Wednesday, December 31, 2008

Gravely ill man goes to NHS emergency room. Not attended to until 6 hours later. Dies

Individuals don't matter in socialized medicine

A hospital trust is facing questions after a man died having waited more than six hours to be seen in an accident and emergency department. Medway NHS Foundation Trust said it was saddened to hear of the death of Stewart Fleming but said that its emergency ward was experiencing long waits because of a high number of admissions.

Mr Fleming, 37, of Rainham, Kent was taken to the Medway Maritime Hospital in Gillingham on December 12 by his wife Sarah. He had a note from his GP requesting immediate admission after a suspected viral infection failed to clear with antibiotics but, the father of two faced a reported six-hour wait before he was assessed again.

By this time his condition had deteriorated. He was eventually admitted and transferred a week later to the Harefield Hospital in West London but died last Saturday. Mrs Fleming said: "Why wait three hours for a triage when a doctor had already done it and put it in writing what was going on?"

A spokeswoman for Medway NHS Foundation Trust said: "The trust is saddened to hear of the death of Stewart Fleming. Due to patient confidentiality we are unable to discuss any details."


Australian private health insurer reports that private hospital surgery includes very complex and costly cases

More than half of the surgery done in Australia is paid for by private health insurance and yet this is still a "drain" on government hospitals? Leftist logic at work again, it seems

High-end surgery in private hospitals, costing health funds $100,000-plus per case, is on the rise, fuelling concerns that it is adding to, not reducing, the strain on public hospitals. Australia's biggest health fund, Medibank Private, which has paid a record $364,859 for a bowel operation, says complex and costly operations, once the preserve of big public hospitals, are being performed increasingly in private hospitals. "Traditionally the high-end surgeries would be borne by the public system. Now we are seeing people electing to use their private health insurance for these types of procedures and enjoying the clear benefits it brings," a Medibank spokesman, Craig Bosworth, said yesterday.

But the drift of advanced cases to private hospitals is disturbing public hospitals because it adding to the difficulties they already face in finding and retaining surgeons and nursing staff. The executive director of the Australian Healthcare and Hospitals Association, Prue Power, said there was "great concern" in public hospitals about the trend to private surgery and the demand it generated for scarce medical staff. Staff shortages in public hospitals made it even more difficult to deal with waiting lists and delays in getting treatment in public hospitals, she said

Ms Power called on the Federal Government to rethink the $3.6 billion health insurance rebate and the level of premium increases for health insurance. The rebate was introduced by the Howard government, which forecast that it, along with other incentives, would boost memberships, keep premiums down and, through increased use of private hospitals, relieve pressure on public hospitals. Private hospitals do more than half the surgery performed in Australia, a plus for those with private hospital insurance, who account for less than 45 per cent of the population.

Health funds, already facing heavy increases in costs, have lodged with the Federal Health Department their applications for what are likely to be significant rises in premiums to take effect from April. Ageing of the population and increasing health-care bills and use of insurance cover by members are driving up costs well ahead of general inflation, the regulator, the Private Health Insurance Administration Council, has stated.

Ms Power said each time premiums rose, so did the cost of the rebate to the taxpayer. The growth in expensive private hospital surgery raised "a basic question of equity". "Funding going to the private sector will just exacerbate the workforce shortages in the public sector." Ms Power said she was not against growth in the private sector but it was a matter of getting the public-private balance right [Who says what is right?] and of getting better integration between the two sectors.

Mr Bosworth said that the rising number of high-cost claims paid by Medibank indicated the private health sector "is increasingly carrying the burden of an ageing population and the complex technologically intensive hospital care older people often require". The overall number of very high-cost claims had leapt in the past year, with Medibank covering 149 claims costing more than $100,000 - a rise of 73 per cent. Among the high-cost operations Medibank paid for in NSW was a neuro-surgery case costing $276,595, neonatal surgery and lengthy post-operative care for a newborn child costing $256,452, and arm nerve surgery on a 24-year-old patient costing $164,134. Mr Bosworth said many of the top claims were for people aged 54 and over, showing that private health insurance was not just for "elective surgery lumps and bumps".


Tuesday, December 30, 2008

The NHS will look after you -- as long as you are not a patient

Public money totalling 1.6 million pounds has been paid out in redundancy settlements to seven senior employees following a merger of NHS trusts in Staffordshire. South Staffordshire Primary Care Trust (PCT), which took over the functions of four previous trusts, has given the money to two chief executives, three directors, a deputy director and a senior manager during the shake-up. Had the money been given to support frontline services, it would be enough to pay the wages of 50 nurses at the average NHS nursing salary of 31,600 including overtime.

Stuart Poyner, chief executive of South Staffordshire PCT, said the payouts, revealed in a Freedom of Information request, were a legal requirement. Other health organisations making big payouts to former employees including NHS West Midlands, the strategic health authority which manages a budget of 7 billion. It spent 2.2 million paying off 97 staff in the two years to August 2008.

Health chiefs are spending 360,000 of public money in an attempt to reduce the high level of sickness and absenteeism among NHS workers in Scotland, where absence rates are 60 per cent higher than in the private sector and are still on the rise. Sick leave in the NHS in Scotland currently costs the taxpayer 222 million a year. However, critics said there was no guarantee that the campaign to combat the problem would produce results, and claimed that managers should be tackling absenteeism in the normal course of their work without incurring extra costs in doing so.

Mark Wallace, of the TaxPayers' Alliance, said: "Spending even more money on the problem is not a solution. If so many staff are taking sick leave, it is a sign that either people are getting away with sickies or they are being mismanaged to the point of illness." Nicola Sturgeon, the Scottish health minister, said the funding of 360,000 from the government at Holyrood would help health boards to meet a target of reducing sickness rates to four per cent by April 2009.

Figures show that in 2007-08 there was a sickness absence rate of 5.28 per cent in the NHS in Scotland - equivalent to 12 days off a year per person - compared to a private sector average of 3.3 per cent, or seven and a half days. Low morale and overwork has been blamed for the problem, which cost the taxpayer 10m more than the previous year. The figures cover all NHS staff, from doctors and nurses to cleaners and porters.


Medi mishaps blowout in the Australian State of Victoria

Crooked official statistics again

Victorian surgeons and theatre assistants mistakenly left 78 objects inside patients last year - seven times more than official records show. Hospital admission records collated for the Herald Sun show 756 objects were accidentally left in patients after surgery since 2000, far more than reported by health authorities or the State Government. The Government's "sentinel events" reports - which rely on hospitals to notify adverse incidents - show 47 instruments or other materials have been left in patients since 2002-03 that required further surgery to remove.

But figures compiled for the Herald Sun by Monash University's injury surveillance unit indicate more than 550 objects were left in patients in the same period. It is unknown how many of the objects required further surgery, but all patients required further hospital care.

Medical Error Action Group spokeswoman Lorraine Long said it was becoming a major problem. "The Government is not aware how common this is because the sentinel event data relies on people reporting it, and the last thing they are going to do is report something that will expose them to litigation," she said. "There seems to be a failure in the counting back of equipment and materials during surgery. "The consequences of leaving materials inside people can be death if it gets infected, but when patients go back to doctors and tell them they don't feel right they are not believed. "It just gets down to personal responsibility because it is not just the person doing the operation, there are another couple of sets of eyes and it gets down to being accountable, concentrating and following procedures of counting swabs and instruments."

Peter Shanahan, 60, is suing Melbourne Private Hospital after a 22cm surgical pack was allegedly left in his bowel for nine months, leading to agonising pain, the loss of a large section of his bowel and a possibly needless hernia operation after he complained of a lump in his lower abdomen. He claims the alleged mishap during routine bowel surgery ruined a year of his life. "Every time I speak to somebody in the medical field about it, they say it can't happen, that it's an impossibility. But I am proof," he said. "I don't know what the answer is, but it just shouldn't happen."

The Government's official sentinel events report listed only 11 instances where doctors reported leaving objects in their patients in 2007-08 - five involving instruments, wires or clips, five of packs or swabs and one case of a dental plate being retained. In 2006-07, the government report detailed eight retained objects, despite hospital records showing the real number was 85 in 2006 and 78 in 2007. But the biggest discrepancy occurred in 2004, when hospital admissions show 157 patients having treatment for objects left in their body. Government records from 2004-05 show just five cases, while the 2003-04 records list only eight.

Department of Human Services spokesman Bram Alexander said the sentinel events reports only dealt with "catastrophic incidents" where discovery was made after surgery was completed and requiring a new operation. He said some unreported instances may have involved items noticed missing before patients left the operating theatre, allowing surgeons to retrieve the items before recording the reason why the operation took longer on their admission records.


Monday, December 29, 2008

Patient safety at risk as NHS repairs ignored

Patients are being put in danger because of a backlog of hundreds of millions of pounds of urgent repairs at hospitals

More than half of hospital trusts have a backlog of repairs which the NHS says need to be urgently completed to ensure patient safety. The NHS defines the work is so pressing that it "must be addressed with urgent priority in order to prevent catastrophic failure, major disruption to clinical services or deficiencies in safety liable to cause serious injury and/or prosecution". Yet despite the urgency of the work, the new figures show that the level of outstanding urgent repairs rose last year, by 11 million to 310 million pounds.

