debate: 0. Just wonderful.

NOTE: The Canadian study above does have some problems. See here. But when one of Canada's leading Leftist politicians goes to the USA for medical treatment that probably tells us more than any statistics. And Stronach is one of many Canadians who go to the USA for treatment that they cannot get in Canada




Man rips out teeth with pliers to beat NHS wait

He was in pain from toothache but was told to wait 3 weeks before he could be treated

A BRITISH man has pulled out seven of his own teeth because he was told to wait three weeks for an appointment to see a National Health Service dentist. Taxi driver Arthur Haupt used pliers and a technique he had learned in the army to carry out the DIY dentistry. He couldn't afford the $170 per tooth treatment he was quoted by a private practice.

"If you can't get anyone else to take your teeth out, you take them out yourself, don't you?" said Mr Haupt, 67, from Melton, in Leicestershire in England's east Midlands. "When they told me to fill out a form and how long I would have to wait I said, 'I've got gob ache now, not in three weeks time'.

Source





25 October, 2007

So health care for the poor is better in England and Canada? Guess again

Post below lifted from Chris Reed. See the original for links

From a new study by Princeton scholars:

This paper reexamines differences found between income gradients in American and English children's health, in results originally published by Case, Lubotsky and Paxson (2002) for the US, and by Currie, Shields and Wheatley Price (2007) for England. We find that, when the English sample is expanded by adding three years of data, and is compared to American data from the same time period, the income gradient in children's health increases with age by the same amount in the two countries.

In addition, we find that Currie, Shields and Wheatley Price's measures of chronic conditions from the Health Survey of England were incorrectly coded. Using correctly coded data, we find that the effects of chronic conditions on health status are larger in the English sample than in the American sample, and that income plays a larger role in buffering children's health from the effects of chronic conditions in England.

We find no evidence that the British National Health Service, with its focus on free services and equal access, prevents the association between health and income from becoming more pronounced as children grow older.

Got that? Poor kids fare better in the U.S. system, with all its flaws, than in England with its single-payer system. Oh, but that's England! Canada is what we want to be like! Michael Moore says so! It must be true. Guess again. Here's the summary of a new study by Baruch College scholars:

Does Canada's publicly funded, single payer health care system deliver better health outcomes and distribute health resources more equitably than the multi-payer heavily private U.S. system? We show that the efficacy of health care systems cannot be usefully evaluated by comparisons of infant mortality and life expectancy. We analyze several alternative measures of health status using JCUSH (The Joint Canada/U.S. Survey of Health) and other surveys.

We find a somewhat higher incidence of chronic health conditions in the U.S. than in Canada but somewhat greater U.S. access to treatment for these conditions. Moreover, a significantly higher percentage of U.S. women and men are screened for major forms of cancer. Although health status, measured in various ways is similar in both countries, mortality/incidence ratios for various cancers tend to be higher in Canada. The need to ration resources in Canada, where care is delivered "free", ultimately leads to long waits. In the U.S., costs are more often a source of unmet needs.

We also find that Canada has no more abolished the tendency for health status to improve with income than have other countries. Indeed, the health-income gradient is slightly steeper in Canada than it is in the U.S.

Got that? Poor people fare slightly better in the U.S. health system than they do in the Canadian system. On a scale of 0 to 100, relevance of these studies to the U.S. health debate: 100.

On a scale of 0 to 100, the likelihood they ever will become part of the U.S. health debate: 0. Just wonderful.




Man rips out teeth with pliers to beat NHS wait

He was in pain from toothache but was told to wait 3 weeks before he could be treated

A BRITISH man has pulled out seven of his own teeth because he was told to wait three weeks for an appointment to see a National Health Service dentist. Taxi driver Arthur Haupt used pliers and a technique he had learned in the army to carry out the DIY dentistry. He couldn't afford the $170 per tooth treatment he was quoted by a private practice.

"If you can't get anyone else to take your teeth out, you take them out yourself, don't you?" said Mr Haupt, 67, from Melton, in Leicestershire in England's east Midlands. "When they told me to fill out a form and how long I would have to wait I said, 'I've got gob ache now, not in three weeks time'.

Source





24 October, 2007

Lance the bloated beast of hospital bureaucracy

Even better to abolish the bureaucracy altogether and send the money direct from the Treasury to the hospitals. Comment below from Australia

In another bout of me-tooism Opposition Leader Kevin Rudd has picked up John Howard's proposal to encourage retired nurses back into the public hospital system by declaring, yet again, whatever you can do I can do better. Confronting the chronic shortage of hands-on nursing staff in the country's public hospitals, a problem encouraged by the introduction of university training for nurses, Howard has announced plans to establish 25 hospital-based training schools for nurses. Howard has also foreshadowed plans to replace state government management of the 750 public hospitals around the country with community-based boards - something that Rudd has rejected, claiming it will add another tier of bureaucracy in the system.

This is rubbish. It is in fact what is urgently needed to attack the bureaucratic monster created by the state Labor governments which is sucking the life out of our public hospital system. It is a sad fact that only about one in six people employed in the public health system is engaged in face-to-face patient care. The bulk of the remainder are involved in what are essentially administrative areas. Hospital funding needs to be directed away from the back office staff and towards the areas where it is needed most - direct patient care.

You can see where the money goes when you look at the plethora of bureaucratic bodies that administer public hospitals in NSW alone under the state Government's Health Department. The charter for these Area Health Services sounds simple - even altruistic: to keep people healthy; provide the health care they need; deliver high-quality health services and manage these services well; and to provide sound resource and financial management with skilled and motivated staff, and so it goes on. Pity it's not working.

And it will be interesting to see if the parliamentary inquiry into a string of patient care and administrative crises at Sydney's Royal North Shore Hospital, which the Iemma Labor Government has reluctantly agreed to hold, will address the real problem of a bloated and dysfunctional bureaucracy. Royal North Shore is one of 20 hospitals situated in the area from Sydney's north shore to the NSW central coast covering a population of 1.3 million. These are administered by the Northern Sydney Central Coast Health Service, which is one of eight similar health service administrative bureaucracies overlording all public hospitals and health care facilities in the state through a complex web of sub-services and committees.

The NSCCHS has a 50-member executive structure operating under a chief executive, with a total staff, including casuals, of 15,700. The 2005-06 annual report by the NSCCHS gives an insight into how this bureaucratic system staggers along in the state. It is clear that an enormous amount of time is spent in strategic planning to identify areas of need and improve efficiencies through seemingly endless reviews. But to what end? For example, detailing its workforce strategies, it says, in part, that it was unlikely the medical and nursing workforce would be enhanced significantly in the next five years. And the report shows that about 35 per cent of emergency department patients had still not been admitted to a hospital bed within eight hours of active treatment starting.

In pointing to a major challenge in clinical sustainability the report acknowledges "a lack of critical mass" in a range of services offered at many acute facilities such as intensive care, emergency services and maternity. It goes on to state that this situation "has the potential to produce many undesirable effects such as inefficiencies, quality and safety concerns, unsustainable rostering demands for current staff and insufficient volumes for teaching purposes". It seems to have concluded that the best way to address this was to instigate a five-year review plan.

But as one senior specialist told The Australian this sort of approach to the crisis in public hospitals was like sending a fire engine to a burning building and then initiating an inquiry into how the fire started before rescuing those trapped inside. Another specialist recounted the story of a senior nurse in a NSW baby health care centre who wanted to change one line in a brochure given to new mothers to make it more intelligible. The process took 12 months and was the subject of innumerable conferences and committee meetings before the change was finally agreed to.

Rudd, like Howard, has identified the extent of the hospital crisis. That is why he announced plans on Friday for a federal Labor government to spend $600 million to help reduce the waiting list for elective surgery in public hospitals. But simply pouring more money into the hospital system in the fond hope that it will go where it is needed it is like filling a bucket full of holes: it's an endless and pointless process. And by the time these funds have gone through the administrative sieve there is not enough left to maintain the sort of health care standard the community deserves.

Howard's move to restore the traditional system of individual hospital boards is a sound start to dealing with waste and mismanagement which has flowed from the over-bureaucratised structure of hospital administration established under the Labor state governments. If the Liberals and Labor are serious about addressing this disgraceful waste of tax dollars and resources they should commit to a national audit of public health care spending to identify where the areas of greatest need are and make sure that commonwealth funding is not sidetracked away from these.

Source




Australia: Leftist State government blames hospital boss for keeping the doors open

They say he should put his budget first, not patients

The boss of the Princess Alexandra Hospital said it was overworked as he slammed Government claims his overspending had led to crucial patient services being cut back. As Premier Anna Bligh yesterday blamed clinical chief executive David Theile for bed and waiting list closures, Dr Theile sent an email to staff explaining how they were recently praised by Queensland Health for efficiency and performance. He said the PA had handled trying conditions "extremely well" in recent months, frequently saving southeast Queensland's health system from "crisis".

A budget blowout over the first quarter forced 40 of the hospital's 892 beds to close and 10 per cent of operating theatre procedures to be cancelled. "For an increased expenditure of 2.1 per cent, we delivered 7.8 per cent more crucial clinical services," Dr Theile said in the email obtained by The Courier-Mail . "When all others were on bypass, we kept our doors open by ad hoc setting up of beds in radiology and theatre recovery. "Please be assured of my pride in this organisation and its achievements, and continue to deliver with the same professionalism in these times of restricted activity. "The administrative efficiency of our delivery has been acknowledged by Queensland Health."

The revelations come less than a week after Ms Bligh praised the progress of the Government's $10 billion health action plan in State Parliament. In a thinly veiled swipe at Dr Theile yesterday, Ms Bligh rejected more funding for the hospital, saying taxpayers were "entitled to see strong management ensuring that budgets are maintained". "The PA, like every other hospital, has to live within its budget," Ms Bligh said. "The PA Hospital budget this year has increased by $33 million. That is a very significant increase that will buy extra and additional services."

The war of words comes after the Government blamed Dr Theile on Friday for the closures. Acting Health Minister Rod Welford distanced the Government from the overspending, saying the PA was managed by a clinical chief executive and not a bureaucrat. "The decision about managing the work flow of surgery is a local hospital decision made by the most senior medical officer in the hospital, the CEO," Mr Welford said.

Source





23 October, 2007

Ending Employer-Based Health Insurance Is a Good Idea

But do we really need a new regressive health insurance tax?

"The U.S. employer-based health-insurance system is failing," declares a new report by the Committee for Economic Development (CED). The CED is a Washington, D.C.-based policy think tank comprised of business and education leaders. And it is right: Employer-based health-insurance is indeed failing. Between 2000 and 2007, the percentage of firms offering health insurance benefits fell from 69 percent to 60 percent. The percentage of people under age 65 with employer provided insurance dropped by 68 to 63 percent. In absolute numbers, those covered by job-based insurance fell from 179.4 million to 177.2 million. Employers are jettisoning health insurance because costs are out of control. Since 2001, premiums for family coverage have increased 78 percent, while wages have gone up 19 percent and inflation is up 17 percent. The consequence is that health insurance is the number one domestic policy issue in the 2008 presidential race.

So what is the CED's prescription for our ailing health insurance system? The report promisingly begins by recommending the creation of "a system of market-based universal health insurance." In order to achieve this, the CED would make health insurance mandatory for every American. The CED proposal envisions the creation of independent regional exchanges that would act as a single point of entry for each individual to choose among competing private health plans. The exchanges would set minimum benefit plans. The exchanges would also cut through the thickets of state health insurance regulations that add substantially to the costs of insurance. Individuals could purchase insurance above and beyond the minimum benefit plans with after tax dollars.

Insurers would be required to take all individuals regardless of prior medical conditions. In order to prevent adverse selection spirals, the exchanges would also do risk-adjustments by transferring some of the premium revenue from insurers that had enrolled more good risks to those who enrolled more poor risks. Consumers pay a price an insurer would receive had it enrolled an average population of risks. Something very similar is already done in Switzerland's mandatory private health insurance market.

So far, so good. Unfortunately, the CED proposals go quickly off the rails when the group recommends that every household receive a fixed-dollar credit sufficient to purchase an approved low-priced quality health plan. This health insurance credit would not be means tested and would be financed by some kind of broadly based tax-perhaps a payroll, value-added or environmental tax. Such taxes, like Social Security and Medicare payroll taxes, are likely to be regressive, which means the poor will pay a larger percentage of their incomes than the rich. In fact, two-thirds of taxpayers paid more in social security and Medicare taxes than they did income taxes.

For example, today every wage-earning American pays a Medicare payroll tax of 2.9 percent. That tax is supposedly divided so that employees and employers each pay 1.45 percent. Of course, employers would give employees the other 1.45 percent if they were not paying the tax, so in reality the employees are paying the whole tax. The same thing goes for the Social Security Ponzi scheme.

The CED proposal is chiefly a ploy to get employers out from under the increasingly heavy burden of buying insurance for their employees. That's a laudatory goal, but it shouldn't be done by imposing yet another tax on employees. The good part of the CED proposal is that employees would purchase private health insurance in a competitive market. If households could find a policy for cheaper than the credit, they could pocket the extra money for themselves. The CED argues persuasively that this kind of competition would tend to keep health care costs down.

But why advocate a tax to pay for the credits? One advantage of such a health insurance credit is that it would avoid the administrative and enforcement costs of coercing people to buy insurance. Such enforcement has proved problematic in other insurance markets. For example, although auto insurance is mandatory, more than 14 percent of motorists are uninsured.

However, there is a better way to expand private health insurance and to obtain the benefits of competition as a way to keep medical spending down. First, retain the CED proposal that health insurance be mandatory. But, instead of a new tax, allow employers to hand over the money they currently spend on health insurance to their employees in the form of money wages. Then, in order to create a level playing field, expand the current tax exemption for employer-purchased health benefits to all individuals. Maintaining the tax exemption helps enforce the mandate because taxpayers will have to report annually how much they paid for their health insurance when they pay their taxes.

What about the poor Americans who do not make enough to afford medical insurance? Give them vouchers to buy private medical insurance and pay for the vouchers by abolishing Medicaid. In 2005, the Federal government and the states spent $316 billion on Medicaid to cover around 17 million households. That works out to about $18,500 per household per year. The annual premium for family coverage in 2007 averaged just over $12,000. Due to increased competition, average premiums for the minimum private plans will drop. This means that some money should be left over from Medicare to pay for the currently uninsured poor. There will be some administrative costs involved with determining voucher eligibility, but the health insurance vouchers themselves would essentially be self-enforcing. The experience of Switzerland, in which nearly one-third of the population receives subsidies to purchase private insurance, suggests that very few would fall through the new health insurance safety net.

Despite its flaws, the CED proposal avoids the huge mistake of centralizing health insurance through a single government bureaucracy. The CED report correctly concludes that "Market-based universal health insurance, with individuals choosing the health plans and delivery systems that they deem best, shows great promise-much greater than any alternative."

Source




Superbug problems worsened by crowding in NHS hospitals

Almost a quarter of hospital trusts are increasing the risk of MSRA and Clostridium difficile by filling wards to “unsafe” levels, The Times can disclose. According to Department of Health figures, 22 trusts in England recorded bed occupancy rates of 95 per cent or more and nearly half 85 per cent or more. But a leaked report by the department suggests that MSRA rates are 42 per cent higher in hospitals where more than 90 per cent of beds are filled than those that fill less than 85 per cent of beds. The Liberal Democrats said the figures showed that many hospitals were effectively full while nurses’ groups blamed the problem on pressure to meet waiting time targets.

The proportion of hospital trusts filling 90 per cent or more of beds has risen from 13 per cent five years ago to 23 per cent. Elderly patients are particularly at risk, with occupancy rates on geriatric wards reaching 91.3 per cent, according to analysis of figures by the Liberal Democrats. Secure learning disability wards had a bed occupancy rate of 94.9 per cent, while mental illness wards had 86.8 per cent. The highest occupancy rate was in East Berkshire Primary Care Trust, which said that all of its 122 available beds were filled during the survey, while the Oxleas Foundation Trust, which provides mental health and disability services for southeast London, said that 453 of its 459 beds were full. The average occupancy rate in 2006-07 was 84.5 per cent, in line with the past five years but a sharp rise since Labour came to power in 1997 when it was 80.7 per cent.

Professor Barry Cookson, an expert on MSRA, said that an 85 per cent bed occupancy was a “safety level above which we start having problems”. A report published this month said that C. difficile caused the deaths of 90 patients and affected hundreds more at Maidstone hospital, Kent, between April 2004 and September last year.

Norman Lamb, the Liberal Democrat health spokesman, said: “These figures mean that for a lot of the time, many hospitals are effectively full - and on red alert. As long as this situation continues, it will undermine efforts to successfully combat hospital-acquired infections. It puts staff under unfair pressure and risks corners being cut in order to get new arrivals admitted on time. The system is under enormous pressure.” The Royal College of Nurses believes the true bed occupancy rate could be even higher. Its own survey found that the average rate was 97 per cent, and that more than half of wards were running at full capacity to meet waiting time targets. The number of death certificates that name MSRA as a contributory factor rose from 51 cases in 1993, the first year of recording, to 1,629 in 2005.

Today the Lib Dems will announce a five-point “Florence Nightingale” charter to combat hospital infections. They suggest copying the Dutch approach in which infected wards are closed, patients transferred and staff sent home. They would also give matrons authority over all staff, including contracted cleaners, and roll out super-bug screening programmes to GPs and care homes.

A Department of Health said that although some trusts had higher occupancy rates they still managed to reduce infection rates significantly.

Source





22 October, 2007

NHS pays 225,000 pounds compensation for husband's 'squalid' death

A boy of nine has been given 25,000 pounds compensation after his father died as a result of hospital negligence. Today, the child's mother - who was awarded a further 200,000 - described the squalid conditions in which she claims her husband was treated and the catastrophic medical errors that she believes killed him.

Debra Luck, 44, said medics left her husband Ian to lie in agony for hours before he died from a heart attack after a duodenal ulcer ruptured. Medical experts say emergency surgery would have saved the 37-yearold but instead Princess Alexandra Hospital in Harlow treated him with drugs. Mr Luck, who was delirious with pain, had been left feeling suicidal by the conditions. A lack of nursing care meant he was forced to vomit on the floor and wet the bed as he lay dying.

He was so appalled by his conditions that he refused to let his son Ben, then four, visit him. The boy was so traumatised by his father's sudden death he had to see a psychologist.

Mrs Luck, from Waltham Abbey, launched a High Court action against the trust after her husband's death. The case was settled when the trust offered the payout without accepting liability. Mrs Luck said she decided to take the money because it would give her son a more secure future. However, she remains horrified by the trust's behaviour. "They never even said sorry and I feel they've got away with murder," she said. "Those last days of his life were a living nightmare I never believed I'd experience in a British hospital. "The lunchtime before he died he called me crying, saying he wanted to jump from the nearest window."

She rushed to see her husband but he urged her to go home to be with Ben. Two hours later she got the call saying he had suffered a heart attack. A trust spokesman said: "The trust is pleased the court has approved a settlement and offers Mrs Luck and her family best wishes for the future." [Smarmy scum!!]

Source





21 October, 2007

MORE OF THOSE GREAT GOVERNMENT HEALTH SERVICES

Five current articles from Australia below:


Another shocking Australian public hospital

With official coverup, of course

TWO sisters told yesterday how they kidnapped their mother from the troubled Hervey Bay Hospital because they feared she was starving to death. The sisters, who are nurses, said they were horrified at the treatment their mother, Marjorie Holland, was receiving after suffering a stroke in November last year. Cecile Lyons and Michelle Downes, 51-year-old twins, said they tricked hospital staff into thinking they were taking their mother out for fresh air.

"My partner John (Reason) was waiting in the carpark for a quick getaway," Ms Lyons said. "I took her out in an armchair with wheels. We ditched the chair in the carpark and sped off to the Royal in Brisbane. "We had no choice. She was lapsing into unconsciousness."

The twins accused some hospital staff of incompetence in a formal complaint in which they alleged their 76-year-old mother was dehydrated and starving. Other more serious allegations cannot be reported on legal advice. They said their mother did not see a doctor for days and was not put on a drip until her eighth day in hospital.

In hospital Mrs Holland developed deep vein thrombosis and later had her leg amputated at Royal Brisbane and Women's Hospital. Mrs Lyons said she and her sister were the first to diagnose the DVT. "It was a nightmare," Ms Lyons said. "She was left to dehydrate and starve as a treatment for stroke. She did not have food for 17 days yet the hospital told us my mother was happy with her care."

An expert panel set up by the Health Quality and Complaints Commission to investigate the sisters' complaints agreed Mrs Holland should have been given intravenous fluids earlier. The panel led by the University of Queensland's Professor Ian Scott, also found that "heparin (anticoagulant) therapy should have been given from the date of admission". However, earlier treatment "was unlikely to have changed the outcome for Mrs Holland", Professor Scott said. The commission concluded that the care provided to Mrs Holland at Hervey Bay was "reasonable".

