British Labour's health chaos: you couldn't make it up

They are trying to close an A&E [ER] department in Casualty. In Holby City more and more patients have to be transferred to specialist centres elsewhere. In No 10 they wish everyone could understand what the scriptwriters do: the NHS is changing.

The voters certainly don’t get it. It used to be Labour’s boast that it was the party of the NHS. And it was true: every single poll showed Labour ahead of the Conservatives on the health service, always. Until this summer. In the past ten years Labour has achieved the extraordinary feat of turning a 49-point lead over the Tories on health into a four-point lead for the Tories (Ipsos MORI). That’s a stunning fall at a time when spending on the NHS under Labour has ballooned from £35 billion to £80 billion, and waiting lists have fallen from 18 to six months.

In part the decline reflects growing cynicism about the Government in general, in part it is a riposte to overblown promises about “saving the NHS”. Ten years after promising to “save” it, the health service has a £500 million debt and 60 hospitals are threatened with closure or downgrading.

What went wrong? First, not as much as it sounds. The debt isn’t a lot for a health service with a budget of £80 billion. Gordon Brown could flick that away with a stroke of his pen, or his big clunking fist.

Nor is it on the whole that the Conservative Party is trusted more with the NHS; Labour is just trusted less. Four in ten people say that they don’t know who would do the best job any more.

That’s the good news for the Government. The rest is bad. With hospital closures imminent and a ferocious Conservative assault on the territory, including a cheeky campaign to “stop Brown’s NHS cuts”, Labour is worried. Not quite worried sick, but it should be.

The drive to cut the debt has coincided with a big push towards “reconfiguration” of services — hospital closures to you and me. It is almost impossible now for ministers to disentangle in people’s minds the idea that the local health service is in debt with the fact that their hospital is under threat. The Government argues that the closure or downgrading of some hospitals was always implicit in its reforms, regardless of the current financial difficulties, as some treatment was brought “closer to the people” while greater specialisation saw fewer, more specialised hospitals. I don’t remember them championing hospital closures when they published their reform programme, the NHS Plan, six years ago. It was an implicit not an explicit part of it.

The area I live in is in debt and has a number of hospitals under threat. Throughout Surrey and Sussex, in East Anglia and other threatened areas, this is the big conversation. It dominates local media. What ministers may have hoped could be contained in a few mainly Conservative rural areas has spilled over into the national press, and they haven’t even started shutting any of the hospitals yet. We are in a pre-consultation planning period, when health authorities are drawing up plans for public consultation next year, and rumours abound as to what hideousness they may contain. The vacuum of information is filled by local GPs, who tell patients they cannot take on the extra work the Government says they are going to do when the hospital closes: no staff, and no space to expand the surgery.

What mastermind at the heart of government, I wonder, planned this? And planned it so perfectly that the next election is going to coincide with massive hospital cuts?

“It’s the right thing to do,” they repeat. Tony Blair is not for turning. Fewer, more specialised hospitals will be safer for patients who will end up overall with better services, not worse. And what is more, we won’t get to the maximum 18-week wait between GP referral and treatment by the end of 2008 unless we do it.

So between spring next year and the end of 2008 the Government is simultaneously going to jump through the hoops of closing hospitals, reorganise local services, open new treatment centres and make the biggest, deepest cut yet in waiting lists? Forget it.

There is a broader tension in government policy that nobody can resolve: just as it claims to be bringing care closer to the people, it is planning to take local A&E and maternity departments further away from them. Local health planners calculate how long an ambulance with a flashing blue light might take to reach the specialist hospital, not an ordinary driver distracted by a sick family member in the car. Ministers have realised that these are the issues that have to be addressed, tangibly, in the local reorganisation proposals, which is why they have been put back until next year.

Let’s assume that the Government is right and a lot of conditions — asthma, diabetes, heart disease, arthritis — as well as many minor operations could be better and more cheaply managed in local communities or at home than in big hospitals. Let’s allow too that superhospitals with knobs on have a better chance of saving the life of a seriously injured person, and that babies are marginally more safely delivered in larger specialist centres (which is why mothers at high risk will be transferred there anyway).

That still won’t answer the “local” problem. People do not feel safe without access to an A&E that they can reach within a reasonable time. They would prefer to have their babies in a local hospital, which means maintaining a full maternity unit — there were some terrible problems in Kidderminster when the maternity unit was downgraded to a midwife-led one. And when a baby is born, or someone is taken ill in the night, the family wants to be able to visit the next day, without making a two to three-hour round trip, plus the visit time.

These are human needs outside the medical charts, and the Government has failed to grasp them. I wonder if it’s too late to ask Casualty’s scriptwriters for help.

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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?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.

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Filth and shame in an NHS hospital

Twenty-four hours to save the NHS! I wonder how often that promise comes back to haunt Tony Blair 10 years later. Week after week reliable reports and the government’s own figures tell a disgraceful story of incompetence, debt, misery and filth in the National Health Service. That story is supported, week after week, by heart-rending personal accounts of horrors on the wards.

The broken new Labour promise that caught most public attention last week was the failure to abolish mixed-sex wards. Janet Street-Porter, the ferocious media personality, wrote about the misery of her sister when dying of cancer in a mixed-sex NHS ward. Plenty of other people have tried to draw attention to this disgrace and Baroness Knight, the Conservative peer, has been campaigning about it for years but — such is the spirit of the times — it takes a loud-mouth celebrity to get public attention.

The same thing happened when Lord Winston made a fuss about the dreadful treatment that his elderly mother received in hospital. Only then did the government stop denying that there was anything wrong.

Street-Porter published extracts last week of the diary of Patricia Balsom, her dying sister. They were horrifying. Among the miseries she endured was lying neglected in a mixed ward, where she was woken more than once to see a naked male patient masturbating opposite her bed. Her shocking stories prompted a flood of others.

The late Eileen Fahey, for instance, dying of cancer, was put onto a mixed geriatric ward where confused people wandered about without supervision. One man with dementia regularly masturbated at the nurses’ station and tried to get into women patients’ beds; he was a threat to them all but staff took no notice, according to her daughter Maureen. Other patients have to give answers to intimate questions in the hearing of other patients. One deaf old man was repeatedly asked when he last had an erection, until tears ran down his cheeks.

A former midwife described eloquently on Radio 4 the indignities of being in a 24-bed mixed-sex ward, stripped of all dignity and intimidated. Bedlam was the word she used, and it applies even more accurately to the secure psychiatric mixed ward in London endured by Susan Craig last year, after a breakdown. She suffered regular sexual harassment, with mentally ill men groping her and exposing themselves. The nurses disbelieved her and told her husband she was “flaunting herself”.

If so (I don’t believe them), their job was to protect a patient from her own folly. Instead they chose, in modern cant, to blame the victim. Sexual harassment is only a small part of the problem. Many people, both men and women, feel their modesty is violated by such closeness to random members of the opposite sex, even when they are not threatened.

Patients lie naked, half washed and forgotten, their sick and ageing flesh exposed to everyone, while nurses rush elsewhere. It is commonplace to have to walk to filthy mixed lavatories with gowns wide open at the back. At a time of sickness and anxiety many people are profoundly embarrassed to be surrounded by a clutter of bed pans, colostomy bags, nakedness, cries of pain and sweat, blood and tears — their own and other people’s.

All this is much worse, for many, when they are surrounded by members of the opposite sex; shame and anxiety are not the best bedfellows of hope and healing. Much has been written about the rape of modesty and the death of shame. However, it is still true in this weary country that most men and women prefer to perform private bodily functions alone if possible, and among their own sex only, if not. That’s why we have separate public lavatories and separate changing rooms in shops and clubs and pubs. That’s why people put up towels on the beach. That’s why women give birth in female wards, not in mixed wards or not — I hope — so far.

