Tuesday, November 24, 2009

High rates of obesity, smoking, absenteeism and poor mental health among NHS medical staff

Health trusts must do more to help doctors and nurses exercise and give up smoking and heavy drinking, says the Government. NHS organisations will be expected to improve access to intervention programmes such as counselling or gyms as part of a drive to reduce sickness absence, which costs £1.5 billion a year. The first national audit of staff habits has found that high rates of obesity, smoking, absenteeism and poor mental health were having a direct impact on the quality of patient care.

The Health Secretary is expected to accept all the recommendations of the final review, drawn up by Steve Boorman, a leading occupational health expert, in a written ministerial statement. The review found that more than 45,000 NHS workers called in sick each day — one and a half times the rate of absence in the private sector.

However, the Department of Health has suggested that health workers should be encouraged to set an example for patients and the general public when it came to promoting healthy lifestyles.

The review found that hospitals whose staff were in poorer health were less productive and had higher rates of patient mortality and superbug infection. More than three quarters of 11,000 staff polled acknowledged that the state of their health affected patient care.

Dr Boorman, a former GP and the chief medical adviser to Royal Mail, told The Times earlier this year that health awareness among NHS staff was “very inconsistent”. He said that a clear correlation had emerged between the performance of hospitals and staff health. His recommendations include cutting smoking rates in the NHS, which are the same as in the general population, and providing more time or opportunities for staff to exercise. Health workers with musculoskeletal and mental health conditions are also to be promised access to early interventions such as physiotherapy or counselling.

The review will call on trusts to appoint health and wellbeing leaders at board level to bring down rates of obesity, drinking and smoking, and on the Department of Health to devise and implement national standards and provide resources to ensure that these standards are given priority. It estimates that reducing the number of sick days taken by staff by a third would save the NHS £555 million a year.

A Department of Health spokeswoman said: “The NHS needs to be serious about the health of its staff if it is to improve the health of the nation. All NHS organisations should have a proactive and focused health and wellbeing strategy in place.”

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Australia. No ambulance service for a Queensland country town: Uproar as patients must travel in the back of a truck

The interesting thing about this story is that it represents a deterioration of service. In earlier times, there was a regular railmotor service on which patients could be transported in some comfort. The railroad tracks are still there but are used for occasional tourist outings only. The budget of Queensland Health must have increased at least 100 times since then but the service is worse

THE sick and injured are being carted to the Mt Surprise airport on the back of trucks and utes [pickups] because the town does not have a helipad or suitable patient transfer vehicle.

The rural community, 290km southwest of Cairns, is demanding the State Government provide the basic services after a patient's trauma, following a serious accident, was increased because of the situation. In the most recent example, a patient was loaded on to the back of a ute and was subjected to an excruciatingly painful journey on the rough 5km trip. Open-sided trucks have also been used.

Outraged Mt Surprise resident Rick Tomkies told The Weekend Post these incidents highlighted the need for a suitable transfer vehicle and a helipad in the community. "Not only is the carriage of persons on the rear of a vehicle illegal but it could also cause further trauma to a seriously ill or injured person with serious consequences," he said. "Already there has been an occasion when an attending Royal Flying Doctor was injured by a flapping tarpaulin, used to shade a patient from the sun. And on another occasion, the legs of a patient became sunburnt."

Mr Tomkies said police figures showed the Mt Surprise area had a higher rate of medical evacuation rates compared with neighbouring communities and it was vital the standards were lifted to an acceptable and legal level.

A spokeswoman from Queensland Ambulance Service said the organisation recently held a community meeting at Mt Surprise to set up a first responder unit in the area. "The community were very supportive of the development of this group and several residents were identified as possible members for a first responder unit," she said. "QAS approved the application to develop a first responder unit in Mt Surprise in September and the establishment of the unit in the area will occur over the coming months."

A Department of Main Roads spokesman said: "The question of whether or not a helipad should be built at Mt Surprise is an issue for the Etheridge Shire Council". "Should Council decide to construct a helipad, the Department of Transport and Main Roads would be happy to discuss with them possible avenues for funding assistance," he said.

