Saturday, September 30, 2006


And kills them!

A coroner has criticised a hospital for offering "despicable" and chaotic treatment after hearing that four elderly patients died in painful and degrading circumstances. John Pollard, who conducted inquests into all the deaths on the same day, said that he would be raising his concerns with the management of Tameside General Hospital in Ashton-under-Lyne, Lancashire. He condemned as "absolutely despicable" the treatment of Watkins Davies, an 84-year-old war veteran, who went into hospital with a fractured hip and contracted MRSA, the hospital superbug, The inquest was told that Mr Watkins, a widower, was the victim of a catalogue of failures in basic nursing care. When he fell out of his chair, while trying to wash himself, no X-ray was carried out to assess any additional injuries.

His family claim that he was left to lie in his own waste and was in severe pain for hours because of shortages in nursing staff. His meals were left up to 6ft out of his reach. Relatives told the inquest that they repeatedly had to ask a nurse to help him. Ivor Davies, his son, said: "My father did not receive adequate medical and nursing care. There was a lack of communication between nursing staff and us. "I went in one day and my dad was lying in excrement. God only knows how long he was like that. I asked whether the infection was MRSA, only to be told it wasn't. A couple of days later I was told it was MRSA after all."

Mr Pollard recorded a verdict of accidental death. He also heard that Hilda Douglas, 75, died at the hospital from a heart attack after fracturing her pelvis. The family of Mrs Douglas, a voluntary worker from Droylsden, near Manchester, said that she broke her hip when she fell from a hospital trolley without sides. There was no record of the fall. Edward Douglas, her son, said: "There was one nurse per three beds and the nurse said she could not cope." He said that medication had been left on the floor.

Recording a verdict of death by natural causes, the coroner said he found this astonishing. "What if that had been vital medication?" he asked. "It is absolutely chaotic." A third inquest heard that Raymond Lees, from Ashton-under-Lyne, who died in May, contracted MRSA after undergoing a knee replacement operation. During his time in the hospital his waist shrank by 14 inches. John Lees, his son, said that it had taken him three hours to discover that his father had not been bathed and that hospital staff did not appear to know his name. "The nurse said, `He gets himself up, dresses himself and does his own teeth'," Mr Lees said. "In fact, he was wearing the same pyjamas he had been wearing for three days. The nurse was cruel and cynical."

A fourth inquest was told that James Kelly, a pensioner from Stalybridge, Tameside, was recovering from surgery but died from pneumonia after he was left sitting in his dressing gown in a draught. Mr Pollard said: "In most of the issues, the nursing care, not the operations or the general medical staff, but the basic care of people, has been in question. I shall be contacting the chief executive and looking at all future deaths at Tameside General Hospital very carefully."

Andrew Burnham, a Health Minister, said: "I understand that the hospital trust has in place a range of measures to ensure that patients receive the high-quality nursing care they have every right to expect. These include daily rounds by matrons to check on patient care, including nutrition and hydration, all of which are reported back to the director of nursing, who has ultimate responsibility for the standard of care." A spokesman for Tameside and Glossop Acute Services NHS Trust said: "These cases are being investigated internally and the trust will act on the results of these investigations."



Too white, probably. That many Canadians and Australians died for England in two world wars apparently deserves no gratitude or recognition from England's present Leftist government -- regardless of the offence that causes to Canadians and Australians

As many of you know my wife and I have recently emigrated to the UK from Edmonton, Alberta. My wife is a Canadian nurse with a first class degree in nursing from an English speaking university, and she herself is a native English speaker. In fact it is her only language, though, like many English-speaking Canadians, she does have 'cereal packet French'.

Before coming to the UK we had to travel down to Calgary, some 300km away, in order that she could sit an British Council English exam (cost $400), which is a prerequisite for 'foreign' nurses coming to work in the NHS (perhaps unsurprisingly for a native English speaker with a degree from an English-speaking university she passed the six hour ordeal - spoken English, understanding spoken English, written English and reading - with a 100% pass mark). Canadian nurses have to go through this costly ordeal in order to get professional registration with the Nursing and Midwifery Council, bizarrely EU nurses do not.

Upon getting here she understood that she would have to be retrained to 'NHS standards', which in itself is laughable due to the fact that Canadian nurses are trained to a much higher level than the average UK nurse. But still, we accepted that this was the price (œ300 to be precise) that we would have to pay.

The whole moving and shipping process took some time, as you can imagine, and when we arrived in the UK and phoned the Nursing and Midwifery Council (NMC) we were informed that it was not really worth her while retraining and applying to register as a nurse in the UK because the Government had just changed the rules of engagement between health sector employers and foreign nurses. Essentially employers, if they wanted to employ a foreign nurse, had to prove that there was no British or EU nurse that could fill the role. Consequently she would be unable to get a job. Tears.

Eventually, after several weeks enquiry, and in the face of ongoing and insistantly negative NMC advice, a man at the Foreign Office informed us, as we expected, that it was illegal to discriminate against anyone with a valid UK work permit (which of course we obtained when we were in Canada). The bureaucracy of the NMC (a body created by Nu Labour); their general incompetence and bad advice; added to the fact that retraining courses for foreign nurses are now very difficult to come by because foreign nurses are actively discriminated against and no longer come here, means that by the time she can get on a course and retrain she will have been out of work as a nurse for six months. And incurring retraining costs along the way.

She (we) decided not to bother. The result is that the NHS, and the country, has lost a specialist paediatric nurse, a skilled immigrant, who can work to an extremely high standard to the benefit of us all. But this is not a story of complete woe; as soon as she decided not to persue a career in the NHS she was immediately snapped up by the private sector to fulfill a paediatric training role. She now earns about the same as she would as a nurse in Canada - 40% more than a UK nurse - but the problem is that she desperately wants to nurse; it is a vocation, not just a career. And to add insult to injury there is a chronic national shotage of paediatric intensive care nurses.

The result of all this is that I have on my hands a wife who is deeply embittered about the way she has been treated by the UK Government. I regret, and she regrets, that we came back, which is a crying shame as we moved here because we love England.

Anyway, I thought I would get that off my chest. In our dealings with government organisations (mostly the NMC) during this whole saga (which would take me a week to relate to you in full) we have found them to be, almost to a man and woman, completely incompetent and unhelpful. The one redeeming organisation was a non-governmental professional body called the Royal College of Nursing, the general secretary of whom is Dr Beverley Malone.

Dr Malone is an extremely politically astute woman, a credit to her organisation, who has railed against the Government's discrimination against foreign health workers. She objects, in particular, to the way the government cherry picked third world nurses from abroad, depleting those countries of their greatest natural resource, and now intends to pack them off against their wishes as soon as their work permit expires and their employers are forced to employ an EU nurse.

We have been the unfortunate victims of the Government's scramle to recruit foreign nurses and then their scramble to unemploy them in the face of criticism of falling standards, poor English, and third world cherry-picking. Wrong place. Wrong time. But our experience probably pales into insignificance compared to some poor souls.

Dr Beverley Malone now turns her attention to government discrimination against the English:

Under English law, patients in homes are entitled to state support for their nursing care but must foot the bill for "personal" care. In Scotland, by contrast, the whole bill is paid.

And there have been allegations that English patients have been subject to a "postcode lottery" caused by variations in interpretation of the rules around the country.

The Royal College of Nursing claimed the new proposals would fail to solve the problems. It called for a single national policy - and objected to plans to hand policy-making to local primary care trusts.

RCN general secretary Dr Beverley Malone,pictured, said: "It is nurses who are put in the impossible position of having to explain complicated and often unfair decisions to patients and their families.