Crumbling buildings and failings in the infrastructure of hospitals have been repeatedly linked to risks to patient safety. Last year, the official investigation into Britain's deadliest outbreak of the infection Clostridium Difficile, which killed more than 90 patients at Maidstone and Tunbridge Wells hospitals cited its high maintenance backlog as a contributing factor in the spread of the disease.

The figures obtained by the Conservatives reveal that more than 120 of England's 210 hospital trusts admitted to a backlog of urgent repairs in the financial year which ended in April 2008. Imperial College Healthcare trust, which runs Hammersmith and St Marys Hospitals, had an urgent repair backlog of 27 million pounds, a figure which was almost matched by the bill at Guys and St Thomas foundation trust. Hospitals in North West London, Worthing and Southlands and Nottingham also reported an urgent backlog of more than 10 million.

Eight years ago, the Government pledged to reduce the total NHS maintenance bill, which then stood at 3.1 billion, by one quarter. The new figures show in fact the total bill has soared to more than 4 billion, including a 29 per cent increase in the last two years. The only category of repairs where the bill fell during 2007/2008 was among those defined as carrying the lowest risk to patients and services.

Shadow health secretary Andrew Lansley described the findings as "very disturbing". He said: "Over the last eight years the Government has done nothing to address this problem and things are going from bad to worse. The Government has no excuse for needlessly putting patients and NHS staff at risk like this." Mr Lansley said the Government could not pretend it was unaware of the issue, since hospitals reported their figures to the Department of Health each year.

A spokesperson for the Department of Health said hospital trusts were responsible for prioritising their investment decisions, and said the Government had invested 12bn in NHS buildings since 2000.


Sunday, December 28, 2008

NHS lost patient details 135 times in two years

The NHS has lost the confidential medical records and personal details of thousands of patients in a “catalogue of errors” uncovered by an investigation into how the health service handles data. A “fundamental re-examination” of how the NHS deals with personal data was demanded last night after research showed that a series of losses and thefts had potentially exposed the private details of 10,000 patients around the country. A total of 135 cases were reported, including the loss or theft of diaries, briefcases, CDs, laptops, memory sticks and, in one case, a vehicle containing patient records.

A back-up tape of an entire system was stolen from a general practice in the East of England this year. In another case, a laptop containing the records of 5,123 patients was stolen from the outpatients’ department of a hospital in the West Midlands.

The revelations will cast renewed doubt over the Government’s ability to handle personal data after a series of high-profile losses by Revenue & Customs and the ministries of Justice and Defence in the past year, and will raise further questions about the scheme to create a computerised national patient database to allow easier communication between GPs and hospitals. The Liberal Democrats, who carried out the series of Freedom of Information requests, called for the Government to scrap its plans for a national computerised database. Norman Lamb, the party’s health spokesman, has also written to Alan Johnson, the Health Secretary, with four other recommendations, including prohibiting the use of mobile devices to store patient records and publishing a set of minimum data protection standards.

Mr Lamb said: “These reports show utterly shocking lapses in security. Patients have a right to expect their personal information to be treated with the utmost care. “The degree of negligence in some cases is breathtaking, given the absolute sensitivity of patient data. There must be a fundamental re-examination of how the NHS deals with personal data. The NHS should regard lapses of standards of care as potential serious misconduct.”

The details, obtained through requests made to strategic health authorities, revealed incidents of data loss dating back as far as 2006. In some cases, private patient notes were found in public places or deserted buildings, or had been dumped in bins and skips. One loss of records was so serious that police and an NHS manager became involved. The incident occurred in January, when a district nurse took home activity sheets with patients’ names and addresses, which were stolen during a burglary.


Australia: Victoria's public hospitals 'fudging' figures

A Melbourne doctor has blown the whistle on data fraud in Victorian hospitals, claiming staff routinely fudge patient figures to meet Government benchmarks for bonus payments. Andrew Buck, a senior emergency registrar with a decade's experience in the state health system, made the allegations in a submission to a Victorian parliamentary inquiry into hospital performance data earlier this month. Dr Buck said senior doctors and nurses were "shifting numbers" to make it look like hospitals were meeting targets for funding and put pressure on junior staff to follow suit. "I am regularly ordered to 'admit the patient to short stay (unit) so they don't blow their time'. This is against DHS (Department of Human Services) policy yet is routine practice in my day-to-day work, and I do it under direct orders from senior medical and nursing staff," he says in the submission.

The revelation comes after a survey of 19 Victorian emergency department directors by the Australasian College for Emergency Medicine found nearly 40 per cent of them were "admitting" patients to "short stay" and other units on computer systems when they were languishing in emergency waiting rooms or on trolleys. The doctors, who remained anonymous for fear of repercussions, said the "virtual wards" were used purely for "creative accounting" to receive funding and avoid "performance watch".

Public hospitals get bonuses for reaching State Government benchmarks, including one which requires that 80 per cent of patients be admitted within eight hours of arrival. Studies have shown that patient care is compromised by spending long periods of time in emergency departments.

When The Age published details of the survey in May, Health Minister Daniel Andrews said he would look into the doctors' claims, but then refused to launch an investigation. He said there was no evidence to suggest the alleged practices were happening. In September, the DHS warned hospitals to submit accurate data. As well, earlier this month the Auditor-General's office confirmed an investigation into the allegations.

Dr Buck said in his submission that Government benchmarks had created "perverse incentives" that put unnecessary pressure on overworked doctors in emergency departments. He expressed anger at Mr Andrews' refusal to act on the Australasian College for Emergency Medicine survey and said a "culture of fear" prevented doctors from talking about the real state of the health system. "If he won't accept hard data and admissions of guilt by emergency department directors, what hope have we got and why should I give a stuff about making the numbers look good?" he says.

Dr Buck's submission could affect the new health-care agreements between the Commonwealth and state and territory governments after federal Health Minister Nicola Roxon said in August that any evidence of fudged patient data would be of serious concern. A spokesman for Mr Andrews said this week he did not know if the minister had seen Dr Buck's submission but "anyone with an issue should raise it through the proper channels and it will be dealt with". Opposition health spokeswoman Helen Shardey said Dr Buck's submission was a "cry for help" that could not be ignored.


Saturday, December 27, 2008

NHS hospital apologises after baby was born on floor

A pregnant woman was left unattended for hours and had to give birth on a hospital floor despite her desperate appeals for a bed. Health board officials have apologised to Lynne Neilson, 36, whose baby started to arrive as she stood, still clothed, in a cold assessment room after hours of waiting to be admitted to the labour ward. As the head appeared, a midwife ran in just in time to put a paper mat on the floor and catch the baby, who had the umbilical cord around her neck.

Mrs Neilson and her husband, Gavin, made an official complaint to the hospital and to Nicola Sturgeon, the Health Minister, after the incident at Edinburgh Royal Infirmary. NHS Lothian announced on Christmas Eve that it had begun an investigation and had apologised.

The couple had arrived at the Simpson Memorial Maternity Pavilion early on December 5, but went home when the labour slowed. They returned at 7pm and were told to sit in the waiting room. Contractions quickened and Mr Neilson asked repeatedly for help until his wife, in pain and barely able to walk, was finally moved to an assessment room and examined by a midwife. Mrs Neilson said: “She said she’d come back in 20 minutes and that’s when it all really went wrong, because she didn’t come back. She was seeing other patients.”

Two and a half hours after they had arrived, their baby, Orla, was born. Mrs Neilson said: “The room we were in was cold. There was a narrow trolley – not a bed – which I couldn’t get up on to. I was shouting out – it was so undignified, because everybody in the waiting room would have been able to hear us. I felt a huge pressure and at that point I knew that the baby was going to be born.” A midwife arrived just in time to find Orla’s head emerging. Mrs Neilson said: “She took control and put down a disposable mat on the floor. She caught the baby – I was standing up and she was born on to the floor. I was very relieved that the midwife had come, because we were panicking.”

After the birth, Mrs Neilson was helped on to the trolley, but the family waited another hour before being transferred upstairs to a labour ward. They said they were told that the room they were placed in had been vacant throughout Mrs Neilson’s labour.

The couple have three older children, who were born in Glasgow, Hong Kong and at Edinburgh Royal, but said that this was the worst experience they have had in a maternity unit. David Farquharson, clinical director of women’s services in NHS Lothian, said: “This is not the experience we would want any mother or family to have.”


Friday, December 26, 2008

Bad Economics & Medicine

ITEM: In an article entitled "5 Myths About Our Ailing Health-Care System" in the Washington Post for November 23, 2008, Shannon Brownlee and Ezekiel Emanuel write that the United States lags behind "many developed countries on virtually every health statistic you can name. Life expectancy at birth? We rank near the bottom of countries in the Organization for Economic Cooperation and Development, just ahead of Cuba and way behind Japan, France, Italy, Sweden and Canada, countries whose governments (gasp!) pay for the lion's share of health care."

ITEM: Writing in the New York Times for December 4, MIT Professor Jonathan Gruber claims that "health care reform is good for our economy. As the country slips into what is possibly the worst downturn since the Depression, nearly all experts agree that Washington should stimulate demand with new spending. And one of the most effective ways to spend would be to give states money to enroll more people in Medicaid and the State Children's Health Insurance Plan. This would free up state money for rebuilding roads and bridges and other public works projects - spending that could create jobs." "Health care reform can be an engine of job growth in other ways, too. Most proposals call for investments in health information technology, including the computerization of patient medical records.... More immediately, it would create jobs in the technology sector."

