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30 April, 2009

Incompetent DC Emergency Medical Services

And hushing it up is all that Mayor Fenty and the DC administration want to do about it



A man whose brother died of a heart attack hours after being told by a D.C. paramedic that he suffered from acid reflux says his family is outraged to learn that fire officials had prior warning that the paramedic needed retraining. "It's just a slap in the face to my family," said Anthony Givens, 36, the brother of Edward L. Givens of Northeast, who died at his home in December after the call to D.C. Fire and Emergency Medical Services.

The Washington Times reported Friday that scores of the District's paramedics either failed to meet the minimum national standard on written exams that tested their medical knowledge or they mishandled basic lifesaving procedures during videotaped assessments, according to videos, documents and interviews with industry professionals.

The materials also were requested on numerous occasions by the family of slain journalist David E. Rosenbaum. The family repeatedly asked about the testing as part of a settlement in 2008 of a multimillion-dollar lawsuit against the city.

Toby Halliday, Mr. Rosenbaum's son-in-law, said he began late last year asking about the tests conducted at the Maryland Fire and Rescue Institute (MFRI), and the fire department refused to disclose the results, even though the testing was initiated more than a year ago. "The department had initial results on these evaluations late last summer. Despite repeated requests, the department has not released the results to the public, but has characterized the performance of their paramedics on these tests in very positive terms," Mr. Halliday said.

"To the extent that the department feels that the MFRI evaluations demonstrate gaps in performance that require remedial training, we support that effort and are eager to hear what additional training is being provided and when that effort began. We recently met with the mayor to discuss our concerns about these tests and other issues in the EMS program. We are awaiting his response to those concerns," he said.

Mayor Adrian M. Fenty told The Washington Times on Friday that he was unaware of the newspaper report and declined to comment on it until he had a chance to review the matter. Asked about a press release with his name on it that was issued by the fire department on Wednesday addressing questions raised by The Times, Mr. Fenty again said he was unaware of the report and would not comment on it before reviewing the matter. "I think I owe that to the people who elected me," he said. Asked whether he would revisit his decision to leave EMS under the administration of the fire department - after pledging in 2006 as a candidate for mayor to separate the agencies - Mr. Fenty said: "No."

Mr. Givens said he was disappointed with Mr. Fenty's decision. "It's just outright disrespectful for the mayor to say one thing, and then we elect him and he does another," Mr. Givens said. Mr. Givens, whose family has sued the District over the handling of his brother's case, said he was angry that fire officials defended the performances on the videos and the written test scores, the vast majority of which were below 60 percent. "It's almost shameful," he said. "It's like a low blow to my family to say some of the things they're saying."

One professional who viewed the videotapes for The Times expressed concerns specifically about the assessment of the firefighter-paramedic who treated Mr. Givens. "Based upon viewing the videotape, I would have serious concerns about him performing any medical practice," said Graydon Lord, a licensed paramedic and former fire and EMS chief in Cherokee County, Ga. "I would recommend that the medical director make his determination as to whether this provider can safely practice medicine in the pre-hospital-care environment," Mr. Lord said.

Fire Chief Dennis L. Rubin told WRC-TV Channel 4 on Friday that he had not seen any of the tapes until they surfaced in news reports. "Of course it is cause for concern, but the entire idea is that we contracted with the Maryland Fire and Rescue Institute, perhaps the best medical agency in the country, to evaluate our performance in a way that we can change our protocols and train our people."

Mr. Givens said fire officials have not acknowledged any wrongdoing in his brother's case. "I'm so [angry] about this situation. The more I try to uncover things, the [angrier I get]," he said. "I think all too often this happens in Washington."

SOURCE




Shortage of Doctors an Obstacle to Obama Goals

Cutting way back on the time and money that doctors have to spend on red tape would be a great start

Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the supply of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president. The officials said they were particularly concerned about shortages of primary care providers who are the main source of health care for most Americans. One proposal — to increase Medicare payments to general practitioners, at the expense of high-paid specialists — has touched off a lobbying fight.

Family doctors and internists are pressing Congress for an increase in their Medicare payments. But medical specialists are lobbying against any change that would cut their reimbursements. Congress, the specialists say, should find additional money to pay for primary care and should not redistribute dollars among doctors — a difficult argument at a time of huge budget deficits.

Some of the proposed solutions, while advancing one of President Obama’s goals, could frustrate others. Increasing the supply of doctors, for example, would increase access to care but could make it more difficult to rein in costs.

The need for more doctors comes up at almost every Congressional hearing and White House forum on health care. “We’re not producing enough primary care physicians,” Mr. Obama said at one forum. “The costs of medical education are so high that people feel that they’ve got to specialize.” New doctors typically owe more than $140,000 in loans when they graduate.

Lawmakers from both parties say the shortage of health care professionals is already having serious consequences. “We don’t have enough doctors in primary care or in any specialty,” said Representative Shelley Berkley, Democrat of Nevada. Senator Orrin G. Hatch, Republican of Utah, said, “The work force shortage is reaching crisis proportions.”

Even people with insurance have problems finding doctors. Miriam Harmatz, a lawyer in Miami, said: “My longtime primary care doctor left the practice of medicine five years ago because she could not make ends meet. The same thing happened a year later. Since then, many of the doctors I tried to see would not take my insurance because the payments were so low.”

To cope with the growing shortage, federal officials are considering several proposals. One would increase enrollment in medical schools and residency training programs. Another would encourage greater use of nurse practitioners and physician assistants. A third would expand the National Health Service Corps, which deploys doctors and nurses in rural areas and poor neighborhoods.

Senator Max Baucus, a Montana Democrat and chairman of the Finance Committee, said Medicare payments were skewed against primary care doctors — the very ones needed to coordinate the care of older people with chronic conditions like congestive heart failure, diabetes and Alzheimer’s disease. “Primary care physicians are grossly underpaid compared with many specialists,” said Mr. Baucus, who vowed to increase primary care payments as part of legislation to overhaul the health care system.

The Medicare Payment Advisory Commission, an independent federal panel, has recommended an increase of up to 10 percent in the payment for many primary care services, including office visits. To offset the cost, it said, Congress should reduce payments for other services, an idea that riles many specialists. Dr. Peter J. Mandell, a spokesman for the American Association of Orthopaedic Surgeons, said: “We have no problem with financial incentives for primary care. We do have a problem with doing it in a budget-neutral way. “If there’s less money for hip and knee replacements, fewer of them will be done for people who need them.”

The Association of American Medical Colleges is advocating a 30 percent increase in medical school enrollment, which would produce 5,000 additional doctors each year. “If we expand coverage, we need to make sure we have physicians to take care of a population that is growing and becoming older,” said Dr. Atul Grover, the chief lobbyist for the association. “Let’s say we insure everyone. What next? We won’t be able to take care of all those people overnight.”

The experience of Massachusetts is instructive. Under a far-reaching 2006 law, the state succeeded in reducing the number of uninsured. But many who gained coverage have been struggling to find primary care doctors, and the average waiting time for routine office visits has increased. “Some of the newly insured patients still rely on hospital emergency rooms for nonemergency care,” said Erica L. Drazen, a health policy analyst at Computer Sciences Corporation. The ratio of primary care doctors to population is higher in Massachusetts than in other states.

Increasing the supply of doctors could have major implications for health costs. “It’s completely reasonable to say that adding more physicians to the work force is likely to increase health spending,” Dr. Grover said. But he said: “We have to increase spending to save money. If you give people better access to preventive and routine care for chronic illnesses, some acute treatments will be less necessary.”

In many parts of the country, specialists are also in short supply. Linde A. Schuster, 55, of Raton, N.M., said she, her daughter and her mother had all had medical problems that required them to visit doctors in Albuquerque. “It’s a long, exhausting drive, three hours down and three hours back,” Ms. Schuster said.

The situation is even worse in some rural areas. Dr. Richard F. Paris, a family doctor in Hailey, Idaho, said neighboring Custer County had no doctors, even though it is larger than the state of Rhode Island. So he flies in three times a month, over the Sawtooth Mountains, to see patients.

The Obama administration is pouring hundreds of millions of dollars into community health centers. But Mary K. Wakefield, the new administrator of the Health Resources and Services Administration, said many clinics were having difficulty finding doctors and nurses to fill vacancies.

Doctors trained in internal medicine have historically been seen as a major source of frontline primary care. But many of them are now going into subspecialties of internal medicine, like cardiology and oncology.

SOURCE





29 April, 2009

Swine flu worse in Mexico than US, but why?

Could it be that the evil capitalistic medical care in the USA is better than the socialized medicine of Mexico? The drug Relenza cures the illness so let me make a wild guess that Americans who need it get Relenza while very few Mexicans do

Why has the swine flu engulfing Mexico been deadly there, but not in the United States? Nearly all those who died in Mexico were between 20 and 40 years old, and they died of severe pneumonia from a flu-like illness believed caused by a unique swine flu virus. The 11 U.S. victims cover a wider age range, as young as 9 to over 50. All those people either recovered or are recovering; at least two were hospitalized.

"So far we have been quite fortunate," said Dr. Anne Schuchat of the U.S. Centers for Disease Control and Prevention on Saturday, just hours before three new U.S. cases were confirmed.

Health experts worry about a flu that kills healthy young adults - a hallmark of the worst global flu epidemics. Deaths from most ordinary flu outbreaks occur among the very young and very old.

Why the two countries are experiencing the illness differently is puzzling public health experts, who say they frankly just don't know. [Such a puzzle!]

It may be that the bug only seems more deadly in Mexico. And while experts believe Mexico is the epicenter of the outbreak, they're not certain if new cases are occurring or if the situation is getting worse. They also don't know if another virus might be circulating in Mexico that could be compounding the problem. A big question is, Just how deadly is the virus in Mexico?

The seasonal flu tends to kill just a fraction of 1 percent of those infected. In Mexico, about 70 deaths out of roughly 1,000 cases represents a fatality rate of about 7 percent. The Spanish flu pandemic of 1918-19, which killed an estimated 40 million worldwide, had a fatality rate of about 2.5 percent. The Mexican rate sounds terrifying. But it's possible that far more than 1,000 people have been infected with the virus and that many had few if any symptoms, said Dr. Michael Osterholm, a prominent pandemic expert at the University of Minnesota.

U.S. health officials echoed him. "In Mexico, they were looking for severe diseases and they found some. They may not have been looking as widely for the milder cases," said Schuchat of the CDC. The U.S. health agency sent two investigators to Mexico on Saturday to help, she said.

Currently, even the counted illnesses are problematic. Only a fraction have been lab confirmed. Severe penumonia-like illness happens all the time, so it's challenging to figure out which ones are really tied to the outbreak, U.S. health officials said. "These numbers need to be confirmed," said Dr. Richard Wenzel, the immediate past president of the International Society for Infectious Diseases.

Other ideas about the difference include:

-Genetic analysis of virus samples in the two countries is continuing. The CDC says tests results show the U.S. and Mexican viruses are essentially the same, but some experts have not ruled out the possibility that the virus is changing as it leaks across the border to the north. [A virus as an illegal immigrant!]

-Perhaps nutrition levels are worse in some Mexican communities - poor nutrition can degrade a person's immune defenses, and make them more susceptible to illness.

-Air quality in Mexico City is considered terrible. That too may have affect patients confronted with a novel respiratory disease.

-Access to medical care has been an issue in Asia, where a rare bird flu - which does not spread easily from person-to-person - has killed more than 200 over the last several years. Maybe Mexican patients have also had trouble getting medical care or antiviral drugs, some have speculated - even though the government provides health care.

All that is speculation at this point.

"The question of why the virus appears to be more virulent in Mexico is one that we are looking intensively into," the CDC's Schuchat said. "Rather than speculate, it's important for the science to lead us on this."

SOURCE




Australia: Fatal ambulance bungle a complete bureaucratic disaster

The more we hear the more unbelievable the mess gets. How could anyone be so stupid? It is bordering on evil that such stupdity was left uncorrected

A COMBINATION of bureaucratic bungling and technical glitches meant vital time was lost in the search for a teenager dying in the New South Wales Blue Mountains, an inquest has heard.

Police were made to fill in request forms and wait almost 24 hours before receiving information that they admit may have saved 17-year-old David Iredale, who died after becoming separated from his friends during a trek in the Blue Mountains, west of Sydney. Superintendent Patrick Paroz told Penrith Coroner's Court he made two separate requests to the state emergency services for copies of 000 calls made by the Sydney Grammar student. He did not receive them until almost a day later.

The inquest heard that a "technical difficulty" was to blame for the delay. A disc containing sound files of the calls had to be driven from the city to Katoomba because computer firewalls in the ambulance service system prevented police receiving them by email.

On December 11, 2006, David repeatedly told three New South Wales Ambulance Service operators that he was on the well-known Mt Solitary walking track heading towards the Kedumba River. The inquest heard vital time was wasted time as authorities looked for "Doherty's Pass", which they concluded did not actually exist. "It was time-consuming," said Superintendent Ian Colless, who led initial rescue efforts.

Superintendent Colless said that based on information received from the ambulance service, police treated the calls as a "priority 3", classed as needing action but not urgent. "This is a call we may get every day of the week," he said. Superintendent Colless, who heard the emergency calls for the first time yesterday, agreed that immediate access to them would have given police a more accurate idea of David's location and health. "Not only of the Mt Solitary track but also which portion of the track," he said.

After hearing the calls, Superintendent Colless admitted it was "completely" wrong to assume David was not in distress. The fact David was "yelling" and had fainted meant the situation was "critical", he said.

SOURCE





28 April, 2009

British grandmother is refused cancer drug

The NHS thinks it has already spent enough money on her

Grandmother Beryl Jarvis, who is battling cancer for the fourth time, has been refused a drug that could save her life – because the NHS says it has already spent enough money on her treatment.

Mrs Jarvis has been told a drug cleared for use last November could help reduce a tumour in her lungs. But the NHS says it is not cost-effective to prescribe the drug. Mrs Jarvis, 66, said: "They are saying that for the sake of £10,000 a year my life is not worth saving. How could they put that price on my life?" Her daughter has described the decision as handing her mother a "death sentence".

Mrs Jarvis first contracted ovarian cancer in the early 1980s. She overcame the disease after she underwent a course of chemotherapy. But in January 2004 she was diagnosed with lung cancer. The former cleaner had a round of chemotherapy, followed by radiotherapy, and was free of the cancer for three years.

Early in 2007 the disease returned and Mrs Jarvis, of Home Close, Southmead, was given another round of chemotherapy. Last spring, her tumour grew again and she underwent more chemotherapy. In November the cancer increased in size and her consultant at Bristol Oncology Centre recommended a drug called Tarceva. He believed it could help reduce the size of the tumour. He applied to NHS Bristol – which is in charge of health spending in the city – to see if they would treat her as an exceptional funding case, but was turned down.

Mrs Jarvis said: "When I heard that Tarceva had been approved I thought I might be entitled to it." But she was turned down because the National Institute of Health and Clinical Excellence (NICE) had not approved it for cases like hers. Other treatments were tried by Mrs Jarvis but she suffered side-effects. She said: "I did not know then that if you had already had two chemotherapy treatments you could not have it. "It seems as though if you have had cancer for so long they don't want to pay money."

Despite this, Mrs Jarvis is determined to continue battling the disease. She desperately wants to attend the wedding of her grandson Lee Brewer in July. It was this determination to see him grow up and get married which got her through her first battle with cancer in the 1980s. Her husband, Nigel, 59, said: "Beryl has been fighting for five and a half years now because she won't give up. The fight is there, why should she be denied this?"

Mrs Jarvis' daughter, Nikki Brewer, said: "When they sent the letter saying they would not pay for the treatment it was a death sentence. They call it exceptional funding, but we are also facing exceptional circumstances."

The drug hit the headlines last year with the case of Carol Rummels, from Stoke Lodge, who was eventually given Tarceva just before the change of guidelines.

Mrs Jarvis, and her husband have been in contact with Mrs Rummels and have also written to their MP, Doug Naysmith. He has passed their concerns on to Bristol South MP Dawn Primarolo in her capacity as a health minister.

A spokesman for NICE said: "The guidance does not recommend erlotinib (Tarceva) for the second-line treatment of locally advanced or metastatic non-small-cell lung cancer in patients who are intolerant of docetaxel, or for third-line treatment after docetaxel therapy because it is not a cost-effective use of NHS resources when used in this way."

NHS Bristol spokeswoman, Julie Hendry, said: "While NHS Bristol has sympathy for Mrs Jarvis, NICE guidelines state that Erlotinib (Tarceva) therapy is not recommended for patients undergoing third- line treatment after docetaxel therapy and our local network of experts have endorsed this guidance. "Every application NHS Bristol receives for this treatment is considered using this guidance in order to ensure fair and equitable treatment for all patients."

SOURCE




Doctors attack embryo screening 'postcode lottery'

The NHS is contributing to needless abortions and the avoidable birth of children with inherited diseases because of a postcode lottery in embryo screening, medical experts said today. Couples who know they are at risk of passing on serious genetic diseases to their children are often refused funding for IVF tests that can detect affected embryos, according to doctors and nurses from Guy’s Hospital in London. This has led to cases in which couples have terminated pregnancies following the results of prenatal tests and incidents where children have been born with a genetic disease that could have been picked up with embryo screening.

When prospective parents know they are at risk of having children with a serious heritable disease, they can use an embryo screening test known as pre-implantation genetic diagnosis (PGD) to ensure they have a healthy baby. Though such couples are generally fertile, they conceive by IVF and a single cell is removed from each embryo for genetic analysis. Only embryos that do not carry the faulty gene carried by the family are then chosen for transfer to the womb.

The service, which costs about £7,000, is available for hundreds of genetic conditions, including cystic fibrosis, Huntington’s disease and muscular dystrophy, and several hundred PGD babies have been born in the UK. The only alternatives are prenatal testing, in which a foetus is tested several months into pregnancy, offering the parents the opportunity to have an abortion if it is affected, or taking no tests at all. All primary care trusts fund prenatal tests during pregnancy when there is a risk but many will not pay for PGD, even though this can prevent abortions.

Alison Lashwood, consultant nurse in genetics and PGD at Guy’s, said: “There are couples we have seen who have not been given funding, who have gone on to have affected children. Others have had to go down the prenatal testing route and some have had terminations.”

Speaking at the launch of Guy’s Hospital’s new Assisted Conception Unit and PGD centre, which opens tomorrow, she described one couple who had been refused PGD on the NHS, who had gone on to have a stillbirth and a baby with a severe inherited disease.

Some PCTs, Ms Lashwood said, apply the same eligibility criteria as they do to IVF for infertility even though it is not a fertility treatment. This means that couples can be refused on grounds of age or because they already have children. The latter is particularly unfair on couples who discover they need the procedure because they have already had a child with a genetic disease. “They cannot get the idea that PGD is an early approach to prenatal diagnosis, not a type of fertility treatment,” Ms Lashwood said. She urged trusts to set up common rules, as are already operated by a consortium of PCTs in south east England.

Yacoub Khalaf, head of the Guy’s unit, said: “More trusts than not understand the need for PGD and that it is not to be mixed up with fertility treatment, but some trusts say they offer prenatal diagnosis, so why don’t you have that? It denies patients a choice.”

Professor Peter Braude, of King’s College, London, said: “Some PCTs regard PGD as a bolt-on to IVF, but it should not be seen that way. Most patients who have PGD are not infertile.”

SOURCE





27 April, 2009

Appalling: NHS Hospital used wrong sperm to fertilise eggs -- kills embryos

The usual bureaucratic carelessness

WOMEN undergoing fertility treatment have had their eggs fertilised with the wrong sperm in a series of mix-ups at one of Britain’s most famous hospitals. Embryos belonging to three couples had to be destroyed and their cycles of treatment abandoned after the errors were discovered at Guy’s and St Thomas’ hospital in London earlier this year. In a separate blunder, a woman had the wrong embryo implanted at the same hospital in 2007.

Fertility experts say the errors, along with similar mistakes at other hospitals, raise serious concerns about the way IVF clinics are regulated. They believe the Human Fertilisation and Embryology Authority (HFEA), the watchdog, is failing to deal with serious problems. [That's because they are too busy persecuting Dr Taranissi, Britain's most successful IVF practitioner, who is, unforgiveably, a PRIVATE doctor]

The mistakes have raised concerns about a “casual approach” to the 37,000 British couples who seek fertility treatment every year. Critics point out that inspection reports from 2007 and 2008 warned that Guy’s and St Thomas’ was carrying out “risky” procedures in the preparation of sperm samples for fertilisation.

A February 2007 report by the HFEA warned that embryologists at the hospital were running the risk of confusing sperm samples from different men by preparing them in the same container. Yet errors were still being made earlier this year.

One of the recent cases was discovered when the embryologist realised she had used a sample from the wrong man to fertilise a patient’s eggs. Within days of this mistake, scientists carrying out tests designed to ensure that babies are free of hereditary diseases found genes showing that the embryos could not belong to the parents they had believed to be the owners.

In 2007 a patient at Guy’s had been implanted with the wrong embryo. The treatment failed to result in a birth and embryologists later discovered that they had put back a weak embryo – despite the patient having created a stronger one that had a greater chance of developing into a baby.

Documents seen by The Sunday Times show a series of mistakes at other clinics that led to general warnings being issued. In one incident, a surrogate mother was given embryos from a couple who had a similar-sounding surname to the couple who had hired her. The surrogate did not become pregnant. The HFEA warned clinics about the mistake in March 2007, but the incident was not made public.

At another unidentified clinic, a woman became pregnant after she was implanted with embryos belonging to another couple with the same surname. The HFEA told clinics about the mix-up in May 2007 but the public was again not informed. The pregnancy ended in miscarriage. At about the same time, treatment for two other couples had to be abandoned after their embryos were mixed-up.

Josephine Quintavalle of the campaign group Comment on Reproductive Ethics, said: “It is horrifying that this information is not available to the public. I didn’t realise the extent of this. The casualness is just dreadful.”

Sue Avery, consultant embryologist at Birmingham women’s hospital and a former chairwoman of the Association of Clinical Embryologists, said the sperm mix-ups at Guy’s were “very serious”. She said it was disappointing that clinics had not learnt lessons from the mistakes that had led to the birth of black twins to a white couple in Leeds in 2002.

Despite the repeated mistakes at Guy’s and St Thomas’ hospital, the HFEA has not carried out an investigation. Avery said: “We would expect in the case of repetition that the HFEA might want to investigate unless they can be thoroughly satisfied that the centre has taken sufficient action.”

The assisted conception unit at Guy’s and St Thomas’ hospital said a thorough internal investigation had been carried out and the HFEA was informed of the mistakes.

The HFEA said that while IVF was a delicate procedure and it was impossible to eliminate human error, only 0.5% of treatments resulted in problems. It added: “The HFEA takes incidents very seriously. When incidents are reported to us, we will investigate and take action where necessary. The risk of mix-ups is a serious concern for patients, clinics and the HFEA.”

SOURCE




Obama policies must lead to severe health care rationing

Charles Krauthammer

In the service of his ultimate mission -- the leveling of social inequalities -- President Obama offers a tripartite social democratic agenda: nationalized health care, federalized education (ultimately guaranteed through college) and a cash-cow carbon tax (or its equivalent) to subsidize the other two.

Problem is, the math doesn't add up. Not even a carbon tax would pay for Obama's vastly expanded welfare state. Nor will Midwest Democrats stand for a tax that would devastate their already crumbling region. What is obviously required is entitlement reform, meaning Social Security and Medicare/Medicaid. That's where the real money is -- trillions saved that could not only fund hugely expensive health and education programs but also restore budgetary balance. Except that Obama has offered no real entitlement reform. His universal health care proposal would increase costs by perhaps $1 trillion. Medicare/Medicaid reform is supposed to decrease costs.

Obama's own budget projections show staggering budget deficits going out to 2019. If he knows his social agenda is going to drown us in debt, what's he up to? He has an idea. But he dare not speak of it yet. He has only hinted. When asked in his March 24 news conference about the huge debt he's incurring, Obama spoke vaguely of "additional adjustments" that will be unfolding in future budgets.

