BRITISH BUCKPASSING KILLS WOMAN

Gordon Brown, the Prime Minister-in-waiting, said today that the NHS had to "be there for people when they need it" after a damning report on the death of a woman who was forced to consult eight out-of-hours GPs in four days over an Easter weekend. Penny Campbell, a 41-year-old journalist and mother, died in March 2005 from multiple organ failure. She had become infected with septicaemia during an operation for haemorrhoids but none of the doctors she spoke to or met diagnosed it. A report by a panel of independent investigators published today found that the actions of at least one of the GPs, together with problems in how the out-of-hours service was run, meant that she was not offered appropriate care.

Camidoc, a private company contracted to provide out-of-hours cover, had no procedures to ensure that notes on patients were easily available to all GPs, so that each time she rang for help they treated her as a new patient. This was a "major system failure" and was a direct factor leading to Miss Campbell’s death, the report said. Ms Campbell's partner, Angus McKinnon, said today that he was convinced that a similar tragedy could happen again. "I’ve had dozens of people contact me, cases where people had really narrow escapes," he said.

Mr Brown was asked about the case at a South London school and said that the Health Service had to "do better". "What I’ve been talking about is how we can extend the range of facilities for healthcare at the weekends and out of hours," he said. "So we need more access to doctors, we need walk-in centres, we need local healthcare centres to be more effective, we need NHS Direct to be working. "And we need pharmacies, interestingly enough, to have more ability to, for example, do blood tests and some of the basic things where you can just walk in off the street and get some of the basic tests done. And we need prescriptions to be translated to people, directly to the chemist, in a way that you don’t have to queue up at the doctor’s for a repeat prescription. "So in all these areas we need more access for patients. The health service has got to be there for people when they need it and we need to do better in the future."

But Mr Brown's intervention was scorned by the Tories. “It is odd that Gordon Brown should now realise that GP cover needs to be improved," said Andrew Lansley, the Shadow Health Secretary. “Just three years ago he allowed a new GP contract to go ahead, which doubled the costs of providing out-of-hours care and led to worsening services for patients.

Today’s report identified weaknesses in the arrangements for out-of-hours care. Responsibility for providing the care passed from individual GPs to Primary Care Trusts in 2004 when the new GPs' contract came in. The report criticises the speed at which the change was implemented, and urges the Department of Health to provide a clear definition of the role of out-of-hours care.

Ms Campbell, from Islington, North London, was diagnosed with various conditions by the GPs, including colic, flu and viral infections, an inquest heard last year. The coroner ruled that the doctors contributed to Miss Campbell’s death because they failed to recognise the seriousness of her condition. All eight doctors voluntarily stepped down from out-of-hours care while the investigation into her death was carried out - although they continue to work as GPs.

Today’s report said that six GPs provided Miss Campbell with a "reasonable standard" of care but one, named as Dr Chuah, did not adequately explore her symptoms to see if she had an acute illness. Dr Chuah failed to offer Miss Campbell a reasonable standard of care during an 11-minute call at 4.50am on Monday, March 28, the day before her death. A transcript of their conversation shows that, when she checked with him that it was "not anything serious", he replied that if it was more serious, she would be a lot more sick and "wouldn’t be talking to me like this".

It adds: "Reviewing this transcript, it is apparent that Penny Campbell was articulate and coherent. In the course of the conversation she describes her symptoms quite clearly. "It is also evident that Dr Chuah did not pick up the cues offered by her or further explore any of these symptoms to clearly and definitely exclude any serious pathology that could have accounted for these symptoms."

The investigation found that the care offered by an eighth GP, Dr Bengi Beyzade, could not be adequately assessed in retrospect. Camidoc has said the six cleared of wrongdoing will be able to work again for them following a review. Dr Beyzade and Dr Chuah would have to go through a much more rigorous process involving a performance review with their PCT if they wished to return to work, it said.

Mr MacKinnon, 40, said the fact that the two doctors may be able to work again showed a "total lack of accountability" and was indicative of a wider problem regarding the work of doctors. "To get justice where doctors have performed unprofessionally, to get justice for the victims of their incompetence, you have to sue them. That’s a broader problem within our health system," he said. "Dr Chuah should be struck off." Mr MacKinnon plans to write to the General Medical Council (GMC) about the conduct of four of the doctors. He is also pursuing civil action over the case.

Islington Primary Care Trust (PCT), which commissions Camidoc’s services, issued a statement today extending its sympathy to Ms Campbell's family and admitting failings in her care.

Today’s report says the system of "safety netting" - where Miss Campbell was told to call back if she did not recover - was "seriously flawed". Each of her calls to doctors were treated as an individual "episode", with Miss Campbell having to recount her symptoms again and again. Although Camidoc had put in place methods to transfer to a computerised records system, it failed to address existing risks and take steps to overcome the problems. The report says that Camidoc was unprepared for its shift to a major out-of-hours provider of care. It also criticises Camidoc’s lack of process for driving up standards, saying that the systems for ensuring clinical governance was in place were not fit for purpose.

