Saturday, October 03, 2009

Fears over out-of-hours medical care in Britain after fatal patient overdose

The health regulator has urged NHS trusts to check the safety of their private out-of-hours GP cover after the death of a patient given an overdose by a locum doctor. An investigation by the Care Quality Commission (CQC) said the case of David Gray, 70, who was given ten times the normal dose of the painkiller diamorphine, suggested the monitoring of independent care in England is a “nationwide problem”.

Primary care trusts (PCTs) have been forced to hire private companies and health staff to provide out-of-hours care since 2004, when contract changes by the Department of Health let GPs opt out of night and weekend care. Most have taken up the option.

The CQC’s interim report, released today, said it feared PCTs across England may not be effectively monitoring out-of-hours services and risk failing to spot patients’ safety concerns. Investigators examined the service provided by Take Care Now, the company that employed Dr Daniel Ubani, who accidentally gave Mr Gray a fatal overdose in February last year.

The German GP, who was working his first out-of-hours shift in Britain, admitted he was exhausted after having only three hours’ sleep before working for a Cambridgeshire health trust.

CQC said monitoring varied across all five trusts served by Take Care Now, NHS Worcestershire, NHS Cambridgeshire, NHS Suffolk, NHS Great Yarmouth and Waveney and NHS South West Essex, leading the watchdog to believe “this might be a widespread problem”. Cynthia Bower, its chief executive, said these examples were “only scratching the surface”. She said: “Although we are still in the early stages of our inquiries, we believe this may point towards a national problem. We are, therefore, encouraging PCTs across the country to scrutinise in more detail the out-of-hours services they commission.”

The report comes two years after an investigation into the death of Penny Campbell, 41, found serious flaws in the out-of-hours system. The journalist died of organ failure in March 2005 after consulting eight doctors over four days. The inquiry criticised one private company, Camidoc, but also identified weaknesses in out-of-hours care arrangements across England. Miss Campbell’s partner, Angus MacKinnon, a journalist from London, said: “It’s pretty alarming and depressing that some trusts are still not monitoring out-of-hours services adequately, despite tragedies like that of Mr Gray and my partner Penny. “It only confirms my belief that patients would be far better served if responsibility for out-of-hours care was returned to local GPs and taken out of the hands of agencies.”

The latest inquiry found Take Care Now had difficulty filling shifts, particularly for doctors, and said this put pressure on other staff. The report said: “Take Care Now needs to complete its work on its policy for managing medicines, as it includes some information that is currently too generic or not appropriate for out of hours.” David Cocks, the chief executive of Take Care Now, said the company welcomed the interim findings and was continuing to work with the CQC. The regulator’s final report is due early next year.

Mike O’Brien, the Health Minister, said patient safety was paramount and PCTs had a “clear, legal responsibility” to provide safe, high quality out-of-hours care. An inquest into Mr Gray’s death is due to be held early next year. Dr Ubani was given a nine-month suspended sentence and a fine of €5,000 (£4,500) in Germany in April for causing death by negligence.


Britain's "free" healthcare has become unaffordable

Britain must charge for health care and raise retiring age to escape debt crisis, says IMF

Gordon Brown was warned last night to raise the retirement age above 65 and introduce NHS charges to tackle the soaring state deficit. In a devastating intervention, the International Monetary Fund called for radical changes to the pension system and spending cuts that go far beyond the plans outlined by the Prime Minister this week. The global watchdog said root and branch changes to public sector spending would be necessary to 'help keep a lid on the debt' and restore financial stability.

The IMF's broadside is highly unusual ahead of an election and reflects grave concern at the debt mountain built up by the Brown government. The public reprimand will rekindle memories of the humiliation of the Callaghan government in 1976 when the IMF forced massive budget cuts on Britain to deal with the collapse of the pound.

Treasury ministers privately admit that the budget deficit is expected to rise to £200billion this year - £25billion more than the Chancellor predicted in the Budget. That is the equivalent of £3,257 of debt for every man, woman and child, or £9,457 for the average family.

Oliver Blanchard, the IMF's top economist, told a press conference at a joint annual meeting with the World Bank that the next British government will 'have to take measures that improve the medium-term debt outlook'. He added: 'That means reforms of the retirement system, that means reform of the healthcare system.'

The IMF said that radical reform of pensions should lead to a rise in the national retirement age from 65 and save billions of pounds. And they called for politicians to target 'unfunded' final salary public-sector pension schemes which will potentially cost the the Exchequer up to £1trillion.

Mr Blanchard said reform was vital, adding that it would be 'a joke' if the Government settled instead for new fiscal rules that might be torn up at times of crisis. The IMF estimated that by next year Britain's debt will represent 81.7 per cent of output. Even with planned cuts and tax increases, it predicted a figure of 98.3 per cent by 2014.