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Sex-offender doctor still allowed to practice

What government mismanagement of medical training leads to

A Tasmanian doctor who sexually assaulted female patients will be practising again by June next year after the Medical Complaints Tribunal factored the state's general practitioner shortage into his punishment. The tribunal last month found Dr Ulhas Lad guilty of professional misconduct over his dealings with two female patients between April 2003 and July 2004. Dr Lad, 61, from Blackmans Bay, was yesterday suspended from practising until June 2007 and ordered to see only male patients when he resumes.

Medical Complaints Tribunal chairman David Porter, QC, said one of the factors the tribunal considered was "the regrettable situation that exists in this state in relation to general practitioners". Should an order to deregister Dr Lad be made there would be no little difficulty in filling the void, Mr Porter said.

Dr Lad's suspension and restriction to male patients arose from a complaint by a woman identified by the tribunal as AB. Mr Porter said Dr Lad's professional misconduct when dealing with AB involved a serious breach of trust and a gross violation of the doctor-patient relationship. Dr Lad sexually assaulted the woman at his surgery on a number of occasions, Mr Porter said. He said Dr Lad fondled his patient's breasts and buttocks, and had her separate her buttocks while she was bent over.

Dr Lad also performed a sex act in front of her at his surgery one night when she went there for pain relief. Mr Porter said the sex act was outrageous behaviour and a serious affront to the patient's dignity. He said Dr Lad's sexual assault of another female patient known as YZ3 was seen by the tribunal as previous relevant conduct.

The tribunal had also taken into account the overwhelming level of support for Dr Lad from the general and professional community, Mr Porter said. Dr Lad's lawyer Ken Procter, SC, presented the tribunal with 32 character references for his client. "We note all that has been said on behalf of Dr Lad," Mr Porter said.

Dr Lad was also fined $1000 for his professional misconduct in relation to a separate complaint by a second female patient known as CD. The woman said Dr Lad required her to undress to be weighed and made inappropriate comments when she saw him for antibiotics for the flu. Mr Porter said Dr Lad's behaviour towards CD was thoroughly inappropriate and his remarks were offensive. The $1000 fine imposed by the tribunal was one-fifth of the maximum amount it could impose, he said.

During the hearing seven more former patients came forward to complain about Dr Lad after reading reports of the case in the Mercury. Dr Lad denied the allegations against him. But the tribunal found it preferred the evidence of patient AB to that of Dr Lad, whose evidence was deemed "not at all convincing".

Dr Lad refused to comment as he left the Federal Court in Davey St, Hobart, yesterday. But his daughter Aparna said her father was innocent. Patient numbers at the surgery operated by her father and mother Dr Geeta Lad had not dropped since the women's complaints were made public nor since the tribunal's guilty finding, she said. Dr Lad's son Anoop said his father could rest easy because he had a clear conscience. The family would be looking at appeal options, he said.

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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?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.

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UNBELIEVABLE MEDI-CAL BUREAUCRACY

And California's Democrat legislators want to subject Californians to more of this!!

The physicians at Roseville Pediatrics say they almost stopped seeing Medi-Cal patients this year out of frustration. It took a year and a half for state workers to issue the practice a new Medi-Cal billing number after a move, said Dr. Ravinder Khaira, one of the two pediatricians at the clinic. During the wait, Khaira said, the clinic was forced to float about $100,000 the state owed for services to low-income patients enrolled in the government health insurance program for the poor. On top of that, workers handling the application were unreachable by telephone, Khaira said. The only way to communicate was via regular mail. "The only reason I would even consider remaining with Medi-Cal is because we want to take care of the kids," Khaira said. "The sheer volume of paperwork that needs to be done is at least triple what would be necessary for commercial insurance."

State officials dispute some details of Khaira's account, saying they have computer records showing the delay was only about a year. They say some of that delay occurred because the clinic filled out the forms incorrectly.

But Khaira's story illustrates one of the hurdles the state faces in trying to attract and retain doctors in the program, which covers more than 6 million poor Californians. According to the California Health Care Foundation, Medi-Cal has about 46 primary care doctors for every 100,000 patients. The standard for Medicaid, the federal program that funds Medi-Cal, is about 60 to 80 doctors per 100,000 patients. The strains on the system could grow if the number of people receiving Medi-Cal continues to increase. Gov. Arnold Schwarzenegger has said he wants to ensure all children eligible for the program are enrolled, which could add hundreds of thousands of new patients to the system.

Stan Rosenstein, the state's Medi-Cal director, said the Department of Health Services recently has made great strides in cutting down delays for doctors seeking to be certified to treat Medi-Cal patients. Two years ago, there was a backlog of about 11,000 applications from doctors waiting to be approved, and the wait averaged six months. Now, after the state hired management consultants and temporarily redirected staff members, there are about 3,000 pending applications, and the average wait is down to about 35 days, Rosenstein said. "Approximately 35 days is as good as we're probably going to get," Rosenstein said. "That is a very good status. The application processing takes time."

Part of the reason it takes time, Rosenstein said, is that the state has enacted new controls to make sure that doctors aren't committing fraud. Still, the system is not equipped to handle problems quickly. When there is a glitch with an application, the state communicates with doctors through the mail. Khaira said he tried to call a phone number listed on the enrollment forms and got a recording. "We are currently unable to staff the call center due to budget reductions and loss of staff," said the message, which was still on the Department of Health Services provider information line as of this week. "You may communicate directly to the branch using regular mail."

Rosenstein said the message was "terrible customer service." He said he had directed his staff members to take it down earlier this year. "I had thought it was changed, and we will get it changed," he said. Under the current system, Rosenstein said, doctors can leave a message and have their calls returned, though there is no way for them to be connected directly for live assistance.

In September, the Legislature approved Senate Bill 1353, which would have enacted some steps to streamline the doctor enrollment process. The governor vetoed the measure, sponsored by the California Medical Association, saying it could potentially create opportunities for fraud in the $33 billion program. The CMA is still hoping for improvements. "We think you can create a more efficient process and still prevent fraud," said Karen Nikos, a spokeswoman for the organization, which represents doctors. "We're having a hard time convincing physicians they should serve in these communities. It's the red-tape issue that the government is so famous for."

Rosenstein said the state is concerned about keeping an adequate number of doctors available to serve Medi-Cal patients. "We want to attract physicians, and we want to make it easier," he said. "We just have to have the balance we need to have strict fraud control."

Source

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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?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.

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Immovable public hospital bureaucracy

In the Australian State of Queensland

Jayant Patel, wanted in Queensland on manslaughter charges, was yesterday labelled a scapegoat by the investigator who first probed his work. Bundaberg Hospital Inquiry Commissioner Tony Morris QC said Dr Patel, allegedly responsible for patient deaths and hiding out in Portland in the USA, was never the problem.

The high-profile barrister, guest speaker at the Whistleblowers Australia conference in Brisbane, instead launched a blistering attack on Queensland Health. "In a strange sort of way he is almost a distraction," Mr Morris said. "Perhaps the enduring tragedy of Jayant Patel is . . . he has become a scapegoat for everything that is wrong in Queensland Health. Patel is not, and never was, the problem." Mr Morris, who was ousted as the inquiry's head after displaying "ostensible bias" against Bundaberg Hospital's managers, said bureaucratic over-administration was at the "heart of the problem". His comments yesterday were a departure from the interim inquiry report handed down in Parliament in June last year.

