Saturday, November 07, 2009

Poor government hospital care 'could be killing patients'

Poor health care could be contributing to hundreds of deaths a year in British hospitals, a new report suggests

One in three patients who died within days of being admitted did not receive acceptable standards of care, an independent health watchdog found. The study reveals delayed operations, complications left untreated and surgery not carried out because theatres closed at night or during weekends. In one case a teenage cancer patient died after doctors took no action despite concerns that he might have the flesh-eating bug, necrotising fasciitis.

Although they cannot quantify figures, the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) say that poor care contributed to at least some of the more than 3,000 deaths they analysed. Patients groups described the examples listed in the report as “shocking”.

More than half of patients suffered delays in being seen by a senior doctor that postponed “timely and appropriate care”. One in seven, 13.8 per cent, had surgery delayed, while for other operations which potentially have benefited their condition were not performed.

The report also found examples of patients not being given the right drugs to prevent potentially fatal blood clots and having a tube incorrectly placed into their airway.

The findings also suggest that Government targets are impacting on patient care. In many cases initial assessments of patients were made by junior doctors rather than more senior colleagues, possibly to avoid breaching a target to have all patients processed through casualty units within four hours, according to the report.

The study also warns that change in recent years had left doctors “transient acquaintances during a patient’s illness rather than having responsibility for continuity of care.” This has created problems around handovers likely to be exacerbated by new European rules brought in this summer which limit most doctors working hours to 48 a week, it warns.

The report also found that access to vital scans could be limited, especially at night, and that one in five do not resuscitate (DNAR) orders were signed by very junior doctors who may not experienced enough to handle the sensitive issue appropriately.

The study reviewed the care of 3,153 patients who died within four days of being admitted to hospitals across Britain between the start of October 2006 and the end of March 2007. Only half of the patients were not expected to survive when they entered hospital. Appropriate care of terminal patients, such as considering reducing the number of drugs they are given, were also not taken in many cases.

Katherine Murphy, from the Patient’s Association, said that the findings ran the risk of undermining “basic confidence” in the NHS. “For almost four out of 10 patients not to get high quality care is appalling, not just for the patients who died but for those nearest to them who were not only bereaved but may be left with terrible memories of what happened.

“Some of the examples are shocking. “Life-threatening complications left untreated, poor notekeeping, seriously ill patients deteriorating without prompt action, lack of facilities for emergency surgery, avoidable complications contributing to patient death. “We're told patient safety is the number one priority for the NHS - this report suggests otherwise.”

John Black, president of the Royal College of Surgeons, said: “This hard-hitting report highlights the loss of proper team working in UK hospitals, resulting in dangerous failures of communication which make it harder and harder for clinicians to provide safe care for patients. “Earlier this month the College published a survey into the early effects of the 48 hour European Working Time limit on surgeons and found that these new rotas had almost entirely removed adequate time for handover of sick patients.”

Around 300,000 people die every year in British hospitals.


British targets 'signalled lack of trust in doctors and nurses'

NHS targets signalled a lack of trust in doctors and nurses, the Health Secretary has admitted ahead of a meeting with President Obama’s health team. Andy Burnham told an audience in Washington that the approach did not win over the “hearts and minds” of frontline staff. Labour has faced fierce criticism over the number of targets in the health service. Some targets, including patients should be processed through accident and emergency wards within four hours, have led to accusations of more serious cases being ignored.

When he became Health Secretary earlier this year Mr Burnham pledged a cull of targets. But he has said that four-hour A&E target would be kept as well as the 18-week guarantee on operations, which he has criticised the Tories for planning to scrap. Speaking to the Urban Institute, a public policy think tank, Mr Burnham insisted that health service targets were necessary when Labour came to power in 1997. “Targets drove the system hard and were the right thing to do,” he said. “But we have come to learn that the top-down approach can only take you so far. “It is not a great way to win the hearts and minds of the people who must make it all work. “Looking back now, I can see that the emphasis on targets began to imply a lack of trust in staff at the front line that became disempowering.”

Other targets introduced by Labour include to link GP salaries to things like carrying out a certain number of check-ups on diabetics in their area.

Mr Burnham gave the speech ahead of a meeting with the First Lady Michelle Obama's policy director Jocelyn Frye. He is also due to meet Kathleen Sebelius, the US Secretary of Health, during the two-day visit to America.

The NHS has become the subject of heated debate in America in recent months, particularly among opponents of President Obama’s proposed health reforms keen to cast it as a model to which their country should not aspire. One American senator claimed that the late Ted Kennedy would not have received treatment for his brain tumour on the NHS, because he was in his 70s. Daniel Hannan, the Tory MEP, also caused controversy when he appeared on American television saying that he "would not wish it on anybody". David Cameron called his views “eccentric”.

