More on government medicine in America

For Dr. Martin Hoffman, the frustration has been growing for at least a year. As the head of physical medicine and rehabilitation for a Veterans Affairs health branch that sprawls through much of the Sacramento Valley, Hoffman wants another physical therapist and another chronic pain specialist in Sacramento. "Frankly, we just don't have enough staff to do the job right," he said.

Pressure to schedule relatively timely appointments for veterans coming home from Iraq or Afghanistan is driving up the waiting time for other veterans, Hoffman said. So far, he said, it's only a matter of a few extra days' wait for the veterans of World War II, Vietnam and other eras who make up the bulk of those seen at Sacramento-area VA facilities. But as more and more service members return from the lengthy Iraq war, no one expects the demand to lessen. Doctors predict the biggest new workload will fall on physical medicine, orthopedics and mental health.

The VA Northern California Health Care System last year won funding to increase its mental health staff by nearly 50 percent, adding 37 positions to an 80-person network of psychiatrists, psychologists, social workers and nurses in clinics from Redding to Oakland. "We have a wonderful thing happening in our VA," said Dr. Maja Jackson-Triche, the local system's chief of staff for mental health. She paints a picture of therapists able to see troubled veterans the same day if needed, and an administration open to more funding requests.

Some who work with veterans locally are more skeptical, and a massive nationwide analysis of VA mental health care by McClatchy Newspapers found serious deficiencies. Today's veterans are getting about one-third fewer visits with specialists in the area of psychiatric problems than a decade ago, McClatchy reported last month. The investigation found wildly uneven care from state to state, with some regions offering psychotherapy appointments as short as 20 minutes.

For those haunted by their time in uniform, stakes for getting help can be perilously high. Sean Benedict, who aids veterans struggling with homelessness and substance abuse, has been mourning the tiny, frenetic Iraq vet who came through the Sacramento Veterans Resource Center earlier this year. Her name was Jessica Rich, and she'd grown up near Chico before becoming entangled in service-related trauma that she just couldn't beat, said Benedict, the center's clinical director. Last month, Rich died in a drunken driving crash in Colorado that Benedict and others who knew her laid directly at the feet of post-traumatic stress disorder. She was 24. Rich had been undergoing therapy in Colorado when she died, and Benedict doesn't believe her death illustrates flaws in VA care. It simply shows how bad things can get, he said, for individuals and for the system that should be there to treat them. "She's the canary in the coal mine. If we start seeing hundreds and hundreds of Jessica Riches, we're in trouble," he said.

Benedict, whose agency gets funding from the VA, sees it as a system full of well-meaning caregivers hampered by too little money and a huge bureaucracy aimed partly at aiding those most desperately in need while stalling those who can wait. "We went to war without adequately preparing for the cost of war," Benedict said. "That's the problem." Amid the added focus on the most recent wave of returning troops, Benedict worries that those who served in peacetime or in Vietnam are slipping lower on the VA's priority list.

Dr. David Siegel, acting chief of staff of the VA's Northern California Health Care System, said there's a "a national mandate" that Iraq and Afghanistan vets not wait longer than 30 days to be seen. Hoffman echoed that, although VA spokeswoman Beverley Pierce said it's a broader goal that also applies to other veterans if they haven't had a medical appointment in the past two years. In 2006, the physical medicine and rehabilitation service at Sacramento's VA Medical Center at the former Mather Air Force Base hit that target only 68 percent of the time for new patients, according to Pierce.

Hoffman, who oversees physical medicine, has been keeping an eye out for trends that could help things get better -- or worse. This week, he was worried that a new screening program has diagnosed more veterans with symptoms of traumatic brain injury, which can crop up in headaches, word-finding difficulties or memory problems after a mild concussion. "If we keep getting large numbers of those, we're going to be struggling even more," Hoffman said.