"The RCN believes that anyone who needs nursing in a care home should get this care fully funded by the NHS. Nursing care is a fundamental part of healthcare and should be funded by the NHS.

Well said that woman. The sad fact is that we no longer have a national health service. It is, of course, beyond her remit to point out the constitutional and funding reasons why this might be so. But I have no doubt that she is aware of the facts.



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 Page is here or here.


Friday, September 29, 2006


For the past couple of days I've been wondering what it is that the rest of the world sees in Mr Brown's NHS reform that I've missed. Those people who don't confidently reply "son of the manse" when asked about Mr Brown instead say "man of substance" and cite his NHS reform plan as evidence of his sagacity. And there am I thinking that it is completely daft.

The policy of giving the Bank of England the power to set interest rates, free from political interference, has been an undoubted success. So now Mr Brown wants to extend that model to the public services, with the NHS most commonly named as the first to be reformed in this way. An independent board will be established to administer the service, with the role of politicians restricted to setting overall goals and strategy. Conservatives are sufficiently enthusiastic about the idea to claim that Mr Brown has stolen it from them. The day will come when the Tories will pretend that they had nothing whatsoever to do with it....

The NHS is not like the Bank of England. The Bank is setting the price of money. The NHS has an output not far off that of Portugal. It handles something like 10 per cent of our national income. It employs thousands and thousands of people. It is a very different animal.

There are two ways of holding such a body to account. The first is through voice - the right to protest to a political representative who depends on your vote. The alternative is exit - the right to take your custom elsewhere, with the seller dependent on your patronage in order to thrive. Mr Brown plans to remove both these forms of accountability. When he describes the new board as independent, you just have to ask: independent of what, exactly? And the answer, it turns out, is independent of you and me.

Sir Peter Lachmann, former president of the Royal College of Pathologists, felt moved to write to this newspaper that Mr Brown's new policy was "probably the best news the NHS has had in the past 30 years". I was not surprised to read this endorsement. The senior management of the service is bound to conclude that the interference of meddling politicians is nothing but a nuisance. They want to run their NHS with our money and without us pesky voters sticking our nose in the whole time.

The Chancellor is arguing that the closure of a local hospital ought to be decided by health service managers without the right of politicians to prevent it. If he isn't saying this, he is saying nothing. But is it really acceptable that such sensitive decisions be made only by a group of unelected people, accountable only to each other and without appeal to the local electorate? The model that Mr Brown intends to apply to the NHS is not really the Bank of England at all. It is, well, the model that the Tories tried to apply to the NHS in the mid-1980s.

In 1985 Norman Fowler, then the Health Secretary, appointed Victor Page as the chief executive of the NHS with the idea of relinquishing political control of administrative matters. It was perhaps with this experience in mind that another former Health Secretary yesterday told me that he thought Mr Brown's plan was "bonkers". Political pressure from voters and the media ensured that it didn't last five minutes. And neither will Mr Brown's plan.

There is an alternative. If Mr Brown truly wants to stop political interference in the day-to-day decisions made by clinical staff and local management there is something he can do. He can replace accountability by voice with accountability by exit. If a local hospital were to close because everyone was using a better service near by it might anger some residents. But no one could claim that the service providers were unaccountable.

The Chancellor has set his face against such a Blairite (actually Tory) solution. But his third way between two forms of accountability is to provide no accountability of all. His NHS board idea was intended to reinforce his image as a man of substance. I think he would have been better off with one of Doddy's wisecracks.

More here


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 Page is here or here.


Thursday, September 28, 2006


Government health inspectors are to investigate how Maidstone Hospital in Kent handled an outbreak of an infection that killed six patients and contributed to the deaths of fourteen others. The Healthcare Commission announced an inquiry yesterday into Clostridium difficile, which it said followed concerns about the rates of infection at the hospital since 2004. C. difficile is the main cause of diarrhoea infections in British hospitals, and contributes to more deaths than MRSA.

The inquiry into Maidstone and Tunbridge Wells NHS Trust will examine whether the rates of C. difficile are high, taking into account all factors. The investigation, one of only two the commission has conducted into C. difficile, will look at outbreaks of the infection and evaluate the trust's systems and procedures for controlling it. It is also likely to consider the trust's arrangements for identifying and notifying cases, the factors contributing to the rates of infection, the trust's response on the wards, and the priority given to its control.

The investigation was requested by the South East Coast Strategic Health Authority and the trust, whose three hospitals serve Maidstone and Tunbridge Wells and surrounding areas including Tonbridge, Sevenoaks and parts of East Sussex. C. difficile can cause a wide range of symptoms, from mild diarrhoea to life-threatening conditions.

Nigel Ellis, head of investigations at the Healthcare Commission, said: "Our investigation will examine how the trust identified and dealt with cases of C. difficile. "We recognise that outbreaks of infection are not always easy to control, but when they do happen they pose a very serious risk to patient safety. "We need to find out what happened, what systems the trust has in place to ensure this does not happen again and whether further improvements are needed to protect the safety of patients."

The commission, which is the independent inspection body for the NHS and the private and voluntary healthcare sectors, will publish its findings and recommendations for improvement in a report expected next year.

Maidstone is by no means the first hospital to suffer a serious outbreak of C. difficile. A total of 334 patients were infected with the bacterium and at least 33 died between October 2003 and June last year at Stoke Mandeville Hospital in Aylesbury, Buckinghamshire. In a highly critical report into that outbreak, published in July, the commission said that there had been serious and significant failings in the way in which senior hospital managers had responded to it.

According to the Office for National Statistics, in 2003 there were 1,748 mentions of C. difficile on death certificates, of which 934 noted the infection as the underlying cause of death. Between April and June, 136 patients at Maidstone Hospital were found to be infected with C. difficile, the trust said. The infection was the definite cause of death of six patients; in fourteen others it contributed to their deaths but was not the main cause, and it was unlikely to have led to the deaths of four other patients who had had the infection.



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 Page is here or here.


Wednesday, September 27, 2006


A former nurse who won her High Court battle against hospital ward closures yesterday said that it was not a genuine victory. Pat Morris, from Altrincham, Greater Manchester, risked her home and savings on waging a campaign against Trafford Healthcare NHS Trust after it decided to cut beds at her local hospital without consulting the community. Mrs Morris, 65, resigned her nursing job to concentrate on her legal battle and faced having to pay the trust's legal costs had she lost the case.

Yesterday Mr Justice Hodge backed her view that the trust's decision in March to close 26 rehabilitation beds for older people without consultation had been illegal, and ordered that it be quashed. However, he refused to order that the two wards at Altrincham General Hospital, where Mrs Morris worked for several decades, be reopened immediately. Mrs Morris and her barrister, Anthony Eyers, who worked on her case for no charge, said that they expected NHS managers to pay lipservice to consultation but to keep the wards closed.

Mrs Morris said: "There are no winners today, only losers. They will just go through the motions only to tell us the wards will stay closed. The challenge has been made and the trust have been found wanting, but the elderly, vulnerable people of Altrincham still don't have their care close to home. "I don't have to pay thousands of pounds, but in human terms we have still lost a lot in the last few months. I have no regrets about bringing the case, except that the judge decided it was not his duty at this time to reopen the beds."

Mr Justice Hodge said that the trust would have to reach a new decision after public consultation. He added: "It cannot be right for this court in its discretion to order the reopening of the wards on the basis that there will be a public consultation which might legitimately then decide to close them again."

Mrs Morris has led the campaign against the cuts at Altrincham General since resigning from her job there in 2003 after 16 beds were cut. She was a member of the Patient and Public Involvement Group, a watchdog representing local residents, but left to fight her battle. At one stage the entire hospital was threatened with closure, but Mrs Morris, a former Tory councillor, organised a self-funded series of public rallies, letters and petitions. Hundreds of people turned up to her public meetings, but it was Mrs Morris who sought the judicial review on behalf of the group Health in Trafford. She risked an 80,000 pound bill for legal costs if the judgment had been made against her.

Trafford Healthcare NHS Trust, which is 9 million in debt, will now have to pay its own legal costs. Mrs Morris was awarded her costs, which were less than 1,000 pounds.

Mr Eyers described the ruling as a "Phyrric victory". He said: "It has ramifications for the whole country because it gives a green light to trusts that they can act first and take the legal flak later. They may have to fight, but they can act with some certainty that their decisions will not be reversed. I now expect the trust to make a series of empty promises that they won't deliver on." Mr Eyers said he had taken the case pro bono as a matter of principle: "I live in the Altrincham area and so it had some personal resonance, but NHS trusts, like any public body, should be accountable to the people they serve." He said the same principles had been behind Mrs Morris's fight: "She would have given every last penny she had if it had achieved something for the people of Altrincham."

Trafford Healthcare NHS Trust said that it had cut the beds because "it was no longer a safe place for patients to receive care. Anyone visiting the hospital would be struck by the dilapidated state of the buildings and the nursing and medical staff were no longer confident that they could provide safe services". [And whose fault would that be?] It added that four public meetings would be held next month to decide the future of in-patient wards at the hospital



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 Page is here or here.


Tuesday, September 26, 2006


They are helping BritGov's battle with its public servants, but at a cost

Private health centres are being paid tens of millions of pounds by the NHS for operations that are not happening. Hardly any of the independent centres set up under generous contracts are meeting their targets, an investigation by Health Service Journal has found. But they still get paid, unlike NHS hospitals, which are paid on the basis of how many operations they do.

The 20 centres were open by March. Information gathered by the journal from public documents, freedom of information requests and parliamentary answers indicates that so far they are doing only 59 per cent of the operations for which they are contracted. The Will Adams Treatment Centre in Gillingham, Kent, is performing at the rate of 945 procedures a year, compared with the 3,954 needed to meet its targets. It carries out hernia operations and day-surgery orthopaedic, gastroenterology and urology procedures.

The Department of Health denies that there is a problem. The centres were set up with five-year contracts and a spokesman said that it was completely misleading to say that activity below 100 per cent represented a waste of money. That could be determined only at the end of the contracts, when it would be clear how many operations the centres had done.

Its own figures put a different gloss on the situation by including other short-term programmes launched to shift the backlog. When those are included, it says that the programme is working at 84 per cent of capacity. Independent sector treatment centres (ISTCs) are controversial because NHS traditionalists say that they take money away from health service hospitals, disrupting their finances. The first ISTCs were set up under contracts that guaranteed an income based on the number of patients they undertook to treat, regardless of whether that many were treated.

Overall, HSJ calculated that the 20 centres should be treating patients at the rate of 78,242 a year, assuming that the target numbers are averaged over the whole of the five-year contract. But in the period to March their treatment rate was 46,073 patients a year, 59 per cent of the target.

In defence of the centres, many have not been open long, and the numbers they treat have not had time to build up. The main cause of the shortfall appears to be a reluctance by doctors to refer patients to them. Attempts have been made to persuade GPs to increase referral rates, but one obstacle is that ISTCs are staffed largely by doctors from abroad who are not known personally to GPs. This may affect judgments and make it less likely that patients will choose to go there.

The centres are costing primary care trusts a lot of money. Local reports suggest, for example, that the underperformance of the Will Adams ISTC is costing Medway PCT 100,000 pounds a month. The trust’s deficit in 2005-06 was £2.4 million.

A survey by HSJ of 42 NHS chief executives found considerable disquiet. More than three quarters felt that their own finances had been damaged by the centres — including 7 per cent who called the effect disastrous. Almost 60 per cent doubted that the centres had added to NHS capacity, and question marks were raised about whether the NHS needed any extra capacity anyway.

The health department, and 10 Downing Street, are unlikely to be unduly alarmed by the findings. The hidden agenda behind the ISTCs was an attempt to break the power of surgeons in NHS hospitals to control waiting lists, and that seems to be succeeding. The policy to allow patients a choice as to where they are treated has had such a dramatic effect on waiting times that top advisers regret that it was not introduced much sooner.


NHS fails as an insurer once again

A new drug that could transform the lives of children with a rare genetic condition might be judged too expensive for the NHS. Hunter Syndrome was in the headlines last year when Andrew Wragg, 40, a former SAS soldier, was driven to despair by the decline of his son Jacob, 10, and smothered him with a pillow. The father, from Worthing, was cleared of murder and given a suspended sentence for manslaughter with diminished responsibility.

The fatal syndrome, suffered almost exclusively by boys, is caused by a defective enzyme that is unable to break down complex sugars produced as waste products in the body. These compounds, called mucopolysaccharides, accumulate in the tissues and organs and cause worsening physical and mental health problems.

The new drug, Elaprase, developed by Shire Pharmaceuticals, has been approved in the US and is expected to be licensed in Europe by the end of the year. Given by infusion, it improves breathing and movement. Parents of some Hunter children say it has transformed them. But it will cost at least 100,000 pounds per child per year, and as much as 300,000 for older, heavier patients who need bigger doses. Although the number of Hunter children in the UK is small — no more than about 100 — the cost of providing it for all of them could well be prohibitive.

A patients’ group has been lobbying ministers to confirm that the drug will be funded under a special scheme for children with rare diseases. Christine Lavery, chief executive of The Society for Mucopolysaccharide Diseases (SMD), said: “Funding for treatments for rare diseases similar to Hunter Syndrome is due to end at Christmas. We expect that to be extended. But there has been no promise that the DoH will fund the new drug for Hunter Syndrome. “All our questions and requests for clarification of the position have met with a lack of response, which leads us to fear the worst.”

Although not a cure the drug, which replaces the missing enzyme, may allow affected children to lead near-normal lives if the condition is picked up early. Dr Ed Wraith, a consultant at the Royal Manchester Children’s Hospital, said: “With this disease, there is damage to the heart, liver, brain and other organs which invariably leads to death well before the age of 20. The treatment is a major breakthrough and it would be a tragedy if the Department of Health didn’t provide the money.”

The Department of Health said: “No decision has yet been made on whether this expensive drug will be funded.” The same is likely to be the case north of the Border, where the Scottish Medicines Consortium has refused a related drug for a girl with a similar condition.

Bob Wragg, 64, grandfather of Jacob, said: “Thank God they have found a treatment at last.” His wife, Anne, a nurse, said: “A lot of people just don’t understand the torment that Andrew went through caring for Jacob and seeing him get worse and worse.” An adult sufferer of the syndrome, Colin Arrowsmith, 26, from Newcastle, has been receiving Elaprase weekly as part of a trial since February 2004. He had already defied doctors’ predictions that he would be dead by his early teens and until five years ago was able to live independently. He worked in the mailroom of an electricity company but was forced to give it up because his hips began to crumble. This forced him into a wheelchair and made him more reliant on his parents.

His mother, Barbara, said: “He was picking up lots of infections and his liver and spleen were very large. Since he began the weekly infusions his general health is better and his liver and spleen are no longer swollen. He has a lot more energy. “The treatment won’t reverse the damage done but we’ve been told that it should prevent further damage.”



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 Page is here or here.