There was a glimmer of hope for Alistair Darling in that the IMF raised Britain's growth forecast for next year to 0.9 per cent from 0.2 per cent. The Chancellor's March budget went for a more optimistic 1.25 per cent.

The upgraded UK forecast was accompanied by caution that unemployment will continue to rise from 7.6 per cent of the workforce this year to 9.3 per cent next year. That would see three million without jobs.

The IMF also warned that Britain risks a new house price slump, despite an apparent recent market upturn. Their global outlook pointed to ' further large declines'.

In a bid to ease public concerns, senior Cabinet sources have revealed that Labour plans to make spending cuts and asset sales worth £75billion, taking an axe to major defence projects and the pay of judges, top civil servants and NHS managers. Asked yesterday whether his spending plans were credible, Mr Brown told Five News: 'Absolutely. I've offered a deficit reduction plan. We've raised the top rate of tax. National insurance will rise by half of 1 per cent and we'll be cutting costs. 'There will be further announcements about how we sell off more than £16billion of assets. I have been absolutely straight with the British people.'

But Philip Hammond, Tory Treasury spokesman, said: 'It is increasingly clear that Labour have no plan to tackle the debt crisis they created. 'At their conference this week they showed absolutely no recognition of the size of the problem, and refused to be straight with people about the fact that their own Treasury documents show they are planning cuts to spending on public services. 'Labour still won't come clean with the British people.'



Sometimes, patriotism can be awkward. Especially when it means admitting to an international TV audience that your nation’s broken health care system forced you onto welfare, into adult diapers, and hobbling with a walker. And all before the age of 30. Embarrassing perhaps, but for Canadian Lin Gilbert, the time had come to share her story publicly this week. Especially after her 15-year-old son was recently diagnosed with the same health condition leading to her suffering. “As a parent, I will do anything to help him. I will borrow the money, I will do whatever it takes,” she said. “If the Canadian system can’t take care of him, I’ll find a way.”

Specifically, Gilbert wants to prevent her son from enduring the agony of government waiting lists she has known all too well. After first encountering excruciating back pain in 2001, she was forced to wait six months for an MRI. Nearly three more years passed before she made it to the top of a waiting list for spinal fusion surgery. Even then, she recalls, one surgeon refused to operate because she “hadn’t suffered enough.” Another, however, saw things differently, lobbying for Gilbert to get the procedure and successfully performing it himself.

At 38, Gilbert is now off public assistance, owns her home, and manages a financial services business. Life is good, though she still suffers immense guilt from memories of being “an absent mother,” agonized by being unable to play with her kids, and struggling to remain coherent as she downed morphine to drown the pain.

Fortunately, Gilbert’s son faces better prospects. Enter Rick Baker, a Canadian determined to improve health care in his country. Baker joined Gilbert Monday at a Vancouver hotel to speak with American reporters as part of a health care dialogue organized by the Colorado-based Independence Institute, a free market think tank where I am a public policy analyst. Baker began by offering a blunt disclosure. “I make my living sending patients to the U.S.,” he said. “This is medical tourism, but instead of sending someone to Thailand, we’re sending them to Delaware.”

Through an innovative partnership with 22 independent American surgery centers and doctors in 13 states, Baker and his American counterparts transport Canadians to the U.S. for timely care at cost savings up to 80 percent. The partnership operates largely outside the traditional health insurance system. And this isn’t just about helping Canadians. Baker now also provides a similar state-to-state service for Americans seeking more affordable or timely care.

Under Canada’s controversial federal health legislation, surgeons are prohibited from charging patients to provide “medically necessary” treatment. In addition, they are limited to performing surgeries to six hours a week. Gilbert recalled one surgeon telling her, “I spend six hours in surgery each week, less time than I spend explaining to sick patients why I can’t perform theirs.”

Currently, Baker is involved an Ontario lawsuit that could effectively eliminate such limits. “The Canada Health Act is responsible for more pain, more suffering, and more death than any other piece of domestic legislation in history,” he said. “Imagine a law that prevents you from taking care of yourself and preventing your own death.”

The Vancouver gathering came as President Barack Obama continues his push to radically expand the role of government in administering American health care. But participants weren’t just focused on bashing Canada as a role model. It was also about explaining that America’s health care woes don’t come from an absence of government, but rather too much government and not enough consumer choice.

“The Canadian system is a Ponzi scheme is that is just a little further along ours,” explained Dr. Keith Smith, an Oklahoma anesthesiologist who partners with Baker and manages his own outpatient surgery center. Baker believes real change will come only when patients are given the incentive to help control costs, freed from being forced to blindly abide by the decisions of insurance companies.