By contrast, the mental health service at the Sacramento center saw 90.5 percent of its new patients within 30 days, Pierce said, adding that anything above 90 percent meets the performance target set nationally by the VA. Beyond the numbers, those who work with veterans in Sacramento are "great people," said Yesica Castillo, who turned to them for help after serving as a military police officer in Iraq's Sunni Triangle. Castillo, 23, had been safely home in Placerville for two years, thinking she was doing all right, until her husband shipped out for Iraq yet again, leaving her with their little daughter. That's when the sleeping problems, the nightmares and the irritability kicked in. Castillo, who attends group classes on post-traumatic stress every other week at the Sacramento VA center, said sometimes she thinks the program is helping, and other times she's less certain. Yet she's sure that the support and advice she's gotten from fellow veterans has been worth the long, gas-guzzling trip from Placerville to Sacramento

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Filth and shame in an NHS hospital

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

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

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

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

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

A former midwife described eloquently on Radio 4 the indignities of being in a 24-bed mixed-sex ward, stripped of all dignity and intimidated. Bedlam was the word she used, and it applies even more accurately to the secure psychiatric mixed ward in London endured by Susan Craig last year, after a breakdown. She suffered regular sexual harassment, with mentally ill men groping her and exposing themselves. The nurses disbelieved her and told her husband she was "flaunting herself". If so (I don't believe them), their job was to protect a patient from her own folly. Instead they chose, in modern cant, to blame the victim.

Sexual harassment is only a small part of the problem. Many people, both men and women, feel their modesty is violated by such closeness to random members of the opposite sex, even when they are not threatened. Patients lie naked, half washed and forgotten, their sick and ageing flesh exposed to everyone, while nurses rush elsewhere. It is commonplace to have to walk to filthy mixed lavatories with gowns wide open at the back. At a time of sickness and anxiety many people are profoundly embarrassed to be surrounded by a clutter of bed pans, colostomy bags, nakedness, cries of pain and sweat, blood and tears - their own and other people's. All this is much worse, for many, when they are surrounded by members of the opposite sex; shame and anxiety are not the best bedfellows of hope and healing.

Much has been written about the rape of modesty and the death of shame. However, it is still true in this weary country that most men and women prefer to perform private bodily functions alone if possible, and among their own sex only, if not. That's why we have separate public lavatories and separate changing rooms in shops and clubs and pubs. That's why people put up towels on the beach. That's why women give birth in female wards, not in mixed wards or not - I hope - so far.

Admittedly there are some who believe that mixed wards are not a problem, but our prime minister is not one. "Is it really beyond the collective wits of the government and health administrators to deal with the problem?" he demanded in 1996, flying high on vectors of dizzying youthful indignation as leader of the opposition. "It's not just a question of money," he went on. "It's a question of political will." Well, he said it and he promised to end mixed-sex wards by 2002.

What we have come to expect of new Labour promises, following failure, changing the goalposts, more failure and exposure, is denial. Sure enough Patricia Hewitt, the health secretary, was sent onto the Today programme in denial mode last week. Although the Healthcare Commission watchdog found that on average 22% of patients have to stay in mixed-sex wards, rising to 60% in some hospitals, Hewitt's officials at the Department of Health say the government has achieved its target of abolishing mixed-sex wards, with 99% of trusts providing single-sex accommodation. It is not difficult to spot the problem with that claim. It is not the same as saying 99% of patients get single-sex accommodation; it may be "provided" for very few. There has been the usual goalpost shifting: hospitals can claim they are providing single-sex accommodation by putting screens between beds in mixed-sex wards. Brilliant.

Hewitt admits there was a problem of perception; she even admitted that there was a "clear gap" between patients' experiences and figures provided by hospital trusts to the Department of Health. One does tend to have a problem of perception, I find, if one is being misled.

My feeling is that mixed-sex wards are not the worst of NHS hospitals' problems, although they demonstrate them. They demonstrate the incompetence and deviousness of hospital management in general, and they also show something worse. In all the stories I've come across what stands out is the ignorance, incompetence, laziness and heartlessness of all too many nurses, who are allowed to neglect and insult their patients without supervision and without sanction - in single-sex wards just as much as mixed. Blair did not just promise to abolish mixed-sex wards, he also promised to save the entire NHS. He believes in divine judgment; I wonder how he will answer.

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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?

For more postings from me, see TONGUE-TIED, GREENIE WATCH, POLITICAL CORRECTNESS WATCH, FOOD & HEALTH SKEPTIC, GUN WATCH, EDUCATION WATCH, AUSTRALIAN POLITICS, DISSECTING LEFTISM, IMMIGRATION WATCH and EYE ON BRITAIN. My Home Pages are here or here or here. Email me (John Ray) here. For times when blogger.com is playing up, there are mirrors of this site here and here.

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