Yesterday he slammed Queensland Health for not implementing real reform since the Bundaberg crisis and "a bureaucracy which actively obstructs every attempt to do so". "In 2006, Queensland Health continues to recycle the self-same individuals whose apathy and dereliction produced the disaster which they are now still pretending to address."

Mr Morris singled out Bundaberg Hospital nurse Toni Hoffman for her blowing the whistle on Dr Patel. Ms Hoffman today will be presented with the Whistleblower of the Year Award jointly with Dr Con Aroney, who made disclosures about people dying on waiting lists.

Warrants for Dr Patel's arrest were issued in the Brisbane Magistrates Court on Wednesday. Detectives provided affidavits on charges, including three counts of manslaughter, five counts of grievous bodily harm, four counts of negligent acts causing harm and eight counts of fraud. Queensland Director of Prosecutions Leanne Clare will now make a formal request for extradition through Federal Justice Minister Chris Ellison.

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How amazing! Public hospital stays open a bit longer!

In the Australian State of New South Wales

The NSW government will try to cut hospital waiting lists by offering patients elective surgery over the Christmas break and recalling staff early from holidays. The period that public hospitals operate at reduced capacity will be trimmed from six to four weeks this year. Clinical staff typically take leave at this time, equipment undergoes maintenance and patients often defer surgery to avoid spending Christmas in hospital.

This year, however, patients who have been waiting a long time for elective surgery or who are overdue will be offered treatment during the holiday break, Health Minister John Hatzistergos says. Mr Hatzistergos said a new government policy would ensure patients requiring surgery within 30 days would be treated appropriately. Patients with less urgent conditions would be treated within 365 days and would not have to wait more than 12 months due to reduced hospital activity during the holiday season, he said. "We're making real progress in reducing waiting times and waiting lists but there's still more work to do," he said.

Source

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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?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.

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NHS PLAYING FAST AND LOOSE WITH DEFINITIONS AGAIN

Their favourite way of meeting their "targets"



The government has been accused of failing to meet a promise to scrap mixed-sex wards in NHS hospitals. The Department of Health said its targets had been achieved, and 99% of trusts are providing single sex accommodation. But patients groups said they were getting an increasing number of calls from people who think they have been in mixed-sex wards.

There appears to be confusion about the definition of the term. Katherine Murphy, from the Patients Association, said there had been 25-30 calls in the last month to the charity's helpline, mostly from elderly patients, who had been nursed on mixed-sex wards.

Andrew Lansley said it was not acceptable to claim that partitioned single-sex bays on mixed-sex wards were doing the job. "If you can be seen by patients of another sex, and they are coming and going past your bed in order to go to the toilet facilities you may not think you have the privacy you want."

The government pledged to scrap mixed-sex wards when it came to power in 1997. Health Secretary Patricia Hewitt said most trusts offered single-sex wards, but said more could be done.

More here





Australian public hospital nurse recognised with whistleblower award

The woman who alerted authorities to the Bundaberg Hospital crisis will be recognised at the annual Whistleblowers Australia conference this weekend. Bundaberg Base Hospital nurse Toni Hoffman will receive the Whistleblower of the Year award for uncovering the alleged criminal malpractice of overseas-trained surgeon Jayant Patel. Patel is allegedly linked with 17 patient deaths, and earlier this week a Brisbane Magistrate approved an arrest warrant for the 56-year-old doctor who fled to the US.

Ms Hoffman says she is thrilled to receive the award. "It's a great honour and I hope to be able to improve whistleblower protection through raising awareness," she said.

The national director for Whistleblowers Australia, Greg McMahon, says it was Ms Hoffman's concern for the community that earned her the award. "Toni Hoffman took the view that more was required of her because of her responsibility so that everybody needed to be protected," he said. Ms Hoffman will share the title with heart specialist Dr Con Aroney, who is being honoured for his role in revealing cutbacks at Brisbane's Prince Charles Hospital in 2004.

Source

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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?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.

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CASH-STRAPPED NHS CANNOT AFFORD NEEDED DRUGS

Plenty of money to pay an army of "administrators", though

The cost of making the breast cancer drug Herceptin available on the NHS will mean that health trusts have to deny patients other treatments, according to doctors writing in the British Medical Journal. Herceptin works for up to 25 per cent of breast cancer patients with a particular defective gene. But the cost of treating 75 patients with the 20,000 pound-a- year drug is equivalent to providing cancer treatment for more than 350 patients - while still requiring 500,000 pounds in extra funding.

In July the National Institute for Health and Clinical Excellence (NICE) recommended Herceptin for those with HER2- positive breast cancer. But three cancer specialists have now challenged the wisdom of the decision. Writing in the BMJ, the doctors, from Norfolk and Norwich University Hospital NHS Trust, calculated that in drug costs alone they would have to find 1.9 million pounds to treat 75 patients with Herceptin. Supplementary costs pushed the figure to 2.3 million, according to Ann Barrett, Tom Roques and Matthew Small.

The team, working with Richard Smith, a health economist from the University of East Anglia, said that they could fund Herceptin if they dropped post-surgery cancer treatments for 355 other patients - 16 of whom were likely to be cured. Or they could stop palliative chemotherapy for 208 patients. Either way they would also need to find 500,000 pounds. The doctors write: "These untreated patients will be people we know. We will be the ones to tell them they are not getting a treatment that has been proved to be effective, which costs relatively little, because it is not the `treatment of the moment'."

Source

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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?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.

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New Hearing for Suit Against FDA

Why on earth anyone would oppose this is incomprehensible. Only bureaucratic rigidity can explain the opposition

A federal court agreed yesterday to rehear a case that aims to get terminally ill patients early access to experimental drugs unlikely to be approved before they die. The full 10-judge U.S. Court of Appeals for the District of Columbia Circuit will probably hear the case next summer, said Richard A. Samp, chief counsel for the Washington Legal Foundation.

The group, with the Abigail Alliance for Better Access to Developmental Drugs, sued the Food and Drug Administration in 2003. It is seeking broader access to drugs that have undergone preliminary safety testing in as few as 20 people and have yet to be approved by the FDA.

In 2004, a district court dismissed the case. In May, a three-judge appeals panel reinstated the lawsuit in a 2 to 1 decision. The FDA, in turn, appealed and asked for the full court to rehear the case.

Source

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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?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.

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Weird: NHS hospitals to advertise themselves

Spending the money on hiring more doctors and reducing their waiting lists has not occurred to anybody, apparently

NHS hospitals are to be allowed to attract patients by advertising, under a Department of Health code. A draft version says that the NHS needs to give “reliable information” to assist patient choice, and should not spend too much on advertisements. There is unlikely to be a cap on trusts’ spending but costly television advertising is likely to be ruled out.

In consultation with GPs, patients now have a choice, albeit limited, of which hospital to have treatment at. Under the new payment-by-results system, hospitals are being given funds per patient treated. The successes of hospitals could be presented to patients through advertising; some independent hospital chains already advertise their services to GPs.

Gill Morgan, of the NHS Confederation, said: “We are trying to change the NHS from being a service where you get what you’re given, really, to a service where patients are much more able to choose what they want.”

Jonathan Fielden, of the British Medical Association, said: “NHS hospitals will have no option but to invest in marketing tactics if they are to survive against private firms. It is a sad indictment of government policy to consider spending public money on advertising NHS services when hospitals are having to make cutbacks in patient care, and redundancies.” The department said that a code on advertising would be put out to consultation soon.

Source

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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?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.