The system of out-of-hours care in England has been much criticised, with a recent study from the Public Accounts Committee saying that the Government thoroughly mishandled its introduction. Prior to 2004, out-of-hours care was managed by GPs but this was handed over to PCTs as a result of the new GP contract.

Mr MacKinnon backed those criticisms today. "If Tesco can open till midnight every night, why can’t our GPs open till midnight every night?" he said. "The National Audit Office said last year that the reform of out-of-hours has been incredibly expensive - it’s massively over-budget - so if they had spent a little less money on doubling doctors’ wages they would be able to afford better night-time and weekend care." Ms Campbell had a son, Joseph, who was 6 at the time of her death.

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Huge public hospital cutbacks in Tasmania

They're learning from Britain's shambling NHS -- trying to disguise cutbacks as specialization

A SWEEPING shake-up of Tasmania's health services was announced yesterday -- with Health Minister Lara Giddings declaring: "We don't have a choice here." Among major changes is a move to immediately turn the Mersey Hospital at Latrobe into an elective day surgery hospital designed to cut waiting lists around the state. In other major plans, more patients will need to travel to either the Royal Hobart Hospital or Launceston General Hospital for specialist surgery or to dedicated disease-treatment units. But a significant slice of the new reforms is also aimed at keeping Tasmanians out of hospitals, with a heightened focus on the prevention of chronic diseases such as heart disease and diabetes, both linked to ageing and lifestyle.

Launching the new Future Health blueprint, Ms Giddings said Tasmania's hospitals -- and the health budget -- would be swamped unless individuals and communities made better decisions about their lifestyles and health. She said it was not acceptable that Tasmanians did not live as long as other Australians, had higher rates of illness and disease, smoked more, exercised less and waited longer for health services. More worryingly, despite the health budget increasing by 78 per cent over the past eight years to more than $1.2 billion a year, the health status of Tasmanians and health service delivery indicators have remained worse than elsewhere. "If throwing money at the problem has not solved it, we have to ask what else needs to be done," Ms Giddings said. "The health system of the past has been a victim of politicking, ad-hoc decision-making and parochialism. We must change that (even though) I recognise some Tasmanians will be upset."

The response of the State Government, following advice from highly regarded Victorian health planner Dr Heather Wellington, has been to reform the entire structure and way Tasmanians will access health services and hospitals over the next 10 to 15 years. The Mersey Hospital will lose its crisis and acute care capabilities [REDUCING capabilities is a great way to increase already-scarce services???] to become a specialist elective day surgery hospital, with some added maternity and rehabilitation services. The North-West Regional Hospital at Burnie will become the only acute and emergency surgery hospital serving the North-West and West Coast.

However, the Mersey Hospital will keep open a 24-hour emergency reception area to stabilise or resuscitate patients needing urgent attention -- such as heart attack or stroke victims from Devonport or anyone involved in a serious car crash -- before they are sent to Burnie or Launceston by ambulance.

Australian Nursing Federation state secretary Neroli Ellis welcomed the plan but said it had severe implications for nurses, especially at the Mersey Hospital. She said many nurses, who have an average age of 51, would consider early retirement rather than stay for the transition of the Mersey to Tasmania's first dedicated elective surgery centre. "Retention is going to be a huge issue," she said, adding specialist nurses at Latrobe might not want to travel to Burnie or Launceston to continue their career paths.

In other major moves, Rosebery Hospital, in the centre of the West Coast mining district, will no longer be staffed by a doctor Another great improvement???] and nurse 24 hours a day. The small rural hospital at Ouse in the Upper Derwent Valley will no longer have a permanent doctor and will be turned into an aged and respite care and community health centre.

Ms Giddings denied the reforms were all about "cutting and gutting". "We don't have a choice here; we just don't have the staff, the people to keep the system going as it is," she said. To take pressure off the three large hospitals and to better integrate health services around the state, at least four major "one-stop" Integrated Care Centres will be built in central Hobart, in Sorell or on Hobart's Eastern Shore, at Kingston and in Launceston.

These new major community medical centres will provide health services that do not require hospitalisation or emergency treatment, such as dialysis, chemotherapy, some day-surgery procedures and regular wound dressing or medical treatments. But there is no new funding for the Government's bold Future Health plan or any new staff resources.

Ms Giddings believes that with less duplication of services, better clarity of roles and more co-operation within the health system, more staff will not be needed and that the number of locums can also be reduced. Timelines for the new changes are also vague, apart from the immediate downgrading of services at the Mersey Hospital......

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

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