Wednesday, October 31, 2007

Out-of-hours NHS care 'failing'

The NHS is failing to offer sufficient out-of-hours GP care for severely ill patients, experts have said. Existing services are "inadequate and inflexible" and there is a need for better diagnostic facilities, the Royal College of Physicians taskforce said. The group also said hospital care needed to be redesigned for those with non-life threatening life conditions that none-the-less require treatment. The government said care was improving after record investment.

The taskforce, which included a range of health professionals, looked at acute medical care. This includes the care of patients with respiratory problems or chest pains or complications linked to epilepsy or diabetes, which are not yet emergencies but could become so. The taskforce said poor standards of weekend and evening GP cover, which is now done by co-operatives of health professionals and private firms after family doctors were allowed to opt out in 2004, was forcing some patients to turn up at hospital for "reassurance".

The report recommended that local navigational hubs be set up to sign-post patients to the right services. And it called for specialist outreach clinics to be set up in the community to bring expert care out of hospitals. It said out-of-hours cover needed better access to diagnostic facilities, which includes scans and blood tests, to create a "see and treat" culture rather than the "see and greet" one that currently exists.

The experts also said hospital services needed to be redesigned to ensure "rapid streaming of patients". The experts said that all too often even patients already in hospital can find themselves moving slowly through the system seeing nurses, junior doctors and then consultants when they really need urgent help. They said acute medical units, rapid assessment, diagnosis and treatment centres which are becoming increasingly common in hospitals, need to be located near other key services such as the emergency department and critical care.

RCP president Professor Ian Gilmore said NHS professionals were facing a challenge - "to change what we do, when we do it and how we do it". He added: "For doctors, nurses, managers and all those involved with the care of acutely ill patients, this task will not be easy, but the status quo is not an option if we are to give these patients a consistently high standard of care."

Health Minister Ben Bradshaw said the government welcomed the report but was already making sure that people have access to care around the clock. "Primary Care Trusts must deliver high quality out-of-hours care, and in addition, patients have access to a range of other services that can provide urgent care out-of-hours including NHS Direct and NHS walk-in centres," he said. "We have invested record amounts in out of hours services and patients are seeing the benefits - eight our of ten patients say that they are satisfied with the service, and six out of ten rated the service as excellent or good."


Australia: Another butcher doctor still operating in Queensland -- a "Professor", would you believe?

Queensland seems to specialize in "overconfident" doctors. The scum is now in private practice. Woe to Brisbane women!

A prominent member of the Brisbane medical establishment has been charged with manslaughter after he allegedly sliced open a woman's vein in a botched operation then prescribed blood-thinning drugs that hastened her death. Before the Dr Death scandal that brought about major health reforms in Queensland, Nardia Annette Cvitic, who was suffering from cervical cancer, went to Brisbane's Mater Hospital to have a hysterectomy performed by Bruce Ward. The 30-year-old collapsed in hospital three days after the operation, having lost half her blood volume. She died on February 22, 2002, despite having undergone emergency surgery, where Dr Ward's initial response of a double-dose of blood-thinning drugs was overruled by experts summoned by his worried colleagues.

Trained in Australia and Britain, Dr Ward - who maintains he is a good doctor - was working at the Mater and Royal Women's hospitals at the time of the death of the mother of two; he was a professor at the University of Queensland and remains a fellow of the Royal Australian College of Obstetricians and Gynaecologists. The Australian revealed last year that the Mater approached Cvitic's family to offer an out-of-court settlement in 2003 - eventually paying out $175,000 for her two young sons.

Dr Ward is understood to have been retrained after Cvitic's death. He has unrestricted registration through the Queensland Medical Board and was released on bail yesterday after Deputy State Coroner Christine Clements formally charged him with manslaughter. Ms Clements used the old Coroner's Act to charge Dr Ward with manslaughter, 18 months after the inquest into the death finished. In the inquest, Ms Clements heard evidence that the bloodied operating theatre at one point resembled the aftermath of the Granville train disaster in NSW in the 1970s.

While Dr Ward testified that he made reasonable, albeit incorrect, clinical decisions, Ms Clements found 13 instances where a properly instructed jury might find him criminally negligent and responsible for the death. Dr Ward declined to respond to the charge yesterday, leaving his barrister, David Tait, to continue his defence in the media, again extending his sympathies to the Cvitic family. Mr Tait said his client was devastated by her death and disappointed by Ms Clements's decision. "Over 20 years he has looked after thousands of women in Queensland for serious gynaecological cancers and, indeed, he has dedicated his life to medicine and to helping women in this position," Mr Tait told reporters, reading from a prepared statement. "Dr Ward is adamant that he has done nothing wrong, he has committed no criminal offence."

Cvitic's elder sister, Helen Liversidge, who was in court to hear Ms Clements's findings, said she was pleased with the result. Describing her sister as "very fun-loving, happy, vivacious young lady, full of life", Ms Liversidge said she had lost the opportunity to see her children grow up. "Her eldest son is now starting his first day as a butcher," she said.

Ms Clements was supportive of the reforms undertaken at the Mater, and across the health system, since the death, but lamented the lack of closer monitoring for blood and fluid loss. "If this had been recorded and coupled with so-called standard blood tests ... the problem of blood loss might have been identified earlier," Ms Clements said.

Ms Liversidge said she believed the reforms introduced after her sister's death were already saving lives. "My sister's death has helped a lot of people," she said. Under the 2003 Coroners Act, Queensland coroners are only able to recommend that charges be laid against a person. However, because Cvitic's death occurred before the law change, Ms Clements was able to charge Dr Ward under legislation passed in 1958.


Tuesday, October 30, 2007

Brits don't recognize Michael Moore's picture of their health system

The fourth estate has always had a bad name, but it seems to be getting worse. Journalism should be an honest and useful trade, and often still is. But now that journalism has more power than ever before, it seems to have become ever more disreputable. In recent years it has been brought lower and lower by kiss-and-tell betrayals, by "reality" TV, by shockumentaries and by liars, fantasists, hucksters and geeks of every kind, crowing and denouncing and emoting in a hideous new version of Bunyan's Vanity Fair.

Outstanding among these is Michael Moore, the American documentary maker. He specialises in searing indictments, such as Fahrenheit 9/11 and Bowling for Columbine, and has, without a doubt, a genius for it. Although his films are crude, manipulative and one-sided, he is idolised by millions of Americans and Europeans, widely seen as some sort of redneck Mr Valiant-for-truth.

Nothing could be further from the truth. His latest documentary, Sicko, was released in cinemas last week. Millions of people will see it and all too many of them will be misled.

Sicko, like all Moore's films, is about an important and emotive subject - healthcare. He contrasts the harsh and exclusive system in the US with the European ideal of universal socialised medicine, equal and free for all, and tries to demonstrate that one is wrong and the other is right. So far, so good; there are cases to be made.

Unfortunately Sicko is a dishonest film. That is not only my opinion. It is the opinion of Professor Lord Robert Winston, the consultant and advocate of the NHS. When asked on BBC Radio 4 whether he recognised the NHS as portrayed in this film, Winston replied: "No, I didn't. Most of it was filmed at my hospital [the Hammersmith in west London], which is a very good hospital but doesn't represent what the NHS is like."

I didn't recognise it either, from years of visiting NHS hospitals. Moore painted a rose-tinted vision of spotless wards, impeccable treatment, happy patients who laugh away any suggestion of waiting in casualty, and a glamorous young GP who combines his devotion to his patients with a salary of 100,000 pounds, a house worth 1m and two cars. All this, and for free. This, along with an even rosier portrait of the French welfare system, is what Moore says the state can and should provide. You would never guess from Sicko that the NHS is in deep trouble, mired in scandal and incompetence, despite the injection of billions of pounds of taxpayers' money. While there are good doctors and nurses and treatments in the NHS, there is so much that is inadequate or bad that it is dishonest to represent it as the envy of the world and a perfect blueprint for national healthcare. It isn't.

GPs' salaries - used by Moore as evidence that a state-run system does not necessarily mean low wages - is highly controversial; their huge pay rise has coincided with a loss of home visits, a serious problem in getting GP appointments and continuing very low pay for nurses and cleaners.

At least 20 NHS trusts have even worse problems with the hospital-acquired infection clostridium difficile, not least the trust in Kent where 90 people died of C diff in a scandal reported recently. Many hospitals are in crisis. Money shortages, bad management, excesses of bureaucrats and deadly Whitehall micromanagement mean they have to skimp on what matters most.

Overfilling the beds is dangerous to patients, in hygiene and in recovery times, but it goes on widely. Millions are wasted on expensive agency nurses because NHS nurses are abandoning the profession in droves. Only days ago, the 2007 nurse of the year publicly resigned in despair at the health service. There is a dangerous shortage of midwives since so many have left, and giving birth on the NHS can be a shocking experience.

Meanwhile thousands of young hospital doctors, under a daft new employment scheme, were sent randomly around the country, pretty much regardless of their qualifications or wishes. As foreign doctors are recruited from Third World countries, hundreds of the best-qualified British doctors have been left unemployed. Several have emigrated.

As for consultants, the men in Whitehall didn't believe what they said about the hours they worked, beyond their duties, and issued new contracts forcing them to work less. You could hardly make it up.

None of these problems mean we should abandon the idea of a universal shared system of healthcare. It's clear we would not want the American model, even if it isn't quite as bad as portrayed by Moore. It's clear our British private medical insurance provision is a rip-off. I believe we should as a society share burdens of ill health and its treatment. The only question is how best to do that and it seems to me the state-run, micromanaged NHS has failed to answer it.

By ignoring these problems, and similar ones in France's even more generous and expensive health service, Moore is lying about the answer to that question. I wonder whether the grotesquely fat film-maker is aware of the delicious irony that in our state-run system, the government and the NHS have been having serious public discussion about the necessity of refusing to treat people who are extremely obese.