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Hospitals drop ball on heart attacks, researchers say

Only about one-third of hospitals provide emergency care to heart attack patients quickly enough to meet scientific guidelines for saving lives, researchers reported Sunday. Even the top performers meet the American Heart Association and American College of Cardiology guidelines for prompt care in just half of their cases, researchers say. "Even among the better hospitals, only a few hospitals routinely meet the recommended guidelines," says Yale cardiologist Harlan Krumholz, a leader of the research team and an architect of a national campaign launched Sunday to help hospitals improve their performance. "By next year, we're going to change that."

About 200,000 people a year have heart attacks caused by blockages in crucial arteries that supply the heart with blood. About 10,000 patients die of these heart attacks in hospitals each year.

Studies show that reopening clogged arteries by inflating a tiny balloon at the site of the blockage is the best way to treat a severe heart attack. The procedure, balloon angioplasty, can cut a patient's risk of dying by 40 percent, but only if it is done within 90 minutes of the patient's arrival at the hospital, the "door-to-balloon" time. If every hospital met the guidelines, Krumholz says, doctors could save about 1,000 lives each year. A study reported in March in the journal Circulation showed that 80 percent of people live within an hour's drive of a hospital that provides balloon angioplasty.

Yet only about one-third of heart attack patients get angioplasty within the 90-minute window. The new study surveyed 365 hospitals to determine what procedures they have in place to get patients angioplasty quickly. Just 35 percent reported an average door-to-balloon time of 90 minutes or less, 48 percent had a door-to-balloon time of 91 to 120 minutes, 13 percent came in at 121 to 150 minutes and 4 percent topped 150.

The study was released Sunday at an American Heart Association meeting and online by the New England Journal of Medicine. Hospitals agreed to participate if they weren't individually identified. Doctors said consumers can contact their local hospitals and ask whether they meet the American Heart Association and American College of Cardiology guidelines for heart attack care. The study was designed to help launch the new campaign, called D2B, by providing hospitals with ways to improve performance. "This is a national undertaking to try to save the lives of people who have heart attacks," says Steven Nissen of the Cleveland Clinic and president of the American College of Cardiology. "We're losing too many lives."

Source

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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?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.

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A NEW CONCEPT FOR CALIFORNIA: HEALTH INSURANCE MANDATES COST MONEY!

A task force established by Gov. Arnold Schwarzenegger to draft a plan for dealing with skyrocketing health costs in California is considering calling for repeal of some treatment mandates on health maintenance organizations. Administration aides said the proposal -- which would require approval by the Legislature -- is one of many under consideration as part of the long-awaited plan the Republican governor says he will unveil in his State of the State speech in January. "Right now, the administration is combing through hundreds of ideas and concepts," said Adam Mendelsohn, the governor's communications director. "No idea is in, no idea is out, and there is no specific plan developed."

Michael Shaw, assistant director for the National Federation of Independent Business, said relaxation of some mandates would lower premium costs for small-business owners and allow them to provide coverage for more employees. "The No. 1 reason that small businesses do not provide health care in many cases is that they simply can't afford it," said Shaw, whose organization has met with members of the governor's task force to urge them to repeal mandates. Employers have complained about the more than 50 mandates since 1999, when Gov. Gray Davis signed health care legislation requiring HMOs to offer a host of treatment and preventive care services. Included are coverage for a variety of mental illnesses, including anorexia and bulimia, cancer screenings and contraception. Employers blame the mandates for contributing to the 55 percent rise in insurance premiums in the last five years alone.

Schwarzenegger has said that reducing the ranks of the more than 6 million uninsured people in California will be one of his top priorities in the coming year. "We feel we shouldn't have 6 million people uninsured," the governor said last week. "We maybe cannot solve the whole problem, but we definitely can cut it in half and do something that really is impressive and shows the rest of the nation that it can be done."

But Beth Capell, a spokeswoman for Health Access, a coalition of more than 200 consumer and community groups that lobby for increased health care coverage for Californians, said she hoped the administration would come up with better proposals. "The idea that eliminating such basic care as Pap smears, mammograms and childhood immunizations saves money has been disproved by study after study," Capell said. "What's the point of having health insurance if it doesn't get you any health care?" Schwarzenegger aides did not specify which mandates would be under consideration for repeal.

Shaw, whose organization represents 35,000 employers in the state, said that because group insurance plans are required to provide more benefits than individual plans, many small business have been priced out of the market. "So we want to create a set of rules for all plans that treat individuals equally but do not cost people the ability to afford health care," he said. Shaw said single men, for example, should not be forced to pay for maternity care "simply because the state determined that it should be part of health coverage."

But state Sen. Sheila Kuehl, who as a member of the Assembly was involved in the crafting of the HMO mandates, said repealing some of the requirements would not improve health care in California. Kuehl, D-Santa Monica, this year wrote a bill that would have insured all Californians and abolished the role of private insurance companies in California, instead setting up a single-payer system in which the state would take over the role of insurers. Schwarzenegger vetoed the measure, Senate Bill 840, saying he opposes "government-run" health care.

"I think (eliminating mandates) is the least desirable way to lower the cost of health care for people in California because it does nothing to address the record profits of the for-profit insurance companies," Kuehl said.

The administration has said the governor's plan will include several measures designed to squeeze cost savings out of the health care system, including reining in overuse of services. A possible model is a program in Illinois that would require doctors to file prescriptions electronically rather than filling them out by hand.

Source




Pennypinching Australian State government tries to cut back on medical training

And Leftists say that private business is characterized by short-term thinking!

A group of the state's most senior emergency doctors has resigned en masse from a high-level government committee, signalling worsening relations between the Iemma Government and its frontline physicians. The doctors say the Government is forcing them to halve the time they spend teaching registrars, which would result in hospitals losing their accreditation to train doctors in emergency medicine. The end result, they warned, was an exodus of young doctors from the NSW health system and dangerously understaffed emergency departments.

In an open letter to the Premier, Morris Iemma, the doctors say NSW Health's plans would result in an unsafe level of care for patients and, as emergency medicine was a compulsory rotation, it would prevent interns from becoming registered. They note that even at current staffing levels not one NSW public hospital met the minimum specialist staffing requirements endorsed by state and territory health ministers.

The dispute began, the doctors say, when they learnt that NSW Health was reneging on a pay deal struck in April that gave a 25 per cent allowance for city-based emergency specialists filling shifts in rural and regional hospitals. The department said it would pay the allowance only if the doctors reduced their clinical support duties such as registrar training, further education and taking part in quality improvement programs. Any reduction in these duties would breach guidelines set by the Australasian College of Emergency Medicine - 75 per cent clinical work and 25 per cent clinical support work - the doctors say.

The executive director of the Australian Salaried Medical Officers Federation, Sim Mead, said NSW Health was pushing for clinical support work to be limited to 10 per cent of doctors' time. "If they move to 10 per cent, the accreditation for all emergency departments for registrar training in NSW will be withdrawn and the registrar workforce would be completely destroyed. "Why would a registrar want to work in a hospital without a training program, if their aim was to become a qualified specialist?"

After months of talks, the specialists have resigned from the Government's emergency advisory committee, the Emergency Care Taskforce. Rod Bishop is a senior emergency physician and was, until he resigned, co-chair of the taskforce. Dedicated to the specialty for 17 years, he is deeply frustrated and disappointed at the attitude of NSW Health. "There is a terrible workforce issue - no emergency department in the state meets the minimum staff specialist requirements . nor do we have the supply of registrars . to meet predicted future needs." If NSW Health did not offer emergency specialists a reasonable employment package, doctors would leave and the losers would be the patients, he said.

