British Doctors call for health boss Hewitt to resign

Junior doctors have called for Health Secretary Patricia Hewitt and Health Minister Lord Hunt to resign over "shambolic" medical training reform. The British Medical Association's junior doctors conference called the Medical Training Application Service's problems "gross negligence". The online job application service was suspended amid fears personal details of applicants could be accessed online. The government says it is working hard to ensure the security of the system.

Earlier, the BMA called for Tony Blair to step in to avert more chaos over the online application system. BMA chairman James Johnson has written to Tony Blair warning doctors' anger will grow if the government does not address the problems with MTAS "with the level of urgency they deserve". He said the mistakes had the potential to damage patients' confidence in the proposed new database of individual health records.

The conference also criticised failures in the Modernising Medical Careers (MMC) scheme and demanded a review into the waste of public money it claims it has caused. The delegates also raised concerns that the implementation of MMC speciality training would have "grave consequences for patient care".

The issue is also mired in internal feuding, with some doctors calling on their own leadership to resign for participating in the government review. Delegate Dr Andrew Smith said there was "more anger and resentment than ever before". Despite this the BMA leadership had remained engaged in and endorsed the "fiasco that is MMC", he said.

Health Secretary Patricia Hewitt has already apologised for the "terrible anxiety" caused to junior doctors over the scheme. BMA junior doctors committee head Jo Hilborne told the conference that modernising medical careers should have brought an end to uncertainty for senior house officers. But instead, she said it had brought the fear of career stagnation, the danger of falling standards and loss of good doctors. She called the application system a "desperate failure". "The fault is with this government which has systematically ignored the people whose lives are being ruined by their ill-thought out, badly implemented policies," she said.

Conference delegates suggested the system should be scrapped and suggested two possible solutions to the MTAS problems. They said either all candidates starting posts in 2007 must be interviewed for all their choices, or all MMC training be postponed and a return made to the old system (SHO/specialist registrars) for a year while a new application process was devised. The MTAS computer system has previously been criticised for not allowing candidates to set out their experience, meaning the best candidates have not been selected for interview. But it has also been attacked for having too few jobs for the number of candidates.

Conference delegates also passed a motion calling for the National Audit Office to investigate how much public money had been spent on the computer system. And they sought guarantees that no junior doctor would be unemployed as a result of system failures.

The BMA estimates that 34,250 doctors are chasing 18,500 UK posts, due to start in August. But it has warned thousands of NHS doctors could go to work abroad because of their disgust at the process.

Lord Hunt insisted it was not a resignation issue and that all the medical organisations had called for the old system to be changed because it was not working. Earlier he told the BBC action was being taken to make the system more secure. "We have brought in over the weekend some independent experts from outside companies. They are clawing through it to make sure it is secure and we will only open it up again when we are satisfied about that."

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?

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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Universal health care's dirty little secrets

What many politicians and many other Americans fail to understand is that there's a big difference between universal health care coverage and actual access to medical care. Simply saying that people have health insurance is meaningless, say Michael Tanner, director of health and welfare studies, and Michael Cannon, director of health-policy studies at the Cato Institute.

Many countries provide universal insurance but deny critical procedures to patients who need them:

* Britain's Department of Health reported in 2006 that at any given time, nearly 900,000 Britons are waiting for admission to National Health Service hospitals, and shortages force the cancellation of more than 50,000 operations each year.

* In Sweden, the wait for heart surgery can be as long as 25 weeks, and the average wait for hip replacement surgery is more than a year.

According to Cannon and Tanner, the uninsured in the United States don't receive substandard care:

* Helen Levy of the University of Michigan's Economic Research Initiative on the Uninsured, and David Meltzer of the University of Chicago, were unable to establish a "causal relationship" between health insurance and better health.

* Similarly, a study published in the New England Journal of Medicine found that, although far too many Americans were not receiving the appropriate standard of care, "health insurance status was largely unrelated to the quality of care."

Everyone agrees that far too many Americans lack health insurance. But covering the uninsured comes about as a byproduct of getting other things right, say Tanner and Cannon. The real danger is that our national obsession with universal coverage will lead us to neglect reforms -- such as enacting a standard health-insurance deduction, expanding health-savings accounts and deregulating insurance markets -- that could truly expand coverage, improve quality and make care more affordable.

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?

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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Pensioner is refused sight drugs – until he goes blind

Socialist "compassion" at work. Elderly people can go blind for all they care

A RETIRED policeman is going blind – because a Yorkshire health trust will not pay for treatment that could save his sight. Leslie Howard, also an ex-Royal Military policeman and former prison officer, suffers from a degenerative eye condition. The drugs needed to save his sight are available on the NHS in other parts of the country. But Mr Howard, 76, has been told by health chiefs not to expect a penny of NHS treatment until he goes blind in one eye and starts losing sight in the other. He fears that after a lifetime of public service the decision by North Yorkshire and York Primary Care Trust could plunge him into total blindness and leave him and his invalid wife Mary Ann, 70, housebound.

As his case led to a new row over NHS "health rationing", Mr Howard, of Acomb, York, said: "The problem is we have lived too long and are just pieces of meat now – a nuisance. "I was advised to go private but was quoted 1,000 pounds an injection for who knows how many injections. I can't afford that kind of money. I've paid tens of thousands of pounds in taxes and to know that I will now lose my sight because I can't afford private treatment is diabolical."

Mr Howard was diagnosed with wet age-related macular degeneration (AMD) in his right eye in November. It can cause sight loss in three months. He says he was advised by the North Yorkshire and York PCT that it would only consider funding once he had gone blind in one eye and developed a similar condition in his second eye. He added: "It is more than three months since I was diagnosed and it is getting worse by the day. Has the Government lost all sense of compassion as well as economics?"

The head of campaigns at the Royal National Institute of the Blind, Steve Winyard, said: "This is a desperate situation for Mr Howard. His care trust is leaving him to go blind in one eye even though sight-saving treatments are available on the NHS. "We hear of more and more patients being forced to use retirement funds or life-savings to pay for sight-saving treatments that should be available readily on the NHS. "In cases like Mr Howard's, where people can't afford private treatment, patients face the prospect of going blind unnecessarily."

The chief executive of the Macular Disease Society, Tom Bremridge, added: "The so-called 'second-eye' policy is wholly unacceptable on ethical and practical grounds." Losing sight in one eye could affect a person's co-ordination and increase the risk of falls, while not treating the condition meant patients had a high risk of developing the problem in the second eye. Unsuccessful treatment in the second eye could then mean total blindness, Mr Bremridge said. He added: "It also makes no economic sense to deny treatment. The cost of supporting people with sight loss far outweighs the cost of treatment."

AMD sufferer and former Halifax Labour MP Alice Mahon, who took legal action against her PCT and forced a U-turn over its refusal to provide similar injections on the NHS, said: "It is an obscene policy. It's outrageous. "The whole fault is handing over all this funding to the PCTs, so it's a postcode lottery and not a national health service. I am particularly concerned there seems to be discrimination against older people who have paid into the NHS all their lives."

The North Yorkshire and York PCT said yesterday Department of Health guidelines were that, until the National Institute for Health and Clinical Excellence (NIHCE) published final guidance on new treatments, NHS bodies should continue local arrangements to manage their introduction.

There was no NIHCE guidance yet for the drugs Mr Howard wanted. So in agreement with other PCTs in the region, the trust was funding such treatments only in cases where there was evidence they would work. If any patient felt they should be considered for treatment the PCT would examine their circumstances, a spokesman added.

Source

And he's not alone:

A WIDOWED grandmother who devoted 30 years of her life to the NHS and twice fought off cancer has become the latest patient in Yorkshire to be warned she faces being denied vital treatment for a condition which causes blindness. Retired midwife Doreen Kenworthy was last week given the devastating diagnosis that she was suffering from the eye condition age-related macular degeneration.