One can only wonder why Sicko is so dishonestly biased. It must be partly down to Moore's personal vainglory; he has cast himself as a high priest of righteous indignation, the people's prophet, and he has an almost religious following. He's a sort of docu-evangelist, dressed like a parody of the American man of the people, with jutting jaw, infantile questions and aggressively aligned baseball cap.

However, behind the pleasures of righteous indignation for him and his audience, there is something more sinister. There's money in indignation, big money. It is just one of the many extreme sensations that are lucrative for journalists to whip up, along with prurience, disgust and envy. Michael Moore is not Mr Valiant-for-truth. He is Mr Worldly-wiseman, laughing behind his hand at all the gawping suckers in Vanity Fair. Don't go to his show.


Monday, October 29, 2007


It's not only the State of NSW that has big problems. Three reports below

Public hospital negligence destroys a baby's future

How would YOU like to send your baby to hospital with diarrhoea and get him back with a damaged brain? It didn't happen to me. When my son developed gastro problems in his early childhood, he was taken to a top private hospital and immediately put on a drip. He was not released until he was well again. He is now a 6' tall healthy wealthy and happy mathematician. Working hard and saving your money really helps. Spending it as you get it is negligent because trusting your children to the government is negligent -- as negligence is all you can reliably expect from any government system. Negligence works in its own way too -- a very sad way, as we see below:

A year ago baby Ryan Mason was a happy, healthy newborn, delighting his young parents with his smiles. But at just 11 weeks Ryan developed severe brain damage after being sent home from Caboolture Hospital while allegedly still dehydrated and suffering gastroenteritis. A few hours after arriving home the baby turned blue, stopped breathing and suffered cardiorespiratory arrest while his parents rushed him back to hospital. Ryan was flown to Royal Brisbane Hospital, where his 22-year-old parents, Teisha-Lee and Tim Mason of Toorbul, north of Brisbane, were told he had brain damage. Ryan, now 13 months, developed cerebral palsy, cannot hold his head up or control his arms and may have vision problems.

A claim for damages for personal injuries has been served on Queensland Health, along with an expert's report, by Quinn and Scattini Lawyers. Dr John Raftos, a senior Sydney emergency medicine specialist, said in the report it was his opinion that if hospital staff "had properly assessed and treated Ryan's gastroenteritis and dehydration he would not, on balance of probabilities, have developed hypovolaemic shock and permanent brain damage".

Ryan had been having bouts of diarrhoea when Mrs Mason first took him to Caboolture Hospital on December 10 last year. He was diagnosed with gastroenteritis and sent home, but the next day he was admitted and treated with intravenous fluids for dehydration. Mrs Mason said that during his second night Ryan had diarrhoea every 20 minutes from midnight until 5am on December 13 and was screaming.

Medical records showed that a pediatric team ordered that Ryan and his wet nappies be weighed four times a day to check on his rehydration. Dr Raftos said in his report this was not done and in his opinion Ryan was discharged home while still dehydrated. Lawyer Damian Scattini said Ryan's case was "another preventable tragedy brought about by systems failure within a Queensland public hospital".

A Queensland Health spokeswoman said the department could not comment on legal proceedings.


State government caves in on one hospital

With a "fudge" that would do the British proud. A "British fudge" is a bit hard to define but it is basically a partial retreat or concession that is disguised as not being a retreat or a concession

The crisis at Brisbane's Princess Alexandra Hospital has been solved, with all beds to be reopened and surgery restored after cancellations. A budget blowout had forced the hospital to turn away the sick last week, with 60 beds closed and 20 per cent of operating theatre procedures cancelled. But Premier Anna Bligh stepped in yesterday and ordered the impasse be resolved. She eased the squeeze on hospital budget constraints - giving the PA an extra year to balance the books - and hinted that extra funds would be handed over in December.

The situation had been in deadlock with PA management and the Australian Medical Association Queensland accusing the Queensland Government of under-funding one of the state's biggest public hospitals. Ms Bligh had refused extra money for the hospital, saying it had to manage on a record $33 million budget increase this year. An eight-hour "bypass" on Wednesday, when all new patients were redirected to another hospital, made the emergency worse.

But Ms Bligh - as she did with the Caboolture Hospital ER crisis two years ago - brokered a peace deal with the AMAQ and hospital managers. There was no initial new money, but sources said the PA Hospital would be well compensated by the Government at the mid-year Budget review. Ms Bligh told The Sunday Mail the agreement would see the projected budget over-run of $18 million progressively reduced over the next 18 months rather than in the current financial year.

She said PA chief executive officer Dr David Theile would introduce efficiency measures, including replacing nursing agency staff with Queensland Health-employed nurses. "This agreement, achieved after constructive talks between the Government, hospital managers and the AMAQ today, is good news for patients," Ms Bligh said. "The PA Hospital will progressively reopen beds and restore theatre lists. This will enable the hospital to return to full activity within a few weeks. "I have restated my commitment to reviewing the need for any increase in the PA Hospital's budget, along with all other public hospitals, in the mid-year Budget review. "Further, the Government will review funding needs for the whole public health system for 2008-09 and following years, as part of the Budget process early next year."

Ms Bligh and Dr Theile had clashed last week, with the Premier saying taxpayers were "entitled to see strong management ensuring that budgets are maintained". She denied a Government backflip on the issue yesterday after sending in her Director-General Ken Smith to negotiate with hospital management and the AMAQ. Ms Bligh said the Government would work with the hospital to manage its budget to ensure clinical standards were maintained, beds were reopened and theatre lists restored.

Leading PA visiting medical officer and AMAQ president Ross Cartmill welcomed the agreement and said the resolution was in the best interest of patients. "The Government's commitments today give me the confidence the PA Hospital can continue to provide top-quality service to our patients now and into the future," he said.


Hospital pen-pusher jobs on increase

ALMOST two-thirds of new appointments in Queensland public hospitals are non-medical, latest figures reveal. From May 2005-2006, Queensland Health boasted, clinical staff increased by 1200, but official figures show that 3196 extra staff were employed. A report stated that Queensland Health spent 82 per cent more on administration than any other state. [Because it is Australia's oldest "free" hospital system (started in 1944) and the cancer of bureaucracy has had longer to grow]

Liberal leader Bruce Flegg said money was being wasted on pen pushers: "Patients should not have to suffer because the numbers aren't right in the budget. Cuts should have been made from non-clinical areas." The Australian Medical Association said no cuts had been made to administration staff at the PA, but patients' operations had been cancelled.

Queensland AMA president Dr Ross Cartmill, who works at the PA, urged QH to investigate how many non-clinical staff were employed. "There are two types of non-clinical staff - the clinical support staff who work with the clinicians to make their life easier, and then there are the other group which is those who are employed purely in an administration role. We do believe too many of those . . . have been employed."

Representatives of QH and Health Minister Stephen Robertson refused to reveal how many non-clinical staff QH or the PA employed in the last year.


Sunday, October 28, 2007

Another attempt at socialized medicine in the USA

The House passed a revised children's health proposal Thursday, but not by the two-thirds margin that supporters will need if President Bush vetoes the measure as promised. The 265-142 vote was a victory for Bush and his allies, who urged House Republicans to reject Democrats' claims that changes to the legislation had met their chief concerns. If the same vote occurs on a veto override attempt, Bush will prevail, as he did earlier this month when he vetoed a similar bill. The tally was seven votes short of a two-thirds majority. Several House members were absent.

Liberal groups continue to run attack ads against Republicans siding with Bush on the issue, which many Democrats consider a winner for their party. Democratic leaders said changes to the bill, which would add $35 billion to the State Children's Health Insurance Program, had addressed critics' concerns about participation by adults, illegal immigrants and families able to afford health insurance. But GOP leaders called the changes insignificant and politically motivated.

The decade-old health program is aimed at families that do not qualify for Medicaid but are too poor to afford medical insurance. As with the bill Bush vetoed, the revised measure would add would $35 billion over five years, financed by a 61-cent increase in the federal excise tax on a pack of cigarettes. Under the revisions, the program would exclude families earning more than three times the federal poverty rate. Low-income childless adults, which some states cover, would be phased out in one year. And states would have to be more rigorous in checking the validity of applicants' Social Security numbers, an effort to exclude illegal immigrants.

House Minority Leader John Boehner, R-Ohio, likened the revisions to "window-dressing rather than substantive changes." However, House Speaker Nancy Pelosi, D-Calif., said the legislation "has the support of the American people." Before Thursday's vote, the White House announced that Bush would veto the revised bill because it does too little to enroll low-income families ahead of those somewhat better off, and because it would cost more than the earlier bill. Democrats said it would cost more because it would cover more low-income children, the program's chief goal. The program now covers 6 million children, and the bill would enroll another 4 million if it becomes law.

On Oct. 18 the House voted 273-156 to override Bush's veto, 13 votes short of a two-thirds majority. Forty-four Republicans joined 229 Democrats in voting to override. Democrats and their GOP allies this week targeted 38 House Republicans who voted to sustain Bush's veto and later outlined their concerns in a letter. The revised bill addressed those concerns, Pelosi said. But Republicans were angry that Pelosi insisted on a vote Thursday, rather than giving lawmakers more time to study the bill and seek GOP converts. "Bringing the bill up today, with no time to even read it, is either a terrible mistake or an intentional partisan maneuver," said Rep. Heather Wilson, R-N.M., who supported the vetoed bill.

Pelosi said the House needed to act this week "because this fits into our legislative calendar." If Republicans support the health program's expansion, she said, "they won't be looking for an excuse to oppose this bill." Democrats said Thursday's vote was not the final test. Senate Majority Leader Harry Reid, D-Nev., said the Senate will vote on the bill next week, when passage by a veto-proof margin is considered likely. If Bush then vetoes the measure, the House could again seek a two-thirds majority to override. But Wilson and others said Republicans will be loathe to vote against Bush on the override question if they voted against the bill this week.