CORRECTION: Many so-called experts may say a nation can spend itself rich, but that doesn't make it so, whether the expenditures are made in the healthcare field or in building pyramids. As with most public-spending schemes, the jobs "created" are visible; the ones lost and economic damage done are not so obvious. Government programs are funded in several ways, including taxing individuals and businesses, giving them less to spend on their own choices; borrowing money, thus increasing deficit spending and the National Debt; and running off more printing-press money, which worsens inflation and drives down the value of the currency. Professor Gruber, quoted above, is one of the "experts" who is pushing this insidious notion. The New York Times somehow forgot to tell readers that he was an economic adviser to Sen. Hillary Clinton and supported her "universal coverage" designs. His piece was called "Medicine for the Job Market," no doubt because "Selling Snake Oil to the Masses" would have been a bit longer and had the benefit of accuracy.

In the meantime, former South Dakota Senator Tom Daschle, President-elect Obama's point man on healthcare, has said the new administration's priorities in this will be "expanding insurance coverage, as well as reducing costs and improving quality." Walking on water will apparently take a bit longer. The various plans that have been advanced by the Democrats, including strategies by Obama, Daschle, and Montana Senator Max Baucus, all involve the creation of a new public entity, variously called a national board, council, or institute, that will make the decisions that otherwise might be made by doctors and those of us on the plantation who might prefer not to have such choices made by bureaucrats.

Daschle, for instance, would establish a National Health Board that would be modeled on the Federal Reserve Board. The politically appointed experts on this board would be, the senator has said, "insulated from politics." It is beyond na‹ve to expect that hundreds of billions in public expenditures are going to be spent without political considerations.

Yet, the idea that government funding can occur without government controls is still trotted out as a selling point, though it does not fit with experience or common sense. Indeed, it would be irresponsible for the government to spend such monies without oversight.

And claims that the United States needs government to fix a flawed private healthcare system ignore government's influence on the healthcare system. Socialized medicine is not just a potential route for the medical-care field in the United States: we are presently quite a way down that dangerous path. The federal government already subsidizes healthcare to a fare-thee-well. Chris Brown, a lecturer at the Australian Graduate School of Entrepreneurship at Swinburne University, has pointed out in an article for the Ludwig von Mises Institute that "government accounted for over 45% of all U.S. healthcare expenditures in 2006; it spends almost 20% of GDP on healthcare; indeed, it spends more per capita than any other" nation in the Organization for Economic Cooperation and Development (OECD), which includes "those with socialist, government-funded healthcare. In short, this is not a free market."

The infant-mortality figures cited in the Washington Post piece above are often trotted out to prove how the "free" market doesn't work as well as those economies where healthcare is socialized. The statistics are very misleading, which is no accident. Writing in National Review in 2007, Ramesh Ponnuru clarified such claims: "The advocates of national health insurance argue that America spends more than any other country on health care and that we still have a higher infant-mortality rate and a lower life expectancy than other developed nations. Both factual points are correct. But the infant-mortality rates are misleading. In this country, a premature delivery followed by death would be counted toward the infant-mortality rate; not so in some other countries. And whatever we think of our health-care system, it is not to blame for the fact that America has a lot of car wrecks and homicides. When health economists Robert Ohsfeldt and John Schneider adjusted for these factors, the U.S. had the highest life expectancy of any developed country."

David Gratzer, a Canadian-born doctor who used to believe in socialized medicine, saw its many weaknesses firsthand and has exposed them. As he noted in City Journal in its Summer 2007 issue, the United States may lag behind other countries in some "crude health outcomes." However, as Gratzer explains,

Such outcomes reflect a mosaic of factors, such as diet, lifestyle, drug use, and cultural values. It pains me as a doctor to say this, but health care is just one factor in health....

And if we measure a health-care system by how well it serves its sick citizens, American medicine excels. Five-year cancer survival rates bear this out. For leukemia, the American survival rate is almost 50 percent; the European rate is just 35 percent. Esophageal carcinoma: 12 percent in the United States, 6 percent in Europe. The survival rate for prostate cancer is 81.2 percent here, yet 61.7 percent in France and down to 44.3 percent in England - a striking variation.

Many healthcare problems here result because of government meddling, not because government hasn't intruded enough. Chris Brown lists just "a few of myriad government and other regulatory programs that keep prices high and stifle innovation: the Center for Disease Control and Prevention, the Food and Drug Administration, the American Medical Association, the United States Department of Health and Human Services, etc. One reason healthcare costs are so high is because the industry is subsidized; and one reason government intervention only grows is because you can expect more of anything that is subsidized. Doctors and physicians raise their prices on those paying privately to cover those who do not pay, i.e., those the government pays for through theft, a.k.a. taxes."

The nation's economy is in dire straits from too much spending and too much regulation. Yet that has not stopped those with ultimate chutzpah from asserting that the way to get out of a hole is to dig ourselves in deeper. One difficulty is that when healthcare spending becomes overwhelming, cost containment is going to be accomplished through rationing (although euphemisms will be used to disguise that). Current health "entitlements" are about 4 percent of Gross Domestic Product, and headed to 15 percent by 2062, according to government projections. That is unsustainable.

Medicare is already the third-largest government program in the budget, behind only Social Security and military spending. The Medicare Trustees' Annual Report released in 2008 projects Medicare's excess costs to be $85.6 trillion, a staggering figure equivalent to about six times the entire U.S. economy in 2007.

The trend is already bad, and nationalizing healthcare even more will only make matters worse. On November 20, the Wall Street Journal examined the emerging Obama health plan, pointing out:

Over the past 40 years, per capita health spending has grown an average of 2.1 percentage points faster than the economy. The dominant U.S. insurer - Medicare - has had no success in mitigating this climb, despite valiant attempts. Since the 1980s, Medicare has actually controlled the prices that physicians and hospitals are paid for thousands of billable services. In 2007, the program spent some $425 billion according to these arbitrary guesses. Because of its huge purchasing power, and because many private plans adopt its reimbursement rates, Medicare significantly shapes all health-care financing and delivery.

Now the Democrats want to double down with the public option, apparently on the theory that the bureaucracies fail only when they're too small. Even without the new program, Medicare and Medicaid costs are rising substantially both as a share of the economy and the federal budget.

And what about all those figures that seem to indicate that the U.S. system is worse than elsewhere? As we have noted, there's a good bit of chicanery about such assertions, whether they emanate from the World Heath Organization (WHO) or the OECD - particularly since those statistics are gathered in an attempt to justify even more government involvement.

Grace-Marie Turner, president of the Galen Institute, has written in the San Diego Union-Tribune that such rankings "are highly influential among policy-makers and help drive health reforms around the world. But common sense suggests that when the rankings show the United States has a health care system worse than Morocco's or Costa Rica's, it's clear that the rankings are a poor reflection of reality. An objective assessment would have listed America at - or certainly near - the top."

The criteria used by WHO and other international bodies are self-serving. As Turner observed: "Countries with tax-funded, socialized health care tend to be ranked higher simply because citizens are treated equally - even when the quality of care is extremely poor. Meanwhile, countries in which citizens have unequal access to medical care tend to be ranked lower, even when the overall quality of care is superior. By the WHO's logic, treating people equally matters more than treating people well. So theoretically, a country with a negligent health care system could improve its rankings just by neglecting everybody more equally."

Who is above the United States in such rankings? Well, the U.K., for one, scores better. This is the same nation where the government cancels up to 100,000 operations annually, in large part because there is a shortage of doctors, nurses, and facilities. That is our bleak future if we try to level the playing field by driving everyone into the ground.


Thursday, December 25, 2008

One in 20 British midwife positions unfilled

One in 20 midwife positions in NHS hospitals are unfilled despite a Government promise to would recruit 1,000 more midwives

Figures show that 583 midwife posts in NHS hospitals are vacant and 276 maternity support worker jobs are unfilled. Barking, Havering and Redbridge Hospitals NHS Trust has the higest vacancy rate, 39 per cent. If its 76 full time midwife positions, 29 posts need to be filled. One in five maternity units (22 per cent) across the country have cut midwife numbers in the past year and some have reported that their maternity unit has been cut in half. Heart of England NHS Foundation Trust has 101 full time midwives last year but this year has 47 which is a 54 per cent drop. The figures were obtained using the Freedom of Information Act by the Conservatives.

This week, Professor Cathy Warwick, general secretary of the Royal College of Midwives, said tens of millions of pounds that were meant to increase the number of midwives have not been received by hospitals. "On the very busy labour wards that are struggling to cope with the rising birth rate, midwives are having to look after sometimes two or three women in labour and that's when the woman ends up being left alone. That's not only unacceptable, that's not safe," she said.

The failure to pass on the money, part of a drive to improve maternity services, means the NHS will not be able to honour promises by ministers to give women a single dedicated midwife during pregnancy and labour. Alan Johnson, the health secretary, in February pledged 330m pounds of extra funding over the next three years to implement the Maternity Matters strategy whose guarantees include giving women the choice of whether to give birth at home instead of at hospital. He also promised that he would recruit 1,000 more midwives to the NHS by 2009.

