Wednesday, September 09, 2009

Thousands of critically ill patients leave British hospitals because of bed shortage

Almost 2,000 critically ill patients were discharged early from NHS intensive care units last year because of a shortage of beds, the Conservatives have claimed. Data from eight out of ten hospital trusts in England suggests that a further 20,000 patients had their discharge from intensive care delayed because there were no suitable beds in other wards to which they could be transferred.

On average, hospitals had all their intensive care beds full for almost one third of the year in 2008, the responses to questions under the Freedom of Information Act show. About 1,000 patients had to be transferred to other hospitals to get an intensive care bed, while double that number were discharged early to make room for other patients.

The Conservatives said that the findings raised concerns about how hospitals would cope with predicted demand because of swine flu and related complications this winter.

A study published in the journal Anaesthesia in July warned that hospitals across England could face shortages of crucial intensive care beds because of swine flu, especially for children. The researchers, from the University of Cambridge, the Intensive Care Society and St George’s Hospital, Tooting, found that demand for beds and ventilators at the peak of a pandemic could be 60 per cent above the number available across England. Demand would outstrip supply by 130 per cent in at least one region, the South East — but London and other areas might cope better, the researchers said.

The Government has said that it can cancel non-emergency operations to increase the overall number of beds available, but the study said that even this would not meet demand. The Department of Health said there were 364 intensive care beds for children in England and 3,637 for adults.

The Tories’ research found that hospitals had at least one of their intensive care beds closed because of a lack of staff for 25 days on average in 2008. Andrew Lansley, the Shadow Health Secretary, commented: “Over the past five years we have consistently pushed the Government to make sure the UK was ready, should a flu pandemic occur. In many areas, the UK is among the best prepared in the world, but there are some issues on which the Government has not taken action — and one of these is critical-care capacity in the NHS. “It is worrying that we have far fewer beds to treat the most critically ill patients than almost any other developed country. If the second wave of swine flu occurs when schools return, as is being predicted, this could cause real problems in the traditional flu season in the autumn.

“The Government urgently needs to review its plans in order to help the NHS provide extra beds to deal with the pandemic and ease the pressure on intensive care units. It should look at how more staff can be trained in ventilatory support and the idea of rest centres to care for patients who can’t look after themselves at home.”


British restrictions on prescription of osteoporosis drugs 'defy belief', says leading doctor

Thousands of women are being denied better osteoporosis drugs because of unnecessarily restrictive Government guidelines, a doctor said last night. Professor David Reid, an expert on brittle bones, said the rules are so stringent that GPs are often prevented from giving alternative treatments to those suffering side-effects from their pills.

A once-a-year jab that could save thousands from the misery of broken bones is also not going to be assessed for use on the NHS in England and Wales for at least three years, despite being available in Scotland. It means that sufferers are being denied drugs that could have a major impact on their health and their quality of life. The news will reignite the debate about the evaluation system used by drugs rationing body the National Institute for Health and Clinical Excellence. NICE has previously been criticised for banning or restricting breakthrough medicines for conditions such as breast cancer and Alzheimer's.

Mr Reid, of Aberdeen University, told the British Science Festival that the NICE guidelines on the disease were 'unnecessarily restrictive'. Up to a quarter of patients taking the first-choice drug, the £50-a-year alendronic acid, will be troubled by indigestion, with some experiencing crippling stomach pain. But under guidelines, sufferers may have to wait up to five years for their condition to deteriorate before being put on more expensive treatments with fewer side-effects.

Mr Reid said: 'The guidelines indicate that a lady can have alendronic acid at a certain level of risk. 'If that person doesn't tolerate the drug and goes back to their GP, the GP might have to say, "Your risk isn't high enough to have the next drug" - and frankly, that is just bad medical practice. It defies logic.'

The science conference in Guildford, Surrey, also heard that thousands of osteoporosis patients in England and Wales are being denied the cutting edge drug zolendronic acid. It has passed the safety checks for use in Britain and has been prescribed in Scotland for about 18 months. But NICE is not due to evaluate it for NHS use in England and Wales for three years, the conference heard.

Although the drug is not vastly more effective than existing medicines, it has the advantage of being given just once a year, through a drip. With studies showing that over 50 per cent of osteoporosis patients find tablets so inconvenient that they stop taking them, the drug could have a huge impact on health. With 1,150 Britons dying each month after breaking a hip, better treatment of osteoporosis could have profound consequences.

A spokesman for NICE said the guidelines 'provide postmenopausal women with consistent access to the most costeffective treatments'.


Australia: Obnoxious Queensland Health manages to sink even lower: Tired doctors told to drink more coffee

SIX cups of coffee - that's the State Government antidote to sleep-deprived doctors killing and harming their patients in a haze of exhaustion. The astonishing remedy forms part of Queensland Health's new doctor fatigue policy, currently being rolled out in public hospitals, The Courier-Mail reports.

The Courier-Mail yesterday reported the confessions of junior surgeons and medics whose exhaustion-induced errors had killed or hurt patients during "on-call" shifts of 30 to 80 hours.

But a guidelines document underpinning QH's Fatigue Risk Management System claims "solutions such as 'we need more staff' might not be achievable or effective in managing a fatigue risk." Instead, the 102-page document deems the "strategic use of caffeine . . . to be beneficial" as a fatigue fighter for doctors on marathon duties. "The recommended dosage for a prolonged and significant reduction in sleepiness during a night without sleep has been suggested at 400mg of caffeine . . . equivalent to about five to six cups of coffee," the document states.