Rarely have two more anodyne words carried such import. "Additional adjustments" equals major cuts in Social Security and Medicare/Medicaid. Social Security is relatively easy. A bipartisan commission (like the 1983 Alan Greenspan commission) recommends some combination of means testing for richer people, increasing the retirement age, and a technical change in the inflation measure (indexing benefits to prices instead of wages). The proposal is brought to Congress for a no-amendment up-or-down vote. Done.

The hard part is Medicare and Medicaid. In an aging population, how do you keep them from blowing up the budget? There is only one answer: rationing. Why do you think the stimulus package pours $1.1 billion into medical "comparative effectiveness research"? It is the perfect setup for rationing. Once you establish what is "best practice" for expensive operations, medical tests and aggressive therapies, you've laid the premise for funding some and denying others.

It is estimated that a third to a half of one's lifetime health costs are consumed in the last six months of life. Accordingly, Britain's National Health Service can deny treatments it deems not cost-effective -- and if you're old and infirm, the cost-effectiveness of treating you plummets. In Canada, they ration by queuing. You can wait forever for so-called elective procedures like hip replacements.

Rationing is not quite as alien to America as we think. We already ration kidneys and hearts for transplant according to survivability criteria as well as by queuing. A nationalized health insurance system would ration everything from MRIs to intensive care by a myriad of similar criteria.

The more acute thinkers on the left can see rationing coming, provoking Slate blogger Mickey Kaus to warn of the political danger. "Isn't it an epic mistake to try to sell Democratic health care reform on this basis? Possible sales pitch: 'Our plan will deny you unnecessary treatments!' ... Is that really why the middle class will sign on to a revolutionary multitrillion-dollar shift in spending -- so the government can decide their life or health 'is not worth the price'?"

My own preference is for a highly competitive, privatized health insurance system with a government-subsidized transition to portability, breaking the absurd and ruinous link between health insurance and employment. But if you believe that health care is a public good to be guaranteed by the state, then a single-payer system is the next best alternative. Unfortunately, it is fiscally unsustainable without rationing.

Social Security used to be the third rail of American politics. Not anymore. Health care rationing is taking its place -- which is why Obama, the consummate politician, knows to offer the candy (universality) today before serving the spinach (rationing) tomorrow.

Taken as a whole, Obama's social democratic agenda is breathtaking. And the rollout has thus far been brilliant. It follows Kaus' advice to "give pandering a chance" and adheres to the Democratic tradition of being the party that gives things away, while leaving the green-eyeshade stinginess to those heartless Republicans. It will work for a while, but there is no escaping rationing. In the end, the spinach must be served.

SOURCE





26 April, 2009

Pregnant mother is refused free NHS maternity dental care after staff said bump, ultrasound and doctor's notes are NOT proof

A woman with most severe dental problems still cannot get treatment in socialized Britain

A mother-to-be has been turned down for free dental treatment - because the surgery will not accept that she is expecting. Sarah Luisis, 27, who is five months pregnant, has been told she needs to provide more proof that she has a baby on the way. That is despite the fact that she has a big bump, a doctor's certificate, antenatal notes and ultrasound pictures of her unborn child.

Miss Luisis, of Hornchurch, Essex, is desperate to see a dentist after enduring weeks of agony with bleeding gums. But the only way she can afford crucial treatment is through maternity cover from the NHS. But the mother of one was turned away from St John's dental practice in Romford because she did not have a Maternity Exemption Certificate. She said: 'I filled in a form to get the certificate when I found out I was pregnant and sent it off. 'But I've discovered that the form was never received in Newcastle where the certificates are issued. 'I now have to fill in another form but that could take up to four weeks to be approved.'

She added: 'I've got a letter from my doctor confirming my pregnancy, my antenatal notes, ultrasound scans and I'm very big for five months anyway. 'You'd think that would be enough.'

Miss Luisis's gums are so bad she wakes up with a mouth full of blood every morning and she fears she has an infection. She has been on the waiting list to see a dentist for the past ten weeks. 'I was recently told that an appointment had finally become available,' she said. 'But it was devastating to be told I'd not be treated because I didn't have the Maternity Exemption Certificate proving that I'm pregnant.'

The part-time admin worker says she cannot afford the £40 fee for the initial appointment, and the cost of further treatment could run into hundreds of pounds. A spokesman for the dental surgery said: 'This is not our policy. It comes from the health authority. 'The PCT have said to us, "We will not pay you if you don't have this information". 'It's not up to us, and we used to take people's word.'

SOURCE




Is Health Care A “Right”? Not According to Governments Who Run Health Care

The advocates of government-run medicine base their claims on the notion that health care is a “right.” They thus attempt to occupy the moral high ground over those who advocate reforms based on the principle of individual choice.

For example, lobbyists in favor of California’s SB-840, a bill that has twice failed to impose a government-monopoly health system, affirm Californians’ “right” to “quality, affordable health insurance.” Many physicians do likewise.

At a recent debate of the Benjamin Rush Society, which comprises physicians and medical students who oppose government control of medicine, Dr. Oliver Fein, represented the Physicians for a National Health Program, (PNHP), which includes the “right” to health care in its mission statement. Fortunately for Dr. Fein, he has not practiced in a country such as Canada, where the government has defined health care as a “right.”

Fortunately for the New York audience, one of the speakers opposing the resolution, that health care should be the responsibility of the federal government, was Dr. Brian Day, a Canadian orthopedic surgeon. He knows all too well the pain caused to both patients and doctors when the government asserts its “right” to control your health care.

Back home in British Columbia, the monopolistic provincial health plan is suing Dr. Day for allegedly receiving direct payment from patients for performing surgeries in his clinic. What makes the case remarkable is that the provincial monopolists have launched their legal attack against Dr. Day based on their new-found conviction that Canadian citizens do not, in fact, have a right to health care.

The state’s claim is remarkable in its arrogance but a necessary legal maneuver if the BC government wants to put Dr. Day out of business. In 2005, the Supreme Court of Canada found that elements of the province of Quebec's monopoly over health care violated citizens' human rights because of the government's failure to deliver care. Since then, other Canadians have launched similar lawsuits in other provinces. It appears they just might win.

By conceding that health care is not a “right,” the provincial monopolists can argue that the 2005 Supreme Court decision is irrelevant. If that is the case, then the government's monopoly obviously cannot violate citizens' rights.

As this episode shows, once the state takes over, the citizen hasn't got a chance. Governments are not competent to provide health care as a “right,” any more than they would be competent to provide shoes as a “right.” Therefore people who define their right to health care differently will have to continue to fight the state to recognize it.

How should it then be defined? When I'm speaking publicly on health reform, people sometimes ask: "Do you think that health care is a human right?" My answer is: "Yes, I believe that you have a right to spend your own money on health care of your choice, free of government interference."

This prompts a moment of reflection in those who understand the difference between a culture in which people take care of each others’ needs as members of a civil society, versus one in which we surrender our liberty to unlimited control of our health-care resources by government agents.

Legislators in Sacramento and Washington need to reflect on those realities, and the plight of Dr. Brian Day. Otherwise governments in the United States may soon be further infringing Americans’ health care choices, and be suing doctors for taking care of patients’ needs.

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25 April, 2009

Girl, 3, has NHS heart operation cancelled three times because of bed shortage

A three-year-old girl awaiting heart surgery has had her operation cancelled three times this month because of a shortage of beds. Ella Cotterell was due to have aorta-widening surgery on Monday at the Children’s Hospital, Bristol. But 48 hours beforehand, the operation was cancelled for the third time as all 15 beds in the intensive care unit were occupied, her parents said.

A hospital spokesman said that procedures would be reviewed, but the case highlights a growing problem of cancelled operations in the NHS. More than 57,000 surgeries were postponed for non-clinical reasons, including a lack of beds, last year – 10 per cent more than the previous year. Latest figures show that the problem persists. At least 43,000 operations were cancelled in the first nine months of 2008-09, with nearly 1,800 patients not being treated within 28 days of their original scheduled date.

Among the excuses for cancellation the previous year were a hospital running out of shavers to prepare patients for surgery, a surgeon going missing following a fire alarm, and a patient’s translator failing to turn up.

Ella needed open heart surgery when she was nine days old to repair her aorta, the body’s main artery, which had not formed properly in the womb. At 18 months old she suffered a stroke after falling down the stairs at her home and banging her head, temporarily paralysing the left side of her body.

Her parents, Ian Cotterell and Rachel Davis, were told last October that she would need an operation within 12 to 18 months. Doctors carried out two angioplasties, where small balloons are inserted and inflated to clear a blocked blood vessel, but neither was successful. Further surgery was initially planned for April 2 but was cancelled because of emergency cases and rearranged for four days later, the couple said. However, the operation was cancelled again for the same reason.

A third date was arranged for April 20 and last Thursday Ella went to the hospital for tests. On Saturday her parents received another call explaining her operation would have to be cancelled. Ms Davis, who works part-time as an accident and emergency nurse at the Frenchay Hospital in Bristol, said that she was devastated when she was told there were not enough beds. “My husband and I were in tears,” she said. “When our six-year-old son Liam asked what was wrong we told him Ella’s operation had been cancelled again and he said we should tell Gordon Brown.”

The family are waiting for another surgery date. In the meantime, Ella is having to take adult doses of medication to control her blood pressure. “We have asked the doctors if she really needs the surgery as she is so happy at the moment and is running around like a normal little girl, but she could drop down dead at any moment,” Ms Davis said. “Twice I have been told that she may not make it through the night and there have been times when I have gone into her room in the morning and wondered whether she’d still be breathing.

She called on the Government to put more money into the NHS before a child died on the waiting list. “I have worked in the NHS for 22 years so I know what happens in hospitals,” she said. “I cannot fault the doctors and nurses for all they have done for Ella – she would not be alive today without them. “I believe Ella is the tip of the iceberg and that there are many other families out there that have had their operations cancelled many more times but have not spoken out about it. “This is a national problem, there are not enough resources in the NHS and it is about prioritising. “It is a matter of time before a child dies on the waiting list and I don’t want it to be Ella. If that does happen the Government will have blood on their hands.”

Michele Narey, of the University Hospitals Bristol NHS Foundation Trust, said that she could not discuss individual cases. She added: “The decision to cancel any patient for any procedure is taken extremely seriously but is sometimes unavoidable because of the need to effectively manage emergency patients requiring beds on a day-to-day basis. “We know that cancelling procedures can cause additional stress for patients so we will always seek to avoid this wherever possible.”

SOURCE




Australia: The charming NSW government ambulance service again

Culture of sarcasm familiar to another victim

THE sarcasm and insensitivity of ambulance call operators towards dying teenager David Iredale is all too familiar for Gareth Redshaw, who was called a "blatant hoaxer" when he called for help minutes after the Waterfall train disaster. Mr Redshaw, then 19, managed to kick a hole in the glass door of the overturned train carriage and climb up an embankment to call triple-0 from his mobile phone about 7.30am on January 31, 2003.

But the operator who took his first call told a clearly distressed Mr Redshaw that his story was unbelievable and a second, more senior operator also accused him of a hoax. In alarming parallels to evidence given at the inquest into Mr Iredale's death, call operators behaved as if Mr Redshaw was a teenage prankster when he could not provide an exact location of the derailment, which occurred in thick bushland between Waterfall and Helensburgh stations.

The Ambulance Service later apologised for questioning the validity of Mr Redshaw's calls and he was told by divisional management that operators would be given more information to help them distinguish between genuine and hoax calls. But yesterday Mr Redshaw, now 25, said the organisation had clearly failed to implement measures that would ensure the situation did not arise again. "I was promised that the issue of failing to deal with people who couldn't provide a cross-street would be rectified and I am disappointed that management has again failed to act. "The whole culture of the ambulance service needs an overhaul."

Mr Redshaw later told police attending the scene the operators "didn't seem to understand that it was on a railway". "They were saying, 'What suburb, what street' and I was saying there was no suburb, it's on a train line, the train's derailed." But a recording played at the special commission of inquiry into the disaster shows the two operators were sceptical.

Leyla Spinelli admitted she did not take the call seriously as she had found the idea of a whole train overturning "incredible". She had been suspicious after a spate of similar prank calls in the days before the accident and because Mr Redshaw's mobile number did not show up on her screen. "You rang up yesterday and told me … about someone hurting themselves in Queanbeyan, didn't you?" He said: "Queanbeyan? No, I told you I'm serious. F---in' train derailed here."

When Brad Deering took over the call he said: "Gareth, you're not mucking us around, are you mate?" and "Well, if this really happened the railway will know about it."

An Ambulance Service spokesman said procedures for incidents in remote or isolated areas with no street address were changed in 2008.

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24 April, 2009

Girl, 6, dies after NHS GP failed to carry out blood test which would have saved her life

Once again the chronic delays and indifference that characterize socialized medicine were the real killers

A six-year-old girl died from kidney disease after a GP failed to give her a blood test that would have saved her. Bethany Townsend's death was preventable and her illness treatable, an inquest ruled. Her devastated parents are considering legal action against their GP.

Coroner Dr Nigel Chapman, who recorded a verdict of death by natural causes, said: 'The window of opportunity to save Bethany was huge and that length of time was totally unacceptable. 'Sadly Bethany died because a blood test wasn't done. Had one been done, it would have shown the abnormality and she would have gone into hospital and her death would not have occurred.'

Bethany died three weeks after being taken to her local surgery in Newark, Nottinghamshire, just after Christmas. But instead of carrying out a blood test which would have diagnosed her illness, Dr Julie Barker referred her to Newark Hospital for the test. When Bethany arrived a week later nurses found she was too thin for them to find a vein and referred her back to her doctor's surgery. Ten days later Dr Barker tried to draw a blood sample but could not find a vein.

The GP then managed to refer Bethany to a specialist paediatrician but could get an appointment only a month later. But Bethany died from kidney failure on January 22, 2007, weighing just 30lb.

Dr Barker told Nottingham Coroner's Court she had made 'an error of judgment'. The GP said she now referred children immediately for specialist treatment if required. Dr Barker added: 'Obviously I wish I had referred her straight away. 'I felt that she would need specialist treatment and had planned to do that but I wanted to get some test results back.'

Dr Malcolm Lewis, a specialist in kidney disease at the Royal Manchester Children's Hospital, said he believed Dr Barker should have put in an urgent request for Bethany to see a specialist paediatrician. Had she done so a blood sample would have been taken within a week and the youngster would have been immediately sent to a specialist renal unit, he said. 'My expectation would be that had she been sent, Bethany would have lived,' he said.

'From the post-mortem reports I would have been optimistic she would have been able to return to good kidney function for a period of time, but given the damage that would have been done she would have needed a transplant in the future. 'From the description of Bethany's Manclinical state I would expect a phone call that day to refer Bethany. I would expect with her condition that she would have been seen within a week and if I were taking that phone call about a child with a urinary infection I would say come up immediately and have a test.'

A statement from Bethany's parents said: 'This has been an incredibly harrowing period for the family and friends of Bethany, with today's inquest reminding us all of a young life lost and a loving daughter who is sadly missed. 'The question of "would things have been different had Bethany seen a specialist?" is one that will haunt us for ever but we are grateful for some kind of closure now that the circumstances surrounding her death have been made public. 'Hopefully lessons have been learned and nobody else suffers in similar circumstances.'

Dr Doug Black, medical director at NHS Nottinghamshire County, said: 'This girl's death is a tragedy. 'It was avoidable and our deepest sympathies go to her family. 'It's a complex case and we have led a thorough review to ensure we learn lessons from it. 'We have acted firmly to put in place a comprehensive action plan under which the GP involved has undertaken further specialist training.'

SOURCE




Health insurance does not mean medical care

Already, many patients "insured" by Medicare and Medicaid have trouble finding a doctor who will take the pittance that the government will pay for their care

Much as I hate to be the bearer of bad news, I must report the shocking facts: Medical care is medical care. Nothing more and nothing less. This may not seem like a breakthrough on the frontiers of knowledge. But it completely contradicts what is being said by many of those who are urging "universal health care" because so many Americans lack health insurance. Insurance is not medical care. Indeed, health care is not the same as medical care. Countries with universal health care do not have more or better medical care.

The bottom line is medical care. But the rhetoric and the talking points are about insurance. Many people who could afford health insurance do not choose to have it because they know that medical care will be available at the nearest emergency room, whether they have insurance or not.

This is especially true for young people, who do not anticipate long-term medical problems and who can always get a broken leg or an allergy attack taken care of at an emergency room -- and spend their money on a more upscale lifestyle.

This may not be a wise decision but it is their decision, and there is no reason why other people should lose the right to make decisions for themselves because some people make questionable decisions. If you don't think government bureaucrats can make questionable decisions, then you haven't dealt with many government bureaucrats.

It is one thing to deal with bureaucrats when you are at the Department of Motor Vehicles and in good health. It is something else when you have to deal with bureaucrats when you are lying on a gurney and bleeding or are doubled over in pain on a hospital bed.

People who believe in "universal health care" show remarkably little interest -- usually none -- in finding out what that phrase turns out to mean in practice, in those countries where it already exists, such as Britain, Sweden or Canada. For one thing, "universal health care" in these countries means months of waiting for surgery that American get in a matter of weeks or even days. In these and other countries, it means having only a fraction as many MRIs and other high-tech medical devices available per person as in the United States.

In Sweden [and Britain], it means not only having bureaucrats deciding what medicines the government will and will not pay for, but even preventing you from buying the more expensive medicine for yourself with your own money. That would violate the "equality" that is the magic mantra.

Those who think in terms of talking points, instead of trying to understand realities, make much of the fact that some countries with government-controlled medical care have longer life expectancies than that in the United States. That is where the difference between health care and medical care comes in. Medical care is what doctors can do for you. Health care includes what you do for yourself -- such as diet, exercise and lifestyle. If a doctor arrives on the scene to find you wiped out by a drug overdose or shot through the heart by some of your rougher companions, there may not be much that he can do except sign the death certificate.

Even for things that take longer to do you in -- obesity, alcohol, cholesterol, tobacco -- doctors can tell you what to do or not do, but whether you follow their advice or not is what determines the outcome. Americans tend to be more obese, consume more drugs and have more homicides. None of that is going to change with "universal health care" because it isn't health care. It is medical care.

When it comes to things where medical care itself makes the biggest difference -- cancer survival rates, for example -- Americans do much better than people in most other countries.

No one who compares medical care in this country with medical care in other countries is likely to want to switch. But those who cannot be bothered with the facts may help destroy the best medical care in the world by falling for political rhetoric.

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23 April, 2009

Teenage girl died in agony 'after NHS hospital said she was just a drama queen'



When the girl's appendix was removed, it must not have been intact and the inexperienced foreign doctor did not notice that. Then everybody else was too complacent to notice anything. With cautious medical practice she would have been given antibiotics and would be alive today. But instead of cautious medical practice she got bureaucratic indifference -- and no-one will be penalized for it. That's the socialized medicine system

A teenage girl died in agony in hospital days after medics dismissed her as a 'drama queen' whose pain was 'all psychological', an inquest has heard. Sian Jones, 15, was admitted to hospital with stomach pains, which doctors suspected were caused by appendicitis. When they removed her appendix the next day, her condition continued to worsen.

Doctors said the pain was from the operation and missed a series of tell-tale signs that she was suffering from perienteritis - a serious infection that inflames the lining of the stomach and intestines.

Sian, from Stirchley, Birmingham, died from multiple organ failure, brought on by the infection, a week after being admitted to the city's Heartlands Hospital in August 2007.

Her sister Sarah, 22, said that four days before Sian's death, staff had told their father 'there was nothing physically wrong with her and that it was all psychological, that she was a drama queen'. The family claimed staff also said the pain was brought on by problems at home, as Sian's father, Andrew, was fighting leukaemia. He has since died from the illness.

The inquest at Sutton Coldfield, West Midlands, heard the medic who had most contact with Sian, Dr Nehtab Ahmad, had only started her surgical training at the hospital three days earlier. Dr Ahmad told the hearing the surgical team, including two more senior surgeons, 'thought there was nothing amiss surgically and had been falsely reassured by a CT scan and a review from a paediatric doctor'.

The doctor added: 'With the benefit of hindsight I can see that she was getting worse, but at the time it was not so obvious. In hindsight all the factors were viewed independently and not together. 'The emotional aspect had been raised to me by my seniors and psychological issues were raised in a conversation with her father.'

SOURCE




FDA’s woes will grow under new leadership

The FDA, which regulates products worth more than $1 trillion -- a quarter of every consumer dollar -- has over the past two decades become a dangerous impediment to patients' getting the medicines they need. Drug development costs are up, approvals are down. Reforming a demoralized and chaotic FDA will require leadership that manages competently, is science-driven, is untainted by ideology, and is sufficiently strong to deflect congressional brickbats.

That's why the Obama administration's selections for the leadership at the FDA are especially disappointing. Although Dr. Margaret Hamburg, the nominee for commissioner (as the agency head is called), boasts significant experience in government and is highly thought of in the public health community, her new deputy, Dr. Joshua Sharfstein, is an inconceivably poor choice. The selection of Dr. Sharfstein -- who is acting agency head while Dr. Hamburg awaits Senate confirmation -- is particularly bad, given that he will reportedly be entrusted with oversight of the most important sector of FDA-regulated products, and is apparently being groomed to head the agency.

FDA commissioner has long been one of the most difficult jobs to fill in the federal government. On most high-profile issues, the incumbent is subject to intense criticism from a number of quarters, and the position has never been a stepping stone to fame or fortune. He or she needs to be equal parts scientist, technocrat, and Lord High Executioner (the latter, in order to keep balky bureaucrats in line).

The new leadership will face the added challenge of addressing the legacy of recent incumbents who imposed excessive and expensive burdens on those trying to bring new medicines to consumers, pushed drug development costs into the stratosphere, damaged agency morale, permitted the drug approval process to become politicized, and allowed drug-safety zealots to dominate agency policymaking and decisions.

The new FDA leadership must also confront a trend -- especially among members of Congress and the media -- toward vilifying drug companies, and even alleging that regulators have become too cozy with industry. In response, the FDA has battered the pharmaceutical industry with overly risk-averse, burdensome new policies, as well as erratic and dubious decisions on individual products. As a result, Sharfstein will need to establish credibility and rebuild trust with a variety of stakeholders -- including drug companies and their investors, patient groups, consumer activists, and members of Congress from both parties.

The probability of that happening approaches zero. Sharfstein has a long history of dubious associations and hostility toward the pharmaceutical industry. While a medical student at Harvard, he led a campaign urging classmates to return textbooks donated by a pharmaceutical company (the project failed -- apparently, most of Sharfstein's classmates were less radical than he). Also, while in medical school, he was an intern for FDA Commissioner David Kessler, whom many consider to be the most disliked and disreputable leader of the FDA within memory. (Kessler, who was unceremoniously fired last year as Dean of the medical school at the University of California, San Francisco, has bragged lately about his close ties to the new FDA leadership.)

Of course, it wouldn't be fair to predict an official's future approach to issues based only on his youthful activism, but Sharfstein's early "us versus them" view of the pharmaceutical industry has persisted throughout his career. He went on to work for anti-drug and anti-industry zealot Sidney Wolfe, and as health policy advisor to Rep. Henry Waxman (D-Calif.), who personifies the divisive approach that castigates and persecutes innovative pharmaceutical companies.

These are difficult times for both the drug industry and its regulators. Leadership at the FDA will demand nuance and the ability to weigh benefits and risks -- including the risks of excessive regulation that inhibits innovation and investment in R&D. Federal regulators should not be collaborators with industry, to be sure, but they must cooperate with drug manufacturers in order to get new drugs to patients in a timely and cost-effective way. Sharfstein has shown no willingness to do so, nor does he have any experience with the arcane and high-risk business of developing and regulating prescription drugs.

The aging American population is literally dying for regulatory reform at the FDA -- but not the kind that is in store.

SOURCE





22 April, 2009

Deliberate dumbing down of NHS emergency-room standards 'are putting lives at risk'

Lives are being put at risk by the introduction of medical centres designed to take the pressure off overstretched A& E departments, doctors have warned. Two patients have already been endangered after staff at 'urgent care' centres failed to recognise their symptoms, a survey found. Dozens more of the centres are due to open to prevent patients with minor ailments clogging up emergency departments. In some cases patients must be assessed by GPs or nurses before they are allowed to enter casualty.

The College of Emergency Medicine, which represents A&E doctors, found that a man who had a stroke was sent home from an urgent care centre because staff could not work out what was wrong. He was eventually admitted to hospital and recovered. Urgent care centre staff also failed to spot that a baby had meningitis. Emergency treatment was delayed but the child made a full recovery. The survey, of A&E staff working alongside the centres, did not name which ones were at fault.

John Heyworth, president of the College of Emergency Medicine, said: 'These are worrying examples of things going wrong in urgent care centres. 'In emergency departments we are used to seeing patients who may develop serious complications. 'We want to make sure GPs appreciate the risks and handle things very carefully. 'Speaking to colleagues around the country, our concern is that having a barrier to people actually getting in to A&E is not helpful.' He added: 'Patients tend to know when they are very sick and although around 10 to 20 per cent of patients may use the service inappropriately, the majority will go to their GP if they have a minor problem.'

Discussions to set up urgent care centres, which are particularly used for out-of-hours care, are underway at almost all of the UK's 270 A&E departments. Schemes are already running in Maidstone in Kent, Portsmouth and South-East Hampshire, Huntingdon in Cambridgeshire and Nottingham.

Dr Heyworth said: 'In some cases, where they sit alongside A&E they can work very well, but it is no good imposing them on hospitals and preventing patients from actually getting in. 'Another big worry is that money that should be going into hospital emergency departments is being diverted into these urgent care centres.'

But health bosses say that by preventing 15 'inappropriate' attendances at A&E per day a local primary care trust could save £328,000 a year. If three patients a day were stopped from being admitted to a ward when they would be better off at home, a trust could save £6,000 a day, or £2million a year.

The Department of Health has published a number of strategy documents, including the Direction of Travel for Urgent Care, which make clear that the creation of more urgent care centres is seen as the best way to improve service to patients.

Dr Richard Vautrey, of the British Medical Association's GPs' committee, said: 'We should not assume that GPs are less able to assess risk but we need to recognise that patients themselves are usually able to select the area of the health service they need to access, depending on the severity of their condition.'

A Department of Health spokesman said: ' Urgent care centres play an important role in providing emergency care for non-patients without taking up valuable A&E resources. 'It is for local NHS organisations working with local people to decide whether urgent care centres are a good idea when organising their services. 'We have been clear that any changes to existing services should be based on what is best for patients.'

Doctors from around the country will discuss their concerns about patients being prevented from walking directly into their local A&E at a three-day conference of the College of Emergency Medicine in Brighton from today.

SOURCE




Queue no more

Canada's surprising proposal for fast tracking new drugs to patients

From Canada, the land of long health care queues, comes a genuinely promising idea for speeding new medicines into the hands of patients—a fast track approval process called progressive licensing. Which is exactly what the U.S. needs. In 2007, the Food and Drug Administration (FDA) approved only 19 new drugs, the lowest number since 1983. Last year saw a minor uptick to just 24 new medicines...

Part of the domestic slow down in drug approvals comes from the fact that since the 1980s FDA regulators have more than doubled the number of clinical trials required to get a new drug approved from 30 to about 70. This increase in trials has raised the cost of getting a new drug through the regulatory maze to over $1 billion, thus limiting the number of new drugs that pharmaceutical companies can afford to pursue.

This is where progressive licensing could rescue our creaky pharmaceutical regulatory system. While the final regulations in Canada are still being hammered out, one exciting possibility is that drugmakers could submit some of their new medicines for approval after completing relatively fast and inexpensive Phase 1 and 2 trials. Such trials would provide preliminary information about a drug's safety and efficacy. In exchange for this fast track pre-marketing approval, drugmakers would agree to greater post-marketing surveillance of drug safety. Which means that patients using a new drug would essentially enroll in the equivalent of a Phase 4 trial. This post-marketing information would allow companies and regulators to continually adjust the balance of benefits and risks over the life cycle of new drugs. One important caveat is that such post-marketing scrutiny must not become as costly as the current system of pre-market regulatory review.

Following Canada's preliminary framework, progressive licensing would initially apply just to drugs that address previously unmet medical needs and in those instances where obtaining extensive clinical information is difficult (such as drugs that treat only a small numbers of patients with rare diseases). But why stop there? Canada's free-market Fraser Institute thinks progressive licensing has the potential to fix the current over-regulation of all drugs. Every beneficial drug also has accompanying risks, after all; the question is who gets to weigh the risks and the benefits.

Currently, regulators make the crucial decisions about the risks and benefits of treatment. But this leads to unbalanced benefit-risk evaluations. Remember that from the point of view of pharmaceutical regulators it's far more important to avoid a single highly publicized death from a new drug than it is to worry about the hundreds of unknown patients who die because of delays in approving new life-saving therapies.

In a 2007 report, the Fraser Institute looked at how progressive licensing could be transformed into a more radically open system that allows patients and physicians to evaluate the benefits and risks of new therapies rather than relying on the judgments of timid bureaucrats. In the report, Fraser's Brent Skinner looked at how the risks of new treatments compare to the risks of alternative treatments that the public already accepts.

For example, consider the case of the over-the-counter pain reliever ibuprofen versus the new drug Vioxx. A novel painkiller introduced in 1999, Vioxx was withdrawn from the market because it was found to increase the risk of heart attacks. But further research indicated that many non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, also increase the risk of heart attacks among users.

Both types of medicine effectively relieve pain, but Vioxx had the benefit of reducing the risk of gastrointestinal bleeding, which NSAIDs exacerbate. But who should weight the risk of dying from heart disease versus the risk of dying from bleeding ulcers versus effective pain relief for rheumatoid arthritis? One 1999 study estimated that there are 103,000 hospitalizations and 16,500 deaths in the United States due to complications from NSAID-associated gastric ulcers. As Skinner notes, a patient who is at high risk from gastrointestinal complications might well choose to take the cardiovascular risks associated with Vioxx. Why not let patients and their physicians have this risk information and choose for themselves?

Progressive licensing could modernize the current process from one where bureaucrats grant extensive permission before new drugs hit the market into a system based on initial indications of safety and effectiveness followed by ongoing risk evaluations. This would give patients greater say in their treatment, allowing those who willing to accept a certain amount of risk early access to the latest treatments, while risk-averse patients and physicians could wait until further information became available. It would also increase the scope for private groups—perhaps along the lines of the Underwriters' Laboratories certification process—to evaluate benefits and risks.

Progressive licensing might turn out to be just what the doctors (and patients) ordered for reducing the backlog of new drugs awaiting the nod from overly cautious regulators.

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21 April, 2009

Is Government Health Insurance Cheap?

The false comparison between the costs of public and private medical plans.

Congress is currently away on a two-week recess, but weighty work is occurring in its absence. Staff negotiators are trying to come to agreement on a budget framework for 2010 and beyond. Although this is happening behind closed doors, it appears likely that the budget deal will eventually include a government-run health-insurance option, or "public plan," to compete with private health insurance under the comprehensive health-care reform called for by President Barack Obama.

Some lawmakers support or oppose a government-run health-insurance option for purely ideological reasons. Others are open to it because they are pragmatic and -- laudably -- want to be persuaded by data and facts. These moderates have been much influenced by the supposed fact that a public plan such as Medicare is more efficient than commercial insurance. Advocates of the public option routinely ask, "Aren't Medicare's administrative costs a fraction of those of private insurers?"

But the comparison between public and private plans is a false comparison. Private insurance and public benefits are not the same business. For all its warts, private insurance tries to manage care. Medicare is mostly about paying the bills presented to it.

Many who favor a public plan as part of comprehensive health-care reform dismiss the administrative "overhead" of private plans as having little or no value. Ways and Means Health Subcommittee Chairman Pete Stark (D., Calif.), for example, insists that "most private plans are poorly managed." Contrasting them with the supposedly sleek and efficient Medicare program, he labels commercial insurance "the General Motors of medical care."

In fact, the administrative expenses of private insurance plans represent money well spent for their members. Here are four reasons:

First, private insurers must build provider networks. These networks can include high-value providers and exclude low-quality providers. Except for certain circumstances, including criminal acts, Medicare is forbidden from excluding poor quality providers. It lets in everyone who signs up. So one question to ask is, will the public plan have Medicare's indifference to quality -- or invest in the cost of a network?

Second, private insurers must negotiate rates. Medicare just fixes prices using a statutory and regulatory scheme. And anyone who imagines a public plan would be less costly than private plans must keep the following issue front and center: In the many procedure categories where Medicare's statutory price does not cover full provider costs, shortfalls are shifted to private payers who end up subsidizing the public program. So, will a public plan negotiate rates or simply use fiat as a means of gaining subsidies from private insurance?

Third, private insurers must combat fraud -- or go out of business. Indeed, these payers have every incentive to invest in antifraud personnel and strategies down to the point where return and investment are equal. But anyone who thinks that a public plan could serve as a "yardstick" for the private sector needs to consider Medicare's dismal record with regard to fraud, waste and other abuse.

In fact, the total amount of Medicare fraud is unknown. The government does not measure or estimate fraud in its programs; instead, it measures payments made "in error." According to Medicare's own most recent data, payments made in error amount to over $10 billion annually. (Medicaid's payment errors in 2007 equaled a whopping $32.7 billion, according to a report by the Department of Health and Human Services.) Others have claimed Medicare's payments made in error are much higher. Even with the inclusion of the budget of the inspector general for the Department of Health and Human Services, Medicare spends less than one-fifth of 1% on antifraud measures -- a small fraction of what private plans invest in their efforts to build a network of honest providers.

Worse, in four of the past five years Congress has turned back Medicare's pleas for $579 million of additional antifraud funding, on the grounds that these dollars subtract from the budget funds for curing cancer and anti-obesity campaigns. Based on experience, Congress will always underinvest in fraud. Yet according to a House of Representatives Budget Committee hearing in July 2007, return on investment for certain Medicare antifraud measures were estimated to be in excess of 13-1. Will a public plan also hemorrhage from fraud because of chronic Congressional underinvestment?

Fourth, private insurers must incur the administrative cost of marketing. Medicare, of course, does not need to market. A public plan competing with other alternatives would have to market itself to the public, and this means tax dollars used to advertise against private plans. Or the public plan could "compete" by using heavily subsidized marketing channels not available to private insurers, such as Social Security mailings, welfare offices, unemployment check stuffers, and the constellation of government-funded "advocacy organizations."

None of these considerations should be interpreted as a defense of the status quo, or a denial of the fact that major health reform is needed. It is, and now.

There are indeed many places where commercial health insurance is inefficient -- for example, by trying to exclude the sick rather than compete for the business of managing their ailments more effectively. Moreover, the facilitation of a national insurance exchange could lower information and search costs for our increasingly mobile workforce.

But the impulse to "just pass something" -- a refrain heard often in the halls of Congress this spring -- is not good enough. There are more governmental paths to making things worse rather than better. As the case of Medicare's anemic anti-fraud efforts painfully illustrates, less management and lower administrative costs do not necessarily mean the program is really less costly. Fraud losses are just categorized as additional spending rather than as administrative expense.

Ultimately, the desire of many advocates of a government-run health plan to exaggerate Medicare's efficiency derives from the fact that the program does not make a profit. These folks are motivated by the naïve assumption that most of the health sector's ills could be cured if profit-seekers were excluded.

As the Congress continues the health-care debate, today behind closed doors, and soon in the open, there should be an honest discussion of administrative costs and their value. Those who believe that health care should have no profit should be open with their views and not hide behind the false economy of Medicare.

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Wrong to expose gross NHS abuses?

Whistleblower nurse who filmed elderly patient neglect found guilty of misconduct over TV exposé. The truth is deadly to socialism

A whistleblower nurse has been found guilty of misconduct for secretly filming the neglect of elderly patients for a BBC documentary. Margaret Haywood, 58, filmed patients suffering in filthy conditions at the Royal Sussex Hospital in Brighton for Panorama. The senior nurse's 20-year career now lies in tatters. A hearing today will decide whether she should be struck off the nursing register. The Nursing and Midwifery Council ruled that Miss Haywood had prioritised filming over her obligations as a nurse and had breached patient confidentiality.

Last night the divorced mother of three from Liverpool told how she risked her career to help patients when working on the Peel and Stewart acute medical ward as an agency nurse between November 2004 and May 2005. She said: 'I did it because of the appalling state patients were in. I knew as soon I went on to the ward there were serious problems. 'There was blood on the curtains which had not been changed. There was faeces on the floor which had not been cleaned. It had obviously been there for days.

'Food was being left on the table when patients obviously needed help to eat. One lady was blind and did not even know the food was in front of her because no one told her. 'There was a lady who used to be a nurse herself who was afraid to ask to go to the toilet because of the nurses' attitude. Another woman who had terminal cancer was left screaming in pain because she was not given pain medication.

'I was absolutely broken-hearted. It's not what you expect when you go into nursing. 'I tried to put things right and get standards improved. I prepared a report, but no one took on board what I was saying. 'It was all being ignored and hushed up; that's why I went to Panorama. I only wanted to help people. I am a very caring and compassionate person.'

The Undercover Nurse programme caused a public uproar when it was screened in July 2005. It later emerged that the hospital, which then had the lowest rating of zero stars and an £8million deficit, had received a number of complaints before filming started. Sussex University Hospitals NHS Trust was forced to a public apology admitting 'serious lapses in the quality of care' after the issue was raised in the House of Commons. Since the programme aired, new care standards have been put into place.

Miss Haywood, a grandmother of seven, now works for a private care home. She admitted breaching confidentiality - even though all patients on the programme gave consent after they were filmed. She said after the hearing: 'I will be devastated if I lose my registration. I've worked so hard. 'Nursing is my life, I'm devoted to it and I'm passionate about what I do. I think it's a case of shooting the messenger. 'I admitted breaching patient confidentiality, but I did not expect them to conclude that my fitness to practise had been impaired.'

Last week a supply teacher who secretly filmed shocking scenes of pupils misbehaving and school cover-ups for a 2005 Channel 4 Dispatches documentary was found guilty of unprofessional conduct and suspended for a year.

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Whistleblower nurse considers High Court appeal

The nurse struck off for using a secret camera to expose the neglect of elderly patients at an NHS hospital is considering a High Court appeal against the decision. Margaret Haywood, 58, gathered evidence of "horrendous" conditions at the Royal Sussex County Hospital in Brighton for a BBC Panorama documentary.

Hundreds of nurses have contacted the Nursing and Midwifery Council to protest its decision to to ban her from the profession, amid fears that it will discourage other NHS whistleblowers from coming forward.

Miss Haywood from Liverpool, who worked as a nurse for 20 years, is now taking advice from her professional body about challenging the ruling at the High Court. Chris Cox, director of legal services at the Royal College of Nursing, said: "The RCN has been providing legal representation for Margaret Haywood from the outset and is very surprised at the severity of the punishment dealt out by the NMC panel. "Our legal team are working with Margaret to explore the various legal options available to her in light of the judgment."

The RCN has also set up a Facebook page and a public petition to build support for Miss Haywood, who was said to be devastated by the misconduct hearing's decision on Wednesday. It ruled that she had breached patient confidentiality by agreeing to take undercover footage for the BBC documentary, which was screened in July 2005, even though it conceded that conditions on the ward where she worked were "dreadful".

Yesterday (FRI) the NMC disclosed that it had received 400 emails and 200 telephone calls in support of Miss Haywood, with most of the complaints coming from other nurses.

The Council for Healthcare Regulatory Excellence (CHRE) which reviews all decisions taken by the NMC, said it would not seek to challenge the ruling, as it only intervened when it believed punishments had been too lenient. "She of course has the right to appeal," a spokesman said. Any appeal must be lodged within 28 days.

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20 April, 2009

When Doctors Opt Out

We already know what government-run health care looks like

Here's something that has gotten lost in the drive to institute universal health insurance: Health insurance doesn't automatically lead to health care. And with more and more doctors dropping out of one insurance plan or another, especially government plans, there is no guarantee that you will be able to see a physician no matter what coverage you have.

Consider that the Medicare Payment Advisory Commission reported in 2008 that 28% of Medicare beneficiaries looking for a primary care physician had trouble finding one, up from 24% the year before. The reasons are clear: A 2008 survey by the Texas Medical Association, for example, found that only 38% of primary-care doctors in Texas took new Medicare patients. The statistics are similar in New York state, where I practice medicine.

More and more of my fellow doctors are turning away Medicare patients because of the diminished reimbursements and the growing delay in payments. I've had several new Medicare patients come to my office in the last few months with multiple diseases and long lists of medications simply because their longtime provider -- who they liked -- abruptly stopped taking Medicare. One of the top mammographers in New York City works in my office building, but she no longer accepts Medicare and charges patients more than $300 cash for each procedure. I continue to send my elderly women patients downstairs for the test because she is so good, but no one is happy about paying.

The problem is even worse with Medicaid. A 2005 Community Tracking Physician survey showed that only 50% of physicians accept this insurance. I am now one of the ones who doesn't take it. I realized a few years ago that it wasn't worth the money to file the paperwork for the $25 or less that I received for an office visit. HMOs are problematic as well. Recent surveys from New York show a 10% yearly dropout rate from the state's largest HMO, the Health Insurance Plan of New York (HIP), and a 14% drop-out rate from Health Net of New York, another big HMO.

The dropout rate is less at major medical centers such as New York University's Langone Medical Center where I work, or Mount Sinai Medical Center, because larger physician networks have more leverage when choosing health plans. Still, I am frequently hamstrung as I try to find a good surgeon or specialist to refer one of my patients to.

Overall, 11% of the doctors at NYU Langone don't participate in at least two insurance plans -- Aetna or Blue Cross, for instance -- so I end up not being able to refer my patients to some of our top specialists. This problem, in addition to the mass of paperwork and diminishing reimbursements, is enough of a reason for me to consider dropping out as well.

Bottom line: None of the current plans, government or private, provide my patients with the care they need. And the care that is provided is increasingly expensive and requires a big battle for approvals. Of course, we're promised by the Obama administration that universal health insurance will avoid all these problems. But how is that possible when you consider that the medical turnstiles will be the same as they are now, only they will be clogged with more and more patients? The doctors that remain in this expanded system will be even more overwhelmed than we are now.

I wouldn't want to be a patient when that happens.

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NHS maternity units will still be short-staffed despite surge in number of midwives

NHS maternity units will still be seriously short staffed even after a surge in the number of midwives promised by the Government, critics claimed today.

More than 3,000 extra midwives will be in place by 2012 but new research has found they will still be delivering more babies per year than stipulated by safety guidelines - putting mothers and babies at risk.

The number of births each midwife handles has been rising relentlessly for six years, and is now higher than at any time since Labour took office in 1997.

Ministers' failure to anticipate a rising birth rate by employing enough midwives has led to a doubling in the number of payouts for medical blunders, and for the fact that rising numbers of women are being left alone and terrified during labour.

Experts believe up to 1,000 babies a year die needlessly because doctors and midwives are too overstretched or poorly trained to detect warning signs.

Safety guidelines, laid down by the Royal College of Midwives, say that midwives should deliver an average of 27.5 babies a year - one every 13 days or so - to ensure mother and child have the best quality of care.

In January, the Daily Mail revealed that the average midwife was delivering 34 babies a year, or one ever 10 or 11 days - almost 25 per cent more than they should under the safety standard.

Ministers have promised an extra 3,400 midwives by 2012 to plug the shortage. But new research by the RCM says this means that only four of the country's 10 health regions will meet the safety standards.

Of the six that will fail, four will have more than 32 births per midwife. The East of England region will have a massive 35.2 births per midwife in 2012, followed by the East Midlands (33.9), Yorkshire and the Humber (33.8), and London (33.6).

The Yorkshire figure is actually worse than the current ratio, largely the result of projected birth rate rises, which are largely down to the impact of immigration.

Critics also claim much of the money ministers are earmarking for maternity services is not reaching wards and is being spent on other parts of the NHS.

They say the figures prove the Government has no chance of honouring its pledge that all women should have one-to-one care from a named midwife during the entire pregnancy by the end of this year.

Cathy Warwick, general secretary of the Royal College of Midwives, said: 'Although the situation for most regions will be better, it will still not be good enough to deliver the quality of care women need.

'A step change is needed at regional level to recruit more midwives, and we hope that decision makers will treat it as a priority and put money they have been given for maternity services into maternity services.'

Conservative health spokeswoman Anne Milton said: 'Midwives' morale is currently low and too much of their time is wasted by bureaucracy and red tape. We need to ensure that the workforce spends more time delivering healthy babies from healthy mothers than filling in needless forms.'

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Australia. A "caring" Leftist health minister says that the red tape comes first: So you must die



The "caring" one above

A SYDNEY woman who has been told she has six months to live will try to raise more than $2 million for life-saving surgery in the United States after her plea for government funding was rejected. Pauline Talty, 36, from Kellyville, was told on Thursday she would not receive money to have a small bowel transplant in Pittsburgh, under the Federal Government's Medical Treatment Overseas Program, because the operation could be performed at an Australian hospital. Specialists at Melbourne's Austin Hospital, while trained in the procedure, have never performed a bowel transplant because of a lack of donor bowels.

Ms Talty has short bowel syndrome, which developed after her intestines were damaged from radiotherapy she received for treatment of childhood cancer of the kidney.

She said having the operation in Melbourne would put her at "risk of serious complication or even death". "My case is very complex and I don't want to be their first one. I only get one shot at this and if the Austin messes it up, I die. I don't get a second chance."

Due to Ms Talty's stunted bowel growth from radiotherapy, she needs a child's bowel, but Professor Bob Jones, head of the Austin's liver transplant program, told her she may have to wait years for a donor. The average wait for a child's bowel in the US is 240 days. "I don't have years. I was told in October that I have 12 months to live and I have just wasted five months trying to appeal the Government's decision.

"In Pittsburgh, they have been doing this for 20 years and have a 96 per cent success rate, which they have only achieved in the past few years. They have an abundance of bowels so I am not giving up."

The federal Health Minister, Nicola Roxon, said: "I have real admiration for Pauline Talty, for her courage, and determination and I know this must be an incredibly difficult time for her. [But] there are clear, established guidelines for assessing applications under this program … which all applicants must meet."

Ms Talty, who was a business strategist before she became ill, has been in Royal North Shore and Royal Prince Alfred hospitals for 13 months. She is fed through tubes in her chest and groin. Ms Talty has already raised about $200,000 for her living expenses and nursing care while in the US but is now appealing to the public for money to pay for the bowel surgery.

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19 April, 2009

'Hospital blunders meant my baby bled to death': Father's grief as NHS staff ignore plea to treat nine-day-old son

And the hospital is covering up -- has already "lost" relevant records that might identify the irresponsible staff. Don't you just LOVE that socialized medicine?

A heartbroken father told yesterday how his newborn son bled to death in hospital after a series of blunders by NHS staff. Joshua Titcombe was nine days old when he died from a common infection picked up from his mother which could have been cured with antibiotics. James Titcombe said he and his wife Hoa had urged staff at Furness General Hospital, in Cumbria, to treat Joshua with antibiotics but they were told he seemed well and did not even need to see a doctor. Mr Titcombe, a 31-year-old engineer, said they were told a paediatrician was 'too busy' to deal with them.

But the baby later had to be airlifted to two other hospitals where he eventually bled to death after the infection damaged his lungs, causing a massive haemorrhage. Mrs Titcombe, 32, a charity worker, went to hospital after her waters broke three weeks prematurely following a spell of feeling unwell. Hours after Joshua was born, Mrs Titcombe collapsed and was given antibiotics for an infection.