But her shock was compounded when doctors told her the NHS would not pay for treatment until she lost the sight in her affected eye and began to lose it in the other – although further loss of sight could be prevented if she paid out thousands of pounds for private care. Her plight is similar to that of York pensioner Leslie Howard who was refused immediate NHS treatment, although a private hospital group has now stepped in to give him the care he needs. Dr Kenworthy, 56, of Stanley, Wakefield, has vowed to fight to get sight-saving treatment.

"I am not prepared to die of cancer, neither am I prepared to go blind whilst fighting it," she said. "I have never been a supporter of the private sector in my professional life. I believe in Aneurin Bevan's philosophy of free healthcare access for all at all levels. "I understand there are cutbacks, although I don't agree with the way the Labour Government has handled the NHS, but to be told 'Sorry you have to go almost blind before you get help' is dreadful."

Dr Kenworthy, who worked as a midwife and later trained midwives before retiring last year from Bradford University, said she was diagnosed with breast cancer two years ago, undergoing a year of treatment before the condition recurred in January. The eye complaint was unrelated but she had already lost some central vision in her right eye which began deteriorating a month ago. She was urgently called for tests at St James's Hospital in Leeds where specialists told her she had the eye complaint and further deterioration could be prevented only by drug injections.

She was told these were only provided by the NHS after she lost her sight in one eye and began to lose it in the other – although they were available privately at a cost of up to 1,000 each over 12-24 months. "I did not expect to be told that I couldn't be treated on the NHS but if I went into the private sector I could be treated tomorrow," she said.

Dr Kenworthy, who has twins aged 31 and four grandchildren, said the only option she had to fund the treatment was by remortgaging her home. "To have to tell your children twice you've got cancer, then to say by the way you're going blind in your right eye and can't have any treatment until it affects your other eye is very hard," she said. "It's been devastating to have cancer twice in two years, to fight it, to retire after 30 years in the NHS and then get this on top."

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?

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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HillaryCare Installment Plan

The Schip strategy for government-run health care


Any doubt that "universal" health care has returned as a dominant political issue vanished with last month's forum for Democratic Presidential candidates in Nevada. "We need a movement," Hillary Clinton declared. "We need people to make this the No. 1 voting issue in the '08 election."

She and her friends in Congress are already working on it, notably by proposing to greatly expand the State Children's Health Insurance Program. "Schip" was enacted in 1997 as Bill Clinton's health-care consolation prize after the implosion of HillaryCare. It expires in September without reauthorization, and Democrats are using the opening to turn it into another giant middle-class health-care entitlement. Call it HillaryCare on the installment plan.

Schip was conceived--or at least sold--as a way to insure children from low-income families that aren't poor enough to qualify for Medicaid. Included as part of the Balanced Budget Act of 1997, Schip began as a federal block grant of about $40 billion over 10 years. States receive an annual fixed federal contribution. Then they match the funds and design their own programs, by expanding Medicaid, creating a separate Schip program or some combination. States determine eligibility and benefits; some have premiums or co-pays, usually at negligible rates.

The Bush Administration wants to add $4.8 billion to the Schip budget, bringing it to $30 billion over the next five years. Democrats want to see that and raise by $50 billion to $60 billion. They pronounce Schip "underfunded"--and sure enough, 2007 funding already falls short of covering enrollees in 18 states by about $900 million.

But this "crisis" arose because some states have grossly exceeded Schip's mandate. They are using the program to expand government-subsidized coverage well beyond poor kids--to children from wealthier families and even to adults. And they're doing so even as some 8.3 million poor children continue to go uninsured.

The Schip legislation defines potential recipients as children in families making twice the federal poverty line, or $41,300 a year for a family of four. But states are encouraged to apply for waivers to allow for more flexibility. Now 15 states have eligibility thresholds above 200% of poverty, and nine of those are at or over 300%. In New Jersey, the figure is 350%. New York recently passed a budget raising eligibility to the highest in the nation at 400%--or $82,600 for a family of four. That's an income close to what Democrats usually define as "rich" when they're trying to raise taxes.

Some states are using Schip to create universal child health programs, regardless of need. Governor Rod Blagojevich recently expanded the Illinois Schip program to insure all children, with premiums and co-pays based on parental income. Pennsylvania's "Cover All Kids" and Tennessee's "Cover Kids" programs do the same.

As of February 2007, the Government Accountability Office found that 14 states were using Schip to cover adults: pregnant women, parents of Medicaid or Schip kids--and even childless adults. Arizona, Michigan, Minnesota and Wisconsin cover more adults than children. In 2005 Minnesota spent 92% of its grant insuring adults, and Arizona spent two-thirds the same way.

And no wonder: The Schip funding structure provides incentives for running over budget. In three-year periods, all unspent Schip allocations across the 50 states are tallied up and redistributed. A state that exceeds its allotment gets more money from a state that didn't. In the 14 states that went over budget in 2005, 55% of Schip recipients were adults.

We're all for federalism, and if states want to raise taxes to pay for government-run health care, they have every right. The problem is when they exploit federal policy loopholes to do so and thus stick taxpayers in more responsible states with a larger tab. In 2005, 28 states received an extra grant, either through redistribution or the feds picking up the check for overruns. Thus the federal government pays about 70% of total Schip outlays, despite the premise of "matching" state grants.

A bill introduced by Senator Clinton and Representative John Dingell would make all of this worse. It would index government Schip outlays to national health spending and growth in states' child population. Without "quantifiable" progress--i.e., expanded rolls--funding drops. The legislation would also create incentives for states to expand Schip to the New York level of 400% of poverty. If this keeps up, a family will soon be eligible for Schip and subject to the Alternative Minimum Tax.

In other words, what began as a hard-cap grant to cover the working poor is evolving into an open-ended entitlement to cover whatever promises states make. And all under the political cover of helping "children." Instead of debating government-run health care on its merits, Democrats are building it step by step on the sly. Or as Mrs. Clinton put it in Nevada, "Make no mistake. This will be a series of steps."

There's a lesson here for Republicans, who agreed to create Schip in a trade for Mr. Clinton's signature on their "balanced budget." Balanced budgets vanish in the blink of an election, while entitlements like Schip live on and expand as an ever-larger claim on taxpayers. Mark this down as another case in which Bill Clinton outfoxed Newt Gingrich. The least Republicans can do now is work to return Schip to its original, more modest purposes.

Source






Fake medical degrees accepted by Australian health bureaucrats

Those guys sure are good at protecting the public

A scandal over purported overseas-trained doctors in a Queensland public hospital is widening after revelations that a Russian nurse used an online medical degree from the Caribbean to get a job, while a Chinese woman used documents showing she would have just turned 14 when she went to medical college in Shanghai. Evidence obtained by Chief Health Officer Jeanette Young in an investigation into the hiring of three junior doctors, or interns, at Cairns Base Hospital has appalled officials and Queensland Health Minister Stephen Robertson, sources told The Australian yesterday.

Queensland's anti-corruption body, the Crime and Misconduct Commission, will soon join the Health Quality and Complaints Commission and the Medical Board in a wide-ranging inquiry into why the hospital bypassed checks and balances before hiring the interns on more than $60,000 a year each. One of the three recruits could not speak English and was unable to communicate with anyone on the wards. Dr Young's investigation began after The Australian revealed, two weeks ago, serious concerns about the interns' qualifications.

Since initial claims by Cairns Base Hospital managers that the recruits were observers who had no unsupervised contact with patients, Dr Young has studied the charts of more than 500 patients and discovered that in a number of cases there were unsupervised examinations, diagnoses, orders for pathology and prescriptions. "The hospital's staff took the view that they would employ the purported doctors and, eventually, the Medical Board would get around to registering them," said a senior health source in Brisbane. "It is untenable. There will bean array of investigators descending on Cairns in the coming weeks." Mr Robertson's spokesman said: "We are concerned about the information emerging. But we can't say anything until we get Dr Young's report."

