Friday, November 06, 2009

Attack in NHS hospital 'every three minutes'

Someone is attacked in an NHS hospital in England every three minutes as doctors describe Emergency rooms as 'war zones', official figures show

Nearly 170,000 violent incidents take place in England's NHS hospitals each year, data obtained under the Freedom of Information Act has revealed. Labour's laws on 24-hour drinking are being blamed for alcohol-fuelled violence in accident and emergency departments in particular. There have been several murders and rapes at hospitals in recent years and thousands of attacks annually involve the use of knives and other weapons. Almost one in four attacks results in injury, yet only a fraction of them are ever reported to the police.

The statistics reveal the dangers that doctors, nurses, paramedics, patients and visitors face in our hospitals on a daily basis. Some hospital A & E departments have been described as "war zones" on a typical Friday or Saturday night. Staff report having knives pulled on them and being punched, kicked and spat at while running battles between rival gangswith knives have been reported in in A & E departments.

Health unions and patients' groups branded the figures "shameful". Shadow Health Minister Mike Penning said the figures showed the Government's promises to tackle violence within the health service to be "worthless".

Of 247 NHS trusts in England, nearly half responded to the Freedom of Information Act request for the number of violent incidents that had taken place "on hospital grounds". They reported 80,831 violent incidents in 2006 and 74,712 in 2007 – in total and an average of 77,772 a year. The same scale of violence across the remaining trusts would see a total of 169,997 incidents taking place each year.

The responses revealed several murders and rapes at hospitals in 2006 and 2007. Among them, paranoid schizophrenic Telahum Tedola, 36, strangled Rosalind McManus, 58, to death. She was in the next bed on a mixed sex ward. Both were being treated in August 2007 at Birch Hill Hospital, Rochdale, Greater Manchester, which is overseen by Pennine Care NHS Foundation Trust.

In April 2006, trainee accountant and former altar boy Stuart Harling, 19, stabbed nurse Cheryl Moss, 33, more than 70 times in a frenzied attack. He had spent months playing violent computer games and researching how to kill. He picked her at random after spotting her taking a cigarette break on a secluded path in the grounds of St George's Hospital in Hornchurch, Essex.

Of the reported outbreaks of violence, 1,496 involved weapons in 2006 and 1,160 in 2007 – an average of 1,328 equating to around 2,902 across all the trusts each year.

In March, a report likened some wards at shambolic Stafford Hospital to a "war zone" and said that patients had been wandering around the hospital fighting each other. In May, police had to seal off Ealing General Hospital's A & E department in west London for six hours after a gang knife fight erupted in the grounds. Last year, rival gangs armed with knives clashed in supposedly secure treatment areas at London's King's College Hospital A & E unit until 20 police officers arrived.

In 2006, 18742 attacks were recorded as having caused injury and 18,236 in 2007 – an average of 18,489 which means around 40,414 incidents result in harm annually across all the trusts. But only 4,317 of the attacks were ever reported to the police in 2006 and 4,372 in 2007, an average of 4,345 a year which would equate to 9,497 across all the trusts annually.

Nottinghamshire Healthcare NHS Trust had the highest number of violent incidents - 14,725 in total over the two years with 554 involving weapons. Other trusts with a high number of total attacks over the two years include Kent and Medway NHS and Social Care Partnership Trust (11,624), North Staffordshire Combined Healthcare NHS Trust (9,603), Birmingham and Solihull Mental Health NHS Foundation Trust (7,735) and Lancashire Care NHS Foundation Trust (6,244).

Previously published statistics have only shown attacks on NHS staff with 55,709 in 2006/7 and 55,993 in 2007/8.

A spokesman for Nottinghamshire Healthcare NHS Trust, a mental health trust which oversees Ramptom Hospital, said the incidents classified as violent included verbal abuse, threats and vandalism as well as assaults. He said: "Due to the nature of some of the Trust’s services covering low, medium and high secure units, some of which are the only services of their kind in the country, we deal with patient groups with very complex and challenging behaviours which can result in a higher occurrence of violent incidents."

