Thursday, July 02, 2009

NHS doctors warn Stafford Hospital deaths scenario will repeat

The problems at Stafford Hospital, where more than 400 deaths were caused by poor care, remain a real risk in the NHS and could easily happen elsewhere, doctors warned yesterday. The preoccupation with budgets and targets is exposing the NHS to pressures that compromise care standards, with managers too quick to pursue financial incentives, such as turning their hospitals into foundation trusts, the British Medical Association’s annual conference was told.

George Rae, a member of the BMA’s council, said that the Government’s reform agenda and its “misplaced confidence in markets getting the right solutions” was one of the main reasons that problems had arisen at Mid-Staffordshire NHS Foundation Trust.

A highly critical report from the Healthcare Commission, published in March, detailed a catalogue of failings at the trust, which runs Stafford and Cannock Chase hospitals, prompting apologies from the Prime Minister and the Health Secretary. Shocking standards of care for patients admitted through A&E put many people at risk and led to deaths, the report concluded. Its authors said that between 400 and 1,200 more people had died than would have been expected in the three-year period to 2008. The report, the most damning yet compiled by regulators on an NHS hospital in England, also raised serious questions about the monitoring and regulation of Mid-Staffordshire, which was awarded elite foundation status and continued to receive positive annual reports despite its many problems.

Gordon Brown said it was an isolated incident, adding that the Healthcare Commission, the predecessor to the newly formed Care Quality Commission, had assured him that there were no other hospitals or parts of the NHS that had displayed similar failings.

But Dr Rae said that the failings in Mid-Staffordshire were “an inevitable, almost inexorable result of a market-based health agenda in England”, which made co-operation and collaboration in the NHS “almost an anathema”.

Speaking in support of a motion highlighting the concerns and condemning the perverse impact of targets and financial incentives, Mary McCarthy, a doctor from Shrewsbury, said that other hospitals were under similar pressures. “The problems that occurred at Mid-Staffs are not unique,” Dr McCarthy said. “The concentration on targets distorts clinical care and the pressure by trusts to keep patients out of hospital may not be clinically safe.” Dr McCarthy said that England had fewer beds per 100,000 population than anywhere else in Europe “by a long way” — 388, compared with 640 in Belgium, 720 in France and 870 in Germany. “The concern is that the Mid-Staffordshire problem is not an isolated incident but has the potential to happen in every other area,” she said.

Families described “Third World” conditions at Mid-Staffordshire, with some patients drinking water from vases because they were so thirsty and others screaming in pain. The Healthcare Commission found deficiencies at virtually every stage, including inadequately trained staff who were too few in number, junior doctors left alone in charge at night, and dirty wards and bathrooms.

The motion, which was passed unanimously, also called for greater support of whistleblowers who raise patient safety concerns.

Speaking on the opening day of the BMA’s conference, Hamish Meldrum, the association’s chairman, issued a warning to the Government. “Don’t play around with our health service. It’s not a toy you cast aside and replace with the latest product off the shelf when you’ve tired of it. It needs looking after. It’s our NHS, make it yours too,” Dr Meldrum said in his keynote address. He said that there had never been a better time to abandon the market reforms in England, calling on Andy Burnham, the new Health Secretary, to “end this ludicrous, divisive and expensive experiment of the market in healthcare in England”.

He added that a target-driven culture had “infested the NHS in recent years and that seems to put financial outcomes for trusts above clinical outcomes for patients”. “We will not tolerate a substandard service for our patients and we will not tolerate a culture of muzzling or bullying of our staff,” Dr Meldrum said.


California Slashes Health Benefits to Save Money

Effective July 1st, the state-run health care insurance system (Medi-Cal/Denti-Cal) will eliminate adult dental care benefits, podiatry benefits and optometry benefits in an effort to save money.

Apparently, health care decision-makers blew right past any thoughts of rationing the benefits and opted to make them simply disappear completely.

The California Primary Care Association pitched a complaint but a Superior Court judge ruled against them.

In any event, one might logically expect a similar approach to cost-saving when a national health care scheme is adopted.


Public schools and the public healthcare option

Imagine a private school where students sat in a math class for weeks misbehaving and learning nothing. Imagine that school gets on TV news because the administrators suspended the young lady who blew the whistle by taking a cell phone video and giving it to her mom who confronted them. Do you think that school would have enough students to start the next school year? Well, this happened at a public high school in the SF Bay Area:
A freshman at Clayton Valley High School in Concord, California says that’s just what she had to endure in algebra as her classmates went wild. “People smoking marijuana in the classroom. They smoke cigarettes.” Arielle said. “There was one kid who peed in a bottle and threw it across the room.'

Clayton Valley High School is a public high school, and I have no doubt that it will open with just as many students next year as it did this year. When parents pay for an education, they absolutely will not tolerate a school run like Clayton Valley HS. When the state provides an education for free, a vast majority of parents will generally take what they can get and call it good enough. They might picket and protest for improvement, but they won’t take their kids out of the school.

What does this have to do with health care? The public option being created as part of “ObamaCare” is rather similar to public schools, in that it is designed to undercut private health insurance on the basis of price:
The Lewin Group crunched the numbers through their health care model and found that premiums for the public option plan would be 30 to 40 percent lower than private plans.

A price difference of that magnitude would lead employers to throw their employees into the ObamaCare option:
Overall, the Lewin Group estimates that if Medicare reimbursement rates are imposed, the number of Americans with private health insurance would decline by almost 120 million, leaving only 50 million Americans in the private insurance market.

That would leave approximately 15% of the population in non-government health care, just slightly more than the percentage of students that go to private school. At that point, ObamaCare will have similar monopoly power to the public schools. I expect abuses and incompetence similar to that captured by Arielle Moore at Clayton Valley High when the public option achieves its monopoly power. The scary difference is that instead of not learning algebra, the people who have to suffer that abuse and incompetence will be missing out on life-saving medical treatments.

A human life is too important to waste on government health care.


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