Health sources said the documentation relied on by the Russian nurse and the Chinese woman to obtain employment in Cairns made the CMC's involvement essential. CMC investigators will be given the task of tracing the documentation of the Russian nurse, whose curriculum vitae was contradictory. The nurse claimed to have received a medical degree from a university in the Caribbean. However, preliminary investigations revealed it was an internet-based qualification and should not have been recognised by Australian medical authorities. "It is a rather unusual degree in that it is an online degree with the teaching done online," a source said.

Dr Young's spokesman said: "The investigation is ongoing and is a matter of priority. The Chief Health Officer is happy to advise that the investigation thus far has uncovered no evidence of patient harm." A former colleague of the Russian nurse has communicated concerns to Queensland authorities about his conduct in a previous workplace. Several Cairns colleagues of the Chinese recruit have rallied to support her as a "person of integrity", with sufficient clinical skills to do a supervised internship prior to an examination by the Australian Medical Council. She has obtained statements from former students of the university in Shanghai who have said they were also aged 14 when they began medical training.

The controversy comes as Queensland prosecutors liaise with US counterparts to extradite Jayant Patel, the surgeon who has been blamed for contributing to at least 17 deaths at the Bundaberg Base Hospital.

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?

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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Your regulators will protect you

The Food and Drug Administration has known for years about contamination problems at a Georgia peanut butter plant and on California spinach farms that led to disease outbreaks that killed three people, sickened hundreds, and forced one of the biggest product recalls in U.S. history, documents and interviews show. Overwhelmed by huge growth in the number of food processors and imports, however, the agency took only limited steps to address the problems and relied on producers to police themselves, according to agency documents. Congressional critics and consumer advocates said both episodes show that the agency is incapable of adequately protecting the safety of the food supply.

FDA officials conceded that the agency's system needs to be overhauled to meet today's demands, but contended that the agency could not have done anything to prevent either contamination episode. Last week, the FDA notified California state health officials that hogs on a farm in the state had likely eaten feed laced with melamine, an industrial chemical blamed for the deaths of dozens of pets in recent weeks. Officials are trying to determine whether the chemical's presence in the hogs represents a threat to humans. Pork from animals raised on the farm has been recalled. The FDA has said its inspectors probably would not have found the contaminated food before problems arose. The tainted additive caused a recall of more than 100 different brands of pet food.

The outbreaks point to a need to change the way the agency does business, said Robert E. Brackett, director of the FDA's food-safety arm, which is responsible for safeguarding 80 percent of the nation's food supply. "We have 60,000 to 80,000 facilities that we're responsible for in any given year," Brackett said. Explosive growth in the number of processors and the amount of imported foods means that manufacturers "have to build safety into their products rather than us chasing after them," Brackett said. "We have to get out of the 1950s paradigm."

Tomorrow, a House Energy and Commerce subcommittee will hold a hearing on the unprecedented spate of recalls. "This administration does not like regulation, this administration does not like spending money, and it has a hostility toward government. The poisonous result is that a program like the FDA is going to suffer at every turn of the road," said Rep. John D. Dingell (D-Mich.), chairman of the full House committee. Dingell is considering introducing legislation to boost the agency's accountability, regulatory authority and budget.

In the peanut butter case, an agency report shows that FDA inspectors checked into complaints about salmonella contamination in a ConAgra Foods factory in Georgia in 2005. But when company managers refused to provide documents the inspectors requested, the inspectors left and did not follow up. A salmonella outbreak that began last August and was traced to the plant's Peter Pan and Great Value peanut butter brands sickened more than 400 people in 44 states. The likely cause, ConAgra said, was moisture from a roof leak and a malfunctioning sprinkler system that activated dormant salmonella. The plant has since been closed.

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?

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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Today's tort system has life-threatening consequences

A diagnosis of non-Hodgkins lymphoma used to be a death sentence. Like many cancers, it was nearly untreatable and families were forced to wait out the days until a loved one died. But new methods of chemotherapy in addition to drugs, like Rituxan, changed all that. One study found that a combination of the two treatments improved survival rates among patients to 70 percent, compared with 57 percent for those on chemo alone. Similar situations exist for a wide range of diseases and treatments, from drug cocktails for AIDS to statins for high cholesterol.

But such novel treatments often do not make it to the market in the first place. For every 100 people helped by a treatment like Rituxan, there may be one patient who suffers serious side effects or even death. And sometimes the drug manufacturer can be held liable in court for those side effects, even when patients are properly warned ahead of time. These liability risks - or torts, in legal speak - add enormous costs to the development and implementation of new technologies and treatments. Fortunately for lymphoma patients, Rituxan has proven effective enough to outweigh legal risks.

But because of legal threats and the potential for debilitating tort payouts, many life-saving or risk-reducing technologies are never brought to market or even invented. Numerous lives are lost through accidental deaths that could have been prevented. According to data from a recent study by two professors at Emory University, America's current tort system was responsible for 2,700 accidental deaths in 2004. By extending calculations back through 1981, we can project that 77,419 lives were lost in accidents that could have been avoided if tort reforms had been adopted.

This loss of life affects not just the families and communities of those who have died. It also impacts the nation's economy. Let's think of this group of 77,000 individuals as a "ghost work force." Had these folks not died needlessly, they would have been alive and working today. It's impossible to predict whether one of these individuals would have discovered the cure for cancer or written the great American novel, but the economic output these individuals would have produced can be measured. The U.S. Bureau of Economic Analysis has concluded that the value of the average worker's output is $90,236. If we apply this ballpark value to each member of our ghost work force, we can calculate that the U.S. economy lost $7.51 billion worth of output.

Most costs of today's tort system are well-known. We see them in the form of higher insurance premiums, higher prices for goods and services, and even the destruction of entire businesses crippled by excessive punitive judgments. But the concept of a ghost work force emphasizes another cost to society - that of what could have been. And with the sacrifice of more than $7 billion in economic output due to tort risks, these costs are far from hypothetical.

A thriving economy depends on an efficient tort system that provides just compensation for those who are injured, which facilitates trade and commerce. But it's critical that the tort system not increase the cost of risk-reducing advances that ultimately save lives, like new drugs. The future costs of an unreformed tort system are difficult to fully calculate. But if the "ghost work force" were alive today, it would provide a boost to our nation's economy. Today's tort system takes away billions of dollars - and thousands of lives - each year. A tort system should operate to save lives, not cost lives.

That fact that the U.S. tort liability system is needlessly costing lives is stark evidence that tort reform is desperately needed. Lawsuits consume more resources than national defense, charity and federal education combined . _ Annual cost of U.S tort liability system: $865 billion. _ Annual Defense Department budget: $500 billion

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?

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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The British hospital experience

Notes from a patient -- Prof. Brignell. He got prompt treatment only because he had private insurance but even then the NHS did not make it easy

Kafkaesque! That is the word. If you don't know what it means, make an appointment as an outpatient with the British National Health Service. An hour or two in the waiting room is enough to induce that feeling of hopelessness endured by Joseph K. In my case they had taken the trouble to write, bringing the appointment forward by half an hour, but I was still there in suspended animation an hour later than the original appointed time. About fifty assorted human beings sat glum and dispirited, some occasionally whispering to each other with a librarian reverence. In the background, people in various shades of uniform bustled through unseeing, intent on their business. Behind the reception desk women rattled computer keyboards with intense determination.

Suddenly my name was called and I found myself whisked from the large waiting room to a small waiting room. There was no silence here. A very large Irish woman was regaling the reluctant company with an account of her recent experiences as an inmate, including details of biological functions we would rather not know about. After another half hour, a woman approached me and said "The registrar has looked at your notes and has decided to let you see the consultant." Perhaps welcome news, except that it was the consultant who had asked me to come back and see him ten weeks after the first examination. People came and went. I waited.