Karen Jennings, head of health for union Unison, demanded a "zero-tolerance" approach to violence in hospitals. She said: "There is no doubt that the binge drinking culture and more round-the-clock drinking has led to an increase in the number of attacks on staff. "Some A & E departments are like war zones on an average Friday and Saturday night. "It is not only frightening for the staff working there but also for the other patients turning up for care they need."

Michael Summers, vice-chairman of the Patients Association, said: "These figures are very worrying. "It is difficult enough for doctors and nurses to cope with the volume of work they face these days. It is really quite shameful that staff are also having to tolerate violence on a regular basis. "Particularly, in the London area, we are seeing knife-wielding teenagers following stab victims to A & E units, which are just not equipped to deal with that level of violence. "The amount of drunkenness among young people and the extending of the hours they are able to drink plays a part."

Shadow Health Minister Mike Penning said: "These figures are yet more evidence of a fearful problem that the Government has allowed to go on for far too long. "Assaults on patients and staff unjustly undermine the dedication of the NHS workforce. "Regrettably, Labour's promises to tackle violence and abuse within the health service seem worthless."

A Department of Health spokesman said: "Any violence in hospitals is unacceptable. "Violence not only harms the immediate victims. Incidents can also divert healthcare professionals from providing essential care to patients." "The NHS Security Management Service works with employers in the NHS to prevent violence where possible and to have offenders punished when it does occur."


The public's best option: Less government, more choice

by Jeff Jacoby

"MY GUIDING PRINCIPLE is and always has been that consumers do better when there is choice and competition." So said President Obama in his address to Congress on health care, making an argument for a government-run "public option" to sell health insurance that many Democrats have echoed. In 34 states, Obama noted, three-fourths of the insurance market is controlled by five or fewer companies. "Without competition, the price of insurance goes up and the quality goes down." But add a public option "administered by the government just like Medicaid or Medicare," he said, and competition would revive.

No, it wouldn't.

A government-run health insurer would radically tilt the health-insurance playing field. It would amount to a new entitlement program, able to undercut the price of private insurance by squeezing hospitals and doctors, reimbursing them at below-market rates. "Just like Medicaid and Medicare," which also underpay medical providers, the public option would force hospitals and doctors to charge private insurers more. Those insurers, in turn, would be compelled to raise their premiums, eventually losing millions of customers to the government plan.

Obama and other Democrats insist that any public option would have to be self-supporting, properly balancing its premiums and risk and not expecting the government to cover its losses. Sound familiar? The same assurances were made about Fannie Mae and Freddie Mac.

"I have no interest in putting insurance companies out of business," the president insists now. As a US Senate candidate in 2003, he sang a different tune: "I happen to be a proponent of a single-payer universal health care program. . . . But as all of you know, we may not get there immediately." Has he changed his mind? Or only his talking points?

More competition among health insurers is a consummation devoutly to be wished. But there are far better ways to get there than a public option. Here are three:

* Tear down the barriers to buying health insurance across state lines. Under federal law, states are permitted to regulate "the business of insurance" as they see fit, and most of them have seen fit to allow the sale only of insurance policies licensed by their own state insurance commissions. As a consequence, there is no competitive national market for health insurance; there are 50 state markets instead, most of which are dominated by a handful of insurers. This, says Michael Cannon of the Cato Institute, is the "original sin" of health insurance regulation.

When it comes to almost any other product or service, Americans would find a ban on interstate commerce and competition intolerable: Imagine being told that you could buy a car or a computer only if it was manufactured in your state. Consumers in the market for a mortgage are free to do business with an out-of-state lender; those in the market for health insurance should be equally free to do business with an out-of-state insurer.

* Repeal mandatory benefits that make health insurance needlessly expensive. Compounding the lack of interstate competition is the way states drive up the cost of health insurance by making certain types of coverage compulsory. Consumers and insurers should be free to work out for themselves just how comprehensive or limited a policy should be. But state mandates prevent such flexibility by requiring insurance companies to sell a fixed array of benefits that many customers may not want. Individuals seeking plain-vanilla health insurance -- a policy that will cover them, say, in case of major surgery or catastrophic illness -- may find themselves forced to pay for a policy that also covers acupuncture, in vitro fertilization, alcoholism therapy, and a dozen additional treatments.