A letter to the director-general of NSW Health, Robyn Kruk, sent 18 days ago, has gone unanswered, and the NSW Industrial Relations Commission is trying to resolve the matter through conciliation. The chairman of the NSW Faculty of the Australasian College of Emergency Medicine, Tony Joseph, also a senior emergency specialist in one of the state's largest public hospitals, said NSW Health did not appear to care that hospitals would lose their training accreditation if its plan was implemented. It preferred to rely on locums paid up to $200 an hour to staff emergency departments, rather than increasing its workforce of emergency specialists, who were paid half that amount. A spokeswoman for NSW Health said the department would conduct a work study and liaise with the college and the union on the matter.

Source

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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?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.

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IMPENDING DRUGS BUNGLE BY THE DIM DEMOCRATS

Nancy Pelosi has promised that when the Democrats come into control of the House, they will repeal the ban preventing Medicare from negotiating directly with pharmaceutical companies, within the first 100 hours. She must expect that this legislation will bring down drug prices dramatically. In fact, it is not obvious that allowing the government to negotiate with pharmaceutical companies will lead to lower prices than those achieved by private drug plans. There are several good reasons that government negotiations may not decrease drug costs.

First, negotiations are a bargaining process. The relative balance of bargaining power determines at which price the deal is struck. People often confuse market power with bargaining power. The thinking goes, the larger the share of the market the buyer represents, the greater the bargaining power and thus the lower the prices negotiated. That line of reasoning fails with drugs, however, because the seller is frequently a monopolist so it cannot be threatened with replacement by a substitute. Instead, the only threat is exclusion from the market.

Rather than market share, a party's bargaining power is determined simply by its ability to say no, to walk away from the table without an agreement. Whether the government or a private drug plan has greater bargaining power is not clear. Which can walk away more easily and declare that some brand-name drug will not be covered on the formulary? Private plans like Kaiser or United are able to negotiate deep discounts with pharmaceutical companies precisely because of the plans' ability to say no -- the ability to include some drugs and to exclude others, allowing the market to judge the resulting formulary. On the other hand, when the government negotiates, its hands are tied because there are few drugs it can exclude without facing political backlash from doctors and the Medicare population, a very influential group of voters.

In fact, the government negotiating on behalf of Medicare beneficiaries may lead to some unintended adverse consequences. Since direct-to-consumer advertising is legal in the U.S., there is nothing preventing pharmaceutical companies from funding a torrent of advertisements for the "latest and greatest" drug, thereby creating a strong demand within the Medicare population for coverage of the drug. How firm can the government stand when negotiating for a drug being clamored for? This is not the sort of bargaining power that will lead to lower prices.

Secondly, by acting as one large buyer, the government will cause price discounts to become more expensive for pharmaceutical companies. In other words, the minimum price that the pharmaceutical company is able to accept increases. All else equal, this will lead to higher, not lower, prices. When private drug plans are negotiating individually with pharmaceutical companies, those companies have the power to "price discriminate," meaning they can charge lower prices to some drug plans and higher prices to others. This ability allows for large discounts. If Pfizer is able to give a deep discount to Kaiser without giving a similar discount to United, then it is less costly for Pfizer to give Kaiser that discount. If, however, Pfizer can give a deep discount to Kaiser only if the same discount is granted to all other Medicare drug plans, then the discount becomes very expensive.

Experience with the Medicaid best-price rule, passed as part of OBRA '90, provides both empirical and anecdotal evidence of price discounts becoming more expensive when buyers' discounts are forcibly linked together. The best-price rule states roughly that Medicaid will be granted a price for a drug that is the lowest price offered to any buyer of that drug. If that price is not low enough, Medicaid receives a fixed discount off the average price. In effect, the best-price rule transforms all private discounts negotiated between a pharmaceutical company and a drug plan into public discounts for Medicaid. Research by academics, along with a slew of anecdotal evidence reported in the press, suggests that after passage of the Medicaid best-price rule, the days of deep discounts to private drug plans have been numbered. Instead, for most drugs the dispersion in prices has declined significantly and the overall level of prices has increased. Even with products for which there are therapeutic substitutes available, price competition has become less intense.

All that aside, many will argue that, clearly, government negotiations lead to lower prices -- just look at Canada, or Britain, or France. True, those governments may obtain lower prices than the public pays in the U.S., but the real question is: Do those governments negotiate lower prices than what would be negotiated were smaller groups of buyers able to deal individually with pharmaceutical companies? Moreover, a great advantage that governments in other countries have over the U.S. government is the ability to control entry. Without direct-to-consumer advertising, citizens in other countries don't even hear about new drugs until the government has approved the drug and negotiated an amenable price. Interestingly, with the expansion of the Internet and unrestrained information flow, other governments have been facing new challenges. Earlier this year, a well-publicized legal battle brought by a U.K. woman against the NHS's decision not to cover Herceptin for early-stage breast cancer has compelled the NHS to reverse its original decision and to offer coverage for that drug.

Finally, there is the familiar economic argument that the market-determined price is the only fair price. How can the government determine what price is "fair," what price appropriately reimburses pharmaceutical companies for all their research and development efforts? How can the government determine what prices will encourage the right levels of future innovation? The government negotiating prices only leaves room for additional gains through political lobbying and campaigning, activities at which pharmaceutical companies have proven themselves rather adept.

Congressional Democrats need to be careful in making the logical leap from market share to bargaining power. Empowering the government to negotiate with pharmaceutical companies is not necessarily equivalent to achieving lower drug prices. In fact, neither economic theory nor historical experience suggests that will be the outcome. Members should think carefully before jumping on the bandwagon -- this promise may bring just the opposite of what was ordered

Source

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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?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.

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Gross mental health negligence in Britain

Cumulative failure of staff at a London hospital led to the murder of a former banker by a man whose schizophrenic condition made him dangerous, a report into the killing found yesterday. The independent inquiry recorded a number of errors in the treatment of John Barrett, 42, who was allowed to walk out of a secure unit despite a history of violence and mental illness. Barrett repeatedly stabbed Denis Finnegan, 50, a retired banker, as he cycled through Richmond Park on September 2, 2004. Two days earlier, Barrett had been admitted to the Springfield Mental Health Hospital in Tooting after hearing voices in his head, and was in a medium- security unit.

The inquiry named Gillian Mezey as the psychiatrist who made the "seriously flawed" decision to grant permission by phone for Barrett to have an hour's unescorted leave in the hospital grounds, even though she had not assessed his condition.

Robert Robinson, the lawyer who chaired the inquiry, was even more critical of management at the hospital and the South West London and St George's Trust, which runs it. He said that clinical decisions were often unsupported by evidence and were rarely challenged by colleagues. In a direct attack on the judgment of Dr Mezey and other clinicians, he said that staff had been too reluctant to intervene against Barrett's wishes, going along with what he wanted in the hope of maintaining his co-operation. That was con- trary to all legal and clinical guidelines, but management at the trust had failed to take action. "The trust knew there were problems and didn't do anything about them," he said.

Many senior managers have been replaced. In conclusion, the 422-page report casts doubt on whether the new senior staff at the trust were up to the job and recommended that a new team of experts be sent in to force through change. "We doubt whether there is the managerial capacity within forensic (psychiatric) services or the wider trust to achieve the necessary changes," it said. It called for the secure unit at Springfield hospital, in which Barrett was treated, to be closed. The trust has rejected this advice.

Dr Mezey, who is also a police adviser on domestic violence and murder, is still employed by the hospital but no longer deals directly with patients. Nigel Fisher, chief executive of the trust at the time of the murder, has been promoted to a job at the Department of Health, where he advises hospitals on how to win foundation status.

