Saturday, November 28, 2009

Another catastrophic British hospital

A hospital trust’s “systemic failings” have led to neglect, poor nursing and deaths, regulators have found. Problems at Basildon and Thurrock University Hospitals NHS Foundation Trust, Essex, included patients being left on dirty trolleys, high rates of infection and bedsores caused by poor hygiene and a lack of basic nursing care. Those contributed to an estimated 71 extra deaths last year among accident and emergency patients.

The Care Quality Commission (CQC), an NHS watchdog, said that the trust had reported “persistently high mortality rates” which had not improved, despite warnings. The commission’s inspectors, who conducted unannounced visits to Basildon and Thurrock over the past year, noted blood on floors, curtains, equipment trays and a child’s blood-pressure cuff, mould on life-support machines and resuscitation room equipment that was out of date. The trust was also found to be making patients wait up to ten hours in its emergency department rather than the national target of four hours.

The mortality rate for emergency admissions was 6.1 per cent last year. The national average is 4.4 per cent. Based on about 4,200 patients seen in A&E at the trust last year, this would have led to 255 deaths, an increase of more than 71 deaths compared with what would be expected according to average mortality rates.

The high death rate prompted comparison with the larger Mid-Staffordshire NHS Foundation Trust, where an official report published in March found that appalling emergency care had led to between 400 and 1,200 patients dying needlessly.

Care at Basildon and Thurrock was rated as “good” by the commission in October. But it said that it had lost confidence in the ability of Basildon and Thurrock trust’s management to address the failings that it found on subsequent checks. It believes that the trust could be in breach of its foundation trust authorisation, and therefore has asked Monitor, the independent regulator of foundation trusts, to use its powers to take action. Monitor has the power to dismiss the board of the organisation or take further control.

Most of the inpatient care at the trust is provided at Basildon University Hospital, which has 777 beds. Outpatient care is provided at Orsett hospital.

The trust was one of the first in England to be granted foundation trust status in 2004, which affords it the freedom to manage its finances and a degree of independence from NHS control.

Cynthia Bower, the commission’s chief executive, said: “The trust has taken our concerns seriously but improvements are simply not happening fast enough.”

Norman Lamb, the Liberal Democrats’ health spokesman, said: “People have a right to know how on earth a hospital can be rated ‘good’ a few weeks before such serious failings come to light. “This Government has set up a labyrinth of bodies and inspectors which are meant to ensure high quality standards in our hospitals but it simply isn’t working. This is yet another case where a hospital has passed the test on paper but where real patient safety has clearly been compromised.”

Andrew Lansley, the Shadow Health Secretary, said: “It is unforgiveable if any lives have been needlessly lost. We need to know what happened after the Government found out about the tragedy at Stafford Hospital. Other hospitals with high mortality rates, such as Basildon and Thurrock, should have been looked at rapidly and effectively by regulators and ministers to ensure that patients were being treated safely.”

Mike O’Brien, a health minister, said that Monitor would rigorously oversee progress on the issues raised by the commission. “We expect these issues to be dealt with quickly and effectively to ensure high quality, safe care for patients,” he said. Michael Large, the trust chairman, said: “I want to reassure our local community that the safety and well-being of our patients is our highest priority. Monitor acknowledge that we have an effective programme in place to make further improvements.

“We welcome the opportunity to work with advisers to specifically focus on the areas where we need to make rapid changes. We have had expert independent clinical advice and nothing has pointed to a fundamental problem with clinical care.”


Maternity funding still not being delivered, British midwives claim

Millions of pounds of government funding intended to improve maternity care is still not reaching frontline services, midwives say. Despite a rising birthrate, nearly a fifth of the heads of midwifery said that their budget had been cut, and almost a third had been asked to reduce their budgets. Last year the Government promised £330 million of extra funding for maternity services, but this has not been ringfenced.

The results, from a survey across Britain by the Royal College of Midwives (RCM), come as the Health Secretary is due to speak at the union’s conference in Manchester. Andy Burnham will today announce a new “Start4life” campaign highlighting the importance of breastfeeding and healthy eating from infancy.

The RCM said that 5,000 more midwives were needed to provide safe and quality care to new mothers. Ann Keen, a health minister, said that it was up to NHS trusts how to invest the additional money. “Where funding is not reaching maternity services I call on Heads of Midwifery to challenge their PCTs,” she said. “We recognise there are concerns around staff morale and attrition rates and we are working with the Royal Colleges and the NHS to address these areas.”


Australia: Another man dies because of an incompetent government ambulance service

No funds for a GPS in each ambulance but plenty of money for a metastasizing bureaucracy

A NEW South Wales man suffering from a heart attack died before ambulance officers reached him because they got lost and did not have GPS, his wife says. The man's wife of 54 years, Velma McFadden, phoned emergency services from a property on the outskirts of the village of Cullen Bullen, near Lithgow west of Sydney, on September 28, she told Macquarie Radio. She waited for the ambulance to arrive, only to be told it was lost. "He was alive when I started CPR," Mrs McFadden said.