Both parties accused the other of turning the debate over children's health insurance into a political game. "It's unfortunate that even after a week of meetings and adjustments to the bill at the Republicans' request, that they would still apparently prefer to play politics instead of reauthorizing a program the vast majority of the country supports," said Democratic Caucus Chairman Rahm Emanuel of Illinois. Boehner said in a floor speech: "This bill is not going to become law." "If you're tired of the political games," he said, "if you're tired of Congress' approval rating being at these ridiculous levels, let's all just vote no."


Saturday, October 27, 2007


We have been hearing mostly about disasters in the NSW hospitals lately but the Qld. hospitals are still worthy contenders for the booby prize. Three current articles below.

Hospital expert gets sarcastic with Qld. State government

FORMER health commissioner Tony Morris, QC, has lampooned the Bligh Government's health reforms for setting up the boss of the besieged Princess Alexandra Hospital to fail. The attack came as Premier Anna Bligh yesterday refused to say whether the management at the Brisbane hospital was pressured to clear waiting list backlogs.

Mr Morris said senior doctors such as PA clinical chief executive David Theile still did not have enough funds to cope with huge workloads. The Courier-Mail reported this week that the PA's overspending by 2.1 per cent had actually achieved a 7.8 per cent increase in clinical services. The budget blowout in the first quarter, which was initially blamed on management, forced the closure of 60 beds and resulted in a 10 per cent cut in waiting lists.

Mr Morris headed the 2005 Bundaberg Hospital Commission of Inquiry, one of two inquiries that resulted in sweeping reforms including having doctors in charge of public hospitals instead of bureaucrats. "Theile's appointment has proved to be the complete disaster that the Charlotte St mandarins (at Queensland Health) would have predicted: A doctor (who) is likely to focus on trivia such as reducing waiting lists, increasing surgical throughput," Mr Morris said. "And while he is enmeshed in such trifles, who is going to concentrate on the really important issues, like whether or not . . . to send the administrative director to a conference in Acapulco? "Dr Theile was set up to fail. They put a man in charge who didn't have enough funding in the right area of clinical services."

His comments came as Ms Bligh refused to deny accusations from the Australian Medical Association that the Government pressured management to clear waiting lists more quickly without realising the extra costs involved. "I can only repeat what I have already said on this: The PA is one of our great hospitals," Ms Bligh said. "We're seeing some really terrific things happening at this hospital."

But Opposition health spokesman John-Paul Langbroek called for the Premier to immediately reopen all available hospital beds at the PA. "Hospitals are meant to treat sick people," Mr Langbroek said. "If the Bligh Government is going to make cuts to public hospitals they should focus on the non-patient areas." [i.e. the bureaucracy]


Major Queensland hospital is "broke"

As time goes by the hospital's service gets worse and worse -- as the ever-growing cancer of bureaucracy strangles it. Money to pay clerks and "administrators" MUST be found. Their pay packets never miss a beat. Too bad about the patients who have insufficient doctors and nurses to see to them

A LACK of money has forced Princess Alexandra Hospital to turn away sick people for only the third time in more than half a century - and more waiting list cancellations are on the way. The eight-hour "bypass" at the major Brisbane public hospital on Wednesday night was on the agenda at a heated meeting between furious senior management last night.

Clinical chief executive officer David Theile was yesterday forced to cancel another 17 operating theatre waiting lists from next week, taking the total cut to 20 per cent of the hospital's roster with as many as six people on each list. About 30 of the 60 beds that were closed earlier this week are expected to reopen from the weekend. PA visiting medical officer Dr Ross Cartmill yesterday said the closure of the emergency department, linked to the cutbacks, was only the third time since 1956. The PA, one of the state's biggest public hospitals, normally handles overflow from other nearby hospitals. "We can't get patients into the beds because the beds just aren't there," Dr Cartmill said.

While Queensland Health has claimed demand has "diminished" this week, hospital sources say that is only relative to peak work levels at the weekend. Premier Anna Bligh has refused extra funding for the hospital, saying it should be able to manage on a record $33 million boost this year. The Courier-Mail reported this week that while the hospital was 2.1 per cent over budget for the first quarter, it had performed 7.8 per cent more work.

Dr Cartmill yesterday said the only meaning of a hospital being efficient and over budget was that it was underfunded. "We clinicians believe we should be service-orientated - not budget-driven," said Dr Cartmill, who is also the Queensland president of the Australian Medical Association.

Acting Health Minister Rod Welford denied the bypass was linked to the bed cutbacks, saying "it can happen regardless of cutbacks". "This was utterly exceptional circumstances (on the southside, with the Mater Hospital also on bypass) and the hospitals do co-operate so if they go bypass the people are moved to another hospital," Mr Welford said.

But the State Opposition is demanding the Bligh Government reach into to its budget surpluses and find some money. Opposition Leader Jeff Seeney called for extra financial support to stop the situation getting worse. "Closing beds in a hospital that has achieved that sort of result seems incomprehensible to me," Mr Seeney said. "It is an intolerable situation."


Crazy government hospital provision in all Australian States

With the unbelievable cutbacks in available beds, it is no wonder that waiting lists are so long. As the bureaucracy has ballooned, the number of available beds has drastically shrunk: Socialism at work. Quite insane.

PUBLIC hospitals throughout the country are failing to achieve essential performance standards, the Australian Medical Association (AMA) says. AMA president Rosanna Capalingua, who will release a report card comparing the performance of public hospitals, says there has been a persistent deterioration in the ability of public hospitals to cope with demand.

"Their capacity has gone down," Dr Capalingua said on ABC radio today. "In fact, would you believe that we have a statistic that there are 67 per cent fewer beds in public hospitals across Australia compared to 20 years ago, remembering the increase in population and increase in age of population we've had in that time in Australia, for the increase in demand."

Dr Capalingua said all jurisdictions had serious problems. "Across the board, all states and territories failed to come up to the benchmarks and standards that we would expect public hospitals to deliver to the Australian public," she said. "In the Australian Healthcare Agreements, we need a top-up of $2 to $3 billion to start off with and then we need an indexation increase."


Friday, October 26, 2007

The de-moralisation of health care

By Melanie Phillips, writing from Britain

How in God's name have we come to this? In three hospitals in Kent, at least 90 patients have died from a superbug infection caused by filthy conditions with unwashed bedpans, staff `too busy' to clean their hands and - most appalling of all - nurses telling patients with diarrhoea to `go in their beds'. This unspeakable situation reveals not just callousness towards suffering and indifference to human dignity but a breakdown of some of our most basic civilised values.

Nor is this an isolated scandal. Last October, an internal memo warned the Government that virtually every NHS trust was reporting superbug infection. The health service, in other words, is institutionally polluted. The Government's response? To ignore this crisis, and then belatedly to bring forth Gordon Brown's pathetic commitment to a sporadic hospital `deep clean'. What has happened to the duty of care in our flagship public service? What has happened, indeed, to our sense of common humanity?

Two things have combined to cause this awful situation. The first is the Government's Stalinist control of the NHS which directly conflicts with patient care. The Kent hospitals focused on meeting waiting time targets to the exclusion of just about everything else; and the NHS management's byzantine structure ensures an almost total absence of accountability.

But that is far from the full explanation. Much more important is what has happened to the nursing profession, where there has simply been a collapse of that ethic of caring first promulgated by the inventor of modern nursing, Florence Nightingale. Of course, it must be said that there are still many dedicated and caring nurses of whom Nightingale would be proud. But in general, her ethic has been all but destroyed.

Nursing is not a job but a vocation. That means it is governed by a sense of moral duty to the patient rather than by the self-interest of the nurse. That sense of vocation lay at the heart of Nightingale's vision. It was no accident that in her seminal Notes On Nursing, published in 1860, she wrote that `the greater part of nursing consists in preserving cleanliness'. It was not just that cleanliness was essential for recovery and health. Keeping both hospital and patients clean meant the nurse needed to have the most elevated of motives to put the care and dignity of her patients first.

Accordingly, lowly functions such as washing, dressing and administering bedpans - where dignity was most fragile - were the functions that in nursing were invested with the highest possible significance. Simply, these were moral acts. Accordingly, wrote Nightingale, if a nurse declined to do these kinds of things for her patient because she was so concerned about her own status, nursing was not her calling. `Women who wait for the housemaid to do this, or for the charwoman to do that, when their patients are suffering, have not the making of a nurse in them.'

Florence Nightingale belongs in the first rank of pioneering Victorian feminists. But the tragedy is that modern feminism has all but destroyed what she stood for. In the 1980s, nursing underwent a revolution. Under the influence of feminist thinking, its leaders decided that nurses were treated like skivvies by doctors, who were mostly men. To achieve equality for women, therefore, nursing had to gain equal status with medicine. So nurse training was taken away from the hospitals and turned into an academic subject taught in universities.

This directly contradicted an explicit warning given by Florence Nightingale herself, that her 'sisters' should steer clear of the `jargon' about the `rights' of women, `which urges women to do all that men do, including the medical and other professions, merely because men do it, and without regard to whether this is the best that women can do.' That, however, was exactly what the nursing establishment proceeded to do. Since caring for patients was demeaning to women, it could no longer be the cardinal principle of nursing. Instead, the primary goal became to realise the potential of the nurse, to deliver equality with the male-dominated medical profession.

In her book The Project 2000 Nurse, Ann Bradshaw, a specialist in palliative care, described how this agenda removed caring, kindness, compassion and dedication from nurse training. Student nurses now studied courses such as sociology, gender studies, politics, psychology, microbiology and management. They were assessed for their communication, management, problem- solving and analytical skills. `Specific clinical nursing skills were not mentioned,' she wrote. In short, nursing ditched its core vocation to care.

I wouldn't have believed this possible had I not been forced to witness how my own mother was treated in a London teaching hospital a few years ago. She suffered under a wretched double burden of multiple sclerosis and Parkinson's disease. In that pitiable condition, which meant she could barely walk, she broke her hip and was admitted for surgery to a fracture ward. If I hadn't been on hand every day, she would have starved. After surgery, she was unable to move at all in her bed. Yet the nurses made no attempt to help her to eat; nor did they even deign to move her pillow to make her more comfortable. Yet when I protested, I was told by the senior nurse on duty the bare-faced lie that an hour previously my mother had been 'skipping round the ward'.