To attract patients, Smith lists the costs of all packaged surgery services on his center’s Web site, adding that if the center’s costs rise above the figures provided, patients aren’t required to pay more. “If we are wrong, we eat it.” Smith hopes the model catches on. “It’s radical. But when people go to our competitor across town and pay $21,000 [for a procedure], and then find out we could have done it for a fifth of that, they start to ask a lot of questions, starting with ‘why didn’t my insurance company go there?’”

Smith says insurance companies opt to pay more at hospitals because of a “cartel” where both inflate the total costs of services as a way to increase profit. Smith’s approach, meanwhile, also includes a commitment to not accepting any federal funding, standing in stark contrast to the position espoused by the American Medical Association, which recently endorsed Obama’s plan. Smith was unsympathetic. “The reason the AMA is endorsing this plan is that 90 percent of its funding comes from the federal government,” he said. “Less than 15 percent of AMA’s budget comes from physician dues, so they are seen largely as irrelevant.”

Hospital lobbyists argue that surgery centers like Smith’s are given an unfair advantage in that unlike traditional hospitals, they are not required to take every patient coming to their door. But Smith rejects this, saying hospitals often exaggerate costs associated with treating uninsured patients as a way to gain political sympathy and more public funding. “They love to see the uninsured person come through the door,” he said. “They run a bunch of tests and say it cost them $80,000. Meanwhile, it probably really cost $1000.” And while Smith’s center is taxed, his “not-for-profit” hospital competitors are not, a distinction Smith says helped net those in his city net up to $100 million in profit last year.

Despite the intense political opposition they face, Smith and Baker are soldiering on, building a new system that is transforming lives one at a time. “I know it sounds a bit naive, but it’s true that reform is as simple as charging less for the delivery of health care,” Baker said. Imagine that.


Australia: Ambulances get seriously ill patients to government hospitals quickly but then cannot offload them for hours

PARAMEDICS spent about 1000 hours "ramping" outside Brisbane's Princess Alexandra Hospital in the three months to the end of August, their union says. The Liquor Hospitality Miscellaneous Union said the time "wasted" by paramedics looking after patients while they waited to be accepted by the hospital's emergency department had cost taxpayers more than $50,000.

LHMU organiser Kroy Day said some ambulances spent more than four hours at a time waiting outside the hospital's emergency department to hand over a patient. "While a crew is ramping at a hospital, they're unable to respond out in the community to the lady who's had the stroke, the man who's had the heart attack," Mr Day said. "What nobody can gauge is who's died and suffered because a crew has been ramped there."

Mr Day said the problem was an issue statewide, not just at the PA, and was costing taxpayers millions of dollars that would be better spent on medical care. "On Friday night, for example, at Nambour Hospital, we had eight ambulances ramped for up to three hours," he said. "On the week of September 14 at Logan . . . at one point we had 11 ambulances ramped for up to two hours. The public need to be very scared about what's happening."

The LHMU, which is in the 11th month of enterprise bargaining negotiations with the Queensland Ambulance Service, has called for an extra 500 paramedics over the next two years.

Australasian College for Emergency Medicine Queensland chairman David Rosengren said ambulance ramping was problem at all public hospital emergency departments, including the PA. "Every single emergency physician, every single paramedic and every single patient who comes by ambulance knows that the ability to offload our ambulance patients into emergency departments is extremely difficult and there are quite often lengthy delays," Dr Rosengren said. "The problem of ambulance ramping is a systemic problem that's been around for a long time and is progressively getting worse year after year."

Dr Rosengren said a shortage in public hospital beds was to blame. "If an emergency department doesn't have a trolley to put a patient on, ambulances can't offload them," he said. "There's an inability to make space in emergency departments because they're so full of patients that can't get a bed in a hospital ward. That's clogging up the system."


Cancer Survival Rates With Government-Run Care

I’ve often said that cancer is the disease about which Americans are most concerned. It’s not hard to understand why. The American Cancer Society estimates that nearly 1.5 million Americans will have been newly diagnosed with cancer by the end of this year. We all have friends, family, and loved ones who have been affected by this terrible disease. We also have some of the world’s best physicians and scientists, who have made great strides in fighting cancer.

Prostate Cancer Awareness Month has just ended, so it is timely to bring to mind the innovation and capability of the American doctors and researchers who have made America’s prostate cancer survival rates the highest in the world. Americans’ five-year survival rate is 91.0%. It beats out the Canadian survival rate of 85.1%, trounces Europe’s 57.1%, and obliterates England’s 50.9%. As Democrats in Congress seek to make America’s health care more like the government-run bureaucracies in these other countries, I cannot help but fear that our survival rates will decline.