When compulsion takes the place of competition, the result is invariably less choice at higher cost.

* De-link health insurance from employment. Nothing distorts America's health insurance market like the misbegotten tax preference for employer-sponsored health insurance. Until that preference is removed, tens of millions of Americans will continue to rely on their employers' health plan instead of buying health insurance for themselves, they way they buy every other type of insurance. Fix the tax code, and no longer could insurance companies routinely bypass employees and deal only with their employers. Instead there would be intensive competition for individual customers -- and the lower premiums such competition would yield.

Yes, Mr. President, consumers do benefit from choice and competition. The key to both is not more government regulation and control, but less.


New Video Warns Americans that European Style Healthcare is Not the Answer

In a video released today by the Center for Freedom and Prosperity Foundation (CF&P), Eline van den Broek of the European Independent Institute warns that European-style healthcare is the wrong approach and that problems in the U.S. healthcare system are the result of too much government intervention already.

In the CF&P video entitled, "Don't Copy Europe's Mistakes: Less Government Is the Right Way to Fix Healthcare," Ms. van den Broek specifically notes that universal health coverage is not the same as universal healthcare, that insurance mandates mean more government control, and that price controls simply do not work.

"As Ms. van den Broek explains, the right to healthcare often means the right to get in a waiting line," said CF&P Foundation President Andrew Quinlan, who also noted, "Copying Europe would undermine quality healthcare in America."

"The video shows that government intervention is undermining America's healthcare system," added Dan Mitchell, Cato Institute Senior Fellow and Chairman of the Board at CF&P. "So it is rather ironic that some politicians think the answer is to further increase the burden of government," he added.


Little real cost-cutting in current bill

Democrats in Congress are embracing the spirit of President Obama's call to slow the runaway rise of health-care costs but are shying away from some of the most aggressive techniques for achieving that. Instead of revolutionizing how care is delivered and paid for, experts say, the legislation being shaped takes a cautious approach to reining in costs. "The bills are directionally correct, but they're not going far enough," said George Halvorson, chairman and chief executive of Kaiser Permanente and the author of "Health Care Will Not Reform Itself."

In years past, policymakers tried taming health-care growth with price controls -- in government reimbursements and through managed care. The Obama administration has advocated a third way: moving away from fee-for-service payments, which reward providers for doing more procedures, to a coordinated system that pays doctors and hospitals for doing better.

Under that vision, providers would be given a few years to move to performance-based medicine, in which fees and results are published, money is directed to evidence-based therapies, and harmful errors such as preventable infections are reduced. In short, the goal is to save money by modernizing and improving.

Now, as the debate reaches a critical juncture, many are worried that the president's ambitious hopes to constrain costs could result in tepid half-measures on Capitol Hill. Among the concerns:

-- A Senate plan to tax high-priced insurance policies saves far less money -- and is less likely to change medical consumption -- than eliminating the tax exemption for employer-sponsored coverage.

-- Proposals on comparative-effectiveness research and a new Medicare cost-cutting commission have been watered down.

-- An array of Medicare pilot projects aimed at paying doctors and hospitals for quality rather than quantity would take years to be implemented nationally -- if they ever were.

-- None of the bills addresses medical liability, even though the Congressional Budget Office has concluded that tort reform could save $54 billion over the next decade.

Overall, Democratic lawmakers have turned to "tried and true" strategies for reducing spending that merely ratchet down payments rather than fundamentally changing how the health-care system operates, said Drew Altman, head of the nonpartisan Kaiser Family Foundation.

More than $110 billion worth of Medicare "savings," for example, simply comes from a cut in reimbursements to insurers that run the private Medicare Advantage program, and much of the $80 billion extracted from drug companies is in the form of higher Medicaid rebates to the government. Both proposals would reduce costs but have little to do with fundamentally refashioning health care.

What's more, Congress has a history of reversing itself on politically unpopular cuts, so it is risky to count on those savings, Altman said.