Health Minister Ann Keen said: "Claims that midwife numbers are falling are complete and utter nonsense. "Validated figures from the latest NHS workforce census show the number of midwives has surpassed 25,000 for the first time and we know there is continuing growth towards recruiting an additional 1,000 midwives by September 2009, rising to 4,000 in 2012. There has also been a 25 % increase in the number of students entering midwifery training since 1997."


Wednesday, December 24, 2008

Budget Office Sees Hurdles in Financing Health Plans

The Congressional Budget Office said Thursday that many of the health care proposals championed by President-elect Barack Obama and other Democrats would carry a high price tag and would generate only modest savings. The budget office, an influential voice in the work of Congress, analyzed 115 options, including proposals to expand coverage and slow the growth of health spending. Some of the options, including proposals to increase taxes on cigarettes and nondiet soft drinks, are sure to meet stiff political opposition.

One bright spot in a generally bleak picture was the estimate of potential savings from a requirement for doctors and hospitals to use health information technology, including electronic medical records, as a condition of participating in Medicare. Such a requirement could save the federal government $7 billion in the first five years and a total of $34 billion over 10 years, by reducing medical errors and avoiding unnecessary tests and procedures, the budget office said. It “would also lower health insurance premiums in the private sector,” the report said.

Without action by Congress, the report said, health costs will continue to soar, the number of people without insurance will rise by nearly one million a year, to a total of 54 million in 2019, and spending on health care will increase to 25 percent of the gross domestic product in 2025, up from 16 percent in 2007. In keeping with its duty to provide objective, impartial analysis, the budget office did not endorse any options, but it fleshed out many ideas circulating on Capitol Hill.

Democrats and many Republicans say they will make a serious effort to overhaul the health care system in 2009. Those changes are essential for economic recovery, they say. But Mr. Obama and other Democrats have not been precise about the cost of their proposals, nor have they said in detail how they would pay for them. One of the Democrats’ favorite proposals, rolling back tax cuts for high-income people, is already scheduled to occur in 2011, so, under the bookkeeping rules used by Congress, it would not produce a windfall of new revenue.

Lawmakers from both parties said they would pay close attention to the cost of new federal subsidies for health coverage because these subsidies — unlike the one-time bailouts for banks and other financial institutions — would be recurring federal obligations for years to come. Requiring employers to provide health insurance to their employees or pay a fee to the federal government would bring in $47 billion of new federal revenue in the next 10 years, the report said. A proposal to establish a national insurance pool for people who cannot obtain coverage on their own in the individual market would cost $16 billion in the next decade, it said.

Mr. Obama and many other Democrats want the government to negotiate with drug manufacturers to get lower prices for Medicare beneficiaries. The Congressional Budget Office said such negotiations “would produce small if any savings” because the government would not have enough leverage to secure significant discounts beyond those already obtained by private insurance companies that manage the Medicare drug benefit.

But the budget office said Medicare could save $110 billion in the next 10 years if Congress simply imposed a form of price controls, requiring drug makers to provide the government with a 15 percent rebate, or discount, on brand-name drugs covered by the new Part D of Medicare.

Eliminating a notorious gap in Medicare coverage of prescription drugs, known as a doughnut hole, would cost more than $130 billion over 10 years, the report said.

Research to compare the effectiveness of different drugs and treatments might help doctors and patients make better decisions. But it would not save the government much — $1.3 billion in the next decade — and it would reduce total spending on health care in those years by less than one-tenth of 1 percent, the budget office said.

The federal government could save $12 billion in the next decade if it established a procedure for approval of generic versions of expensive biotechnology drugs, the report said. It did not estimate the additional savings for consumers and employers, which could be substantial.

The report sets forth an elaborate proposal that would allow doctors and hospitals to share in the savings if they improve the quality and reduce the cost of care for people on Medicare. Under the proposal, Medicare would pay bonuses to groups of doctors who met certain performance measures. In response to such financial incentives, the report said, doctors would become more efficient and would reduce “the volume and intensity of services provided to their patients,” saving $5 billion for Medicare in the next decade.

In one particularly sobering chapter, the report notes that, under existing law, Medicare will cut fees paid to doctors by 21 percent in 2010 and by about 5 percent in each of the next few years. To avoid such cuts and freeze payment rates at their 2009 levels would cost the government $318 billion over the next decade, the report said.


New Zealand doctors flown in to fill Australian hospital staff shortages

Where is all that wonderful socialist "planning"? Last minute patch-ups is more like it.

FLY-IN, fly-out doctors from New Zealand and interstate are filling staff shortages in [Left-run] Queensland's public hospital system, paid at a premium. At least nine of the state's public hospitals have employed NZ doctors on a fly-in, fly-out basis in the past year, mostly to fill vacancies in obstetrics and gynaecology, emergency medicine and anaesthetics. Australian Medical Association Queensland president-elect Mason Stevenson said the doctors were paid premiums of up to 50 per cent more than permanent specialists of similar experience. "This actually creates a certain discontent amongst doctors working very hard in the public hospital system when they do work side by side with the fly-in, fly-out locum doctors from overseas who are being paid substantially in excess for doing exactly the same work," he said. But he said fly-in, fly-out specialists were a necessary "Band-Aid solution" to stop Queensland public hospital waiting lists becoming intolerable.

Bundaberg Hospital has had four fly-in, fly-out doctors from NZ acting as its emergency medicine director in the past year, each working for 10 days a month. However, a permanent director will take up the position in February. The hospital has also employed a NZ anaesthetist on four occasions, for about a week at a time, in the past 12 months.

Queensland Health deputy director-general of policy, planning and resourcing, Andrew Wilson, said fly-in, fly-out doctors were only employed as temporary locums to fill staffing shortages. All were suitably registered to work in Australia. "They are employed to fill critical vacancies on a temporary basis while recruitment efforts are under way," Dr Wilson said. "Queensland Health does not have any services or facilities staffed on an ongoing fly-in, fly-out basis." Besides Bundaberg, affected hospitals include Caboolture, Redcliffe, Toowoomba, Rockhampton, Clermont, Mackay, Nambour and Caloundra.

Sylvia Andrew-Starkey, of the Australasian College for Emergency Medicine, said Queensland Health also employed interstate doctors on a fly-in, fly-out basis to fill senior emergency department positions throughout the state. "I know that Hervey Bay, Bundaberg and Rockhampton are relying on interstate people," she said. Dr Stevenson said the practice was expected to continue for another five to 10 years until recent medical graduates were able to fill specialist shortages. Queensland Health Minister Stephen Robertson could not be contacted yesterday for comment.


Tuesday, December 23, 2008

Healthy pay: NHS doctor gets $500,000

A hospital doctor is earning more than 290,000 pounds from his National Health Service salary and a series of bonuses, including a 40,000 supplement to be on call. Figures obtained by The Sunday Times under the Freedom of Information Act suggest hundreds of NHS consultants earned more than 190,000 in the financial year ending in March – more than Gordon Brown – putting them in the top 1% of earners. By contrast with highly paid workers in the private sector, who now face widespread unemployment, they also enjoy full job security.

Previously NHS consultants turned to private work for extra income. The figures show they can now more than double their basic salaries by sticking with the health service, thanks to bonuses inflated by incentives to meet government targets to cut waiting lists.

The generosity of the NHS towards its senior staff may anger patients who have recently been deprived of modern cancer or osteoporosis treatments because they have been deemed too expensive. The consultant who earned more than 290,000 in the last financial year is a breast surgeon at University Hospitals of Morecambe Bay NHS Trust in Lancashire and Cumbria. On top of his 120,000 basic salary he is paid an annual bonus of 90,000 as a “merit award” or “clinical excellence award”. These extras, given for exceptional contributions, are paid to thousands of consultants every year. The surgeon was also paid 40,000 for overtime shifts and a 40,000 supplement for being on call.

A doctor at the Royal Devon & Exeter NHS Foundation Trust earned about 130,000 in extra payments, including 50,000-55,000 to run a regional service and 35,000-40,000 to bring down waiting lists.

Another consultant, working for Worcestershire Acute Hospitals NHS Trust, was paid a supplement of 77,000 in the last financial year for carrying out extra shifts to meet a target of giving all patients treatment within 18 weeks.

Katherine Murphy, director of the Patients Association, said: “It is unethical for the medical profession to line their pockets in this way knowing that NHS trusts are being forced to cut services. Patients are being left in pain. “Doctors are always complaining about how underpaid they are. The reverse is the case. They are being given bonuses for what should be part of their day jobs.”

A spokesman for the Morecambe Bay NHS trust said: “The consultant is highly productive and provides a high quality of care. The trust is fortunate to have his skills, knowledge and experience.”

Last month The Sunday Times reported that an NHS nurse had broken the 100,000 barrier for the first time. The nurse consultant in Rotherham, South Yorkshire, doubled her basic salary of 50,000 by working overtime to bring down waiting lists.

The health department has already been accused of awarding unduly generous new contracts to NHS employees without achieving better treatments for patients. A report by the public accounts committee found that a contract for consultants boosted their pay by 27% without any measurable improvement in productivity.