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Australian government’s non-solution to hospital crisis a wasteful threat to private practice

By Dr Jeremy Sammut

Under the $275 million Super Clinics program, the Rudd government is funding the start-up costs involved in bringing together GPs and allied health professionals, such as physiotherapists and podiatrists, who want to amalgamate their practices into an initial 36 ‘one-stop shops.’

This move has the potential to nationalise Australian general practice, and the Doctors’ Action group is right to be worried about the impact of Super Clinics on the traditional family GP.

Why would young doctors buy into an established practice when they join a Super Clinic for free with the capital costs paid for courtesy of taxpayers?

The legitimate fear is that state-funded Super Clinics represent creeping socialism and will render private practice uncompetitive. Once it becomes too costly and difficult to establish a private surgery from scratch, future governments might force doctors to work in Super Clinics on a salaried basis.

The official rationale for Super Clinics is they will take the pressure off overcrowded public hospitals. But in reality, taxpayer’s money is being wasted on a non-solution for the hospital crisis.

Every credible study shows that public hospitals are dangerously overcrowded because of the national shortage of hospital beds, which forces over one-third of all seriously ill emergency patients to wait longer than eight hours to be admitted to a bed.

Yet the Rudd government maintains Super Clinics have already proven worthwhile. A Tasmanian Super Clinic has reportedly reduced the number of people with minor illness turning up at the nearby emergency department by 13%.

A number of previous studies have demonstrated that patients with minor conditions such as a cold or sore toe account for only between 10 and 15% of total emergency presentations.

The same studies have also shown that treating these patients constitutes a mere a fraction, 2 to 3%, of the total emergency workload, and that it is far cheaper to treat them in the emergency department rather than incur the capital and infrastructure cost of establishing alternative GP facilities.

In other words, diverting ‘GP-style’ patients into Super Clinics is imposing a huge cost per occasion of service on the federal budget. The Rudd government’s highly inefficient spending on Super Clinics makes a mockery of its supposed commitment to micro-economic reform.

Dr Jeremy Sammut is a Research Fellow at The Centre for Independent Studies and author of ‘The False Promise of GP Super Clinics’ and ‘Why Public Hospitals are Overcrowded.’

The above is a press release from the Centre for Independent Studies, dated November 20. Enquiries to cis@cis.org.au. Snail mail: PO Box 92, St Leonards, NSW, Australia 1590.





Splits widen for Democrats over health reform

President Barack Obama’s mission to reform US healthcare vaulted another legislative hurdle over the weekend, but the scramble to secure his own party’s votes sheds light on the messy compromises that may be needed to get it to the finish line.

Fissures between liberal and centrist Democrats cracked open on Sunday in the aftermath of a procedural vote, which paved the way for the estimated $848bn (€570bn, £514bn) draft Senate bill to be debated on the floor. Leaders hope there will be a vote on the bill by Christmas. If passed, the House and Senate versions will have to be mashed together.

If this weekend is anything to go by, it will not be a pretty process. All Democrats and Democrat-leaning independents voted to push the bill forward – creating a filibuster-proof majority of 60 – but some of those votes came far from quietly. A group of centrist Democrats, unhappy about elements of the bill such as a public insurance option, managed to wring concessions from the leadership in return for their acquiescence.

In what wags have already dubbed the “Louisiana Purchase”, Mary Landrieu was offered at least $100m in extra federal money for her state. Ben Nelson won the omission of a provision that would strip health insurers of their anti-trust exemption. Blanche Lincoln won more time.

The group’s disproportionate power in the debate has antagonised some liberal Democrats. “In the end, I don’t want four Democratic senators dictating to the other 56 of us and to the country, when the public option has this much support, that it’s not going to be in it,” said Sherrod Brown of Ohio on Sunday on CNN. “But in the end, I think that all four of our colleagues surveyed this . . . and I don’t think they want to be on the wrong side of history. I don’t think they want to go back and say, ‘You know, on a procedural vote, I killed the most important bill in my political career’.”

As the debate gets going, the centrists will face increased pressure at home, where they are vulnerable to losing their seats if they are seen to let their colleagues in Washington push them too far to the left. Lobbyists on both sides of the debate are well aware of this, and are blitzing their home states with adverts.

Ms Lincoln claimed that groups had spent $3.3m on advertising in her state of Arkansas. She said she would refuse to yield to either side, but was shocked by the “unbelievable type of threats” she had received. “These ad groups seem to think this is all about my re-election. I simply think they don’t know me very well,” she said on the Senate floor.