Unlike past reform efforts that barely gave a nod to tackling double-digit medical inflation, the bills this year "have some of the right rhetoric," but they fall short of real-world applicability, said Jack Lewin, chief executive of the American College of Cardiology. Without significant financial incentives and strict deadlines, he predicted, few doctors would rush to move toward the coordinated-care models reformers say are needed to save money and maintain high quality.

Ralph Neas, head of the nonpartisan National Coalition on Health Care, noted that "these bills do very little in terms of reining in long-term cost growth," adding: "There is not enough in the public sector and virtually none in the private sector."

More here

Obama plan neglects importance of incentives

While undoubtedly well-intentioned, President Barack Obama’s health care reform plan ignores a central concern of economics. Economics is the science of incentives. As most economists learn early in their careers, an efficient, productive society is one in which individual incentives are aligned as closely as possible with desirable social goals. Consider, for example, Adam Smith’s observation that in most markets producers find it in their self-interest to meet other peoples’ needs.

That is why most economists reject socialism, in which everyone at the bottom has a self-interest in undermining a plan imposed by a few people at the top.

It turns out there’s something worse than socialism. It involves giving everyone an incentive to undermine the top-down plan, then imposing a collective punishment on them when they respond to the perverse incentives. That is the way Obama proposes to control health care costs.

Obama is not alone. This is the way many European countries attempt to constrain health care spending. It also is the way our federal government tries to control Medicare costs. At the risk of oversimplification, it works something like this.

The federal government sets the fees for all doctor services, but leaves doctors free to decide how many of those services to perform. The fee for a patient visit is strictly regulated, for example, but the number of visits is not. Then the government announces if total collective Medicare spending fails to moderate, it will impose an across-the-board percentage reduction in all doctor fees.

This sets up a vicious cycle in which everyone’s incentives are perverse. The more the doctors act in their self-interest, the more social waste there is, and the more we are all punished.

From the individual physician’s point of view, after all, there is nothing he or she can do to affect the total amount of spending. The doctor’s own behavior is such a small part of the whole system, it is imperceptible. But the doctor knows the only way he can increase his own income—or just maintain his standard of living—is to increase the number of services. Care that might have been more efficiently delivered in a single patient visit, for example, gets spread out over two or three visits.

When the collective spending again fails to meet the target, the government imposes another across-the-board fee reduction and the cycle starts all over again.

Suppose, however, we could put the doctor in a room with a Medicare official and free them to agree on a different compensation system. Given that opportunity, every primary care physician in the country could think of ways to save taxpayers money and increase his own income at the same time! Services provided over three visits, for example, could be provided with one visit plus a phone call or two, or one visit plus an e-mail exchange—if only the government would pay more for the one visit.

Thus if doctors could freely re-contract with Medicare, they would repackage and re-price their services in ways mutually beneficial to them and to Medicare—and the taxpayers. They would substitute higher-quality visits for lower-quality ones and economize on resources and the use of patients’ time.

What makes all dysfunctional systems dysfunctional is that people do not have the opportunity to make such mutually beneficial adjustments. Unfortunately, most private payers today are every bit as bureaucratic as Medicare and tend to pay the same way Medicare pays.

What Obama should be doing: thinking of ways to free doctors in the manner just described. What Obama is going to do instead: impose more perverse incentives on all providers.

He said so himself. In his remarks to the joint session of Congress in September, Obama endorsed the idea of an “automatic trigger” to cut payments to hospitals and physicians if Medicare spending fails to meet a target.


If you like Congress’s health plan, ya wanna buy a bridge?

When I was younger, we thought the line “I’m from the government and I’m here to help you,” the height of hilarity, invariably greeted with derisive hoots of laughter. Today it seems that any government official’s exhortation to “Trust me” is greeted as holy gospel, with nary more to be said. A case in point is the newly unveiled health plan from House Democrats, which despite taking up 1,990 pages, does not include the details of what the government’s own insurance plans would include or what they would cost or who would be forced to participate under them. Instead, a “Health Benefits Advisory Committee” of political appointees, headed by a new health czar (a/k/a a “health choices commissioner”)—are to be trusted with a blank check drawn against all of our lives and deaths, and given 18 months to decide the terms and restrictions on our future access to health care. They are empowered to define “all covered benefits and essential, enhanced, and premium plans,” and what the “cost-sharing”—i.e., insurance premium—will be for plan participants. In short, the health czar will have extraordinary powers to define what health care services insurance—public or private—will cover, at what cost, for whom. Those claiming that participation in government insurance plans is and will remain voluntary are also advised to have a little less trust and a little more skepticism: in short, read the bill.