Mrs Holland, who suffered some brain damage, now lives in a NSW retirement village. There were findings against Hervey Bay Hospital in 2005 in the health inquiry headed by Geoff Davies, QC. The Courier-Mail understands several former patients have since received confidential settlements.

Source




Australia: Government hospitals under fire for mistreating elderly

POOR care of the elderly in some hospitals is prompting nursing homes to photograph their patients before admission and as they leave. Aged patients are often discharged from hospital malnourished and with bed sores, a national survey of 370 nursing homes found. A majority of nursing homes said they experienced several cases every year of residents returning from hospital with ulcers and skin tears, but without acknowledgement in the hospital's clinical notes. The author of the study, Tracey McDonald, professor of ageing at the Australian Catholic University, said the numerous "compromised skin integrity" cases raised by nursing homes was "a very disturbing issue".

The reputation of some hospital staff was such that at least four nursing homes had taken to photographing their residents' skin before and after hospital stays to prove to relatives of the patient that the nursing home care was of good quality. Nursing home staff saw few attempts by hospital staff at preventing trauma or even treating wounds when they occur. "In fact, respondents [to the survey] perceive an attitude of mendacity and blame emanating from the hospitals . where some clinicians falsely accuse aged care homes of causing the wounds and even mislead families into blaming the aged care home."

Professor McDonald's report was commissioned by Aged Care Association Australia, which represents nursing homes, as a result of significant concerns about the condition of patients transferred between nursing homes and hospitals. The report assessed the detailed answers from 371 nursing homes who responded. A breakdown of the findings showed that NSW hospitals performed better than other states on most indicators, but poorly on medication arrangements for aged care patients leaving hospital. Inadequate or absent notification of drug requirements could lead to "dangerous" problems in such areas as the prescription of sedatives and psychotropic drugs for mental illness.

Poor nutrition of elderly patients was also at disturbing levels and while NSW reported fewer problems, the issue was still a cause for concern, with 40 per cent of nursing homes in large regional centres reporting residents with nutritional problems on return from hospitals. Another key issue was the timing of transfer of residents to aged care facilities, which said Professor McDonald, could often be late at night and at short notice, a confusing experience for people in their 80s or 90s.

Other shortcomings often mentioned were lack of patient records provided by the hospital on the patient's treatment, hampering the home's efforts to provide proper care of what could be life-threatening conditions. Poor care of mental health patients was also reported, with evidence suggesting that in some cases patients were sedated before departure from hospital, leaving them unsupervised and vulnerable at points in the transfer process.

The chief executive of the Aged Care Association, Rod Young, called for urgent action to avoid harm to vulnerable and confused patients which, he said, would inevitably end up "leading to death in some instances".

Source




Negligent NSW public hospital staff doomed baby boy

GRIEF-stricken Fatima Abdallah should be celebrating her baby boy's four-month birthday this weekend - instead she is mourning his death and left wondering how a Sydney hospital failed to diagnose her son's life-threatening heart condition. Marwan Yahya died on June 19, five days after being sent home from Liverpool Hospital despite showing signs of a serious problem.

NSW Health has launched an investigation but his heartbroken mother contacted The Daily Telegraph yesterday desperate for authorities to explain the bungle. "It's been four months and I still haven't been told anything," a distraught Ms Abdallah said yesterday. "I keep calling the hospital but they brush me off and tell me to wait. I have a feeling they just want this to go away."

The first-time mum knew something was wrong with her little boy just hours after he was born. Marwan was blue around his mouth and fingers, breathing faintly and, as the hours passed, he refused to eat - just laying in his cot. Ms Abdallah said she asked nurses what was wrong but was told his condition was "normal". "I didn't enjoy those first few days with him because I was so worried. I knew something was wrong. I felt like they were treating me as if I had no idea," she said.

Her worst fears were confirmed when the two-day-old infant was sent home and started having seizures because his brain was starved of oxygen. After rushing back to Liverpool Hospital, Ms Abdallah and Marwan were transferred to the Children's Hospital Westmead, where tests revealed he had hypoplastic left heart syndrome. Doctors told the family that, had the condition been detected at birth, Marwan could possibly be alive today. "They had booked him on a flight to Melbourne where the operation is performed but when they found out how severe his brain damage was, there was nothing they could do," Ms Abdallah said. "We were told to say goodbye to him and they turned off the machines."

The harrowing ordeal follows a litany of hospital scandals that have embarrassed Health Minister Reba Meagher. South Western Sydney Health Service apologised to the family when they met with them yesterday. A health service spokeswoman said the disease that claimed Marwan can be "difficult to detect at birth". Ms Abdallah said she could not comprehend how doctors or nurses at Liverpool could have missed her son's condition. "He may still have been alive today if someone had listened to me," she said.

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Man dies after old ambulance breaks down

Plenty of money for bureaucrats but no money for new vehicles

A MAN has died after paramedics from a broken-down ambulance were forced to run almost two blocks to try to revive him in Melbourne's southeast. Ambulance Employees Australia (AEU) general secretary Steve McGhie confirmed a 56-year-old man died from a cardiac arrest before paramedics could reach him at his Elwood home last night. Mr McGhie said an ambulance broke down about two blocks from the house about 6pm (AEST), forcing paramedics to run with life-saving equipment, including a defibrillator. But the man's heart had stopped by the time the paramedics arrived.

"The vehicle had 160,000 on its odometer - it should be retired ... even though the Government has assured Victorians that they are safe and secure," Mr McGhie said. "The ambulance had power failure and they couldn't keep it running. "They grabbed the defibrillators and the oxygen equipment and ran to the house. "They tried to resuscitate the man at the scene but were unsuccessful."

The death follows a bitter dispute between the Metropolitan Ambulance Service (MAS) and its members' union over "unsafe" vehicles. Paramedics last week said the MAS threatened them with $6000 fines unless they use the vehicles, which have exceeded their agreed service life of three years or 150,000km. About 45 Mercedes ambulances had exceeded their agreed lifespan, Mr McGhie said.

Mr McGhie called on Victorian Health Minister Daniel Andrews to get new ambulances on the road, saying it "was a sad state of affairs in Victoria" if paramedics are forced to run to save their patients. "This is the sixth incident in the last two weeks and the Government has to step in," he said. "They've got to get more vehicles."

Tim Pigot, spokesman for Mr Andrews, said it was an operational decision by the MAS of how they managed resources. "We have more than doubled funding for ambulance services across Victoria since 1999," Mr Pigot said. "This has resulted in an extra 738 paramedics and 101 ambulances on Victorian roads. "Victoria has the safest and best ambulance system in Australia." Metropolitan Ambulance Service spokesman James Howe said the service was investigating the incident.

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Inert bureaucracy incapable of dealing with the sort of family problems they are set up to deal with

More "child welfare" destructiveness. They should sack all the Left-indoctrinated social workers and employ experienced mothers instead -- who would have learnt some commonsense from experience and who should at least be a lot less intimidatory. If the mother below had REALLY been a druggie, they would have had the kid back with her straight away. That is the firm rule of social workers worldwide -- because it shows how "non-judgmental" they are. Accusing normal middle-class families of "witchcraft" and the like is fine, however

All Michelle wants is what most mothers take for granted. To be able to tuck her seven-year-old son tightly into bed every night with a kiss and a fond "sleep tight". But for five long years, that has not happened often. For Michelle is the mother of Cameron, the autistic boy whose plight of being trapped for five years in an inappropriate respite centre for severely disabled and disturbed people in Hobart was raised in the Tasmanian Parliament on Thursday.

After a public furore yesterday, the State Government announced last night that Cameron would finally be leaving the Lutana facility where he has lived most of his young life this weekend to live with a foster family. The Government's Director of Children Services, Mark Byrne, said on Thursday that despite four years of trying, it was not possible for Cameron to live with his own family. Human Services Minister Lara Giddings wrote in a letter to Opposition Leader Will Hodgman in March that "after many efforts to support Cameron in his home environment" his mother had acknowledged "he could not return home as she was unable to care and support him".

It is these sort of official judgments and comments that make Michelle distraught, bewildered and angry. "I'd move heaven and earth to get Cameron living here with us," a tearful Michelle said yesterday. "There's not a day that goes by that I don't wish he was here with all of us. "And I've never said I won't have him. I just want him home."

The first Michelle and her partner knew about the uproar over Cameron's plight was when she looked at the newspaper yesterday morning. She could not believe what she read. First, that letters expressing dire concern about her son and his future had been circulating between ministers and within high levels of the Government for the past 12 months, without her being told. Second, that the Government was claiming Cameron's mother did not want him to return home. And finally, that allegations were being made that she was somehow a "troubled mother" with a dysfunctional lifestyle and a drug problem who had given Cameron a horrific start to life and who then rarely visited him while he was in care.

Michelle and her partner claim nothing could be further from the truth. It is why yesterday morning they rang Mr Hodgman -- who highlighted Cameron's predicament in Parliament this week after 11 months of government inaction -- and then got in touch with the Mercury. They wanted to tell their side of the story. And it is a very different one to that portrayed.

Instead of being a tale of abandonment and a callous lack of caring by a little boy's mother, it's a story of how battling families can become so worn-down and demoralised by government bureaucracy, bullying and inertia that they feel they no longer have any rights or say about their own child. Mixed in with that is a sorry saga of government departments failing to communicate with each other. And of a mother, fearing judgments were being made about her every time she visited her son or met Child Protection case managers, developing a reluctance to interact with government officials and disability workers about her own aspirations and wishes for Cameron.

But amid the sadness and lack of communication, there is also hope. Hope instilled by a close-knit Glenorchy family with little money but lots of resilience, desperately longing for nothing more than to have Cameron back living in their midst, alongside his four brothers and sisters. A shiny new boy's bicycle sits in the backyard of the red-brick home on a steep hill. It's the longed-for bike that Michelle and her partner gave to Cameron last weekend for his seventh birthday, when he came home for an afternoon visit after a birthday party organised by staff from the Lutana home at Hungry Jack's in Glenorchy. All the family were there to see Cameron, including his sister and brother. And there was the new bike, a big chocolate mudcake covered with candles -- and plenty of love and excitement.

A weepy Michelle shows photos of Cameron, a beaming smile on his face as he tried out his bike surrounded by family and friends. "We all love him to bits, he's such a gorgeous fantastic kid," Michelle's partner said. "Sure, he can be a handful, but Michelle's a great mother and she adores that kid -- we all do. "All this about him having troubled family life and Michelle having a drug problem, it's all just rubbish."

Michelle says she has never been on drugs or had a drug issue. She doesn't deny when she left Cameron at Lutana aged just under two that she was at her wit's end. He had just been diagnosed as autistic, she had a tiny baby and older boy to cope with too, her partner had just left her, and she was clinically depressed. Just after putting Cameron into respite care, for what his mother hoped would be just a short-term stay, she had a nervous breakdown and tried to commit suicide by overdosing on pills. But since then, and since moving in with her partner to his Glenorchy home four years ago, life has become much more settled for Michelle and her extended family.

Cameron, a bright little boy who loves nothing better than curling the hair of visitors, is at Glenorchy Primary School, while his brother is a budding soccer star. Michelle has just got a part-time job working in a canteen, while her partner is a pensioner while he waits for a knee reconstruction next week. "We've always been battlers, but the kids come first," Michelle's partner said. "It's like that when Cameron comes to stay -- we take him out fishing on the boat or take him driving in the four-wheel-drive -- we'll do anything to help our kids."

Michelle angrily denies she has not visited Cameron for six months at a time and disputes court documents that say she has refused to collect Cameron or "engage with (departmental) services (staff).". Instead, she tells a story of not being offered help. Of not being told about support systems that were available -- which she has since been offered in droves since yesterday when Cameron's case was made public. "It's not as if I ever said that `OK, he's autistic, I'll dump him here and someone else can deal with him'," Michelle sobs. "But you just feel after a while that you are banging your head against a brick wall; that the department is stretched to the limit and doesn't seem to have the funds or the services they need to have to help people like me or Cameron."

The big issue for the couple is really as much about public housing as getting more support to cope with an autistic child. They say they cannot have Cameron back with them while they live in their Glenorchy home surrounded by steep steps, footpaths, fast cars and a little back garden. "Ideally, we need another government house that is a bit bigger and out of town on a bigger flat block, where Cameron can ride his bike and play, without me having to watch him 24 hours a day," Michelle said. "I've never said I don't want Cammy, just that this house is too dangerous for him to live in."

The family have never been offered a combined case management session with a public housing representative and a disability services or child support worker. Last night, Michelle was told that a foster family had been found for Cameron to live with immediately. At first tearful, she then conceded it was probably a good thing in the short term for Cameron, if only to get him out of the inappropriate Lutana centre. But after the fuss of the past day, Michelle and her partner are determined to get Cameron back living with them in the long term, and for regular access visits in their home while he remains in foster care.

Mr Byrne said he was reviewing all of Cameron's case and was absolutely prepared to "re-engage with the family" if they wanted to be involved. Michelle said: "All I can hope is that out of all these half truths and lies told about me and my family in the past day, that it is all for Cameron's good in the long run. "I don't want empty promises -- I've had enough of them -- but if we can get a more suitable house and some help with Cameron and then get him home, that's all I could ever want."

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20 October, 2007

Health Care Debate's Real Issue is Who Decides

At a recent campaign stop in Iowa, Democratic presidential candidate John Edwards told an audience that under his plan for national health care, preventive care would not just be paid for by the government, it would be mandatory. Every American would be required to get annual physicals and regular tests such as mammograms and colonoscopies. Although Edwards didn't spell out the penalties, presumably scofflaws would face fines or worse. It's easy to make fun of Edwards' proposal. (Can we look forward to the spectacle of couch potatoes who miss their doctor's appointments being dragged off in handcuffs?) But we should actually be grateful that Edwards has so clearly illustrated the fundamental question that should be at the heart of any debate over health care reform: Who decides?

That is, after all, the central question of most politics. Whether talking about educating your children, what charities you support, how you behave in your bedroom, or how you operate your business, the complexities of the political process boil down to whether you will make these decisions or whether the government will. In health care, the question is whether you, together with your doctor, will make your most personal and important health care decisions, or whether the government will make them for you. Government-run national health care systems are all about limiting choices. For example, nearly all national health care system impose global budgets, strictly limiting how much can be spent on health care.

This leads to the rationing of care, either directly by denying certain procedures altogether, or indirectly by limiting the availability of modern medical technology. The United States has five times as many MRI units per million people and three times as many CT scanners as, say, Canada. Today, more than 800,000 Canadians are on waiting lists for medical procedures. As Canadian Supreme Court Chief Justice Beverly McLachlin wrote in a 2005 decision striking down part of Canada's universal care law, many Canadians waiting for treatment suffer chronic pain, and "patients die while on the waiting list."

And if you think that the rationing wouldn't affect you, some national systems actually make it illegal to spend your own money for care or prohibit buying private insurance. At the very least, if the United States were to adopt a national health care system, millions of Americans who are satisfied with the insurance coverage they have today could lose it and be forced into a government-designed plan that forced you to pay for benefits you didn't want or limited your choice of doctors.

Of course, you wouldn't have the choice not to participate. In Massachusetts, former Gov. Mitt Romney pushed through a plan that required all residents to buy a government-designed insurance plan. Those who fail to comply have to pay huge tax penalties. And, speaking of taxes, let us remember that any national health insurance program will be financed through a huge tax increase. Edwards estimates that his plan will cost some $120 billion per year in new taxes.

Sen. Barack Obama's proposal is slightly less expensive, but still estimated at $60 billion to 80 billion. Sen. Hillary Clinton hasn't told us what her plan will cost, but we know it will be expensive. Yet every dollar you have to spend funding national health care is a dollar you can't spend on your family.

National health care sounds wonderful. After all, it promises health care for everyone - for free, no less. In reality, it cannot deliver what it promises, but the politicians are still happy to make the promise anyway. All they want in return is our freedom. We should be thankful John Edwards has shown us what's really at stake.

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British 'nurse of the year' leaves for private sector

The "Nurse of the Year" 2007 has quit the NHS after becoming "ground down" by the bureaucrats and excessive paperwork that plague her profession. Justine Whitaker was awarded the Nursing Standard title this year but is leaving East Lancashire Primary Care Trust next month for the private sector and to become a lecturer.

The 36-year-old has told how nursing staff were made to use cheaper bandages and dressings while health bosses wasted money on long meetings that achieved nothing. She yesterday warned that a culture of "mistrust and fear" had crept into the NHS and things were bound to go "completely wrong" in Britain's hospitals if nothing is done. She said: "Sitting in meetings we are constantly being told 'We're going for this cheaper option with this bandage; we're going for that cheaper option with that dressing; we need to be mindful of resources'.

"I'm absolutely fine with that - I run my household like that - but what I see as a waste of resources is when I'm sitting in a big meeting and as a clinician I am the cheapest person there at 35,000 pounds a year and decisions are still being put off to another meeting."

The lymphoedema nurse, who has 14 years of clinical experience, added: "There is no sign the red-tape is being reduced. It all leads to more bureaucracy, which all leads to more form-filling and paperwork. "But as a nurse, I just want to nurse, I want to look after patients. "

Royal College of Nursing secretary Peter Carter said: "It saddens us that such a distinguished nurse is leaving the NHS." A spokesman for the Department of Health promised there would be a dialogue with staff and patients. [More meetings!!!] He said: "The health secretary has acknowledged that too much change can affect morale."

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19 October, 2007

Stop feeding the dysfunctional NHS

Whatever you made of the Chancellor's various sleights of hand on Tuesday, lurking beneath his Budget plans was one inescapable fact. The hungry maw of the NHS is swallowing more and more resources, at the expense of virtually everything else. The defence budget is at its lowest since 1930, despite our dwindling troops being dotted across three continents. Prison overcrowding is at such record levels that Jack Straw will have to release even more inmates early in a few weeks' time. But the health service marches relentlessly on, having hoovered up two thirds of the increase in public spending in the past five years.

Even "enterprise" - once one of Mr Brown's favourite words - has been tapped. This week's new taxes on small business seemed unwise, given the fragility of the economy. They were also wholly avoidable, had the NHS been awarded the 3 to 3.5 per cent spending settlement that was expected. But a 4 per cent annual rise for the NHS, raising its budget from o90 billion to almost o110 billion by 2010, seemed to have become a political imperative.

Why? Well, 4 per cent is a nice round number. It is also more than half the 7 per cent annual increases that the service has got used to. But it is also simply very hard to row back once you've built an expanded State. This applies to all public services - which is why I wonder whether Messrs Darling and Brown will actually meet their lower spending targets - but it is particularly acute in health.

The NHS is Britain's last big state monopoly. It is the largest employer in the developed world. Its 1.4 million staff outnumber the private and public healthcare workforce of Germany, a country with 25 per cent more people and better health outcomes. Its powerful unions view any slowdown in spending growth as a "cut". And cut is a deadly word in political terms. The Government had its chance, when it was flush with cash, to demand reform as a quid pro quo for more money. But it did not go far enough.

In the 1990s it was possible to argue that the NHS was starved of cash. But not any more. Britain is now spending at about the European average, but lags behind too many other European countries in terms of results. Far too many cancer patients, babies and stroke victims are still dying needlessly. Far too many patients, particularly the elderly, are treated with a callousness bordering on brutality. Almost everyone I know who has had a baby recently has been told by the nurses to bring their own Jif, and not to set foot in an NHS shower without scrubbing it. World-class that isn't.

Sir Derek Wanless, Gordon Brown's former health guru, reported last month that almost half of the extra o45 billion that has been spent in the past five years has gone on pay and price inflation. The NHS generates its own inflation as though it were a country in its own right. But the slowdown in government spending is not, sadly, due to a realisation that there are diminishing returns to spending in a monolithic health service. It is merely the Government running low on cash.

The real issues are repeatedly obscured by homilies about the NHS being the envy of the world. The latest to fall into this trap is Lord Darzi of Denham, the eminent surgeon who is supposed to be reviewing the structure of the NHS. Thank heavens he is still practising on Thursdays and Fridays. For his interim report last week was little more than an advert for the Government's two populist priorities: extending GP opening hours and tackling MRSA. Until then, the greatest worry about the Darzi review had been that it might delay progress towards much needed reforms. No one had dreamt that he would be coopted into a propaganda exercise. We do not need a top surgeon to tell us to wash our hands. Nor to invent another centralised "Innovation Council" to champion change, a snip at o100 million. The NHS badly needs more innovation. But you cannot impose it. You can only nurture it, by liberating doctors and by introducing competition.

