NHS FLOUNDERING

Patricia Hewitt, the Health Secretary, admitted yesterday that the NHS “no longer knows where it is going”. “Where will we be in five years, ten years, fifteen years’ time?” she asked. She gave no answer, other than it lay in the hands of local NHS organisations — and the Government’s reforms were designed to empower them to discover it.

In a speech peppered with such admissions, Ms Hewitt said that it was hard for anyone to understand that after years of unprecedented investment, the service was dealing with financial problems. “After years of more staff, there are now job losses,” she acknowledged — a fact she has hithero denied by arguing that posts, and not jobs, were being lost. But she went insisted that reforms were the way to sustain the values of the NHS and that the Government would not undermine those values. “The changes and reforms we are making are not only compatible with our traditional values: they are essential if we are to protect those values in a fast-changing world,” she told an audience in London.

Speaking to the Institute for Public Policy Research, Ms Hewitt said that the NHS was “a 1940s system operating in a 21st century world”, and where patient care was improving it was despite the system, not because of it. Calling for an end to the old “top-down” system, Ms Hewitt emphasised the need for strong local commissioning of services, underpinned by national standards and targets. On the issue of private service providers, she said: “If independent providers can help the NHS provide even better care and value for patients, we should use them.”

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The usual government approach to "child welfare"

No Australian State is free from such gross official negligence

A baby suffered serious electrical burns, witnessed repeated acts of domestic violence and lived in horrific conditions for 22 months before Victorian welfare authorities finally took her away from her drug-addicted mother. The state's Department of Human Services was first notified of concerns for the girl in March 2001, when the child was three months old. Despite the mother's first child being removed from her care in 1999, the second child was not removed by the department until January 2003.

The full horror of the girl's first two years of life have been detailed in a judgment handed down by the Victorian Civil and Administrative Tribunal. A non-government child welfare worker, who made repeated visits to the mother's Melbourne home between August 2002 and January 2003, detailed the appalling conditions the child was forced to endure. On her first visit, the worker found the child, then 19 months old, wearing only a sodden nappy that had leaked on a three-seater couch. It left a pool of urine that the mother made no attempt to acknowledge or clean up.

The girl was also eating yoghurt with hands that were covered in urine. Asked by the worker to take away the yoghurt, bath her daughter and change her nappy, the Aboriginal mother, who was 21 years old when she gave birth, said: "I'll do it after I finish my smoke and coffee." Despite the electrical burns suffered eight months earlier, the worker - on the next visit - saw the girl playing with electrical cords plugged into the wall. On September 13, 2002, the worker found the mother and girl lying together on a filthy mattress. A male friend was present and said he and the mother had been drinking the previous night. An open beer bottle was at his feet. It was 9.30am.

The girl, who was unclean and naked, picked up an empty baby bottle that she pushed against her vagina and then placed in her mouth. The worker noticed a large bruise and graze on the girl's knee. Five days later, the worker returned and saw a bump "the size of a walnut" on the girl's head. The mother said her daughter had fallen over. Asked if the girl had seen a doctor, the mother said "she didn't need to because she was OK". The next day the worker returned to find the bump on the girl's head was "still large and now (had) a large dark blue bruise surrounding it". She suggested the mother take her to a doctor as she could have a concussion. The mother said "she could not because she had access today and then had to go shopping".

The mother subsequently took the child to a parenting group. The girl became extremely distressed, screaming and banging her head against the floor. The mother ignored her and only picked her up after urging by a welfare worker. The department was first notified about the child when she was nearly three months old. Seven months later, in October 2001, the department received a second notification. In January 2002, three days after her first birthday, the girl received serious electrical burns to her foot requiring skin grafts.

A supervision order was made in the Children's Court of Victoria in March 2002. But the mother repeatedly breached it, turning up to the department high on drugs and with the girl. On November 14, 2002, the mother said her daughter had been vomiting and had suffered diarrhoea for two days. The welfare worker suggested she take her to a doctor but the mother said the girl was "alright (and) was getting better". "The (worker) noticed piles of cat faeces in the bedroom that appeared to have been there for many days," the VCAT summary said. "(The mother) said her toilet was blocked and that she was using a bucket to urinate in and tipping it out around the back of the flat". The worker returned with a social work student to clean up the flat. "The smell of faeces in the flat was overpowering," she said. "There was six empty methadone bottles on the lounge room floor and on the mantle that were easily accessible."

On January 2003, the mother brought her daughter to a welfare agency, the Caroline Chisolm Society. After smelling the girl's dirty nappy, the worker saw patches of raw skin on her bottom and noticed a rash and thrush halfway down her leg. The mother said she had been drinking vodka and had forgotten to take the girl to the doctor. Evidence from another welfare worker outlined how the girl picked up a used syringe. The mother appeared unconcerned.

The girl was removed from the mother's care after a report to the department from the Royal Children's Hospital in January 2003. The mother was subsequently found to have a history since early childhood of severe domestic violence, substance abuse, neglect and deprivation. When the mother was three, her older sister had been murdered. She was placed in foster care but had suffered repeated sexual abuse there. She lived on the street from the age of 14 and had convictions for theft and robbery from the age of 15. She also took heroin. The mother now sees her child, supervised, for two hours every three weeks. Senior VCAT member Robert Davis rejected her bid for shared guardianship. He said the girl, now five, appeared to be well settled and "thriving" with her foster parents, their two children and her sister.

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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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