There is little argument that the health insurance industry is not chronically in need for reform—mostly of the current government mandates that have broken it—and many more expert than I have put forth well-researched and presented proposals that effectively resolve the problems of insurance being too expensive and unavailable for some: allowing individuals to purchase insurance from any firm, anywhere (currently prohibited by law); and extending the tax-deductibility of health insurance premiums to individuals. This would arguably incent those risk-takers who currently choose to spend their money on something other than health insurance to purchase coverage for themselves, and make insurance affordable to those many for whom it is not currently. Of the remaining uncovered, as demonstrated throughout our history, ours is a nation of extremely generous individuals who time and again have provided voluntary assistance to those in need. (See, for example, our “Health Insurance Before the Welfare State: The Destruction of Self-Help by State Intervention.“) The anecdotal horror stories offered up as evidence of the dire need for a nationalized solution to health care gaps have been largely discredited upon further investigation, and there is better evidence to believe that the voluntary sector can and will pick up those others than blind faith that a centralized bureaucracy will do so.

Bay Area commuters have been learning first-hand the irrevocable consequences of going along on pure faith and little evidence. Following the damage done to the Bay Bridge by the 1989 earthquake, sound proposals were made for relatively simple reform for the bridge’s shortfalls by seismic retrofitting and repairing the existing bridge. Initial projections were that the bridge could be retrofitted for $150-200 million, in about four years. And then the big thinkers entered the fray: Rather than just the same old bridge, why not a whole new one? The bureaucrats duly studied the question, and decided that for $843 million a replacement bridge could be built that would be safer and last longer.

But soon, rather than simply providing a secure form of transportation between the East Bay and San Francisco, the bridge was completely repurposed. As Berkeley’s mayor put it, the bridge “should make a statement about the beauty of our side of the bay.” Oakland’s public works director likewise chimed in, calling for a “world-class design”—a bridge capable of “creating an inspirational identity for Oakland and the East Bay.”

Eventually, the story was a floated—and bought—that a new bridge could be built for $987 million, and take eight years, versus retrofitting for $909 million. Hardly a dime’s worth of difference! And thus began a saga in which a politically-appointed “Bay Bridge Design Task Force” eventually selected a design for a bridge never before built, protested by knowledgeable engineers as unsafe, especially for the seismically active Bay Area, and for which no bids matching projections could be obtained—none of which interfered with actually proceeding to build to a “signature design” rather than a functional mode of transportation.

The bridge is currently projected to be completed in 2013, at a cost of $6.3 billion, but no one now expects those dates or dollar figures to hold, any more than any of the previous ones did. Two months ago, while work was being done to tie-in one of the newly-built sections to the existing bridge, serious problems began manifesting themselves. A retrofit to get the bridge reopened nearly on schedule was hastily fabricated, which dramatically failed last week in the middle of Tuesday evening’s rush-hour. Meanwhile, the previous bridge has been being dismantled, removing any possibility of a fall-back. Thus, one of the nation’s busiest bridges, carrying an estimated 270,000 vehicles per day, was closed for five and a half days as engineers experimented with fixes for a “signature design” gone wrong.

Low-tech, low-cost reforms to resolve current problems do not make heroes of elected officials and do not provide opportunities to enure vast new budgets and powers to them; vast new “replacement” schemes do. The current, largely extremely well-functioning, health care industry does not need replacing by a federal plan any more than our utilitarian but slightly flawed Bay Bridge needed this new “world class” design, so beautiful in the eyes of its bureaucratic proponents. If Americans buy this health plan, they can expect to see spiraling costs and shrinking benefits, in line with the actual record of every other government program. If politicians can’t fix our schools or our bridges, why do we want to hand over our very lives?


No comments: