Don't get ill late at night in Britain

Because I have a perversely nocturnal brain I often write late into the night. So I had only just gone to bed last Thursday when the phone rang. My bedside clock said 3.11am. I answered with a sense of foreboding. Aside from the odd wrong number, any call we get between three and seven in the morning usually means that someone we know well is in some sort of trouble.

So it proved. We had been called by a service called Lifeline. If you are old, infirm or housebound and live by yourself, you wear an electronic device like a pendant round your neck. Should you take a tumble and can't get up, you press it to speak to a central operator who has the phone numbers of your nearest and dearest. It's a reasonable system, though I can't help thinking guiltily that if we - we as individuals, and we as society - really cared about our elderly we wouldn't leave them quite so much to fend for themselves.

Anyway, we flung on pullovers and whizzed two miles up the road to see what had happened to the lady concerned: a close relative, aged 86. The sight that greeted us was shocking. She had fallen on her way to the loo, opened up an ulcer, was shivering and half-conscious. Her skin was a ghastly blue. Worst of all, she was crumpled into a pool of her own blood. To my untutored eye, she seemed to have lost pints.

It was just after 3.30am. I dialled 999. When I described the old lady's condition the operator gave clear, concise first-aid instructions and said an ambulance was on its way. We found blankets, made her as comfortable as we could, and prayed that help wouldn't arrive too late.

Alas, this is Britain, 2007. At around 3.45am the phone rang. It was the London Ambulance Service. The essence of the call was: we're a bit busy tonight, sorry; can you cope? We said we would do our best. Seven minutes later our patient lost consciousness. Panicking, we called 999 again. Hang on in there, we were told. More agonising minutes passed. There is no helplessness worse than watching someone's life slip away for lack of prompt medical care in the middle of one of the richest, most sophisticated cities on the planet.

At 4.05am we heard a noise outside and glimpsed a flashing blue light coming along the road. I raced down the stairs to guide the ambulance to the flat. But the surreal sight that greeted me almost made me keel over with amazement. It was a fire engine.

The crew were already running towards me, breathing-gear and hoses at the ready. "Where's the incident?" one shouted. "What incident?" I replied. "The incident at this address," he said. "Someone phoned 999 for the fire service." "We called for an ambulance," I said. "An old lady's had a bad fall."

The firemen looked bemused but undaunted. They leapt up the stairs with every bit of medical clobber they could find. But I sensed that the spectacle in the flat alarmed them almost as much as it terrified us. By now the pool of blood stretched a couple of feet in every direction from where the woman lay. It was 4.10am - 40 minutes after we had made the 999 call. Luckily, skilled help was soon on hand. A paramedic turned up in a car. She administered oxygen and issued an urgent request for an ambulance on her radio. Only then did it transpire that there were no ambulances available in our area: a huge swath of northwest London. One would have to be despatched from Islington. "Eight minutes max, this time of night," said one of the firemen, trying to be reassuring.

It took 25. At 4.35am, about 65 minutes after we had made the first call, the ambulance arrived. The old lady finally got to hospital more than two hours after she had pressed her alarm.

Interestingly, A&E was virtually empty. There had been - surprise, surprise - no horrific incident tying up all the ambulances in North London in the early hours of last Thursday morning. The truth, it seemed, was that there was only one manned ambulance covering the entire area that night. Why? Because (we were informally told) the authority concerned had suspended ambulance crews' overtime, presumably in an attempt to alleviate its well-publicised financial problems.

Once again, as so often in Blair's Britain, we had encountered a colossal gap between what the politicians tell us is right with the country, and what our own eyes and brains tell us is wrong. More than 92 billion of our taxes is poured into the health service annually. That's around 1,800 pounds a year for every man, woman and child in England and Wales. We are assured that things are getting better all the time. The NHS certainly boasts more bureaucrats and fancy computer programs than ever before. Yet a semiconscious 86-year-old lies in a pool of her blood for 65 minutes waiting for an ambulance. In what sense is that progress? What are the NHS's priorities, if not for dealing with that?

The old lady, you will be pleased to know, is slowly recovering. Those Blitz-generation Londoners are as tough as nails. I'm the one who's still in shock. Where on earth did that fire engine come from?

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Australia: Lawyers squealing about damages cap

Insurance premiums will be reviewed to ensure that they have fallen in the wake of reforms to personal injury laws which capped compensation payouts, the State Government says. Premier Peter Beattie yesterday stopped short of endorsing Attorney-General Kerry Shine's claim that the laws were unfair, but said the Government was willing to check whether the changes made in 2002 were still working.

However, he warned lawyers they should not expect the laws to be significantly relaxed. "I just want to be really clear that ambulance chasers shouldn't get too excited," Mr Beattie said. "We are not going to go back to the bad old days when we couldn't get insurance to cover our doctors. "(But) the insurance industry had an obligation to reduce their premiums. I don't think it's unreasonable that we should actually have a look at that too, to make sure they have done that."

In an earlier interview with The Courier-Mail, Mr Shine had criticised the laws, saying they had unfairly blocked people with minor injuries claiming compensation, because their court costs could not be covered. He accused insurance companies of profiting from the crackdown, which was aimed at addressing the public liability insurance crisis when soaring premiums were sending community groups and charities to the wall. Under the changes, general damages were capped at $250,000 and court costs limited on payouts of less than $50,000.

Australian Lawyers Alliance state president Ian Brown welcomed the Attorney-General's comments and called for an immediate overhaul. "It is now widely accepted that the so-called insurance crisis was not the result of an increase in claims, but rather inherent problems within the insurance industry and external global financial factors," Mr Brown said. "Of course insurance companies must remain profitable, but not at the price now being paid by Queenslanders - and particularly our most vulnerable, the elderly and children, who have almost completely lost the right to fair compensation for injury caused by the wrongdoing of another."

Source

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

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