Monday, September 25, 2006


A couple who lost their baby after they were turned away from the nearest maternity unit have exposed a crisis of overcrowded hospitals shutting their doors to women in labour. Andrew and Rachel Canter have launched a campaign to prevent other mothers and babies being put at risk by maternity hospitals closing to new admissions for up to 30 hours at a time. The couple's son, Jake, was born dead after they were forced to drive past the maternity hospital where they had planned to be admitted and take a 20-minute detour to another unit. Rachel was in the late stages of labour and needed urgent attention.

Their case reflects a national trend for busy maternity hospitals frequently to close their doors to new admissions, even turning away women who have booked places on their wards. Evidence compiled by The Sunday Times shows:

* In one year, maternity hospitals in Greater Manchester had to close on 90 occasions, some for up to a day. One had to close 29 times. A shortage of staff has forced Greater Manchester and East Cheshire hospitals to plan cuts in the number of maternity units from 13 to 8.

* Women are frequently turned away from London's major hospitals. St Thomas's hospital is understood to have closed to new admissions three times in a fortnight but has refused to disclose details. Chelsea and Westminster hospital has closed its maternity unit four times in the past year for up to 11 hours.

* Last month a woman in labour was turned away from maternity hospitals in Hastings and Eastbourne before setting off on a 30-mile journey to Pembury, Kent.

* The Barratt maternity unit at Northampton general hospital had to close during two weekends in March, once for up to 30 hours, forcing 10 women to be redirected.

The problems have emerged as the NHS is bracing itself for the permanent closure of maternity units across the country. David Nicholson, its chief executive, recently warned that the number of maternity hospitals would need to be cut. Managers say there are not enough doctors.

Andrew Canter, who runs an advertising agency and lives in Welwyn, Hertfordshire, believes his son could have lived had Barnet maternity unit not closed to new admissions on the day his wife gave birth. He said: "This baby could have been born alive. It was an absolute disgrace that we were treated in this way. This was a classic case of underfunding and understaffing. We now want changes so that Jake didn't die in vain."

The Royal College of Midwives says a lack of doctors and midwives is responsible for the closures. Barnet and Chase Farm Hospitals NHS Trust said the maternity unit had to close on the weekend that Jake Canter was stillborn last October because it was too busy. The hospital had not been designed for the number of women who gave birth there


Long delays for cancer diagnosis in Australia

Women suspected of having breast cancer are waiting longer than seven days to be diagnosed because of a national shortage of pathologists. Instead of the recommended 24-hour diagnosis, the Royal College of Pathologists of Australasia (RCPA) reports that some women are waiting more than a week to be diagnosed. The lack of pathologists also means some women wait as long as four months for autopsy results after a miscarriage.

The Sunday Telegraph revealed earlier this month that some families had been forced to wait a year to learn their loved ones' cause of death because the Westmead morgue had been unable to fill vacancies for forensic pathologists. The college has blamed the Commonwealth and state governments for failing to honour commitments to fund additional training positions to address the problem.

RCPA chief executive officer Debra Graves said the situation had reached crisis point, with patient health potentially put at risk. She said some women with breast lumps had to repeat diagnostic procedures because of the pathologists shortage. Dr Graves said it was advisable that a pathologist perform or supervise diagnostic procedures to ensure the correct cells were taken, but the unavailability of pathologists had resulted in cases where incorrect cells had been taken, forcing patients to repeat procedures. "It is best practice to have a woman with a lump diagnosed within 24 hours, but what we are seeing at the moment is women having to wait for anything up to a week because they've had to come back," she said. "That is a terribly stressful time for a woman, but it's happening everywhere and it's getting worse."

According to the RCPA, there are 70 pathologist vacancies nationally, with the shortage affecting hospitals across Australia. Figures from the college show there are 1290 practising pathologists in Australia, 20 per cent of them aged over 60. In 2003, the Australian Medical Workforce Advisory Committee recommended that an extra 100 training positions be created over the next five years. But since that meeting, only 39 new positions have been funded instead of the recommended 300. The college put forward a budget submission to the Commonwealth for an additional $13.75 million to fund an extra 40 positions. The Commonwealth agreed to fund 10. The NSW Government has provided funding for four pathologist positions.

In the most recent RCPA Path Way journal, the college cites a cancer being undiagnosed by an overworked pathologist as a worst-case scenario if the shortage is not immediately addressed. A spokeswoman for Health Minister Tony Abbott said the training of pathologists was the responsibility of state and territory governments, but added the Commonwealth had a program to train pathologists in the private sector. "In 2004-06, $3.7 million in funding was allocated," she said.



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 Page is here or here.


Sunday, September 24, 2006


If you really want to understand what makes the U.S. economy tick these days, don't go to Silicon Valley, Wall Street, or Washington. Just take a short trip to your local hospital. Park where you don't block the ambulances, and watch the unending flow of doctors, nurses, technicians, and support personnel. You'll have a front-row seat at the health-care economy.

For years, everyone from politicians on both sides of the aisle to corporate execs to your Aunt Tilly have justifiably bemoaned American health care -- the out-of-control costs, the vast inefficiencies, the lack of access, and the often inexplicable blunders.

But the very real problems with the health-care system mask a simple fact: Without it the nation's labor market would be in a deep coma. Since 2001, 1.7 million new jobs have been added in the health-care sector, which includes related industries such as pharmaceuticals and health insurance. Meanwhile, the number of private-sector jobs outside of health care is no higher than it was five years ago.

Sure, housing has been a bonanza for homebuilders, real estate agents, and mortgage brokers. Together they have added more than 900,000 jobs since 2001. But the pressures of globalization and new technology have wreaked havoc on the rest of the labor market: Factories are still closing, retailers are shrinking, and the finance and insurance sector, outside of real estate lending and health insurers, has generated few additional jobs.

Perhaps most surprising, information technology, the great electronic promise of the 1990s, has turned into one of the biggest job-growth disappointments of all time. Despite the splashy success of companies such as Google and Yahoo!, businesses at the core of the information economy -- software, semiconductors, telecom, and the whole gamut of Web companies -- have lost more than 1.1 million jobs in the past five years. Those businesses employ fewer Americans today than they did in 1998, when the Internet frenzy kicked into high gear.


Meanwhile, hospitaL administrators like Steven Altschuler, president of Children's Hospital of Philadelphia, are on a hiring spree. Altschuler has added the equivalent of 4,000 new full-time jobs since he took over six years ago, almost doubling the hospital's workforce. To put this in perspective, all the nonhealth-care businesses in the Philadelphia area combined added virtually no jobs over the same stretch.

Altschuler plans to add 3,000 more employees over the next five years as the hospital, one of the nation's leading pediatric centers, spends $1.7 billion to expand. Next up is a new 1.2 million-square-foot research facility that will be packed with well-paid scientists and support staff. "Health care is the major engine for the economy of the city of Philadelphia," says Altschuler.

The City of Brotherly Love is hardly alone. Across the country, state and local politicians, desperate for growth, are crafting their economic development strategies around biotech and health care. California will pour $3 billion into stem cell research over the next 10 years, and other areas are on the same path. "Our downtown business leaders and politicians have traditionally considered health care as a cost center, not as an economic engine," says Baiju R. Shah, a former McKinsey & Co. consultant who runs Cleveland's BioEnterprise, a nonprofit founded four years ago to stimulate the local health-care and bioscience industries. "But people are waking up."

What they're waking up to is the true underpinnings of the much vaunted American job machine. The U.S. unemployment rate is 4.7%, compared with 8.2% and 8.9%, respectively, in Germany and France. But the health-care systems of those two countries added very few jobs from 1997 to 2004, according to new data from the Organization for Economic Cooperation & Development, while U.S. hospitals and physician offices never stopped growing. Take away health-care hiring in the U.S., and quicker than you can say cardiac bypass, the U.S. unemployment rate would be 1 to 2 percentage points higher.

Almost invisibly, health care has become the main American job program for the 21st century, replacing, at least for the moment, all the other industries that are vanishing from the landscape. With more than $2 trillion in spending -- half public, half private -- health care is propping up local job markets in the Northeast, Midwest, and South, the regions hit hardest by globalization and the collapse of manufacturing (map).

Health care is highly labor intensive, so most of that $2 trillion ends up in the pockets of workers. And at least so far, there's little leakage abroad in terms of patient care. "Health care is all home-produced," says Princeton University economist and health-care expert Uwe Reinhardt. The good news is that if the housing market falls into a deep swoon, health care could provide enough new jobs to prevent a wider recession. In August, health-services employment rose by 35,000, double the increase in construction and far outstripping any other sector.

John Maynard Keynes would nod approvingly if he were alive. Seventy years ago, the elegant British economist proposed that in tough times the government could and should spend large sums of money to create jobs and stimulate growth. His theories are out of fashion, but substitute "health care" for "government," and that's exactly what is happening today.

Make no mistake, though: The U.S. could eventually pay a big economic price for all these jobs. Ballooning government spending on health care is a major reason why Washington is running an enormous budget deficit, since federal outlays for health care totaled more than $600 billion in 2005, or roughly one quarter of the whole federal budget. Rising prices for medical care are making it harder for the average American to afford health insurance, leaving 47 million uninsured.

Moreover, as the high cost of health care lowers the competitiveness of U.S. corporations, it may accelerate the outflow of jobs in a self-reinforcing cycle. In fact, one explanation for the huge U.S. trade deficit is that the country is borrowing from overseas to fund creation of health-care jobs.

There's another enormous long-term problem: If current trends continue, 30% to 40% of all new jobs created over the next 25 years will be in health care. That sort of lopsided job creation is not the blueprint for a well-functioning economy. One solution would be to make health care less labor-intensive by investing a lot more in information technology. "Low productivity in health is mostly a product of low investment," says Harvard University economist Dale Jorgenson.

For now, though, health-care hiring is providing a safety net in areas where manufacturing and retailing are no longer dependable sources of jobs. Take Johnstown, Pa., a town that once hummed with activity from local steel mills, coal mines, and nearby factories. As most of these businesses closed, the town emptied out, going from a population of 63,000 in 1950 to 23,000 today.

Now, Conemaugh Health System, with about 5,000 workers, is the biggest employer in town. "Everyone has a Conemaugh parking sticker on their car," says Linda D. Suter, 48, who's in her second year at the nursing school Conemaugh operates. Suter's dad worked at a factory in a nearby town, now closed, that made backyard swing sets for kids.

Frank Kosnowsky sold appliances at the Sears in Johnstown for 10 years, starting right out of high school. But he got fed up with the way the company was changing and started thinking about going to nursing school. "One day I had a disagreement with my boss, and the application went right in," says Kosnowsky, 29. "I wanted something that had a future." He worked part-time at Sears while he went to nursing school. Now, three years later, he's the first and only male nurse working at Conemaugh's neonatal intensive-care unit -- a career far different than that of his coal miner dad.

Suter and Kosnowsky live smack in the middle of the "Health Belt" that stretches from New England down through New York and Pennsylvania, across the Midwest and down through most of the South. These are areas where health care has been the major source of job growth over the past five years.

Nowhere is that truer than in Cleveland. There, Cleveland Clinic, with 29,000 employees, is the biggest employer by far. Next-largest is another hospital system, University Hospitals Health System, with 21,600 staffers. Then comes insurer Progressive Corp. and KeyCorp., each with fewer than 10,000 workers in the area. Cleveland Clinic's performance is pretty good for an outfit that started in 1921 with four docs in a building they planned to turn into a hotel if their vision didn't pay off.

Beyond its immediate employment tallies, the Clinic has a huge multiplier effect on the local economy. CEO Dr. Delos M. Cosgrove says it supports perhaps 75,000 jobs in all in the area, ranging from Clinic staffers to workers at hotels and restaurants -- which patients and their families use in more than 2.9 million patient visits per year -- to 3,000 suppliers to the Clinic.

Only a few years ago manufacturers were Cleveland's job engines. Companies such as machine-tool giant Warner & Swasey Co. don't even exist anymore. Conglomerate TRW was sold in 2002, and parts of it moved away. Fittingly, the Clinic now occupies its former headquarters, which TRW donated.

Health care has been one of the few economic bright spots in the Detroit area, too. Nancy M. Schlichting heads the sprawling Henry Ford Health System, founded by the great man himself in 1915. Schlichting is overseeing the construction of a new 300-bed hospital in West Bloomfield, Mich., a suburb of Detroit, which will eventually generate the equivalent of 1,200 full-time jobs. This expansion comes at a time when Ford Motor Co. (F ) is considering big layoffs.

Then there's North Carolina. Since 2001 it has seen a total job increase of 24,000, or 0.6%. Meager enough -- but take out the 60,000 jobs added by health care, and the state's jobs would have decreased by 36,000. Employment in manufacturing, retailing, trucking, utilities, and information all fell. And construction added only 5,000 jobs, a mere fraction of health care's contribution.

Oddly enough, the retirement meccas of Florida and Arizona are among the least dependent on health-care jobs for growth. Over the past five years the two states have gotten only 10% and 15%, respectively, of their new jobs from health-care services -- hospitals, doctor's offices, and nursing homes. Phoenix showed a job gain of 240,000, but only 30,000 were in health care. That's partly because the influx of elderly has been balanced by a rise in younger workers, too.

Is the health-care economy a good deal for workers? It is for Patricia A. McDonald, a second-year student nurse at Conemaugh. Before going to nursing school, McDonald, 46, sold insurance door-to-door, often driving close to 1,000 miles a week in rural areas to make cold calls. Her take in sales commissions was $35,000 to $40,000 a year, but that was before deducting expenses. Registered nurses in the Johnstown area, by comparison, are paid an average of almost $43,000 -- with no traveling. "This will be much better," says McDonald.

Unlike many other industries, health care offers a full range of jobs, from home health aides making very low wages through technicians and nurses making middle-class salaries up to well-paid doctors. On average, annual pay in private health services is $43,700, slightly above the private-sector average of $42,600.


Even more promising, health care has taken over the role manufacturing used to play in providing opportunities for less skilled workers to move up. Jeffrey Lites started as a part-time cashier in the cafeteria at Philadelphia's Children's Hospital in 1996 after being laid off as a computer operator. "I never envisioned working in a hospital," say Lites. But now, close to finishing his degree in early childhood education from Temple University, Lites works as a child-life assistant, providing recreation and activities for young patients who may stay for weeks or even months. "I have the best job in the entire hospital," says Lites, who moonlights as a musician on weekends.

The expansion of health care is also spinning off related jobs. Cleveland Clinic Innovations, a unit that funds startups, has already created 19 companies in its five years of existence. Together they employ about 186 people, including more than 50 in the Cleveland area. One, Cleveland BioLabs Inc. (CBLI ), went public in July and trades on NASDAQ. "We like to say that the New Economy is alive and well in the 40 blocks of the Cleveland Clinic," says Christopher Coburn, executive director of Cleveland Clinic Innovations.

James A. Martin is pursuing the same pot of gold in Shawnee, Kan., a city of almost 60,000 located just outside Kansas City. Martin, executive director of the Shawnee Economic Development Council, is helping the city set up a biosciences development district, the first in the state. He's hoping to build on the jobs already there, including the animal-health division of Bayer HealthCare (BAY ). "The high growth potential of biosciences jumped out at us," says Martin. "We got the bug."

Scott Becker, CEO of Conemaugh, is leading the effort to develop a technology park in a prime location in the center of Johnstown, where a mammoth dairy used to be. Potential biotech and info tech tenants include a company dealing with electronic medical records and another that's involved with drug trials. "The goal is to bring a new, younger workforce back to town," says Becker.


Shah of Cleveland's BioEnterprise cautions that biotech may not be the right economic development strategy for many places. For one, it's hard to develop a local biotech industry from scratch. "I've seen a lot of regions that take a swing at that," says Shah. Besides, he says, biotech mainly provides jobs for a small number of highly paid workers. For many communities, Shah favors a broader strategy of encouraging health-care delivery and medical equipment and supplies.

Still, using health-care spending to create the vast majority of new jobs, while beneficial in the short run, is not desirable over the long run. A well-balanced economy needs to provide a wide variety of jobs, not just positions for doctors, nurses, and medical technicians.

The biggest worry is that demand for health care will absorb too much of the workforce and squeeze out other types of jobs. If medical spending rises to 25% of gross domestic product by 2030, as many economists expect, health care's share of jobs could grow to 15% or 16% of the labor market from today's 12%, based on historical patterns.

Such a shift in employment would require health care to be the single biggest creator of jobs in the economy for the foreseeable future. And while the U.S. could in theory afford to spend 25% of GDP on health care, it's hard to imagine a world in which our children have to choose between working for the local hospital or the local health insurer.

The real question, then, is whether it is possible to restructure the health-care system to provide equally good care with fewer workers. The answer is yes, say some experts. "What we have consistently found is that the supply of physicians, except at the low end, has rather little influence on patient outcomes," says David Goodman, a professor at Dartmouth Medical School who started his career as a pediatrician in a rural county in Northern New Hampshire. Jonathan Weiner, a professor at Johns Hopkins University's Bloomberg School of Public Health, agrees: "I am absolutely certain that we can provide quality health care with fewer doctors."

These assertions miss the point, says Richard Cooper, a professor at the University of Pennsylvania School of Medicine. Cooper, a former dean at the Medical College of Wisconsin, argues that the health-care workforce grows along with real incomes and GDP. "When you get richer, you aren't going to triple your food expenditures," says Cooper. "But there's much more that can be done to improve health." Princeton economist Reinhardt concurs, noting that "if you did geriatric health properly, you'd need a lot more geriatricians."

But both sides can agree that more spending on information technology could reduce the need for so many health-care workers. It's a truism in economics that investment boosts productivity, and the U.S. lags behind other countries in this area. One reason: "Every other country has the payers paying for IT," says Johns Hopkins' Gerard Anderson, an expert on the economics of health care. "In the U.S. we're asking the providers to pay for IT" -- and they're not the ones who benefit.

Breakthroughs in technology offer other enticing possibilities for making health care less labor-intensive over the long run. Hakon Hakonarson just moved from Iceland to start up the new Center for Applied Genomics at Children's Hospital of Philadelphia. Hakonarson's group is using cutting-edge automated technology to analyze hundreds of DNA samples from hospital patients and their parents per day, something that wasn't possible until recently. His aim is to collect enough data within a short period of time to understand the genetic causes of childhood diseases and determine which children will respond best to which drugs. "If we go at this pace," says Hakonarson, "we will have something very powerful to analyze before yearend." The eventual result could be better, cheaper treatments, with fewer expensive side effects.

Meanwhile, Hakonarson employs 10 people in his lab as well as five nurses and medical assistants in the field who do nothing but ask families to participate in the study. For now, the health-care economy marches on



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 Page is here or here.


Saturday, September 23, 2006

The great wait

Governor Schwarzenegger plans to veto legislation creating a government-run, single-payer health care system in California. It's the right decision. Californians are understandably frustrated with the current health care system. Costs are rising rapidly, straining both businesses and workers. Doctors are burdened with paperwork and the limitations of managed care. Roughly 19 percent of Californians lack health insurance altogether. That's 6.5 million people. While many of the uninsured are covered by Medicaid and other government programs, California still has the nation's fifth highest number of uninsured in the country.

But simply saying that you are going to give every Californian "free" health insurance will do nothing to fix those problems. In fact, it may well make things much worse. The one common characteristic of all single-payer health care systems is that they ration care. Sometimes they ration it explicitly, denying certain types of treatment altogether. More often, they ration it indirectly, imposing global budgets or other cost constraints that limit the availability of high-tech medical equipment or imposes long waits on patients seeking treatment. For example, at any given time, one million Britons are waiting for admission to National Health Service hospitals and shortages force the NHS to cancel as many as 100,000 operations each year. Roughly 90,000 New Zealanders are facing similar waits. In Sweden, the wait for heart surgery can be as long as 25 weeks, while the average wait for hip replacement surgery is more than a year.

In Canada more than 800,000 patients are currently on waiting lists for medical procedures. As the Canadian Supreme Court noted in striking down the part of Canada's single-payer law that prohibited private payment for health care, "Access to a waiting list is not access to health care." The court went on to note that "in some cases patients die as a result of waiting lists for public health care" and "many patients on non-urgent waiting lists are in pain and cannot fully enjoy any real quality of life."

Not only would a single-payer system limit the availability of quality health care, it would add enormously to California's tax burden. "Free" health care is anything but free. The plan would be paid for by a 3 percent increase in the state income tax as well as a job-killing 8 percent payroll tax hike. For an already overtaxed state like California, these enormous hikes would be the kiss of death.

The first rule of health care reform should be taken from the Hippocratic Oath: First do no harm. We should not forget that for all its flaws, America offers the highest quality health care in the world. Many of the world's top doctors, hospitals, and research facilities are located in California. The University of California's San Francisco Medical Center, for example, is widely respected and attracts thousands of patients from around the world every year. The same is true of the Stanford University and UCLA medical centers, among others.

Eighteen of the last 25 winners of the Nobel Prize in Medicine are either citizens or residents of the United States—five in California. U.S. companies have developed half of all the major new medicines introduced worldwide over the past 20 years. In fact, Americans have played a key role in 80 percent of the most important medical advances of the past 30 years. By almost any measure, if you are diagnosed with a serious illness, the United States is the place you want to be. Do Californians really want to exchange all this for a centrally-planned health care system run by the state equivalent of FEMA?

We can make our health care system better, and we can lower costs and improve quality by giving health care consumers more choices. Health Savings Accounts, deregulation, and reforms to Medicare and Medicaid would be a good start toward making health care more accessible and affordable. Health care is literally a matter of life and death, so Californians should be very wary of entrusting it to a costly, government-run single-payer system.



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 Page is here or here.


Friday, September 22, 2006


You can be having a heart attack in Australia and they won't even let you in the door. See here

The July death of a Waukegan woman who waited nearly two hours in a hospital waiting room was ruled a homicide today during a Lake County coroner's inquest. Though the immediate cause of Beatrice Vance's death in the early morning hours of July 29 was a heart attack, she also died 'as a result of gross deviations from the standard of care that a reasonable person would have exercised in this situation,' said Lake County Coroner Richard Keller, reading from the jury's verdict.

Members of Vance's family were present at the hearing, but declined to comment after the verdict was reached. Monique Vance Beatrice Vance's daughter who was with her mother in the waiting room of Vista Medical Center East has previously said she believes her mother died because she was made to wait too long.

'It's a staggering result,' said Allen N. Schwartz, a Chicago attorney retained by the family. Schwartz declined to comment further, saying he had not yet seen hospital records of Vance's hours at the hospital.