If this simple fact is not obvious to ministers by now, then all is lost. For the limited moves that the last Blair administration made to introduce competition have paid off handsomely. Letting independent providers carry out some procedures has slashed waiting lists for hip replacements, cataracts and heart operations, and has raised the standard for what can be achieved. Payment by results and the NHS tariff have helped to make costs more transparent and to give a wake-up call to poor performers. Giving the best hospitals more freedom as foundation trusts, under a savvy regulator, has injected a new sense of financial rigour.

Yet ministers have always been embarrassed to claim credit for these achievements, which are loathed by the unions. They are in the strange position of presiding over some brave reforms while having to bloviate about minor issues: free health checks (didn't we used to get those at the doctor?) and expanded GP opening hours (which was the norm, until ministers decided to pay them more to do less).

Ministers are too easily persuaded that the battle is between public and private provision. They are ashamed to endorse the private. But the real battle is between those who want to protect their monopolies - including many private hospitals - and those who want competition. Many NHS insiders who believe most fervently in the service are those who are fighting for competition. But they are still an endangered species. It is of no help to them when ministers send ambivalent signals.

No one is quite sure yet how committed the new Prime Minister is to market-based reforms. The opposition parties will not ask him. Labour's largesse has boxed them into a corner. Neither Conservatives nor Liberals dare to make the case for proper reform. That is the real price of having built a bloated State. No one dares speak the truth, because there are so many vested interests to offend. But the writing is on the wall: a tax-funded free healthcare system is looking ever less sustainable. Politicians always fear the "popularity" of our health service. But that popularity will wane if the NHS comes to be seen as the enemy of every other public service.

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Medical Competition Works for Patients

By John Stossel

Health-care costs overall have been rising faster than inflation, but not all medical costs are skyrocketing. In a few pockets of medicine, costs are down while quality is up. Dr. Brian Bonanni has an unusual medical practice. His office is open Saturdays. He e-mails his patients and gives them his cell-phone number. "I need to be available 24 hours a day," he says. "I want to be there when a patient has questions, and I want to be reachable."

I'll bet your doctor doesn't say that. Bonanni knows he has to please his patients, not some insurance company or the government, because he's paid by his patients. He's a laser eye surgeon. Insurance rarely covers what he does: reshaping eyes so people can see without glasses. His patients shop around before coming to him. They ask a question that people relying on insurance don't ask: "How much will that cost?" "I can't get away with not telling the patient how much exactly it's going to cost," Bonanni says. "No one would put up with it. And the difference of a hundred dollars sometimes makes their decision for them."

He has to compete for his patients' business. One result of that is lower prices. And while the procedure got cheaper, it also got better. Today's lasers are faster and more precise. Prices have fallen and quality has risen in other medical fields where most people pay for care themselves, like cosmetic surgery. Consumer power works -- even in medicine.

When government and insurance companies are kept away from the transaction, good new things happen. A doctor in Tennessee I talked to publishes his low prices, such as $40 for an office visit. Most doctors would say you can't make money this way. But Dr. Robert Berry told me you can. "Last year, I made about the average of what a primary-care physician makes in this country," he said. Berry doesn't accept insurance. That saves him money because he doesn't have to hire a staff to process insurance claims, and he never has to fight with companies to get paid.

His mostly uninsured patients save money, too. Unlike doctors trapped in the insurance maze, Berry works with his patients to find ways to save them money. "It's coming out of their pockets. And they're afraid. They don't know how much it's going to cost. So I can tell them, 'OK, you have heartburn. Let's start out with generic Zantac, which costs around five dollars a month.'" When his patients ask about expensive prescription medicines they see advertised on television, he tells them, "They're great medicines, but why don't you try this one first and see if it works?" Sometimes the $4 pills from Wal-Mart are just as good as the $100 ones.

Speaking of Wal-Mart, medical clinics are popping up in Wal-Mart stores and in other similar markets. The clinics offer people with simple problems like sore throats and ear infections relatively hassle-free care ... cheap. Almost everything costs $59 or less. And the clinics are typically open seven days a week. Grace-Marie Turner, president of the Galen Institute, a health-policy research organization, explains how these clinics thrive: "They're figuring how to do something faster, better, cheaper! They're responding to consumer demand because they see that they might make some money on this."

When consumers pay for medicine themselves, saving insurance for the big things, and doctors deal directly with consumers, doctors begin to compete. They start posting prices and work to keep them low. And consumers gain more control of their health care. Instead of governments and insurance companies deciding for patients, patients decide. Competition gives consumers more choices. And choice gives them power. Remember that when you hear a politician promise to make health case accessible and affordable through the force of government.

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18 October, 2007

NHS official condemns NHS

Condemns government meddling

The departing chairman of a hospital trust at the centre of an infection scandal has called for a “root and branch” review of all aspects of nursing across the NHS, in an astonishing letter of resignation. James Lee, the chairman of Maidstone and Tunbridge Wells NHS Trust, yesterday became the latest victim of the scandal following the damning report released last week which found that Clostridium difficile infections had caused the deaths of 90 patients at the trust over a two-year period. Mr Lee offered his resignation by letter to the Health Secretary, which Alan Johnson, in a statement to the House of Commons, later announced had been accepted.

But in a separate letter detailing his reasons for stepping down, the senior manager openly condemned a culture of “command-and-control” in the NHS. The comments made by Mr Lee come after the Healthcare Commission found a “litany” of errors in infection control at all levels in the trust’s three hospitals. He said that the pressure of government targets, the desperate financial position of the trust and failings in nursing care contributed to the spate of infections at Maidstone, Kent & Sussex, and Pembury hospitals.

The target to reduce waiting times was “never really achievable at the trust” while it was “struggling with a state that is pretty close to bankruptcy”, he stated. He added: “I would strongly recommend that the NHS needs to have a root and branch review of all aspects of nursing. I am convinced that something has gone badly wrong.”

His letter started: “Dear Secretary of State, by now you will have received my letter of October 14th, offering you my resignation. “The events described in a report by the Healthcare Commission were nothing short of a tragedy . . . I am writing to you now to help you to understand some aspects of the background to this story. “I am very conscious of the fact that this may seem like an excuse. It is not. There is no excuse for what happened. 90 people died. I simply want to place recent events in their proper context and for us all to learn the lessons.”

Mr Lee went on to explain that the trust’s board had to “devote an inordinate amount of time” to targets and finances, at the expense of managing infections. He concluded: “In my opinion, it was never practical to apply the same uniform target to all trusts, regardless of their starting position, their capability, or the ability of local commissioners to fund the necessary growth in capacity. I strongly urge you to consider making these targets more flexible.” He also recommended that the Department of Health reviews the financial position of health authorities in West Kent.

“We knew that the Treasury was pumping money into the NHS, but quite frankly none of this seemed to be getting to the coal-face,” he added. “I am personally convinced that the formula, which is used to allocate funds to local health economies, is very badly flawed. “I describe these pressures, not to justify or excuse the awful tragedy, which befell our patients, but to help you and the public understand the back story to these terrible events.”

Kent County Council has offered the trust a 5 million pound loan to help to restore public confidence in the hospitals where 1,176 patients were infected with C. difficile during two outbreaks of the infection between April 2004 and September 2006. Of those, at least 345 patients later died.

Mr Johnson described the Healthcare Commission report into the outbreaks at the trust as “a truly shocking document” and apologised to affected patients and relatives on behalf of the Government and the NHS. Rose Gibb, the chief executive of the trust, resigned just days before the publication of the damning report. Mr Johson insisted that “the awful failures” were unrepresentative of the standards of care expected and delivered in hospitals across the country.

But in response, Andrew Lansley, the Shadow Health Secretary, said that the outbreaks in Kent were not an isolated occurrence. “We have had other cases and the common link between them is that managers in the NHS have been more focused on the Government’s targets and the Government’s imperatives, than they have on patient safety,” he said. “Alan Johnson must accept the reality that the target culture is compromising patient safety.” Glenn Douglas, the new acting chief executive for the trust, has promised “zero tolerance” of C. difficile.

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Australia: NSW hospital crisis deepens: Toddler with head injury waits five hours for treatment

More examples of the state's crumbling health system had the Government on the back foot yesterday, after two Sydney families reported waiting up to five hours in emergency for treatment. Howard Williams likened Liverpool Hospital's emergency department to a "war zone" after he rushed his injured son to hospital on Monday night. Mr Williams, a marine engineer, condemned the Government for forcing the public to sit and wait in "third world conditions". Having moved from the US 10 years ago, Mr Williams said he was considering returning because of the poorly run state.

When he arrived at Liverpool Hospital's emergency department at 6.40pm, Mr Williams did not expect to see close to 40 people in front of him. His screaming 15-month-old son George had blood dripping down his head yet it was not until 11.30pm that Mr Williams said he left emergency. "There were people who had been waiting hours before me just sitting out on the street with IVs in their arms," he said. "It was like a war zone." A hospital spokeswoman denied the toddler waited an excessive period. [I would like to see him wait around for 5 hours with his head split open!]

Another family from Sutherland gave up waiting at St George Hospital and took their hysterical son - who had split his head open - to Sydney Children's Hospital, Randwick where he was admitted immediately. The entire debacle took close to four hours.

A member of the Government's Emergency Department Taskforce and Nepean Hospital's head of trauma Dr Rob Bishop said there was no excuse for the public to wait. "We don't accept that people should have to wait for long periods and hospitals are overcrowded," he said. "We should be able to treat these people and not have their experience described like a war zone. "It's not a war zone, it's a first class health system." .... [!!!!]

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17 October, 2007

Government meddling inhibiting complex modern medicine

In the early 1920s, Quaker Oats offered $900,000 to buy a new method to enrich the vitamin D content of food. Sensing an opportunity to peddle health and pleasure in a single package, cigarette and beer companies also wanted the patent. The inventor, Professor Harry Steenbock of the University of Wisconsin, opted instead to set up an independent foundation to license the technology and return the proceeds to his lab. Ten years later, the foundation had earned more than $17 million on the patents—and rickets had almost disappeared from the United States.

Much as vitamin deficiencies did back then, chronic obesity now destroys joints, breaks bones, swells body tissues, and causes heart disease. For one exhilarating decade, Pfizer made a fortune suppressing just one molecule in the long, toxic list of things we shouldn’t consume but often do. Then statin patents began to expire. On June 22, 2006, Merck still owned a statin, Zocor, that earned the company over $3 billion a year in the United States alone. The next day, the formula belonged to humanity.

Lipitor, though introduced later, had quickly eclipsed Zocor in the market, and its patent still had five years to run. But Zocor was now set to take a Pyrrhic revenge. U.S. insurers immediately began jiggering co-pay schedules to migrate patients to generic versions of Zocor. Consumer Reports estimated that a wholesale shift would save $7 billion to $11 billion a year. Lipitor’s market share dropped 4 percentage points in the first half of 2006. Wall Street saw it coming: a few months earlier, Pfizer’s stock price had hit an eight-year low, almost 50 percent below its Lipitor peak. Zocor still sold at about $3 a pill in early 2006; generic copies now sell for as little as 50 cents.

Statins end up very cheap for much the same reason that cholesterol did: there are huge economies of scale in farming cows for milk and fungi for statins, or in brewing up synthetic versions of almost anything. But it takes a delicate choreography of patent-protected monopoly and cutthroat competition to get the innovation first and the rock-bottom prices later. At present, the front end is financed mainly by the United States. Drug companies introduce most new drugs here first, and affluent Americans pay premium prices while the patents last. Less affluent Americans, along with public and private insurers in the United States, Britain, Canada, and the rest of the developed world, get a sharply discounted ride on their economic coattails. Three-dollar statins in New York in 1996 get 30-cent statins to London in 2006 and three-cent statins to Kuala Lumpur a few years later.

Governments are impatient, however, especially when they have promised to supply what they can’t possibly afford but can readily seize. The promise of universal care implies state-of-the-art care, so governments’ principal response has been to skip straight to the three-cent pill. In the developing world, the authorities just fail to notice when pirates manufacture knockoffs. Most developed countries have gone halfway there, by instituting a monopoly buyer to bargain against the monopoly patent. Some members of Congress want to let U.S. patients order drugs from Canadian pharmacies, so that Ottawa will bargain with Pfizer on behalf of the poor in Oshkosh. Others want to set Washington up as the monopoly buying agent for all drugs that it pays for.

Drug companies, however, are quite smart enough not to develop three-dollar pills for three-cent buyers. Collectively, these price-depressing strategies already make it unprofitable to pursue many drugs that treat rare diseases, and drugs for all but the most common diseases earn most of their profit in the unregulated U.S. market. From Big Pharma’s perspective, we are now about half a country away—the rich-America half—from making most diseases too thrifty to bother with. Wherever it’s implemented, every new scheme to undercut the value of an existing patent lowers the incentive to discover new drugs. Every such scheme sacrifices long-term global health for short-term political gain. Every last one of them is ice cream today, and never mind about tomorrow.

That is the real crisis in health care—not medicine that’s too expensive for the poor but medicine that’s too expensive for the rich, too expensive ever to get to market at all. Human-ity is still waiting for countless more Lipitors to treat incurable cancers, Alzheimer’s, arthritis, cystic fibrosis, multiple sclerosis, Parkinson’s, and a heartbreakingly long list of other dreadful but less common afflictions. Each new billion-dollar Lipitor will be delivered—if at all—by the lure of a multibillion-dollar patent. The only way to get three-cent pills to the poor is first to sell three-dollar pills to the rich.

With almost $30 trillion under management, Wall Street could easily double the couple of trillion it currently has invested in molecular medicine. The fastest way for Washington to deliver more health, more cheaply, to more people would be to unleash that capital by reaffirming patents and stepping out of the way.

On the other side of the pill, molecular medicine can only be propelled by the informed, disciplined consumer. Any scheme to weaken his role will end up doing more harm than good. Foggy promises of one-size, universal care maintain the illusion that the authorities will take good care of everyone. They reaffirm the obsolete and false view that health care begins somewhere out there, not somewhere in here.

Neither Pfizer nor Washington can ever stuff health itself into a one-price, uniform, One America box—not when health is as personal as ice cream, genes, and pregnancy, not when every mother controls her personal consumption of carbs, cholesterol, Flintstones, and Lipitor. But the thought that government authority can get more bodies in better chemical balance than free markets and free people is more preposterous than anything found in Das Kapital. Freedom is now pursuing a pharmacopoeia as varied, ingenious, complex, flexible, fecund, and personal as life itself, and the pursuit will continue for as long as lifestyles change and marriages mix and match. Given time, efficient markets will deliver a glut of cheap Lipitor for every glut of cheap cholesterol. And given time, free people will find their way to a better mix.

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Australia: NSW government caves in -- authorizes full public hospital enquiry

ROYAL North Shore Hospital's emergency department was on its knees the night Jana Horska miscarried in a public toilet of its waiting room, but the hospital has refused to concede just how overcrowded it was. The Herald has learned that at the time she miscarried about 9pm there were 43 patients in emergency and all 28 acute beds were full, including the three resuscitation bay beds.

Ms Horska waited twice as long as her designated triage category of one hour. Sixteen patients had been admitted to the hospital but were waiting for an inpatient bed, and seven of those had been waiting more than eight hours.

Yesterday, the Premier, Morris Iemma, bowed to pressure and said he would support a full, open parliamentary inquiry into systemic problems at the hospital, proposed by the Christian Democrats MP Fred Nile.

Ms Horska, 32, was 14 weeks' pregnant when she miscarried on September 25 after waiting for two hours in acute pain for medical attention. The incident led to a flood of serious complaints by doctors, nurses and patients of similar cases, but the Government had insisted it would not broaden its investigation beyond the incident to examine the entire hospital.

The Herald has repeatedly asked the hospital to explain how crowded the emergency department was that night. Yesterday, a spokeswoman for the hospital said it had already explained that the emergency department was "busy". "Clearly, it was a really busy night, but I don't know whether all the beds were full," she said. She confirmed that 43 patients were in emergency at 9.06pm on September 25. Of those, she said one was categorised as the most critical triage one - a child suffering a seizure who required immediate attention. There were seven triage two patients who needed to be seen within 10 minutes, and 14 triage three (to be seen within 30 minutes). There were 18 semi-urgent category four cases needing review within 60 minutes, including Ms Horska, and five non-urgent cases requiring attention within two hours, she said.

She said the acting director of clinical operations, Julie Hartley-Jones, had previously apologised to Ms Horska and her family. "She [Ms Hartley-Jones] mentioned that the emergency department was busy with staff treating a number of critical cases on the night Ms Horska was waiting to be seen," the spokeswoman said. An internal investigation into Ms Horska's case was launched immediately. "Royal North Shore Hospital felt Ms Horska's case was serious and deserved to be responded to in its own right," she said.

Emergency heads from several public hospitals are to meet the Health Minister, Reba Meagher, this week to discuss their concerns about staffing. Mr Nile will move a motion in the upper house today for a joint select committee to inquire into clinical management systems at the hospital, staffing, resource allocation (particularly in emergency), complaints handling, and to consider strategies for improving patient care which could also be adopted at other public hospitals.

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16 October, 2007

The twin problems of medical ignorance and perverse incentives

Below is a list of characters in Shannon Brownlee's story of America's health care system. Try to guess which are the good guys and which are the bad guys.

* A doctor who found a way to treat breast cancer with massive doses of chemotherapy and bone marrow transplants

* Insurance companies that refused to pay for the breast cancer treatment, until attorneys fought on behalf of patients

* A typical independent practicing physician

* Kaiser Permanente and other medical care behemoths

* Doctors who rely on intution, experience, and personal knowledge of the patient to make treatment recommendations

* A statistician who looks at data to evaluate treatments

If you made the usual guesses about the villains and the heroes, then Overtreated will surprise you. For example, concerning the aggressive treatment for breast cancer, Brownlee concludes (p. 141):

insurers unwittingly made the treatment a feminist cause by refusing to pay for it. Breast cancer advocacy groups...threw their weight behind the embattled women...When transplanters like Peters testified in court that the procedure was established practice, when in fact it was not, they stoked the perception among patients that high-dose chemo offered a shot at cure.

Hope Rugo stopped performing transplants on breast cancer patients in 1999...she said, "We believed in it passionately. Now I think about all the women who died during transplant, who would have lived much longer without it."

Doctors and hospitals did not wait for clinical trial results before embracing what turned out to be an ineffective, painful, and debilitating procedure. Brownlee repeatedly chides physicians who rely solely on habit and intuition while remaining ignorant of statistics. The biggest hero in her book is Jack Wennberg, the Dartmouth statistician who has documented the large differences in rates of medical procedures across regions--with the procedure-intensive regions showing no better outcomes than the those regions with fewer procedures.

Why Not McMedicine?

Another point that Brownlee stresses repeatedly is the inefficiency of independent physicians, as compared to large managed-care companies. Independent physicians do a poor job of co-ordinating care of the individual patient, and they lag behind in their use of electronic medical records.

Brownlee does not come right out and advocate McMedicine, but she comes close. She writes (p. 278), "How often does all of this coordinated care actually happen? Outside of a few systems, like the VHA [Veterans' Administration], Group Health, and Kaiser, rarely at best."

As a journalist, Brownlee assumes that the lack of co-ordinated care represents a market failure that government needs to fix. As an economist, I wonder why the market has not produced more McMedicine. Here are some possible answers:

1. With consumers responsible paying for less than 15 percent of personal health care spending out of pocket, health care providers are insulated from the pressure to provide quality service at low cost.

2. Perhaps, for the majority of patients, fragmented care works well. When you only have one condition at a time, the cost of co-ordinated effort may exceed the benefits. Co-ordination only becomes important when you have multiple conditions, or a disease like diabetes that requires thoughtful management.

3. Most of the potential for efficiency gains from large-scale medical providers are precluded because of licensing laws and practice restrictions.

I think that (3) is worth pondering. Our system for licensing doctors, nurses, physical therapists, and so forth, makes it very hard to rationalize and improve our health care delivery system. If you wanted to make McMedicine really work at delivering quality care at low cost, you would economize on the use of highly-educated professionals. Instead, you would use technicians and trained apprentices. You would attain the trust of consumers by earning an overall corporate reputation for reliable service, not by having each employee display a sheepskin on the wall.

The point is that getting the advantages of McMedicine may not be a matter of sheer collective will, as Brownlee would have it. Instead, it might require radical deregulation of medical licensure and practice regulations.

Physician Compensation

Brownlee points out, as many others have noted, that compensating physicians for procedures creates some unwanted incentives. In particular, it rewards doctors for doing more procedures. Doctors try to see as many patients as possible who are in their particular "sweet spot:" if you are an orthopedist who specializes in knee surgery, then you try to see lots of people with bad knees.