It was then that I realised that all the excuses about NHS failure being caused by lack of money were a lie. It was then that I understood that there was, instead, a lack of something infinitely more profound - conscience, kindness, a sense of duty to others - and that the image of the NHS as the embodiment of altruism was a grotesque illusion. If you were old and incapable, it was an encounter to be feared. The memory of my mother's terrible experience still makes me cry; and I weep also for all those poor souls who have died at the hands of the NHS in Kent, and all those other frail and powerless patients who are being treated so abominably in hospitals up and down the country.

What's happened in our hospitals surely reflects a still wider social breakdown. Our society seems to have turned into a Darwinian nightmare in which the fittest prosper mightily while the old and weak are tossed aside as of no value. That's why we starve and dehydrate some elderly people to death. That's why we turn a blind eye to the dreadful conditions in so many old people's homes. And that's why nurses become managers, and preen themselves as expert professionals in meetings and seminars and conferences and away- days while patients in their hospitals are left to die in their own filth.

And what about the Labour Party, for which the NHS is the ultimate symbol of its own superior social conscience? Are Labour MPs agitating about the filth in our hospitals and the deaths it is causing? Dream on. Labour MPs are currently wholly occupied with inspecting their own navel and analysing who is up or down in the Gordon Brown/David Cameron circus. And as for the Health Secretary, while patients are dying as the direct result of the system over which he presides, he appears to think that the biggest threat to the future of the very planet is that people are too fat.

Our NHS is now the symbol of a society that has lost its moral compass along with its heart and soul.


One unfixable Australian public hospital

Despite huge pressures on the politicians, it is still a disaster zone

WHEN young mother Sara Claridge received a third phone call from Royal North Shore Hospital relaying the news that her urgent surgery had been postponed yet again, she broke down in tears. The 26-year-old was in line to have cervical surgery to remove pre-cancerous cells and relieve crippling pain from a gynaecological condition, but was told the hospital's theatres were closed. Ms Claridge - whose mother had a similar condition and had a hysterectomy at the age of 27 - had already had her operation cancelled once before she was moved up the priority list for surgery in October.

The incident is the latest in a string of alarming cases emerging from Royal North Shore Hospital following the case of 32-year-old Jana Horska, who miscarried in the hospital toilets last month. Following Mrs Horska's miscarriage tragedy, Associate Professor Bill Sears, a neurosurgeon at the hospital, spoke out, revealing operations are cancelled frequently at the last minute because of theatre closures.

Ms Claridge's setbacks now, sadly, catapult her into being a new symbol for Premier Morris Iemma's Government's failure to cope with the state's growing hospital crisis - a crisis that Health Minister Reba Meagher appears reluctant to admit, address or provide policy responses for. This latest case will increase pressure on the Government to explain how it intends to turnaround health care in NSW - it is another example of ordinary people being let down.

"But then she called and said the theatre was closed and we'd had to reschedule again to November. I was in tears, I just couldn't handle it any more," Ms Claridge said. "The pain knocks me sideways. Some days I can't get out of bed and I don't want to leave the house. "I'm 26, I shouldn't have to worry that when I have a shower my hair falls out in clumps. "I should be able to take my daughter to the park, or even be able to get up and make her breakfast without feeling like I have to go back to bed for the rest of the day."

An RNSH spokeswoman said the postponement of Ms Claridge's surgery was the decision of the doctor, who already had 21 patients on his waiting list. "(The) hospital has contacted Mrs Claridge and is investigating the possibility of an earlier date for surgery by transferring her care to another surgeon," the spokeswoman said.

Opposition health spokeswoman Jillian Skinner said yesterday it was a standard State Government defence to blame the doctors. "It is another example of the minister being at odds with doctors and their clinical decisions," she said. "She is in discomfort and she has a toddler to care for - it is cruel to delay the surgery."


Thursday, October 25, 2007

So health care for the poor is better in England and Canada? Guess again

Post below lifted from Chris Reed. See the original for links

From a new study by Princeton scholars:
This paper reexamines differences found between income gradients in American and English children's health, in results originally published by Case, Lubotsky and Paxson (2002) for the US, and by Currie, Shields and Wheatley Price (2007) for England. We find that, when the English sample is expanded by adding three years of data, and is compared to American data from the same time period, the income gradient in children's health increases with age by the same amount in the two countries.

In addition, we find that Currie, Shields and Wheatley Price's measures of chronic conditions from the Health Survey of England were incorrectly coded. Using correctly coded data, we find that the effects of chronic conditions on health status are larger in the English sample than in the American sample, and that income plays a larger role in buffering children's health from the effects of chronic conditions in England.

We find no evidence that the British National Health Service, with its focus on free services and equal access, prevents the association between health and income from becoming more pronounced as children grow older.

Got that? Poor kids fare better in the U.S. system, with all its flaws, than in England with its single-payer system. Oh, but that's England! Canada is what we want to be like! Michael Moore says so! It must be true. Guess again. Here's the summary of a new study by Baruch College scholars:
Does Canada's publicly funded, single payer health care system deliver better health outcomes and distribute health resources more equitably than the multi-payer heavily private U.S. system? We show that the efficacy of health care systems cannot be usefully evaluated by comparisons of infant mortality and life expectancy. We analyze several alternative measures of health status using JCUSH (The Joint Canada/U.S. Survey of Health) and other surveys.

We find a somewhat higher incidence of chronic health conditions in the U.S. than in Canada but somewhat greater U.S. access to treatment for these conditions. Moreover, a significantly higher percentage of U.S. women and men are screened for major forms of cancer. Although health status, measured in various ways is similar in both countries, mortality/incidence ratios for various cancers tend to be higher in Canada. The need to ration resources in Canada, where care is delivered "free", ultimately leads to long waits. In the U.S., costs are more often a source of unmet needs.

We also find that Canada has no more abolished the tendency for health status to improve with income than have other countries. Indeed, the health-income gradient is slightly steeper in Canada than it is in the U.S.

Got that? Poor people fare slightly better in the U.S. health system than they do in the Canadian system. On a scale of 0 to 100, relevance of these studies to the U.S. health debate: 100.

On a scale of 0 to 100, the likelihood they ever will become part of the U.S. health debate: 0. Just wonderful.

NOTE: The Canadian study above does have some problems. See here. But when one of Canada's leading Leftist politicians goes to the USA for medical treatment that probably tells us more than any statistics. And Stronach is one of many Canadians who go to the USA for treatment that they cannot get in Canada

Man rips out teeth with pliers to beat NHS wait

He was in pain from toothache but was told to wait 3 weeks before he could be treated

A BRITISH man has pulled out seven of his own teeth because he was told to wait three weeks for an appointment to see a National Health Service dentist. Taxi driver Arthur Haupt used pliers and a technique he had learned in the army to carry out the DIY dentistry. He couldn't afford the $170 per tooth treatment he was quoted by a private practice.

"If you can't get anyone else to take your teeth out, you take them out yourself, don't you?" said Mr Haupt, 67, from Melton, in Leicestershire in England's east Midlands. "When they told me to fill out a form and how long I would have to wait I said, 'I've got gob ache now, not in three weeks time'.


Wednesday, October 24, 2007

Lance the bloated beast of hospital bureaucracy

Even better to abolish the bureaucracy altogether and send the money direct from the Treasury to the hospitals. Comment below from Australia

In another bout of me-tooism Opposition Leader Kevin Rudd has picked up John Howard's proposal to encourage retired nurses back into the public hospital system by declaring, yet again, whatever you can do I can do better. Confronting the chronic shortage of hands-on nursing staff in the country's public hospitals, a problem encouraged by the introduction of university training for nurses, Howard has announced plans to establish 25 hospital-based training schools for nurses. Howard has also foreshadowed plans to replace state government management of the 750 public hospitals around the country with community-based boards - something that Rudd has rejected, claiming it will add another tier of bureaucracy in the system.

This is rubbish. It is in fact what is urgently needed to attack the bureaucratic monster created by the state Labor governments which is sucking the life out of our public hospital system. It is a sad fact that only about one in six people employed in the public health system is engaged in face-to-face patient care. The bulk of the remainder are involved in what are essentially administrative areas. Hospital funding needs to be directed away from the back office staff and towards the areas where it is needed most - direct patient care.

You can see where the money goes when you look at the plethora of bureaucratic bodies that administer public hospitals in NSW alone under the state Government's Health Department. The charter for these Area Health Services sounds simple - even altruistic: to keep people healthy; provide the health care they need; deliver high-quality health services and manage these services well; and to provide sound resource and financial management with skilled and motivated staff, and so it goes on. Pity it's not working.

And it will be interesting to see if the parliamentary inquiry into a string of patient care and administrative crises at Sydney's Royal North Shore Hospital, which the Iemma Labor Government has reluctantly agreed to hold, will address the real problem of a bloated and dysfunctional bureaucracy. Royal North Shore is one of 20 hospitals situated in the area from Sydney's north shore to the NSW central coast covering a population of 1.3 million. These are administered by the Northern Sydney Central Coast Health Service, which is one of eight similar health service administrative bureaucracies overlording all public hospitals and health care facilities in the state through a complex web of sub-services and committees.

The NSCCHS has a 50-member executive structure operating under a chief executive, with a total staff, including casuals, of 15,700. The 2005-06 annual report by the NSCCHS gives an insight into how this bureaucratic system staggers along in the state. It is clear that an enormous amount of time is spent in strategic planning to identify areas of need and improve efficiencies through seemingly endless reviews. But to what end? For example, detailing its workforce strategies, it says, in part, that it was unlikely the medical and nursing workforce would be enhanced significantly in the next five years. And the report shows that about 35 per cent of emergency department patients had still not been admitted to a hospital bed within eight hours of active treatment starting.