Stressed Australian nurses quit public hospitals for prostitution

Exhausted and demoralised nurses would rather work as prostitutes than in Queensland's crumbling hospitals, says one former registered nurse. The mother of two with 10 years' experience as a registered nurse, who wanted to be known only as Jenna, has told how she and at least four of her colleagues have found new jobs working in brothels. "We could no longer work in such an understaffed and stressful environment," she said. "I was overworked, poorly paid and a mistake could have led to charges if I caused a death. "I came to the conclusion the nursing shortage wasn't my problem but it was my responsibility to protect myself from burning out or making a fatal mistake."

Queensland Nurses Union assistant secretary Beth Mohle said the union was aware nurses were leaving the system due to workloads and burnout, and were experiencing record levels of frustration. "A survey of nurses' attitudes undertaken last year found most nurses love nursing but hate their jobs," she said. "There's a tension there that nurses feel they can't deliver the quality of nursing they want to." She said based on population growth projections, Queensland would need an additional 16,000 nurses in the private, public and aged-care sectors by 2014. "Queensland is already behind the rest of Australia in terms of registered nurse numbers and is over-represented in the unlicensed assistant-in-nursing category," Ms Mohle said. "Of the 16,100 nursing assistants in Australia in 2006, Queensland had a massive 7300, or nearly 50 per cent. This points to a serious skill mix problem, as well as a numerical problem, within the Queensland nursing workforce." The QNU survey also found 45 per cent of nurses had experienced workplace violence, which is more prevalent in the public and aged-care sectors than in the private sector.

Jenna said violence was more of a concern in hospitals than in the sex industry. "The security (at the brothel) is wonderful. We have buzzers in our room, there are bracelets we can request if you have a client you're a bit suspicious of." Jenna said she had gone to great lengths to hide her new occupation from her family. "I wear my nurse's uniform to work, I carry my hospital ID. But when I get to work I change. There's a couple of others who do the same," she said.

Health Minister Stephen Robertson said it was disappointing some nurses were seeking alternative careers. "Queensland nurses are now among the highest paid in Australia, having benefited from a 26 per cent wage increase since 2006," he said. "This is one of the factors which has helped us to recruit an extra 5834 nurses since June 2005."

Jenna highlighted the "tiny tea-rooms" for nurses and the lack of recognition they received. "After the Bali bomb blasts, the burns unit of the Royal Brisbane and Women's Hospital treated many additional patients. At the end, the doctor was given an award. The nurses got nothing," she said. She also revealed how doctors at the RBWH referred to nurses as "Libra fleurs" - because they believed the floral tops of their uniforms resembled tampon boxes.

But Mr Robertson said the Government had created a "safe and supporting working environment for nurses". "We'll continue to work ... to ensure we have a strong nursing workforce, equipped to give Queenslanders the first-class health care they expect and deserve," he said.


Monday, December 22, 2008

NHS bosses to limit doctors’ hours -- by hiring more bureaucrats!

This must be a high-point of socialist stupidity. They are hiring more bureaucrats in order to reduce the hours that doctors work. As if the person making up the rosters at the moment cannot simply make them up differently! It is more doctors, not more bureaucrats that are needed. So how about spending the money instead on hiring more doctors?

The NHS is appointing a new layer of managers to ensure that doctors do not work too hard. Hospitals say the bureaucrats are needed to ensure compliance with European legislation which says that, from August next year, no doctors will be allowed to work more than 48 hours a week. At the moment, junior doctors can work up to 56 hours.

Scarborough and North East Yorkshire Trust appointed a “working time directive project manager” in 2006-7. Mid Essex Hospital Services NHS Trust is advertising for one at a salary of up to 44,527 pounds. A spokeswoman said the purpose was to “redesign roles and rotas in preparation for compliance next year”.

Last week the European parliament voted to end Britain’s opt-out. Unless a compromise is reached in the European Union’s council of ministers, this will mean doctors cannot work longer hours even if they want to. The Royal College of Surgeons has issued a warning that the NHS will not be able to cope when hours are cut next year.


Australia: Claims of public hospital cover-up after fall from surgery table

The NSW Health Minister has ordered an investigation into claims of a cover-up at a Sydney hospital, where a woman had part of her intestine removed without her knowledge. Rachel Hale arrived at Campbelltown Hospital on December 12 expecting routine surgery to have her appendix removed. When she woke up, she was told part of her bowel had also been removed, because "a lump" was detected. But hospital insiders allege Mrs Hale's bowel was ruptured because she fell from the operating table while under general anaesthetic just prior to the operation. They allege the fall also caused a minor head injury. The insiders claim there were no staff in the operating theatre when she fell. They allege Mrs Hale was told "a pack of lies" by hospital officials to conceal the truth.

It is alleged that once she was anaesthetised, a doctor and nurse left her unattended to work on another patient elsewhere in the hospital. When staff re-entered the room, it is alleged they found Mrs Hale hanging head first because her feet had been strapped to the table. When she hit the floor, a trocar - a hollow sharp cylinder used to introduce cannulas into blood vessels - that was inserted in her side had sliced through her bowel. A source said: "It could so easily have killed her. "They had to open her belly up, remove the section of perforated bowel then stitch her back up and rush her to intensive care." Mrs Hale spent five days in hospital.

The Sun-Herald was told an internal critical incident report was compiled hours after the surgery, which stated Mrs Hale's injuries were sustained because she was left "unattended." On December 19, the same day The Sun-Herald began making inquiries, NSW Health Minister John Della Bosca was briefed that no such report existed. The hospital then told the minister, that same day, the report had just been compiled - a week after the incident.

Mrs Hale said she was seeking legal advice. "This is absolutely not what they told me," she said. "I was there because my appendix needed removing immediately. When I woke up, they said there had been 'complications'. They said part of my bowel had been removed because they discovered a small lump. They added it had been sent to a pathologist and it came back fine. I had a bump on my head. They said I hit that on a control panel." Mrs Hale said she wanted the truth. "I need to know what the lasting implications are and how this is likely to affect the rest of my life."

Hospital insiders said they chose to speak out because Campbelltown Hospital was providing the same "sub-standard care" that in 2003 had sparked the state's largest inquiry into patient care and safety standards. "It's become routine practice to leave anaesthetised patients unattended and to cover up negligence using any means necessary," the source said. Royal Australasian College of Surgeons executive director Dr John Quinn said: "I find the episode you are recounting almost non-tenable. Patients in a hospital operating theatre, who are given a general anaesthetic, are not left unattended. It just shouldn't occur."

Australian medical experts meanwhile have cast doubt on the hospital's version of events. Cancer Institute NSW head Jim Bishop said for a complex operation involving the removal of bowel cancer, it would be "very unusual" not to gain the patient's consent first. Professor Bishop said it was common practice for doctors to first perform scans, biopsies and follow-up tests to see whether the cancer had spread and if so, how far. Director of Research at the Sydney Cancer Centre, Bruce Armstrong said: "Best practice would generally be to seek formal consent, from the patient . to inform them of what was found and to conduct further investigations."

Medical Error Action Group spokeswoman Lorraine Long said: "Doctors and nurses are swamping our hotline with stories of negligence that make you want to cry." Mr Della Bosca said the incident was being fully investigated. "If the family has concerns, we would urge them to contact the Health Care Complaints Commission. Alternatively, they can contact my office." Opposition health spokeswoman Jillian Skinner said: "This is one of the worse examples of patient care. To claim an internal report wasn't compiled until a week later is suspicious, to say the least."


Sunday, December 21, 2008

The Growing War Between Modern Medicine and the Public

The article below is a bit on the paranoid side but has some good points nonetheless

Everybody is talking about health-care reform, but true reform is clearly out of the question. Like the banks and the automobile manufacturers, the health-care system should be allowed to collapse without a government bailout. But the federal government has been bailing out the failed health-care industry all along.

Tom Daschle, the newly appointed health policy adviser to President-elect Barack Obama, and soon to be Health and Human Services secretary, says the U.S. health-care system is in need of a major overhaul, and most agree, but it appears the government will continue to expand insurance coverage for a broken health-care system, paying for more unproven and even disproven treatments.

Moreover, government intends to expand health insurance coverage for millions of Americans, which will surely increase demand for services at a time when there is a shortage of primary care doctors.

Won't expanded coverage ($2500 per uninsured American) prompt many families to drop their existing insurance plans and attempt to qualify for the new government plan, thus causing the whole program to implode with burgeoning costs? Furthermore, the federal government estimates about 40 million Americans are uninsured, but this figure is likely to grow by millions in the current economic downturn. How does government intend to rein in health-care costs and at the same time increase utilization?

Job creation is now paramount in the incoming Administration. Long term, planners are counting on the Baby Boomers getting older and sicker, thus creating new jobs in the health-care arena. Americans had better get sick on time, and develop chronic diseases that require more and more health care, so more Americans can be employed as nurses, nurse's aides, home health aides, etc.

How does a nation significantly reduce health-care costs and yet plan on increased employment in the health-care industry? This is the moral crux for American medicine. Should Americans become healthier and need less health care, there will be fewer jobs. Maybe this is why modern medicine drags its feet when it comes to preventive medicine.

According to the Bureau of Labor Statistics, among all occupations in the economy, health-care occupations are expected to make up 7 of the 20 fastest growing occupations, the largest proportion of any occupational group. These health-care occupations, in addition to exhibiting high growth rates, will add nearly 750,000 new jobs between 2006 and 2016, according to government projections. More than 3 out of every 10 new jobs created in the U.S. economy are predicted to be in either the health-care and social assistance or public and private educational services sectors. What if these jobs never materialize?

