Saturday, January 13, 2007


And all this is after a huge increase in funding

The NHS will miss its target of halving superbug infections by 2008 and may never be able to control the problem effectively, the Government has admitted secretly. A leaked Department of Health memo has revealed that officials believe that government pledges to cut cases of MRSA substantially are not achievable, while the even more deadly Clostridium difficile is now "endemic throughout the health service".

More embarrassing still, much of the memo is devoted to "spinning" the failure to meet the targets so as to minimise its public impact. The memo was sent last October by Liz Woodeson, director of health protection at the Department of Health, to ministers. Politicians and health campaigners said that it deepened the sense that ministers and department officials were more interested in spin than substance.

The memo, leaked to Health Service Journal, states that the target to cut cases of the superbug methicillin-resistant Staphylococcus aureus (MRSA) by 50 per cent by April 2008, set by the former health secretary John Reid in November 2004, is unlikely to be met. There were more than 7,000 cases of MRSA in patients' blood-streams recorded in 2004, since when the number has dropped only slightly. "Although the numbers are coming down, we are not on course to hit that target and there is some doubt about whether it is in fact achievable," the memo said. "The opinion of infection experts is that we will succeed in reducing MRSA bloodstream infections by a third rather than half - and that, even if we had a longer period of time, it may not be possible to get it down to half." The memo adds that C. diff is now endemic throughout the health service, and poses an even greater threat to patient health. It gives warning that it is harder to tackle than MRSA, and that some techniques used to cut MRSA, such as alcohol rubs, do not work for C. diff.

The leaked memo sets out six ways of handling the failure to meet the MRSA target, including driving at the target as it is and face the consequences (a policy favoured by Downing Street), extending the target or accepting that it is unworkable and dropping it completely. Another tactic suggested is to enlarge the target to include C. diff, or even all hospital-acquired infections without specifying which ones.

Ms Woodeson admits in the memo that the battle to combat MRSA "doesn't seem to be having much impact on C. difficile, which is a far bigger problem". The note quotes figures from 2004 showing that while MRSA caused 360 deaths, C. diff was responsible for an estimated 1,300.

A Department of Health spokesman said of the memo: "We deplore this leak. This paper confirms that from the Prime Minister and Health Secretary downwards, the Government is determined that the NHS should get on top of the problem of MRSA and other infections." He admitted that progress had been slower than anticipated and that faster progress is needed to meet the target. "We have always said the target is challenging; that is why we set it. We remain committed to this target."

The memo is the second damaging leak to the HSJ from the department in successive weeks, suggesting that there are disgruntled civil servants prepared to risk their jobs to reveal what is going on. Andrew Lansley, the Shadow Health Secretary, said: "The Government needs to get a grip. Gordon Brown's target culture has increased costs with little improvement in care."

[And now for examples of the famous British "fudge"]

Six ways to fudge a target

* Keep it as it is, and drive as hard as we can to meet it - the policy favoured by the No 10 Delivery Unit. But Liz Woodeson, director of health protection at the Department of Health, admits: "We will be criticised if we fail to meet the target"

* Drop the target altogether, but this would be hard to get past No 10, and handling would be "extremely tricky" given media interest. "Dropping the target would probably provoke more criticism than failing to meet it in 2008," she says

* Extend the target to 2009. That would give more time, but would be open to charges of fiddling, and it may still be missed "because a certain level of MRSA infection is unavoidable"

* Extend the target, adding something on C. diff. That would be welcomed by people and might make hospitals take C. diff seriously, "as we suspect some simply see it as unavoidable". But there are many other hospital-acquired infections. It would be absurd to set a target for each, she said

* Change the target to hospital-acquired infections generally. That could not be done as mandatory reporting covers only five infections and there are "dozens of others"

* Switch to locally set targets. That would have the advantage of including C. diff, but "would be presented by the media as a cop-out because we knew we weren't going to hit the national target"



Health tourists are receiving free National Health Service kidney treatment worth about œ30,000 a year, and potentially competing with British patients for scarce transplants, according to new data. The information, released under the Freedom of Information Act, shows that one hospital is spending up to a million pounds a year on dialysis for nearly 40 non-British residents; another has placed two asylum seekers on its waiting list for transplants and a third has recovered only 2% of its costs from overseas patients.

Doctors and patient groups say the NHS is struggling to provide kidney dialysis for British patients and is ill-equipped to cope with the extra demand. They warned of an acute moral dilemma as doctors balance their overriding responsibility to help those in greatest need with the fact that the patient may not be legally entitled to treatment.

There are fears some foreign patients, so-called "health tourists", may travel to Britain to take advantage of free NHS care. Dr Jonathan Kwan, head of renal services at Epsom and St Helier hospitals trust in Surrey, said: "Non-UK residents are putting pressure on the system, which is already under too much pressure." Kwan said British patients risked losing out to those from overseas who needed treatment more urgently. "Patients waiting for dialysis may be displaced by a clinically urgent case. Doctors try to prioritise the urgent cases irrespective of residency status."

There are a record 6,000 patients on the kidney transplant waiting list, with about 400 dying each year in Britain before an organ becomes available. Patient groups say some British sufferers are forced by a lack of dialysis machines to receive treatment at night. While most health tourists seek one-off operations, patients suffering from kidney failure require dialysis three times a week for life unless given a transplant.

According to the figures, Barts and The London NHS Trust, which covers two of the largest hospitals in the capital, is providing 37 non-UK residents and an extra 14 asylum seekers with dialysis. Two asylum seekers are on the kidney transplant waiting list at the Royal Berkshire NHS Foundation Trust in Reading.

Although trusts may try to invoice non-UK residents for treatment, they usually recover only a fraction of the cost. Asylum seekers are entitled to free treatment while their case is being considered. In the last financial year St George's hospital in south London spent about 100,000 on dialysis for overseas patients but has recovered only 2,100.

Timothy Statham, chief executive of The National Kidney Federation, said: "Capacity is at breaking point," he said. "We have very ill British patients needing to dialyse through the night because there is not sufficient capacity. Some patients may come from abroad because dialysis was not available in their country. We seem to be offering a world health service."


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

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