It was quite different once I penetrated the inner sanctum. The consultant was urbane and gentlemanly, radiating that cultivated assurance that we used to expect of our medical advisors. He recommended that I have a course of intravenous antibiotics, but we would have to wait for a hospital appointment, as it should commence under observation in case there were any reactions. I mentioned that I had managed to retain sufficient medical insurance to cover hospital admission, so he left it with me to make the appointment. When I phoned BUPA there were no problems and a bed was found for me for the following weekend.

The difference! When you approach the NHS hospital, the first thing you see is a large yellow notice with ominous black capitals announcing THIS IS A WHEEL-CLAMPING ZONE. Just the thing for people in distress and pain, who have to grope around to see if they have the coins to feed the meter! It induces the same sort of anxiety as a notice I remember from almost forty years before YOU ARE NOW ENTERING THE GERMAN DEMOCRATIC REPUBLIC. The notice at the entrance of the private hospital said "Welcome" and directed you to the car park. Inside, the atmosphere was calm and kindly. What was striking was the obsessive hygiene and asepsis, from another age. Inside and outside each patient's door were dispensers for alcoholic hand rubs, which visitors were encouraged to use. Despite the occasional puncturing it was actually a pleasurable experience.

My local GP practice had volunteered to carry on the injections, so the consultant had arranged that I would pick up the antibiotics at the town pharmacy and take them in. I received a phone call to say that the pharmacy had discovered that it was not licensed to handle those particular antibiotics and would I drive back to the hospital pharmacy (a three hour round trip) to pick them up? Five days of injections went smoothly, but hanging over me was that threat of the unknown - THE WEEKEND. Don't worry, I was told, just phone one of these numbers and arrange an appointment with the out-of -hours service and we will give you the kit of parts to take with you.

Hello, is that the out-of-hours service?

Yes.

I would like to make an appointment for some intravenous injections.

How did you get this number?

I was given two numbers and the first one did not work.

This is an administration number, you are not supposed to have it.

What would happen if I had used the other number?

It would come to the same place, but that is not the point.

I would like to make an appointment for some intravenous injections.

Well you can't. The system does not work like that. You will have to phone on the day.

I went back to the local surgery and the receptionist kindly arranged the appointments for the Saturday and Sunday. Fortunately, the appointments were in nearby Shaftesbury, at a local cottage hospital of the sort that the Government is trying to close. It was charming and, above all, clean, even having a hand-rub dispenser on the waiting room wall.

The professional staff were kindly and efficient, indeed magnificent. This is not just a ritual nod of politeness. These people, fully aware that they are working in a mad system, still manage to maintain and integrity and dedication that is a wonder to behold. As the intravenous injections are a slow business, there was an opportunity for conversation, during which I elicited some interesting remarks:

Reorganisation is the norm in the NHS.

The rules change so often that nobody actually knows what they are.

The trouble with the big hospitals is that the cleaners are no longer part of the team, as they were in matron's day, and anyway they can barely communicate in English.





Some patients get no treatment at all in Tasmanian public hospitals

ONE in seven patients leaves the stretched Royal Hobart Hospital emergency department before being treated because of long waits. Between December and March, 13,058 patients presented to the department but 1821 -- an average 15 a day -- did not to wait to see a doctor. Some of the patients had been assessed as suffering "life-threatening" or "potentially life-threatening" illnesses or injuries and severe pain.

But department director Tony Lawler said the "majority" were patients who had presented to triage with "potentially serious" or "less urgent" conditions. He said there was always a "concern" that patients who did not wait would die, but stressed they were encouraged to stay or given options for medical help. "We don't put people in the waiting room and forget them," Dr Lawler said. "We try to maintain supervision." [Hard to do when they have walked out!]

RHH chief executive Craig White said the "did not wait" figures were steadily climbing but the hospital was working hard to bring them down. The figures come as the emergency department -- which moved into its new $15.4 million home last month -- comes under increasing pressure and criticism. In the past month, nurses, patients, politicians and ambulance officers have complained of long waits for medical help. Ambulances have been "ramping" or building up at the department, unable to offload patients because the hospital is full. And an elderly woman died in the emergency department last month after four days trying to get help and hours in waiting rooms.

Dr Lawler said patients were prioritised on clinical need, sometimes causing frustration. "Sometimes a patient might not appear to be very ill," he said. "It sometimes seems there's an inequitable process about who is seen first." He said some patients felt better and left or decided to see their GP, but conceded some patients who left were rated category one, two and three.

Dr White said waits had increased because more patients were presenting to emergency and beds in wards were harder to access. He said access block was "complex" but recent nursing-home closures meant aged-care patients were taking up 16 beds. Access block figures from the second half of 2006 show 29 per cent of patients admitted through the RHH emergency department wait more than eight hours for a ward bed. This compares with a 27.4 per cent national average.

Dr Lawler said the hospital had started holding daily bed management meetings to free up beds and new systems would help ease the wait. The new emergency department allows patients to be "streamed" through three paths and there is a clinic dedicated to patients in the lowest categories. This means a patient needing stitches can be "in and out" without having to wait for a cubicle. A short-stay unit will open in July for patients who require observation but don't need to be admitted. Dr Lawler said this area would act as a "pressure valve" to the department and reduce waits.

He could not compare the RHH "did not wait" figures to other hospitals but Australian Nursing Federation state secretary Neroli Ellis said they seemed "high". She attributed the figures to the closure of 1B North, a 30-bed ward closed for six months for renovations that only began last month. Ms Ellis said up to 16 patients stayed in the emergency department overnight on trolleys waiting for a bed.

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?

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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The Dr. McClellan Medicare cure

Republicans won a big victory this week, shooting down a Democratic plan for more government-run health care. The GOP victors, and free-marketeers, might send their thank-you notes to Dr. Mark McClellan. Dr. McClellan is the 43-year-old internist who, until recently, held the thankless job of running Medicare. He was handed the further thankless task of designing and implementing Congress's tepid 2003 Medicare reform. And he's the big brain who then wrung every last ounce out of that authority to create a striking new model for Medicare competition that is today not only performing beyond expectations, but is changing the political health-care debate.

High praise, yes, but borne out by this week's GOP defeat of a bill to allow the government to fix Medicare drug prices. That was a top Democratic promise this last election, as the party sought to play off public anger over health-care costs. Liberals saw it as an important step toward their all-government, health-care nirvana. Nancy Pelosi and Harry Reid also felt this was an issue on which they could once again roll Republicans, by flashing the impoverished-senior-citizens card.

Instead, Dr. McClellan's new model came online and wowed the older class. Private companies have flocked to offer a drug benefit, giving most seniors a choice of 50 innovative plans. The competitive jockeying has slashed prices from an expected $37-a-month premium to an average $22. The cost of Medicare Part D for taxpayers was 30% below expectations its first year--unheard of in government. And Medicare Advantage, which allows seniors to choose between private insurers, has grown to encompass nearly one in five beneficiaries.

This success has rebutted Democratic criticisms of the drug benefit and shown up those who tar the Bush administration as incompetent. The program's success emboldened Republicans to vote for free-market health care this week. Democrats have seen flagging public support for their program of more government and fewer drugs. While Mr. Reid held his caucus together this week, some are worried about bashing a drug benefit that has an 80% senior approval rating. "Congress only wishes it had an 80% approval rating," chuckles former Democratic Sen. John Breaux, an author of the 2003 reform. "A lot of folks campaigned last year on 'We're going to fix this program,' only to be told by seniors, 'Wait a minute, it ain't broke.'"