The federal government will soon be unable to meet its obligations to provide health care for retirees. The Medicare program will default on $62 trillion of care it promised to deliver to aging Baby Boomers, beginning in 2012. The only foreseeable way out of this problem is to reduce demand for care by prolonging the health span (years of healthy, unimpaired, unmedicated life) before age-related diseases set in. A delay of 7 years before the onset of age-related disease would save the Medicare program from bankruptcy.

The increased life expectancy of Americans has largely been achieved over the past century by reductions in childhood mortality. Now the focus is on reduction of mortality rates among senior Americans, adding more healthy years to the end of life.

The prospect for an anti-aging pill that can slow aging is not a pipe dream. A few years ago the Rand Corporation think-tank, addressing future technologies that may impact Medicare, added an "anti-aging" pill to the future Medicare budget. Health planners know such a technology may soon become a reality. These pills could stave off the onset of disease, even quell infections without conventional antibiotics, and may actually prevent many diseases rather than a pill for every different disease. Such a pill may not emanate from a pharmaceutical laboratory. It may come from nature.

A growing body of scientific evidence which shows that dietary supplementation with vitamin D, fish oil, and molecules found in red wine (resveratrol, quercetin, ferulic acid, etc.) and bran (whole grains), may reduce the need for medical care altogether. Dr. Bruce Ames of the University of California at Berkeley suggests the higher prevalence of disease among the poor emanates from undernutrition, a problem that could be remedied with an inexpensive multivitamin.

There is concern that with a poor economy and growing unemployment, more Americans will choose cheap, less nutrient-dense foods, which may increase the incidence of disease. This would increase the need for food fortification and dietary supplementation.

Europeans visiting America are shocked to see so many overweight Americans. Never do Americans realize, unlike other nations, they are being intentionally bred to overeat. The medical profession does little to stop this, treating all dietary-related diseases as if they are drug deficiencies. Processed foods are adulterated with taste stimulants and other ingredients that create more hunger by raising insulin resistance. Insulin that can't enter cells to produce energy, disengages satiation. This is one way food producers increase their sales, by getting Americans to eat more food.

The government is complicit in spawning the diabesity epidemic by subsidizing the production of non-nutrient-dense foods and high-fructose corn syrup, and promoting a "food pyramid" that suggests Americans consume more food, not less (17-23 servings a day), and many servings of meat, processed gains and dairy products which foster obesity.

It is obvious that modern medicine is an industry that wants more, not less, disease to treat. Patients are aware that doctors aren't interested in disease prevention. Conventional medicine is quick to dismiss any truly preventive therapies as unproven and requiring more study. A current hidden agenda is to publish pseudo-science in medical journals so nutritional approaches to disease prevention can be dismissed as not being "evidence based."

Yet, by comparison, there are very few treatments in modern medicine that are truly "evidence based." For example, statin anti-cholesterol drugs are approved by the FDA even though they don't reduce mortality rates and prevent a non-mortal heart attack in less than 1 in 100 healthy adults. Add flu shots to the list of disproven therapies. They have not been shown to reduce mortality from flu-related illness among high-risk groups (young children and older adults.) The cervical cancer vaccine has not saved one life, and may never do so, and may produce nothing more than side effects (9,749 adverse reactions and 21 reported deaths related to this vaccine in the last two years).

There are no proven cures for cancer, and radiation and chemotherapy cannot even penetrate solid tumors, which represent 70-90% of cancers, but patients are never told this. There is no way chemotherapy can work because tumor resistance is inevitable and it destroys the immune system. A published study shows chemotherapy only contributes to the 5-year survival of cancer patients 2.3% of the time. (Would you return to an automobile repair shop that only fixed your car less than 3% of the time?) Chemotherapy is approved by the FDA if it temporarily shrinks a tumor by 50%, not if it prolongs survival. Who can blame cancer patients for searching for unproven alternatives? Chemo and radiation therapy have been disproven.

It has been said that the only technologies that have been validated in modern medicine are the repair of bone fractures, the repair of teeth, and the removal and replacement of cloudy cataracts with clear lens implants.

It's no wonder a whopping 38% of American adults (12% of children) have opted for alternative medicine, says a newly released study conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics. Where else can the public turn? But this statistic is thrown out as if it is evidence of a mindless public that elects to choose unproven therapies over FDA-approved drugs and devices. Yet studies show the most educated citizens utilize alternative medicine. Americans elect to choose alternatives because conventional medicine is ineffective, even hazardous, and is simply beyond affordability.

Many patients are belittled when they tell their doctors they are taking dietary supplements in lieu of problematic prescription drugs. Under the guise that dietary supplements may interfere with prescription drugs (actually, it's the other way around), the National Institutes of Health has conjured up a program to encourage patients to "confess" to their doctors that they are taking dietary supplements. The vitamin pill inquisition is underway.

Modern medicine realizes it has lost market share to alternative medicines. Americans are increasingly distrustful of prescription medicines, reading daily news reports of people dying needlessly from side effects from FDA-approved drugs. According to a Harris Poll (2005), 35% of Americans who were prescribed drugs didn't take them because they wanted to save money and another 28% left their drugs on the medicine shelf because of "frightening side effects."

More Americans are going to have to find ways to stay healthy outside of running to the doctor for everything that ails them. The health-care system, and the insurance system, won't be there for them. An unorganized self-care revolution is now in progress, which proceeds largely without doctor guidance or cooperation. More Americans are shunning problematic and overpriced prescription medications for vitamin and herbal supplements. The National Health Federation is leading that effort.

It is becoming increasingly clear that conventional medicine is working at odds against the public welfare. Yet, with the realization that American medicine is a broken system, Americans inexplicably return to the doctor's office for more of the same. Those Americans who don't learn self-care are going to suffer the most in this ongoing collapse of modern health care.


Saturday, December 20, 2008

NHS patients are cheated by 100m pounds a year extra for their dental work

Patients are being ripped off by more than 100million a year thanks to the Government's 'botched' reforms to NHS dentistry, figures suggest. Loopholes in a new contract for dentists are being exploited so that patients are effectively being charged twice for what should be one course of treatment, critics say. Dentists are accused of recalling healthy patients for checkups and splitting up courses of treatment unnecessarily. The Department of Health admits there is evidence that the tactic has become widespread since the introduction of the contract in April 2006.

Now data obtained from every primary care trust shows patients could have saved up to 109million in incorrect charges - almost a quarter of the 475million paid every year. And without the loophole, up to 6.5million appointments could have been freed up for people who currently do not have a Health Service dentist.

The Tories have calculated that the overcharging works out at an average of 7.77 pounds a year per patient, almost a quarter of the average annual charge of 33.80.

A deal drawn up by the Government means dentists can claim twice as much by spreading treatments across different appointments or calling patients back for unnecessary check-ups. NHS guidance, stating that no patients should be called back to their dentist for a check-up or have courses of treatment split up within a three-month period, appears to be being widely ignored.

Shadow Health Secretary Andrew Lansley, who obtained the figures, said: 'Labour's management of NHS dentistry has been appalling. Not only have millions been left without a dentist, but now we learn that those who do have one are often being charged more money than they should be. 'The blame here lies with Labour's botched dental contract, which incentivises dentists to increase the number of charges to patients and has led to such drastic cuts in the number of people being able to find an NHS dentist. 'The Government urgently needs to admit that the dental contract has been a monumental failure, get a grip and put an end to these practices immediately.' Dentists' leaders insist there is no evidence that anyone is playing the system.

But last week, the Government effectively admitted that its reforms have backfired when it announced an independent review of access to treatment. Health Secretary Alan Johnson appointed a team to investigate why 1.2million people have lost their NHS dentist since the changes were implemented.

Average dentists' earnings stood at just over 96,000 in the first year of the deal - a rise from 87,000 from the year before. For the top-earning dentists who own their own practice, income rose by a third to 172,494.

A decade ago, the Government pledged that all patients would have access to treatment on the Health Service within two years. But surveys suggest one in 20 patients is resorting to DIY treatment, in some cases pulling out their own teeth. And one in five says they have gone without treatment because they could not meet the cost.


Quality medical care for the poor?

Not in the public hospitals of the Australian State of New South Wales

Registered nurses will be replaced by cheaper, less-qualified nurses and unqualified assistants, in the latest round of cost cutting by the State Government. The plan to substitute university-trained registered nurses with enrolled and trainee nurses contradicts a $1.2 million study commissioned by NSW Health last year, which found that increasing the proportion of less-qualified staff in hospitals caused a range of preventable complications and deaths.

Hospital managers have been ordered to save $32 million within four years by downgrading nursing cover at small and rural hospitals. The ratio of assistants-in-nursing will increase to 50 per cent of the combined registered and enrolled nurse numbers. Assistants-in-nursing have no minimum level of education and are not regulated by any nursing body. Some are students and others have a TAFE certificate in aged care. Since 1993, registered nurses have been university trained.

NSW Health says the cuts are justified because many hospitals are, in effect, working as aged-care facilities due to a shortage of nursing home places. But the lead author of the Glueing It Together study, Christine Duffield, said the plan flew "in the face of the evidence that shows the more RNs you have, the better the patient outcome". The three-year study used data from 27 NSW hospitals and found that a higher proportion of registered nurses produced lower rates of bed sores, intestinal bleeding, sepsis, shock, pulmonary failure, pneumonia and death of patients from a hospital-acquired complication. "In the mini-budget [the Government] said no frontline services will be cut, but nursing is a frontline service," said Professor Duffield, from the Centre for Health Services Management at the University of Technology, Sydney. "They're just doing it to save money."