As this coffee intake is "not always feasible or realistic", QH proposes caffeine tablets as an alternative. Energy drinks also are recommended. "Compared with other psychoactive drugs, for example, modafinil (a prescription-only narcolepsy treatment), caffeine is supported in its use as it is more readily available and less expensive," the document says.

World-renowned addictions physician John Saunders slammed the advice, saying it would turn doctors into addicts. He said caffeine addiction became clinically significant at 600mg a day. But some people would be addicted, or on the threshold of dependence, at 400mg daily. "They're suggesting 400mg is a perfectly fine dose? I would absolutely dispute that," said Professor Saunders, the Pine Rivers Private Hospital alcohol and drug program director. "For a health department to suggest that doctors use caffeine like this is the height of irresponsibility."

Prof Saunders said acute effects of 400mg of caffeine a day were heart palpitations, raised blood pressure, dizziness, anxiety and hand tremors. Doctors caught between caffeine fixes might suffer serious withdrawal consequences. "These will include headache, depressed mood, blurred vision and maybe some degree of confused thinking," Prof Saunders said.

He said the spectrum of side-effects could mean a doctor hooked on caffeine posed a greater threat than a tired colleague who did not use the substance. "I think it certainly could lead doctors to make potentially bad decisions when they are managing patients," Prof Saunders said.

Organisations Systems Professor Peter Smith said fostering caffeine use among doctors was "inappropriate". "It would seem to me to be a strange way of managing long-term fatigue," Prof Smith, of Central Queensland University, said. "(Queensland Health) might be aware that nicotine enhances alertness but they probably wouldn't be promoting that. It's the same with amphetamines."

The $3.6 million FRMS is a key plank of QH human resources policy, aiming to drop the risk of patient harm from doctor fatigue to "as low as reasonably practicable". Its overarching framework involves a suite of fatigue-reduction modules, strategies, education programs and auditing measures. [What a lot of crap! They just need more doctors]

Each hospital is directed to use the guidelines document, or "resource pack," to help tailor a site-specific plan. More than three pages of the document are dedicated to the case for caffeine in an appendix titled "Fatigue Countermeasures". The central nervous system stimulant is extolled for "increasing alertness, sustaining wakefulness and delaying sleep onset". "Caffeine use has been associated with (an) increase in cognitive performance such as sustained vigilance, reaction time, memory and mood."


1.7 million Danes have private health insurance

That's how satisfactory they find their "free" government medical care. Denmark has a population of 5 million so that's a third of them who are strongly motivated to seek something better than the "free" care that the government provides. It's similar in Australia, with about 40% privately insured

1.7 million Danes have private insurance, entitling them to free treatment at private hospitals. It is far more than previously anticipated. Danes are apparently wild on private health care. At least 1.7 million Danes have private insurance, entitling them to free treatment at private hospitals,

It is far more than previously anticipated, and thus, the Danish health system got a much stronger private component in the last few years. It was known that 900,000 Danes have a health insurance through their employer. But a comprehensive new survey of 5000 Danes, made by a group of researchers from the University of Southern Denmark, shows that 800,000 other Danes are insured privately to get faster treatment in private hospitals.

The survey shows that insurance is very unfairly distributed between the private and public sectors and between men and women. The insurance is extremely popular among employees, but received more coolly by union top brass.

Operation Insurance helps to undermine equal and free access to health care, says Poul Erik Skov Christensen, chairman of 3F for Monday morning.

Professor Kjeld Møller Pedersen, who headed the research, however, calls the union's struggle against the insurance plans a "Don Quixote fighting against windmills." He calls instead on the government to regulate the employer paid insurance in the same way as the individual schemes and Health insurance Denmark. At the moment, only the employer paid health insurance is tax-free.

More here (in Danish. Apologies for the rough translation above)

Obama blurs line on public insurance

The Obama administration's bottom line on a government health insurance option blurred Sunday as White House officials stressed support but stopped short of calling it a must-have part of an overhaul.

As President Barack Obama prepares for a Wednesday night speech to Congress in a risky bid to salvage his top domestic priority, no other issue is so highly charged. Obama's liberal supporters consider the proposal for a public plan to compete with private insurers do-or-die. Republicans say it's unacceptable. It appears doubtful the public plan can pass the Senate.

White House political adviser David Axelrod said Obama is "not walking away" from a public plan. But asked if the president would veto a bill that came to him without the option, Axelrod declined to answer. The president "believes it should be in the plan, and he expects it to be in the plan, and that's our position," Axelrod told The Associated Press. Asked if that means a public plan has to be in the bill for Obama to sign it, Axelrod responded: "I'm not going to deal in hypotheticals. … He believes it's important."

The biggest challenge Obama faces in his prime-time address is to take ownership of health-care legislation that until now has been shaped by political conflicts in Congress. Lawmakers return this week from a summer break that saw eroding public support for an overhaul and contentious town hall meetings in their districts.

The idea of a public plan has become a symbol for the reach of government in a revamped health-care system.

Supporters say it would give workers and their families similarly secure benefits as older people now get through Medicare, while leaving medical decisions up to doctors and patients. The plan would be offered alongside private coverage through a new kind of purchasing pool called an insurance exchange. At least initially, the exchange would be open to small employers and people buying coverage on their own.

Insurers say they could never compete against the price-setting power of government. Employer groups warn it would undermine the system of job-based coverage.

More here

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