None of this was inevitable, but goes back to the competent Dr. McClellan. President Bush came to town pushing Medicare reform, and had a shot at an historic overhaul. The GOP could offer the carrot of a new drug benefit, in return for opening the entire decrepit program to private competition. Instead, Bush and Co. became more interested in claiming credit for an $8 trillion entitlement, and settled for meager reform.

Dr. McClellan nonetheless took this pared-down opportunity and used it to show private competition can work. His success, in particular with the drug benefit, rests in two broad ideas. The first was to design a program that immediately attracted a critical mass of private players to provide price and choice competition. At the time, nobody thought that possible. Mr. Breaux remembers Congress worrying that so few private players would participate that whole areas of the country would lack private drug plans.

Dr. McClellan's solution was a program that gave companies maximum freedom to design plans, bundle drugs and turn a profit. He was a salesman, talking up the opportunities and even traveling to New York to reassure Wall Street. It worked, and by the first days of business most seniors were being courted by anywhere from 11 to 23 plan sponsors. Those numbers have only grown, creating so much competition that sponsors are eliminating deductibles, lowering premiums, offering more drugs. It's also led to smart cost-cutting and efficiencies; an estimated 60% of Medicare prescriptions are now for generics.

Dr. McClellan's other strategy--and the flip side of the coin--was to get seniors enrolled quickly. His team designed an Internet program that allowed seniors to punch in their information and examine the best plans. His agency reached out to local organizations--church groups, community centers--and enlisted their aid in explaining details. A call center at one point handled 400,000 plan questions a day. Today, some 90% of Medicare recipients are enrolled in the benefit, numbers that have further attracted private players, further spurred competition, further lowered prices. "This is how you come in under budget, increase satisfaction," says the man himself, Dr. McClellan. He adds, humbly, "Nobody should think this is perfect yet, but it's clearly accomplishing some good things."

Good things or no, the reforms are still at risk. There was a time when Democrats believed in Medicare reform, but now most prefer it as a political stick to beat President Bush. There are also liberals--Henry Waxman, Pete Stark--who understand this is a crucial moment in the national debate over government-versus-private health care, and will do what they can to sabotage the reforms.

Expect, therefore, more votes over Medicare's right to price-fix. If a broad bill can't pass, liberal politicians will instead target individual, high-cost drugs, arguing that since Medicare foots most of the bill for these products, it should have the right to "negotiate." The real goal will be to get any foot in the price-setting door, making it harder for private companies to craft flexible drug packages, and laying the groundwork for more price-setting down the road.

Expect, too, a push to starve the competitive programs of cash. Critics know how effective this is, having siphoned dollars out of the old Medicare Advantage program in the 1990s, causing private plans to drop out, and giving the program a bad name. Dr. McClellan's reforms, and a Republican Congress, have re-energized the program, but the key to future success is in the budget. Republicans would do well to spend more time touting the competition successes of the reform, rather than the drug giveaway.

In a perfect world, the Bush administration would never have swallowed that entitlement in the first place. In our imperfect world, it at least had the wisdom to hand the reform challenge to a guy who was able to demonstrate the merits of health-care competition, and optimistically, pave the way for broader reform down the road.

Source






Incompetent British ambulance service

Patients are less likely to be treated by a paramedic in London than in Wales, government figures show. Nationally, only half of front-line ambulance staff are fully trained paramedics, according to figures released under the Freedom of Information Act. London has the lowest percentage of paramedics, at 34 per cent, and Wales the best, at 61 per cent. There are also concerns that a preoccupation with meeting the Government's target of answering life-threatening calls within eight minutes is putting lives at danger.

The ambulance service will today tell Tonight with Trevor McDonald on ITV1 that meeting the target is a higher priority than sending the appropriate staff member. Most ambulances are staffed by emergency medical technicians, who carry less specialist equipment than a paramedic.

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?

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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NHS has billions for useless computer projects but not enough money for nurses

Nurses have voted overwhelmingly to take industrial action unless ministers improve a "miserly and insulting" pay deal for health workers. The Government has offered nurses in England, Wales and Northern Ireland a 1.5 per cent pay rise this month, with another 1 per cent to come in November, in defiance of the recommendations of an independent pay review board. But delegates at the Royal College of Nursing (RCN) annual conference rejected the offer yesterday, and called on the Government to agree the recommended full 2.5 per cent pay rise immediately - as it already has in Scotland - or face the consequences.

Thousands of ambulance workers, porters and other NHS staff who are members of the GMB union have said that they are also prepared to take industrial action over a similar staged pay deal. If industrial action were taken it would be the first on a national scale by nurses. In an angry and passionate debate at the conference in Harrogate, delegates said that a strike was unlikely but that they would be prepared to take action such as working to rule, which would mean nurses working their contracted hours and no more.

Such measures are designed to minimise any impact on patients, but could mean longer waiting times for nonessential operations. The union's council will now seek an emergency meeting with Gordon Brown, the Chancellor, and Patricia Hewitt, the Health Secretary, to discuss the issue before deciding whether to ballot members next month.

Peter Carter, the RCN's general secretary, said that the staged offer was equivalent to a 1.9 per cent pay rise, which was "unacceptable and miserly", but that he did not want to proceed in a "ramshackle way". He added: "Let's be clear, we want to avoid strike action. We are hoping that Gordon Brown and Patricia Hewitt will wake up and take this seriously. But we are prepared to find ways to hurt the Government while trying to protect patients. We mean business."

Ministers at the Scottish Assembly, with elections looming next month, have agreed to award nurses a 2.5 per cent pay rise from this month. Ann Taylor-Griffiths, of the RCN's Welsh board, told the conference: "We are one nursing body, we are one NHS and deserve one nationally implemented pay award." David Harding-Price, a nurse from Nottingham, was given a standing ovation as he said: "Stand up now and tell the Government: no more rhetoric. Action, action, action now. Unison, the public sector union, is also expected to support industrial action by nurses when it meets at its conference in Brighton next week.

Ministers have defended the staged offer as fair for nurses and affordable for the economy. A spokeswoman for the Department of Health said: "What we have suggested is a sensible increase that's fair for NHS staff and affordable for the economy. In fact we expect the overall average earnings of nurses to rise by 4.9 per cent next year, above the national average." Mothers and newborn babies are being put at risk because of a lack of specialist care for postnatal depression, the RCN says. The conference will be told today that suicide is the biggest killer of new mothers and that more resources are needed to support women who suffer mental illness during pregnancy or after childbirth. 6.5 hours of unpaid overtime worked on average by nurses every week Source: RCN estimate

Source





Australia: A deeply corrupt State public hospital system

Two contradictory pieces of advice about cancer treatment for Maryanne Smith* led Maryanne and her husband, Michael*, to question a doctor's competence. In the beginning, all they wanted was a straight answer. But as the Sydney South West Area Health Service obfuscated and the shutters came down on a bureaucracy used to getting its own way, it turned into so much more.

Almost 2.5 years after their initial complaint, Maryanne Smith is gravely ill and only one thing is clear: NSW has learnt little from the bitter and heartbreaking patient safety scandal at Camden and Campbelltown hospitals. A Herald investigation has found that the internal inquiry into the Smiths' complaints against Concord Hospital was conducted with little regard for fairness, key doctors were not interviewed and the results were heavily censored. A specialist who supported the Smiths was investigated in an attempt to silence him and the doctor alleged to have given the contradictory advice continues to practise.

The dispute shines a light into the often murky dealings of the state's health system. It leads along a trail of relentless and expensive legal action against doctors and through a complaints handling system that in some hospitals still seeks to silence rather than openly discuss problems. In this world, there is no resolution for anyone: not patients, and not doctors or other health professionals.