The United States is credited as the leader in at least eight of the ten greatest medical inventions in the past thirty years. We come to expect this in a country that rewards and promotes advancements in technology. It may seem unfair that America spends more money to develop these new treatments and drugs than other nations, but would it be worth forgoing the MRI? Heart bypass surgery? Anti-depressants?

The United States is a world leader in health care, and it should come as no surprise that American investment and market competition are the driving forces behind successes like our high cancer survival rates. That is why we need to inject competition into the health insurance market as we have the markets for providers and treatments. By allowing all Americans to purchase health insurance at the same tax-preferred rates as their employers, we can make insurance companies innovate and compete with each other to provide the best service—to strive to meet our needs.

American medicine is a field of innovation. Rewarding this innovation has brought our nation the highest prostate cancer survival rates in the world. It is now time for health insurance companies to meet the challenges of patients just as health care providers and researchers have. With market competition, we can have both high survival rates and excellent coverage for every American without government control of health care.


States Show How Not To Fix Health Care

Since the debate over the government takeover of medical care exploded onto the national stage, advocates of market-based, patient-centered reforms have pointed to the failed government health care systems of Canada and the U.K. as examples of what America should not replicate. And rightfully so. Democrat proposals have duplicated many components of these systems, creating frighteningly similar base lines here to these unsuccessful foreign models of "universal" coverage.

Yet we don't need to peer over borders and across oceans to find government health care that does not work; indeed, we have examples here in our United States. Hawaii, Oregon, Massachusetts, Tennessee and Maine have all created some version of government takeover or administration of health care, and all are a mess.

Hawaii's Prepaid Healthcare Act and its coverage mandates have left Hawaiians with fewer coverage choices, higher costs and nearly double the number of uninsured. Recent budget cuts resulted in discontinuation of its coverage for children.

Oregon's state-controlled care includes an official list that dictates what treatments will be covered based on annual budget constraints. If your disease is above the treatment line, you are covered. Below the line, you're not. However, patients being denied treatment often receive an additional note in their denial letters, the system telling them it will pay for "physician aid in dying." Oregon won't help you live, but it will help you die.

In the three years since the Massachusetts "universal" coverage plan was launched, the state still has thousands of uninsured, costs have exploded to unsustainable levels, and waiting lists for treatments have appeared.

Tennessee's "TennCare" program, an attempt to expand coverage to low-income uninsured, included dead people, escaped felons and NBA stars. It drove doctors and insurers out of the state, and has been on the brink of insolvency several times. Tennessee's Democrat governor, Phil Bredesen, recently went to Washington, D.C., to explain to Congress that government health care does not lower cost.

But perhaps the worst and closest example of why a federal takeover of health care won't work comes from Maine. The name of Maine's government-run universal health care plan "Dirigo Health" is derived from the state's motto "to lead." Fitting, as this failed attempt at government health care has led its people right off a cliff. Maine's universal coverage plan is most similar to the plans circulating on Capitol Hill. It was proposed in May 2003 by Democrat Gov. John Baldacci and passed a scant four weeks later. Much like the $787 billion federal "stimulus" plan that passed Congress in February of this year, nobody read the Dirigo plan either.

While greasing the pipeline for quick passage of Dirigo Health, the governor assured that all of Maine's 128,000 uninsured would be covered by 2009, the bureaucracy would be streamlined and health costs lowered, and the plan would fund itself based on system savings with no tax increases, a similar claim to what President Obama has said about a new federal plan.

Six years after it was passed, it has insured only 3% -- roughly 3,400 -- of the 128,000 promised. By 2007, the system was so broke that it closed to new enrollees. It still has not reopened and has also cut and capped benefits. The "streamlined" bureaucracy has cost the state's taxpayers $17 million in administrative costs to cover 9,600 people, leading one to wonder if there are more bureaucrats in the system than enrollees. Systemwide insurance costs have increased 74% since Dirigo was passed, and the governor and legislature have tried -- unsuccessfully -- to raise taxes to fund the system.

Dirigo's more "efficient" bureaucracy started out with an aggregator agency for health records and a cost administration agency, but it now includes numerous councils to study this, that and anything else bureaucrats can conceive. These agencies also dictate to providers how much they can spend on new technologies and diagnostic machines even though these costs are borne by physicians and hospitals and not the state. Dirigo has failed because it lacks market forces, ignores the nature of the uninsured and was more interested in bloating its bureaucracy than providing care to patients.

These states could have fixed the broken pieces of the system by implementing market-based, patient-centered reforms that bring people into the private insurance market, thus lowering costs and increasing access. Instead, they layered enormous bureaucracies over patients and physicians, and separated them both from each other and from quality care.

Government intrusion is not reform. Congress must use the failures of state-run health care as cautionary tales of change to avoid. It's time to start pushing for real reforms that increase access and portability and, above all, protect the primacy of the doctor-patient relationship.


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