But while Joshua's temperature fell, his family's pleas for him to be examined by a doctor were ignored. Mr Titcombe said: 'My concern for Joshua was immense. I repeatedly asked if he needed antibiotics and was very surprised to be told he didn't. 'This seemed counter-intuitive to me but I had no choice but to trust what I was told.' It became clear the next day that Joshua was unwell - and at this point he was given antibiotics before being airlifted to Manchester and then Newcastle.

Mr Titcombe said: 'The day after he was born, I had come to take my wife and baby home when they found him not breathing well. It was a horrific shock. 'They told us he had a problem with his heart, then with his oesophagus. All the time I just suspected he had the same infection as his mother.'

In Newcastle consultants said his problem was an untreated pneumococcus infection - the same condition as his mother. Joshua died a week later in October 2008 on a life-support machine.

His parents, who have a four-year-old daughter, said they are also upset that the medical records of Joshua's stay in Furness General appear to have gone missing. They have asked the Health Service Ombudsman to investigate. Mr Titcombe said: 'His observation chart, which I saw when we were in the hospital, has been lost and we have had no explanation as to how this could have happened. Anything which could lead to the identification of individuals who failed him has mysteriously disappeared. The records would have answered a lot of our questions.' He added: 'The failures that led to Joshua's death must not be swept under the carpet.

Tony Halsall, chief executive of The University Hospitals of Morecambe Bay NHS Trust, told the couple in a letter: 'The care received by Joshua was not acceptable. We let him down and as a direct consequence he lost his fight for life. I would like to offer my heartfelt apologies.' He added yesterday: 'We are doing everything we can to prevent this from ever happening again.' [Bullsh*t, Bullsh*t, Bullsh*t]

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Desperate attempt to fix the unfixable

The NHS has recruited two captains of industry, a former director-general of the BBC, a vice-admiral and an author and psychologist in an effort to improve leadership in the health service, The Times has learnt.

Greg Dyke, who ran the BBC for four years, and Sir Stuart Hampson, the former chairman of John Lewis, are among a group of health service “outsiders” being brought in to give insights on raising standards in very large organisations. Lessons on discipline and motivation are likely to come from Vice-Admiral Sir Adrian Johns, a former Second Sea Lord and Commander-in-Chief of Naval Home Command, who commanded HMS Ocean in the Iraq war.

The move, which mirrors Gordon Brown’s attempt to create a government of all the talents, will also involve contributions from Daniel Goleman, author of the bestselling book Emotional Intelligence, and Gary Kaplan, a doctor and chief executive of a network of private clinics in the US.

The appointment of the five men as patrons of a new National Leadership Council will be announced this morning, with the council’s first meeting scheduled for next week. The patrons will receive set fees of £144.62 a meeting. The council has been given the task of driving up standards in the NHS by showing what world-class leadership looks like and trying to develop such skills at every level.

It will also have 25 core members, all with longstanding NHS experience, who will focus on championing five key areas: clinical leadership, encouraging more doctors and nurses to take on executive roles, improving the standard of NHS trust boards, getting the highest quality applicants for all senior jobs, improving “inclusion” to ensure that leaders reflect the community they serve, and identifying the next generation of leaders. Each issue will have a lead member, who will be expected to provide two days a week and receive pro rata payment in line with their current NHS salaries.

A faculty of fellows is also being created to support the council, which will meet six times in its first year, with patrons attending when called upon.

The NHS, which employs 1.4 million people, has faced repeated criticism over the years for failing to make the most of its talent pool and resources. The latest warning came last month when the health regulator identified a failure of leadership at Mid-Staffordshire NHS Foundation Trust as key to safety issues that may have contributed to more than 400 deaths at its hospitals.

David Nicholson, the NHS chief executive, who will be chairman of the new council, said that the overhaul was essential to ensuring that the highest standards were achieved. “Leadership is the vital ingredient that can make all the difference to the quality of care that our patients experience,” he said. “Great leadership, which focuses on improving services for patients, will help transform the NHS.” “We want to improve the overall quality of our leaders, equipping them with the skills to make our vision a reality.”

Mr Nicholson said that the council was being created as part of a commitment set out in the Government’s strategy for the future of the NHS, High Quality Care for All, and after extensive consultation with the NHS and leadership experts.

Mr Dyke said yesterday that his new appointment brought a range of challenges. “This is an exciting initiative at a critical moment. Leadership is at the heart of the NHS,” he said. “I look forward to making a contribution and ensuring that we deliver results that inspire confidence from all within and outside the NHS.”

Mr Goleman, an American psychologist and journalist, developed the argument that “non-cognitive skills” can matter as much as IQ for workplace success, which became the subject of an international bestselling book. Sir Adrian Johns, who trained as a helicopter pilot, served in the Royal Navy for more than 30 years. Dr Kaplan is chief executive of Virginia Mason Medical Centre, a private, not-for-profit organisation offering a network of primary and specialtyspecialist care clinics in the United States.

The NLC will work in partnership with the recently announced National Quality Board (NQB).

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Australian public hospitals that can't even get simple basics right

If putting the correct ID armband on a baby is too hard for them, what does that say about more complex things that they do?

NEWBORN babies in Queensland are being regularly mixed up and wrongly tagged, with some errors taking days to fix. In one case, a mother had to have HIV and other tests after being given the wrong baby to breastfeed. The blunders have more than doubled in three years, with staff blaming distractions, poor communication and increasing workloads.

Newborns are supposed to have three tags for accurate identification but documents obtained by The Courier-Mail reveal there were 57 bungled identifications last year. Parents or Queensland Health staff found almost half of them had no tags or all three tags with the wrong name, mother's name or patient number.

In the breastfeeding case at the Royal Brisbane and Women's Hospital last October, a mother had to have hepatitis and HIV tests after being given the wrong baby. "(The) wrong baby was taken to the mother," the report obtained under Freedom of Information laws found. "Baby's arm bands were not checked. Baby was fed by wrong mother before mistake was discovered."

Another case took four days to solve after a baby was transferred from Townsville Hospital to Cairns Hospital. The baby arrived in Cairns with no tags and weighing 160g less than when it left after staff in Townsville failed to conduct routine ID checks for three days before the transfer. "The baby has been identified as certain as possible at this point in time," staff said on October 2, 2006, after checking every baby at both hospitals. The identity was finally confirmed on October 5.

Queensland Health child safety director Corelle Davies yesterday defended the increase in cases, saying the bungles were always rectified before the babies went home. "Accurate patient identification is fundamental to the provision of safe health care and is taken seriously by staff in all Queensland Health facilities," Ms Davies said. "Staff are trained and work hard to ensure babies have correct identification. Very stringent guidelines are in place to ensure baby name tags are checked by both the mother and staff."

However, Australian College of Midwives state executive officer Jenny Gamble said the errors were a result of an understaffed system requiring urgent restructure. "Every man and his dog is involved - midwives, nurses, different sorts of allied health staff -- but no one is there all the time like two or three midwives could be," she said. "We need it to be much more personal."

The FOI documents show the number of cases reported jumped from 27 in 2006 to 55 in 2007 and 57 last year. In a typical case at Toowoomba Base Hospital last October, a staff member bathing a newborn discovered the baby had no identification. "When I undressed the baby to do a demonstration bath, I discovered that the baby had no identification bands and no identification tape on her back," the staffer said in a report.

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18 April, 2009

Mother who died giving birth in NHS hospital toilet never saw twins

There have been notorious examples of this in Australian public hospitals too. Delay, delay, delay is the hallmark of public medicine and it can be fatal -- as in this instance.

A woman died in labour in a hospital lavatory after her induction was delayed because of a lack of specialist staff, an inquest was told yesterday. Sarah Underhill, a policewoman aged 37, was in her 36th week of pregnancy when she was admitted to hospital suffering from pre-eclampsia.

The birth was to have been induced because of her condition, which causes high blood pressure. She was admitted to the John Radcliffe Hospital, in Oxford, on October 2 last year but the procedure was planned for October 6. However, the day before she was due to be induced she collapsed in the toilet and was forced to call for help by banging on the door.

Doctors fought to save her twins, conceived by IVF, but she died without having seen them. The babies were delivered by emergency Caesarean section and survived after a “magnificent” effort by staff.

Yesterday the inquest was told that doctors could not have prevented her death. Mrs Underhill had previously suffered a miscarriage in 2006 after an earlier IVF pregnancy. [Which should have meant extra care this time]

Sebastian Lucas, a pathologist, told the hearing that Mrs Underhill died after amniotic fluid from the womb entered her bloodstream. He told Oxford Coroner’s Court that the condition could be survived, but was “unpreventable”. Professor Lucas said: “Why did she draw the short straw and suffer severely where others may not? Who knows? It is an act of God.”

Mrs Underhill’s husband Richard, 39, a fellow Thames Valley Police officer, was not with his wife when she died. He had left her bedside the previous day because he was suffering from a cold and did not wish to pass on any germs. Close to tears, he told the inquest: “I wish I had stayed.”

Mr Underhill now cares for the twins, Hannah and James, at his home in Didcot, Oxfordshire. The inquest heard that it was “extraordinary” that both infants survived.

Previously, Mr Underhill described his wife as “glowing” in the days before she gave birth and said that she was greatly looking forward to becoming a mother. The couple met in 2000 and married five years later. Mr Underhill spoke of the doctors’ decision to induce the birth. “I think we were relieved, because the bump was getting so big,” he said. “Sarah just wanted it over and done with.” He said he was told that the induction was planned for October 6 — a Monday — rather than the preceding weekend, because of a lack of specialist staff on the maternity unit. In a written statement submitted to the inquest, he said he believed that his wife should have had the babies delivered sooner.

Lawrence Impey, a consultant obstetrician who treated Mrs Underhill in the days before her death, said: “If I had known what was going to happen on the Sunday, I would completely agree with him. But we had no indication this was going to happen.” He said that the condition that killed her, amniotic fluid embolism, was “impossible to predict”. He added: “What is clear is that it is not the pre-eclampsia that did this. We have clear evidence that it was a completely different diagnosis, which is usually fatal and which is impossible to predict.”

The Oxford Radcliffe Hospitals Trust offered its condolences to Mr Underhill for his wife’s death and said that it was keen to learn any possible lessons from the tragedy.

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Wal-Mart Diagnoses Your Ills: Medical-Office Inconvenience and High Prices Driving Consumers to Retail-Owned Clinics

Americans, frustrated by endless waits at the doctor's office, are sidestepping their family physician and taking their rashes, strep throat and pink eye to stores such as Wal-Mart and Walgreens instead. As this trend gains more traction, experts say it could define the market for primary care. "In many ways these retail clinics are a response to a broken health care system," Jonathan Weiner, professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health, told CNNMoney.com. "Not everyone has good access to primary care. We're also dealing with a shortage of primary care doctors in this country," he said.

Public health experts say retail clinics can, to some extent, fill the gap. But there's one caveat. "I suspect these store clinics will be around for a long time, but they won't take over everything that a doctor can do," Dr. Sherry Glied, chairwoman of the Mailman School Department of Health Policy and Management at Columbia University's School of Public Health, told CNNMoney writer Parija B. Kavilanz.

Wal-Mart, Walgreens, CVS and Rite-Aid are among an expanding number of retailers that operate in-store health clinics. It's not merely a public service — Bruce Carlson, publisher with healthcare market research firm Kalorama Information, says retail clinics are a lucrative niche market for merchants, CNNMoney reports.

The firm said these clinics numbered just over 1,200 in 2008 with annual revenue of $545 million. By 2013, Carlson said the total is estimated to reach 2,400 with revenue of about $2 billion. These "retail clinics" are typically staffed by nurse practitioners. They administer vaccinations and treat customers — both uninsured and insured — for minor ailments. They also test for conditions such as hypertension and diabetes.

Although in-store clinics have only been around for a few years, it's only recently that their appeal has grown with consumers, according to the latest industry survey from consulting firm WSL Strategic Retail. The survey, which polled 1,500 consumers, showed awareness about retail clinics has jumped to 56% in 2009, up from 38% in 2007.

The survey also showed that usage of store clinics has increased the most among younger consumers, who are less likely to have ties to a family physician or to have insurance.

Candace Corlett, principal and retail analyst with consulting firm WSL Strategic Retail, believes the survey findings indicate consumers are treating health care as a commodity. "Just like you pick your favorite store to get your beauty advice and products, people are picking their favorite store to get their earache treated. There's a cultural shift that's going on with how we approach health care, and I think the retail market is ready for health care becoming a commodity," Corlett told CNNMoney.

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Australia: No privacy under socialism

Patient files demanded from doctors

THE Rudd Government will demand patients' intimate medical records - from past infectious diseases to current medications - under a plan to catch doctors defrauding Medicare. Doctors will be forced to hand over the patient medical files to prove they have performed the services they have claimed in a move the Government says will save taxpayers about $148 million over four years.

The plan immediately sparked warnings about the dangers of providing bureaucrats with highly sensitive personal information. But while the draft legislation - which was released on the eve of the Easter long weekend - was condemned by the Australian Medical Association and the Australian Privacy Foundation, the Government yesterday argued it was needed to ensure the sustainability of Medicare.

AMA president Rosanna Capolingua warned that patients would not be honest with their doctors if they knew their records could be seized. "The patient record will be completely exposed, extracts obtained, copied, retained and potentially submitted in court for all to see," Dr Capolingua said. "Doctors will be compelled to hand over highly sensitive medical information to justify Medicare claims, potentially including a patient's intimate concerns and examination findings, their test results, weight, sexual health, infections - nothing is protected."

The Health Insurance Amendment (Compliance) Bill 2009 also allows the Government to fine health professionals who make incorrect claims of more than $2500.

A Senate inquiry will be held into the legislation. Human Services Minister Joe Ludwig said yesterday only authorised Medicare staff would be able to view "relevant" extracts within doctors' files, and information would be stored securely and then destroyed after the audit process. [In Britain, bureaucrats LOSE similar information roughly once a month -- exposing it to anyone who finds it. How would you like your medical details left on a train for anyone to pick up and read? That's what the British experience is. Does anybody seriously think that our bureaucrats are more careful?]

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17 April, 2009

The NHS killed my mother: MP Nigel Evans reveals how a routine operation ended in horror

Total indifference to patient welfare

The last, harrowing moments of my mother's life will live for ever in the collective memory of my family. An 86-year-old lady of infinite grace and dignity, she had the most agonising of deaths. Lying bewildered and distressed in an NHS hospital bed, her body racked with pain, she kept desperately grabbing at the air with her hands as if she was drowning, while all the time being violently ill.

'It was torture, worse than a horror film. We felt so helpless,' says my sister, Louise, who witnessed the tragic scene. But it should never have been like this. My dear mother should have been able to depart this earth in serenity and peace, not forced to go through such a traumatic experience. The reasons for her ordeal can, I believe, be found in a mixture of neglect, incompetence and indifference shown by the NHS.

For my mother died of the notorious superbug Clostridium difficile, known as C.diff, which she must have contracted while undergoing hospital treatment in Swansea. If she had been cared for properly, if the ward had been cleaner or greater urgency had been shown in handling her case, then this tragedy might never have happened.

The NHS is often a saviour, but it can also be a killer. What happened to my mother is all too common in the health service. There were 8,324 deaths from C.diff in 2007, with most of the victims elderly people. That statistic is too high for a 21st century healthcare system in an advanced industrialised country. Moreover, an estimated 59,000 people in this country are disabled or die because of poor hygiene or care in our hospitals.

Even the essentials, such as providing patients with sufficient fluids or cleaning bathrooms properly, are neglected. That is why I am campaigning for drastic improvements in the basics of healthcare in the NHS, so deaths from C.diff and other superbugs can be eliminated. I have demanded an investigation into the circumstances surrounding my mother's death at the Singleton Hospital in Swansea, but I also want the lessons of this episode to be learned much more widely, so that Britain has a health service that meets the needs of its users, not one that carries the risk of killing them.

My mother's case encapsulates the best and worst of the NHS. On one hand, she had the highest quality treatment from a leading surgeon after she was diagnosed with cancer of the oesophagus. On the other, when she returned to hospital for a routine operation - unconnected with the cancer - she received nothing like the same expert, attentive care. That is almost certainly why she contracted C.diff and why medical staff were too slow in responding to symptoms. It seems as if there is a deep contradiction within the NHS, pulling the service in two directions. We have phenomenal advances in drugs, medical technology and surgery, which can conquer-disease and prolong life in a way that would have been revolutionary only two decades ago. Yet, at the same time, we have abandoned the most basic standards of hygiene and care.

My mother deserved better from the NHS. Determined, kind and diligent, she was a pillar of strength, not just to my family but to the community in her area of Swansea, where she and my late father ran a newsagent's shop. After my father died, she carried on working until she was 85. She was a wonderful mother, instilling her strong sense of morality in me and my siblings and giving us the best possible education. With her ethic of service, she was the reason I became involved in politics. Her unwavering maternal devotion was a tremendous source of support. Whenever I became disillusioned, she urged me to keep going, and I became Conservative MP for the Ribble Valley in Lancashire. Now she is gone - and in the grimmest way imaginable.

The heart-breaking saga began at Christmas, when we noticed she was not her usual cheerful self, had lost her appetite and complained about not being able to swallow properly. We arranged for her to undergo tests. Cancer of the oesophagus was diagnosed quickly. She was in the care of James Manson, an excellent specialist at the Singleton Hospital. I was aware of Mr Manson's brilliant work because 11 years earlier he'd operated on my brother to combat oesophageal cancer. The prognosis for my brother had been bleak, yet more than a decade later, he is still with us - a tribute to Mr Manson's skill.

The same wonders were performed on my mother. After an initial failed attempt to fit a stent in her throat to push back the tumour, he refused to give up and tried again. The second procedure was a success, and Mr Manson told my sister Louise that the tumour was 'not as bad as I thought'. Radiating confidence, he said there was no reason why my mother could not live another two years or more. So when she returned home, the family was in a positive frame of mind. But then the real problems started - and they were nothing to do with cancer.

In March, my mother had to go into the Singleton Hospital again for the removal of a gallstone. It was the most routine of operations and initially appeared to have been a success. But during her overnight stay in hospital, she developed a high temperature, so bedclothes were removed and a window opened to try to cool her. The next day, Wednesday, March 18, she was discharged.

What surprised me was that she was sent home without having seen a doctor. A nurse gave her approval for the discharge. Just as disturbing were my sisters' reports of the lack of hygiene in the hospital. There was litter under my mother's bed, and the toilets did not seem to have been cleaned properly.

Though we were told the gallstone removal had been a success, my mother was not well, complaining of severe stomach pains. Her distress was all the more difficult to watch because she was not a woman to complain. But her condition was so bad by Friday that my sister Louise decided she had to be brought back to hospital. There, she was rehydrated intravenously and given painkillers, anti-sickness tablets and some laxatives, the last a rather odd choice given that she had not complained of bowel problems.

Discharged once more, she seemed much better on Saturday. But then she deteriorated rapidly. That Sunday, Mother's Day, she was quiet and had lost her appetite. Then on Monday, she had the first bouts of chronic sickness and diarrhoea that were to plague her last days. At first, my sister thought her quietness and disturbed stomach were related to nerves at having to embark on the first radiotherapy session for her cancer that day. But her condition was too serious for this to be the explanation. On Tuesday, she was so weak she could hardly walk down the stairs.

After further consultation with the GP, more anti-sickness tablets were prescribed, but they did not alleviate the problems. Yet even in the midst of her suffering, she retained her stoical outlook, apologising to my sister for the inconvenience she'd caused. But something urgent had to be done as her decline accelerated.

On Thursday, my sister called an ambulance. The paramedics who took her to hospital treated her with great tenderness. It is an indicator of the respect and affection in which she was held by the local community that they knew her well, having often visited her newsagent's shop. On the ambulance's arrival at the Singleton, there was at first no bed available, so my mother was asked to wait in the ambulance while one was found. Again, the paramedics could not have been more sympathetic. But the same cannot be said of all the staff at the Singleton. Though she was admitted to the hospital in the morning and soon underwent tests, my sisters were not properly consulted until late afternoon.

First, they saw one oncologist, who asked a series of questions about her recent medical history. Then they saw another and had to run through the same routine again. This second oncologist seemed off-hand and evasive. At one stage, she had an extraordinary exchange with Louise, telling her it would be 'inappropriate' to admit my mother to intensive care 'because of her condition'. 'What condition is that?' asked Louise. 'Her inoperable cancer.' 'But Mr Manson has fitted a stent. He says she may live for two years or more.' 'Perhaps he's being optimistic.' 'Mr Manson is a realist, not an optimist,' she replied.

This conversation was all too indicative of the cold, impatient, fatalistic way my mother's case was handled that last night. It is bizarre that it was not until the early evening that the hospital finally revealed she had C.diff and therefore began treatment. Here she was, a sick 86-year-old on her third hospital visit in nine days, yet nothing had been done to check the most likely cause of her condition. It would have been easy, after her first difficult night following the gallstone operation, to carry out a check for C.diff. Even on that last day, the hospital could have moved more quickly, instead of leaving her for almost nine hours without acting.

The indifference carried on through the night. My sisters were not made aware of how lethally serious the situation was. That is why I was not urged to come down from Westminster. It was in the early hours of Friday that the last anguish descended, as the full effect of the virus tightened its grip and my dear mother began to choke. Shaken, my sisters did all they could to help, receiving little support from staff.

Suddenly, they were ushered to a side-room by a doctor. There he asked if they had 'ever discussed resuscitation' with my mother. It was a bewildering question. If my mother was at death's door, surely the doctor should have been trying to save her, rather than indulging in a debate? While they were with the doctor, my mother passed away. Yet even then, they were not told she had died. They were merely informed that they could go and 'sit with her'. If they had known that my mother was in her death throes, they would never have left her.

This is not the way such cases should be handled. Families must be kept informed. Early, routine tests for C.diff must be carried out. And, above all, hospitals need to be cleaned up. Progress in medicine is useless if the basics are going wrong. If we can achieve improvements here, then my mother will have left a legacy to be treasured.

A spokesman for Singleton Hospital said they met Nigel Evans and his family and are more than happy to look into the questions raised and provide a full response to them.

With regard to Mrs Evans's care, they confirmed that she was taken in as an emergency patient 'when she was promptly assessed, treated and monitored by a number of medical staff, including surgeons. Sadly, she died a few hours later'.

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Australia: Royal North Shore Hospital in trouble still

Firetrap fears for children at NSW government hospital

SICK children are being treated in the maternity unit of a major hospital because its children's ward is still a firetrap. More than a year after the children's ward at Royal North Shore Hospital was deemed a deathtrap, The Daily Telegraph can reveal that the hospital has been forced to set up a makeshift children's ward. It is also still treating children in its children's ward, which was deemed a deathtrap by fire investigators. Sources told The Daily Telegraph that about half the beds in the children's ward had been moved to the maternity unit because airconditioning vents still had not been coated with fire retardant.

It is the latest bungle to hit the trouble-plagued hospital and its $1 billion upgrade. A fire brigade's inspection exposed the safety risk in April last year, yet yesterday the safety upgrade still had not been completed.

Children had also been allowed to remain in the ward despite work going on there. Others were moved to a part of the maternity unit, fenced off by a makeshift plywood gate with a piece of A4 paper stuck to it reading "Children's Ward".

The mother of a child recently discharged from the hospital told The Daily Telegraph she was shocked to learn of the arrangements and would have taken her sick baby elsewhere had she known. Brianna Casey took her six-month-old baby Oliver Herngren to Royal North Shore with bronchialitis, a viral disease particularly dangerous to children under a year old. Ms Casey was shocked to discover Oliver was put into the maternity ward. "They couldn't find a bed for us upstairs in the children's ward," she said.

Ms Casey said that while staff had done the best they could, the area seemed completely inappropriate. They even had to bring down a cot for her son. "There's no equipment. This place is a joke," she said.

