NHS BANNING NECKTIES

In an attempt to deflect blame for MRSA from where it really belongs -- dirty hospitals and negligent staff

Doctors have been banned from wearing ties in an effort to contain the spread of superbug MRSA. An NHS trust has told hospital staff, including senior consultants, that the wearing of ties and "other superfluous clothing" could result in disciplinary action. The rules have been introduced by the Brighton and Sussex University Hospitals NHS Trust in a bid to reduce its rate of MRSA infection, which is one of the highest in England. The new dress code policy also bans staff involved in direct clinical care from wearing jewellery, watches, scarves and wraps.

But doctors say the new rules stem from political correctness rather than scientific evidence and fear that patients will have less confidence in casually dressed medics. One consultant, who works for the trust but did not want to be named, told the Sunday Times: "If you come to see a consultant, you will be greeted by an open-neck-shirted doctor who will look as if he is the hospital DJ, but will in fact be the consultant." Dr Michael Dixon, chairman of the NHS Alliance, which represents primary care trusts, and wears a bow-tie at his GP surgery, told the paper: "This is political correctness rather than science. Patients need to be able to respect and trust their doctors and going around without ties might damage that relationship."

Earlier this year the British Medical Association suggested that doing away with functionless items of clothing such as ties may help reduce rates of MRSA and other hospital acquired infections. Over 3,500 cases of MRSA blood-stream infection were reported in NHS hospitals between October 2005 and March 2006 and the number of deaths where the superbug is mentioned on death certificates has increased each year from 1993 to 2004. A spokeswoman for the trust said action was needed to improve infection control rates and that the new measures were introduced following consultation with staff.

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Harmed in NSW public hospitals: 500 errors a record

NSW is Australia's most populous State

Almost 500 medical errors in NSW public hospitals either seriously harmed patients or could have done so in 2005-06 - the highest number in the three years the statistics have been collected. Problems with diagnosis, treatment and specialist referral topped the list of incidents judged to be in the most serious category, followed by 137 suicides that occurred outside hospital within a week of the person having been seen by a mental-health professional. Birth problems and avoidable falls also figured prominently, and 36 operations or X-rays were either performed or planned for the wrong person or part of the body. Instruments were left in the body after 11 operations. There were four serious problems with medication or intravenous fluids in the reporting period to June 30.

In a separate notice distributed to area health services in April, the Health Department informed doctors and managers of a "near miss" involving the leukaemia drug vincristine, which is intended for intravenous injection and is almost always fatal if injected into the spinal canal.

The Minister for Health, John Hatzistergos, said the increase - to 499 serious incidents from 429 the previous year - did not mean hospitals were less safe, and instead reflected an increased willingness by health workers to record incidents they witnessed. As well, the reporting program had been extended to the ambulance and prison health services.

Cliff Hughes, the chief executive officer of the Clinical Excellence Commission responsible for analysing the cases, said the increase in reports "tells us the system has a desire to improve". "The aim is to be proactive in preventing serious adverse events from harming our patients," he said. The reports demonstrated health workers' confidence in bringing dangerous incidents to light in a no-blame environment, he said, and represented "a huge culture change".

The commission was formed as a supervisory body for public hospital treatment standards after a group of nurses at Camden and Campbelltown hospitals revealed numerous medical errors. Its analysis found policies and procedures were to blame for a quarter of the errors and near misses. These included inadequate training requirements for some staff. Another quarter were attributable to communication problems, particularly when patient care was handed over to a different medical team or between shifts. Incompetence or outdated skills were behind almost 100 cases, and inadequate ratios of medical staff to patients, or rostering of junior doctors into senior roles, was at the heart of about 70 of the problems. Equipment failure was much less common.

Some improvements could be made by basic changes to practice, Professor Hughes said. Hospital infection rates had been reduced after the provision of bedside alcohol-based gels for cleaning hands, instead of requiring health workers to go to the sink to wash. New protocols were being developed to identify people most at risk of falls - the over-65s and those taking multiple medications - so they could be given extra assistance in hospital.

But Mr Hatzistergos said a certain level of human and system error was unavoidable. "We haven't reached a stage where we have infallibility or perfection in medical science," he said. The collection of data would be further expanded to take in private hospitals in NSW, which perform the majority of colonoscopies and some other procedures.

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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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