In pointing to a major challenge in clinical sustainability the report acknowledges "a lack of critical mass" in a range of services offered at many acute facilities such as intensive care, emergency services and maternity. It goes on to state that this situation "has the potential to produce many undesirable effects such as inefficiencies, quality and safety concerns, unsustainable rostering demands for current staff and insufficient volumes for teaching purposes". It seems to have concluded that the best way to address this was to instigate a five-year review plan.

But as one senior specialist told The Australian this sort of approach to the crisis in public hospitals was like sending a fire engine to a burning building and then initiating an inquiry into how the fire started before rescuing those trapped inside. Another specialist recounted the story of a senior nurse in a NSW baby health care centre who wanted to change one line in a brochure given to new mothers to make it more intelligible. The process took 12 months and was the subject of innumerable conferences and committee meetings before the change was finally agreed to.

Rudd, like Howard, has identified the extent of the hospital crisis. That is why he announced plans on Friday for a federal Labor government to spend $600 million to help reduce the waiting list for elective surgery in public hospitals. But simply pouring more money into the hospital system in the fond hope that it will go where it is needed it is like filling a bucket full of holes: it's an endless and pointless process. And by the time these funds have gone through the administrative sieve there is not enough left to maintain the sort of health care standard the community deserves.

Howard's move to restore the traditional system of individual hospital boards is a sound start to dealing with waste and mismanagement which has flowed from the over-bureaucratised structure of hospital administration established under the Labor state governments. If the Liberals and Labor are serious about addressing this disgraceful waste of tax dollars and resources they should commit to a national audit of public health care spending to identify where the areas of greatest need are and make sure that commonwealth funding is not sidetracked away from these.


Australia: Leftist State government blames hospital boss for keeping the doors open

They say he should put his budget first, not patients

The boss of the Princess Alexandra Hospital said it was overworked as he slammed Government claims his overspending had led to crucial patient services being cut back. As Premier Anna Bligh yesterday blamed clinical chief executive David Theile for bed and waiting list closures, Dr Theile sent an email to staff explaining how they were recently praised by Queensland Health for efficiency and performance. He said the PA had handled trying conditions "extremely well" in recent months, frequently saving southeast Queensland's health system from "crisis".

A budget blowout over the first quarter forced 40 of the hospital's 892 beds to close and 10 per cent of operating theatre procedures to be cancelled. "For an increased expenditure of 2.1 per cent, we delivered 7.8 per cent more crucial clinical services," Dr Theile said in the email obtained by The Courier-Mail . "When all others were on bypass, we kept our doors open by ad hoc setting up of beds in radiology and theatre recovery. "Please be assured of my pride in this organisation and its achievements, and continue to deliver with the same professionalism in these times of restricted activity. "The administrative efficiency of our delivery has been acknowledged by Queensland Health."

The revelations come less than a week after Ms Bligh praised the progress of the Government's $10 billion health action plan in State Parliament. In a thinly veiled swipe at Dr Theile yesterday, Ms Bligh rejected more funding for the hospital, saying taxpayers were "entitled to see strong management ensuring that budgets are maintained". "The PA, like every other hospital, has to live within its budget," Ms Bligh said. "The PA Hospital budget this year has increased by $33 million. That is a very significant increase that will buy extra and additional services."

The war of words comes after the Government blamed Dr Theile on Friday for the closures. Acting Health Minister Rod Welford distanced the Government from the overspending, saying the PA was managed by a clinical chief executive and not a bureaucrat. "The decision about managing the work flow of surgery is a local hospital decision made by the most senior medical officer in the hospital, the CEO," Mr Welford said.


Tuesday, October 23, 2007

Ending Employer-Based Health Insurance Is a Good Idea

But do we really need a new regressive health insurance tax?

"The U.S. employer-based health-insurance system is failing," declares a new report by the Committee for Economic Development (CED). The CED is a Washington, D.C.-based policy think tank comprised of business and education leaders. And it is right: Employer-based health-insurance is indeed failing. Between 2000 and 2007, the percentage of firms offering health insurance benefits fell from 69 percent to 60 percent. The percentage of people under age 65 with employer provided insurance dropped by 68 to 63 percent. In absolute numbers, those covered by job-based insurance fell from 179.4 million to 177.2 million. Employers are jettisoning health insurance because costs are out of control. Since 2001, premiums for family coverage have increased 78 percent, while wages have gone up 19 percent and inflation is up 17 percent. The consequence is that health insurance is the number one domestic policy issue in the 2008 presidential race.

So what is the CED's prescription for our ailing health insurance system? The report promisingly begins by recommending the creation of "a system of market-based universal health insurance." In order to achieve this, the CED would make health insurance mandatory for every American. The CED proposal envisions the creation of independent regional exchanges that would act as a single point of entry for each individual to choose among competing private health plans. The exchanges would set minimum benefit plans. The exchanges would also cut through the thickets of state health insurance regulations that add substantially to the costs of insurance. Individuals could purchase insurance above and beyond the minimum benefit plans with after tax dollars.

Insurers would be required to take all individuals regardless of prior medical conditions. In order to prevent adverse selection spirals, the exchanges would also do risk-adjustments by transferring some of the premium revenue from insurers that had enrolled more good risks to those who enrolled more poor risks. Consumers pay a price an insurer would receive had it enrolled an average population of risks. Something very similar is already done in Switzerland's mandatory private health insurance market.

So far, so good. Unfortunately, the CED proposals go quickly off the rails when the group recommends that every household receive a fixed-dollar credit sufficient to purchase an approved low-priced quality health plan. This health insurance credit would not be means tested and would be financed by some kind of broadly based tax-perhaps a payroll, value-added or environmental tax. Such taxes, like Social Security and Medicare payroll taxes, are likely to be regressive, which means the poor will pay a larger percentage of their incomes than the rich. In fact, two-thirds of taxpayers paid more in social security and Medicare taxes than they did income taxes.

For example, today every wage-earning American pays a Medicare payroll tax of 2.9 percent. That tax is supposedly divided so that employees and employers each pay 1.45 percent. Of course, employers would give employees the other 1.45 percent if they were not paying the tax, so in reality the employees are paying the whole tax. The same thing goes for the Social Security Ponzi scheme.

The CED proposal is chiefly a ploy to get employers out from under the increasingly heavy burden of buying insurance for their employees. That's a laudatory goal, but it shouldn't be done by imposing yet another tax on employees. The good part of the CED proposal is that employees would purchase private health insurance in a competitive market. If households could find a policy for cheaper than the credit, they could pocket the extra money for themselves. The CED argues persuasively that this kind of competition would tend to keep health care costs down.

But why advocate a tax to pay for the credits? One advantage of such a health insurance credit is that it would avoid the administrative and enforcement costs of coercing people to buy insurance. Such enforcement has proved problematic in other insurance markets. For example, although auto insurance is mandatory, more than 14 percent of motorists are uninsured.

However, there is a better way to expand private health insurance and to obtain the benefits of competition as a way to keep medical spending down. First, retain the CED proposal that health insurance be mandatory. But, instead of a new tax, allow employers to hand over the money they currently spend on health insurance to their employees in the form of money wages. Then, in order to create a level playing field, expand the current tax exemption for employer-purchased health benefits to all individuals. Maintaining the tax exemption helps enforce the mandate because taxpayers will have to report annually how much they paid for their health insurance when they pay their taxes.

What about the poor Americans who do not make enough to afford medical insurance? Give them vouchers to buy private medical insurance and pay for the vouchers by abolishing Medicaid. In 2005, the Federal government and the states spent $316 billion on Medicaid to cover around 17 million households. That works out to about $18,500 per household per year. The annual premium for family coverage in 2007 averaged just over $12,000. Due to increased competition, average premiums for the minimum private plans will drop. This means that some money should be left over from Medicare to pay for the currently uninsured poor. There will be some administrative costs involved with determining voucher eligibility, but the health insurance vouchers themselves would essentially be self-enforcing. The experience of Switzerland, in which nearly one-third of the population receives subsidies to purchase private insurance, suggests that very few would fall through the new health insurance safety net.

Despite its flaws, the CED proposal avoids the huge mistake of centralizing health insurance through a single government bureaucracy. The CED report correctly concludes that "Market-based universal health insurance, with individuals choosing the health plans and delivery systems that they deem best, shows great promise-much greater than any alternative."


Superbug problems worsened by crowding in NHS hospitals

Almost a quarter of hospital trusts are increasing the risk of MSRA and Clostridium difficile by filling wards to “unsafe” levels, The Times can disclose. According to Department of Health figures, 22 trusts in England recorded bed occupancy rates of 95 per cent or more and nearly half 85 per cent or more. But a leaked report by the department suggests that MSRA rates are 42 per cent higher in hospitals where more than 90 per cent of beds are filled than those that fill less than 85 per cent of beds. The Liberal Democrats said the figures showed that many hospitals were effectively full while nurses’ groups blamed the problem on pressure to meet waiting time targets.

The proportion of hospital trusts filling 90 per cent or more of beds has risen from 13 per cent five years ago to 23 per cent. Elderly patients are particularly at risk, with occupancy rates on geriatric wards reaching 91.3 per cent, according to analysis of figures by the Liberal Democrats. Secure learning disability wards had a bed occupancy rate of 94.9 per cent, while mental illness wards had 86.8 per cent. The highest occupancy rate was in East Berkshire Primary Care Trust, which said that all of its 122 available beds were filled during the survey, while the Oxleas Foundation Trust, which provides mental health and disability services for southeast London, said that 453 of its 459 beds were full. The average occupancy rate in 2006-07 was 84.5 per cent, in line with the past five years but a sharp rise since Labour came to power in 1997 when it was 80.7 per cent.

Professor Barry Cookson, an expert on MSRA, said that an 85 per cent bed occupancy was a “safety level above which we start having problems”. A report published this month said that C. difficile caused the deaths of 90 patients and affected hundreds more at Maidstone hospital, Kent, between April 2004 and September last year.

Norman Lamb, the Liberal Democrat health spokesman, said: “These figures mean that for a lot of the time, many hospitals are effectively full - and on red alert. As long as this situation continues, it will undermine efforts to successfully combat hospital-acquired infections. It puts staff under unfair pressure and risks corners being cut in order to get new arrivals admitted on time. The system is under enormous pressure.” The Royal College of Nurses believes the true bed occupancy rate could be even higher. Its own survey found that the average rate was 97 per cent, and that more than half of wards were running at full capacity to meet waiting time targets. The number of death certificates that name MSRA as a contributory factor rose from 51 cases in 1993, the first year of recording, to 1,629 in 2005.

Today the Lib Dems will announce a five-point “Florence Nightingale” charter to combat hospital infections. They suggest copying the Dutch approach in which infected wards are closed, patients transferred and staff sent home. They would also give matrons authority over all staff, including contracted cleaners, and roll out super-bug screening programmes to GPs and care homes.

A Department of Health said that although some trusts had higher occupancy rates they still managed to reduce infection rates significantly.


Monday, October 22, 2007

NHS pays 225,000 pounds compensation for husband's 'squalid' death

A boy of nine has been given 25,000 pounds compensation after his father died as a result of hospital negligence. Today, the child's mother - who was awarded a further 200,000 - described the squalid conditions in which she claims her husband was treated and the catastrophic medical errors that she believes killed him.

Debra Luck, 44, said medics left her husband Ian to lie in agony for hours before he died from a heart attack after a duodenal ulcer ruptured. Medical experts say emergency surgery would have saved the 37-yearold but instead Princess Alexandra Hospital in Harlow treated him with drugs. Mr Luck, who was delirious with pain, had been left feeling suicidal by the conditions. A lack of nursing care meant he was forced to vomit on the floor and wet the bed as he lay dying.

He was so appalled by his conditions that he refused to let his son Ben, then four, visit him. The boy was so traumatised by his father's sudden death he had to see a psychologist.

Mrs Luck, from Waltham Abbey, launched a High Court action against the trust after her husband's death. The case was settled when the trust offered the payout without accepting liability. Mrs Luck said she decided to take the money because it would give her son a more secure future. However, she remains horrified by the trust's behaviour. "They never even said sorry and I feel they've got away with murder," she said. "Those last days of his life were a living nightmare I never believed I'd experience in a British hospital. "The lunchtime before he died he called me crying, saying he wanted to jump from the nearest window."

She rushed to see her husband but he urged her to go home to be with Ben. Two hours later she got the call saying he had suffered a heart attack. A trust spokesman said: "The trust is pleased the court has approved a settlement and offers Mrs Luck and her family best wishes for the future." [Smarmy scum!!]


Sunday, October 21, 2007


Five current articles from Australia below:

Another shocking Australian public hospital

With official coverup, of course

TWO sisters told yesterday how they kidnapped their mother from the troubled Hervey Bay Hospital because they feared she was starving to death. The sisters, who are nurses, said they were horrified at the treatment their mother, Marjorie Holland, was receiving after suffering a stroke in November last year. Cecile Lyons and Michelle Downes, 51-year-old twins, said they tricked hospital staff into thinking they were taking their mother out for fresh air.

"My partner John (Reason) was waiting in the carpark for a quick getaway," Ms Lyons said. "I took her out in an armchair with wheels. We ditched the chair in the carpark and sped off to the Royal in Brisbane. "We had no choice. She was lapsing into unconsciousness."

The twins accused some hospital staff of incompetence in a formal complaint in which they alleged their 76-year-old mother was dehydrated and starving. Other more serious allegations cannot be reported on legal advice. They said their mother did not see a doctor for days and was not put on a drip until her eighth day in hospital.

In hospital Mrs Holland developed deep vein thrombosis and later had her leg amputated at Royal Brisbane and Women's Hospital. Mrs Lyons said she and her sister were the first to diagnose the DVT. "It was a nightmare," Ms Lyons said. "She was left to dehydrate and starve as a treatment for stroke. She did not have food for 17 days yet the hospital told us my mother was happy with her care."

An expert panel set up by the Health Quality and Complaints Commission to investigate the sisters' complaints agreed Mrs Holland should have been given intravenous fluids earlier. The panel led by the University of Queensland's Professor Ian Scott, also found that "heparin (anticoagulant) therapy should have been given from the date of admission". However, earlier treatment "was unlikely to have changed the outcome for Mrs Holland", Professor Scott said. The commission concluded that the care provided to Mrs Holland at Hervey Bay was "reasonable".

Mrs Holland, who suffered some brain damage, now lives in a NSW retirement village. There were findings against Hervey Bay Hospital in 2005 in the health inquiry headed by Geoff Davies, QC. The Courier-Mail understands several former patients have since received confidential settlements.


Australia: Government hospitals under fire for mistreating elderly

POOR care of the elderly in some hospitals is prompting nursing homes to photograph their patients before admission and as they leave. Aged patients are often discharged from hospital malnourished and with bed sores, a national survey of 370 nursing homes found. A majority of nursing homes said they experienced several cases every year of residents returning from hospital with ulcers and skin tears, but without acknowledgement in the hospital's clinical notes. The author of the study, Tracey McDonald, professor of ageing at the Australian Catholic University, said the numerous "compromised skin integrity" cases raised by nursing homes was "a very disturbing issue".

The reputation of some hospital staff was such that at least four nursing homes had taken to photographing their residents' skin before and after hospital stays to prove to relatives of the patient that the nursing home care was of good quality. Nursing home staff saw few attempts by hospital staff at preventing trauma or even treating wounds when they occur. "In fact, respondents [to the survey] perceive an attitude of mendacity and blame emanating from the hospitals . where some clinicians falsely accuse aged care homes of causing the wounds and even mislead families into blaming the aged care home."

Professor McDonald's report was commissioned by Aged Care Association Australia, which represents nursing homes, as a result of significant concerns about the condition of patients transferred between nursing homes and hospitals. The report assessed the detailed answers from 371 nursing homes who responded. A breakdown of the findings showed that NSW hospitals performed better than other states on most indicators, but poorly on medication arrangements for aged care patients leaving hospital. Inadequate or absent notification of drug requirements could lead to "dangerous" problems in such areas as the prescription of sedatives and psychotropic drugs for mental illness.

Poor nutrition of elderly patients was also at disturbing levels and while NSW reported fewer problems, the issue was still a cause for concern, with 40 per cent of nursing homes in large regional centres reporting residents with nutritional problems on return from hospitals. Another key issue was the timing of transfer of residents to aged care facilities, which said Professor McDonald, could often be late at night and at short notice, a confusing experience for people in their 80s or 90s.

Other shortcomings often mentioned were lack of patient records provided by the hospital on the patient's treatment, hampering the home's efforts to provide proper care of what could be life-threatening conditions. Poor care of mental health patients was also reported, with evidence suggesting that in some cases patients were sedated before departure from hospital, leaving them unsupervised and vulnerable at points in the transfer process.

The chief executive of the Aged Care Association, Rod Young, called for urgent action to avoid harm to vulnerable and confused patients which, he said, would inevitably end up "leading to death in some instances".


Negligent NSW public hospital staff doomed baby boy

GRIEF-stricken Fatima Abdallah should be celebrating her baby boy's four-month birthday this weekend - instead she is mourning his death and left wondering how a Sydney hospital failed to diagnose her son's life-threatening heart condition. Marwan Yahya died on June 19, five days after being sent home from Liverpool Hospital despite showing signs of a serious problem.

NSW Health has launched an investigation but his heartbroken mother contacted The Daily Telegraph yesterday desperate for authorities to explain the bungle. "It's been four months and I still haven't been told anything," a distraught Ms Abdallah said yesterday. "I keep calling the hospital but they brush me off and tell me to wait. I have a feeling they just want this to go away."

The first-time mum knew something was wrong with her little boy just hours after he was born. Marwan was blue around his mouth and fingers, breathing faintly and, as the hours passed, he refused to eat - just laying in his cot. Ms Abdallah said she asked nurses what was wrong but was told his condition was "normal". "I didn't enjoy those first few days with him because I was so worried. I knew something was wrong. I felt like they were treating me as if I had no idea," she said.

Her worst fears were confirmed when the two-day-old infant was sent home and started having seizures because his brain was starved of oxygen. After rushing back to Liverpool Hospital, Ms Abdallah and Marwan were transferred to the Children's Hospital Westmead, where tests revealed he had hypoplastic left heart syndrome. Doctors told the family that, had the condition been detected at birth, Marwan could possibly be alive today. "They had booked him on a flight to Melbourne where the operation is performed but when they found out how severe his brain damage was, there was nothing they could do," Ms Abdallah said. "We were told to say goodbye to him and they turned off the machines."

The harrowing ordeal follows a litany of hospital scandals that have embarrassed Health Minister Reba Meagher. South Western Sydney Health Service apologised to the family when they met with them yesterday. A health service spokeswoman said the disease that claimed Marwan can be "difficult to detect at birth". Ms Abdallah said she could not comprehend how doctors or nurses at Liverpool could have missed her son's condition. "He may still have been alive today if someone had listened to me," she said.


Man dies after old ambulance breaks down

Plenty of money for bureaucrats but no money for new vehicles

A MAN has died after paramedics from a broken-down ambulance were forced to run almost two blocks to try to revive him in Melbourne's southeast. Ambulance Employees Australia (AEU) general secretary Steve McGhie confirmed a 56-year-old man died from a cardiac arrest before paramedics could reach him at his Elwood home last night. Mr McGhie said an ambulance broke down about two blocks from the house about 6pm (AEST), forcing paramedics to run with life-saving equipment, including a defibrillator. But the man's heart had stopped by the time the paramedics arrived.

"The vehicle had 160,000 on its odometer - it should be retired ... even though the Government has assured Victorians that they are safe and secure," Mr McGhie said. "The ambulance had power failure and they couldn't keep it running. "They grabbed the defibrillators and the oxygen equipment and ran to the house. "They tried to resuscitate the man at the scene but were unsuccessful."

The death follows a bitter dispute between the Metropolitan Ambulance Service (MAS) and its members' union over "unsafe" vehicles. Paramedics last week said the MAS threatened them with $6000 fines unless they use the vehicles, which have exceeded their agreed service life of three years or 150,000km. About 45 Mercedes ambulances had exceeded their agreed lifespan, Mr McGhie said.

Mr McGhie called on Victorian Health Minister Daniel Andrews to get new ambulances on the road, saying it "was a sad state of affairs in Victoria" if paramedics are forced to run to save their patients. "This is the sixth incident in the last two weeks and the Government has to step in," he said. "They've got to get more vehicles."

Tim Pigot, spokesman for Mr Andrews, said it was an operational decision by the MAS of how they managed resources. "We have more than doubled funding for ambulance services across Victoria since 1999," Mr Pigot said. "This has resulted in an extra 738 paramedics and 101 ambulances on Victorian roads. "Victoria has the safest and best ambulance system in Australia." Metropolitan Ambulance Service spokesman James Howe said the service was investigating the incident.


Inert bureaucracy incapable of dealing with the sort of family problems they are set up to deal with

More "child welfare" destructiveness. They should sack all the Left-indoctrinated social workers and employ experienced mothers instead -- who would have learnt some commonsense from experience and who should at least be a lot less intimidatory. If the mother below had REALLY been a druggie, they would have had the kid back with her straight away. That is the firm rule of social workers worldwide -- because it shows how "non-judgmental" they are. Accusing normal middle-class families of "witchcraft" and the like is fine, however

All Michelle wants is what most mothers take for granted. To be able to tuck her seven-year-old son tightly into bed every night with a kiss and a fond "sleep tight". But for five long years, that has not happened often. For Michelle is the mother of Cameron, the autistic boy whose plight of being trapped for five years in an inappropriate respite centre for severely disabled and disturbed people in Hobart was raised in the Tasmanian Parliament on Thursday.

After a public furore yesterday, the State Government announced last night that Cameron would finally be leaving the Lutana facility where he has lived most of his young life this weekend to live with a foster family. The Government's Director of Children Services, Mark Byrne, said on Thursday that despite four years of trying, it was not possible for Cameron to live with his own family. Human Services Minister Lara Giddings wrote in a letter to Opposition Leader Will Hodgman in March that "after many efforts to support Cameron in his home environment" his mother had acknowledged "he could not return home as she was unable to care and support him".

It is these sort of official judgments and comments that make Michelle distraught, bewildered and angry. "I'd move heaven and earth to get Cameron living here with us," a tearful Michelle said yesterday. "There's not a day that goes by that I don't wish he was here with all of us. "And I've never said I won't have him. I just want him home."

The first Michelle and her partner knew about the uproar over Cameron's plight was when she looked at the newspaper yesterday morning. She could not believe what she read. First, that letters expressing dire concern about her son and his future had been circulating between ministers and within high levels of the Government for the past 12 months, without her being told. Second, that the Government was claiming Cameron's mother did not want him to return home. And finally, that allegations were being made that she was somehow a "troubled mother" with a dysfunctional lifestyle and a drug problem who had given Cameron a horrific start to life and who then rarely visited him while he was in care.

Michelle and her partner claim nothing could be further from the truth. It is why yesterday morning they rang Mr Hodgman -- who highlighted Cameron's predicament in Parliament this week after 11 months of government inaction -- and then got in touch with the Mercury. They wanted to tell their side of the story. And it is a very different one to that portrayed.

Instead of being a tale of abandonment and a callous lack of caring by a little boy's mother, it's a story of how battling families can become so worn-down and demoralised by government bureaucracy, bullying and inertia that they feel they no longer have any rights or say about their own child. Mixed in with that is a sorry saga of government departments failing to communicate with each other. And of a mother, fearing judgments were being made about her every time she visited her son or met Child Protection case managers, developing a reluctance to interact with government officials and disability workers about her own aspirations and wishes for Cameron.

But amid the sadness and lack of communication, there is also hope. Hope instilled by a close-knit Glenorchy family with little money but lots of resilience, desperately longing for nothing more than to have Cameron back living in their midst, alongside his four brothers and sisters. A shiny new boy's bicycle sits in the backyard of the red-brick home on a steep hill. It's the longed-for bike that Michelle and her partner gave to Cameron last weekend for his seventh birthday, when he came home for an afternoon visit after a birthday party organised by staff from the Lutana home at Hungry Jack's in Glenorchy. All the family were there to see Cameron, including his sister and brother. And there was the new bike, a big chocolate mudcake covered with candles -- and plenty of love and excitement.

A weepy Michelle shows photos of Cameron, a beaming smile on his face as he tried out his bike surrounded by family and friends. "We all love him to bits, he's such a gorgeous fantastic kid," Michelle's partner said. "Sure, he can be a handful, but Michelle's a great mother and she adores that kid -- we all do. "All this about him having troubled family life and Michelle having a drug problem, it's all just rubbish."

Michelle says she has never been on drugs or had a drug issue. She doesn't deny when she left Cameron at Lutana aged just under two that she was at her wit's end. He had just been diagnosed as autistic, she had a tiny baby and older boy to cope with too, her partner had just left her, and she was clinically depressed. Just after putting Cameron into respite care, for what his mother hoped would be just a short-term stay, she had a nervous breakdown and tried to commit suicide by overdosing on pills. But since then, and since moving in with her partner to his Glenorchy home four years ago, life has become much more settled for Michelle and her extended family.

Cameron, a bright little boy who loves nothing better than curling the hair of visitors, is at Glenorchy Primary School, while his brother is a budding soccer star. Michelle has just got a part-time job working in a canteen, while her partner is a pensioner while he waits for a knee reconstruction next week. "We've always been battlers, but the kids come first," Michelle's partner said. "It's like that when Cameron comes to stay -- we take him out fishing on the boat or take him driving in the four-wheel-drive -- we'll do anything to help our kids."

Michelle angrily denies she has not visited Cameron for six months at a time and disputes court documents that say she has refused to collect Cameron or "engage with (departmental) services (staff).". Instead, she tells a story of not being offered help. Of not being told about support systems that were available -- which she has since been offered in droves since yesterday when Cameron's case was made public. "It's not as if I ever said that `OK, he's autistic, I'll dump him here and someone else can deal with him'," Michelle sobs. "But you just feel after a while that you are banging your head against a brick wall; that the department is stretched to the limit and doesn't seem to have the funds or the services they need to have to help people like me or Cameron."

The big issue for the couple is really as much about public housing as getting more support to cope with an autistic child. They say they cannot have Cameron back with them while they live in their Glenorchy home surrounded by steep steps, footpaths, fast cars and a little back garden. "Ideally, we need another government house that is a bit bigger and out of town on a bigger flat block, where Cameron can ride his bike and play, without me having to watch him 24 hours a day," Michelle said. "I've never said I don't want Cammy, just that this house is too dangerous for him to live in."

The family have never been offered a combined case management session with a public housing representative and a disability services or child support worker. Last night, Michelle was told that a foster family had been found for Cameron to live with immediately. At first tearful, she then conceded it was probably a good thing in the short term for Cameron, if only to get him out of the inappropriate Lutana centre. But after the fuss of the past day, Michelle and her partner are determined to get Cameron back living with them in the long term, and for regular access visits in their home while he remains in foster care.

Mr Byrne said he was reviewing all of Cameron's case and was absolutely prepared to "re-engage with the family" if they wanted to be involved. Michelle said: "All I can hope is that out of all these half truths and lies told about me and my family in the past day, that it is all for Cameron's good in the long run. "I don't want empty promises -- I've had enough of them -- but if we can get a more suitable house and some help with Cameron and then get him home, that's all I could ever want."


Saturday, October 20, 2007

Health Care Debate's Real Issue is Who Decides

At a recent campaign stop in Iowa, Democratic presidential candidate John Edwards told an audience that under his plan for national health care, preventive care would not just be paid for by the government, it would be mandatory. Every American would be required to get annual physicals and regular tests such as mammograms and colonoscopies. Although Edwards didn't spell out the penalties, presumably scofflaws would face fines or worse. It's easy to make fun of Edwards' proposal. (Can we look forward to the spectacle of couch potatoes who miss their doctor's appointments being dragged off in handcuffs?) But we should actually be grateful that Edwards has so clearly illustrated the fundamental question that should be at the heart of any debate over health care reform: Who decides?

That is, after all, the central question of most politics. Whether talking about educating your children, what charities you support, how you behave in your bedroom, or how you operate your business, the complexities of the political process boil down to whether you will make these decisions or whether the government will. In health care, the question is whether you, together with your doctor, will make your most personal and important health care decisions, or whether the government will make them for you. Government-run national health care systems are all about limiting choices. For example, nearly all national health care system impose global budgets, strictly limiting how much can be spent on health care.

This leads to the rationing of care, either directly by denying certain procedures altogether, or indirectly by limiting the availability of modern medical technology. The United States has five times as many MRI units per million people and three times as many CT scanners as, say, Canada. Today, more than 800,000 Canadians are on waiting lists for medical procedures. As Canadian Supreme Court Chief Justice Beverly McLachlin wrote in a 2005 decision striking down part of Canada's universal care law, many Canadians waiting for treatment suffer chronic pain, and "patients die while on the waiting list."

And if you think that the rationing wouldn't affect you, some national systems actually make it illegal to spend your own money for care or prohibit buying private insurance. At the very least, if the United States were to adopt a national health care system, millions of Americans who are satisfied with the insurance coverage they have today could lose it and be forced into a government-designed plan that forced you to pay for benefits you didn't want or limited your choice of doctors.