Peter Houghton, the trust's new chief executive, said now that the inquiry had been published he would explore whether disciplinary action would be taken. Along with the criticism of the health trust, the inquiry condemned the independent Mental Health Review Tribunal that allowed Barrett to leave secure care at Springfield hospital in 2003, only a year after he had stabbed three people at random at an outpatient clinic in St George's Hospital. One man almost died in the attack.

The tribunal spent only 45 minutes considering the case, examining reports from Springfield hospital that recommended conditional discharge. At the time of the 2002 stabbing he was considered so dangerous that he was placed under the direct care of the Home Office. Only the Home Office raised objections to his release, making it clear that it did not want him back in the community. Barrett failed to adhere to the conditions laid down for his release, including taking his antipsychotic drugs and staying off recreational drugs. The conditions were not monitored or enforced, and he began to behave erratically and complained of hearing whispering voices. That led to his returning to Springfield hospital on August 31, 2004. He was furious when he was placed in a secure ward, believing that he should have been placed on an open ward. In the hope of calming him down and retaining his co-operation for treatment, Dr Mezey granted him "ground leave" from which he absconded and murdered Mr Finnegan, a stranger.

Michael Howlett, director of the Zito Trust, a mental health charity set up in 1994 after the murder of Jonathan Zito by a man suffering from paranoid schizophrenia, said that it was the most damning report he had seen in the past decade. "It beggars belief that John Barrett, who was a restricted patient under the responsibility of the Home Office for a very serious offence of violence in which he very nearly killed a man in 2002, should have been granted a conditional discharge by a mental health review tribunal as early as 2003," he said.

Source





Australia: A billion dollars worth of ambulance funding evaporates

Britain is not alone in spending more to get less

The number of emergency service vehicles on Queensland streets has declined over the past three years while community taxes have raised almost $1 billion in revenue for the State Government. Figures from recent Emergency Services annual reports state the number of operational vehicles - including ambulances, fire units and emergency helicopters - had fallen by about 50 each year since the introduction of the community ambulance levy. Last financial year $238 million was raised from fire levies and about $110 million from ambulance taxes.

Across Queensland, 2145 vehicles were stationed last year, a drop of 95 since 2004-05, but these figures were disputed yesterday. Emergency Services Minister Pat Purcell, who admitted on radio that he did not know how many ambulances were in the fleet, said the reporting conditions had changed and there was an increase of 18 ambulances from the previous year. "Vehicles are only one part of the picture," he said.

Opposition emergency services spokesman Ted Malone questioned how the additional funds were spent and called for a review. "The focus has been taken off running a lean, mean department of service delivery right at the cutting edge all the time," he said.

Source

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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?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.

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U.K.: Police-check fiasco stops 12,000 nurses working

Thousands of nurses and public sector staff have been left unable to work for months because of a backlog of police checks. Up to 50,000 workers, including 12,000 nurses, were caught in delays as new computer equipment meant criminal records checks were stockpiled. A row has broken out between the Metropolitan Police and the Criminal Records Bureau over who is to blame for the fiasco.

The delay occurred when the bureau installed a new computer system which was not compatible with the Met's software. It meant all new applications were stacked up until the police fitted their own new system. During that time nurses and other staff could not legally work. Agency nurse Sally Powell, from Islington, threatened to sue the police after delays meant she was unable to work for five months. A letter to her from the Met, passed to Nursing Times, said: "The problem arose because the Criminal Records Bureau went live with a computer system linking to a national database in February 2006. "The Metropolitan Police Service told the Criminal Records Bureau that its computer system would not be ready to link into this in time and that they should not send referrals on that system until the Metropolitan Police Service was live. "However the bureau went ahead anyway and the Met had no choice but to stockpile the CRB referrals."

Ms Powell, 53, filed her application in April but did not get clearance to work until September. Ms Powell, a senior nurse who has been in the NHS since 1969, said: "99.99 per cent of the time you never even need these checks but every time you change organisation you have to get it done. "I was told the check would take between four and six weeks but it took five months. I had to take work doing odd jobs. I had to freeze my mortgage because I had no money coming in. "Some nurses have had to wait for eight months and that has impoverished them. It is an infringement of my civil rights to employment as a qualified nurse. I have written to the Home Secretary." Ms Powell was told by the Met that 50,000 people had been caught up in the delay and 12,000 of those were nurses.

A spokesman for the Met said: "The technical problems which are referred to in the letter sent to Ms Powell were addressed when the MPS system went live on 2 May 2006. "There are a number of outstanding checks - however the backlog referred to has been reduced considerably. Since the new system went live the Metropolitan Police have been processing 50,000 checks a month." A spokeswoman for the Criminal Records Bureau said the problem arose as new systems were introduced and data was added to a national database. She said: "The CRB's first and foremost priority is to help protect children and vulnerable adults by assisting organisations who are recruiting people into positions of trust. "Priority must be the safety of children and vulnerable adults - neither the CRB or the Met will sacrifice quality for speed.

Source




Australia: Old medical equipment risking public hospital patient care

The Australian Medical Association (AMA) says lives are being put in danger because of outdated equipment at regional hospitals. The AMA's Victorian president, Dr Mark Yates, says a CT scanner at the Bendigo Hospital has been breaking down continually and it was out of action for two weeks recently. He says some patients were taken to a private hospital for tests, but critically ill patients could not be moved, and had to be treated without vital diagnostic assessment. Dr Yates says doctors in Bendigo are extremely concerned about the backlog of inadequate medical equipment. "In Bendigo there's a significant problem, we've got an old piece of machinery in a hospital that is a critical trauma centre and that needs to be fixed and we certainly can't have a situation where patients are put at risk," he said.

Source

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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?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.

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U.K. dental shortage leads man to superglue own tooth

The Brits have paid their government to provide them with health insurance but collecting what they have paid for is another matter



A man fixed his front tooth with superglue after failing to find an NHS dentist. Gordon Cook, 55, has used the bizarre "DIY dentistry" technique on a loose crown for the last three years - with each fresh application of glue lasting around two months. The father of seven, who was erased from his original dentist's register after moving to a new home in Tranmere, Merseyside, said he turned to glue after losing hope of finding a dentist. He said: "I tried to find a new dentist but they had all gone private. "A lot of them said they would take me on as an NHS patient, but only if I agreed to have the loose crown fixed as a private patient, which would cost around 100 pounds.

"In the end, I just decided to take matters into my own hands. I had read somewhere that super glue was invented for medical use, to bond skin, so I gave it a go. "I tried a few different brands but the one I use now, which is just called Industrial Super Glue, is the best. "You can't really taste it but you do have to be careful not to use too much, in case you glue your mouth shut." Mr Cook, a security manager, has now found an NHS dentist and hopes to have the crown fixed professionally.

Councillor Chris Blakeley, chairman of Wirral Council's social care and health overview and scrutiny committee, said: "Mr Cook's solution was rather extreme but he is not alone when it comes to dentistry horror stories. "People are finding it extremely difficult to find an NHS dentist, and we are currently gathering evidence to assess the scale of the problem, which is not unique to this area."

Source






Australia: A government ambulance service near-meltdown

Ambulance employees racked up 610,058 hours in overtime last year - the equivalent of an extra 334 full-time staff - as the state's health system continued to struggle. The overtime hours cost the Government about $23.5 million for the extra hours. It came as the demand for emergency code 1 services increased by 12.2 per cent last year and hospitals continued to struggle to provide services.

Ambulance Employees Australia Queensland spokesman Steve Crow said the continued reliance on overtime was akin to a "pressure cooker" situation. "My concern is how long they can they keep it up," he said. "It's just stupendous - or stupid." Mr Crow said the organisation received daily reports from paramedics about their overtime concerns, particularly in the busy metropolitan regions, compounding their already stressful job. "It is a stressful job," he said. "Our ambos take home a great deal of work on their shoulders."

Emergency Services Minister Pat Purcell said overtime was an integral part of the Ambulance Service's delivery model. Despite the growth in demand, the service reduced its overtime hours "as a result of more efficient and effective work practices and resource development, including matching resources to community demand profiles". "When recalled to duty, paramedics are paid overtime for all time worked," Mr Purcell said. Although the actual overtime hours worked were down 25,332 on last year, the cost was up $1.167 million.

Opposition emergency services spokesman Ted Malone said the figures cast serious doubts on the management. "There are some real problems within the managerial side of the QAS," he said. "With no disrespect to the people, if you had a heart attack do you really want a person who has been working for 16 hours to save your life?" He said reasons for the increases included ambulances being "used as hospitals" while emergency departments were on bypass.

Queensland's hospitals continue to experience massive demand. In the most recent Hospital Performance Report to the end of September, 11.9 per cent of patients awaiting category 1 elective surgery had "long waits". Likewise, 22 per cent of patients waiting for category 2 surgery and 32.9 per cent of patients awaiting category 3 surgeries had long waits.

The Department of Emergency Services annual report said the service would employ 70 additional paramedics this financial year to cope with the increasing demand. A further 144 frontline staff will be employed over the next two years to address issues of health and safety, fatigue and roster reform. Last October, paramedics took industrial action for the first time to highlight the increasing demands on workers.

Source

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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?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.

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THE BRITISH DENTAL DISASTER CONTINUES

Plenty of money for ever more bureaucrats but cutbacks in money for employing dentists -- with the inevitable results. Sad that it is hurting kids, though

THOUSANDS of children are being forced to wait three years or more for braces or corrective dental treatment, after new government regulations that affect the way dentists work. Patients needing treatment to straighten protruding teeth or correct misaligned jaws are facing long waits and permanent dental damage because of a shortage of practitioners and a lack of funding for orthodontic work, the British Dental Association (BDA) has said.

An estimated two million Britons are now unable to find NHS dentists after the introduction of dental contracts by the Department of Health in April, prompting increasing numbers to seek treatment abroad.

While many children require dental surgery before adulthood to prevent permanent damage, the new contracts will cut the number of children receiving orthodontic work by up to a fifth, the BDA says. Under the previous system, dentists were responsible for budgeting for orthodontic treatment. They are now limited to spending a certain amount each year, forcing them to limit treatment to the most needy.

A lack of funding for training has also exacerbated the shortage of specialist orthodontic dentists, experts say. A BDA spokeswoman told The Times: "The BDA is aware that since the introduction of the new dental contract in April, access to orthodontic treatment has been reduced. "This is a national issue surrounding the funding for these treatments. Only those patients who most need treatment will be able to get it on the NHS. "It's estimated the new criteria will reduce the number of children treated by up to 20 per cent. Those who do qualify for treatment may find they are on a waiting list of several years."

Some dentists who formerly provided orthodontics in less complex cases have now been given purely dental contracts, which has led to a reduction in the amount of orthodontic treatment, the BDA said. The Department of Health said yesterday: "The transition to the new arrangements has inevitably thrown up some challenges, but we are confident the NHS is now taking advantage of the reforms to put orthodontic services onto a more secure footing for the future." [Pure waffle!]

Source

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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?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.

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The strange priorities of government social workers again

They only take kids away from responsible, loving parents. It doesn't give them a rush of power to take kids off trash parents

A teenager was returned to a foster family even though care officials knew the adolescent had been repeatedly sexually abused by a family member, a scathing report into Tasmanian foster care has found. The case was one of seven of alleged abuse of children in foster or "out of home" care studied by Tasmania's outgoing Commissioner for Children.

In his report, released yesterday, David Fanning said the foster system had failed children and that abuse was likely to be occurring still. He recommended a review, particularly of foster parent selection and placement monitoring, as well as improvements to support for foster children and carers. "There probably can be no greater failure of a system that seeks to protect children than actually (placing) a child in ... circumstances where they are further abused," he said. The system had failed children. "And ... I can't guarantee they're not failing children currently or won't fail them in the future," he said. The failings were so serious that a further audit of the files was pointless. Instead, he called for immediate reform and increased funding. "In all likelihood, any audit would reveal instances of abuse," he said.

In the worst case, Department of Health and Human Services workers returned an adolescent to a family in which it was known the child had been abused. The placement was supported by DHHS "even though there were ongoing concerns noted onfile by several workers that the adolescent child was at risk of sexual abuse by another family member, also residing in the same home". "There were several notifications that the child was indeed being sexually abused by the family member over a long period of time," Dr Fanning's report found. "The DHHS response to this abuse was to interview all parties, including the child and the alleged perpetrator and to accept assurances, including the child's, that sexual abuse was not occurring in the home. "It was later disclosed by the parties that there had been an ongoing sexual relationship between the child and the family member and therefore the child had not been protected in the placement."

Dr Fanning's report, carried out at the recommendation of an earlier damning ombudsman's investigation into abuse of state wards, is the fifth released in recent days pointing to a fundamental failure of child protection in Tasmania. Health and Human Services Minister Lara Giddings conceded last week that the system had failed and announced the appointment of an interim replacement for Mr Fanning. But that replacement, former welfare department head Dennis Daniels, withdrew on Friday after a victim of physical abuse made allegations relating to Mr Daniels's time as a staff member in a boys home in the 1960s.

Source

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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?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.

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Massachusetts medical mess

How to know when a politician is lying, asks an old joke. The answer: his lips are moving. There were plenty of loose lips leading to last spring's passage of the Massachusetts health reform that instituted an individual mandate, placed fees on employers, and offered increased subsidies to low income residents.

Led by Republican Gov. Mitt Romney, supporters promised that health insurance could be provided with only a slight increase in expenditures. Skeptics at the time pointed out that this would not be possible, but were dismissed. Mr. Romney was celebrated as a bold innovator in the national press. Many governors have taken note and are reportedly looking at adopting similar plans. California is no exception. If re-elected, Gov. Schwarzenegger has said that health care reform will be the main platform in the 2007 State of the State address. It is likely that a Romney-style plan will be the cornerstone of his reform agenda.

The klieg lights are now off and the press has moved on to other stories. It's time to bring heaven to earth and make this thing work. What's the story? Administration officials are now telling Wall Street they expect the plan to be quite expensive. In an Aug. 17 filing to support general obligation bonds, officials project that the new plan will increase Massachusetts government health spending by $276.4 million in 2007. That's a $151 million boost over what the public was told the plan would cost as recently as April. "Somebody once told me: if you want to know what is really going on in state government, look at the bond documents," the writers at HealthyBlog, who are tracking the details of the implementation process, pointed out, when posting the filings. "They can say whatever they want to the public, but they can go to jail for fibbing to Wall Street."

The filing reveals why Mr. Romney and friends had no problem getting consensus from the health community, legislative Democrats, and even Sen. Ted Kennedy, Massachusetts Democrat. The plan provides $386 million in rate increases for "hospitals, physicians and managed care organizations." Current government programs get a boost of $85.2 million, restoring the gold-plating to Mass Medicaid benefits, that is, including dental and eye care, costing $51.7 million, and expanding MassHealth to families living at three times the poverty level added another $38 million. Although federal taxpayers are expected to pick up some of this tab, the majority of it will fall on Bay State taxpayers. And the real bill will certainly be higher. The filing discloses that the plans being discussed by the panel for low income people will cost $25 million more than originally projected. This would put total first year costs north of $300 million.