There are an estimated 8000 deaths in Australia each year as a result of medical errors, more than the annual road toll of about 1600. Hidden beneath innocuous labels such as "complications", "misadventure" and "sequela", these deaths and injuries have become an accepted part of health care, experts argue. "Harm caused by health care ranges from the mundane to the catastrophic, from a small skin tear on the arm of a frail, elderly patient being helped into bed, to quadraplegia or death," say Merrilyn Walton and colleagues Bill Runciman and Alan Merry, the authors of the recently released Safety and Ethics in Healthcare. "These problems were, for many years, viewed as part of the price to be paid for the great benefits of modern health care."

Walton, an associate professor of medical ethics at the University of Sydney who was NSW's first health care complaints commissioner, is incensed that governments have not moved faster to prevent the rising toll of serious harm and deaths from medical errors. "I am talking about system errors that are getting repeated and repeated - at some stage the governments in this country are going to have to be brave and deal with this," she says. "We have acknowledged there are a high number of adverse events, but we haven't gone the step further . that means confronting some hierarchies around the design of the system to force change."

In addition, violations of basic standards of care are tolerated daily, she warns. "Routine violations happen, for instance, around handwashing . a system that tolerates routine violations is a dysfunctional system and yet it happens regularly in every hospital because there are no consequences."

The authors say that 10 per cent of admissions to acute hospitals are associated with an adverse event. In NSW, where government figures put the annual admission rate to acute care hospitals at 1.3 million a year, that means up to 130,000 patients are being harmed or experience near misses each year.

The Smiths are waiting to hear whether the Independent Commission Against Corruption will investigate their concerns. The director-general of NSW Health, Robyn Kruk, referred the case to the watchdog just weeks before last month's state election. Since then, there has been a familiar refrain from bureaucrats and politicians: "I cannot comment on a matter that is before ICAC."

The poor advice Maryanne Smith received may not have been a medical error that resulted in death, but even small mistakes can lead to prolonged suffering, delayed treatment, more pain and unnecessary confusion.

NSW Health is fighting a war on several fronts, some official, others under the radar. Camouflaged in carefully written policies and the weasel words of bureaucratise, the state's health officials and the revolving door of ministers have sought to convince a sceptical public the NSW health system is safe. After surviving the horror years of multiple investigations into 19 patient deaths at Camden and Campbelltown hospitals, two other state-run hospitals have been called to the NSW Coroner's Court this month to explain themselves. The court is separately investigating the deaths 18-year-old Jehan Nassif, who died from meningococcal disease at Bankstown hospital last year, and Vanessa Anderson, 16, who died at Royal North Shore Hospital in November 2005, three days after being admitted for a head injury. She was treated by overtired and junior staff, after the hospital had been warned about a potential staffing crisis.

The inadequacies of our mental health system were also laid bare this week with the news that in 2001 a teenager was discharged from a psychiatric unit without treatment or medication after a suicide attempt, and then became a quadriplegic after another suicide attempt days later. He is suing the Sydney South West Area Health Service for negligence.

Add to that a steady stream of specialists leaving the public health system citing flagrant breaches of patient safety as a factor and one thing becomes abundantly clear: it is only a very thin veneer of safety and accountability that cloaks our public hospitals.

Maryanne Smith had a slow-growing tumour and was referred to a doctor then on staff at Concord Hospital in June 2003. She was advised, as a matter of urgency, to pursue a particular form of treatment. "I cannot overemphasise to you just how strongly [the doctor] advocated that I agree to submit to an urgent . treatment," Smith wrote in her first letter of complaint to Concord Hospital on November 28, 2004. "In contrast, none of my former specialists . ever spoke to me in terms of such urgency."

Alarmed at the doctor's approach, she returned to her regular doctor, who reassured her that her condition did not yet need to be treated with urgency. By April 2004 the cancer had progressed and she was again referred to the doctor at Concord. This time he gave her advice that she says contradicted his earlier recommendations. "This time he stated very definitively that [treatment] would in no way reduce the bulk of my tumours. Both my husband and myself left this second appointment somewhat confused and distressed." Again, her cancer specialists were perplexed by this advice and she was referred to a second specialist at Concord. That second specialist told her the therapy would help reduce the bulk of her tumours. After careful consideration and much angst, she had the treatment.

The doctor in question has denied many times that he gave Smith conflicting advice. When the couple complained about the inconsistencies in his advice and attitude, they were assured by senior health bureaucrats his performance had not been called into question. Yet information they obtained under freedom of information laws tells a different story. It shows multiple concerns have been raised about the doctor's performance - and that his own colleagues had complained about his clinical and professional behaviour, some as far back as 1998.

Four months after her initial complaint, the area health service wrote to Smith, rejecting her allegations and giving the doctor's interpretation of the two consultations. The cover-up had begun. Infuriated, she wrote a second letter of complaint in August 2005. She believes the doctor falsified his notes from their meeting, and one of the findings from one of the three investigations into this issue showed the doctor had not taken contemporaneous notes at his consultations, in contravention of NSW Health and hospital policy.

Beyond the doctor's treatment of Smith, there were other serious problems relating to his performance, a senior staff specialist told the Herald. "I had innumerable clinicians complain to me about what he was doing," the specialist says. The most serious complaints relate to allegations that patients had received radiotherapy unnecessarily because the doctor had mistakenly interpreted bone scans as showing the presence of cancer. The specialist wrote his first letter to a senior hospital bureaucrat in April 1998, warning that the doctor's performance had "reached a dangerous level, impacting on patient care". "I personally had to intervene to stop one such patient being treated with high-dose radiation unnecessarily," the specialist says. On another occasion, the doctor prematurely and wrongly stopped a patient's therapy, he says.

In October 2005 the doctor again denied Smith's allegations in a letter to South West Area Health Service obtained under FoI laws. "I have not 'lied' to any person or intentionally misled them. I . can only reiterate my recollection of the consultations with the support of my letters to her referring physician," he writes. "I regret [Smith] has the perception I closed the door to discussion about possible . treatment. This was not my intention."

More correspondence followed - much of it written by Michael Smith as he repeatedly laid out the initial complaints his wife made about her treatment, followed by a growing number of complaints about their treatment by the area health service's bureaucrats. In May last year the Smiths received a four-page letter from Mike Wallace, the chief executive of the newly formed Sydney South West Area Health Service, saying an investigation had been completed and 49 recommendations had been made. Despite repeated requests, Wallace would not release the recommendations or discuss the findings with the couple.

All the area health service would tell the Herald is this: "The chief executive has referred this matter to the Independent Commission Against Corruption . on 24 January 2007. It is therefore inappropriate for the area health service . to comment. In mid-2006 the AHS offered to meet with and mediate with the family through the Health Care Complaints Commission. This offer was not taken up."

A spokeswoman said the doctor whose performance was in question had "fully co-operated with the investigation into the . family's complaint. The investigation found that there was a difference of opinion about the information conveyed by [the doctor] at the two consultations with [Maryanne Smith]."

Cliff Hughes, the chief executive of the NSW Clinical Excellence Commission, is a former senior cardiac surgeon who faced his demons as a young doctor in the public system. He is a strong believer in being up-front with patients about errors, and encourages his colleagues to do the same. And despite the problems in the state's health system, he is determined that patient safety will improve under his watch. "We are at one stage along a very rapidly progressing path - in most of the areas I think NSW is leading the procession down this path," Hughes says.

Eradicating medication errors - one of the most common causes of harm - is high on the list. The introduction of a national in-patient medication chart goes a long way to ironing out common problems and mistakes, he says. Anticoagulants such as warfarin have been tagged as a major problem, mostly because until recently such drugs have usually been dispensed about 9pm, after the prescribing doctor had gone home. Modern lab techniques mean blood test results - vital for deciding whether the drug is needed and in what quantity - are now available much earlier in the day. That means the doctor who ordered the tests in the morning is still on duty when they come back in the afternoon, Hughes says, reducing the potential for communication errors between shifts.