Area health services have been identifying registered nurse positions that can be replaced since August, pre-empting the $32 million edict in the mini-budget last month. A leaked memo shows Greater Southern Area Health Service will turn 53 full-time equivalent registered nurse positions into enrolled nurse roles, each saving about $20,000 a year in salary, for a total of $800,000 by June. Karen Lenihan, the director of nursing and midwifery at Greater Southern, said most registered nurses would be lost through natural attrition, not redundancy. "It's not really about saving money; it's about being efficient."

But the president of the NSW Nurses Association, Brett Holmes, said the modelling used to devise the skill mix was "based on budget, not patient need". He had serious concerns about patient safety and nurses' workload. Less qualified nurses did not have the training to deal with critical emergencies and trauma, such as car accidents, he said. The Opposition health spokeswoman, Jillian Skinner, said the changes would put lives at risk.


Friday, December 19, 2008

NHS Cancer patient given less than two months to live is told she must wait 25 days for drugs

A cancer patient given less than two months to live has been refused a life-prolonging drug until an NHS trust finishes a month-long investigation. Margaret Jones hopes to be treated with Revlimid for myeloma, an incurable cancer of the bone marrow. Her consultant says the drug, which costs around 4,300 pounds for each cycle, could extend the 72-year-old's life without debilitating side effects. But bosses at her primary care trust ruled they would not pay for Revlimid because it was not 'cost effective', even though other PCTs prescribe it for myeloma sufferers.

Mother-of-three Mrs Jones - backed by her family, MP, doctor and cancer charities - appealed on the grounds that another patient living nearby successfully overturned the trust's decision to block the same drug treatment in September. But on December 5 Anne Walker, chief executive of East and North Hertfordshire PCT, said her case was still being investigated and said a response would be sent 'within 25 working days' - about half of Mrs Jones's life expectancy.

The case reignites the controversy over the 'postcode lottery' for NHS care and the time taken by the Government's rationing body to approve new cancer drugs. The National Institute for Health and Clinical Excellence (Nice) ruled last month that it would deny Revlimid to patients with myeloma despite admitting that it could extend life by up to three years.

Mrs Jones, of Welwyn, Hertfordshire, was diagnosed with myeloma just before Easter 2006. She had been using the controversial drug thalidomide to fight the cancer but recently began to suffer damaging side-effects, including loss of feeling in her hands and feet, and excruciating pain elsewhere in her body. Following advice from her consultant-haematologist at the Queen Elizabeth II Hospital in Welwyn Garden City, backed by the charity Myeloma UK, she applied to the trust to use Revlimid - but was declined.

Yesterday she said: 'It seems wrong that there is a drug that can help people and yet the authorities put it beyond the reach of them. It is like being in a cage and somebody putting a piece of bread just out of reach. It is cruel.' Her son Jon Jones, 37, said: 'The concerning aspect of this case is that decisions on whether to provide a treatment are being made on the basis of total cost and do not consider the clinical effectiveness of those therapies. 'Elsewhere in the country, Revlimid is being provided. The PCT making this particular decision is located in one of the wealthiest counties in the country. The issue of a postcode lottery for health care is not going away and is still a heart-breaking issue for many people and their families.'

The 37-year-old former RAF pilot, who lives in Wiltshire, added that the PCT's decision to spend up to 25 days investigating his mother's appeal was 'upsetting'. He said: 'If you have got someone who has got a matter of weeks to live then 25 days is too long. It should become a matter of urgency. 'I am not saying that those responsible at the trust are off playing golf. I accept they are busy people. But when a decision needs making very quickly, they need to act quickly.'

Mrs Jones's Tory MP, Grant Shapps, said: 'The PCT should be utterly ashamed of itself. They have a woman's life in their hands and they should overturn their original decision immediately.'


Thursday, December 18, 2008

Pervasive NHS inadequacies

When Florence King's husband was admitted to hospital for a major brain operation, she discovered how, while the National Health Service is superb at matters of life and death, it often fails badly at the smaller touches that mean so much to patients . . . She explains: 'Over the past few months, my husband has had a major operation on the NHS and half-a-dozen follow-up stays in hospital. 'The medical treatment has been beyond reproach. He is making a good recovery and we can only express our gratitude. 'But so close and extended an experience of hospitals - not just of the one where he had his operation, but other hospitals where he underwent tests - highlighted a whole range of areas where a little thought would have improved the experience for patient and visitor alike.

'Many of the faults would cost little or nothing to remedy: it is more a matter of attitude than money. The overwhelming impression was of a system - as years of almost permanent revolution come to an end - that is expensively over-managed at the top and grievously undermanaged at the patient level. 'Most of those involved, including nurses and ancillary staff, are so wrapped up in the system that they fail to appreciate how it looks and feels to the people in their care - the people who are, after all, the whole reason the hospital is there.

'Before his operation, my husband could barely walk. He needed door-to-door transport, which meant the car. And when the hospital is out of town, a car makes visiting more flexible, which is how I encountered that most vilified of "hidden" NHS costs: parking charges. 'Now, I completely understand why hospitals in urban areas or on small sites levy charges: they don't want parking spaces that their staff need clogged up with visitors' cars and they don't want commuters squatting there for free. 'And if you have a disabled sticker, as my husband does, you do not have to pay to park. No complaints there.

'As an able-bodied visitor, though, I stuck to the rules, which meant shelling out more than 30 pounds for each of the first two weeks, until I discovered that, as a regular, you could buy a weekly season ticket for 12. 'I would not say, though, that they were exactly advertising that fact. The aggressively worded instruction boards at the car parks warned - among other things - that it was an offence not to display a valid ticket; that the machine dispensed no change; that the charge had recently gone up to 2 pounds for three hours; that charging operated 24 hours a day, seven days a week; and that there were regular checks. 'Oh yes, and they warned that thieves were about - so the patrols were about money, not security. Thanks.

'I discovered the good news about season tickets by chance, from the small print of a leaflet in the hospital coffee shop. But not before learning how more experienced visitors coped. Dozens park on surrounding roads, which creates traffic jams at visiting times. 'There was also what seemed a well established practice of passing your ticket (with its unused time) to a new arrival as you left, or leaving it on the machine for the next person to pick up. That seems fair enough. 'The 2 pounds-for-three-hours charge particularly grated because official visiting hours are two separate sessions of two hours. This means you have to pay at least 4 pounds if you visit both times.


'As an arriving in-patient, my husband would have an official letter and a window of time allocated for his arrival. Invariably, there was no one manning the central reception desk or the entrance to the ward. 'Despite all the stories you hear about poor hospital security (from petty crime to stolen babies), I have entered and got lost wandering around every hospital my husband has been in. Invariably, no one has challenged me. 'Signposting is absolutely hopeless: non-existent, inconsistent; or in such impenetrable jargon that no outsider has a clue.

'Some reception desks, it turns out, are staffed only at certain times or particular days of the week, and the staffed hours bear no relation to when new patients actually arrive. For whose benefit, you ask, are they manned at all? 'Sometimes I had to winkle semi-willing staff out of adjacent side rooms where they were on a break.

'One newer hospital of my acquaintance, a positive paean to the Private Finance Initiative, has an atrium that rivals any major airport with ranks of reception desks to match, except that only the central desk is staffed - so there are muddled queues. 'It is too expensive to staff the other desk said a grumpy porter. All this public space - which has to be cleaned, heated and lit, if not actually staffed - is an extravagance. 'It is also intimidating for semi-mobile patients, who find themselves having to hobble enormous distances, even if lifts and automatic doors make it a great deal easier than in older hospitals. 'Why was the money spent on a lavish atrium rather than separate wards rather than separate bathroom facilities for men and women?


'The doctors I dealt with were, without exception, informative and calming. It was almost as though they had graduated from a course in "dealing with patients and their relatives as intelligent people and how not to alarm them". Perhaps they had. 'I didn't feel at any time that the top specialists were patronising me or my husband, and they seemed to make conscious efforts to avoid using impenetrable technicalities.

'I do not doubt, though, that having doctors in the family and long familiarity with the medical minutiae of my husband's illness probably helped communication. In general, the junior doctors seemed more off-hand.

'If I have a complaint, it is the general invisibility of doctors outside the ward round. Of course, they have other places to be: in the operating theatre, seeing acute patients, lecturing. 'But they seem to inhabit a planet from which they occasionally descend, with a certain delay for effect, at the behest of ever-changing teams of nurses. The continuing, and glaring, doctor-nurse divide left me feeling that some doctors found it easier to talk to me than to the nursing staff.


'As visitor, you would go into the ward - sometimes you had to ring to be admitted, sometimes not - and want to announce yourself to someone. 'I felt that someone should know I was there; that it would be better not to wander around the beds looking for my husband (sometimes he was in a side ward, sometimes not); and it would be useful to know before I saw him how he was. 'No one, even at official visiting times, routinely met the visitors. Official visiting times existed, and there were rules discouraging young children and more than two visitors per patient. But hospitals seem to make a virtue of permissiveness. 'When my husband was very ill, I was grateful for the flexibility. But permissive visiting makes for a lot of coming and going. 'Not enforcing the rule about young children and multiple visitors made for more noise and bustle than my husband easily tolerated. It was, frankly, an imposition.