It is understood that when the ward was handed over by builders in 2003 it complied with fire safety regulations. However, the rules have been tightened since then and the building has not been upgraded accordingly. At least 15,000 children pass through the hospital's emergency department every year.

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16 April, 2009

Electronic health records raise doubt

When Dave deBronkart, a tech-savvy kidney cancer survivor, tried to transfer his medical records from Beth Israel Deaconess Medical Center to Google Health, a new free service that lets patients keep all their health records in one place and easily share them with new doctors, he was stunned at what he found.

Google said his cancer had spread to either his brain or spine - a frightening diagnosis deBronkart had never gotten from his doctors - and listed an array of other conditions that he never had, as far as he knew, like chronic lung disease and aortic aneurysm. A warning announced his blood pressure medication required "immediate attention."

"I wondered, 'What are they talking about?' " said deBronkart, who is 59 and lives in Nashua. DeBronkart eventually discovered the problem: Some of the information in his Google Health record was drawn from billing records, which sometimes reflect imprecise information plugged into codes required by insurers. Google Health and others in the fast-growing personal health record business say they are offering a revolutionary tool to help patients navigate a fragmented healthcare system, but some doctors fear that inaccurate information from billing data could lead to improper treatment.

"The problem is this kind of information should never be used clinically, especially if you don't have starting or ending dates" attached to each problem, said deBronkart's primary care doctor, Daniel Z. Sands, who is also the director of medical informatics at Cisco Systems.

Personal health records, such as those offered by Google Health, are a promising tool for patients' empowerment - but inaccuracies could be "a huge problem," said Dr. Paul Tang, the chief medical information officer for the Palo Alto Medical Foundation, who chairs a health technology panel for the National Quality Forum.

For example, he said, an inaccurate diagnosis of gastrointestinal bleeding on a heart attack patient's personal health record could stop an emergency room doctor from administering a life-saving drug.

Ideally insurance claims could provide a trove of data that could greatly accelerate the Obama administration's effort to computerize all medical records within five years. The stimulus package contained $17 billion to help computerize doctors' records. But transferring existing information from paper or outdated computers could take years and hundreds of millions of dollars to complete.

Insurance data, by contrast, is already computerized and far easier and cheaper to download. But it is also prone to inaccuracies, partly because of the clunky diagnostic coding language used for medical billing, or because doctors sometimes label a test with the disease they hope to rule out, medical technology specialists say.

"Claims data is notoriously inaccurate and notoriously incomplete with respect to an expression of the problems a person has," said Dr. David Kibbe, a senior technology adviser to the American Academy of Family Physicians.

Google Health directed questions to Dr. Roni Zeiger, a product manager for the company; he said Google draws its information from a variety of sources sent by its partner hospitals, pharmacies, and laboratories, including claims data. He acknowledged that such billing information can sometimes be imprecise, but he argued that the overall benefit of having some information is better than no information and that accuracy will improve over time. For example, he said, a list of allergies, medications and recent lab reports can save a patient's life, particularly in an emergency.

"Test results from last week can make the difference between the right decision and the wrong decision," he said. Zeiger said doctors need to evaluate information based on where it comes from and calibrate treatment decisions accordingly, which they often have to do anyway with paper records that can be incomplete, disorganized, or unavailable.

But Google records do not always clearly indicate the source of data for each diagnosis. "That's something I think we could do better on," Zeiger said.

DeBronkart's case shows how accuracy gets lost in translation. His cancer had at one point spread to his skull, but there is no code for that, so the hospital probably instead used the code for metastases to the brain or spine, according to Sands.

"Chronic lung disease" probably refers to the bronchitis deBronkart has had at various points in recent years. "Anxiety disorder" apparently referred to the anxiety deBronkart complained about during intensive chemotherapy, at a time he thought he might have months to live - though he has not experienced it before or since.

The list of diagnoses also gave no indication of their severity. "Aortic aneurysm" was probably a slight widening of his aorta, Sands said, not a blood-filled bulge that burst. Google also did not date-stamp many of deBronkart's problems, so at times it did not distinguish current issues (cancer) from past ones (low potassium levels two years ago). Some of the dates were wrong - his cancer diagnosis was months off.

Patients who discover mistakes in their health records can delete information, add notes, or ask providers to correct problems. Dr. Todd Taylor, a former emergency room doctor who now works for Microsoft Health Solutions group, which makes the personal health record Microsoft HealthVault, said patients "need to take an active role in managing their health data," preferably by reviewing them with a medical professional.

DeBronkart, an early Internet enthusiast, considers himself an "e-patient," someone who regularly connects with other patients and doctors to learn about his own healthcare. He and Sands speak at conferences on the importance of active patient involvement.

But it was not immediately clear to deBronkart how to fix the errors in his Google Health record. At first he wanted the hospital to handle it, but that would involve changing codes on insurance bills from years ago, said Dr. John Halamka, chief information officer at Beth Israel Deaconess.

Ironically, Beth Israel has one of the most advanced electronic medical records systems in the country, with clinical records carefully tended by doctors and accessible to patients on a secure website. Sands, his doctor, said if deBronkart needed quick access to his file, he would be better off using the Beth Israel system.

But Google Health prefers providers send information in coded form to build the list of a patient's medical conditions so the program can guide patients to additional information on the Internet about each disease using links. The neatly packaged billing codes are easier to link to than the mix of medical terms and standard language doctors use in their clinical records.

Halamka and Zeiger said the records will improve as more precise coding language is adopted in the coming years. Halamka said thousands of Beth Israel patients have had access to Google Health since last May, but deBronkart is the only one who has complained of serious problems.

In the meantime, said Tang, who was recently appointed to a new committee advising the Obama administration on health technology, the risks to patients need to be studied further. "Probably for some patients it's a net benefit, and for others it's a risk," he said. "We need to know what the risks are so we can mitigate them better."

DeBronkart - who blogged about his Google Health experience on the website e-patients.net - has some simple advice for patients who use personal health records. "Check it," he said. "See if it's accurate."

SOURCE




Australia: Another failure of government medical services -- a fatal one

Bureaucratic emergency operator could only go by the book -- and scolded man as he lay dying in the bush

TRIPLE-0 operators told off a dying teenager as he made desperate calls for help while lost in bushland in the Blue Mountains - even repeatedly asking him to name the street he was in. An inquest into David Iredale's death yesterday heard six heart-breaking calls made to emergency services after he became lost and disorientated during a bushwalk in December 2006, The Daily Telegraph reported.

The 17-year-old was two days into a three-day trek, having run out of water almost 24 hours earlier and endured temperatures of up to 37C, when he made the first of the increasingly frantic emergency calls. Ambulance officers admit to rescue failure

During the calls, which dropped out each time due to poor reception in the area, David told ambulance staff he was lost, had fainted and was unable to walk. Despite telling operators he was deep within the Blue Mountains National Park, he was repeatedly asked "What's the address, what suburb are you in?" and "Can you name any of the streets?". During one of the calls an operator scolded David for his tone, telling the scared teen "Don't yell at me" when he raised his voice to overcome the poor phone reception.

David's parents Stephen and Mary Anne walked out of the inquest as recordings of David's increasingly frantic pleas for help in his final moments were played.

Michael Windsor SC, representing the NSW Ambulance Service, admitted that there had been major failings. The inquiry heard rescuers were not provided key information about David's location until four days after he first became lost and transcripts of his calls to triple-0 were driven to Katoomba police station. "The service acknowledges that there was a failure on its part to accurately convey the details of the conversations with David Iredale to police," Mr Windsor said. "The service unreservedly apologises to the Iredale family because of the failures."

Jeremy Gormly SC, counsel assisting Coroner Carl Milovanovich, read the last words David wrote in a log book on Mt Solitary the morning before making his descent towards the river. "Got to the top!!! Haven't had H2O for a whole day but river coming up! Enjoy the view," he wrote.

Mr Gormly was scathing of the NSW Ambulance Service response, recommending that the inquest find that an urgent upgrade to procedures allow triple-0 calls to be emailed directly to rescue workers.

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15 April, 2009

NHS dental dark ages: 'I couldn't find a dentist... Now, aged 21, I've had to have all my teeth removed'

Like so many young women, Amy King always took great pride in her appearance. Standing in front of the mirror to check her make-up before a night out, the 21-year-old would always try a smile - friends told her they loved the way it lit up her face. Eight weeks ago, all that changed. The student from Plymouth was admitted to hospital where, in a single operation, she had every tooth in her mouth removed.

Amy, whose dental problems were caused by untreated gum disease, does not go out any more. And when she looks in the mirror she hardly recognises the face staring back at her. 'Even with my mouth shut I look different,' she says. 'My cheeks are hollowed and my face looks thinner. I look like an ugly, old woman.'

Amy's story gets worse. First, doctors have told her they can't fit a set of false teeth until her gums are sufficiently healed and that could take six months. But she has also been warned that there is a slim chance they will never recover enough for dentures to be fitted.

Second, Amy believes that had she been able to get dental treatment earlier, then all the pain and disfigurement she has experienced might have been avoided. 'I feel that if I'd managed to see a dentist sooner or could have afforded to have private treatment I wouldn't be like I am today,' she says, explaining how it took months of searching and dozens of phone calls to find an NHS dentist willing to treat her - by which time it was too late. 'I thought that losing all your teeth only happened to people in the Dark Ages - not a 21-year-old living in modern Britain.'

If only that was the case. While Amy's experience is an extreme one, it highlights growing concerns about the state of the nation's dental health. Last week, statistics obtained by the Liberal Democrats revealed that the number of people having teeth extracted in hospital has risen by one third in the past four years. More than 175,000 Britons had their teeth removed under general anaesthetic in 2007/08, up 40,000 on the 2003/04 figure.

The number of children having teeth out has shot up, too. But more pertinent is the fact that the rate of these extractions gathered pace after a deeply controversial contract for NHS dentists was introduced in April 2006. The year before, the number of extractions was fewer than 150,000. Two years later, it had risen to more than 175,000 - an increase of 16 per cent. Could the contract - hailed by the Government as a revolution in the provision of state-subsidised dental care - be linked to this alarming new trend in tooth extraction?

Critics such as Norman Lamb, the Lib Dems' health spokesman, are in little doubt. He says: 'I am hearing from people who still cannot see an NHS dentist and are therefore neglecting their teeth or waiting until it is an emergency. 'Other patients have to pay extortionate amounts for private treatment to save a tooth or else wait weeks, often in pain, to get a tooth extracted on the NHS.'

But it is not just a continued lack of access to NHS dentists that is causing concern. There is also growing evidence that the new payment system introduced by the contract is discouraging dentists from undertaking more complex, time-consuming work. This work is not being done at all or being left to newly-trained dentists. Both routes are more likely to end up with the patient being referred to hospital to have teeth extracted. The end result is more people like Amy - who, for the rest of their lives, will only have to look in a mirror to be reminded of a dental system that is still failing to deliver.

For a reminder of the depths to which NHS dentistry had sunk under New Labour, pay a visit to Scarborough. In 2004, three years after the date by which Tony Blair promised that everyone in Britain would have access to an NHS dentist, hundreds of people queued on the town's streets. They were desperate to register for NHS treatment at a new dental surgery. Most were unsuccessful and the image summed up the shocking state of this key plank in the nation's healthcare.

More shocking still was the story of local resident Valerie Holsworth. Her inability to access NHS dental care since the year 2000 had forced her to resort to excruciatingly painful DIY dentistry. Valerie described how, using a pair of her husband's pliers, she wrenched out seven teeth. 'I have a gum disease for which I take painkillers,' says the 68-year-old great-grandmother. 'But when the tooth becomes agonising I have to take it out myself. I take a good mouthful of whisky before I get started to keep it sterilised. 'Then it is just a matter of tugging and wiggling until the root comes loose. I then just throw the tooth in the bin.'

Evidently, something had to be done. While the number of registered dentists has steadily increased over the past two decades, many had drifted away from state-funded treatment and moved into the private sector. In a bid to reverse this trend, and to target treatment effectively, the dental contract was introduced. As a sweetener, it held out the promise of improved pay. Indeed, incomes have increased by 11 per cent since the reforms - to an average of more than £96,000.

But the most fundamental change focuses on the way dentists are paid for the work they carry out. Under the old system, there were 400 treatments, each commanding a separate fee. The concern was that dentists were effectively being paid for piece-work - the more 'drilling and filling' they did, the more money they got paid. Instead, it was decided that dentists would be paid according to Units of Dental Activity (UDAs). These relate to the treatment on offer, the 400-odd individual procedures in turn being divided between three bands.

The value of UDAs is set by Primary Care Trusts, varying around the country according to need. But to the average dentist, each UDA will be worth about £25. If a dentist does a 'simple' band one treatment, involving a checkup, X-rays, cleaning and polishing, they will earn one UDA, or £25. A more complicated band two treatment, involving fillings or extractions, will earn the dentist three UDAs (£75), while a band three course that needs lab work (such as dentures or crowns) earns 12 UDAs (roughly £300). And unless they are exempt from paying due to age or pregnancy, patients must still pay charges ranging from £16.50 to £198.

In theory, it all sounds easy. In practice, however, serious problems have emerged. UDAs are related to completed treatments and not the number of items in the treatment plan. So, a treatment with crowns will pay 12 UDAs irrespective of whether there is one crown or 20. (It is much more expensive for the dentist to perform such treatments privately.)

Equally problematic is the fact that each band covers such a wide range of treatments. Some are easier and quicker to perform, yet all attract the same payment. Finally, the number of UDAs each practice can earn is fixed in advance by the care trust. If dentists exceed that number, they will not be paid extra work.

The terms of this contract are complicated, bureaucratic, and heavily target-driven. The upshot has been to alter the behaviour of the health practitioner in unintended ways. Mark Watson, chief executive of the Dental Practitioners' Association, explains: 'We have gone from a system where dentists were paid to do as much as possible to one that encourages them to do as little as possible. The idea is that they will see more people, but each person gets less done.' This is all well and good if the patient has healthy teeth and gums and does not require much treatment. But while dental health among the young is improving, there remains a large number of people whose needs are more complicated. Under the contract, there is little incentive to take these cases.

'Everyone who is self-employed looks at what is profitable and what is not, and tends to want to do as much of the profitable stuff as possible,' says Mr Watson. 'Dentists are no different. As there are only three bands, any course of treatment at the upper end of a band makes a loss while that at the lower level makes a profit.' The Department of Health's argument is that it is swings and roundabouts - what dentists lose on one treatment they make on another. But life doesn't work like that.

It is this chain of events that some believe is behind the increase in hospital tooth extractions. Dentists are not encouraged to carry out the sort of complicated work that might prevent a patient from ultimately having their teeth removed.

Further evidence of this move away from complex treatments was highlighted by the Commons Health Committee. It found that the number of treatments such as crowns, bridges and dentures had plummeted by 57 per cent since 2006. The MPs believed this was happening because NHS dentists have no financial incentive to give appropriate treatment. In Scotland, which did not bring in the new contract, the number of complex operations had gone up.

What is equally galling is that despite pumping more taxpayers' money into NHS dentistry - and more dentists taking on NHS work - the number of patients being treated fell after the introduction of the contract. In the two years following the reforms, 26.9 million people saw their dentist - just 52.7 per cent of the population. That is down 1.2 million compared to the two years leading up to the changes.

An annual survey by Simplyhealth, a group of healthcare companies, found that the numbers struggling to find an NHS dentist have increased in the past year - up from 23 per cent to 35 per cent. If these people can't find an NHS dentist what options do they have? Suffer in silence or go private. The private route can be extremely expensive, forcing increasing numbers to travel abroad for cut-price treatment.

In 2007, there were 50,000 dental tourists. Simon Purchall, founding director of Smile Savers Hungary, has seen a 60 per cent rise in patients since January 2007. 'A lot of people come to us after years of putting off dental work,' he says. 'They can't find an NHS dentist, they're not willing to accept the solution offered such as dentures or they can't afford the high prices charged by private British dentists for modern solutions, such as implants.'

Louise Webb, a 44-year-old careworker from Stoke-on-Trent, knows this only too well. Plagued by dental problems, she was referred to Birmingham NHS Dental Hospital and was told the only option was to have all but four teeth removed. 'They told me they were going to rip them all out and then they would leave me for three or four months until the gums had healed before they gave me dentures,' she says. 'I'd already given up my job because I was so embarrassed by the way my teeth looked.' Desperate to end the pain, Louise agreed to the operation. But the day before it was due to take place it was cancelled. This happened on two subsequent occasions. In the end, her husband Andrew, who works for the NHS as a locum audiologist, found the solution.

'He came in one day and found me, exhausted, asleep with my head on the table,' she says. 'I had a hot water bottle on one side of my face to try to deaden the pain. I looked awful. He just thought: "Enough is enough." '

Having searched the internet, the couple came across Smile Savers and within a week Louise was in Budapest having the first of two operations. These involved the removal of 14 teeth and their replacement with 13 implants plus 22 crowns. It cost £12,000, a lot less than the £70,000 she was quoted by a private British dentist.

While Louise does not expect the NHS to provide cosmetic dentistry, she says it was the failure to end the pain that left her feeling let down. 'We pay our taxes, and yet I was unable to get the treatment I deserved,' she says. 'I was known as the Yoghurt Queen because I was having to liquidise my food. I lost two stone in weight. My NHS dentist's hands were tied because she could only do so much treatment.' The dental work has transformed Louise's life. 'My daughter says the biggest change about me is that I am happy,' she says. 'I used to go out with a scarf wrapped around my mouth to hide it, but now I laugh all the time.'

Just how many people will leave their NHS dentists with a smile on their face, only time will tell. A Department of Health spokesman says: 'We have appointed an independent review team to help us understand what more needs to be done to ensure that every person who wants to visit an NHS dentist can do so, make NHS dentistry fit for the future and ensure that all NHS dental services meet the highest standards of care.' [The British bureaucracy is very good at bulldust -- but not much else]

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14 April, 2009

Open-source healthcare

The healthcare industry is a textbook example of what Ivan Illich (in Tools for Conviviality) called a “radical monopoly.” The central function of the government’s “safety” and “consumer protection” regulations, in most cases, is either to exclude competing providers of a good or service from the market, to circumscribe the areas of competition between them, or to set a floor on the capitalization required for doing business and thus impose a mandatory minimum overhead. The overall effect, as Paul Goodman put it in People or Personnel, is to create a 300% or 400% markup in the cost of doing anything, and render us all dependent on institutional providers with bureaucratic cultures and high overhead costs. By mandating centralized, high-tech, and skill-intensive ways of doing things, the state makes it harder for ordinary people to translate their own skills and knowledge into use-value. Tollgates are erected between effort and consumption, so that it becomes harder to meet our subsistence needs through our own direct labor or through barter with other small producers outside the wage system. As a result, “decent poverty becomes impossible.”

For example, schooling becomes something you can only get from somebody with a degree from a teacher’s college, according to a state-prescribed curriculum. According to Illich in Deschooling Society, the first thing students learn at school is to confuse process with substance, and to view almost every form of consumption good imaginable as something properly provided by a professionalized institution. Self-treatment, self-education, etc., are things that only dangerously irresponsible people do. Back in the 1920s and 1930s, public school Home Ec curricula threw their weight behind the creation of mass consumer society, teaching students that home-baked bread, home-canned vegetables, and home-sewn clothing (in fact, pretty much homemade anything) was old-fashioned and grounds for suspicion by right-thinking people.

In the field of housing, around a third of which was still self-built in the U.S. as late as the 1940s, self-building is virtually illegal thanks to local housing codes set by licensed contractors and their lobbyists. This despite the fact that the available technology for self-building (modular houses, “cob” building, etc.) is far more user-friendly than it was sixty years ago.

And in healthcare, state intervention artificially skews the model of service toward the most expensive kind of treatment. For example, the patent system encourages an R&D effort focused mainly on tweaking existing drugs just enough to claim that they’re “new,” and justify getting a new patent on them (the so-called “me too” drugs). Most medical research is carried out in prestigious med schools, clinics and research hospitals whose boards of directors are also senior managers or directors of drug companies. And the average GP’s knowledge of new drugs comes from the Pfizer or Merck rep who drops by now and then.

The professional licensing cartels outlaw one of the most potent weapons against monopoly: product substitution. Right-wing libertarians are fond of using “food insurance” to illustrate the effect of third-party payment: if there were such a thing as grocery insurance, with low deductibles and a flat premium, people would be buying a lot more filet mignon and a lot less hamburger. The problem is that we’ve got a medical licensing system that criminalizes the sale of hamburger and mandates the sale of filet mignon. While healthcare consumers fall into many tiers of income, the state mandates only one tier of service regardless of ability to pay.

Much of what an MD does doesn’t actually require an MD’s level of training. Unfortunately, no matter how simple or straightforward the specific procedure you need done, you have to pay for an MD’s level of training. The medical, dental and other lobbies make sure that legislation is in place prohibiting advance practice nurses or dental hygienists from performing even the most basic services without the “supervision” of an MD or DD.

In an open-source healthcare system, someone might go to vocational school for accreditation as the equivalent of a Chinese “barefoot doctor.” He could set fractures and deal with other basic traumas, and diagnose the more obvious infectious diseases. He might listen to your cough, do a sputum culture and maybe a chest x-ray, and give you a round of zithro for your pneumonia. But you can’t purchase such services by themselves without paying the full cost of a college and med school education plus residency.

The government having made some aspects of treatment artificially lucrative with its patent system and licensing cartel, the standards of practice naturally gravitate toward where the money is. The newly patented “me too” drugs crowd out drugs that are almost (if not entirely) as good, so that the cost of medicine is many times higher than necessary. The licensing cartel requires diagnosis and treatment by someone with an MD’s level of training, when something much less might be all that’s needed.

Result: radical monopoly. The state-sponsored crowding-out makes other, cheaper (and often more appropriate) forms of treatment less usable, and renders cheaper (but adequate) treatments artificially scarce.

I’m very big on the idea of reviving the mutuals or sick-benefit societies that working people organized for themselves, back in the days before the state and the capitalist insurance companies conspired to destroy them. One small-scale attempt at doing this sort of thing is the Ithaca Health Fund, created by the same people involved in Ithaca Hours.

But such things alone are not enough. The problem with such systems is they handle only the financing end of things, while delivery of service is still under the control of the same old institutional culture. Any real solution will have to involve cooperative control over the provision of healthcare itself, as well.

Imagine, for example, a cooperative clinic at the neighborhood level. It might be staffed mainly with nurse-practitioners or the sort of “barefoot doctors” mentioned above. They could treat most traumas and ordinary infectious diseases themselves, with several neighborhood clinics together having an MD on retainer (under the old “lodge practice” which the medical associations stamped out in the early 20th century) for more serious referrals. They could rely entirely on generic drugs, at least when they were virtually as good as the patented “me too” stuff; possibly with the option to buy more expensive, non-covered stuff with your own money. Their standard of practice would focus much more heavily on preventive medicine, nutrition, etc., which would be cheap for members of the cooperative who didn’t have to pay the cost of an expensive office visit to an MD for such service. Their service model might look much more like something designed by, say, Dr. Andrew Weil. One of the terms of membership at standard rates might be signing a waiver of most expensive, legally-driven CYA testing. For members of such a cooperative, the cost of medical treatment in real dollars might be as low as it was several decades ago. No doubt many upper middle class people might prefer a healthcare plan with more frills, catastrophic care, etc. But for the 40 million or so who are presently uninsured, it’d be a pretty damned good deal.

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13 April, 2009

NHS bureaucracy spending doubles

Government spending on central bureaucracy in the health service has more than doubled in five years, research has found.

Opposition politicians said the figures demonstrated that the NHS had become a "bureaucratic black hole" under Labour, with money diverted away from the front line to pay an increasing army of administrators. The analysis by the Conservative Party shows that funding for the Department of Health, its quangos and regional authorities reached more than £12 billion last year, a rise of 103 per cent since 2003.

The £12.6 billion budget for central administration was seven the amount spent on either maternity services or dentistry, which each received £1.8 billion, or Accident and Emergency departments, which received £1.7 billion. Billions more was spent on administration at hospitals and primary care trusts across the country, for which specific administration figures are not compiled.