The group, which also includes independent senator Joe Lieberman, all said they wanted more changes made to the bill in the coming weeks. “When I saw the bill I said, ‘This can be amended, this can be improved’,” Mr Nelson said on Sunday on ABC. He said language on federal funding for abortion, which is softer than that of the House bill, was one problem. He did signal he was willing to compromise on a public option, but said it would have to be much weaker than the current version, which has already been watered down to allow states to opt out. “We could negotiate a public option of some sort that I might look at, but I don’t want a big government, Washington-run operation that would undermine the . . . private insurance that 200m Americans now have,” he said.

Mr Lieberman, though, was more intransigent. “[A public option] is a radical departure from the way we’ve responded to the market in America in the past,” he told NBC. “We rely first on competition in our market economy. When the competition fails then what do we do? We regulate or we litigate.”

The weekend’s vote was a victory for Harry Reid, Senate leader, but he acknowledged that it was simply an opening skirmish in a battle that is now set to break into full force. Much of that battle will take place within his own party. “Tonight’s vote is not the end of the debate,” he said on Saturday night. “It is only the beginning.”

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Free to Choose

Affordability, accessibility, quality?the hallowed trifecta at the center of the debate over health care reform. Proponents of reform argue that these three goals must be achieved for all Americans before any reform effort can be called a success. As a means to this end, supporters of market-based solutions to the health care problem are pushing to lift restrictions preventing the sale of health insurance across state lines. They maintain that allowing consumers to shop for insurance nationwide would increase competition, thereby lowering prices.

Critics of this measure warn, however, that overturning the current ban on interstate sales of health insurance will harm, not help, consumers. They argue that such a policy would enable out-of-state insurance companies to skirt strict consumer protection laws currently at work in states like California. Essentially, these laws mandate what kinds of services and treatments must be covered by all health insurance plans in their state; and, if the interstate ban was lifted, these states would have no power to regulate the content of policies purchased by their citizens from companies based out-of-state.

To put it another way, opponents of interstate insurance sales don't want consumers to be able to choose a policy that fits their specific needs; they want them to be required by law to purchase only those policies that government bureaucrats think is best for them.

This blatantly anti-choice position is, of course, couched in terms of "consumer protection." Politicians and consumer advocacy groups insist that mandates are necessary to protect vulnerable consumers from the unscrupulous machinations of greedy insurance companies. They fear that opening the market for insurance sales across state lines will result in a "race to the bottom," in which "insurers compete to sell bare-bones policies at the lowest price, lacking benefits such as maternity care."

This rationale is the equivalent of saying that consumers looking for a cell phone should not be allowed to purchase the Jitterbug because it lacks the features of the i-Phone, or that people should be prevented from buying the Ford Ranger because the Ford F-250 Super Duty is a bigger, better vehicle with superior towing capacity and greater horsepower. There are, undoubtedly, individuals out there who would like to be able to purchase a policy that meets their basic needs?a"Jitterbug" or a "Ranger"?and who don't want and can't afford coverage for maternity care, in vitro fertilization, reconstructive surgery, or tobacco cessation classes.

The issue in question boils down to an matter of choice. The bureaucrats have decided that the people need Big Brother to dictate their health insurance decisions because they can't be trusted to make good choices themselves. This is the height of paternalism: Government knows best and damn the torpedoes.

The flip side of this seemingly benevolent government coin is that when people are unable to afford the "Cadillac" plans mandated by state law and barred from purchasing lower priced alternatives, the rest of the taxpaying public is forced to subsidize the cost of the pricey state-approved plan in an attempt to achieve coverage for all. Meanwhile, companies willing to sell basic, affordable insurance are shut out of the market.

If our representatives at the state and federal levels are serious about securing affordable, accessible, and high quality health care options for every American citizen, they would do well to support reform efforts that include a wide variety of insurance options -- options generated by the market, not by regulators. Consumer choice should guide the health insurance market, not the dictates of know-it–all bureaucrats who presume to know what's best for the rest of us.

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1 comment:

snowbird said...

Canada's Health care system

http://www.mta.ca/about_canada/study_guide/doctors/delivery.html