President Obama is still hoping to pass significant health reforms by the end of the year, although his plans have been watered down in the face of a sustained campaign against them.

To coincide with Mr Burnham’s visit the Department of Health released a report by the independent Commonwealth Fund which surveyed doctors in 11 countries and ranked Britain top in a number of areas including short waiting times for specialist care, quality of care and the management of chronic diseases. However, a new analysis of figures by the Organisation for Economic Co-operation and Development (OECD) shows on international rankings on death from disease Britain has slipped from 9th to 10th out of 15 since 1997, behind countries like the Czech Republic.

The latest available figures, from 2006, show that the UK ranks in the bottom quarter of European countries on deaths from breast cancer and that deaths from lung disease are 75 per cent higher than the European average. The Tories, who did the analysis, said the figures showed that Labour had failed the NHS. A spokesman for the Department of Health said that the figures were old and did not take account of recent progress made on diseases including cancer.


Woman forced to wait six-hours in Australian public hospital emergency department after suffering suspected miscarriage

A WOMAN who presented at Geelong Hospital on Sunday after a suspected miscarriage was forced to wait six hours in emergency before being told her case was not serious enough to receive an ultrasound. The young couple last night told the Geelong Advertiser how they endured a frustrating day agonising over whether their first child was still alive as they waited in a crowded waiting room for medical attention.

Pregnant Jess, not her real name, was eventually seen late in the afternoon, but was told only urgent cases with a serious health risk were entitled to ultrasounds on weekends. Instead, Jess received a blood test, followed by a secondary blood test on Tuesday, revealing she had suffered a miscarriage.

Husband Rob, also not his real name, said they should have been told they were not eligible for an ultrasound upon arrival, saving his suffering wife six hours of languishing in a waiting room.

Barwon Health spokesperson Kate Nelson said all patients were categorised using the five triage categories identified by the Australasian College of Emergency Medicine. "Unfortunately, at times of high demand, which it was on this occasion, patients with a triage category of four may experience extended waiting times or stays in a cubicle," she said in a written statement.


One Obama supporter is recklessly honest

One of the more revealing WNO soundbites in recent days was its interview with DC delegate to Congress Eleanor Holmes Norton. Not only did Norton – a close Obama associate – warn that “in our zeal to get a [healthcare] bill,” Congress may shift the cost to the middle class, she admitted that -- Obama’s assertions to the contrary -- there are no “revenues” to pay for the costly bill:

House Bill May Roil Retiree Health Care

Efforts by House Democrats to protect retiree health benefits could end up doing just the opposite while also undermining their vow to keep the health care overhaul from adding to the deficit. Section 110 of the House health care bill would prohibit employers from altering health benefits for retirees enrolled in employer-sponsored insurance plans. It would bar employers from increasing premiums or reducing benefits by more than 5% annually unless active employees get the same reduction in their health care benefits or the employer gets a waiver from the Labor Department.

But it would only apply to current retirees. Companies could discontinue benefits for future retirees. The provision might make that more likely, adding to federal health obligations down the road. The provision also would create temporary "reinsurance" subsidies for employer-based retiree plans. "This section is really troublesome," said Rep. Phil Gingrey, R-Ga. "Companies that need to make sound financial decisions, if they can't get retirees to pick up more of the cost, they'll just stop offering those benefits."

But liberal supporters say it offers much-needed protection. "This is an important provision that attempts to stem the tide in the erosion of retiree health benefits," said Alexander Hertel-Fernandez, a researcher at the union-backed Economic Policy Institute. "Employers are already shirking their responsibilities and pushing their employees onto public programs." If companies stopped providing retiree benefits, that could mean that retirees aged 55-64 could become eligible for Medicaid or government subsidies to buy health insurance on an exchange. Retirees 65 and over would likely end up on Medicare.

President Obama has pledged that reform will cost about $900 billion over 10 years. Upon releasing the latest version of the health care overhaul last week, Speaker Nancy Pelosi said: "The bill is fiscally sound, will not add one dime to the deficit." The Congressional Budget Office estimated that the bill would cost a net $894 billion and reduce the federal deficit by $104 billion over 10 years. (The gross cost was $1.055 trillion, and last-minute changes have likely boosted that to $1.2 trillion.)

The CBO stated that its initial estimate "does not reflect the impact of section 110." It did not respond to questions about whether it would estimate those costs. But they could be substantial.