Another project Hughes says will reduce harm to patients is the campaign to reduce the number of unnecessary blood transfusions. "Blood is a good product but it is not entirely safe, there is the risk of both minor and major infections, immune reactions and so on," he says. "The evidence that we have collected indicates that we can reduce the level of blood usage by about 10 per cent or so across the system."

The prevention of hospital-acquired infections, via a handwashing campaign and a project on intravenous lines, as well as a falls-prevention campaign, a program to reduce aspiration pneumonia in stroke patients and a clinical leadership training package are all new, positive steps.

But even Hughes admits that guidelines are not enough. There are still 400 to 500 events in NSW that cause serious harm or death to patients each year, he says. "The real change is the whole of the system wants to measure themselves regularly, that is the big change from pre-Campbelltown days . we have got a whole system, all 108,000 [health system employees], who can report [errors] and when they report, we can take action." He acknowledges some are still reluctant to throw themselves on the mercy of the system - particularly when individuals are wrongly singled out for blame in a system where errors occur mostly as part of a chain of events. "We need to recognise there are always going to be people who are frightened of what has just happened or what nearly happened, who don't quite know what they should do and are worried about retribution."

Is change happening quickly enough? "All of us . where the risks are patients lives or wellbeing, want to move faster," Hughes says. "I don't believe NSW Health is in crisis, but we have recognised the urgency of all of these programs - it can be expensive at times, it can be draining at times, it can require more personnel at times, but we must move forward."

It could have been so different for the Smiths. This dispute could have ended so many times in the past 2® years - if the hospital or the area health service had conducted a proper investigation and if the Smiths had felt their complaints had been dealt with seriously. There were many opportunities to do it right. But what began as a simple complaint about conflicting medical advice became a lesson in dealing with the dysfunctional and bullying bureaucracy of one of the state's largest area health services.

The Smiths are idealists. They believe public servants should serve the public. They are livid at what they see as the misuse of power by senior bureaucrats who backed a doctor whose clinical skills were under a cloud following the persistent complaints from his colleagues, patients and their families.

The NSW Ombudsman and the NSW Medical Board have received complaints from the Smiths, as have the Health Care Complaints Commission, Medicare, NSW Health and the NSW Health Minister. It is unclear how those complaints are progressing.

Since the multiple inquiries into patient deaths at Camden and Campbelltown hospitals, NSW Health has gone some way to addressing medical errors and how they are investigated. Clinical governance units have been established in all health services and the Government is spending $60 million over five years to implement its patient safety and clinical quality program, a spokesman says. "The NSW health system has adopted the 'open disclosure' standard . [that] aims to promote a consistent approach by all hospitals to open communication with patients . following an adverse event." Yet for all the talk about a system of open disclosure of errors, about involving patients more in the process of health care, it seems NSW public hospitals and the bureaucrats who run them have a lot to learn.

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?

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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NHS care 'left to student nurses'

Lives are being put at risk because student nurses are being left on their own with patients, a study has claimed. A poll by the Royal College of Nursing of 1,500 student nurses found nearly half had been left unattended with patients without warning. Guidelines say student nurses should always be monitored except those in their final year and even that has to be prearranged. The government said patient safety was of "paramount importance".

The survey showed 44% of student nurses had been left unattended without warning and without a doctor or qualified nurse present. Eight in 10 of those said it had happened on at least three occasions. Of the 553 first-year students questioned, 42% said they had been left on their own. And 15% said they had witnessed adverse events while left unattended. But 84% said they did not report that they were left unsupervised.

Gill Robertson, the RCN's student nurses adviser, said there were reports of students just eight weeks into their training being left alone. She said this could happen on surgical wards and other areas of a hospital where patients were extremely ill. "That is like the average person being left with a patient. It should not be happening and is a risk to patient care."

She added nurses were being stretched because of the cuts being made - the RCN estimates over 22,000 health staff posts have been lost in the last 18 months. And another survey of nurses working in 173 hospital wards revealed a third of nurses thought patient care was being compromised on each shift because of reduced staffing.

RCN general secretary Peter Carter agreed the financial problems in the NHS were to blame for the problem. "Those registered nurses left have to do ever more with even fewer resources." Mr Carter also said he was concerned by the reports of student nurses not being able to get jobs once they had qualified. "I am hearing worrying stories from nurses who qualified last September who are still unable to get jobs because trusts are freezing entry levels posts to save money."

Health Minister Lord Hunt said: "Patient safety is of paramount importance to the government and NHS staff alike. "We would expect any nurse, whether in training or in practice, to report any incident they feel has an adverse effect on patient safety." Liberal Democrat health spokesman Norman Lamb said: "This is extremely worrying - patients' lives could be at risk. "The damaging deficits in the health service not only result in job losses but have a serious impact on the remaining workforce."

Source





NHS bungles pay deal -- more pay for less work

A pay deal that gave hospital consultants [senior doctors] a salary increase of 25 per cent left them working shorter hours and treating fewer patients, the National Audit Office has found. It says that the consultants deserved more money, but it was regrettable that the public and the NHS had not seen benefits in greater productivity and better services.

The contract, agreed in 2003, cost œ715 million in the first three years - œ150 million more than the Department of Health estimated. In that time the average consultant's pay rose to œ110,000 a year while the average number of hours worked fell from 51.6 a week to 50.2. Although there was an 11.3 per cent increase in the number of consultants working in the NHS in the two years after the agreement, the amount of consultant-led activity increased by only 4 per cent. "The bottom line is that the Department of Health has increased consultants' salaries without demonstrating any extra productivity in return," said Edward Leigh, MP, chairman of the Commons Public Accounts Committee, to which the audit office reports. "This is one more example of weak financial management by the Department of Health. It drove through the new pay deal with scant regard for proper evidence and solid financial forecasting."

Sir John Bourn, the Comptroller and Auditor-General and head of the National Audit Office, said: "Consultants deserve to be paid properly for the work that they do. However, the new contract was introduced to benefit not only consultants but patients and the health service in general. "Although a new contract was needed, it is regrettable that the costs are higher than expected and that we are not yet seeing any clear evidence of improvements in productivity or services for patients."

In negotiating the contract, the department used out-of-date information on the hours that consultants actually worked. In spite of evidence that the average was between 50 and 52 hours a week, the department worked on the assumption that it was 47 hours. It then agreed a contract with the British Medical Association that was based on an average of 43 hours a week. In fact, consultants continued to work much longer hours than these, and under the new contract were paid for them. As a result, the contract cost œ150 million more than the department expected.

Lord Hunt, the Health Minister, said: "The new arrangements reward and incentivise consultants who make the biggest contribution to service delivery and improving health services. This has helped us to recruit and retain highly skilled consultants, historically a challenge for the NHS. We now have low vacancy rates - fewer than 2 per cent - and more than 10,000 more consultants working in the NHS than when the Government came to power."

Andrew Lansley, the Shadow Health Secretary, said: "This confirms that the Government simply didn't understand what consultants were doing before they made assumptions about the new contract."

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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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NHS knowingly used contaminated blood

Victims of the contaminated blood scandal renewed their calls for compensation yesterday, as evidence emerged that the Government was told about the dangers of using "skid row" blood products as early as 1975. At an independent public inquiry into the supply of tainted blood to haemophiliacs during the 1970s and 1980s, survivors and relatives of those who died said that questions still needed to be answered about what successive governments knew.

At least 4,500 haemophiliacs were infected with HIV and hepatitis C from contaminated plasma. A total of 1,757 have died and thousands more are terminally ill.

One letter presented to the inquiry showed that in January 1975 the Wilson Government was warned that one of the US companies it bought plasma treatments from sourced all its blood from "skid row derelicts". The letter, written by Stanford University Medical Centre to the Blood Products Laboratory at the Lister Institute, said that these clotting products, known as Factor 8, had proven to be "extremely hazardous", with recipients having a 50 to 90 per cent chance of developing hepatitis.