Brownlee proposes the alternative of paying doctors a salary, based on the number of patients that they see. However, I would argue that this would create the opposite incentive. Under a capitation based compensation system, a doctor would want to see as few sick patients as possible, because each one takes a lot of time. You will be paid more if you have a large roster of healthy patients than if you have a small roster of sick ones.

As an economist, I believe that there is no perfect way to compensate doctors. I would like to see experiments tried with different systems than the one we use today, to see if they improve things. But I would definitely not say that shifting to a capitation based salary system would bring nirvana.

More Evidence

One of Brownlee's primary recommendations that I can wholeheartedly endorse is an effort to obtain more knowledge about the effectiveness of medical procedures. She writes (p. 291-292),

[Doctors] are required to take a statistics course, but they don't actually learn how to interpret medical evidence...Does every patient who undergoes major surgery need a vena cava filter...Doctors still disagree. Is lithotripsy, using ultrasound to blast kidney stones into tiny bits, better than surgery? It might not be as safe as doctors and patients think it is. Does everybody with slightly elevated cholesterol really need to take high doses of cholesterol-lowering drugs? These questions represent a microscopic fraction of the mysteries that remain in medicine.

On this point, I have no quibbles. Ian Ayres, in his new book Supercrunchers, gives an example of a straightforward exercise in probabilistic analysis that 75 percent of doctors get wrong (p. 214 of his book). I know I once had a Harvard-trained doctor who got a similar problem wrong and gave me bad advice as a result (he is no longer my doctor).

In my own book, I advocated a Medical Guidelines Commission to try to add to our medical knowledge. I think that such an approach will threaten the typical doctor, just as the Moneyball baseball stat geeks threaten traditional scouts. But we need to turn the supercrunchers loose on medical data and see what they can do for us.

Overall, Shannon Brownlee deserves praise for providing a more nuanced and accurate picture of the problems in our health care system than what gets portrayed in the popular media. My main reservation with her book is that she tends to make the solutions seem more straightforward and less problematic than I believe them to be.

Source




Many Brits pay twice for dentistry

It's supposed to be provided by their government health insurance

Scores of patients are being forced to pay for private dental treatment because of a continuing lack of NHS dentists, a large survey suggests. Almost a fifth of NHS patients have gone without treatment because of cost. Others are even resorting to extracting their own teeth after the largest shake-up of NHS dentistry in 50 years. According to the Government’s own estimate, more than 2 million people who wish to access NHS dental care are unable to do so. In April last year, ministers introduced a new dental contract, which aimed to increase access and simplify charges.

But the Dentistry Watch survey conducted by Patient and Public Involvement (PPI) Forums throughout England suggests that a majority of dentists believe that the quality of patient care has declined since the changes and that huge problems remain in finding dentists who will accept NHS patients. For example, when a new dental practice opened in Portsmouth in April hundreds of people queued around the block to register.



Between July and September this year 5,212 patients and 750 dentists were asked for their views: 78 per cent of private dental patients reported abandoning the NHS because either their dentist stopped treating NHS patients, or because they could not find another one who would. Of those patients not using NHS dental services, 35 per cent said it was because they could not find an NHS dentist close to their homes. Only 15 per cent claimed it was because they believed they could get better treatment. Six per cent of patients said they had treated themselves, including extracting their own teeth, because they were unable to get treatment.

The arrangements under the new contract have been criticised by dentists as a crude, target-driven system, which does not encourage them to treat complicated cases or take on new patients. Of the dentists surveyed, 45 per cent said that they were not accepting any more NHS patients and 58 per cent said that the quality of care patients have received since the introduction of the new dental contracts has got worse. Nearly three quarters said they were aware of patients declining treatment because of the cost. However, 93 per cent of patients receiving NHS treatment said they were were happy with the treatment provided.

Sharon Grant, Chair of the Commission for Patient and Public Involvement in Health, which organised the survey, said: “These findings indicate that the NHS dental system is letting many patients down very badly. “It appears many are being forced to go private because they don’t want to lose their current trusted and respected dentist or because they just can’t find a local NHS dentist. This is an uncomfortable read for all of us, and poses serious questions to politicians.”

Commenting on the findings, the British Dental Association said that the survey highlighted the “serious concerns” about the impact of reforms to NHS dentistry in England. Susie Sanderson, chairman of the association’s executive board, added: “The new contract has done nothing to improve access for patients and failed to allow dentists to deliver the kind of modern, preventive treatment they want to give.”

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15 October, 2007

Hillary Clinton's Learning Curve

On most issues, you can line up Hillary Clinton on one side and the Bush administration, free-market think tanks and conservative economists on the other. It would be a surprise to find the former first lady lifting ideas from her longtime opponents. But in this case, there is not one surprise but two: She's not only doing it, but she's doing it on health insurance, where she once embodied Big Government.

The chief question before the country right now is what to do about the 47 million people in the United States who lack health insurance. Their being uninsured is regrettable because it prevents them from getting adequate care and forces the rest of us to shoulder the cost when they get sick. Not only that, it causes anxiety among the insured, who worry about losing coverage. The magnitude of the problem is such that this year, the presidential candidates have been forced to come up with plans to assure everyone, or almost everyone, will be covered.

For years, many conservative experts have proposed a way: making health insurance more affordable by changing how it's treated in the tax code. In this year's State of the Union address, President Bush urged that individuals who buy medical insurance get the same tax break that businesses get when they purchase policies for their workers. In his plan, any family that obtains private coverage would get a $15,000 tax deduction.

But more is required to expand coverage among low-income Americans. Since they pay little or nothing in income taxes, the deduction wouldn't help them much. So the president's plan would provide them a "refundable" tax credit -- a fancy way of saying that if they don't owe taxes, they would get money to buy health insurance. It amounts to a federal voucher for medical coverage.

Bush's solution certainly appeals to his ideological allies. His former chief economic adviser, Harvard professor Gregory Mankiw, has praised the concept. So has Tyler Cowen, a George Mason University economist affiliated with the libertarian Cato Institute. David Gratzer, a physician at the conservative Manhattan Institute, raised the idea in an article for National Review Online.

The case has been neatly summarized by Nina Owcharenko, a policy analyst at the Heritage Foundation who says approaches like this have a host of conservative virtues. "Instead of building on bureaucratic structures or relying on outmoded welfare programs," she writes, "they can promote personal choice in health plans and benefits by transferring decisionmaking power in the health care system to individuals and families."

The change would also make a huge difference. Mark Pauly, a health care economist at the University of Pennsylvania's Wharton School, says that with a credit of $2,000 per person, "I'd guarantee a 50 percent reduction in the number of uninsured." A larger subsidy could boost that figure to 85 percent.

Part of the value of this strategy is that it would vastly expand the individual insurance sector, which now performs poorly because it is so small, has such high overhead expenses and attracts so many high-risk individuals. Arming millions of healthy people with tax credits, Pauly ventures, would be a potent stimulus to competition and efficiency in the private market.

This is not a goal of those who favor government-run health care. So you wouldn't expect Hillary Clinton to embrace the idea. But her new plan says, "Working families will receive a refundable tax credit to help them afford high-quality health coverage." (How big, she doesn't say.)

Is that a change? Well, back in 1993, when we got the original version of HillaryCare, it was opposed by a coalition called Citizens Against Rationing Health, whose alternative plan included -- what's this? -- a refundable tax credit for the poor.

This is not to say that Clinton has joined the Milton Friedman fan club. Her program is still heavy on the kind of intrusive government dictates she has always found so alluring. It would fine large employers that fail to provide coverage for their workers, force insurance companies to offer policies to everyone, with no "excessive premiums," and order pharmaceutical manufacturers to sell drugs at "fair prices." It would force private insurers to compete with a government-sponsored program that could be priced at a loss to put them out of business.

When it comes to health care, Clinton has a long way to go. But conservatives can hope that she has only begun to learn from them.

Source




British government doctor training policy diagnosed a failure

Changes to medical training introduced since 2002 have been rushed, poorly led and implemented and are unlikely even to produce very good doctors, according to a new report. Sir John Tooke, who chaired an independent inquiry set up by the Department of Health, said it had been a sorry episode from which nobody emerged with credit.

The new policy, called Modernising Medical Careers (MMC), was introduced without clear definition of what it was meant to achieve. Weak development, implementation and governance had made it worse. "Put simply, `good enough' is not good enough," Sir John writes. "Rather, in the interest of the health and wealth of the nation, we should aspire to excellence."

Problems with MMC first became apparent when the computer-based application system used for selecting doctors for higher training failed this year. The Medical Training Application Service (MTAS) had to be abandoned, and the furore about it drew attention to wider defects. The report by Sir John, who is Dean of the Peninsula College of Medicine, will make uncomfortable reading for the department, and for Sir Liam Donaldson, the Chief Medical Officer, who was the main driving force behind MMC.

Sir John refused to name those directly responsible for the debacle. "The medical profession itself was complicit in MMC, and it is hard to target any individual for responsibility," he said. The policy had failed in its key aim, which was to eliminate the "lost tribe" of senior house officers who did most of the work in NHS hospitals but were regularly denied opportunities to train to become consultants.

When MMC came in, such doctors found that they had to compete with the growing output from British medical schools and doctors from abroad allowed to work in Britain. Despite repeated warnings, the department at first ignored the problem, and its plan to introduce a policy whereby doctors' jobs only went to overseas candidates if there was not a suitable home applicant was stymied in the courts. This meant that 8,352 foreign doctors were free to apply for posts in 2007, along with 1,500 from the EU and 11,994 British citizens.

While acknowledging the "fantastic contribution" made to the NHS by foreign doctors, Sir John said it was not sensible to have a policy which allowed them to compete with doctors trained in Britain at a cost each of o200,000 to o250,000. The department moved to rectify the situation yesterday by announcing a consultation to look at proposals for managing overseas applicants in the future.

Sir John's report suggests that all those successful in getting a place in a medical school should be guaranteed a training place for the year after they graduate. At present, under MMC, this is not guaranteed - which means medical graduates cannot call themselves doctor, or even work as doctors.

He also suggests that the Postgraduate Medical Education and Training Board should be incorporated into the General Medical Council, which is already responsible for the undergraduate curriculum and for registering doctors. "The management of postgraduate training is currently hampered by unclear principles, a weak contractual base, a lack of cohesion, a fragmented structure and, in England, deficient relationships with academia and service," the report said.

Andrew Lansley, the Shadow Health Secretary, said that it laid bare "the shameful mismanagement by the Government of junior doctors' training. Hundreds of junior doctors still need action taken to ensure those who continue to meet the necessary standards will have the training [made] available to them." Ben Bradshaw, the Health Minister, said that the Government had learnt important lessons from MMC and would consider the report fully.

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14 October, 2007

Ridiculous medical credentialism

Ideally one would hope that certification to operate in one State would automatically apply to all at all times but at least in emergency situations that should be so.

Laws aimed at breaking legal hurdles that prevented hundreds of doctors and nurses from volunteering to help Hurricane Katrina victims in 2005 are gaining momentum in states from Oregon to Pennsylvania. The legislation would allow doctors, nurses, pharmacists, coroners, emergency medical technicians and veterinarians who aren't licensed in states struck by disaster to get quick authorization to offer medical help. Laws have been approved in Colorado, Kentucky and Tennessee and are awaiting the governor's signature in California. Proponents say they expect 20 more states to consider legislation in 2008.

Interest stems from the confusion and government red tape that kept volunteer health workers out of New Orleans when flooding wiped out hospitals and left residents desperate for medical care. At the city's Superdome shelter, Jullette Saussy and a handful of doctors struggled to provide basic care with few supplies and very little help. "We found out later that there were hundreds, if not thousands, of volunteers that were stopped (80 miles away) in Baton Rouge and were not allowed to come into the city and help" because of questions about credentialing and liability, says Saussy, emergency medical services chief for New Orleans. Two years later, Saussy says, "It gives me goose bumps, it makes me so angry."

Health care workers wanting to help in disasters would have to register with the government. Once approved, they would be under the supervision of officials in the state where they volunteer. Using the registries, officials in disaster zones could check to verify that volunteer health workers are properly credentialed and insured. The legislation grants states and practitioners protection from lawsuits.

The National Conference of Commissioners on Uniform State Laws, group that drafts model laws for legislatures, came up with the proposal last year. In a disaster, officials coping with problems from lack of phone service and impassable roads shouldn't be expected to deal with the complex legal and medical issues involved in allowing doctors to practice across state lines, says Raymond Pepe, a member of the commission.

In Louisiana, "in the fog of war, so to speak, people didn't know what the rules were," Pepe says. It was a source of frustration for those who wanted to help. Preston "Chip" Rich, chief of trauma surgery at the University of North Carolina Hospitals, headed to New Orleans shortly after Katrina hit in a 35-car convoy of 100-plus health care workers - but the group never got across the Louisiana line. State officials wouldn't let them come in and start practicing. "It was just a brick wall" of bureaucracy, Rich says. "It was chaos."

Source




AUSTRALIA'S PUBLIC HOSPITAL MADNESS CONTINUES

Four current articles below


Rage boils over at public hospital delays

Three days in great pain waiting for treatment becomes too much

TERRIFIED patients and staff were evacuated from the Gold Coast Hospital as an enraged bikie demanding immediate haemorrhoid surgery for his wife threatened to call in his gang to "trash the place", a court was told yesterday. "I'm the king of the Gold Coast and we don't wait in line for anyone," senior Finks bikie gang member Richard Savage told hospital staff. "I'm going to get 30 of my Finks mates and drink piss and party 'til my wife gets her operation."

Savage pleaded guilty yesterday in Southport District Court to threatening violence and wilful damage. The charges stemmed from a fracas on July 8, 2005, when Savage's wife was in the Gold Coast Hospital awaiting haemmorrhoid surgery. Crown prosecutor Bob Falconer said Savage became aggressive as the wait for surgery continued. Mr Falconer said Savage snapped after being told by staff that operating theatres were full and it was doubtful his wife would be operated on that day. He punched a hole in the wall and told staff: "You better call the police because my mates are on the way. "We're going to trash this place. My wife has been waiting for surgery for three days and I'm sick of waiting."

Mr Falconer said frightened and tearful patients, some of whom had just had surgery, had to be evacuated from the ward, along with staff. He said while the Crown accepted that Savage's wife was in "terrible pain" and he was frustrated, his behaviour was unacceptable. Barrister Tony Glynn, for Savage, said his client had been under great stress but accepted his actions went "well beyond what was a proper and measured reaction to that sort of stress". Mr Glynn said Savage had completed an anger management course and was so impressed he referred two associates.

Judge Fleur Kingham said she accepted that Savage's wife was in extreme pain and had been for some days. But she said he had "simply lost control" and reacted in a way which was "firstly out of proportion and, secondly, entirely unacceptable". "In seeking to alleviate the pain and distress your wife was in, you also caused a great deal of distress, including to patients who had already undergone surgery," Judge Kingham told Savage. She accepted Crown and defence submissions for a wholly suspended 12-month jail sentence for Savage.

Source




Hospital doctor shortage getting worse, not better

SYDNEY's emergency departments are in crisis with one in five senior doctor positions vacant and no recruitment program in place, leaving burnt-out staff angry and ready to quit. More than 22 specialist positions in 24 metropolitan emergency departments had been vacant for several months, despite pleas from doctors who were working overtime to cover the shortfall, the executive director of the Australian Salaried Medical Officers Federation, Dr Sim Mead, said yesterday. "The health department is denying there is a freeze on recruitment, so why are they not advertising these positions? It is completely baffling and I can only draw the conclusion that the longer they take to fill the positions, the more money they save, but it is at the expense of the doctors trying to hold the system up." Dr Mead said advertisements for some positions were later cancelled when it was discovered all the applicants were from other Sydney emergency departments "It's moving the deck chairs around on the Titanic."

The NSW chairman of the Australasian College for Emergency Medicine, Dr Tony Joseph, said emergency specialists could earn up to $100,000 a year more in Queensland and many younger doctors were tempted to leave. "When you spend all day cajoling and arguing with people about moving patients out of the emergency department and into wards, the registrars see that and they don't want it for the rest of their lives." Dr Joseph said the Health Department needed to address overcrowding in hospitals, employ adequate numbers of senior doctors and start listening to staff on the frontline.

One emergency medicine registrar, Dr Claire Skinner, said several doctors were reducing their hours because they felt burnt-out and unable to cope: "The intensity of the work is incredible and has definitely increased. It is stressful and emotionally intense and there is no recovery. We cannot provide the quality of care that we should be able to and that is making us all very stressed. People are leaving and there is a massive risk that we won't be able to train the next generation." She said 43 per cent of emergency department registrars were trained in Australia, with the balance made up of overseas-trained doctors and locums, costing the State Government an extra $35 million a year. "Some are great and some are disasters. Most locums are not familiar with the environment, and emergency departments are quite chaotic at the best of times. It is also erosive for morale when permanent staff are overseeing locums who are earning three times as much as they are."

A survey in May by the University of Sydney's Workplace Research Centre found that almost half of the 140 emergency doctors surveyed said they did not have the time to take a toilet break as soon as they needed. About 66 per cent of the doctors had reported rarely or never completing clinical support activities in rostered time. The Health Department said yesterday it was advertising in Britain and that it had increased the number of staff specialists by 13 per cent and junior staff by 10 per cent in the past three years.

Source




Stupid penny-pinching by hospital bureaucrats

Firing just one of their many "administrators" would have done a whole lot more good but bureaucrats are sacrosanct, of course

A SURGEON says removing cracker biscuits from Royal Hobart Hospital operating theatres to save money is exhausting staff and putting patients' lives at risk. Senior surgeon Stephen Wilkinson said low blood sugar interfered with doctors' ability to make life and death decisions during overnight emergency surgery that often ran into the morning. "It's administration gone mad," said Dr Wilkinson, who was doing emergency surgery into the early hours yesterday. "Morale is already at an all-time low, with surgeons close to walking out. All we want is the Salada biscuits and Vegemite reinstated. It might sound petty but it makes a big difference. "We get hypoglycemic, a headache and we're trying to think clearly so you can make difficult decisions on the run. People's lives are relying on it."

He said the hardest work was at night. "That's when you get the car accidents, bowel obstructions, perforated ulcers," he said. "We need to get our concentration back and sugars up. "It's a stressful environment already. I think it's unsafe." The operating suite tearoom had long had "simple crackers and biscuits", but now had only teabags and instant coffee.

Dr Wilkinson was so angry he rang chief executive officer Craig White during the early hours of yesterday. The hospital said it had stopped providing food and snack items to maximise resources for direct patient care. "The RHH is experiencing significant budget pressure and identified the provision of food and snack items to doctors' lounges and staff tea rooms as an expenditure that would be redirected to patient care," spokeswoman Pene Snashall said.

Source




And we trust Indian doctors?

There is no way these doctors can have received anything like Western-standard medical training

A COUPLE has been charged with the murder of one of their sons after they tried to transfuse his blood into his elder brother to make him smarter. The elder boy is fighting for his life. The Indian Express said the couple were both doctors and the mother had a dream in which a guru advised blood transfusion to make their elder son do better at his studies. Police said the couple initially claimed the boy, 11, was killed in an attack but later confessed.

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13 October, 2007

Corrupt NHS hospital

The NHS has become a honeypot for bureaucrats -- particularly if they are incompetent. Sick people are bottom priority

The Health Secretary has instructed an NHS trust at the centre of a super-bug scandal to withhold a redundancy payment to its departing chief executive amid the possibility of a criminal investigation. Rose Gibb left her job as head of Maidstone and Tunbridge Wells NHS Trust last Friday, days before a damning report revealed that mismanagement of an outbreak of Clostridium difficile had contributed to more than 90 deaths at the trust. The investigation by the Healthcare Commission, published yesterday, found “significant failings” in infection control at every level of the organisation and was heavily critical of the management regime by Ms Gibb during the worst outbreaks ever recorded of C. difficile.

Alan Johnson made the request to postpone any severance payout amid rumours that Ms Gibb could expect to receive 500,000 pounds or more after serving in her post for four years. Annual accounts showed that she earned around 150,000 in salary, 5,000 in benefits and 12,500 in pension in 2006-07.

Mr Johnson said yesterday morning that the circumstances leading to the deaths had been a “scandal”, before announcing last night: “I have instructed the trust to withhold any severance payment to the former chief executive of Maidstone and Tunbridge Wells NHS Trust, pending legal advice.” The Department of Health said that it was consulting lawyers to confirm whether the Secretary of State had powers to prevent such a payment. “We believe this is an unprecedented case,” a spokeswoman said. “It’s usually up to the trust to decide payments to its staff.”