At the hearing in the county administration building in downtown Waukegan, Deputy Coroner Robert Barrett testified that he subpoenaed the records after noticing discrepancies in the hospital's version of events after Vance arrived at the emergency room at 10:15 p.m. July 28. Vance was seen by a triage nurse at 10:28 p.m. According to hospital records, she complained of nausea, sweating and chest pain of a level she rated as a '10, with one being the lowest and 10 being the highest,' Barrett testified. 'The triage nurse classified her condition as 'semi-emergent,'' he said. At 12:25 a.m., an emergency room nurse went to the waiting room and called for Vance, but got no response, he said. Vance was leaning on her side on a waiting room seat, unconscious and without a pulse.

Doctors rushed her into the emergency room, administered CPR and put Vance on intravenous blood thinners, Barrett said. At about 12:55 a.m., doctors were able to generate a weak pulse. About 10 minutes later, the pulse stopped and doctors restarted CPR. Vance was pronounced dead at 2 a.m.



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 Page is here or here.


Thursday, September 21, 2006


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

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

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


The usual government approach to "child welfare"

No Australian State is free from such gross official negligence

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

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

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

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

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

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

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

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



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 Page is here or here.


Wednesday, September 20, 2006

NHS patients left waiting on operating tables by computer failures

Hospital operations and consultations are being delayed across England because the new NHS computer system suffers almost one “major incident” failure every day. Patients have been left waiting on operating tables and others have had appointments cancelled because of problems with the £12.4 billion system. The scale of the failures has prompted calls for the Government to rethink the future of the world’s largest non-military computer system amid fears about the impact on patient safety.

More than 110 major incidents have been reported by hospitals and GPs over the past four months, Computer Weekly magazine reports today. The scale of the problems at such an early stage will come as a blow to the National Programme for IT, which is at the heart of Tony Blair’s efforts to modernise the NHS. Over the next ten years the system is due to link more than 30,000 GPs in England to almost 300 hospitals. Connecting for Health, the body that oversees the programme, said, however, that the new computer system was much more reliable than those that it is replacing.

Reported problems include failures of the system used by surgeons to see X-ray pictures on a computer screen in wards and operating theatres. On some occasions the system has crashed during an operation, forcing the surgeon to suspend the procedure while a hard copy of the X-ray is found. Hospitals have also lost access to their patient administration systems, which hold records on appointments and planned treatments, so that they do not know who is due to have consultations or treatments.

Experts are concerned at the level of failures so early in the use of the system. Patients will be at even greater risk if the failures continue when the system is expanded across the country to prescribe drugs, order test results and store 50 million medical records. More than 20 of the major incidents reported over the past four months have affected multiple NHS sites. In July a data centre in Maidstone, Kent, crashed, causing the loss of central services and systems to 80 NHS trusts.

The Nuffield Orthopaedic Centre NHS Trust in Oxford said this year that it had identified “major issues of patient safety” when patients were lost in the system after being dropped from waiting lists or were not being called for important treatment.

Richard Bacon, a Tory member of the Commons Public Accounts Committee, said that the Government needed to reconsider the scheme. “This is the latest evidence that there are serious and growing problems with the whole National Programme for IT in the health service,” he said. “In many respects the NHS IT programme is making things worse, not better, while sowing distrust and disillusionment across the health service.”

Richard Vautrey, a member of the GPs’ joint IT committee of the British Medial Association and the Royal College of General Practitioners, said: “Any system in healthcare has to be available to clinicians and any downtime, however short, can have significant implications. If it is not possible to access the information during the consultation that can make the consultation particularly difficult.”

A Connecting for Health spokesman said that what constituted a major incident was open to interpretation and often problems were reported when systems were simply running slowly. “Connecting for Health is operating systems 24 hours a day, seven days a week in hundreds of locations across England,” he said. “In that context, what is being quoted represents a very small service interruption and we expect performance to compare favourably with any large-scale organisation that uses IT, especially in the first year of operations.”


The good old generous taxpayer again

The Queensland Government will subsidise the travel of public-sector doctors to attend an extravagant medical conference in Beijing later this month, despite running a cash-starved health system that has lurched from crisis to crisis. The annual conference of the Queensland branch of the Australian Medical Association, the lobby group that was particularly vocal during the recent election campaign in which health was a key issue, will be held over five days in the Chinese capital. But delegates will have to attend only four morning sessions over the week and will hear from two keynote speakers - both of whom are based in Brisbane. All afternoons are taken up with leisure activities or sightseeing, with the only evening commitment the "conference farewell dinner".

Senior public health professionals who choose to attend can pay for it from the $20,000 they receive each year for professional development, an allowance secured by the AMAQ during salary negotiations held earlier this year. The Australian understands that senior government officials are disappointed by the AMAQ's choice of location, particularly when the enterprise bargaining agreement requires the allowance to be paid without restrictions.

The middle day of the conference, which will be held from September 25 to 29, begins with a breakfast on the Great Wall followed by a visit to the Summer Palace and Lake Kunming. "Comfortable rubber-soled hiking boots are strongly recommended," the conference itinerary states. Lunch is included. On the other four days, delegates will only have to attend programs on medical issues for a few hours each morning. Queensland AMA president Zelle Hodge said while she would not be attending the conference, it was a chance for doctors and other health professionals to network and share information. "This is an opportunity for people to develop some continuing professional development and it's not going to make any difference to the crumbling health system," Dr Hodge said. "It is not uncommon to share speakers across countries and understanding the complexities of healthcare across different countries."

A spokeswoman for Queensland Health said yesterday it was unclear how many public-system officials would attend the conference because it was organised on a "district by district" basis. The AMAQ was also unable to provide information about how many health professionals would be attending. State Health Minister Stephen Robertson could not be reached for comment. The AMAQ held its conference last year in St Petersburg, Russia.

While most health professionals attending the conference would be working in Queensland's private health sector, senior medical officers and superintendents working in the public system receive $20,000 each year to spend on continuing education programs. Dr Hodge said it was a matter of personal choice how public-sector officials chose to spend their salaries. "That money is part of their salary package which they utilise however they see fit and any travel they do for professional development is part of that package," she said. "This is part of their salary package, and it's not as if that money would not come out of that salary package and patients in Queensland are actually going to be adversely affected."



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 Page is here or here.


Tuesday, September 19, 2006


Authoritarian medicine in Britain

Women may be prevented from having twins through IVF treatment because so many are being born that they are swamping intensive-care units. Would-be mothers will be allowed to have only one embryo implanted at a time, under proposals drawn up by a group of leading doctors. The change could reduce women's chances of having a successful pregnancy but the group says the move is needed to halt the sharp rise in IVF twins, who are blocking neonatal intensive-care beds.

At present women are allowed to have two embryos implanted to increase their chances of success, but this has contributed to a near doubling in twin births to 9,500 a year since the late 1970s. Mothers of twins are six times more likely to suffer from pre-eclampsia - high blood pressure during pregnancy - and three times more likely to die in childbirth. Twins are four times more likely to die within 28 days of birth and five times more likely to have cerebral palsy than single babies.

Professor Peter Braude, who chairs the expert group for the Human Fertilisation and Embryology Authority (HFEA), said twins were "a complication, not a bonus. "The public does not realise that twins are a health risk. The need to tackle the problem is unequivocal. Neonatal units are stretched to the extent that you cannot always get your baby into one. "If you deliver your baby in London, you find the baby is being shipped off to Northampton. We need to separate mother and baby or one twin from another. If we could lower the multiple pregnancy rate, we would have more cots available. It is stopping other babies getting into neonatal units."

His group is expected to recommend that only one embryo is implanted at a time in women under 35, while remaining embryos are to be frozen for transplanting if the first attempt at pregnancy fails. Those having IVF privately would also be affected because the HFEA licenses all clinics, not just those on the National Health Service. About 30,000 couples have IVF each year. The group is expected to say that, for NHS patients, the state should fund the implantation of another frozen embryo if the first attempt fails.


Public protests achieve what useless "regulators" would not

The story below appeared in the Gold Coast Bulletin of 18 Sept. 2006

The [Qld.] State Government will close a legal loophole that allows convicted rapists to work as doctors. Work is already under way on new laws to stop doctors convicted of certain offences from continuing to treat patients in Queensland's health system. A spokesman for Premier Peter Beattie yesterday confirmed processes to create the new legislation were set in motion soon after the Government swept back to power on September 9. "There has already been an exchange of letters and we will be liaising with stakeholders about what needs to be done," he said. "We want to make sure any legislation is effective."

The move comes in the wake of public outrage after the Queensland Medical Board re-registered convicted rapist and known drug addict James Samuel Manwaring in July. After pleading guilty in 2002 to a vicious attack against his then wife, Manwaring was told by District Court judge Brian Hoath that nothing could 'excuse your involvement in these offences'. However, the Health Practitioner's Tribunal last July allowed him to immediately apply for re-registration after he had met a stipulation to submit hair for drug testing. He passed the drug test and was registered to work within days. The tribunal imposed a further 24 conditions on his registration which would be strictly monitored.

The board said its hands were tied by laws which forced them to allow Manwaring to re-register if he met the tribunal's criteria. At the time Mr Beattie vowed to investigate closing the loophole, ordering a report from the Medical Board into the laws and any potential effects.

Manwaring's victim Pat Gillespie, who has agreed to be identified, said there was no way Manwaring should be allowed to treat patients. She welcomed Mr Beattie's announcement, saying it would protect all Queenslanders. "I welcome what the Premier is doing for the patients of Queensland," she said. "This loophole needed to be closed and I am just really pleased and relieved that this is going to happen."


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 Page is here or here.


Monday, September 18, 2006


The National Health Service could save at least 500 million pounds a year by adopting techniques that could halve the recovery time of patients after surgery. A new trial at the Freeman Hospital in Newcastle upon Tyne has shown that bowel surgery patients were ready to be discharged in just 7 days, rather than 14. The surgeons told a conference in Lisbon yesterday that better preparation and education of patients, greater use of keyhole surgery and a technique for improving fluid balance and blood circulation during and after surgery could greatly reduce the recovery period. The trial was the latest evidence of the effectiveness of CardioQ, a blood monitoring device developed by a British company, Deltex Medical.

If repeated across the country, the savings to the health service would exceed last year’s NHS deficit of 500 million pounds. However, the device was used in fewer than 5 per cent of possible NHS procedures, reflecting the difficulty of getting new devices used by the service. Alan Horgan, consultant colorectal surgeon at the Freeman Hospital and leader of the study, said: “These results are remarkable. Everyone involved in surgery and NHS management should read this study. “Fluid-balance during and after surgery is incredibly important to patient wellbeing. Our surgical recovery programme means the Freeman Hospital is already a leader in recovery times, but the CardioQ has allowed us to get even better. We have proven that it is possible to save the NHS both time and money, while also enhancing patient care.”

CardioQ works by monitoring how much blood the heart is pumping. Blood lost during operations is “topped up” by using a colloidal solution that mimics the behaviour of blood. Getting the volume exactly right is critical to ensuring that sufficient oxygen is delivered to the organs. Too little can lead to organ failure and even death. But too much can cause heart failure, so doctors have had to tread a fine line between the two. CardioQ monitors blood volume using an ultrasound probe inserted down the throat. The probe measures blood flow by bouncing ultrasound waves off blood cells flowing through the aorta, the main blood vessel.

The trial covered 108 patients. Half were given fluid at the discretion of the anaesthetist, while the other half had their fluid levels monitored by CardioQ. The national average recovery time for bowel surgery is 14 days, but at the Freeman, discharge took an average of only 7 days. The largest part of the improvement was the result of the recovery programme, which included the use of keyhole surgery. But CardioQ also contributed another two days, and patients treated with it also had far fewer post-operative complications — 2 per cent rather than 15 per cent. None needed an unplanned admission to the critical care unit, compared with 11 per cent of patients not treated using CardioQ.

Every day in a general or surgical ward costs 400 pounds per patient. The CardioQ monitor costs 7,000 pounds and the probes used in the trial 55 pounds each, meaning that the monitor could pay for itself in days. It could be used for a range of operations, not just those on the bowel. The National Institute for Health and Clinical Excellence described CardioQ as “standard clinical practice”. Yet such is the reluctance of the NHS to adopt new approaches that it is used in fewer than one in twenty operations in which it could provide benefits. Ewan Phillips, managing director of Deltex Medical, said: “Embracing this technology should be a no-brainer.”



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 Page is here or here.


Sunday, September 17, 2006

Britain: Stupid new government rules on sperm donors have the predicted effect

Hundreds of infertile couples could miss the chance to have a baby because of a nationwide shortage of sperm donors. More than two thirds of British fertility clinics have been unable to recruit donors or have had “great difficulty” in buying supplies, since the Government lifted donors’ lifelong anonymity last year, research shows.

BBC News found that 50 of the 74 clinics and sperm banks that responded to its survey are not recruiting new donors. There are 84 licensed centres for sperm donation in Britain. Those that can find men to donate have only 169 approved donors on their books and 90 per cent of these serve just ten clinics. There is only one registered donor in Scotland, and none in Northern Ireland.

This compares with a peak of 459 in the 1990s, when men could donate sperm knowing that any offspring would not have the right to trace them. This provision was removed in April last year, despite warnings from fertility doctors that it would lead to a collapse in supply. The Government argued that children conceived from donated sperm or eggs had a right to know the identity of their biological parents. Allan Pacey, head of andrology at Sheffield University and Secretary of the British Fertility Society, said: “If there aren’t enough men who are willing to donate and be identified to the donor-conceived offspring later in life, and if we don’t have the ability to import sperm from other countries because the regulations are too tough, then we are not going to be able to treat patients that require donor sperm treatments. “Sadly some will go without. I think we are certainly in a crisis at the moment. Most of the clinics are finding it very difficult to get enough sperm to treat their patients.”

He said that many patients who needed donated sperm to conceive were considering travelling abroad. “It leaves patients in a desperate situation. If they are unable to get treatment in their local clinic, then they are looking to other sources. Some are getting flights to other European countries. Others may turn to internet sites that provide sperm for home insemination. These are signs of desperation and I thoroughly understand them.”

Zoe and Colin Veal, whose only possibility of conceiving is by using donated sperm or an IVF technique called ICSI (intra-cytoplasmic sperm injection), were told by their Bristol clinic that there was no sperm available. Mrs Veal said: “I think it was a huge shock as for the first time we realised that we weren’t going to be able to access treatment. You then have to start thinking about where you go from here and then you have to start thinking about risks that you might have to take, such as buying fresh sperm over the internet or whether you just move on and become a childless couple permanently. Without sperm you can’t have a baby, and so that is the end of the line.”

Mark Hamilton, chairman of the British Fertility Society, said: “The British Fertility Society is well aware of the difficulties many patients throughout the country are experiencing in accessing gamete donation services, in particular donor insemination treatment. “Provision of such services requires significant resources to attract, recruit, screen, and counsel prospective donors. The survey reinforces our own findings that many clinics are now finding it impossible to provide these services



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 Page is here or here.