The plan is premised on the belief that cost-shifting by the uninsured and inefficient usage of the current system is driving costs. Full coverage is the lynchpin of the plan. Yet it's hard to see how the state will get even close to 100 percent participation, the whole point of the expensive exercise. On the subsidized plans, families will be expected to spend up to 7.7 percent of their income on health coverage. If eligible residents say "no thanks" to this new monthly bill, people are supposed to pay penalties under the individual mandate. This could lead to the absurd result of confiscating a person's earned income tax credit -- a government handout -- because one refused to accept a health care subsidy.

Officials haven't even started designing the private plans -- the plans that non-poor individuals must purchase by July of 2007 or face fines. Today, the average health plan for an individual in Massachusetts costs more than $5,000, thanks to state regulations that prohibit sensible underwriting and load plans up with mandated benefits. The new, supposedly unsubsidized plans are promised to come in at $300 a month with all current and future mandates intact. The CEO of Harvard Pilgrim Health Care, a large insurer, recently told the Boston Business Journal that this would only be possible "with a lot of cost sharing [and] limits on certain kinds of services on a covered basis and the co-insurance after that." Cost sharing is simply code for taxpayer subsidy. As for mandate relief, don't count on it. Mr. Romney recently added another mandate to Massachusetts' already long list when he signed a bill prescribing how insurance companies must reimburse for prosthetic devices.

The extra money must come from somewhere, and the state's employers will be in the crosshairs. Mr. Romney is on his way out and the new governor, as well as the people he appoints to the new health care bureaucracies, will have not been party to any deal limiting business contributions to $295 a head. Conservative supporters of the plan claimed that the $295 would be the ceiling of a possible payroll tax, but it will more likely prove to be a floor. State activists, legislatures and the Democratic gubernatorial hopeful are already grumbling that businesses need to pay more. "I don't think it's the final word," Democratic gubernatorial nominee Deval Patrick told CommonWealth magazine when queried on the new health care law. "I think what we have is a framework for debate."

Given the trajectory and timeline of the process, what Massachusetts might have is a framework for a debate over which presidential hopefuls' health care reform was a bigger boondoggle, Mr. Romney's or former Massachusetts Gov. Michael Dukakis'. That is something other governors might take note of before they jump on the mandate express.

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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?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.

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UNPLEASANT NURSES IN THE NHS

A NATIONAL Health Service trust is offering nurses free cappuccinos and chocolate chip biscuits to encourage them to smile at patients. King's College hospital NHS Trust in London introduced the reward scheme after surveys raised concerns that nurses were not being nice enough to the sick. One common complaint was that nurses almost ignored the patient and chatted about the person's condition as if he or she were not present.

In recent years there have been growing concerns about nurses who are "too posh to wash" and prefer to spend their time on administrative and technical tasks rather than basic care. Two years ago a resolution at the annual congress of the Royal College of Nursing proposed that nurses were now "too clever to care" and suggested that the compassionate part of their job should be delegated to healthcare assistants. The provocative motion was a reference to nurses increasingly concentrating on technical duties.

The new motivational scheme originated in a Seattle fish market, where it was used to boost sales. Trusts are introducing new initiatives to improve their "customer services" because, under government reforms, hospitals now need to compete for patients. Matrons at King's College hospital hand special thank-you cards to nurses who are seen smiling at patients or relatives, chatting with patients, having a positive attitude or doing something to make someone's day better. The thank-you cards are then entered in a draw and nurses whose cards are picked out are entitled to free coffee and biscuits at the hospital cafe.

Selina Truman, head of nursing in general medicine at the trust, said: "When our patient survey and complaints came through, we could see that the attitude of some of the nurses was not as positive as it might be. Patients said nurses did not spend enough time with them. We felt that the way in which nurses engaged with patients could be better. "This scheme is very motivating because matrons and ward sisters praise the nurses directly. It has put patients back at the centre of our work." Truman added that although staff were initially cautious about how the scheme would work, they had enjoyed receiving the praise and the treat.

However, an editorial in Nursing Times magazine said nurses did not need bribes to be helpful and pleasant to patients. It said: "Excessive workloads and paperwork prevent nurses from spending time with their patients and caring for them properly. This is a fundamental problem that can never be rectified with a hot drink and a biscuit, or other such imports from industry." Katherine Murphy, of The Patients Association, said: "Good patient care should be part and parcel of the job of nursing, not an add-on."

Source

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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?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.

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Mother love defeats bureaucracy -- but at a cost of $200,000



This Aussie infant was born with a $200,000 price tag and three mothers -- two of them on the other side of the world. Infertility and strict Australian surrogacy laws forced her mother to visit a revolutionary baby factory in California, where she hand-picked her egg donor and the woman who would give birth to her baby. The business transaction made her dream of a second child come true.

"She is a miracle -- what price do you put on a miracle," said the commissioning mother, Nadia, who did not wish to be identified. "Her creation was approached in a very business-like manner, but she is my baby."

A handful of Los Angeles-based mothers, including two Australians, formed egg donation and surrogacy agency Miracles Inc in response to the increasing number of childless couples who turn to surrogacy for their chance at a family. They charge almost $20,000 for an egg and more than $50,000 to carry a child to full term. The commissioning parents cover all other costs, which can take the bill to $200,000.

While Australia is unlikely to commercialise surrogacy -- where donors and the surrogate can charge for their services -- the nation's attorneys-general met yesterday to discuss uniform laws across the states. The call came after Victorian Labor senator Stephen Conroy and wife Paula Benson's daughter, Isabella, was born to a surrogate mother on Monday. The couple had to go to NSW for the procedures as surrogacy is illegal in Victoria. They are now facing up to five years of paperwork to formally adopt their daughter.

For Nadia, who is in her early 40s, searching overseas for a surrogate mother was a costly but simple process that took 18 months and $200,000. She joined the swelling ranks of women advertising for egg donors, but soon realised she would be relying on the goodwill of strangers because the "archaic" Australian laws make it illegal to profit from surrogacy. "I gave it two months and then I decided I'd never get anywhere. I had cut out an article I read in the newspaper about surrogacy clinics in America so thought I would try there," she said.

Nadia and her husband, whose sperm was used in the process, sifted through 200 profiles before choosing an egg donor and then a separate surrogate. In California, where the process is legal, the egg cost them $19,500 and the price for pregnancy was $52,000. "Although the cost is enormous, the component that goes to the surrogate and donor is minuscule compared to the overall cost," Nadia said. Legal bills, insurance, travel costs, drugs, IVF bills that were not covered by Medicare and astronomical American hospital bills added up to a $200,000 figure that the couple were not expecting. "We didn't truly appreciate the cost until it started, but we were in the privileged position of being able to keep going," Nadia said. "Now, when I look at her I don't think of dollars, or what we went through to get her -- she is just my child."

Still in close contact with the surrogate mother, Nadia helped deliver her daughter and stayed in the same hospital room as the surrogate for the days after the birth. Now back in Sydney, where her child will grow up, there are times when Nadia forgets her daughter's first nine months were spent in another women's womb. "She does something which is very characteristically me and I forget I didn't actually give birth to her," Nadia said. "You are just so caught up in being a parent, and I just love her so much."

Source

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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?

Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Pages are here or here or here.

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