Monday, June 15, 2009

This should be the last straw for Britain's IVF regulator

They have wasted huge amounts of time and money in a fruitless legal assault on Dr. Taranissi's highly successful private IVF clinic while ignoring real sloppiness at a government IVF clinic

A MOTHER desperate to have a second child has told how she lost her last IVF embryo when the NHS implanted it into the wrong patient. When the other woman found out that the embryo was not hers, she aborted it.

Details of the blunder raise fresh questions about the way IVF clinics are regulated. The Sunday Times has previously revealed that women undergoing fertility treatment have had their eggs fertilised with the wrong sperm.

Deborah, the woman who lost her chance of another baby, is so traumatised by the error that she is reluctant to risk further IVF to have a longed-for sibling for her son, Jamie, 6. Because Deborah is 40 her prospects of having another child with her boyfriend, Paul, 38, are slim and diminishing. Deborah, who does not want to disclose her surname, said: “I will never forget the moment the hospital broke the news to us. Initially, the hospital told me there had been an accident in the lab and that the embryo had been damaged. I thought that someone had, perhaps, dropped the embryo dish. “I remember thinking: ‘That’s our last hope gone – we will never have another child.’ I left the hospital feeling totally shell-shocked. “When we went back to the hospital two days later and we were told the truth about my embryo being given to someone else I was so angry.”

Deborah, a healthcare worker, and Paul, who have been together for 17 years, went on the NHS waiting list for fertility treatment in 1996. After two failed attempts, Jamie was born on the third cycle in 2003. Three of the couple’s remaining embryos were frozen and they tried for another child with the only embryo to survive the freezing process at the IVF Wales fertility clinic, University Hospital of Wales, in Cardiff in December 2007.

The causes of the blunder remained secret until the couple instructed lawyers to obtain reports into the incident. Documents acquired by their solicitor, Guy Forster of Irwin Mitchell, showed that, the previous year, there had been “near misses” because of problems in monitoring the ownership of embryos. These were reported to the Human Fertilisation and Embryology Authority (HFEA), but Forster says it let patients down by failing to ensure that the problems at the clinic were sorted out.

Forster said: “We are concerned that the HFEA missed opportunities to take action in relation to IVF Wales before this incident occurred. “A report by HFEA investigators shows that the error occurred primarily due to failures by laboratory staff and theatre staff to carry out basic procedures.”


NHS waiting time targets hamper superbug fight, claim BMA

Waiting time targets in the NHS are hampering efforts to reduce “superbug” infections such as MRSA, doctors’ leaders have claimed. Patients are being placed on dirty beds to help hospitals meet the requirement to start treatment within four hours of admission.

Today the British Medical Association (BMA) called on the Government to allow more flexibility in the target to ensure there is enough time to clean equipment. Despite declining rates of MRSA and Clostridium difficile, healthcare-associated infections remain a “significant” problem for the NHS, with Britain having some of the highest rates in Europe, the BMA said in a report on tackling the issue.

The pressure to admit patients quickly and a shortage of isolation facilities at peak times are “critical challenges to maintaining high quality patient care”, the report states. Moving staff and patients around the hospital, in an effort to meet targets, also contributed to the spread of germs. The BMA said that patients with non-urgent conditions would understand if they had to wait an extra hour to be admitted to hospital while a ward was properly cleaned to minimise the risk of infection.

There needed to be a focus on long-term action and a will to drive down all infections, not just MRSA and C. difficile, it added. Medical processes could be improved, and meticulous hand-washing and proper prescribing of antibiotics should be encouraged, as overuse of the drugs is known to build up the resistance of microbes, the report concludes.

Jonathan Fielden, chairman of the BMA’s consultants committee, said: “Hygiene, hand-washing and antibiotic policies have extremely important roles to play, but if we want to reduce the spread of infections we must put safety in front of political targets. “With many hospitals already working at full capacity, they will only get more pressurised as winter arrives, but you need time to clean. “If you ask a patient whether they want care now or safe care in an hour, they wouldn’t mind waiting for the safe care. Existing targets need to take the need for good infection control into account.”

The BMA’s report said that staff or hospitals should face sanctions if they failed to implement simple strategies such as washing hands with soap and water or using alcohol gels. A £50 million deep clean of all hospitals in England was ordered by ministers in 2007, concluding in March last year. But Vivienne Nathanson, the BMA’s head of science and ethics, said that the policy needed to be part of a package of long-term measures to maintain regular, thorough cleaning of hospitals. “Deep cleaning is a good thing provided you go in and do all the other organisational things and keep your cleaning at a high level,” she said. This includes proper cleaning of things such as bedside lockers and rails, the buttons on machines and switches.