Mike Penning, the shadow health minister, said he was horrified by the findings of the report, which was drawn up by the Conservatives' research team. He said: "I am absolutely appalled, particularly at a time of such economic difficulty, by the Government's continued failure to deliver value for money for the NHS."

The report found that while staff numbers rose by 18 per cent in five years, the amount spent on them rose by 48 per cent. The rise in the number of administrators outstripped the rise in numbers of doctors and nurses. Mr Penning described the report as evidence of a "bureaucratic black hole" which was attracting billions away from patient care. "It appears that the further staff are away from the patient, the more costs rise," he said.

Government figures show there are now more than twice as many bureaucrats as midwives, and 5,000 more managers than hospital consultants. Last year the number of managers rose by nine per cent while nurse numbers increased by just 2 per cent. The average pay for a chief executive running a foundation hospital trust reached £157,000 last year.

Katherine Murphy, from the Patients Association, said: "Of all the billions poured into the NHS, it is just sickening to see how much of it has been soaked up by this ever-expanding bureaucracy, particularly these quangos and authorities who have proved unable to prevent appalling patient care seen in the scandals at Stafford Hospital, or the hundreds of deaths from Clostridum difficile at Maidstone Hospital and at Stoke Mandeville Hospital before that."

The dozens of NHS quangos funded by the taxpayer include NHS Professionals, which was set up in 2004 with a remit to reduce the amount spent on agency nurses. It spent more than £1 million employing two senior managers in just two years. The agency paid a private company £1,700 a day for chief executive John Faraguna and £1,150 a day for director of operations Stephen Dangerfield, even though body was created in order reduce the amount of money wasted by the NHS on private agencies.

Other agencies include NHS Connecting for Health, in charge of the long-delayed programme to computerise health records which has caused repeated problems in the hospitals which have tried to introduce it.

The DoH, which employs more than 2,000 civil servants, has created dozens of "arms-length" agencies and committees, including a Cosmetic Surgery Steering Group, Advisory Board on Registration of Homeopathic Medicines, Alcohol Education and Research Council, Herbal Medicines Advisory Committee, Independent Advisory Group on Sexual Health and HIV, and the Leadership and Race Equality Action Plan Independent Panel. Eleven regional health authorities are responsible for managing performance at 200 hospital trusts and 150 primary care trusts.

Mark Wallace, campaign director for the TaxPayers' Alliance, said: "The figures demonstrate that the only boom this country is enjoying is in NHS bureaucracy, and I think people are fed up with paying increasing taxes to fund a succession of quangos and back office functions when the money is needed at the front line."

The DoH described the Conservatives' interpretation of figures comparing spending on the DoH, its "arms length agencies" and health authorities in 2003 and 2008 as "fundamentally flawed" because the central budgets included some services that directly benefited patients, such as funding for childhood vaccinations and grants for social care. A spokesman said the 2008 figures also included £2.5 billion passed on to hospitals to subsidise a system of "payment by results" for operations carried out. He added: "Administrative and clerical staff form only eight per cent of the NHS workforce of over 1.3 million, and are essential to the day-to-day running of the organisation."

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Australia: An IVF baby is priceless, but who pays?



ISABELLA Zogopoulos is a gorgeous $70,000 miracle that we all helped to create. The 13-month-old was conceived after her mother, forklift driver Theona Zogopoulos, endured 10 cycles of IVF at a personal cost of $30,000. Taxpayers chipped in the rest via the Medicare safety net scheme, making the long-held dream of parenthood a reality for Ms Zogopoulos and her council worker husband, Chris. "I call her my little miracle on ice," the besotted mother says. "She was on ice for 18 months."

But without the 80 per cent rebate on the IVF procedure — the family also had other medical expenses — it's doubtful the Zogopouloses, who took out a $20,000 bank loan to cover their costs, would have been able to afford so many IVF cycles. Now, as the Federal Government scrapes for savings ahead of the May 12 budget, it is looking again at publicly funded IVF and obstetric services, which cost taxpayers $141 million a year through the safety net scheme.

The Zogopouloses fear such a move would render their dream of giving Isabella a brother or sister financially impossible. "It is very disappointing," Ms Zogopoulos, 37, says. "There are plenty of other things that the Government can look at and cut money from."

The issue of tampering with public funding for fertility services is politically fraught, as the previous Howard government discovered, because the area of assisted reproduction is emotionally charged and access to IVF is now widely accepted as a right in Australia. It is a right that is increasingly expensive: the safety net scheme, which has leapt 28 per cent since 2007, now costs $319 million a year, 44 per cent of it IVF and obstetric services.

How much taxpayers should subsidise assisted reproduction, and whether it should be means tested, remains controversial. When the Howard government tried to rein in the public cost in 2005 by limiting funding to three cycles a year for women up to the age of 42, or three in total for older women, it was a disaster. But with Labor's economic strategists now considering ways to pare back the safety net scheme, the IVF industry fears rebates on fertility and obstetric services are again at risk. Options being considered by the Government are believed to include capping the number of (now unlimited) publicly funded cycles available, means testing, and restricting access on the basis of age.

In the lead-up to the 2007 election, Health Minister Nicola Roxon pledged there would be no move to tamper with the safety net, introduced by the Howard government in 2004 to cover 80 per cent of out-of-pocket medical costs above $1111.60 in any given year (or $555.70 for low-income earners). Yesterday, Ms Roxon declined to "engage in speculation ahead of the May budget" with The Sunday Age.

But Access Australia, which represents IVF consumers, is taking no chances. It has been encouraging its members to flood the offices of Prime Minister Kevin Rudd and Treasurer Wayne Swan with angry emails. Sandra Dill, Access chief executive, argues that infertility is a medical condition like any other funded through Medicare and should not be singled out. Means testing or restricting public funding would make IVF affordable only for the wealthy, even though fertility issues affected as many as one in six Australians, she said.

IVF is now the preferred treatment for infertility, and the number of babies born with the help of assisted reproductive technology has trebled since 1995, to 11,000 a year.

"I find it curious that on the one hand the Government recognises the economic benefit of having children … and yet for another group of people who are trying to have them who need medical help they are threatening to make that even more unaffordable," Ms Dill said. She did not believe access to IVF should be restricted on the basis of age because individual doctors made decisions on a case-by-case basis and were unlikely to recommend IVF to women who had a low probability of success.

In Ms Zogopoulos' case, each of the 10 IVF cycles involved an upfront cost of $5300. The usual cycle costs $4400, but she was also using the ICSI technique, in which sperm is injected directly into an egg. Should she attempt IVF again, she will need to have a $3280, non-Medicare rebatable procedure in which cells from her embryos would be tested each cycle, to check for any genetic abnormality. The test could help avoid the previous nightmare of repeated failed implantations. But it will add to the overall cost and if rebates are cut, could mean the Zogopouloses cannot afford to try for a second baby.

Ms Zogopoulos believes the only fair cut would be a means test, by which wealthier people get smaller rebates. "I feel sorry for people just starting out on IVF. It is always very stressful financially," she said.

The extraordinary 28 per cent blow-out in the safety net bill since 2007 has been linked to the rise in gynaecologists' fees, which, according to one estimate, have increased by more than 400 per cent since the scheme was introduced in 2004. A senior Government source said the safety net had blunted competition in the health sector, allowing obstetricians to raise fees. But the president of the National Association of Specialist Obstetricians and Gynaecologists, Dr Andrew Pesce, denied that charging for IVF in Australia was spiralling out of control, saying costs were relatively low by world standards. He said the increase was due to IVF becoming the treatment of choice for infertility, whereas previously it was one option among several, including surgery.

Federal MP Tony Abbott, who as health minister in 2005 tried to implement the disastrous attempt to limit public funding for IVF, concedes now that: "If you are a fortysomething woman who is desperate to have a baby and the Government decides that the rules are going to be changed to make it harder for you to pay for this, you get very, very unhappy."

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12 April, 2009

America already has a big problem with socialized medicine

Last week, when Congress passed the largest deficit spending budget in American history, it included more than $720 billion for an exponential expansion of Medicare and Medicaid. It also included an additional $634 billion “reserve” fund to be used, according to the White House, “over 10 years to finance fundamental reform of our health care system that will bring down costs and expand coverage.”

In short, the fund was Mr. Obama's down payment on the government takeover of America's health care industry. And, as is so often the case when politicians bloviate, it was built on a deliberate deception.

What the politicians know full well—and bend over backwards not to admit—is that the more government spends to subsidize and socialize the health care industry, the more health care costs are going to escalate, and the less quality service will be available.

The fact is—again, as the politicians know full well—the primary reason medical costs are already out of sight is that subsidies are already out of control. And that's because medical bills themselves are largely works of fiction.

Simply put, the price most patients pay for medical treatment today is a far cry from the actual cost of the procedure. Built into each bill is a substantial surcharge to help pay for the hospital's overhead—which is sent through the ceiling because so many patients already fail to pay their own way. And, it gets even worse.

Since there's a limit to how much hospitals can add onto the cost of any given procedure, even the padded payments fail to cover the free riders' exorbitant bills. And who makes up the difference? You guessed it: the American taxpayer. In fact, by some estimates, taxpayers are already paying some 85 percent of unpaid hospital bills.

For those who remain skeptical of the cost of subsidized—i.e., socialized—medicine, a quick glance at the average emergency room is in order. Public law now demands that emergency room treatment be administered regardless of whether the recipients can pay all—or, in fact, any—of the bill. The result of such misguided utopian altruism is that many “underprivileged” Americans now consider the ER their family doctor.

And who foots the bill for such outrageous abuse? Take a look in the nearest mirror.

So, now comes Barack Obama and his querulous gaggle of cloying quacks to tell us that the way to reduce medical costs is to increase subsidization—the facts of the matter (and the burgeoning deficit) notwithstanding. And when no one is any longer able to afford either subsidization or the true costs of actual treatments (on the rare occasions when they will still be available), well, there go the actuarial charts and in walks the Grim Reaper.

Actually, of course, the way to reduce medical costs is to end subsidization altogether. Does this mean that some people will not be able to go to the emergency room for a band aid or a bottle of aspirin? Probably. In fact, it may even mean that some people will not be able to charge others (as in, you) to cover the costs of their catastrophic illnesses.

But for most people, it will mean that America's health care system will continue to be the best this side of Shangri-La. And it will also mean that, though nobody lives forever, those who are willing to work hard and pay their own way will have a fighting chance to top the charts. As fortunate as that may be.

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11 April, 2009

Pharmaceutical evolution

Innovation is the lifeblood of the pharmaceutical industry. Over the last century, that industry has been responsible for thousands of new drugs, based on hundreds of thousands of smaller incremental innovations. The breakthrough “blockbuster” drugs taken by millions of patients today were not produced from thin air. Most represent the combined weight of seemingly small improvements achieved over time. The advantages of incremental improvements on existing drugs are paramount to overall increases in the quality of health care. As the pharmaceutical industry developed, classes of drugs—those with similar chemical composition and which treat similar conditions—have grown to provide physicians with the tools they need to treat diverse patient groups.

Still, critics have been highly condescending about what they call “Me-too” drugs—drugs within the same chemical class as one or more others already on the market—which they claim add little or no therapeutic value and are nothing more than an opportunity for pharmaceutical companies to fleece unsuspecting consumers. While some claim that there are too many similar drugs, and that pharmaceutical industry research and development could be more profitably directed toward developing entirely new classes of medicines, drugs based on incremental improvements generally represent advances in safety and efficacy. They also provide new formulations and dosing options that significantly increase patient compliance—both of which lead to improved health outcomes. From an economic standpoint, adding new drugs to a class of medicines also offers the possibility of lower drug prices as competition between manufacturers increases. Additionally, pharmaceutical companies depend on incremental innovations to provide the revenue that will support development of the riskier, capital-and research-intensive blockbuster drugs.

When critics refer to Me-too drugs, they do not mean exact generic copies of already existing drugs, or illegal counterfeits. Instead, Me-toos have a similar chemical composition to one or more others on the market, and have similar biological effects. But, in order to be approved, Me-too drugs must undergo the same extensive clinical testing as other new drugs to determine their safety and efficacy because they are chemically different. In addition, these differences, even if small, typically must represent a medical advancement—such as fewer side effects or improved efficacy for patient sub-populations—in order to attract a portion of the market away from the first approved drug in the class. Nevertheless, many drug industry critics have called for federal policies to inhibit the development and marketing of such incrementally improved medicines. But policies that curb incremental innovation will ultimately lead to a reduction in the overall quality of existing drug classes and could arrest the creation of truly novel drugs.

Research in any industry is a building process. Few scientists develop groundbreaking drugs from no prior research. Most work within, and respond to, existing knowledge—reading the same medical literature, and reacting to new technological breakthroughs at the same time. It is not hard to imagine, therefore, that many different companies would be working on similar drugs. In fact, it is often the case that the only reason why one drug is called novel and another a Me-too analogue is the speed at which each moves through the regulatory process.

Like other technological and value-added industries, the pharmaceutical industry depends on small steps for the creation of blockbuster drugs, which often result from a long series of small innovations. It also depends on these steps for the creation of drugs that provide slight, incremental improvements on existing drugs—thereby adding to a drug class, increasing competition among drugs, and incentivizing further innovation. As the National Research Council has observed, “the cumulative effect of numerous minor incremental innovations can sometimes be more transforming and have more economic impact than a few radical innovations or ‘technological breakthroughs’.” The net effect of increasing the number of drugs through innovation leads to advances in safety, efficacy, selectivity, and utility of drugs within a specific class.

Importantly, providing physicians with a variety of prescription options within a given therapeutic class is paramount to the provision of optimal health care. This is especially true for some drug classes, such as those relating to the central nervous system, for which overall response rates can be as low as 50 percent. For unknown reasons, certain patients respond differently to different drugs within a single class. If physicians have many options at their disposal, they can calibrate their prescribing patterns to better address the needs of specific patients. The existence of multiple similar molecular agents also provides backup in situations where the novel drug in a class is found to have unacceptable side effects and is thus removed from the market. As patients come to depend on a particular class of drugs, it is essential to make sure that they do not lose access to needed medication as a result of regulatory action.

One of the most vehement criticisms made against Me-too drugs is that they siphon money away from research that could be devoted to the creation of novel breakthrough drugs. This assumption is incorrect for a host of reasons, the most important of which is the fact that the pharmaceutical industry depends on selling the products of incremental innovations to provide the revenue for research and development of breakthrough drugs. Additionally, while it is unrealistic to presume that every incremental innovation leads to cost savings, the sum of all drug innovations can result in cost savings by reducing overall treatment costs, shortening or obviating hospital stays, increasing worker productivity and reducing absenteeism, and lowering drug costs through increased competition among manufacturers.

Ideally, every new drug would represent an unprecedented breakthrough and lead to the creation of a completely novel treatment. This, however, is not the reality of the pharmaceutical industry, or of any other development-based industry. Creating drugs based on incremental innovations provides pharmaceutical companies with a secure stream of revenue, which can be directed to higher-risk, potential blockbuster-yielding research. Policies aimed at reducing the industry’s ability to obtain revenues from incremental innovations could be self-defeating, as those industries will then have less revenue to reinvest in R&D for new drugs. Put simply, limiting incremental drug innovation is analogous to limiting competition. The ultimate result could have devastating consequences for the future of the pharmaceutical industry and for the millions of patients who depend on it.

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Aged care funding via vouchers now being considered in Australia

A good move

FUNDING could be stripped from Australian aged care homes and vouchers of up to $50,000 handed directly to residents in a radical aged care overhaul being examined by the Federal Government. Under the proposal, vouchers would go directly to Australian seniors and their families, allowing them to decide what sort of care they wanted. The proposal has been floated by Warren Hogan, author of a landmark report on aged care funding for the previous Howard government.

It has the backing of mainstream facilities - including one of Queensland's largest providers, TriCare, which wants a more consumer-focused approach to an industry facing "the perfect storm of an ageing demographic and a declining number of aged care beds".

A spokesman for Minister for Ageing Justine Elliot yesterday confirmed the minister was looking at the issue of "consumer-directed care". "This is a radical area of policy development and we would need to proceed cautiously," he said. "In addition, we would have to ensure that there were strong safeguards to protect the frail aged."

Professor Hogan - along with the Productivity Commission and the National Health and Hospitals Reform Commission - expressed deep concern about the nation's ageing demographic. All are pushing for aged care facilities to be more responsive. Professor Hogan said central planning at the core of existing policy strategies introduced inefficiencies and rigidities, sparking a retreat by providers and "regulated scarcity". He said allowing government aged care funding to be directed to users of services and their families could be arranged just as readily as sending the money to providers. "By issuing vouchers to residents and potential residents for the value of the care to be met by government, these users could determine in discussions with the provider of their choice the type of services suited to their needs as specified by an Aged Care Assessment Team."

Care subsidies paid annually to providers range from $3000 to $50,000 a year, with more than 60 permutations and calculations in between. But, generally, a high-care provider receives between $30,000 and $50,000 a year to care for a resident.

Jim Toohey - the spokesman for the national Aged Care Alliance and who also heads up TriCare - said the idea was one of a range of proposed new funding models which appeared to have merit. "Establishing a relationship with the consumer in which the consumer has power is the way towards innovation in the aged care sector," Mr Toohey said. He said good-quality providers would welcome removal from a situation where they relied on a government subsidy to one allowing the market to determine what services they should provide. Mr Toohey said the proposal, in practical terms, could allow ageing Australians to opt out of an aged care facility altogether.

A Brisbane resident in a $700,000 home who required aged care could choose to opt for a reverse mortgage on the home, collect the government voucher, and use the funds to arrange for private aged care inside the home. Alternately, seniors wanting a high quality of life could opt to top up their voucher with their own money for more luxurious care.

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10 April, 2009

Putting you in charge of your own health care

Americans are ready for change in the way they receive and pay for health care. Surprisingly, it may not be the changes that most politicians, big businesses, insurance companies and special interests are pushing. Americans are ready to take back control of their health care. They are ready for a change from unaffordable insurance that comes only from an employer they may prefer to leave -- insurance that seems to provide more of a hassle than convenient protection from unexpected expenses. They are sick of sitting for an hour to see a doctor, then seeing a nurse for 10 minutes and the doctor for three and often left to wonder about what happened. They are burdened by high taxes for government programs that seem to provide health benefits for everyone but them while the same government clamors to cover even more in financially unsustainable programs. They have heard enough of empty promises from politicians who care only about getting re-elected and having more power. Yet even with all these and other problems, many Americans have given up and figure that it is up to the government to solve the problem. They wonder if the government solution will still allow them rapid access to high quality health care they deserve.

The current proposals for reform are cloaked as big changes, but as it turns out, they are actually more of the same. They can be summed up in this way: turn more control over to the government and insurance companies while politicians and special interests jockey for credit and work behind the scenes to benefit -- at the expense of individual Americans. Albert Einstein once defined insanity as doing the same thing over and over and expecting different results -- but that is what is being proposed today. While most American want more individual control over their own lives, the health reform proposals will expand the control over health care held by third party payers (insurance companies and government). This would make matters worse for Americans.

The story of how we got to where we are today is long but has its roots in the World War II era policy that stated that a tax deduction could only be applied to health insurance provided through a job. That lead to employers control of health insurance purchase and removed the consumer from the decision -- decisions they make every day for auto, homeowners and life insurance (products that are affordable). Insurance companies then sold to employers -- not to consumers. Insurance products then began to expand from "accident and sickness" policies, to "health" insurance. Thus they cover every minor expense except for a token deductible from patients.

While this seems desirable on the surface, in the end it leads to little control over demand for medical tests and treatments and drives up the cost of health care and insurance for all. Instead of asking your doctor, "Do I really need another pill" or an MRI, or a surgery, consumers take the "free" benefit. Unfortunately, doctors often do more tests and treatments to survive government-fixed prices through high volume services and to protect themselves from lawsuits. This leads to what the government and insurance companies call "over-utilization", the boogeyman they seek to kill by having more control over what kind of care every patient can be authorized to receive. Authorized by someone else besides the patient through cookbook medicine and rationing of care. That is the same thing that happens in socialized medicine in other countries.

There are many other problems created by government: requiring that young and healthy people pay the same high insurance rate as older and sicker patients, allowing anyone to buy insurance (even after they are sick or injured!), mandating that every insurance policy cover some things that not everyone wants to buy insurance for (like hair prosthesis, acupuncture, chiropractic care, maternity care for men and Viagra for women).

So what solutions do politicians like Barack Obama, Senator Max Baucus, Tom Daschle, and groups like the AARP, Families USA, big insurance and big business propose? They want to mandate that everyone buy the same expensive insurance that many can't afford (with a tax if you don't buy) - a plan that is failing in Massachusetts. They would create a "Health Care Fed" that would create cookbook medicine and rationing protocols and force your doctor to follow them under the threat of lower pay or a phony report card score that has nothing to do with quality and has everything to do with how much third-party money was being "wasted" on actual patient care. This would be enforced through a mandate to enter your health data into a computer that would be forward to the government where it would be subject to loss or accidental exposure of private health information. They would expand the Medicare program, which is scheduled to bankrupt its own trust fund next decade, to people who are 55 years old. They would put more children in government health programs even though such a plan failed in Hawaii after only 7 months -- leaving many children previously insured privately without coverage!

The way we pay for health care must change. It is clear that the politicians are making more promises that they can't keep and will resort to "bailout" mode with high taxes and lower quality health care when it fails. The good news is that there is a better way. Instead of expanding control of third party payers -- the same parties responsible for our current mess -- we can put the control of health care financing right where it belongs: into your hands.

Right now, you can buy a low cost health insurance package and fund your own private health savings account with tax free money. You can use that account to bargain for lower prices from hospitals and demand that your doctor spend more time with you and explain how you can be managed without every test and treatment they can provide. Your insurance will provide 100% coverage for preventive care and for true medical catastrophes that occur rarely in our lives. You can ask for your right to have a tax break when you buy insurance on your own (outside your employer). You can demand that the government stay out of the patient-physician relationship and not institute cookbook medicine and rationing. You can require that your politicians reserve government assistance for the poor and those who have no other means for health care -- not expand that care to everyone merely to get re-elected on an empty promise.

There are reform plans that will put you back in the driver's seat with your doctor at your side as your advisor and partner. They are proposed by people like Senator Tom Coburn, Representative Tom Price, Representative Tom Shadegg and Representative Paul Ryan. However, they will be very difficult to pass through Congress. It will require that you demand changes that empower you economically as individuals. Demand that you be able to have an individual tax benefit when you purchase insurance outside of employment. Demand that you be able to purchase insurance from another state. Ensure that Health Savings Accounts remain an option and grow in scope and size. Fight against expanded public saving for health care. Make sure that Government committees like the Comparative Effectiveness Coordinating Council don't create rationing protocols. In short, demand that you be in charge of your own health care financing and decision making. When you are in charge of your own health care, the politicians will not decide what kind of medical care you receive. Only you will.

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Britain: Hospitals have never needed Chaplains more

A&E departments are a war zone. There could not be a worse time to get rid of their chaplains

There is no way of telling how many prospective doctors and medical students watched The Hospital on Tuesday night, but we should, for all our sakes, pray it was a low number. The first part of Channel 4's fly-on-the-wall series, which runs for another two weeks, looked into the modern world of emergency medicine. This wasn't ER or Scrubs, this was ugly reality - wave upon wave of young people, drunk, regardless, violent and rude, brought in with various terrible injuries as a result of intoxication.

It was some of the most powerful documentary television I've seen: the young people were both victims and propagators of alcoholic mayhem; the doctors were dead-eyed, high-pay-grade streetsweepers.

We would be sensible to regard it as a modern morality play, especially in a week when the National Secular Society called for the NHS to stop funding hospital chaplains. The society estimates that £40 million a year is spent on giving religious groups a presence in hospitals. In many areas secularism has much to recommend it. In this instance they are wrong and mean-spirited. There has never been a greater need for a spiritual presence in hospitals.