Meanwhile, the Health and Safety Executive (HSE) met Kent Police yesterday to discuss whether to bring criminal charges against the trust or Ms Gibb as an individual. Lawyers said yesterday that the trust or Ms Gibb could be charged under existing criminal or health and safety law, but recent changes to make organisations more accountable for deaths under the new offence of corporate manslaughter will not come into force until April next year. A spokeswoman for the HSE said: “We look for evidence admissible in court whether there has been any breach of law by the corporation. “If you can prove that, then you could also prosecute those in charge, such as the directors or chief executive. There you are looking for evidence that by deliberate action of those in charge, the breach occurred.” Deliberate action would mean that the chief executive or directors knew that people could die or an adverse outcome could occur from a breach of the Health and Safety at Work Act.

A spokesman for Kent Police added: “We are in the process of reviewing the contents of the report given to us by the Healthcare Commission. Until such stage we have digested the contents of the report, we cannot say we are going to fully investigate this. We have got to review it first. The purpose of the review is to see if any criminal acts have taken place.” He said that if any criminality was found, police would gather evidence and liaise with the Crown Prosecution Service.

Appalling hygiene standards at Kent & Sussex Hospital, Pembury Hospital and Maidstone Hospital resulted in C. difficile contributing to 345 deaths, of which it was directly linked to 90. More than 1,100 patients were infected at the hospitals over a two-year period, the Healthcare Commission found.

The trust has refused to disclose how much money Ms Gibb received after leaving, but it is understood that managers in a similar position have been awarded up to 900,000 pounds. A spokesman for the trust said yesterday: “As with any employee, the financial arrangements are confidential.” In a statement last week the trust chairman and Ms Gibb said that they had “agreed that this is the right moment for her to move on”. It said that she was leaving to “pursue new challenges”.

Geoff Martin of the campaign group Health Emergency said that the intervention by Mr Johnson had been “absolutely right and proper”. “A severance payment should never have been considered in the first place,” he said. “I have heard from Maidstone NHS staff this morning that [she] is rumoured to have received a massive payoff from the trust. “If it’s true, we have a right to know how much taxpayers’ money is involved and it would fuel the scandal even more if it turns out that senior managers have walked away from this carnage with their pockets stuffed with NHS cash.”

Source




Australia: Public hospital gridlock kills

TWO patients with lung cancer went undiagnosed although early signs of the disease had been detected on X-rays but not reported to the referring doctors at Liverpool Hospital. The hospital has a huge backlog of scans that have not been interpreted by radiologists. It has emerged that emergency patients are being called back months after being examined.

As evidence of the state's health woes continues to mount, the embattled Health Minister, Reba Meagher, declared yesterday that she trusted the word of nurses over that of a senior doctor in the case of an elderly patient at Royal North Shore Hospital who was moved out of a ward and into a treatment room overnight. Tony Joseph, the hospital's head of emergency, who is also the NSW chairman of the Australasian College for Emergency Medicine, said that Ms Meagher should admit that hospital emergency departments were in chaos.

Meanwhile, the director of radiology at Liverpool Hospital, Glen Schlaphoff, confirmed that two patients examined at the hospital in the past two years had early signs of lung cancer that were detected on X-rays but not reported to the referring doctors. He said one of the patients, X-rayed last year, had died and the second, seen this year, was still living. In both cases, X-rays had revealed a cancerous lump in the lung. "The nodule was reported and a report issued, but the doctor team that requested the report never saw the report," Dr Schlaphoff said.

Investigations into both incidents had blamed the hospital's paper-based system for the failure to pass on such crucial information. He said he had campaigned for four years to have an electronic system of reporting radiology examinations. This would be installed by next year. A senior staff member, who did not want to be named, said that at best X-ray reports were completed within several days of examination, but "there are examples of reports that come to us with significant findings that come to us months after the person has passed through the emergency department. You are left in an awkward position of having to contact the person and calling them back to the hospital." While most doctors were trained in how to read an X-ray, "radiologists are able to detect more subtle findings". The Herald reported on Saturday that the hospital's official estimate of the backlog was 4500 images that had not been reported on by a radiologist.....

Source





12 October, 2007

NHS superbug negligence kills 90

At least 90 patients died and more than 1,100 became infected as hospital managers failed to control the worst outbreaks ever recorded of the super-bug clostridium difficile, a report states today. Inadequate staffing levels, dirty wards and too much focus on cost-cutting and government targets contributed to two serious outbreaks of C difficile in as many years at Maidstone and Tunbridge Wells NHS Trust, an investigation by the Healthcare Commission found. The Health and Safety Executive and Kent Police are now considering the possibility of criminal charges being brought against the trust or its executives.

The commission found "significant failings" in infection control at three hospitals run by the trust between April 2004 and September last year, including unwashed bedpans, a lack of isolation units, beds being spaced far less than the recommended 3.6 metres apart to stop the spread of infection and nurses telling some patients with diarrhoea to "go in their beds". Pictures taken as recently as February disclosed continuing hygiene concerns. Rose Gibb, the chief executive of the trust, left her job on Friday by mutual agreement with the board.

The failure to contain and treat infections at all levels contributed to 1,176 patients being infected with the bug at Kent and Sussex Hospital, Pembury Hospital and Maidstone Hospital, Kent, the watchdog said. A total of 345 patients died while infected with the bacterium between April 2004 and September 2006, 21 died as a direct result of infection and for 69 patients it was probably the main cause of death, it added. In addition, C difficile could also be considered a "contributing factor" in as many as 241 of the deaths, although the report said that patients, many of them elderly or frail, may well have died of other causes if they had not acquired the infection. The trust had previously told the Healthcare Commission there had been "no deaths that were definitely caused by C diff" between April 2004 and March 2006.

The first big outbreak was between October and December 2005 but, despite the number of infected patients quickly doubling to 150, the trust did not identify the outbreak. The second significant outbreak was between April and September 2006, in which 258 patients were affected, and was recognised as serious by the trust. But despite these problems, the trust declared itself compliant with national government standards for hygiene and infection in May 2006.

At the time of the outbreaks the trust was carrying out a programme to save 40 million pounds over three years in the face of huge debts. At the end of 2003, the trust had an accumulated deficit of 17.6 million. Last year, it reported a deficit of 4.5 million.

The commission said that there was evidence patients had been moved between several wards, increasing the chance of spreading infection. It said this was partly due to concerns over hitting the Government's targets on waiting times for treatment in A&E.

Anna Walker, the chief executive of the commission, said that the lack of infection control at the trust had been "unacceptable" but that conditions had improved as a result of monitoring by the commission. Improvements included increasing the space between beds, appointing a new director of infection prevention and control and implementing a policy on the use of antibiotics which are known to help C difficile thrive.

"What happened to the patients at this trust was a tragedy," Ms Walker said. "This report fully exposes the reasons for that tragedy, so that the same mistakes are never made again." She called for the NHS to treat C difficile as an illness rather than just an added complication.

Health Protection Agency figures showed that rates of C difficile are now lower than the NHS average last year. A spokeswoman for the Health and Safety Executive said that it was working with Kent Police to consider the report.

Patients were treated on open wards instead of in isolation. A former children's ward was being used for adults. It contained an uncleaned shower, one wash basin for 12 beds and beds placed only 30cm (less than a foot) apart. A shortage of nurses contributed to the spread of infection "because they were too rushed to undertake hand hygiene, empty and clean commodes, clean mattresses and equipment properly" and wear aprons and gloves. High bed occupancy - over 90 per cent at Maidstone and the Kent and Sussex - led to less time for cleaning. Staff used alcohol wipes, which are ineffective against C. Diff spores, to clean commodes instead of soap and water. Old commodes were used despite the trust agreeing to replace them and setting aside 250,000 pounds to do so

Source




Political stupidity about superbug prevention

Government plans for tackling superbugs, such as MRSA, have been condemned by a leading medical journal for not being based on scientific fact. The Lancet said there was little evidence to support hospital "deep cleans" or short-sleeves for medical staff as recently proposed. Instead of "pandering to populism" politicians should listen to the evidence, the editorial said.

The government said the plans were part of a wide range of preventive measures. On Sunday, Prime Minister Gordon Brown announced plans to "deep clean" hospitals ward-by-ward over the next year to return hospitals to the state they were in when they were built. His comments followed proposals from Health Secretary Alan Johnson for a new dress code for NHS staff which would advise against long-sleeved coats and ties for doctors as they can become contaminated.

But The Lancet said a government working group had found no conclusive evidence that uniforms or other work clothes posed a significant hazard in terms of spreading infection. And the focus should be on disinfection of high-touch surfaces rather than deep-cleaning wards to get rid of visible dirt, the journal said.

The editorial said: "Brown also plans to double the number of hospital matrons, to check on ward cleaning, and accost doctors wearing long sleeves. "They would be better employed making sure doctors, nurses and visitors wash their hands properly, the proven way to stop hospital acquired infections," the editorial stated.

Professor Richard James, director of the Centre for Healthcare Associated Infections at the University of Nottingham agreed the evidence on transmission of infection from clothing such as long sleeves was not clear but short sleeves may encourage staff to wash their hands properly. He added: "The main route of transmission of MRSA is person-to-person contact and this will be affected little by deep cleaning.

"In contrast, Clostridium difficile is transmitted by contact with faecal contamination so it may be more effective here." He said in addition to hand washing, other useful strategies would be screening patients for MRSA on admission, regular use of hydrogen peroxide vapour generators to kill bugs in the hospital environment and educating patients and visitors on ways they can reduce risk.

Chief Nursing Officer, Professor Christine Beasley said there was no single solution and the new proposals were part of a wider set of measures to reduce hospital-acquired infections. She agreed that there was no evidence that uniforms themselves pose a significant risk of transmitting infections but said long sleeves and watches "get in the way of washing and decontaminating the hands, wrists and forearms". "Clean and tidy hospitals and staff are very important to patients," she said. "We make no apology for asking hospitals to take every reasonable measure to reduce infection and increase patient confidence that this is an issue the NHS is taking seriously."

Dr Mark Enright, an expert in molecular epidemiology at Imperial College, London said deep cleaning would be a waste of resources and an inconvenience to patients and staff. "MRSA is a major problem in the UK because it is present, mostly unknowingly, in patients and staff. "Interrupting the chain of transmission from these people to new hosts should be the main focus of infection control, not attempts at the sterilisation of floors and windows."

Source




Australia: Public hospital doctors revolt against NSW government lies

HEALTH Minister Reba Meagher's credibility is in tatters today as leading emergency doctors break their silence to condemn patient care at Royal North Shore Hospital. As the minister frantically downplayed The Daily Telegraph's revelation that a 91-year-old grandmother had been placed in a supply room, experts came forward to tell the truth about the RNS.

NSW chairman of the Australasian College for Emergency Medicine, RNS senior emergency doctor Tony Joseph, disputed the minister's claims that the rooms were used for "clinical" reasons. He confirmed it was hospital policy to shuttle patients into rooms not designed for patients when the emergency department overflowed. "They are unsafe and it is part of the over-crowding policy," Dr Joseph told The Daily Telegraph. "When emergency departments are bursting . . . they will put patients in these side rooms."

The "over-census" policy was even admitted to by one of Ms Meagher's hospital bureaucrats, who said the side rooms were used to deal with over-crowding. The 91-year-old's granddaughter yesterday said the family were unhappy with the treatment of their frail grandmother

Source





11 October, 2007

Australia: ANOTHER DAY OF PUBLIC HOSPITAL REVELATIONS

Three articles below


Grandmother, 91, left in hospital storage room



On the same day embattled Health Minister Reba Meagher met with staff at Royal North Shore Hospital, 91-year-old patient Edith King was wheeled into a storage room - and left there. The shameful treatment of the great grandmother has plunged our public health system to a new low. Suffering from blood clots in her legs and in need of treatment Mrs King, of Hornsby, was wheeled into the storeroom of ward 10B at the embattled hospital - and left there for 24 hours. She was moved to the storage room just hours after her granddaughter Sharon Hooper left her bedside on Monday afternoon.

It came on the same day Ms Meagher visited the hospital to meet with aggrieved medical staff and establish a professional practice unit to deal with complaints from staff and patients. Ms Meagher hoped her visit to the hospital would bring an end to almost two weeks of constant criticism of the State Government.

Despite their spin, Mrs King's treatment proves nothing has changed since expectant mother Jana Horska miscarried in the hospital's waiting room toilet two weeks ago. Hooked up to a drip and monitor and without an emergency buzzer, Mrs King's bed was left just centimetres from a sink and basin - with a bedpan and oxygen tanks stored nearby. Above her bed were shelves stacked with medical equipment. The room affording the ailing woman little privacy or rest. While nurses kept an eye on Mrs King, she suffered the indignity of being left in essentially a thoroughfare with staff pushing past her bed to get to supplies and handbasins.

The Daily Telegraph reports health sources revealing that at least one patient would be housed in the storage room most days. Mrs King was finally moved to a ward yesterday afternoon, but her spot in the store room was taken by another patient.

Mrs Hooper said yesterday she was shocked to learn her grandmother was left in the storage room. "I'm glad you got a picture. She turns 92 on October 24 and she doesn't deserve to be chucked in a room like that," Mrs Hooper, who works as a doctor's receptionist, told The Daily Telegraph. "I work with people who are ill everyday and I know how they should be treated. "That's pathetic when a person can't get up and fend for themselves. "She's confused at the best of times but (being left in a room) would have thrown her right out. "You think your relatives are safe in there. Now I know she's not safe and it's going to worry the daylights out of me every day," Mrs Hooper said.

Mrs King was transferred to RNSH from Hornsby Hospital last Thursday and placed in a ward after 13 hours lying on a bed in the emergency ward. Ms Meagher last night tried to defend the shameful treatment of Mrs King by stating she was moved to the storage room for her "own safety". "I'm advised she was confused and nursing staff decided she needed close observation to prevent her falling," Ms Meagher said. "The decision was made because her allocated room was not in view of the nursing station."

Source




Stretchers become beds; Ambulance service stopped

SYDNEY'S problem-plagued Royal North Shore Hospital was yet again plunged into crisis this week, with ambulance services crippled by a shortage of beds. Six ambulances sat in the RNSH car park for more than four hours on Monday night, unable to answer calls because their stretchers were needed as beds for patients waiting in hallways.

One patient, an elderly woman brought in by one of the ambulances for a fractured hip at 8.30pm, was still waiting for medical attention at 3.30am. Three others, two men and a woman injured when their car overturned in Delhi Rd on Monday night, waited over four hours to be assessed by a doctor. The chaotic scenes are further proof of the ongoing staffing and management crisis at RNSH, which is already the subject of two clinical inquiries and a massive overhaul.

A paramedic, who did not want to be named, said he feared "someone could die waiting - and it's happened before". "We have more than enough paramedics but what we don't have is beds and doctors," he said. "Normally in half an hour you've unloaded and are ready to go, but there are no beds. "I've been here four hours and I can't do anything but wait."

Source




Bureaucracy is the public hospital problem: Federal minister gets it

By Tony Abbott, the federal Minister for Health

Inadequate funding has been a serious problem at Royal North Shore Hospital but not as serious as management structures which intimidate staff and cover up bad decisions. A leaked letter from Northern Sydney Central Coast Health's acting chief executive officer shows that, this year, Royal North Shore is expected to make do with $13 million less than last year's budget and $31 million less than last year's actual spending (of $377 million). This is a 9 per cent cut imposed on a hospital already under great strain. The acting CEO's letter to Royal North Shore Hospital managers demonstrates a fixation with meeting budget rather than treating patients. A department or ward is a "cost centre". A hospital is a "major cost centre".

In fact, the whole NSW hospital system is obsessed with meeting budget rather than delivering services. Managers are told that "achieving this [budget] target will be a central component of assessing your performance". They're warned that "efficiency contributions" must be achieved and told that "under no circumstances" can they spend above budget without written authority from the area head office. They're instructed to reduce operational costs by "absorbing additional volume within current funding levels". Given this type of official bullying, it's no wonder that emergency departments are under extreme pressure.

The acting CEO's letter also reveals that the overall Area Health Authority has had a budget increase of just 1 per cent this year (compared with 7 per for the rest of the state) and that even this paltry increase is funded by "internal contributions and efficiencies".

Like Royal North Shore, public hospitals on the (Liberal voting) northern beaches have had a 7 per cent budget cut. The discrepancies between the acting CEO's figures and the self-serving claim of the NSW Health Minister, Reba Meagher, that Royal North Shore had a 10 per cent budget boost over two years reflect the administrative chaos inside NSW public hospitals. No one really seems to be in charge or accountable to anyone else.

The Howard Government is proposing to replace faceless area health bureaucracies with individual hospital boards including local doctors and nurses. These couldn't prevent state governments from imposing budget cuts but they could at least warn people about them in advance. Hospitals with local management boards would be less obsessed with budgets and more focused on treating patients. It would be harder for officials to move services around like pieces on a chess board, regardless of the views of patients and clinicians. This is why state governments don't like them. Although the "Dr Death" Royal Commission in Queensland noted the need for co-ordination of public hospital services, it concluded that "hospital boards . were attentive to local issues [and] planning was firmly focused on the clinical needs of the immediate population".

More money is certainly needed for better public hospital services but it's just as important to reform the way public hospitals are run. Patients, doctors and nurses need access to someone with the authority to fix their problems. A CEO accountable to a local board would treat the hospital budget as a means to an end rather than an end in itself. It certainly wouldn't resolve all the difficulties inherent in meeting public expectations but it would at least guarantee that patient and staff concerns were taken seriously. With real authority over the hospital budget and the capacity to keep extra revenue, the "buck could stop" with a hospital CEO in a way it never can with state health ministers, let alone a prime minister.

Kevin Rudd's claim that, as prime minister, the "buck" would stop with him for every single hospital problem is just spin. It's only necessary to imagine the call: "Mr Rudd, I've been waiting two hours in the emergency department. Could you please get me a doctor?" to dismiss this flaky boast.

Rudd thinks that the ultimate solution to public hospital problems is a takeover by the federal government. By contrast, John Howard thinks that the best answer is a takeover by the local community. Rudd was part of the Queensland Government that abolished hospital boards and cut 2200 public hospital beds. This ultimately produced the current disastrous situation in that state, described by the Dr Death commissioner: "There are so many bureaucrats writing memoranda to one another, reading memoranda from one another and attending meetings with one another that nobody has time left to actually get anything done". Hospitals need fewer bureaucrats but more doctors and nurses. Labor can't deliver this but local boards would.

Source





10 October, 2007

More Leftist unconcern about truth

The "Poor" SCHIP Kid: Post below lifted from Flopping Aces. See also Blue Crab

The latest liberal deception is their "tug the heartstrings" story which they rolled out nationwide by using a 12 year old kid named Graeme Frost from Maryland to give the radio response to President Bush. The kid was in a accident with his sister and were severely injured. The Baltimore Sun:

Graeme, a seventh-grader at the Park School, has a message for the president.

"If I could speak to him, I would say, 'You have to sign this bill,'" he told reporters yesterday during his first visit to the Capitol. "I'm guessing he wants this money for Iraq. Our future isn't in Iraq. It's here."

The blond, bespectacled youth rose at 6 a.m. in his family's home in the Butchers Hill neighborhood of Baltimore yesterday for the trip to Washington.

Earlier in the week, two staffers from the office of Senate Majority Leader Harry Reid had called to ask Graeme about his health care experience.

Graeme and his 9-year-old sister, Gemma, were passengers in the family SUV in December 2004 when it hit a patch of black ice and slammed into a tree. Both were taken to a hospital with severe brain trauma. Graeme was in a coma for a week and still requires physical therapy.

Bonnie Frost works for a medical publishing firm; her husband, Halsey, is a woodworker. They are raising their four children on combined income of about $45,000 a year. Neither gets health insurance through work.

Having priced private insurance that would cost more than their mortgage - about $1,200 a month - they continue to rely on the government program. In Maryland, families that earn less than 300 percent of the federal poverty level - about $60,000 for a family of four - are eligible.

The Senate staffers wrote the script for Graeme.

So here are the facts as laid out by the Democrats.  The kids parents only earn 45 grand a year and they receive no insurance through their work.  Getting insurance on their own would cost 1200 bucks.

But the internet is an amazing thing.  You can fact check stories like never before and this one was indeed fact checked by icwhatudo at Free Republic:

His sister Gemma, also severely injured in the accident, attended the same school prior to the accident meaning the family was able to come up with nearly $40,000 per year for tuition for these 2 grade schoolers. Confirmation both attended Park found here using edit-"find on this page"-Gemma. It will take you to an article in the schools newspaper about a fundraiser for Gemma class of 16, and Graeme class of 13. Here are photos of the school's 44,000 square foot Wyman Arts Center: two galleries, an outdoor ampitheater, Meyerhoff Theater, Macks-Fidler Black Box Theater, practice rooms, rehearsal space, and ceramics, 3-D sculpture, woodworking, jewelry, painting, photography, digital graphics studios, recording studio, and keyboard lab.

