Hope snatched from dying child by government medical system

In Australia's notorious State of New South Wales, unsurprisingly

After being told two months ago nothing could be done to save her, a little girl received an extraordinary second chance at life, only to have it taken away. Kayla Hilderbrandt's health improved just enough to ensure she could survive surgery to replace her faulty heart valve. Her doctors and parents seized the window of opportunity, booking her in for urgent surgery at Sydney's Westmead Children's Hospital.

Since being admitted last week, her life-saving operation has been cancelled three times because the hospital had no intensive care beds available. She is angry, her parents are angry, but the hospital says there is nothing they can do about it. "I felt angry because they made me fast and not drink and my stomach gets all upset," Kayla said from her hospital bed yesterday. "The medicine was disgusting and made me feel like wanting to be sick."

It has been an emotional roller coaster for the 13-year-old from Mangrove Mountain on the NSW Central Coast, who has been too ill to go to school for most of this year. She is terrified about the surgery and has been even more anxious each of the three nights before her scheduled operations, which required fasting and special anti-bacterial bathing.

Kayla's mother Gina was especially distressed yesterday, saying the cancellation of her child's surgery was "absolutely disgusting". "They are using the ICU as an overflow from the emergency department, so there is no room for any of the surgical patients," she said. "All the kids who needed heart operations were cancelled the same day that Kayla was. "Kayla needs this surgery now while she is well enough to have it. Two months ago we were told there was no hope for her."

Mrs Hilderbrandt said her daughter suffered from high blood pressure, which had been managed with medication for four years. This year the medication stopped working, leaving Kayla's liver and kidneys congested because her heart was so weak. Doctors have told the family Kayla needs her mitral valve replaced - one of the heart's major valves.

Her operation has been rescheduled for Wednesday, with no guarantees it will definitely go ahead. "I just want a yes/no answer," Kayla's father Kit said. "I don't want her prepared for surgery only to have it cancelled again." Westmead Children's Hospital CEO Professor Kim Oates said the hospital would "move heaven and earth" to ensure Kayla's booking for surgery on Wednesday morning will go ahead. Professor Oates said Kayla's surgery was cancelled because the ICU was full because of the problems caused by the busy winter period. "It's not a financial problem, it's a staffing problem," he said. "We won't do heart surgery unless we have a fully-staffed ICU bed for the next 72 hours."

Kayla is just one of up to 30 per cent of surgical patients across the state whose operations are cancelled on the day because an intensive care bed is not available for them. Dr Patrick Cregan, chair of the NSW Health's Surgical Services Taskforce, established last year to manage surgery patients, said Westmead Hospital's cancellation rate was close to 30 per cent for patients needing an intensive care bed after their operation. "It is always terribly distressing for the patient to be cancelled on the day of their operation," he said. "The patients for which it happens more frequently is those needing intensive care beds."

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AMBULANCES UNDER ATTACK IN BRITAIN

The number of ambulances could be halved within the next six years as part of an overhaul of emergency care in the NHS. A government review of ambulance services to be published next week is expected to recommend a sharp reduction in the number of people taken to accident and emergency departments. Non-urgent call-outs, such as a cut finger or earache, are to be given to a growing army of emergency care practitioners (ECPs), who are trained to treat minor ailments outside hospital. Peter Bradley, the national ambulance adviser to the Department of Health and leader of the review, told a conference last week that he could envisage a significant decrease in ambulance use.

A cut in the number of ambulances is not suggested in the review, although it will outline the importance of a significant reallocation of resources to make the service more focused on "treatment than transport". It is known that Mr Bradley and George Alberti, the national director for emergency access, hope to increase the use of ECPs, who combine elements of nursing, medicine and the role of paramedics. ECPs travel alone in people carriers carrying the basic equipment for their work.

The national ambulance review will outline ways to reduce the number of patients taken to accident and emergency departments by a million a year. Mr Bradley, the chief executive of the London Ambulance Service Trust, said that he wanted to see the service becoming a "mobile unit of the NHS taking healthcare to patients". His vision, outlined at the NHS Confederation conference and reported in Health Service Journal, includes doctors dealing with 999 calls in call centres, with ECPs taking on extra services such as diagnostics and blood sampling. "We are going to see a big shift from not only providing clinical guidance in the field but also in the control centres - dealing with patients at source rather than elsewhere," he said. Mr Bradley said that in London ECPs could rise from 3 to 30 per cent of the NHS workforce by 2011. Less than half of all callers would be taken to A&E, compared with three-quarters now. "Maybe in 2011 we'll have only half as many (ambulances)," he said. "We'll have ECPs singly responding in people carriers. We'll be a lot less reliant on a big 3-tonne ambulance going out at o140,000 apiece."

Last night the Department of Health denied that any ambulances would be cut as part of the overhaul of emergency care. The BBC Radio 4 Today programme yesterday highlighted discrepancies in ambulance response times by different trusts. The programme claimed that many trusts do not start the clock until 1® or 2 minutes after the call is received, and in at least one case the delay may be as much as 3 or 4 minutes, distorting results

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation.

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