Mrs McFadden said a man waited at the local pub for the ambulance so he could direct it to Mrs McFadden's property, two kilometres from the pub. She received a call advising the ambulance was lost. "I was told they haven't got GPS in their ambulances," she said. "That they would have them up here in a couple of years time in the western area."

By the time the ambulance arrived Mrs McFadden's husband was dead.

In a separate incident in far northern NSW this week, an emergency services operator hung up on a man who needed help at a remote property near Boomi. Stuart Jamieson dialed triple zero to get help for a local man who had become seriously unwell after working in the heat. The call was terminated because Mr Jamieson was unable to provide a street number and the operator could not find his location on a map.

The incident followed an inquest earlier this year that found triple zero operators bungled their response to calls for help from Sydney schoolboy David Iredale because they did not have a street address. The 17-year-old died after he became separated from his two classmates on Mount Solitary during a three-day trek in 2006.


Australia: Man waits six years to see a public hospital doctor

TOWNSVILLE man Bill Edwards has waited six years to see a specialist at the Townsville Hospital. Mr Edwards was diagnosed with tinnitus, or ringing in the ears, by his family doctor on November 25, 2003 and was referred to see an ear, nose and throat specialist at Townsville Hospital. But on Wednesday, six years later to the day, Mr Edwards said he was more likely to win the lotto than see an ear specialist. "To me it's more ludicrous than upsetting," he said. "Waiting six years for an appointment is just ridiculous."

Townsville Health Service District executive director of medical services Dr Andrew Johnson yesterday said the six-year wait wasn't good enough. "Waiting six years for a specialist appointment is clearly not good enough and we apologise unreservedly for this regrettable delay," he said.

Mr Edwards, now 54, was diagnosed with tinnitus after taking the drug Zyban to help him stop smoking in 2003. The condition is a possible side-effect for a small portion of the population who take the drug. "I've still got ringing in the ears and it seems like I'm stuck with it," Mr Edwards said. "I just want to have it physically checked out and I need the advice of a specialist on how to proceed. "I'm fairly sure that once you've got it, you can't get rid of it but I would still like to know one way or the other."

Dr Johnson said the Townsville Hospital only had one full-time ear, nose and throat specialist on its staff, who saw around 15 patients a week. Another specialist was due to start in January. "We've had difficulty recruiting ear, nose and throat specialists as we're in competition on a global basis for skilled staff," Dr Johnson said. "Unfortunately, this has affected patients who need to see such specialists." He said the hospital had 1692 referrals for appointments with ear, nose and throat specialists so far this year.

Mr Edwards was admitted to Townsville Hospital twice since 2003, for a back operation in 2006 and for an eye problem in 2008. He said the staff were faultless. "It seems once you are in there it's fine but getting in there is the hard part," he said. "I'm on the lowest scale of urgency but ... even if they saw 10 patients a day - that's 50 a week - I'd have more chance of winning the lotto. "I'm on a disability pension and ... I am entitled to medical help."

Dr Johnson said the hospital had scheduled an appointment for Mr Edwards within the next three months. [Big of him!]

Opposition Health spokesman Mark McArdle said Queensland's hospital waiting lists were the worst in the country. "Queenslanders are putting themselves at risk when they place themselves at the mercy of a health system which is pathologically incapable of meeting their needs," Mr McArdle said.


Hiding Health Reform's Real Costs

Senate Democrats say their reform bill will cost $848 billion over 10 years. They're misleading the public by starting the count in 2010. The true cost would be $1.8 trillion over a decade. The $848 billion figure is based on a 10-year run beginning in 2010 when there will be little, if any, spending — even though the taxes that fund the new welfare state program will begin the next year. In fact, only 1% of the spending will come in the first four years of the 10 years the Democrats are counting, according to the Congressional Budget Office.

To understand the real 10-year cost, the clock needs to be started in 2014. It's the first true year of spending. After four years of minimal activity, almost $50 billion will be spent in 2014. The spending roughly doubles in the next year and jumps by about 50% in 2016. By 2023, the real 10th year of the program, the federal government will spend nearly $270 billion. Add up all 10 years, and the price tag is $1.5 trillion, nearly twice as costly as the Democrats' bogus estimate.

And that's a humble beginning. The five years after that, which are not shown on the accompanying chart, would cost an additional $1.7 trillion, says Jeffrey Anderson of the Pacific Research Institute. "Thus," Anderson wrote Monday in National Review Online, "the true first-15-year costs of the bill would be a cool $3.5 trillion -- according to the CBO's projections."

But let's not stop there. As long as we're discussing real costs, we should mention the estimate made by the Cato Institute's Michael Cannon. He projects that the House bill, passed Nov. 7, will cost $2.5 trillion over the decade that the Democrats are using for their estimate. His assessment includes the $250 billion that's been removed from the health care bill to be voted on in separate legislation. This is the "doctor fix" that's supposed to ensure that Medicare reimbursements for physicians won't be sharply cut.