In a Baltimore Sun article the family claims to be raising their four children on combined income of about $45,000 a year. "Bonnie Frost works for a medical publishing firm; her husband, Halsey, is a woodworker. They are raising their four children on combined income of about $45,000 a year. Neither gets health insurance through work."

What the article does not mention is that Halsey Frost has owned his own company "Frostworks",since this marriage announcement in the NY Times in 1992 so he chooses to not give himself insurance. He also employed his wife as "bookkeeper and operations management" prior to her recent 2007 hire at the "medical publishing firm". As her employer, he apparently denied her health insurance as well.

His company, Frostworks, is located at 3701 E BALTIMORE ST. A building that was purchased for $160,000 in 1999. The buildings owner is listed as DIVERSIFIED INDUSTRIAL DESIGN CENTER, LLC whose mailing address is listed as 104 S Collington Ave which is the Frost's home. The commercial property he owns is also listed as the business address for another company called Reillys Designs which leads to the question of whether rental income is included in the above mentioned salary total

The current market value of their improved 3,040 SF home at 104 S Collington Ave is unknown but 113 S COLLINGTON AVE, also an end unit, sold for $485,000 this past March and it was only 2,060 SF.

A photo taken in the family's kitchen shows what appears to be a recent remodeling job with granite counter tops and glass front cabinets

Lets do the math here.  The value of their house is up over a half a million, the value of the commercial property would have to be close to 300 grand or so now, and the family may be renting some of the property out to another company for more income.  Now we come to their mortgages which I'm sure cost a bit but this family was able to send two of their kids to a private school at 20 grand a piece, so the mortgage's couldn't be killing them.
About that tuition.  Didn't the article state they only make 45 grand combined per year?  So after sending their kids to school they take home 5 grand for the whole year.  Riiiiight.  I smell unreported income here or they received tuition assistance from the Park School which would mean a couple with four children have two of them attending a private school rather than a public school at the expense of taxpayers. 

Oh, and one more thing, the cost of private insurance IS NOT 1200 bucks.  Rather its 700. 

A check of a quote engine for zip code 21250 (Baltimore) finds a plan for $641 with a $0 deductible and $20 doc copays.

Adding a deductible of $750 (does not apply to doc visits) drops the premium to $452. That's almost a third of the price quoted in the article. Doesn't anyone bother to check the facts?

This is the family the Democrats chose to represent SCHIP?  If there was a more perfect family why SCHIP should not be expanded its this one.  They are doing quite well with their own business, a 3000 square foot house with a beautiful kitchen. And on top of all that they send their kids to private school.

Now this is what our tax dollars should be going to! Sigh..



Australia: Stupid government formula responsible for hospital disaster

Basing funding on actual demand was too simple for these brainiacs. Result was a famous meltdown at the RNS hospital

A NSW Health executive told a forum of 150 senior managers and clinicians that the high rate of health insurance in northern Sydney was taken into account when funding public beds at Royal North Shore Hospital, a senior doctor said yesterday. Yesterday, Danny Stiel, clinical director for the Division of Medicine and Aged Care at the hospital, confirmed with the Herald that he had asked the then acting chief executive of the Northern Sydney Central Coast Area Health Service, Terry Clout, whether the level of private health insurance was taken into account in the funding formula. Mr Clout, who was recently appointed chief executive of South Eastern Sydney Illawarra Area Health Service, rejected the comment yesterday.

The exchange took place at a question and answer session at the Northern Sydney Central Coast Area Health service managers forum, held at the Central Coast Leagues Club on August 29. "We've never previously had anyone admit openly that it is taken into account," Dr Stiel said. "Colleagues have said to me I've never heard anyone actually confirm that that is the case and now that we know that is the case we can at least take it into account. "My main issue was bed block . it seems to me that ours is worse because we seem to be less bedded because of this type of formula. We think we're particularly disadvantaged by our otherwise good fortune in having people with private health insurance." Another hospital administration source, who did not want to be named, first contacted the Herald about the exchange. "The question was, is Royal North Shore funded based on the fact that we have a wealthy population and we have a high rate of private health insurance, and Terry Clout said absolutely, without a doubt," she said. "His answer was 'yes, Danny, you're spot on, that's how the hospital was funded' . most people weren't really that surprised."

This follows the revelation in the Herald on September 28 by a former staff specialist, Linda Dayan, that staff were told 10 months ago it was Government policy to slash the budget because "people on the North Shore had money" and could afford to use private hospitals. The Health Minister, Reba Meagher, rejected that claim.

Dr Stiel said yesterday that he asked Mr Clout specifically if private insurance affected how many public beds were funded. "The question I was asking was, when people determined how many public beds there should be, is the private/public mix in a particular geographic area taken into account in that decision-making, so if an area is very heavily insured . is that taken into account, and the words that he said were 'absolutely'," Dr Stiel said. "What he said was 'yes, by doing that the number of public beds is likely to be less than it would have been if there had been no private beds in the area', and that explained to us that that could be why we have worse bed block than other areas."

Dr Stiel said "as a consequence [of an assumption] that you don't have to worry about funding these people because they have private beds and we can now fund areas of need, one of the unforeseen consequences of that is bed block . "The point I make is it is true, that that's taken into account. Maybe people should rethink the funding formula."

Mr Clout said yesterday the funding formula is a "health-needs adjusted, population-based formula". "What I then said was that there is clearly some correlation between a population that have a, that is more affluent, and the rate of health insurance . and to that extent there is a relationship - that's how I answered that question." He denied ever saying the rate of private health insurance was taken into account. "It's not in any way, it's not. It's a clear formula. It's those determinants of health that I have indicated to you," he said.

A spokesman for the North Sydney MP, Joe Hockey, said the hospital was also used by people from out of the area, and not all locals could afford insurance.

Source





9 October, 2007

Big gain to Texas from malpractice reforms

In Texas, it can be a long wait for a doctor: up to six months. That is not for an appointment. That is the time it can take the Texas Medical Board to process applications to practice. Four years after Texas voters approved a constitutional amendment limiting awards in medical malpractice lawsuits, doctors are responding as supporters predicted, arriving from all parts of the country to swell the ranks of specialists at Texas hospitals and bring professional health care to some long-underserved rural areas.

The influx, raising the state’s abysmally low ranking in physicians per capita, has flooded the medical board’s offices in Austin with applications for licenses, close to 2,500 at last count. “It was hard to believe at first; we thought it was a spike,” said Dr. Donald W. Patrick, executive director of the medical board and a neurosurgeon and lawyer. But Dr. Patrick said the trend — licenses up 18 percent since 2003, when the damage caps were enacted — has held, with an even sharper jump of 30 percent in the last fiscal year, compared with the year before. “Doctors are coming to Texas because they sense a friendlier malpractice climate,” he said.

Some experts say the picture may be more complicated and less positive. They question how big a role the cap on malpractice awards has played, arguing that awards in malpractice lawsuits showed little increase in the 12 years before the law changed. And some critics, including liability lawyers, question whether the changes have left patients more vulnerable. With doctors facing reduced malpractice exposure, they say, many have cut back on their insurance, making it harder for plaintiffs to collect damages. Moreover, the critics say that some rural areas have fewer doctors than before.

The measure changing Texas’ malpractice landscape, Proposition 12, was narrowly approved in a constitutional referendum on Sept. 12, 2003. It barred the courts from interfering in limits set by the Legislature on medical malpractice recoveries. For pain and suffering, so-called noneconomic damage, patients can sue a doctor and, in unusual cases, up to two health care institutions for no more than $250,000 each, under limits adopted by the Legislature. Plaintiffs can still recover economic losses, like the cost of continuing medical care or lost income, but the amount they can win was capped at $1.6 million in death cases.

All but 15 states have adopted some limits on medical damage awards, according to the National Conference of State Legislatures. But the restrictions in Texas go further than in many states, where the limits are often twice as high as they are here. “Other states have passed tort reform, but Texas implemented big changes all at once,” said Lisa Robin, a vice president for government relations at the Federation of State Medical Boards, a national umbrella group based in Dallas.

Some experts say that the lack of a state income tax, combined with what William M. Sage, a law professor at the University of Texas in Austin, called a “relatively rapid transition in its tort reputation as a plaintiff-friendly state,” has contributed to the state’s appeal to doctors. Dr. Timothy George, 47, a pediatric neurosurgeon, credits the measure in part with attracting him and his sought-after specialty last year to Austin from North Carolina. “Texas made it easier to practice and easier to take care of complex patients,” he said.

The increase in doctors — double the rate of the population increase — has raised the state’s ranking in physicians per capita to 42nd in 2005 from 48th in 2001, according to the American Medical Association. It is most likely considerably higher now, according to the medical association, which takes two years to compile the standings. Still, the latest figures show Texas with 194 patient-care physicians per 100,000 population, far below the District of Columbia, which led the nation with 659.

The Texas Medical Board reports licensing 10,878 new physicians since 2003, up from 8,391 in the prior four years. It issued a record 980 medical licenses at its last meeting in August, raising the number of doctors in Texas to 44,752, with a backlog of nearly 2,500 applications. Of those awaiting processing, the largest number, after Texas, come from New York (145), followed by California (118) and Florida (100). In some medical specialties, the gains have been especially striking, said Jon Opelt, executive director of the Texas Alliance for Patient Access, a medical advocacy group: 186 obstetricians, 156 orthopedic surgeons and 26 neurosurgeons. Adding to the state’s allure for doctors, Mr. Opelt said, was an average 21.3 percent drop in malpractice insurance premiums, not counting rebates for renewal.

Source




It's not only Britain that has poor public hospital hygeine

MORE than 7000 patients die and billions of dollars worth of health care is wasted every year in Australia because doctors and nurses do not wash their hands enough. And now they risk being sued for negligence for failing to prevent the spread of infectious disease.

The startling revelations have come from evidence and background documents given at public hearings last week of the Queensland Parliamentary select committee on health. Health Quality and Complaints Commission chief John Youngman said in evidence that half of all healthcare providers did not have appropriate hand hygiene processes in place. Surgery was a high-risk area in Queensland hospitals because of poor hand hygiene, he said. Dr Youngman said poor hand hygiene "is a major cause of healthcare-associated infection". He said research confirmed that "over half the adverse events that occurred were related to the operating theatre". Dr Youngman said the new health commission had published guidelines to fight infection outbreaks.

The report points to a lack of education, a lack of recognition and a lack of understanding of good hand hygiene. It said there was a lack of commitment and awareness at government level. The guidelines stress the need for hand washing with antiseptic rubs to reduce transmission of antimicrobial-resistant organisms such as methicillin-resistant staphylococcus aureus, or "golden staph".

It is estimated there are as many as 150,000 healthcare-associated infections in Australia a year. Yet compliance with hand washing guidelines "remains universally low", according to the report. "These infections can result in a prolonged hospital stay, culminating in significant financial and health outcome implications for both the patient and the hospital," the report says.

A companion report warned health professionals they risked claims for civil damages and criminal actions. "It is conceivable that medical administrators could be charged with offences if they were to permit the spread of infectious disease," the report warned. During the inquiry into the Bundaberg Hospital, whistleblower Toni Hoffman said infamous surgeon Jayant Patel did not wash his hands regularly.

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8 October, 2007

Australia: MORE PUBLIC HEALTH REVELATIONS

Three articles below:


More deaths due to government medical services

Zoltan Fekete, 30, went into Maroondah Hospital for a routine operation to remove his appendix, but he never went home. The hospital, dubbed "The Killing Fields" by doctors who say it relies on under-trained doctors to manage critical cases, is being investigated by the State Coroner.

Great-grandmother Nancy John died after her doctor's call for an ambulance to respond to her "heart failure" was initially ignored in a mix-up. Paramedics were sent only after the doctor called a second time, demanding urgent help.

The family of 1.98m tall "gentle giant" Mr Fekete are too distraught to talk about their son's death, but they want answers. Mr Fekete checked himself into the hospital on August 22 suffering stomach pains and was told he needed to have his appendix out. But the next day, after he was anaesthetised for surgery, it is understood his heart failed and his brain was starved of oxygen. Family and friends were told there had been "complications". They went to the hospital and found Mr Fekete in a coma. On August 29 his life-support machine was switched off. Friend Mat Veale said: "It was meant to be a simple operation. That's what is so hard to take. We all want to know what went on."

Questions also hang over the August 29 death of pensioner Mrs John, a volunteer for the Red Cross and Dimboola East Ladies Hospital Auxiliary. Andre Coia, of Rural Ambulance Victoria, said a doctor at Mrs John's Dimboola home called for an ambulance at 7.55am. "The doctor said it was heart failure," he said. "It was categorised as a non-urgent case. The doctor then called back at 8.12am saying it was urgent and the patient was quite unwell. A crew arrived at 8.21am." Mrs John was dead when the ambulance arrived. RAV has admitted the case was wrongly categorised, but there has been no external investigation.

Opposition health spokeswoman Helen Shardey said the tragedies pointed to chronic problems in Victoria's health system.

Source




Bloody-minded hospital bureaucrats again

Five doctors who alleged Melbourne Health tried to force them to work 60-hour weeks for only 36 hours' pay, have been paid $293,000 in compensation. The revelation is an embarrassment for the health service and State Government.

Doctors claimed the network tried to bully them into working the extra hours by warning their contracts would not be renewed. The Australian Salaried Medical Officers' Federation alleged harassment in the Australian Industrial Relations Commission.

The network yesterday confirmed it had settled with the doctors. A Melbourne Health spokesman said the service had "addressed the issues . . . and the matter has been resolved". Opposition Health Spokeswoman Helen Shardey said it was disgraceful the staff were treated in such a way.

Source




Replace doctors with nurses??

When will they face the fact that they need to train more doctors? There is no shortage of applicants for university medical places -- just too few places

THE Australian Medical Association has slammed a Federal Parliament report suggesting practice nurses could do up to 70 per cent of the work now performed by GPs. The report comes as other GP groups call on both sides of politics to commit to funding a nurse for every general practice in Australia. The Practice Nursing In Australia research paper, by the Australian Parliamentary Library, said: "Review of research into the substitutability of nurses for doctors has also suggested that nurses could assume up to 70 per cent of the work currently undertaken by doctors and this could enhance the quality of primary care services."

But AMA president Rosanna Capolingua, a GP, said the idea was "simplistic" and "puzzling" and suggested the report was part of a Government agenda of "task substitution" directed at addressing the shortage of GPs. She said the current distinction between nurses and doctors, where the doctor is the natural team leader due to their superior medical knowledge, worked well.

On Friday, the Royal Australian College of General Practitioners called for the Government to "provide a nurse with every doctor". The Howard Government has spent $234 million since 2001 to entice GPs to employ practice nurses for tasks such as immunisation, wound care and pap smears. Almost 60 per cent of doctors' surgeries now have at least one practice nurse. They cost the Medicare system less with a rebate of $10.60, rather than $30.

Dr Capolingua said practice nurses were not the solution to the GP shortage. "We need to make sure when an Australian needs to see a doctor they get to see a doctor." Australian Practice Nurses Association chief executive Belinda Caldwell said: "Nurses provide a different clinical experience which enhances the experience for the patient, rather than being a substitute for the doctor."

Source





7 October, 2007

THE AUSTRALIAN GOVERNMENT HOSPITAL REVELATIONS CONTINUE

FIVE articles below today:


Useless Queensland health complaints body

Probably better known as the hospital whitewash commission

VALERIE Prowd was admitted to Nambour hospital in January 2005 with a broken leg. Sixteen days later she was dead. The tragedy rocked her loving husband Ray, who is relentlessly seeking answers. He has waged a paper war on health bureaucrats and has even attacked the Queensland Health Quality and Complaints Commission, which he said was too slow to investigate his wife's death. Mr Prowd believes his wife suffered a severe reaction to a narcotic painkiller which should not have been prescribed. He says he had five different death certificates - all "useless bits of paper".

At a Maryborough sitting of the Queensland parliamentary select committee on health, Mr Prowd had his day. "The Health Quality and Complaints Commission is about as useless as they come," he said. When told the commission said it needed six more weeks to complete a report, he told the hearing: "I could write a novel in that time." Mr Prowd complained also to the Crime and Misconduct Commission and was astounded when it referred his complaint against the commission to the commission.

Also critical of investigators was Leesa MacLeod, whose 57-year old mother, Ursula, died on the Gold Coast after obesity surgery known as biliary pancreatic diversion or BPD. Mrs MacLeod was 136kg when the operation was carried out at Allamanda Private Hospital. The hospital ceased BPD when it was revealed others also had died from the procedure. In a poignant submission to the select committee, Ms MacLeod said she was kept in the dark about the probe. "The investigation has taken so long it has greatly added to my grief and suffering," she wrote, claiming the commission was a grossly under-resourced toothless tiger.

Then she made what must be seen as a startling observation - the Health Quality and Complaints Commission and the Medical Board did not co-operate with each other. If correct, it is an astounding claim. "Information is not freely passed between the two entities," she said. She also said they changed courses of action when it suited them.

Source




38 more patient deaths probed in Queensland

QUEENSLAND'S new health watchdog is investigating the deaths of 38 patients believed to have died from negligence or catastrophic failures in the medical system. Medical staff are facing criminal prosecutions over two of the deaths. With only seven of the 38 investigations finalised, more prosecutions are likely.

Informed sources said the remaining 31 cases could take a year to complete while investigators quiz scores of doctors, nurses, ambulance officers, wardsmen and grieving family members. The deaths were among 5067 complaints fielded by the independent Health Quality and Complaints Commission in its first year. More than 4400 complaints were "resolved", some over the phone.

The Courier-Mail learned the watchdog body received disturbing claims of gross negligence, system error and communications breakdowns resulting in deaths in Brisbane, the Gold Coast, Logan, Townsville, Cairns, Redcliffe, Normanton, Cherbourg and other Aboriginal communities.

Some of the details filtered out last week during Queensland parliamentary select committee hearings into the commission's first year. One serious case involved a 43-year-old Woodridge woman - previously reported in The Courier-Mail - who died on a stretcher at Logan Hospital because no beds were available. Other deaths were blamed on drugs mix-ups. The parents of a psychiatric patient who committed suicide complained their daughter was sent home without adequate treatment.

Nine complaints were referred to the State Coroner and two to the Child Guardian. Not all complaints were about failures in hospitals, with 1600 mostly minor grievances with private medical practitioners and dentists. The Health Quality and Complaints Commission was set up in 2006 after a health systems review by private consultant Peter Forster. It followed health inquiries by Anthony Morris, QC, and Geoff Davies, QC, who revealed major flaws in the system highlighted by the Bundaberg Hospital tragedy.

The new watchdog's CEO, Cheryl Herbert, said the commission had made a significant impact in its first year. "We are immensely proud of our achievements," she said. Mrs Herbert said complaints could be broadly placed in two categories: service and quality. She said the commission had 77 staff, of which 58 were permanent. Mrs Herbert called for better co-operation between the Coroner, the Crime and Misconduct Commission and police in investigating complaints. She said a computer systems upgrade in November would lead to better management of complaints.

Source




NSW Surgeons told to accept cuts -- as saving lives 'too expensive'

A CASH-strapped Sydney hospital has ordered orthopaedic surgeons to cut back on operations and not book "emergency" cases outside business hours because it costs too much money. In another indication the NSW health system is at breaking point, The Daily Telegraph can reveal Sutherland Hospital this week told surgeons to scale back orthopaedic surgery as it was having a "detrimental effect" on the budget. The internal memo by the hospital's clinical group manager Aileen Lawther, sent on Tuesday, also complained of increased costs caused by "emergency" operations conducted after 5pm.

The letter has outraged surgeons who are concerned management is putting lives at risk. "Overall, the elective cases are being managed well ahead of the allocated clinical timeframes," the letter said. "While that is an indicator of the improved efficiencies within the service and beneficial to patients, it is having a detrimental effect on the budget for the procurement of goods to support the work."

At the same time, the hospital has also made an embarrassing plea for donations from the public to fit out its operating theatres. In a pamphlet distributed to families in southern Sydney, the hospital urges people to donate $100 to help buy six anaesthetic machines at $80,000 each. "We need your assistance to purchase these machines and ensure the best possible treatment is available to all residents of the Sutherland Shire," the letter said. The Daily Telegraph revealed last month that the State Government was capping the amount of donations hospitals could receive from charities to buy equipment.

Australian Society of Orthopaedic Surgeons co-ordinator Stephen Milgate said the hospital's actions would impact on already long waiting lists. "We are concerned that elective surgery is coming under pressure again and waiting lists will grow because operations have to be scaled back," he said. Opposition health spokesman Jillian Skinner said Sutherland Hospital was indicative of the health system. "It is very revealing of what middle management is dictating to doctors how they are to treat their patients and it's all driven by cutting costs," she said.

Health insiders yesterday said they hadn't seen so many senior doctors going on the record slamming the health system since the Camden/Campbelltown crisis. In the last week two senior doctors, Dr Tony Joseph from Royal North Shore and Dr Valerie Malka from Westmead, have condemned the system - calling it a shambles and demanding the Government take immediate action.

Yesterday Dr Kate Porgeos, a member of the Australasian College for Emergency Medicine and acting director of Gosford and Wyong hospitals, added her name to the list. "Everywhere across Sydney we are seeing severe access block, you can't see patients in appropriate places, we are very dependent on junior medicos and often overseas trained doctors or locums - we feel like we are losing registrars because they say it is a sweat shop and go elsewhere," she said. "It is a very stressful workload and you constantly feel like you are cutting corners and it is unsafe."

Source




Radiology logjam in NSW

I have been in hospitals (e.g my local Brisbane Catholic hospital) where a typed radiological report was made available to me within an hour or two of the scan. That's what's possible. That's not remotely what many Sydney people are getting, however

THOUSANDS of X-rays and other medical scans are not being interpreted by radiologists in Sydney hospitals because of outdated technology and a national shortage of radiologists. In some cases films and scans have been lost. Liverpool Hospital has confirmed it has a backlog of 4500 images that have not been reported on by a radiologist. But a radiologist from the hospital, who did not want to be named, said the number of X-rays, CAT scans and MRI scans not being diagnosed by a radiologist was twice that.

At Westmead Hospital, staff say the backlog of scans not accompanied by a radiologist report is even greater, running into tens of thousands. The Opposition health spokeswoman, Jillian Skinner, said the backlog at some hospitals was putting patients in danger by delaying the diagnosis of potential conditions, including cancer. "A backlog of X-rays means patients aren't getting treated and therefore their lives are potentially at risk," she said. "The Commonwealth provides the training places at the university but without the resources and support from the State Government at the hospital level, they can't work."

Hospitals including Royal Prince Alfred and Westmead Children's have a computerised digital imaging system and are not reporting the same level of backlogs of unread scans. Some hospitals are paying private radiologists twice the rate they pay salaried radiologists to report on scans. Westmead, Liverpool, Royal North Shore, Nepean and Coffs Harbour hospitals are among those believed to be experiencing delays in reporting on images and are waiting for digital systems to be introduced.

A spokeswoman for Sydney South West Area Health Service said Liverpool Hospital would move to electronic reporting of all radiology examinations within 12 months. The health service and the Government denied that patients' safety was compromised and said that even if a radiologist had not viewed the images, a doctor or other professional would have in most cases.

Michael Fulham, head of medical imaging for the area health service, said the digital imaging system installed at Royal Prince Alfred Hospital in 2000 ensured that films were always available to medical teams managing patients. The digital system itself was not the solution, but "where you have a shortage of radiologists, I think the next best thing is ensuring the films are available where they are needed", Professor Fulham said.

The president of the Royal Australian College of Radiologists, Liz Kenny, blamed a national shortage of radiologists and radiographers for the problem. But Dr Kenny, who also represents the interests of private radiologists, was reluctant to plumb the depth of the problem. "It is hard for radiologists to read all the scans that are taken," she said. "The number not being reported is likely to be many thousands." She called for more radiology training positions.

The Health Minister, Reba Meagher, said NSW had increased the number of trainee positions for radiologists from 56 to 93 in the past six years. "The Royal Australian and New Zealand College of Radiologists has not approached the Health Department to suggest this number of trainees is insufficient," a spokeswoman for Ms Meagher said.

Source




Bully culture rife in NSW hospital

NSW Premier Morris Iemma says he is disturbed by a report alleging bullying of staff at Sydney's Royal North Shore Hospital. Mr Iemma said today Health Minister Reba Meagher had briefed him on the September 18 report into the RNSH, which was leaked to News Ltd newspapers yesterday. Written by public servant Vern Dalton and nursing professor Judith Meppen, it found evidence of endemic misconduct by nurses, doctors and other medical staff at the hospital.

It said there were strong concerns about bullying and harassment and staff have been too terrified to speak out. The report was written shortly before a pregnant woman miscarried in the hospital's emergency department toilets after waiting two hours for attention.

Mr Iemma said he was "disturbed to see these reports" and pledged to weed out any bullying. "It has no part in our health system," he told reporters. "It is a disciplinary matter that does go to misconduct. "Anyone found to have acted in this way will be dealt with." He said new northern Sydney area health chief executive Matthew Dally had already made a good start in tackling the bullying problem at RNSH.

Source





6 October, 2007

MORE FLAILING AT THE AIR OVER THE NHS

1.3 million employees and less than 70,000 of them doctors. Blind Freddy could see what is wrong with that. But there are none so blind as those who will not see

Take a blank canvas. Talk to 1,500 NHS staff. Spend 12 weeks thinking hard. And then come up with the ideas you first thought of. That, in a nutshell, is a brutal but not inaccurate summary of the review of the NHS by Lord Darzi of Denham, published yesterday. Astonishingly, it identified as problems exactly the same things the Prime Minister and the Health Secretary have themselves been talking about for months: access to family doctors out of hours (Gordon Brown) and MRSA (Alan Johnson). Surely, in a system that now costs 90 billion a year, employs 1.3 million people and treats a million patients a day, Lord Darzi might have identified issues not already flagged up in a hundred tired political speeches?

To a tiny degree, he did. He correctly points out the glacial slowness of the NHS to adopt new ideas or buy into new technologies. He then goes on to propose the wrong solution, a centralised health innovation council to “champion” change. Such bodies have come and gone as swiftly as the dew on an autumn morning. Remember the NHS Modernisation Agency? Or the NHS Institute for Innovation and Improvement? (One of them is still around, not that you’d notice.) In a document that says local NHS organisations have the responsibility for change, Lord Darzi has proposed another top-down, London-based, all-the-usual-names body in a misguided attempt to impose it.

The NHS does not change because the incentives are not there. Managers who innovate take risks. If they go wrong, cost money, or produce headlines in the newspapers, the Department of Health can be relied upon to provide no backing. The trick of survival as a NHS manager is to change nothing and balance the books.

Lord Darzi also correctly identified stroke as a disease where the NHS has failed, miserably. He might have added allergy, liver diseases, osteoporosis or a host of other equally deserving conditions. The system is fundamentally unresponsive unless it is kicked. And kicking is no longer in fashion, so heaven knows how change will occur in future. His report also mentions health inequalities, which are widespread and growing. But both he and Alan Johnson appear to believe that such inequalities can be put right by a greater provision of healthcare.

Of course it is right that everybody should have roughly the same chance of seeing a GP. But evidence over many years shows that the actual provision of doctors has little impact on inequalities. In the new NHS, which is supposed to be evidence-based, Lord Darzi has ignored all this evidence, which points to the need for better education, nutrition and antenatal care, among other things. Instead we will have GP clinics open 12 hours a day, seven days a week, to satisfy the Prime Minister, while the gaps between rich and poor in expectation of life continue to widen.

Perhaps the most depressing thing of all is not what the report says, but the reaction to it. Almost all the great and the good who have backed every half-baked intitiative for the past decade emerged to say how pleased they were. Not only has the NHS stifled good healthcare; it has bought off those who are supposed to act as candid friends, and made them complicit in perpetuating its failures.

Source




Australian Medical Assoc. backs better checks on foreign doctors

DOCTORS have backed a report which found under-qualified foreign medical practitioners are getting work in Australia because of inadequate checks of their credentials. The Monash University study found state and federal authorities were reluctant to require compulsory assessments of foreign doctors' qualifications and work histories, for fear of deterring them from coming to Australia.

Australian Medical Association (AMA) president Rosanna Capolingua said today she was not happy with the existing vetting of overseas-trained doctors' credentials. "We're not satisfied and we're very pleased to see the scrutiny that has come upon these processes," she said. "We've had a need for overseas-trained doctors for a long time and they've served us very well, but of late we've become aware of situations where the qualifications of doctors or their clinical skills ... have not been quite right."

The immigration department approves foreign doctors' visas, including character and security checks. But it is up to state medical boards and each doctor's recruitment agency - often a state health department - to ensure their work histories stack up. Dr Capolingua said health authorities were reluctant to conduct compulsory checks of qualifications, referees and work histories because it slowed the process of recruiting doctors. "It is variable - it's not done in some states," she said. "Some states do primary qualification verification, but it needs to be nationally consistent. What we find is if governments get involved, the imperative for them is to get doctors in. They are a little resistant to wanting to go through these processes."

She called for offshore screening to assess doctors before they come to Australia, as well as a clinical interview before they begin work. A senate inquiry last month called for urgent action to implement nationally consistent checking of overseas doctors' credentials to prevent a repeat of Queensland's scandal involving Indian-born Dr Jayant Patel. Dr Asif Ali, a colleague of former terrorism suspect Dr Mohamed Haneef, was sacked from his Gold Coast Hospital job earlier this year for giving misleading information on his CV.

Up to 37 per cent of GPs in rural areas are foreign-trained. Australia is significantly short of medical professionals and has turned to overseas-trained doctors to make up the shortfall, with 3000-4000 arriving each year.

Health Minister Tony Abbott today rejected suggestions that large numbers of incompetent foreign doctors were slipping into Australia. "If particular boards have approved particular doctors who people think are not adequately trained, well let people say which board has made that mistake and which doctor has been inadequately assessed," he said. Queensland Health Minister Stephen Robertson said overseas-trained doctors applying for work in his state faced the most stringent registration system in the world. [Ho, Ho!]

Source





5 October, 2007

Australia: THE NSW GOVERNMENT HOSPITALS MELTDOWN

Replacing most of the army of bureaucrats with medical staff is the only solution but it is not going to happen. Three current articles below



The NSW public hospitals disaster is government-created

By Dr. John Graham, an emeritus honorary consultant physician at Sydney Hospital, where he is also chairman of the department of medicine

LET me say from the outset that I am not a professor of medicine or surgery. I am not a professor of nursing. I am not an economist, a bureaucrat or a politician. I am simply a medical practitioner with 40 years’ experience in five public hospitals in Sydney, two of them teaching hospitals. My comments are thus based on experience limited to NSW.

Until I entered medical school in 1962 at the University of Sydney, no medical student in Australia had been subject to an entry quota. But now young Australians have to be Albert Einstein to gain entry to any medical faculty anywhere in Australia. This is sad. To be a good doctor, one probably only needs a Universities Admissions Index of about 85 to 90 (certainly not 99 plus), an aptitude for rote learning and a passionate desire to help one’s fellow man.

When I began my student clinical years in 1966 at Sydney Hospital, student nurses lived and trained in the hospitals. Their practical skills and compassion were fantastic. Then some disgruntled soul decided to move nurse education into universities. Another big mistake. Resident medical officers also resided in the hospitals, thus enabling a far greater opportunity for learning than is available today.

Medicare, introduced as Medibank by the Whitlam Labor government, hasn’t helped either. It lets the well-off take up beds in public hospitals, which should be available for the disadvantaged. Reinstatement of a means test, or more accurately a wealth test, for classification of public-private status in public hospitals is long overdue.

During the 1970s, some huge advances occurred in the technologies relevant to diagnosis, therapeutics and surgery. As a result it was possible to treat many more patients in considerably shorter times in the available hospital beds, but that put more pressure on the public purse, especially as Medicare had made the treatment notionally free.

To cut the costs, and with little regard for the general wellbeing of the community, it was decided the number of beds should be cut. But there was no health minister with the courage to make the cuts. And so in the ‘80s the NSW Labor government dreamed up the idea of area health boards to make the cuts on behalf of the minister. These cuts, however, also required the silencing of all adversaries to the plan, and so the NSW Labor government removed nearly all the independent public hospital boards.

Next to go were the general medical superintendents who, until then, had made sure the interests of patients were paramount. And from that point onwards the chain of communication from clinicians to administration collapsed, and out the window went efficiency, morale, trust and institutional loyalty. You didn’t have to be a Harvard business school professor to know that corporate disaster for public hospitals would be just around the corner.

Governments, through their area boards, became deceptive on budgets. No longer was a hospital budget a firm commitment, and few hospitals would be given their budgets until nearly six months into a financial year. That made it easier for governments to throw all the blame on clinicians for budget overruns that were artificially orchestrated.

The health bureaucracy burgeoned with countless people who have since spent their working lives attending endless meetings, staring at computer screens and doing precious little else. As a result, much of the funding intended for patient care and for the salaries for nurses and hospital doctors had to be switched to salaries for health bureaucrats. In NSW alone more than $2 billion each year is spent by NSW Health on salaries for people who don’t heal anyone.

The reasonable expectation of young doctors that they will be granted a Medicare provider number as soon as they are qualified has also no doubt caused federal governments to put a limit on entry into university medical faculties, which brings us back to the start. It is quite outrageous that Australia should be importing doctors.

Fortunately for all Australians, the Howard Government has indicated it is going to roll back the mistakes that have been made by health bureaucrats and state politicians during the past 40 years. The recent announcement by John Howard and Tony Abbott that they wish to see nurse training reintroduced to the hospital setting is to be greatly applauded. Universities can still play their part by providing the postgraduate nursing courses in intensive care unit nursing and the like. The further announcement that a Howard Government would return a discrete community board of directors to every public hospital in Australia will bring joy to the heart of every nurse, doctor and patient across the land. This has been the single most important health initiative to be announced by any government in Australia for a half century.

By comparison, the federal Labor Opposition so far has offered only a few hypothetical platitudes that won’t cure anything before mid-2009. In fact, Kevin Rudd has amazingly offered to pour another $2 billion into a system that is patently faulty.

Source




Nurses juggling 17-hour shifts at government hospital

A FRUSTRATED nurse at Royal North Shore Hospital's emergency department has spoken of despicable working conditions saying: "I get paid $22 an hour and have five patients' lives in my hand." The nurse - who asked not to be identified - yesterday described the situation at the hospital as unbearable, comprising 17 hour shifts, in-fighting between staff at different wards, patients being placed on top of desks and in store rooms and staff having to share basic equipment.

In an exclusive interview with The Daily Telegraph, the nurse said it was understandable the public was angry about the lack of care. "No one knows what is going on behind that door when they walk through emergency," the nurse said. "The reason why you might be waiting for hours is because there are just no beds, no doctors and even though we try and help we just don't have the time. My biggest worry is the neglect of patient care."

Embattled Health Minister Reba Meagher has agreed to review the state's emergency departments. But the nurse said it would take a massive injection of money into all hospitals before horror stories cease.

Royal North Shore has been embroiled in controversy since Jana Horska miscarried in the toilet last week. The nurse did not want to comment on the circumstances surrounding Ms Horska's case but said the triage nurses would never be able to forget the tragic night. "Those nurses left for the day and it will never leave them," the nurse said.

"People don't realise we are working 17-hour shifts, sometimes twice a week. By the time you are reaching your 16th hour you are scared you are going to make a mistake. "You are arguing with your colleagues and then you have to fight with the ward up the other end just to get a bed."

There are 100 nursing vacancies at Royal North Shore, with staff leaving faster than they can be replaced. If those jobs were filled, John Tague says his elderly mother may not have "suffered in hell" on her deathbed. Mr Tague, of Pyrmont, sat with his 85-year-old mother Elizabeth, who died of heart complications, around the clock because he was not confident of the care she was receiving. "You would call for attention but it could take up to an hour sometimes," he said. "I had to remind nurses to give her her medication. Sometimes there wasn't someone senior enough on shift who had the authority to change her medication. You could see there just weren't enough nurses."

Mr Tague's mother was placed in a store room at night because she was suffering from hallucinations and was disturbing patients. He said while individual nurses were not to blame, pressure on staff caused some to have appalling attitudes. "There's an expectation that Royal North Shore will be an excellent hospital but the reality is vastly different," he said.

Opposition health spokeswoman Jillian Skinner said the Government could not persist on refusing a full inquiry. "It's pointless holding a review into all emergency departments . . . a full, independent inquiry is needed into Royal North Shore," she said.

Source




Don't blame the medical staff

By Dr Phil Huang, an intern at Royal North Shore Hospital. Dr Huang sounds like the sort of doctor everyone would like to have

I have just finished four evenings in emergency at Ryde Hospital, part of the North Shore network, with minimal sleep over the long weekend. I am a mere intern, fresh out of medical school, driving with a learner's licence, but driving nonetheless. Recent events at Royal North Shore Hospital and its aftermath have brought tremendous sorrow into my life. Sorrow for the mother who miscarried, sorrow for the hospital and sorrow for our health profession. What is more unfortunate however, is that the event has become a platform for politicians to campaign while the real problem disappears into the background. There is no doubt that what happened to Jana Horska was a tragedy. Miscarriage at any stage is a harrowing experience and you do not need medical training to appreciate that.

We live in a time of medical miracles. Heart attacks can be prevented and stopped as they are happening, degenerating hips are replaced with synthetic ones, cancers can be beaten into submission through chemicals. But we are helpless in effecting change in the early period of pregnancy. There are no absolute predictors for which pregnancy will proceed and which will terminate. Such is the nature of conception. Mothers are usually fit and healthy. Telling them that something may go wrong is exceedingly difficult.

For better or worse, our emergency departments are designed for emergencies. Patients are categorised by severity and reversibility. It is unfortunate but necessary. Patients who may die from a easily reversible condition are given priority over patients who we are helpless to assist. In an ideal world, Ms Horska would have been placed into a bed and protected from the ultimate horrors that ensued, but hospitals in their current form cannot provide that. We as health professionals have no control over who receives a bed. Guidelines and codes determine which patients receive a bed.

The attempt to categorise human suffering has led us ultimately to this destination. Having spent all my student years at Royal North Shore Hospital and feeling like I was part of a family, I have watched it degrade over the past five years. It is no secret that many hospitals are underfunded and under-resourced. Budgets are exceeded each year and the response by the bureaucrats is to give less. This will encourage less spending over the next financial year as workers attempt to be more fiscal at a cost to patients. Thus reports of budget "blow-outs" are often misrepresented because hospitals have less to work with each year. Hospitals are not businesses and yet are managed as such with boards and chief executives. Patients are not profits and yet economic models are applied in attempts to manage them. These are the cards we are dealt everyday.

There is a belief that we practise medicine for financial gain yet, any doctor working in today's health system will laugh when this is suggested. I am not implying that doctors are scraping the poverty line and most do live quite comfortably. But the sacrifices made to attain that level of comfort come at the expense of their own families and their own lives. Thus the real reward in medicine lies in the ability to help another even if there are difficulties in expressing this undeniable truth.

I was completing a research masters at Cambridge when my professor discovered I was finishing to pursue medicine. He laughed and tried to dissuade me. "What would you rather, Phil?" he asked in a typical pompous British accent. "To affect the life of one? Or the life of millions ?" I chose the life of one. The doctors, nurses and health workers I have encountered at North Shore and elsewhere have served to confirm my initial decision. I can confidently say that most I have encountered hold the above ideal true. This ideal is what brings my colleagues and myself into work every day, to face abuse from patients for an article they read that morning, to go through shifts of 14 hours or more without breaks and to find increasingly that we have less to work with. This ideal and its current state forms the basis for my compulsion to write and make an impassioned plea.

As the hype settles and the blame game takes its turn moving around the board, I hope the real issue resurfaces. What happened with Ms Horska is the tip of the iceberg of faults that exist in the health system and not just at Royal North Shore Hospital. Inquiries and articles blaming doctors, nurses and health workers may satisfy the anger of the mob, but it will never effect change.

In a period of prosperity, the resources of hospitals and universities have dwindled. Politicians will debate the foibles of my colleagues and seniors, shifting blame and providing a smokescreen to the truth. I love my job and medicine in spite of the system and I can attest that many of my colleagues feel the same. Yet the current system has drained the passion away from so many, turning them apathetic as they are blamed for actions beyond their control. The media have tremendous power and effect. Effect that can be directed towards change and empowering individuals. Effect that is lacking in current stories about blame and fear.

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4 October, 2007

No More Free Lunch at the Health Care Buffet

All this health care talk can sometimes get confusing. Who doesn't want better health care for less money? I'd love to pay less for my insurance as long as I could still go to the doctors of my choice, the hospitals of my choice, and get the procedures and treatments of my choice. I'd like my prescription drugs to be cheaper too. I don't want to wait several weeks to get in to see a doctor, and when I get in, I want the comfort of knowing that he or she is qualified to do what I expect.

I want all of this, and I'm sure you do too. Who doesn't? But, this isn't what the health care debate is really about. Let me be politically incorrect and state the obvious.

