CHILDREN HIT BY NHS COST-CUTTING

Four children's hospitals have warned ministers that they face large deficits and cuts in services as a result of the latest NHS reforms. The chief executives of Great Ormond Street Hospital for Children in London, Alder Hey in Liverpool and Sheffield and Birmingham Children's Hospitals say in a letter that the operation of the tariff - the list of fixed prices for NHS procedures - will leave them about 22 million pounds a year worse off.

The tariff is a key feature of payment by results, one of the NHS reforms the Prime Minister is expected to extol in a speech today. Payment by results means that hospitals are paid for what they do, according to the fixed prices laid down in the tariff. Specialist hospitals have long argued that the tariff is insufficiently sophisticated to take account of the greater complexity of the operations and other procedures they carry out.

There have been discussions about adding special supplements to the tariff for children's hospitals to try to reduce the losses, but in a letter sent to Lord Warner, the Health Minister, and Sir Ian Carruthers, acting chief executive of the NHS, the hospitals say that this has not been done in the latest version of the tariff. Based on calculations that they have made so far, Great Ormond Street expects to lose 5.93 million in 2006-07, Alder Hey 11.03 million, Sheffield 2.5 million, and Birmingham Children's Hospital at least 2.6 million - a total of 22 million. These forecasts "pose fundamental problems for business continuity and access to specialist services", the letter says. "It has been clear to us for some time that these problems are largely the result of an inaccurate and highly insensitive tariff."

To make ends meet, the hospitals say, they will have to identify those services on which they stand to lose most money and stop providing them. Obvious candidates include heart, brain and spinal surgery. "We are extremely concerned that vital specialist paediatric capacity, particularly in surgical specialties, will be lost at regional and national levels this year, which will lead to public concern," the letter says. "The new opportunities presented by choice and through payment by results should be benefiting children and young people, but quite the opposite seems to be the case."

Steve Webb, the Liberal Democrat health spokesman, said: "The whole process of NHS reform is being conducted at breakneck speed, simply in order to guarantee the Prime Minister a `legacy'. "On present form, the Prime Minister's legacy risks being a decimated NHS, thrown into chaos by over-hasty reform and permanent revolution."

The letter could not have come to light at a worse moment for the Prime Minister. In his speech today to the New Health Network, Mr Blair will herald the new tariff system as central to the government health reforms as he attempts to shift the focus away from the financial deficits that have forced hospitals to cancel operations and make redundancies. He will claim that his structural changes to the NHS have reached "crunch point" and will vow not to back down.

The first phase of Labour's health reforms, in which ministers used strong central targets to improve services and bring down waiting lists, is complete, he will say. The Government is now embarking on the second stage in which the idea of an old monolithic NHS will be abandoned and replaced with one that is more decentralised.

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Australian public health officials 'unreceptive' to superbug concern

Federal health authorities have been "unreceptive" to concerns about an evolving epidemic of new strains of golden staph, a senior public health official says.

Dr Keryn Christiansen, of Royal Perth Hospital (RPH), says community acquired methicillan resistant staphylococcus aureus, or CA-MRSA, is increasing for unknown reasons in some parts of Australia and particularly Western Australia. Dr Christiansen and co-authors of a study published in this month's Australian Medical Journal, surveyed 2,600 golden staph isolates (germs) collected from around Australia. Nationally, the appearance of the CA-MRSA strain rose from 4.7 per cent to 7.3 per cent of the sample, compared with similar surveys in 2000 and 2002. WA had a quarter of all national cases of CA-MRSA, between July 2004 and February 2005. The article refers to the issue as an "evolving epidemic".

But Dr Christiansen, head of microbiology and infectious diseases at RPH, says she has had trouble drawing the issue to the attention of federal authorities. "Unfortunately we've been unable to engage the federal government in this," she told AAP. "They've got other things on their agenda like pandemic flu and bio-terrorism and they're really putting a lot of money into that and not looking at this."

Methicillin-resistant Staphylococcus (MRSA), or Golden Staph, has long plagued hospital patients but other virulent related strains are now infecting people who have had no hospital contact. "In the past when we've seen the resistant strains, we've seen them in hospitals and they've been resistant to many, many antibiotics," said Dr Christiansen. "What we're seeing now is something completely different. "These patients have had no contact with hospitals, have never acquired these organisms from hospital contact and when you look at the organism genetically, they are quite distinct from the hospital variety. "Our other concern is that some of these strains contain a toxin called Panton-Valentine leukocidin (PVL), and this toxin actually breaks down white blood cells."

Dr Christiansen said they were not sure why the number of cases in WA was so high, but the state had a rigorous reporting process, not in place in other states and territories. "Every single MRSA that's isolated in this state is notified and we collect at my lab - we actually get the organism and we test it," she said. "We're not really sure why they should be so high ... we've got a few studies going to try and look at reasons for our high rates. "Our concern is that it is becoming more and more resistant and therefore will be difficult to treat," Dr Christiansen said.

Symptoms of community-acquired MRSA could be sores that turned into large abscesses or carbuncles, or wound infections that did not respond to treatment. A federal department of health spokeswoman said the department had met Dr Christiansen and there was ongoing discussion with expert committees on the best way to address community-acquired infections

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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