Dr Nathanson added that areas of a hospital that posed the greatest risk of harbouring germs were not always included in cleaning contracts. Roughly half of all hospital cleaning has been outsourced to private companies.

Ann Keen, the Health Minister, responded that the latest figures showed that MRSA infections had fallen by 65 per cent and C. difficile infections were down by 35 per cent. “It is difficult to understand the BMA’s suggestion that our broad integrated strategy to reduce healthcare associated infection has been anything other than a success. “However, we accept that one preventable infection is one too many and we continue to battle against infections on every front.”

Norman Lamb, the Liberal Democrat health spokesman, said: “This report provides further evidence that the Government's obsession with targets is putting patient safety at risk. “Ministers need to stop micromanaging the NHS and trust doctors and nurses to decide the best way to care for their patients.”


Reform must empower the consumers

As Congress moves forward with proposals for reforming the U.S. health care system, it is possible to draw some important lessons from the experience of other countries.

First, universal health insurance does not mean universal access to health care. In practice, many countries promise universal coverage but ration care or have extremely long waiting lists for treatment.

For example, at any given time, 750,000 Britons are waiting for admission to National Health Service hospitals, and shortages force the NHS to cancel as many as 50,000 operations each year. In Canada, more than 800,000 patients are on waiting lists for medical procedures. The Canadian Supreme Court has found that many of these individuals suffer chronic pain and that some die awaiting treatment.

Those countries that have single-payer systems or systems heavily weighted toward government control are the most likely to face waiting lists, rationing, restrictions on the choice of physician and other barriers to care. Those countries with national health care systems that work better, such as France, the Netherlands and Switzerland, eschew centralized government control and incorporate market mechanisms such as competition, cost-consciousness, market prices and consumer choice.

Second, rising health care spending is not an uniquely American phenomenon. While other countries spend considerably less than the U.S. on health care both as a percentage of the gross domestic product and per capita, it is often because they begin with a lower base of expenditures. But their costs are still rising, leading to budget deficits, tax increases and/or benefit cuts. As the Wall Street Journal notes, "Europeans ... face steeper medical bills in the future in their cash-strapped governments." In short, there is no free lunch.

Yet many in Congress naively think that if we simply expand coverage, cost control will take care of itself. If, as expected, health care reform costs $1 trillion to $1.5 trillion over the next 10 years, Americans should brace for massive tax increases — and not just for the wealthy. In fact, many of the tax increases being considered to pay for health reform — taxing employer-provided health benefits; soda and beer taxes; restricting or eliminating flexible spending accounts and health savings accounts; eliminating the deductibility of health expenses above 7.5 percent of adjusted gross income, etc. — fall heavily on the middle class.

Moreover, current estimates probably understate the actual cost of health reform. The Urban Institute, for example, suggests the actual cost will be closer to $2 trillion, noting: "If all uninsured people were fully covered [in 2008], their medical spending would increase by $122.6 billion." If we assume that the cost of covering the uninsured will grow at the same rate the federal government assumes for all health spending growth (6.2 percent), then from 2010 through 2019 the cost of covering the uninsured would be $1.8 trillion.

Furthermore, cost estimates for government programs have been wildly optimistic over the years, especially for health care. For example, when Medicare was instituted in 1965, it was estimated that the cost of Medicare Part A would be $9 billion by 1990. In actuality, it was $67 billion. Similarly, in 1987, Medicaid's special hospitals subsidy was projected to cost $100 million annually just five years later; it actually cost $11 billion, more than 100 times as much. And in 1988, when Medicare's home care benefit was established, the projected cost for 1993 was $4 billion, but the actual cost was $10 billion. If the current estimates are off by similar orders of magnitude, we would be enacting a new entitlement that could bury future generations under mountains of debt and taxes.

Finally, the broad and growing trend in countries with national health care systems is to move away from centralized government control and to introduce more market-oriented features. As Richard Saltman and Josep Figueras of the World Health Organization explain, "The presumption of public primacy is being reassessed." The growth of the government share of health care spending in European countries, which had increased steadily from the end of World War II until the mid-1980s, has stopped, and in many countries, the private share has begun to increase, in some cases substantially.

Other countries are loosening government controls and injecting market mechanisms, particularly cost-sharing by patients, market pricing of goods and services, and increased competition among insurers and providers. Pat Cox, former president of the European Parliament, said in a report to the European Commission, "[W]e should start to explore the power of the market as a way of achieving much better value for money."

There is even evidence of a growing shift from public to private provision of health care. If many of the proposals in Congress would push us toward more of a European-style system, the trend in Europe is toward a system that looks more like the U.S.

If there is a lesson that U.S. policymakers can take from national health care systems around the world, it is not to follow the road to government-run national health care, but to increase consumer incentives and control. The U.S. can increase coverage and access to care, improve quality and control costs without importing the problems of national health care.


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