The rich will always be able to get the quality health care they want because they can simply buy it. But the poor cannot get quality care, because they simply can't afford it. If they're going to get health care at all, it will have to be given to them for free, or nearly free. The vast majority of us somewhere in the middle simply want to continue getting the best health care we can afford while paying for only our "fair share" and not being taken advantage of. We want the biggest bang for our buck without being played for fools.

The real issue in the current health care debate isn't about the rich or the middle class, however. It's about the poor and the best way to provide them free services without ruining the whole system for everybody else. Liberals look to Europe and Canada as examples, believing that socialized medicine is the solution. Conservatives believe that would be exactly the wrong way to go. We want less government in health care, not more. We want more market dynamics in the process and we want to allow people more ownership over their health care decisions. We believe this will solve most of the current problems and greatly improve the entire health care system without having to overcorrect, panic and hit the "HillaryCare" button.

There's one fundamental dynamic that must be changed in our health care system, whether we go the liberal or the conservative route, and it has to do with basic human nature. If something is free, it will be undervalued, underappreciated, taken for granted with a sense of entitlement, over-consumed, and ultimately wasted before finally being rationed. Think of those cafeteria-style restaurants with an all-you-can-eat buffet. Would we get healthier people and waste less food by giving them a "Free Buffet Coupon" every day for dinner or a $20 bill and the choice of ordering off a menu and keeping the change?

Obviously, someone does pay for the "free" healthcare provided to the poor: the American taxpayer. But, instead of taxpayers handing a "Free Buffet Coupon" directly to the cashier for all the poor, what we've got to do is provide the poor-and all health care consumers-with a greater sense of ownership, individual responsibility and choice to eliminate the incentive to overeat and waste food. The best way to do this is with money, either in the form of cash or credit. After all, if we want people to save for college or retirement, we offer them a tax-free IRA. If we want people to buy houses, we allow them to deduct the mortgage interest from their taxable income. And, if we want people to save money for health care, we should let them open a tax-free Health Savings Account. And, if we want them to buy health insurance, we should allow them to deduct the health insurance premiums.

Put simply, if we want people to lead healthier lives, we need to give them the incentive to do so. The message has got to be, "An unhealthy life costs you money, a healthy life saves you money." If you lead a "high risk" lifestyle, you should expect to pay a higher premium on your health insurance than someone who is more health conscious. If good drivers with clean records can get a discount on their auto insurance, then why can't those who lead a healthy life get a discount on their health insurance? This isn't discrimination, it's the market doing what it does best: analyzing risk and fixing cost.

We've got to come up with a way for the poor to take ownership of their health care and the best way I know of to do this is with money. If we don't do this, I'm afraid liberals will convince a majority of voters that HillaryCare is our only option "for the poor," and we're going to lose the best health care system in the world.

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Australia: Surprise! Patients shun disaster hospital



It is a damning indictment of what the NSW public thinks of its health system - a deserted waiting room at Royal North Shore Hospital's emergency department. Only a week ago the same waiting room was crawling with people and staff so busy they were unable to attend to a woman who miscarried in a toilet.

Health Minister Reba Meagher today admitted relations between emergency doctors and the NSW Health Department have broken down. She said emergency staff "feel pressured to perform and they feel pressure to meet the targets around performance that are set for them." Ms Meagher said she met with senior staff last night. "It came out during the course of the meeting that relationships had broken down between the Department of Health and our senior emergency physicians. That's a concern to me," she said. "I understand there have been some difficult industrial negotiations recently and I'm also confident with the position that was put to me by the emergency physicians that they feel pressured. "There is no doubt that there is pressure. Demand for emergency services is rising very rapidly. For June this year it was an 8.8 per cent increase on last year."

However the admission came as demand at Royal North Shore Hospital was reaching record lows, with staff telling The Daily Telegraph they had never seen the ward empty and were concerned patients had turned their backs on the hospital. As the exclusive photograph shows, the waiting room at 1.15pm yesterday was like a ghost town - with critically ill patients choosing to attend other Sydney hospitals. The decline in admissions follows a week of horror stories emerging from the hospital. A nurse in the hospital's emergency department told The Daily Telegraph the waiting room had never been empty. "We have never seen it like this - it has been like this since last week when all the attention started," he said. "Normally there are at least 20 to 30 people and we are run off our feet."

The only people entering through the hospital's emergency doors were the elderly or those who were being transported via ambulance. "All we are doing is restocking supplies," the nurse said. "There is nothing we can do but we have to turn up for work."

One person who has vowed not to return to Royal North Shore is Cathy Wastell of Cromer, who was given a bucket for her miscarriage in 2005. "I received excellent care in the foetal department but I would never go back to emergency," she said last night. "I have lost faith in the system - I can understand why people would not want to go there." Mrs Wastell, who now has a one-year-old daughter Mia, was at Royal North Shore for six hours before being told to put her lifeless baby in a bucket. "I was bleeding profusely and a nurse gave me a fresh sanitary napkin. That was the level of medical care I received," she said.

As the State Government refuses to accept the health system is in disarray, it has also emerged that paramedics are having to store critically ill patients on the floor of ambulances. Yesterday The Daily Telegraph revealed the Ambulance Service was spending $53 million in overtime because of staff shortages. Paramedics have said there are now serious concerns a death will occur because crews are being delayed for hours at blocked emergency departments - leaving no ambulances to respond to urgent medical calls elsewhere in the city. "If we are stuck in the emergency department and an urgent call comes through, then one of us has to stay behind with the bed while another officer attends the job," the paramedic, with 15-years service, said. "We have had to place patients on the floor. "I don't like working overtime . . . some do it because there is just not enough ambulances out there."

Health Minister Reba Meagher was last night holding a crisis meeting with hospital emergency department heads to address the litany of problems. Doctors and nurses are split over whether a Howard Government plan to install local hospital boards will improve patient care or lead to an abdication of health planning.

Opposition Leader Kevin Rudd has attacked the plan even though his own $2 billion health policy states "regional and local communities would directly participate in the management of public hospitals'

And Health Minister Tony Abbott denied the plan would add yet another layer of bureaucrats to health care management and said hospital board members would "work for the love of it and not the money".

Australian Medical Association president Dr Rosanna Capolingua said local hospital boards would "bring management responsibility right back to the community". "It is a good idea," Dr Capolingua told The Daily Telegraph.

The NSW Nurses Association feared the Howard Government would use local boards to "meddle in the employment conditions of nurses and other hospital staff". But mother of two Therese McKay, who publicly condemned Royal North Shore Hospital as having the conditions of a "third world country" after her husband Don died last May, welcomed the plan. "At least with hospital boards it is more personal, you can go and speak to someone and thrash it out," she said. "After Don died I tried to make a complaint and it was like shadow boxing, no one was listening."

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3 October, 2007

INSTANT DENTISTRY: EAT YOUR HEARTS OUT, BRITS

I developed a problem with one of the fillings in my teeth over the weekend so first thing on Monday, I rang a few dentists listed in the phone book and got an appointment NEXT DAY at a dentist less than 15 minutes drive from where I live.

I arrived on time at 2.30pm, was in the chair within 10 minutes, and out of the chair with my filling fixed in another 10 minutes. It cost me $50 (about the price of 4 packets of cigarettes) and I was home again within 45 minutes of setting out.

And a small but pleasant bonus: The dental receptionist was a real stunner -- pushup bra and all.

I even had time for a chat with the dentist about the "evils" of the old amalgam fillings, of which I have several. He pointed out that the dentists who were handling daily the mercury used to make up the amalgam should have been the ones most at risk but that there was no evidence that they were affected.

In Britain, a large part of the population rely on NHS dentistry but just cannot get the service that is supposedly available. Some have even resorted to pulling their own teeth out with pliers etc.

In Australia, people have always seen dentistry as a private expenditure which can be included in your private health insurance (up to a point) if desired. There is a "free" government service but the wait for it stretches into the years and it is therefore seen as only for the very poor.

If Britain had a voucher system for dentistry instead of the present dysfunctional system, all Brits could have the sort of rapid relief from discomfort that I experienced.




SCHIP financing burns poor

Congressional Democrats have chosen an unlikely source to pay for the bulk of their proposed $35 billion increase in children's health coverage: people with relatively little money and education. The program expansion passed by the House and Senate last week would be financed with a 156 percent increase in the federal cigarette tax, taking it to $1 per pack from the current 39 cents. Low-income people smoke more heavily than wealthier people in the U.S., making cigarette taxes a regressive form of revenue.

Democrats, who wrote the legislation and provided most of its votes, generally portray themselves as champions of the poor. They do not dispute that the tax plan would hit poor communities disproportionately, but they say it is worth it to provide health insurance to millions of modest-income children. All the better, they say, if higher cigarette taxes discourage smoking. "I'm very happy that we're paying for this," Senate Majority Leader Harry Reid, Nevada Democrat, said Friday, noting that the plan would not add to the deficit. "The health of the children is extremely important," he said. "In the long run, maybe it'll stop people from smoking."

Congress probably will revisit the cigarette tax issue soon because President Bush has pledged to veto the proposed $35 billion expansion of the State Children's Health Insurance Program. The decade-old program helps families buy medical coverage if their income is too high to qualify for Medicaid. Mr. Bush has proposed a more modest growth for the program, and both political parties seem inclined to pay for it through a tax on an unpopular group: cigarette smokers.

By most measures, the average smoker is less privileged than the average nonsmoker. Nearly one-third of all U.S. adults living in poverty are smokers, compared with 23.5 percent of those above the poverty level, according to government statistics. The American Heart Association reports that 35 percent of people with no more than 11 years of schooling are smokers. Those with 16 or more years of formal education smoke at a 12 percent rate. Non-Hispanic black men smoke at slightly higher rates than non-Hispanic white men. But the reverse is true among women.

The demographics of smoking and taxation received scant attention during last week's House and Senate debates, perhaps because many Democrats and Republicans agree that cigarettes are the best target for a tax increase if the insurance program is to grow. A few lawmakers, however, took a swing. "I know there is very little sympathy for smokers these days," Rep. Jack Kingston, Georgia Republican, said during the House debate. "But it is still a tax increase on the backs of the smokers. And in order to get enough money to pay for this, it would require 22 million new smokers."

Rep. Frank Pallone, New Jersey Democrat, defended putting the burden of expanded medical care on smokers. "The tobacco tax is a great way to pay for it," he said, "because if you tax people who are smoking and they smoke less, then we have less health problems." Rep. Jim McCrery, Louisi-ana Republican, did not buy that logic. "To propose funding a growing program with a declining revenue source is, I would submit, irresponsible fiscal policy," he said.

If the federal cigarette tax nears $1 per pack, smokers in many states will pay hefty sums into government coffers unless they kick their habit. On top of the federal tax, New Jersey levies a $2.57-per-pack tax on cigarettes, followed by Rhode Island at $2.46. California is near the middle, at 87 cents a pack. Three states tax cigarettes at less than 30 cents per pack. South Carolina is the lowest at 7 cents.

Bill Phelps, spokesman for Philip Morris USA in Richmond, said a steep tax increase could accelerate the national decline in smoking to the point that the insurance would have to find other revenue sources. The average U.S. price of a pack of cigarettes has risen by 80 cents since 1999, Mr. Phelps said, largely because of state tax increases. Governments received more than $21 billion in cigarette excise taxes in the 2006 budget year, he said, "so we think this trend is unfair to adults who smoke and to retailers who sell tobacco products."

In Congress, these groups receive little sympathy. But some lawmakers say voters should know the details of the insurance program's proposed funding structure. Rep. Mike Pence, an Indiana Republican who spoke against the bill in last week's debate, said: "The headline ought to read, 'Smokers in America to pay for middle-class welfare.' "

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2 October, 2007

Reverse Robin Hood: Congress' Regressive SCHIP Expansion Would Tax Poor to Fund Health Insurance for Middle and Upper-Middle Class

A successful effort by Congress to expand the State Children's Health Insurance Program (SCHIP) by $35 billion over five years over White House protests would require low-income Americans to subsidize health insurance for children and young adults in the middle and upper-middle classes, says a September 2007 paper by David Hogberg, Ph.D. published by the National Center for Public Policy Research.

If SCHIP is expanded as Congress now proposes, says the paper, people making under 200 percent of the poverty line will subsidize health insurance for children and young adults in families over 200 percent, perhaps as high as 400 percent, over the poverty line:

Both SCHIP bills passed by Congress take the tax revenues from those under 200 percent of the poverty level and give it to those children who live in families above 200 percent of poverty, likely all the way up to 400 percent of the poverty level... It is not inconceivable that a parent with one child with an income of $13,690 will be funding benefits for two children in a family of four with an income of $82,600. In short, SCHIP expansion would result in families whose income puts them in the bottom 15 percent of households funding benefits for children who are in families close to the top 25 percent of households.

The paper also notes that Congress supports reimbursing states for SCHIP expenses for middle and upper income children and young adults at a higher rate than it reimburses Medicaid expenses spent on the poor:

SCHIP is supposed to insure children for families that make too much money to qualify for Medicaid. Presumably, then, children on Medicaid are in families that are poorer than are children on SCHIP. Yet the federal government matches the dollars states spend on SCHIP at a proportionally higher rate than it does Medicaid. In 2006, states spent a total of about $132 billion on Medicaid, while the federal government matched that with $165 billion. That means, on average, the federal government spends 1.2 dollars on Medicaid for every one dollar the states spend. For that same year, states spent almost $2.4 billion on SCHIP and the federal government sent the states $4.8 billion in matching funds.20 Thus, the federal government spends two dollars on SCHIP for every one dollar the states spend. In short, the federal government spends proportionally more on the children in SCHIP than it does on the poorer children in Medicaid.

The paper, "SCHIP Expansion: Socialized Medicine on the Installment Plan," by David Hogberg, Ph.D., is available online at www.nationalcenter.org/NPA560.html.

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Australia: Government hospitals crisis is Statewide

Sacking half the bureaucrats and employing medical staff instead would transform the situation rapidly but Leftist governments regard bureaucrats as sacrosanct -- far more important than healthcare for the peasants. Bureaucrats = CONTROL in their sick thinking

DOCTORS in charge warn that every emergency unit in the state public health system is plagued with chronic management problems that jeopardise patient care. Valerie Malka, head of trauma at Westmead Hospital, said the situation was so critical that lives were at risk. "My philosophy is that patients should get the care I would want my mum and dad and family to get, and there is no way that would happen, certainly not at Westmead," she said. "You cannot get anything done for patient care at Westmead because everything you try to do is an obstacle." The head of the trauma unit since 2000, Dr Malka said she was at the "end of her tether" and ready to quit.

Sally McCarthy, head of emergency at Prince of Wales Hospital, and Tony Joseph, head of trauma at Royal North Shore Hospital, have also warned of systemic problems across NSW. "They just don't listen to anyone at the clinical coalface," Dr McCarthy said.

Dr Malka said some toilets in the wards at Westmead were so filthy that patients refused to use them. Misdiagnosis was common because junior and inexperienced doctors were left alone after hours and at weekends. "Patients are at the mercy of the system and its failures," said Dr Malka, a surgeon. Her comments followed a wave of complaints about lack of staff and resources in emergency departments after Jana Horska, 32, miscarried in the toilets of Royal North Shore last week after waiting two hours to be seen.

Dr McCarthy, who is vice-president of the Australasian College for Emergency Medicine, said every emergency department was under intense pressure. She said the problems at Royal North Shore were "the tip of the iceberg" and all emergency departments had similar issues.

The Health Minister, Reba Meagher, has launched an inquiry into Ms Horska's treatment but has refused to broaden it to include all emergency departments. Instead, she announced a new "model of care" for pregnant women.

The Opposition health spokeswoman, Jillian Skinner, said the announcement was a knee-jerk reaction, while Dr McCarthy described it as "absolute rubbish" because it was devised by bureaucrats who were not emergency specialists.

Ms Meagher's spokeswoman said the minister had also established a taskforce to examine workforce issues, but doctors say the system is in crisis and will only improve when the Government's attitude changes.

Dr McCarthy said that two weeks ago an elderly woman was made to wait on an ambulance stretcher at Prince of Wales for almost six hours, with 12 ambulances in the bay, because there were no emergency beds. "There needs to be a change in attitude because out-of-date bureaucrats in NSW Health think that emergency departments are meant to be chaotic but fail to acknowledge that we are treating the most critically ill people there are, people who are often much sicker than anyone that turns up in an ambulance," Dr McCarthy said.

Dubbed the "invisible minister", Ms Meagher has been accused of refusing to meet doctors and health groups in the six months since taking on the health portfolio. Her spokesman rejected the claim, saying she had made more than 50 visits to hospitals since March.

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1 October, 2007

NHS failure on allegies

An epidemic of allergic diseases is sweeping Britain while treatments languish and people's lives are blighted, according to an influential House of Lords committee. Britain is "the laughing stock of Europe" for its neglect of treatments that work and are routinely used elsewhere, said Baroness Finlay of Llandaff, who chaired an investigation by the Science and Technology Committee.

Allergies - which include hay fever, asthma, some skin conditions and peanut allergy - are often poorly diagnosed by GPs, who lack facilities to which they can refer patients for proper testing. As a result, many allergy patients go untreated while others go through life convinced that they are suffering from allergies they do not have. Waiting lists for the few allergy clinics that exist are long, and would be longer still if the many neglected patients could be referred to them.

Teachers are poorly trained to deal with allergic emergencies, the food industry is lax about labelling foods that have the potential to kill and advice given by the Department of Health to pregnant women to avoid peanuts is baseless - and could even be making the situation worse.

Lady Finlay said that her committee was extremely alarmed by the advice to pregnant women, and to children from families with a history of allergy, to avoid peanuts. "Academics and clinicians have told us that a growing body of evidence suggested this guidance may not only be failing to prevent peanut allergy, but might even be counterproductive," she said.

It was possible that exposure to peanuts in the womb or when young could prevent peanut allergy rather than cause it. The evidence did not justify the advice the department was giving, and it should be withdrawn. In parts of the developing world where groundnuts were used in a "soup" for weaning babies, there had not been the explosion in the number of people allergic to peanuts, she said.

The committee recommended setting up a network of centres headed by an allergist and staffed by other specialists such as immunologists, dermatologists, paediatricians, gastroenterologists and chest medicine specialists. It also called for an overhaul of food labelling regulations to improve on "vague and defensive" information such as "may contain nuts".

Allergies cost the NHS in England 1 billion a year for drugs and treatment, and the cost to the economy of asthma alone is o2.3 billion a year. Millions of people suffer allergies: 3.3 million suffer hay fever at some time in their lives and 5.7 million have asthma. Food allergies kill about 20 people a year through the severe reaction called anaphylactic shock.

Lady Finlay called for increased funding for research. The recommendation was welcomed by Stephen Holgate, of the University of Southampton, a leading expert. He said: "We need new environmental research, trying to find out what it is about our environment that causes allergies. We need to set up proper studies. This is the fourth report in recent years to criticise UK allergy treatments."

The National Allergy Strategy Group said that the four reports had said much the same. "But the department has not acted to bring about change. Unless strategic health authorities and primary care trusts are directed to develop services, patient care will not improve." The committee said more use should be made of immuno-therapy, where people are exposed to small doses of the substance that causes a reaction to "desensitise" them.

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Australia: Got breast cancer? Too bad

QUEENSLAND Health will struggle to diagnose suspected cancer victims identified through a new breast screening campaign because of staff shortages. The $1.5 million advertising campaign, which features veteran television journalist Jana Wendt, is aimed at increasing rates of regular screening among women aged 50 to 69.

But documents obtained by The Courier-Mail reveal women suspected of having breast cancer following the screen are likely to be exposed to lengthy delays in their diagnosis and treatment at Queensland hospitals. Queensland Health's latest "Allied Health Vacancy Data" shows the state has an acute shortage of radiographers, who are trained to operate medical imaging machines. In southeast Queensland alone there are currently 35 vacant radiographer positions listed as "critical", meaning their absence has caused or will cause service closures. The number of critical vacancies is three times worse than a year ago and has been predominantly caused by unfilled positions at the Gold Coast's Robina Hospital and Brisbane's Princess Alexandra Hospital. The Courier-Mail revealed in June that the advertising campaign featuring Ms Wendt had been shelved amid concerns BreastScreen Queensland could not cope with extra patients.

Health Minister Stephen Robertson yesterday said the service was now well-placed to cope with increased demand with only 10 vacancies and two clinics with unacceptable wait times. Mr Robertson said the Government was also addressing the shortage through a new pay deal. "There is an enterprise bargaining agreement currently in the process of being finalised that will ensure that we are nationally, and arguably internationally, competitive," he said.

The campaign is aimed at addressing figures showing only 58 per cent of Queensland women aged 50 to 69 have regular breast screens. Wendt said women often delayed screening but research showed it could dramatically cut the number of breast cancer deaths.

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