What was so interesting about The Hospital, apart from its shock appeal, was the moral landscape it painted of our society. Here was a stage, you realised, where everyone had become brutalised. The patients showed a total lack of responsibility for their actions. They swore at staff, they smirked, they were abusive, complaining, obstructive, hysterical and completely unapologetic. As for gratitude, why, it's a free service, isn't it? What's to be grateful for? There was an almost total lack of the embarrassment or thanks that former generations would have displayed.

Even when approached, sober, for their reflections they were not given to remorse. Rather they were insouciant. Danielle, a 19-year-old mother of two, who had arrived at A&E after being trapped under a taxi, her shattered legs bent up over her shoulder, was oblivious of any moral subtext. After she had spent a month in hospital she was asked if she had paid a high price for her drinking. Nah, she joked, I only spent £20 and got a free taxi.

Equally you could see the impact on the battle-fatigued staff. Like military mercenaries, their moral values had either ceased to exist or they had been buttoned away for fear of revealing disgust.

I've encountered exactly the same dead eyes in big city A&E departments. Once, at one of these hospitals, notorious for dealing with relentless violence and knife crime, I attended my child who had been rushed there with a suspected neck injury. Fortunately it turned out just to be a torn muscle, but I found it an unnerving experience, and not for the obvious reason.

The doctor, a young man with empty eyes and a hard-drinking face, did not engage with us. He spoke as if we were five miles away. For all he was utterly professional and faultless, I felt as if something had died inside him. He was almost like an addict: I wondered if he was so hooked on the adrenalin of coping with stab wounds and fights that nothing less than that stirred him.

You see the same look in abbatoir workers' eyes. They shut down all feeling, all judgment. The patients, deserving or not, have become lumps of meat to them. Monica Garnsey, the maker of the documentaries, believes that what patients want most is the sense that their doctor is sympathetic. But their patience has been stretched too far.

So maybe a little moral panic would be a good thing; maybe we need more chaplains, if only to check the growth in this new amoral, compassion-neutral transaction, where the drunk and feckless not only waste billions of pounds but leave hospital as ignorant and unreformed as they went in. Maybe we need to be a bit more judgmental, for all our sakes.

In a world sometimes scarily lacking in values, chaplains have a vital symbolic role as well as a practical one. Chaplains, in my experience, do not proselytise; they simply afford patients the kind of time, care and compassion that medical staff can no longer give them. No, they cannot cure binge drinking, but they do stand for something resolutely good and wise.

The secularists have missed the point completely. They contacted 233 acute and mental health trusts, which spent £26.72 million on chaplains. This money, they say, could be used to employ 1,300 nurses or 2,645 cleaners, which is as facile as saying that we could save £3 billion plus in A&E budgets by banning booze. Terry Sanderson, the president of the society, even claimed that people in hospital should seek visits from their own vicar, priest, rabbi or imam if they needed religious support.

What an arrogant man he sounds. It is non-religious people, lost in a crisis, who need chaplains the most. Look at Jade Goody, married and blessed as she was dying. Look at the tragic, chaotic lives of some of the young people lying in A&E with no family to phone. It is the injured, the dying and the bereaved, who seek, not necessarily God, but a little kindness and succour at their time of greatest need.

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9 April, 2009

Starved by the NHS: 242 patients die from malnutrition in a single year

Malnutrition killed more than 240 patients on NHS wards in 2007, the highest toll in a decade, figures show. The appalling statistics reveal that the number of men and women starving to death in hospitals has risen by 16 per cent since Labour came to power. Since 1997, 2,311 hospital patients have died from malnutrition and the effects of hunger. There were 209 cases in 1997, when Tony Blair was elected under a pledge to save the NHS. Ten years later the toll was 242. In one area the number of deaths from malnutrition rose by more than 50 per cent.

The figures also show that over the past decade 55 patients have starved to death in council-run care homes.

Conservative health spokesman Stephen O'Brien said: 'Malnutritionhas been a growing problem during Labour's time in charge of our NHS. 'There can be no excuses, the least that patients should be able to expect is to be fed properly when they go into hospital for treatment. 'But unfortunately NHS frontline staff are often overburdened by red tape and paperwork and are consistently being spread too thin and too wide across the service. 'They must be released to do the job that they are there to do, to help people, or risk yet more unnecessary and needless deaths.'

The Daily Mail's Dignity for the Elderly Campaign has highlighted the scandal of old people not being fed properly in hospital. Food is often so unappetising that patients do not eat - and 11million meals are taken away untouched every year. Sometimes food is placed out of patients' reach and taken away untouched, because nurses claim they are too busy to help patients eat.

The starvation statistics cover the ten years to 2007 and were obtained by the Tories from a parliamentary question. They show that the poorest performing regions were the West Midlands, where 409 people died from malnutrition, and the South East, where 388 died. The biggest jumps in hospital deaths from malnutrition in the decade were in the East Midlands (up 55 per cent), the South East (up 27 per cent) and the North West (23 per cent).

Some of the patients would have been suffering from malnutrition when they entered hospital. However, the figures come just weeks after it was revealed that more patients are discharged from hospital with malnutrition than are admitted with the condition - and the overall figures are rising. In 1997, 70,658 patients were admitted with malnutrition and 75,431 discharged from hospital with it. By 2007, these figures had jumped to 130,594 admitted and 139,127 discharged.

A spokesman for the Department of Health said: 'The majority of patients are satisfied with the food they receive in hospitals, and the Dignity in Care campaign is working to drive standards of care further. 'It is crucial that everyone in care is always treated with dignity and respect, including during mealtimes.'

Michelle Mitchell, charity director for Age Concern and Help the Aged, said: 'It's scandalous to see that malnutrition is still a huge problem in our hospitals and care homes. 'Nutritious food and help with eating is an essential part of basic care which must be recognised by all staff. 'Malnutrition and dehydration can be very serious for older people as it often leads to a delay in recovery from illness and in some extreme cases can lead to loss of life.'

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Australian public hospitals a turnoff for expectant mothers

THE death of four Sydney babies involved in home births in the past nine months has obstetricians asking what they have to do to improve women¿s confidence in a hospital birth. It has also raised questions about what might happen next year when it could become illegal for midwives to attend such births.

Australia is one of the safest countries in which to give birth or be born but these statistics cover up a growing discontent with our impersonal maternity system. It is this discontent that is behind some women’s decision to opt for a riskier home birth. The recent tragic outcomes of that choice have put a spotlight on the need for reform.

A Government review of maternity services that reported in February called for a major overhaul of the system to give midwives a greater role.

Fears about the nation’s high caesarian rate, a lack of access to birth centre services and some women’s distaste for turning what is a natural process into a clinical nightmare drives the choice for a home birth.

Obstetricians said overcrowded and overworked public hospitals where the care is impersonal was also a factor. The Australian College of Midwives said there was no continuity of care for pregnant women using public hospitals. They may never see the same midwife or obstetrician twice and can often wait for up to five hours for a quick pre-birth check up. As a result many women approach labour with fear, College president Professor Pat Brodie said.

Most women turned off by a hospital birth who choose to have their baby at home have positive birth experiences. But Westmead Hospital clinical director of women’s health Andrew Pesce said the safety of home births had been taken for granted. Those advocating them do not do enough to acknowledge the risks involved, he said.

Australian studies showed the chances of a baby dying in a home birth were three times greater than in a hospital setting. “There are one or two extra deaths per 1000 home deliveries and we wish people would acknowledge that,’ he said. Dr Pesce was also alarmed that in the past nine months there were eight “very bad outcomes” from home births that he knew of. Four of those babies died and four of them may have brain damage.

While mothers have a right to choose how they give birth, there were concerns that sometimes decisions were being made for ideological reasons without the clinical risks being properly assessed. Older mothers, those who have previously had caesarians, those undergoing a breech birth who have higher risks attached to their births were choosing sometimes to go it alone. “When it leaves the realm of health science and becomes politics and ideology you’re not thinking clinically, you’re thinking ideologically,” Dr Pesce said.

He said some of the coronial inquiries into home birth deaths in New Zealand showed midwives refusing to do vaginal observations on women in labour in case they distress her with news of slow progress. “They are only reacting to disaster at the last minute when the only way to minimise deaths is to minimise the risks,” he said.

Home birth advocates counter with claims about the damage hospital births often inflict on the mother and baby. Home births represent a very small number of all births that take place in Australia each year - 0.25 per cent. In 2006 there were 708 babies delivered in a home birth out of 277,436 babies born. More than 97 per cent of babies were born in a hospital. Even in New Zealand, where home birth is government-funded, only 2.5 per cent of mothers go ahead with a home birth.

Home births in Australia could get even riskier from next July when a new national registration scheme for health professionals kicks in. From then health professionals will need indemnity insurance to gain the registration they need to practise. Midwives working outside the hospital system have been refused insurance since the indemnity crisis of 2001. Unless the Government offers to pick up the indemnity bill, they will be unable to practice home births from next year.

Professor Brodie said if women were unable to get a midwife’s help for a home birth they would be forced to go it alone and “that is completely unacceptable”. But Dr Pesce questioned whether the government should be indemnifying higher-risk home births.

Both obstetricians and midwives want the maternity system reformed. They agreed women needed continuity of care, a link with a midwife or doctor they know and trust for the entire pregnancy. Dr Pesce hoped such a system might make a hospital birth a more appealing option for those women he now calls refugees from our health system.

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8 April, 2009

‘NHS culture and lack of cash delay stem-cell hopes’

The promise of stem-cell research to deliver new therapies for conditions such as diabetes, Parkinson’s, heart disease and paralysis is being held back by funding problems and the NHS’s institutional culture, a report suggests. Although British academic stem-cell science is internationally competitive, a lack of commercial investment and NHS support is hindering its potential to help patients and create profits, scientists at the University of Nottingham have said.

Paul Martin, of its Institute of Science and Society, who led the research, said: “While the Government has identified regenerative medicine as a national priority and the US has lifted its ban on stem-cell therapy, urgent public policy action is needed if it is to become a reality.” His report, co-authored by Emma Rowley, is published as scientists gather in Oxford today for the UK Stem Cell Network’s annual conference, organised by the Biotechnology and Biological Sciences Research Council.

SOURCE




Desperate Australian mothers turn to home births

Meltdown of public hospital obstetrics in NSW. Sounds a lot like Britain

MIDWIVES in New South Wales public hospitals are supervising the labour of up to three women simultaneously because staff numbers have not kept up with the nation's baby boom. Overcrowding, lack of birth options and the closure of many rural obstetric services is forcing women into home births.

The Daily Telegraph reported yesterday at least four babies had died during home births in the last nine months and another four suffered possible brain damage. One of those babies was born without the assistance of a doctor or a midwife in contravention of NSW policy which requires two midwives to be present at a home birth.

The Australian College of Midwives said chronic understaffing had turned maternity departments into factories where women were left alone in labour as midwives ran between birthing suites. The overcrowding and inability to constantly monitor women giving birth has increased the intervention and caesarean rate, spokeswoman for the college Associate Professor Hannah Dahlen said. Thirty one per cent of babies in Australia were delivered by caesarean compared to the OECD average of 22 per cent. In private hospitals the rate is 41 per cent.

The college said the factory-like treatment of women in labour was one reason they were turning to home births. Clinical director of women's health at Westmead Hospital Dr Andrew Pesce said pregnant women must get continuity of care from the same doctor or midwife through pregnancy. This option was available to just 3 per cent of pregnant women in NSW.

Meanwhile, crucial maternity services are being cut across regional NSW forcing expectant mothers to choose alternative birthing methods including home births.

Heavily pregnant women are being forced to travel up to two hours for antenatal care or for birth as many services have either being downgraded or have closed their doors across the state. There are plans to cut four midwife positions at Port Macquarie while antenatal classes could be axed at Kempsey after more than 20 years under a staffing review of the North Coast Area Health Service.

On the Far South Coast, Pambula Hospital is closing its maternity service and merging with Bega, which had caused community anger. In the Southern Highlands, there are plans to downgrade maternity services at Bowral Hospital. Blue Mountains Hospital is constantly opening and closing because it cannot get an obstetric anaesthetist.

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7 April, 2009

Number of NHS tooth extractions soars by 30% in four years

Very primitive

Thousands of Britons are having teeth needlessly pulled out, it was claimed yesterday. The number of extractions has soared by 30 per cent in four years, according to figures obtained by the Liberal Democrats. The party claims this demonstrates how much dental care has deteriorated under Labour, leaving thousands missing out on treatment that could save their teeth. More than 175,000 Britons had their teeth extracted under general anaesthetic in 2007/08, up 40,000 on the 2003/04 figure, a parliamentary answer revealed.

Of these, 44,300 were aged between six and 18 and 14,200 were under five years old. LibDem health spokesman Norman Lamb said: 'The extraordinary number of people needing their teeth extracted under general anaesthetic could well be the result of the appalling access to NHS dentistry.' He pointed the finger at the general difficulty in finding a Health Service dentist since the Government introduced a 'botched' contract in April 2006.

Designed to increase access to NHS dentistry, the deal actually saw hundreds of dentists leave the NHS. The number of patients seeing a dentist fell by 1.2million, leaving thousands without the treatment that could have stopped their teeth getting so bad that they had to be pulled out. But dentists' salaries have soared by 11 per cent since the change – to an average of more than £96,000.

Mr Lamb added: 'The dental contract was supposedly designed to improve the situation, but the staggering rise in tooth extractions proves the massive failures of thisbotched initiative. The crisis in NHS dentistry is one of this Government's most shameful legacies.'

Although the rate of extractions increased throughout the four-year period following April 2003, it gathered pace after the new contract for NHS dentists was introduced. In 2005/06, the year before the new contract, the number of extractions stood at a little more than 149,100. Two years later it had risen to just over 175,400 – an increase of 18 per cent.

The contract also changed how dentists were paid. Experts have warned that the incentives it offers make it more profitable for dentists to take a tooth out than to try to save it with complex treatments such as crowns or bridges. A patient has to pay £45.60 for a tooth to be taken out, and £198 for crowns, bridges or dentures. Before the contract dentists were paid per procedure, but after it came in they were paid to provide a specific rate of procedures in the coming year. With the money already in the bank, the fear is that some dentists may feel less inclined to carry out complex and expensive procedures and instead choose the cheaper option of taking the tooth out.

Last year MPs concluded that patients were having teeth pulled out unnecessarily as a result of the dental contract. The Commons health select committee found that the number of complex treatments such as crowns, bridges and dentures had plummeted by 57 per cent since 2006, at the same time as the number of extractions were rising. It said this happened because dentists had no financial incentive to give appropriate treatment. In Scotland, which did not bring in the new contract, the number of complex operations has gone up.

The British Endodontic Society said the contract provides dentists with a 'financial incentive to persuade a patient to have a decayed tooth extracted rather than undergo the more complex procedure of restoring it'. The soaring number of extractions under general anaesthetic comes even though the British Dental Association advises that such strong anaesthetics should only be used in hospitals.

SOURCE




Australia: Public hospital bed shortage as deadly as road toll

HOSPITAL emergency department overcrowding is responsible for at least as many deaths every year as occur on Australian roads, doctors say. In a damning series of reports in the Medical Journal of Australia, emergency medicine specialists suggest about 1500 Australian deaths could be avoided each year. The specialists say caring for patients waiting for a hospital bed represents about 40 per cent of the workload in major emergency departments, and up to 70 per cent in some.

They are critical of politicians and bureaucrats who deny that hospital overcrowding has major adverse effects on patient care. Ideally, for a hospital to function effectively, the doctors say occupancy should be no more than 85 per cent to allow for fluctuations in demand. But the Australian Medical Association says hospitals such as Townsville, in Queensland's north, operate at more than 100 per cent capacity "most of the time".

Australia has 2.6 hospital beds per 1000 people - far short of the average of 3.9 per 1000 for countries in the Organisation for Economic Co-operation and Development. A snapshot of overcrowding in accredited Australian emergency departments at 10am on June 2 and September 1 last year, found more than half the patients in non-NSW emergency departments were waiting to be admitted, three-quarters of them for more than eight hours.

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6 April, 2009

NHS Hospitals granted foundation status despite a plethora of failings

More than 20 hospitals which failed to meet basic health care standards have been awarded "foundation trust" status allowing their bosses to take massive pay rises, an investigation has revealed. Ministers promised that only the best hospitals would be given the freedom to run their own affairs, including setting salary levels which have brought huge pay boosts for senior managers.

Yet investigations by this newspaper show that 22 hospital trusts in the past three years have been given the coveted status despite a range of serious failings including high rates of superbugs, delays treating cancer and heart attack victims, long waits in Accident and Emergency (A&E) departments and lack of proper care for the elderly and the mentally ill.

Patients groups described the revelations as "a shocking exposure" of a regulation system which they said was failing to protect patients or provide the public with any reassurance about where good hospital care could be found.

In a separate development, an investigation has been launched into care standards at a foundation trust which suffers from the highest death rate in England. External consultants have been called in by Basildon and Thurrock University Hospitals NHS Foundation Trust, in Essex, which was among the first wave of trusts awarded foundation status in 2004, but which last year had a mortality rate 32 per cent above expected. The trust believes the high rate is due to data errors, a lack of local hospice places and a high incidence of heart and respiratory disease among local residents.

When Labour introduced foundation trusts, then-health secretary Alan Milburn said that winning the status would be a challenging process "even for the best performing hospitals" who would have to demonstrate high standards of care. Those awarded the status include Mid Staffordshire Foundation trust, which runs Stafford Hospital, where hundreds of people died amid conditions which left dehydrated patients forced to drink out of flower vases while others were left lying in soiled linen. Board papers reveal that the regulators who granted the license to give the trust "foundation" status were aware of a litany of failings in patient care in Mid Staffordshire. At the point the authorisation was made, the trust was missing government targets to reduce MRSA, had long waits in A&E, and for clot-busting treatment for heart attack victims, the documents from Monitor, the regulator, show.

A further 21 trusts were also given the coveted status despite concerns about the quality of the care they provided. As Monitor sent the letters of authorisation it simultaneously issued the trusts with "side letters" highlighting the problems with patient care.

At the point the trusts were awarded the status, 18 were missing or about to miss targets to reduce levels of the superbug MRSA; three had long delays for cancer patients; and four were unable to give urgent treatment to heart attack victims who required clot-busting drugs. Two had been assessed as providing "weak" services for the mentally ill, one had been criticised for staff shortages in paediatric wards, and one was found to be failing to look after frail and elderly patients.

Three of the trusts, including Mid Staffordshire, had high death rates which were discussed during Monitor's board meetings. The documents identify Medway trust in Kent – granted foundation status in October 2007 – as being in the worst 10 per cent of trusts for mortality. Blackpool Fylde and Wyre trust had above-average mortality rates in 2005/6, the documents show, but Monitor granted it foundation status in Dec 2007 after being assured the rates were reducing. Since then, they have risen.

When United Bristol Healthcare trust was granted foundation status last May it had failed the latest annual targets to reduce MRSA, it had high levels of the infection Clostridium difficile, and its patients faced long waits in A&E.

Foundation trusts have more autonomy to run their own affairs and set their own levels of pay. The average pay for their chief executives is now £157,000 – 18 per cent more than that received by those running standard NHS hospitals.

Katherine Murphy from the Patients' Association said the failings identified in the authorisation process undermined claims by foundation trusts that they could offer the best care. "The public has been given the impression that these hospitals are the best. When hospitals are given foundation status despite all these failings, the term just becomes a way for trust boards to give more pay to senior managers," she said.

Norman Lamb, the Liberal Democrat health spokesman, added: "It is really worrying, especially given what we have found out recently about Stafford Hospital, to see that the threshold for foundation status appears to be lowering. "It is absolutely critical that quality of care is the priority when these trusts are being assessed," he added.

A spokesman for Monitor said the regulator would only authorise a trust's application if it had robust action plans to improve its performance, and said the issuing of "side letters" did not represent a lowering of the bar for applicants, but a mechanism to ensure that their performance was closely monitored.

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5 April, 2009

One in three Brits can't find an NHS dentist - and half can't afford one

Despite Government promises to improve access, research reveals that 35 per cent of adults are struggling to get the dental care they need - up from 23 per cent the year before. In some parts of the country, half the adults said they cannot see an NHS dentist - forcing them to go without treatment or to pay privately.

The credit crunch is also having an impact on the nation's dental health. The poll revealed that almost 50 per cent of the population say they are put off going to the dentist over fears of the cost. Last year the figure was one in five.

Abby Bowman from Simplyhealth, the private dental provider which carried out the survey, said: 'The NHS dental contracts introduced three years ago were supposed to give more people access to dentists, but as our research shows this is only getting worse.'

The survey of 1,700 people indicates that Plymouth is a leading NHS dentistry blackspot, with 51 per cent unable to find a dentist; followed by Southampton on 45 per cent and Manchester on 45 per cent.

The credit crunch is having the greatest effect in the capital, with 54 per cent in London saying they would be put off from visiting a dentist because of cost worries.

Dental charges have risen since the introduction of the new contract for dentists in 2006. Prior to this contract, the average cost of a basic NHS checkup was £5.54, and the price of a filling about £10. Under changes introduced in 2006, individual charges for NHS treatments were replaced with a system of bands with a maximum charge of £198. A check-up costs £15.90 and a filling £43.60. The contract was designed to improve access to the NHS, but around 500 dentists left the Health Service, claiming they were not being paid properly.

Figures released last autumn showed that the number seeing a dentist has plummeted by 1.2million in two years, so that fewer than half of all adults saw a state-funded practitioner. The situation has led to some patients being forced to pull out their own teeth because they cannot afford to go private. Others have turned up at hospital casualty departments for emergency dental work.

Even though dentists are seeing fewer patients their pay has soared - up 11 per cent since the start of their new contract to an average of more than £96,000. Yesterday the Government said dentists would receive a pay rise of 0.21 per cent - effectively a pay cut because of inflation.

Conservative health spokesman Mike Penning said: ' Perhaps this will finally persuade Labour ministers to scrap their ludicrous contract and to take real action to improve outcomes for patients.'

Susie Sanderson, chairman of the British Dental Association, said the problems facing NHS dentistry were well documented. But health minister Ann Keen said: 'These findings do not reflect reality. 'Thanks to over £2billion investment in NHS dentistry, recent official statistics show that access has actually increased and there's 655 more dentists than the year before.'

SOURCE




ANOTHER birth in an Australian public hospital toilet

A WOMAN gave birth to a stillborn baby in the toilets of Bankstown Hospital after being told by two doctors that she was just constipated. Health officials have confirmed that the woman, aged 21, went to the hospital unaware she was pregnant, after consulting two local general practitioners. It is the fifth serious incident to have occurred in the toilets of a NSW hospital since a miscarriage at the Royal North Shore in September 2007 prompted the State Government to open a special commission of inquiry into the health system. The Garling commission handed down its 139 recommendations just last week.

Complaining of pains in her stomach on Thursday night, the woman was taken for X-rays, a process that can be harmful for pregnant women. The results confirmed she was heavily pregnant, but the woman wandered off from the radiology section of the hospital before she was informed.

While she was in the hospital toilets, her waters broke and she gave birth to the child in a toilet bowl. It is understood the baby had a pulse and hospital staff rushed to try and resuscitate the child, but were unsuccessful.

A Sydney South West Area Health Service spokesman said the details of the events were still being investigated. "[The woman] gave birth to a baby that sadly did not survive," he said. "These are very unusual and upsetting circumstances for the patient and hospital staff. The woman is receiving ongoing support and care. "The family have requested no further details be released. This is now a matter before the coroner and it is inappropriate to comment further."

A spokesman for the Health Minister, John Della Bosca, said he was first alerted to the incident by a media report, but confirmed it would be referred to the coroner to be investigated. "[Mr Della Bosca's] very concerned about this. He has already made phone calls to make sure that woman involved gets the support she needs," the spokesman said.