Of course, you wouldn't have the choice not to participate. In Massachusetts, former Gov. Mitt Romney pushed through a plan that required all residents to buy a government-designed insurance plan. Those who fail to comply have to pay huge tax penalties. And, speaking of taxes, let us remember that any national health insurance program will be financed through a huge tax increase. Edwards estimates that his plan will cost some $120 billion per year in new taxes.

Sen. Barack Obama's proposal is slightly less expensive, but still estimated at $60 billion to 80 billion. Sen. Hillary Clinton hasn't told us what her plan will cost, but we know it will be expensive. Yet every dollar you have to spend funding national health care is a dollar you can't spend on your family.

National health care sounds wonderful. After all, it promises health care for everyone - for free, no less. In reality, it cannot deliver what it promises, but the politicians are still happy to make the promise anyway. All they want in return is our freedom. We should be thankful John Edwards has shown us what's really at stake.


British 'nurse of the year' leaves for private sector

The "Nurse of the Year" 2007 has quit the NHS after becoming "ground down" by the bureaucrats and excessive paperwork that plague her profession. Justine Whitaker was awarded the Nursing Standard title this year but is leaving East Lancashire Primary Care Trust next month for the private sector and to become a lecturer.

The 36-year-old has told how nursing staff were made to use cheaper bandages and dressings while health bosses wasted money on long meetings that achieved nothing. She yesterday warned that a culture of "mistrust and fear" had crept into the NHS and things were bound to go "completely wrong" in Britain's hospitals if nothing is done. She said: "Sitting in meetings we are constantly being told 'We're going for this cheaper option with this bandage; we're going for that cheaper option with that dressing; we need to be mindful of resources'.

"I'm absolutely fine with that - I run my household like that - but what I see as a waste of resources is when I'm sitting in a big meeting and as a clinician I am the cheapest person there at 35,000 pounds a year and decisions are still being put off to another meeting."

The lymphoedema nurse, who has 14 years of clinical experience, added: "There is no sign the red-tape is being reduced. It all leads to more bureaucracy, which all leads to more form-filling and paperwork. "But as a nurse, I just want to nurse, I want to look after patients. "

Royal College of Nursing secretary Peter Carter said: "It saddens us that such a distinguished nurse is leaving the NHS." A spokesman for the Department of Health promised there would be a dialogue with staff and patients. [More meetings!!!] He said: "The health secretary has acknowledged that too much change can affect morale."


Friday, October 19, 2007

Stop feeding the dysfunctional NHS

Whatever you made of the Chancellor's various sleights of hand on Tuesday, lurking beneath his Budget plans was one inescapable fact. The hungry maw of the NHS is swallowing more and more resources, at the expense of virtually everything else. The defence budget is at its lowest since 1930, despite our dwindling troops being dotted across three continents. Prison overcrowding is at such record levels that Jack Straw will have to release even more inmates early in a few weeks' time. But the health service marches relentlessly on, having hoovered up two thirds of the increase in public spending in the past five years.

Even "enterprise" - once one of Mr Brown's favourite words - has been tapped. This week's new taxes on small business seemed unwise, given the fragility of the economy. They were also wholly avoidable, had the NHS been awarded the 3 to 3.5 per cent spending settlement that was expected. But a 4 per cent annual rise for the NHS, raising its budget from o90 billion to almost o110 billion by 2010, seemed to have become a political imperative.

Why? Well, 4 per cent is a nice round number. It is also more than half the 7 per cent annual increases that the service has got used to. But it is also simply very hard to row back once you've built an expanded State. This applies to all public services - which is why I wonder whether Messrs Darling and Brown will actually meet their lower spending targets - but it is particularly acute in health.

The NHS is Britain's last big state monopoly. It is the largest employer in the developed world. Its 1.4 million staff outnumber the private and public healthcare workforce of Germany, a country with 25 per cent more people and better health outcomes. Its powerful unions view any slowdown in spending growth as a "cut". And cut is a deadly word in political terms. The Government had its chance, when it was flush with cash, to demand reform as a quid pro quo for more money. But it did not go far enough.

In the 1990s it was possible to argue that the NHS was starved of cash. But not any more. Britain is now spending at about the European average, but lags behind too many other European countries in terms of results. Far too many cancer patients, babies and stroke victims are still dying needlessly. Far too many patients, particularly the elderly, are treated with a callousness bordering on brutality. Almost everyone I know who has had a baby recently has been told by the nurses to bring their own Jif, and not to set foot in an NHS shower without scrubbing it. World-class that isn't.

Sir Derek Wanless, Gordon Brown's former health guru, reported last month that almost half of the extra o45 billion that has been spent in the past five years has gone on pay and price inflation. The NHS generates its own inflation as though it were a country in its own right. But the slowdown in government spending is not, sadly, due to a realisation that there are diminishing returns to spending in a monolithic health service. It is merely the Government running low on cash.

The real issues are repeatedly obscured by homilies about the NHS being the envy of the world. The latest to fall into this trap is Lord Darzi of Denham, the eminent surgeon who is supposed to be reviewing the structure of the NHS. Thank heavens he is still practising on Thursdays and Fridays. For his interim report last week was little more than an advert for the Government's two populist priorities: extending GP opening hours and tackling MRSA. Until then, the greatest worry about the Darzi review had been that it might delay progress towards much needed reforms. No one had dreamt that he would be coopted into a propaganda exercise. We do not need a top surgeon to tell us to wash our hands. Nor to invent another centralised "Innovation Council" to champion change, a snip at o100 million. The NHS badly needs more innovation. But you cannot impose it. You can only nurture it, by liberating doctors and by introducing competition.

If this simple fact is not obvious to ministers by now, then all is lost. For the limited moves that the last Blair administration made to introduce competition have paid off handsomely. Letting independent providers carry out some procedures has slashed waiting lists for hip replacements, cataracts and heart operations, and has raised the standard for what can be achieved. Payment by results and the NHS tariff have helped to make costs more transparent and to give a wake-up call to poor performers. Giving the best hospitals more freedom as foundation trusts, under a savvy regulator, has injected a new sense of financial rigour.

Yet ministers have always been embarrassed to claim credit for these achievements, which are loathed by the unions. They are in the strange position of presiding over some brave reforms while having to bloviate about minor issues: free health checks (didn't we used to get those at the doctor?) and expanded GP opening hours (which was the norm, until ministers decided to pay them more to do less).

Ministers are too easily persuaded that the battle is between public and private provision. They are ashamed to endorse the private. But the real battle is between those who want to protect their monopolies - including many private hospitals - and those who want competition. Many NHS insiders who believe most fervently in the service are those who are fighting for competition. But they are still an endangered species. It is of no help to them when ministers send ambivalent signals.

No one is quite sure yet how committed the new Prime Minister is to market-based reforms. The opposition parties will not ask him. Labour's largesse has boxed them into a corner. Neither Conservatives nor Liberals dare to make the case for proper reform. That is the real price of having built a bloated State. No one dares speak the truth, because there are so many vested interests to offend. But the writing is on the wall: a tax-funded free healthcare system is looking ever less sustainable. Politicians always fear the "popularity" of our health service. But that popularity will wane if the NHS comes to be seen as the enemy of every other public service.


Medical Competition Works for Patients

By John Stossel

Health-care costs overall have been rising faster than inflation, but not all medical costs are skyrocketing. In a few pockets of medicine, costs are down while quality is up. Dr. Brian Bonanni has an unusual medical practice. His office is open Saturdays. He e-mails his patients and gives them his cell-phone number. "I need to be available 24 hours a day," he says. "I want to be there when a patient has questions, and I want to be reachable."

I'll bet your doctor doesn't say that. Bonanni knows he has to please his patients, not some insurance company or the government, because he's paid by his patients. He's a laser eye surgeon. Insurance rarely covers what he does: reshaping eyes so people can see without glasses. His patients shop around before coming to him. They ask a question that people relying on insurance don't ask: "How much will that cost?" "I can't get away with not telling the patient how much exactly it's going to cost," Bonanni says. "No one would put up with it. And the difference of a hundred dollars sometimes makes their decision for them."

He has to compete for his patients' business. One result of that is lower prices. And while the procedure got cheaper, it also got better. Today's lasers are faster and more precise. Prices have fallen and quality has risen in other medical fields where most people pay for care themselves, like cosmetic surgery. Consumer power works -- even in medicine.

When government and insurance companies are kept away from the transaction, good new things happen. A doctor in Tennessee I talked to publishes his low prices, such as $40 for an office visit. Most doctors would say you can't make money this way. But Dr. Robert Berry told me you can. "Last year, I made about the average of what a primary-care physician makes in this country," he said. Berry doesn't accept insurance. That saves him money because he doesn't have to hire a staff to process insurance claims, and he never has to fight with companies to get paid.

His mostly uninsured patients save money, too. Unlike doctors trapped in the insurance maze, Berry works with his patients to find ways to save them money. "It's coming out of their pockets. And they're afraid. They don't know how much it's going to cost. So I can tell them, 'OK, you have heartburn. Let's start out with generic Zantac, which costs around five dollars a month.'" When his patients ask about expensive prescription medicines they see advertised on television, he tells them, "They're great medicines, but why don't you try this one first and see if it works?" Sometimes the $4 pills from Wal-Mart are just as good as the $100 ones.

Speaking of Wal-Mart, medical clinics are popping up in Wal-Mart stores and in other similar markets. The clinics offer people with simple problems like sore throats and ear infections relatively hassle-free care ... cheap. Almost everything costs $59 or less. And the clinics are typically open seven days a week. Grace-Marie Turner, president of the Galen Institute, a health-policy research organization, explains how these clinics thrive: "They're figuring how to do something faster, better, cheaper! They're responding to consumer demand because they see that they might make some money on this."

When consumers pay for medicine themselves, saving insurance for the big things, and doctors deal directly with consumers, doctors begin to compete. They start posting prices and work to keep them low. And consumers gain more control of their health care. Instead of governments and insurance companies deciding for patients, patients decide. Competition gives consumers more choices. And choice gives them power. Remember that when you hear a politician promise to make health case accessible and affordable through the force of government.