'WHEN my husband was admitted to the hospital ward, I saw a notice on the wall behind the nurses' desk team saying: We operate a team nursing system." I soon discovered that this meant that no one individual was in charge - everyone was equal. 'The combination of having no one visibly in cahrge and incomprehensible shift patterns meant neither patients nor visitors had any obvious continuity.

'My husband seemed to receive his medication with punctilious regularity, and was duly recorded, along with any problems, in the handover log. 'But there were slips and times when the log was completed with a delay: "Whoops, I forgot, but I know I gave him his dose . . ." 'Every individual seemed to have a high sense of personal responsibility. Yet the fact no one demonstrably in charge left doubts. It all seemed a bit haphazard.

'I was not made to feel unwelcome. On the contrary, at mealtimes I was cheerfully called up for feeding duty. I just felt that a single, obvious contact point every day would have been desirable. The counter-argument, of course, is that everyone is too busy and hierarchies belong in the ark.


'Thank goodness: with the introduction of individual screens, the age of the blaring TV at the end of the ward is over in many hospitals. 'But it was not only the visiting times, as my husband told me, that could be noisy. Nights were also noisy, and only partly because some patients became agitated. 'My husband's biggest complaint, though, was about the nurses and their chatter and laughter. He was on a ward for patients who'd had brain operations or suffered brain injuries. They really needed quiet. Again, who is a hospital for?


Ward hygiene was good. The hand-washing and disinfectant messages have got through to the staff. I have to say, though, that I didn't like seeing nurses arrive and leave in uniform.

'I was surprised that most patients, except the very ill, were encouraged to wear their own clothes, which meant I had a pile of dirty laundry to take home a couple of times a week. I have a car and washing machine, but some relatives might not.

'What I found shocking was how often nurses seemed to prefer the patient to soil himself rather than help him to the commode. 'At one point, my husband was well enough to be detached from a catheter, but still too ill or slow to get up or reach for the urinal in time. A more considerate attitude by the nurses, not necessarily more of them, could have reduced the number of 'accidents'.

'In two hospitals, I complained several times about the lack of loo paper and general filth of the lavatory facilities for visitors. Nurses and ward staff say it is nothing to do with them and I could never find anyone who'd admit to having responsibility.


'Meal service was separated from nursing everywhere and seemed to have a life of its own. 'The times were generally not too uncivilised, and the quality and choice were better than both of us had feared. 'My husband could also ask for toast or an ice-cream at almost any time if he had missed a meal or felt peckish. He lost a lot of weight while recovering from his operation and enjoyed these little extras.

'But, oh, the service! OK, so you don't expect restaurant standard or even charm. But I think you could expect to have the plates set down somewhere where you might be able to reach them in the order you might want to eat what is on them. 'And the amount of time allotted for eating was minimal, so the hungry patient feels pressured to gobble, and anyone who has difficulty eating simply gives up. Those who made a fuss generally got fed, but often had to wait so long that the food was cold.

'Expectations about patients' ability to eat when in bed were unrealistic. While nurses and meal staff equipped themselves with disposable plastic aprons off a big roll, patients had to make do with a tiny paper napkin. 'A disposable plastic bib or a cloak like the ones you have at the hairdresser's would be a vast improvement.

'It would also be a good idea for someone to review all the menus for ' eatability'. Roast chicken came in joints and was clearly popular, but my husband could not have begun to tackle his if I hadn't been there to cut it up; he could not even lift it! 'Anything that cannot be picked up easily by hand, fork or spoon is a nightmare. Even boneless meat, if it is in one piece or drowned in gravy, is a challenge. I especially dreaded 'pea' days - they ended up all over the bed.'


'A lot of people complain about the tariff for hospital phones. All the hospitals my husband has been in, though, allowed patients to use their mobiles, which most did with discretion. That's good.


'I know that if I were in hospital and reasonably conscious, I would love to have my own TV and radio. The arrival of bedside TV and games consoles - a bit like those in passenger planes - is a great advance.

'Aha, but the NHS has news for you. It is not as simple as it seems. First of all, you need to pay, and while I would be happy to do so, the system seemed expressly designed to extract the maximum amount of money in a rather deceptive way. 'You could pay for a day, three days or a week. But the time was consecutive. So, if you had an operation on day two and were incapable of watching TV that day, you lost that day. To pay for just one day, though, was much more expensive.

'The method of payment left much to be desired. All right, you can't expect nurses to collect TV fees. But you have to buy a card at a slot machine that says it gives change and accepts notes, but doesn't, or pay by credit card on-screen. 'For me, able-bodied and equipped with a mobile phone and credit card, this was complicated, didn't work initially and necessitated two frustrated calls to the inquiry desk.

'For my husband, with fingers that didn't work well, problems with his voice and difficulties sitting up (before the operation), setting up the TV payments would have been impossible. In the week after the operation, it was even worse. 'Plus, his bed was moved first to a different ward and then to various positions in the ward. Each move meant having to re-start the TV, using a long ID number. Mostly, he gave up. 'And a head operation meant wearing a headset was not just uncomfortable but impossible, yet no earpiece was on offer.


Wednesday, December 17, 2008

British woman driven 200 miles to give Caesarian birth to premature twins and then finds after delivery that the hospital has only one incubator available!

Vast lack of facilities. Even a Caesarian was too hard for three hospitals. And as for incubators for premmies! What do you think you are? In the 21st century? And this is in London, not on some remote island!

A new mother was sent to four different hospitals in four days to give birth only to have her premature twins separated after they were born. Angela Breeds, 30, was forced to make a 200 mile trip because surgeons were unable to perform a necessary caesarian section at the first three hospitals she was sent to. And when she finally gave birth to Suzie and Sonny, the twins were separated after just five minutes because of a lack of cots.

Ms Breeds, a self employed hairdresser from Stanford-le-Hope said: "I'm just so angry about being pushed around everywhere. "Then when I found out they had to be separated I was completely gutted."

The mother's ordeal started on December 3 when doctors at King's College Hospital in south east London told Miss Breeds she needed a caesarian section because one of the twins was not getting enough nutrition. She was transferred 31 miles away to Basildon Hospital in Essex that night for the operation. But after she arrived, she was told the hospital did not have the right facilities for the procedure so she was sent to Peterborough Hospital in Cambridgeshire, 96 miles away.

She waited in the hospital for three days before being told surgeons at the facility could not perform the operation either. So she was again transferred to Whipps Cross Hospital in east London, another 86 miles away, on Sunday December 7 where she gave birth the following day. But there were not enough incubator cots for both tots and within five minutes of giving birth, Sonny was taken away from his mother and sister to Royal London Hospital in Whitechapel.

Katrina Coulson, an NHS East of England spokeswoman said the NHS in the region was hoping to increase the number of special and intensive care cots


Tuesday, December 16, 2008

10,000 Polish women get NHS abortions

Ten thousand Polish women had abortions in Britain last year, it has been reported, in procedures which are thought to have cost the NHS between 5million and 10m pounds. Thousands of the women are thought to have come to Britain specifically for the procedure, which is illegal in Poland. People coming to Britain as temporary workers are given a National Insurance number, which allows them to register with a doctor and have NHS treatment.

Britain is thought to be a particularly popular destination as terminations can be carried out as late as 24 weeks into a pregnancy. In several other EU countries, abortions can not be carried out after 12 weeks. A pill given to women under nine weeks pregnant costs the NHS about 500 pounds while an operation necessary for those further into pregnancy costs about 1,600 including after-care.

The figures were reportedly disclosed by the Polish Federation for Women and Family Planning. Aleksandra Jozefowska, a spokesman for the Federation, told The Sun: "On Polish internet sites you can find lots of information on how to obtain an abortion in Britain. And every week I have two or three phone calls from women who want to know about abortion in England."

One unnamed London doctor was reported to have told the newspaper: "As long as they get an NHS number, they haven't got a problem. They can say: 'I didn't know I was pregnant until I got here, I'm in an impossible situation and need help'."


Australia: Is Victoria's ambulance service unfixable?

The complaints never seem to stop

Long delays for ambulance services are putting lives at risk, the Victorian ambulance union says. A log of 291 incidents from August to November showed dangerously slow response times, Ambulance Employees Association Victorian secretary Steve McGhie said. Ninety-six scheduled shifts failed to run on time during that period. In one case, an 89-year-old woman with severe chest pains was taken to hospital by car after waiting 23 minutes for an ambulance to arrive, Mr McGhie said.

"These figures show the ambulance service is failing the community,'' he said in a statement. "People's lives are being put at risk by slow response times and cancelled ambulances. "Paramedics are working massive hours to cover our over-stretched service, and when everyone else is with their friends and family at Christmas, this is their busiest time of the year.''

Mr McGhie said the only way to attract new people to the profession was to offer fair wages and 10-hour rest breaks. "The community needs to be extremely cautious over the holiday season, because this log shows the ambulance you need in a crisis simply may not be there.''

A spokesman for Health Minister Daniel Andrews said the State Government had committed 258 extra paramedics and provided $186 million to services during 2008.