The Opposition health spokeswoman, Jillian Skinner, describing the incident as "horrific" and "unbelievable", said Mr Della Bosca needed to show some leadership and extend the coroner's powers. She said the incident had echoes of the Vanessa Anderson case. Her death in November 2005 highlighted systematic failings of the health system.

"A coroner looks at death, a coroner doesn't look at the system and how it has let this mother and her child down," she said. "I expect a coronial inquiry, but we also need to know what else in this whole process went wrong …" "This is more than a death, it's about a whole systemic failure to address what went wrong, and this woman has been subjected to error after error after error." It is the fourth time a woman has lost a child in a NSW hospital toilet since September 2007.

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4 April, 2009

Regulator orders 21 NHS hospital trusts to clean up their filthy hospitals

Warnings about substandard levels of hygiene and infection control have been issued to twenty-one NHS trusts, including four flagship foundation hospitals. The Care Quality Commission (CQC), the new “super-regulator” for health and social care that started work on Wednesday, said that the trusts had failed to meet standards on cleanliness.

All 21 have had strict conditions placed on their registration with the commission, which is a legal requirement. Hospitals that fail to act to improve hygiene levels could be issued with warning notices and fines, or face prosecution or closure.

The CQC rulings, issued today, show that ten acute hospital trusts, six primary care trusts, four mental health care trusts and one ambulance trust have registration conditions as a result of failing to meet the criteria fully. The four trusts with foundation status — a supposed marker of excellence — are Kettering General Hospital, Leeds Partnerships, Medway and Alder Hey Children’s.

Fears over the regulation of foundation trusts were raised last month after it became clear that Mid Staffordshire NHS Foundation Trust had been awarded the status despite concerns over its death rates. The Healthcare Commission, the CQC’s predecessor, published a damning report on “appalling standards” of care at the trust. Between 400 and 1,200 more people died there than would have been expected between April 2005 and March 2008.

Today’s data shows that some trusts have been given a deadline for taking action to meet hygiene standards while others have conditions on their registration, such as the need to keep wards clean. Examples include ensuring that the decontamination of surgical equipment is satisfactory and developing tighter policies to tackle infections such as MRSA, Clostridium difficile and legionella.

Overall, 388 NHS trusts have been registered with the CQC, which replaces the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission.

As part of their assessment, trusts declared whether they were compliant with national hygiene standards. The CQC also looked at other information, including patient and staff surveys, hygiene inspections carried out by the Healthcare Commission and MRSA and C. difficile rates. Of the 21 trusts, 13 declared non-compliance with some of the criteria set down by the CQC for registration.

In another eight cases, the CQC had evidence that the trust had repeatedly failed to achieve required standards for infection control, had a high infection rate and/or was identified by the Healthcare Commission as having substantial problems that could risk patient safety.

The CQC defended its decision not to issue a hygiene warning to East Sussex Hospitals NHS Trust, which runs the Eastbourne hospital where a strain of C. difficile last month was linked to the deaths of 13 patients. It said that a warning had been considered, but the trust was handling the outbreak efficiently and appeared to have been victim of the small chance all hospitals have of such an incident occurring, rather than as a result of poor hygiene.

Over the next year, up to half of all NHS trusts providing acute, primary care, mental health and ambulance services will be inspected by the CQC.

Baroness Young of Old Scone, the chairwoman of the CQC, said that recent decreases in rates of MRSA and C. difficile reflected how infection control was improving nationally. “Most trusts have stronger systems to protect patients from infection than a few years ago, and trusts’ boards are taking the challenges seriously. We commend them for that,” she said.

She said that registration of NHS trusts based on healthcare-associated infection marked the first step in a new system to drive further improvement and ensure patients’ safety. “This was an opportunity for trusts to let the public know that they are taking effective action to tackle these infections. The overwhelming majority of trusts provided the assurance needed to register. We will closely monitor their performance to ensure they continue to meet the regulations and make improvements when required.”

Of the 21 trusts that had fallen below the CQC standards, she said: “We have placed rigorous conditions on these trusts’ registration and will monitor them closely.”

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3 April, 2009

Overnight NHS hospital beds fall 10% in just three years

DESPITE a growing population

The number of overnight beds in NHS hospitals has plummeted by almost 10 per cent in just three years. Experts say the falls have exacerbated overcrowding on wards, which is putting patients at increased risk of infection. And the pressure to discharge elderly patients quickly because of the low number of beds was endangering their health, they warned.

The official figures show the number of beds remained virtually constant over the early years of Labour control, but began to fall in 2005 - the year of the financial crisis which engulfed the NHS and forced the closure of dozens of wards and the cutting of hundreds of jobs.

There were 198 overnight beds per 100,000 people in 2007/08. This is down from 219 per 100,000 in 2004/05, the year before the financial crisis, and 222 when Labour came to power.

Ministers say fewer overnight beds are needed because medical advances mean people are no longer kept in hospital for as long. But patients groups claim beds and sometimes entire wards are being shut for cost reasons, while doctors warned the NHS will be unable to cope in times of crisis such as a big flu outbreak. There are also concerns that low numbers of beds lead to high occupancy rates - putting people at risk of catching superbugs because there is not enough time to clean wards properly.

The pressure to free up dwindling numbers of beds has also led to fears that elderly people are being discharged too early, putting them at risk. Last year nearly 150,000 people over the age of 75 had to be re-admitted as emergency admissions within 28 days.

Liberal Democrat health spokesman Norman Lamb said: 'The loss of beds is putting hospitals under an impossible strain, with many seeing increases in emergency admissions. 'It is complete mismanagement to cut the number of NHS beds when the number of emergency readmissions and the number of cancelled operations are on the rise. 'Hospitals across the country are full to overflowing, and staff are being put under impossible pressure thanks to this Government's mistakes.'

Conservative health spokesman Andrew Lansley said the bed cuts would also make it harder for the Government to meet repeated pledges to eradicate mixed-sex wards. 'It is madness to cut beds when wards are overcrowded, when there aren’t enough isolation rooms to control hospital infections and patients are still placed in mixed sex accommodation,' he said. 'Labour’s complacent assumption that there would not be any more winter crises is now having disastrous consequences for patients. 'In 2000 Labour said that bed numbers needed to increase, but these figures demonstrate again how badly they have failed. The Government needs to explain why our hospitals have so many fewer beds than hospitals in other European countries.'

Michael Summers of the Patients Association said: 'In an ageing population we need a proper number of beds available, but what we are seeing is beds being cut to save money, leaving patients to suffer - as we saw in Mid Staffordshire. 'It can be no accident that the number of beds began to fall after the time of hospital deficits. 'Overcrowding in wards makes them more difficult to clean and encourages the spread of infections. It means the NHS will be less likely to be able to cope if there is a big outbreak of flu or something like that. 'And elderly people could end up being discharged earlier than is good for them, which is counter-productive. These bed cuts are silly, short term decisions by managers.'

A survey out earlier this year showed that the UK had far fewer beds than almost any other country in Europe, with less than half the number per head of population than Germany. The study in the Lancet found that overcrowding in hospitals was linked to superbug outbreaks, and 71 per cent of hospitals had occupancy rates of more than 82 per cent - a recognised safe level. Around a quarter of trusts exceeded 90 per cent.

The new figures, revealed in a parliamentary answer and published in Pulse magazine, show that in only one part of the country has the numbers of beds stayed constant over the past year. This was the South Central region, covering Oxfordshire, Hampshire and neighbouring counties, where there are 164 beds per 100,000 people - one of the lowest rates in the country.

There were wide regional variations, with people in deprived areas like the North East having two thirds more beds per head of population than those in East Anglia - 245 to 151 per 100,000. Across the country, the rate was 222 per person in 1997/98, when Labour took office. It remained constant until 2004/05, when a financial crisis hit the NHS and dozens of hospitals were forced to make cuts to jobs and close wards to save money. From then on, the numbers started to fall.

Answering the parliamentary question, health minister Ben Bradshaw said the fall in the number of hospital overnight beds was the result of dealing with patients more efficiently and releasing them more quickly. 'Experts all agree this is the best way to deliver healthcare,' he said. 'Advances in medical technology and shorter stays for routine operations mean fewer beds are needed. This is part of a long-term downward trend in the average length of stay in hospital. 'But where the NHS needs more beds, there are more beds.' There were 47 per cent more day beds, he said.

However, Dr Jonathan Fielden, chair of the British Medical Association's consultants' committee, said funding cuts meant specialists were relying on already stretched GPs to pick up the slack. 'While we have hospitals with this limited capacity - as we saw this winter - we will have more delays in getting patients in and we will be much more reliant on our GP colleagues to look after patients a bit longer and take them that little bit earlier.'

Dr Paddy Glackin, a GP in north London, said primary care trusts were cutting costs and leaving GPs to pick up the pieces. 'It's a rolling door. Every day, GPs have to see patients who have been hurtled out of hospital too quickly. Every single Friday one local hospital is on an emergency beds system and we are fighting to get our patients accepted. We are under pressure continually to manage patients at home.'

Richard Hoey, deputy editor of Pulse, said: 'Moving patients out of hospital more quickly is great if it's genuinely justified on medical grounds, but it's certainly not acceptable just as a way of saving money. 'The Government must also ensure that if patients are increasingly managed in primary care, rather than in hospital, that there is a concurrent shift in resources. At the moment, hospitals continue to soak up too much of NHS funding.'

SOURCE





2 April, 2009

Patients of Problem VA Clinics Infected

Viral infections, including hepatitis, have been found in 16 patients exposed to contaminated equipment at Veterans Affairs medical facilities, a department spokeswoman said Friday. So far, 10 colonoscopy patients from the VA medical center in Murfreesboro, Tenn., have tested positive for hepatitis, VA spokeswoman Katie Roberts told The Associated Press. In a later e-mail, she reported six patients at the VA's ear, nose and throat clinic in Augusta, Ga, tested positive for unspecified viral infections. The number of reported infections could rise.

More than 10,000 veterans were warned to get blood tests because they could have been exposed to contamination at those two facilities plus a medical center in Miami. All three sites failed to properly sterilize equipment between treatments, and the problems dated back for more than five years at the Murfreesboro and Miami hospitals.

Roberts said the department doesn't yet have results from most of the veterans it warned. A VA alert to patients said they "could have been exposed to body fluids from a previous patient."

Roberts said four Tennessee patients have tested positive for hepatitis B and six have tested positive for hepatitis C. No one has tested positive for HIV, she said.

Hepatitis is a viral infection of the liver. The most common form, hepatitis C, is potentially life-threatening and can cause permanent liver damage. Both the B and C forms are spread by contact with the blood or other body fluid of an infected person, according to the Centers for Disease Control and Prevention.

Roberts stressed that the source of the infections isn't known and may never be identified. "There's no way to scientifically, conclusively prove they contracted this due to treatment at our facility," Roberts said. But the VA will make sure those who tested positive "get the best possible treatment," she said.

The VA's inspector general office has started a review, spokeswoman Joanne Moffett said Friday. According to a VA e-mail, only about half of the Murfreesboro and Augusta patients notified by letter of a mistake that exposed them to "potentially infectious fluids" have requested department blood tests. Some veterans said they decided to seek tests from their private physicians, rather than the VA.

The public first became aware of problems in February, when the agency announced it had sent letters to about 6,400 patients who had colonoscopies between April 23, 2003, and Dec. 1, 2008, at Murfreesboro and to about 1,800 patients treated over 11 months last year at Augusta. Roberts said the problem in Tennessee was discovered in December and an internal alert was issued.

This week the VA announced it sent letters advising 3,260 patients who had colonoscopies between May 2004 and March 12 at the Miami Veterans Affairs Healthcare System that they also should get tests for HIV, hepatitis and other infectious diseases. "We feel that the risk of cross-contamination among patients is small, and many patients are at no risk whatsoever," Dr. William E. Duncan of the VA Health Administration said in an e-mail. "Since we cannot know which patients are at risk, we are notifying everyone we feel may possibly have been placed at risk."

Two weeks after a review of procedures and training at VA facilities nationwide, Roberts said the VA cannot yet say if patients at other locations were exposed to equipment that was not properly sterilized.

U.S. Rep Ileana Ros-Lehtinen, R-Fla., said VA officials told her and other members of Congress on Thursday that the Miami facility initially reported it was free from problems only to later backtrack. Ros-Lehtinen said the details were disclosed by the VA in a closed-door meeting convened by U.S. Rep. Steve Buyer, R-Ind., the top Republican on the House Committee on Veterans' Affairs.

Joe Davis, a spokesman for the Veterans of Foreign Wars in Washington, said he has notified his 20,000 newsletter subscribers about the situation. "We are obviously very concerned anytime anybody's health is at risk from going to see the doctor," he said Friday. "We believe the VA has done an adequate job in quickly notifying those veterans who might be affected."

SOURCE




UK: Mental services ’shut to elderly’

Older people are often denied access to the full range of mental health services available to younger adults, a watchdog has found. At four out of six mental health trusts examined in England decisions were based as much on age as clinical need, the Healthcare Commission found. Out-of-hours, alcohol and crisis services, and psychological therapies were often unavailable to the over 65s. A body representing trusts said new policies would benefit older patients.

Healthcare Commission chief executive Anna Walker called the findings "unacceptable".

The research showed that older people were often prevented from accessing care because of stretched services or a lack of age-appropriate care. Some staff said patient groups considered to be of high risk to the public or where government targets were applicable were often prioritised, leaving older people's services lagging behind with little funding.

Ms Walker said: "Trusts are not always providing appropriate mental health services to the over 65s. "It is truly unacceptable that out of hours and crisis services were often not available to older people. "There needs to be a fundamental shift towards providing care based on a person's clinical need rather than their age. "Considering a quarter of admissions to mental health inpatient services are over 65, this issue needs urgent attention."

Kate Jopling of Help the Aged said: "It's shocking to think that, despite the need, older people are routinely being denied treatment for mental health services. "The date on a birth certificate should not be the measure of whether or not someone receives the help they need for a mental health problem."

And Gordon Lishman of Age Concern said the services that did exist for older people were often chronically under funded and are not of the same quality to those offered to adults of working age. He said the situation was scandalous and urged the government to use laws to stamp out age discrimination.

Care Services Minister Phil Hope said any unfair discrimination against older people was unacceptable. "We are taking action and we expect NHS trusts to make improvements."

Steve Shrubb, director of the mental health network which represents the majority of mental health trusts said: "We have some of the best mental health services in Europe yet it is clear that there are still improvements to be made to mental health services especially to ensure that older people get access to the correct care when they need it." He said new policies, such as quality accounts, would put the needs of patients into sharper focus.

Meanwhile, a second study from the Commission of all 68 NHS specialist community mental health trusts in England, found that almost half of under 65s needing specialist mental healthcare still do not have an out-of-hours number if they are in a crisis. Half of people with schizophrenia have not been offered recommended psychological therapies, it suggested.

SOURCE





1 April, 2009

Did Canadacare kill Natasha Richardson?

By Michelle Malkin

Dr. Cory Franklin had a provocative piece in the New York Post yesterday exploring whether Canada’s government-run health care system contributed to the tragic skiing death of Natasha Richardson. He writes:

Richardson died of an epidural hematoma — a bleeding artery between the skull and brain that compresses and ultimately causes fatal brain damage via pressure buildup. With prompt diagnosis by CT scan, and surgery to drain the blood, most patients survive.

Could Richardson have received this care? Where it happened in Canada, no. In many US resorts, yes. Between noon and 1 p.m., Richardson sustained what appeared to be a trivial head injury while skiing at Mt. Tremblant in Quebec. Within minutes, she was offered medical assistance but declined to be seen by paramedics.

But this delay is common in the early stages of epidural hematoma when patients have few symptoms — and there is reason to believe her case wasn’t beyond hope at that point.

About three hours after the accident, the actress was taken to Centre Hospitalier Laurentien, in Sainte-Agathe-des-Monts, 25 miles from the resort. Hospital spokesman Alain Paquette said she was conscious upon reaching the hospital about 4 p.m.

The initial paramedic assessment, travel time to the hospital and time she spent there was nearly two hours — the crucial interval in this case. Survival rates for patients with epidural hematomas, conscious on arrival to a hospital, are good.

Richardson’s evaluation required an immediate CT scan for diagnosis — followed by either a complete removal of accumulated blood by a neurosurgeon or a procedure by a trauma surgeon or emergency physician to relieve the pressure and allow her to be transported.

But Sainte-Agathe-des-Monts is a town of 9,000 people. Its hospital doesn’t have specialized neurology or trauma services. It hasn’t been reported whether the hospital has a CT scanner, but CT scanners are less common in Canada.

Actually, it has been reported that Richardson received a CT scan at Centre Hospitalier Laurentien. The hospital does have the equipment.

Defenders of universal health care think this ends the debate and accuse critics of Canada’s system of “exploiting” Richardson.

But health care blogger Dr. T points to the government-engineered lack of specialists in Canada:

Neurosurgeons are not so easy to find in Canada where subspecialization is not rewarded, and 50-60% of boarded neurosurgeons leave the country to practice somewhere else within 2 years of their certification.

The last good data I could find listed only 174 neurosurgeons in the entire country. In the U.S. we have 3,500. A study on the need of neurosurgeons listed the density of neurosurgeons in the U.S. to be about 1/55,000 people which means that an analogous number of neurosurgeons needed in Canada would be about 604.

It is true that neurosurgeons eschew emergency room coverage in the United States, but it is for completely different reasons than in Canada. Here, our ED’s don’t want to pay what it takes to hire a neurosurgeon for coverage; in Canada, no one wants to even be a neurosurgeon.

So, in a sense, the Canadian model for health care failed Natasha Richardson because of an artificially created shortage of subspecialists, which is a purposeful design meant to keep costs low in a taxpayer-funded-system. The U.S. would very much like to go in this direction and the plan is to broaden non subspecialized care options while reducing higher-tech procedures, diagnostics and physicians.

But as we go towards a single-payer system, we can all expect that when we need it most, the system will not be there for us, as it was not there for Natasha Richardson.

Additionally, Matthew Vadum and a top Montreal doctor point to Canada’s woeful lack of a medical flight system. There’s no shame in asking what went wrong, how our health care system can minimize preventable deaths, and whether current proposals to radically alter our health care system would increase these tragedies.

It would be irresponsible to do otherwise.

***

Read this. Hat tip - Greg Pollowitz:

Connie and Donald McCracken were watching CNN one evening last week when they learned of the tragic death of actress Natasha Richardson from a head injury. Immediately, their minds turned to their 7-year-old daughter, Morgan, who was upstairs getting ready for bed.

An injured Morgan McCracken has benefited from awareness after Natasha Richardson’s death. Two days earlier, Morgan, her father, and brother had been playing baseball in the yard of their Mentor, Ohio, home when her father hit a line drive that landed just above Morgan’s left temple. A lump formed, but the McCrackens iced it down and the swelling subsided within an hour.

“For the next two days, she was perfectly fine,” Donald McCracken says. “She had no symptoms. She went to school both days and got an A on her spelling test as usual. There were no issues whatsoever.”

But after hearing about Richardson’s death, the McCrackens wondered if Morgan was really as OK as she seemed. After all, Richardson had been talking and lucid immediately after her fatal injury. When they went upstairs to kiss Morgan good night, she complained of a headache. “Because of Natasha, we called the pediatrician immediately. And by the time I got off the phone with him, Morgan was sobbing, her head hurt so much,” McCracken says.

The McCrackens took Morgan to the emergency room at LakeWest Hospital in neighboring Willoughby, where doctors ordered a CT scan and immediately put Morgan on a helicopter to Rainbow Babies and Children’s Hospital in Cleveland, with her father by her side. “I knew it was bad when she had to get there by helicopter in six minutes, instead of the 30 minutes it would have taken to get to Cleveland in an ambulance,” McCracken said.

When the helicopter arrived at Rainbow, the McCrackens were greeted by Dr. Alan Cohen, the hospital’s chief of pediatric neurosurgery. He whisked Morgan into the operating room, pausing for a moment to tell McCracken that his daughter had the same injury as Richardson: an epidural hematoma.

McCracken remembers standing in the emergency room, feeling like the life had just been sucked out of him. “My heart sank,” he says. “It just sank.”

Unlike Richardson’s, Morgan’s story has a happy ending.

SOURCE




Australia: Melbourne public hospital lied over waiting lists

THE Royal Women's Hospital has been systematically lying about its surgery waiting list for almost a decade, says a damning report that has forced the Government to overhaul Victoria's hospital funding system. Health Minister Daniel Andrews yesterday apologised to patients who waited months longer for surgery than the Women's has claimed since the late 1990s. He said an independent audit — commissioned after The Age earlier this month revealed the hospital had incorrectly reported data to the Government — confirmed the creation of a "second waiting list" that was disguising the hospital's real performance.

About 180 patients waiting for semi-urgent surgery every year waited an average of 95 days longer than the hospital was reporting, the audit found. This occurred in the context of inadequate scrutiny at the executive level. The finding comes after The Age revealed allegations last May that hospitals were manipulating data to meet benchmarks for bonus funding. Mr Andrews consistently denied the practice was taking place and refused to investigate.

In response to the audit's finding, Mr Andrews yesterday announced that:

* A long-standing $40 million bonus funding pool used to reward hospital performance would be scrapped.

* Six hospitals would be audited without warning every year.

* Patients would be notified in writing if their waiting-list status changed, so they could challenge any discrepancies.

Mr Andrews said he was furious about the audit results and put all Victorian hospital boards on notice that data manipulation was unacceptable. "Health services are accountable for their data and there is an expectation that they record and report it accurately," he said.

The audit of the Royal Women's Hospital found that although staff spoke of "two waiting lists" in front of senior and executive management, executives claimed they knew nothing of it. A "data-entry instruction sheet" revealed that when patients neared a benchmark for how long they should wait, they were put on a secret list, which effectively stopped the clock.

The Government rewards most hospitals with bonus funding if they meet performance benchmarks, but the Royal Women's is not on this list. Mr Andrews said it had previously been on the list and that data manipulation appeared to be a long-standing practice potentially motivated by the incentives. He said he had appointed a delegate to the board of the Royal Women's to ensure the fraud was eliminated. The secretary of the Department of Human Services had received the report and would take legal advice on what action could be taken against those involved, he said.

Royal Women's chief executive Dale Fisher said she had ordered a clinical review to establish whether patient care was affected by the list rorting. She said that, "on the face of it", there was no effect on patients because the list manipulation did not change the booking date of an operation, only the report of the patient's waiting time. "The people got treated at the next available opportunity," she said.

But Ms Fisher admitted it might have hurt the hospital's gynaecological department. "That's one of the disappointing things … that it did compromise our view of demand in gynaecology," she said. "We could have strategically allocated more resources." She said "appropriate disciplinary action" would be taken against staff involved in the practice. This could range from counselling to sacking — but no one had yet lost their job.

Ms Fisher defended her management of the hospital, saying there was no reason the executive team would have spotted the practice, because it was designed to "iron out" the kinds of peaks and troughs that drew management attention. "I am pleased that we found the problem and fixed the problem," she said.

But Ms Fisher said she may never have realised the seriousness of the issue if it was not for a report in The Age this month about waiting-list fraud in unnamed hospitals — a month after she knew about the list problem at her own hospital. "When I found this … I viewed it as a management problem that we needed to fix. The level of seriousness was raised as a result of that article … It was the issue of possible fraud (that) raised the level of seriousness." The hospital will centralise training of staff to get greater control over data reporting, and its internal auditors have been asked "to make sure we're not missing anything else".

The Victorian president of the Australian Medical Association, Doug Travis, welcomed the decision to scrap the bonus pool, saying it would allow hospitals to focus on patient care. "There has been a culture in Victorian hospitals to hit your (key performance indicators) no matter what," he said. "Our community needs to be assured that hospital funds and resources are directed where they are needed."

Shadow health minister Helen Shardey said the Government's response was inadequate because six random audits a year would allow a major hospital to go three years without being audited. "There should be an immediate independent audit of all hospital waiting lists," she said.

SOURCE