Cannon also prices in the cost of the individual mandate -- the requirement that those who don't have health insurance buy it for themselves -- because the costs of the premiums are not included in the CBO's estimates.

Democrats did this because they learned from a previous mistake. The CBO included the cost of individual mandate premiums in the Clinton 1994 health care plan, and it was a primary reason why that legislation failed. This time, though, with the help of White House Budget Director Peter Orszag, who was CBO director in 2007 and 2008, they were able to hide the costs.

Supporters of health care reform simply haven't been honest about the cost of either bill. The Washington Post editorialized a week ago about "fantasy savings" in the Senate plan. Republican Sen. Kit Bond of Missouri says the entire reform effort is "a trillion-dollar scam." Cannon calls the House's muddying of the facts "the biggest fiscal obfuscation in the history of American politics." "The current leadership," he wrote in National Review Online the day before the Nov. 7 vote, "has rigged the legislation so that 60% of its total cost will not be made public by the CBO in advance of the House vote."

Though accurate, those are all mild descriptions of what the Democratic leadership is trying to do to the country. If it successfully forces its expensive agenda on an ostensibly free people, it will have committed an act that some will justifiably consider to be a crime.


Time for an Alternative to PelosiCare

As it becomes increasingly clear in the light of day that the bill passed by the U.S. House in the dark of night cannot find the necessary votes in the Senate, it is time for leaders to explore alternatives that have the support of the American people and will set us on a path to contain costs and achieve our goals without massive tax hikes and ever more spending.

Last month my firm surveyed 500 nationally representative registered voters about competing visions for health care reform. The results were clear: voters want a plan in line with what GOP leaders offered as their alternative on Saturday night. Voters preferred a comprehensive, step by step, common sense restructuring of the health care system over the massive, incredibly expensive, one size fits all, all at once plan offered by Speaker Pelosi. Voters were especially drawn to reforms which reduce the costs to consumers without adding to the deficit, create no new government agencies, and are less costly than the Democrat’s plan.

This should be welcome news to wary Legislators, especially those from red states and red districts. The public is not ready for a rapid and radical transformation of the health care system – they prefer a step by step solution to accomplish meaningful reforms. A strong plurality of voters believe that the President and Congress are trying to accomplish too much when it comes to healthcare and an overwhelming 63% of voters agree that “my health care is too important to risk on one gigantic piece of legislation rushed through Congress. I would rather see Congress take a more thoughtful step by step approach, focusing on common sense reforms.”

Support for this step by step approach grew as we added more components of the Republican and Democrat plans: support for the GOP plan soared when a “no new tax” pledge coupled with an incremental approach was tested against a comprehensive reform plan that includes tax increases. Indeed a clear consensus emerged from the data: Americans believe that if we make the right decisions, we can reform our health care system without raising taxes.

Our survey also shows that liberals are misreading the American public with their overwhelming emphasis on coverage, to the exclusion of cost reductions. Americans are indeed concerned about access to care (83% say “finding a way to provide health insurance coverage to most Americans” is an important part of health care reform), but there is greater concern and demand for solutions that lower costs. A nearly universal 97% deem “making insurance more affordable” an important part of reform, with 69% rating it extremely important.

Even when we asked voters to make direct tradeoffs between increasing coverage, lowering costs, and improving the quality of care, their preferences were clear. Respondents were asked what percentage of a health care reform plan should be focused on each of these three goals - 55% of voters assigned more weight to cost than they did coverage, and on average they assigned cost seven times the weight and importance they gave to coverage. The Democratic plan, with its myopic focus upon coverage while doing almost nothing to decrease health care premiums for most Americans, misses what Americans feel is the most crucial part of the debate.

Ultimately, when asked to choose between complete descriptions of the Republican and Democratic plans (without labeling them such), voters chose the GOP plan: 63% chose “a limited, incremental, step-by-step approach to reform, which has no new taxes. This plan would lower premiums; but would not do anything to address the number of uninsured Americans. This plan would go into effect immediately;” and only 37% preferred “one comprehensive reform bill that would include multiple tax increases, would minimally impact premiums, but would provide insurance to most Americans. This plan would not go into effect for three years, though the tax raises would occur immediately.”

We have worked closely with Congressman Dave Camp as he helped forge this alternative plan and it is clear to us, clear to Congressman Camp, clear to congressional Republicans, and clear to 39 moderate Democrats, America is ready for health care reform – just not a sweeping re-creation of the entire system. Far from acting as the party of “No”, Republicans are showing a way forward on this debate that fits the prescription required for our ills. We hope in the coming days that a majority of the US Senate will also come to understand this as well. If they do, we can achieve meaningful reforms that the American people can agree on, and take a stop toward restoring their confidence in the legislative process and their elected representatives.


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