The inquiry, chaired by Lord Archer of Sandwell, a former Solicitor-General, heard that other products were bought from companies that acquired blood from prisoners in America.

Those giving evidence yesterday spoke of their harrowing ordeals. Sue Threakall, whose husband died in 1991, aged 47, after contracting HIV following the use of Factor 8, told the inquiry: "This terrible tragedy should never have happened; it was wholly avoidable. Warnings were ignored, lessons were not learnt and our community was lied to by the people it should have trusted most."

The Government has not confirmed whether it will allow ministers or civil servants to give evidence to the inquiry, which is scheduled to report by late summer.

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Malnutrition in NHS patients

Patients are at risk of malnutrition because of a shortage of nursing staff to feed them properly, a survey suggests. Almost half of the 2,000 nurses questioned by the Royal College of Nursing said that they did not have enough time to make sure that patients got their meals and were able to eat them because they were too busy. The findings come six years after the Government spent 40 million to improve nutrition in hospitals.

Difficulties getting food for patients outside set mealtimes was cited as the main problem by 49 per cent of nurses. Almost as many (46 per cent) nurses blamed a lack of staff to assist those patients who needed help eating.

Campaigners from the charity Age Concern say that elderly patients in particular are regularly going without meals because they are placed out of their reach or because they are unable to eat without assistance. The survey was released at the annual congress of the college in Harrogate yesterday.

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NHS goes private to hit target

EMERGENCY funding totalling 160,000 pounds has been set aside so that more than 40 patients can be treated at a private hospital and waiting list targets can be achieved in East Lancashire. General surgery and orthopaedics cases being dealt with by East Lancashire Hospitals NHS Trust were in danger of exceeding 20-week in-patient treatment targets. The hospitals trust has undertaken a series of waiting list initiatives to meet the NHS goal and a number of patients had been transferred to the private sector Abbey Gisburne Park Hospital, near Clitheroe, for treatment.

But since an initial batch of patients were relocated to Gisburne Park in December, the transfer rate appears to have dried up, according to a Blackburn with Darwen Primary Care Trust report. The report adds: "East Lancashire Hospitals Trust has repeatedly been reminded, via performance meetings and e-mails, of the opportunity to transfer patients to the independent contract, if additional capacity was needed to meet the March targets. "They have however made, limited use of this, preferring to retain the patients at the hospital trust, and giving assurances that they could manage the lists internally."

Every patient on the 20-week waiting list should have been given an appointment date by February 16 and the hospital trust has been asked if any outstanding patients can still be moved to Gisburne Park. Some of the 40-plus outstanding cases, were not medically suitable for transfer to Gisburne Park, others refused to attend the hospital, and a proportion were reluctant to change their consultant mid- treatment. But in the meantime the primary care trust has also held talks with Beardwood Hospital, the privately-run facility in Preston New Road, Blackburn, about dealing with NHS patients there.

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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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NHS model crumbling

The NHS is unlikely to be free at the point of use within 10 years, say doctors. A British Medical Association poll of 964 young GPs and hospital doctors found 61% thought patients would have to pay for some treatment by 2017. Nearly half of all young doctors also expect to leave the NHS within 10 years, according to the survey. All three main political parties have ruled out bringing in a form of charging in the short-term.

The doctors questioned were members of the BMA's Junior Members Forum, which effectively represents the top doctors of the future as it includes those who have graduated within the last 12 years and students. The poll also revealed 94% thought the role of the private sector would continue to grow. A total of 48% of those questioned said they envisaged they would have left the NHS within 10 years, with only a third (35%) of those saying that would be through choice.

Forum chairman Dr Andrew Thomson said it was time to have a debate about the future of the NHS because of pressures from the ageing population and new, ever-more expensive drugs. "Doctors fear that current reforms are damaging the NHS beyond repair. "We seem to be selling off the service to the highest bidder without considering the legacy for future generations of patients. "Government reforms are having negative effects on both services and the morale of doctors. We need to find ways of moving the NHS towards a period of stability. At the moment it is under serious threat. "We will be the ones making the decisions in the future and implementing changes so we want to know what the public, profession and political parties think."

Various options have been put forward, including asking patients to contribute towards the cost of some minor treatments, such as varicose veins, or excluding them from NHS care altogether. There has also been suggestions that an NHS tax could be introduced to help pay for the extra demands on the health service. Dr Thomson said his members were not expressing a favour for any one option, but he suggested patients may well be ready for a change in the system.

BMA policy is still that the NHS should be free at the point of need, although the issue is likely to be discussed at the doctors' annual conference, which sets policy, later this year. But a spokeswoman for the Patients Association said: "I think it is an important principle that where care is needed it is free. "We would not be in favour of patients paying for care where doctors say it is necessary."

The Department of Health has defended NHS reforms, saying it is committed to creating "a truly patient-led service". "What will not change is our commitment to a universal, tax-funded service, with equal access for all," said a spokesman.

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The NHS computer meltdown continues

What's a wasted few billion among friends? Hundreds of millions are often spent on government computer projects before they are abandoned but it takes the NHS to commit waste on this scale. Think how many more doctors and nurses they could have hired with 12 billion! Once again, Britain makes Kafka look unimaginative. The whole affair is beyond rational comprehension. The one thing it shows is how unbelievably wasteful a socialist government can be with the people's money in pursuing their dreams of control

Urgent action is needed to rescue the 12 billion pound programme for upgrading the NHS computer system, the Public Accounts Committee of the House of Commons has said. Over budget and behind schedule, the National Programme for IT is "not looking good", according to a report from the committee.

Edward Leigh, the Conservative MP who chairs the committee, said: "Urgent remedial action is needed if the long-term interests of NHS patients and taxpayers are to be protected. "The electronic patient clinical record, which is central to the project, is already running two years late; the suppliers are struggling to deliver; and, four years down the line, the costs and benefits for the local NHS are unclear."

Ministers said that the criticisms were out of date and that the costs of the programme had not escalated.

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Tasmanian hospital worker protests over appalling care

And the only response is buck-passing

A WORKER at the coalface of the Royal Hobart Hospital has slammed conditions in Tasmania's biggest Emergency Department. Noreen Le Mottee has broken ranks to write to RHH chief Craig White, emergency boss Dr Tony Lawler, Premier Paul Lennon and political leaders about bed closures.

As a triage clerk, she works on the front line dealing with patients and distressed families. "It is disheartening to arrive at work night after night only to find the waiting room full of sick and understandably irate patients who have been waiting up to eight hours to be seen by a doctor," she wrote. "Too often these are category 3 (urgent) patients who should be seen within 30 minutes according to the national standard."

Health Minister Lara Giddings said emergency pressures had got worse and blamed Federal Government under-funding. Mrs Le Mottee's March 27 letter has been released by the State Liberals, who said they asked for a response before going public. Her concerns included:

"As I write there are 10 patients awaiting beds, the request for one submitted 10 hours ago. "My own and other staff's frustration and embarrassment ... is nothing compared to the pain and anguish suffered by the patients. "With no ED cubicles ... no option but for patients to remain on their ambulance trolleys. "Patients are waiting because the department becomes bed-blocked when other patients cannot be sent to a ward. "I feel extremely angry knowing that Ward 1BN, some 30 beds, has been closed since before Christmas ... it must be addressed urgently before the situation worsens with the onset of winter."

Mrs Le Mottee said yesterday she would not speak further and that her letter "said it all". Category 3 includes severe illness, people with head injuries but conscious, major bleeding from cuts, major fractures, persistent vomiting or dehydration.

Liberal health spokesman Brett Whiteley said Mrs Le Mottee had still not heard from anyone apart from the Liberals. Ms Giddings said the Howard Government's neglect meant Tasmanians were finding it harder to get health care and the results were showing up in all public hospitals. Australian Nursing Federation secretary Neroli Ellis said there were 34 beds closed.

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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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