In 2005, 12.5% of private-sector establishments offered retiree health benefits, according to the Employee Benefit Research Institute. That's down from about 20% in the 1997, though it has hovered around 12% since 2000. The Census Bureau reports that 22.9 million seniors aged 55-64 have employer-based coverage. The report doesn't say how many of those are retirees. Some 13.2 million seniors 65 and older receive some form of employer-based coverage — though the data don't make it clear if they get full private benefits or just "Medigap" coverage for expenses Medicare doesn't pay for. "The vast majority of private plans are Medigap," said James Gelfand, senior manager of health policy at the U.S. Chamber of Commerce.

Dropping Medigap benefits would not directly lead to higher Medicare costs. But critics suggest that seniors without such policies would push harder for expanded Medicare benefits — and fiercely resist any bid to curb Medicare spending.

The Chamber, along with 11 other business groups, including the National Association of Manufacturers and the National Retail Federation, sent a letter to Pelosi back in July arguing that "mandating benefits in this manner significantly increases both the cost and risk to the employer of voluntarily providing retiree health plans at all."

Gelfand also stated that Section 110 was a variation on a bill by Rep. John Tierney, D-Mass. Tierney sits on the Education and Labor Committee, one of three panels that drafted the House bill. His office did not respond to requests for comment.

Some argue that the reinsurance portion will stabilize employer-based retiree benefits. "The retiree health insurance pool is unstable," said Hertel-Fernandez. "Given its high costs and small size, costs can vary a lot from one year to the next. It's one reason employers drop coverage or decrease the value of their coverage. The reinsurance can bolster the prohibitions on reducing coverage."

Under Section 110, retiree plans can submit claims to the Department of Health and Human Services. If the claim is more than $15,000 but doesn't exceed $80,000, HHS can then reimburse 80% of the claim. HHS would pay claims out of a temporary $10 billion "Retiree Reserve Trust Fund." But nothing would prevent Congress from replenishing the fund if it ran short.


Health bill means the Return of the Inflation Tax

The Pelosi tax surcharge applies to capital gains and dividends

All of those twentysomethings who voted for Barack Obama last year are about to experience the change they haven't been waiting for: the return of income tax bracket creep. Buried in Nancy Pelosi's health-care bill is a provision that will partially repeal tax indexing for inflation, meaning that as their earnings rise over a lifetime these youngsters can look forward to paying higher rates even if their income gains aren't real.

In order to raise enough money to make their plan look like it won't add to the deficit, House Democrats have deliberately not indexed two main tax features of their plan: the $500,000 threshold for the 5.4-percentage-point income tax surcharge; and the payroll level at which small businesses must pay a new 8% tax penalty for not offering health insurance.

This is a sneaky way for politicians to pry more money out of workers every year without having to legislate tax increases. The negative effects of failing to index compound over time, yielding a revenue windfall for government as the years go on. The House tax surcharge is estimated to raise $460.5 billion over 10 years, but only $30.9 billion in 2011, rising to $68.4 billion in 2019, according to the Joint Tax Committee.

Americans of a certain age have seen this movie before. In 1960, only 3% of tax filers paid a 30% or higher marginal tax rate. By 1980, after the inflation of the 1970s, the share was closer to 33%, according to a Heritage Foundation analysis of tax returns.

These stealth tax increases—forcing ever more Americans to pay higher tax rates on phantom gains in income—were widely seen to be unjust. And in 1981 as part of the Reagan tax cuts, a bipartisan coalition voted to index the tax brackets for inflation.

We also know what has happened with the Alternative Minimum Tax. Passed to hit only 1% of all Americans in 1969, the AMT wasn't indexed for inflation at the time and neither was Bill Clinton's AMT rate increase in 1993. The number of families hit by this shadow tax more than tripled over the next decade. Today, families with incomes as low as $75,000 a year can be hit by the AMT unless Congress passes an annual "patch."

The Pelosi-Obama health tax surcharge will have a similar effect. The tax would begin in 2011 on income above $500,000 for singles and $1 million for joint filers. Assuming a 4% annual inflation rate over the next decade, that $500,000 for an individual tax filer would hit families with the inflation-adjusted equivalent of an income of about $335,000 by 2020. After 20 years without indexing, the surcharge threshold would be roughly $250,000.

And by the way, this surcharge has also been sneakily written to apply to modified adjusted gross income, which means it applies to both capital gains and dividends that are taxed at lower rates. So the capital gains tax rate that is now 15% would increase in 2011 to 25.4% with the surcharge and repeal of the Bush tax rates. The tax rate on dividends would rise to 45% from 15% (5.4% plus the pre-Bush rate of 39.6%).

As for the business payroll penalty, it is imposed on a sliding scale beginning at a 2% rate for firms with payrolls of $500,000 and rising to 8% on firms with payrolls above $750,000. But those amounts are also not indexed for inflation, so again assuming a 4% average inflation rate in 10 years this range would hit payrolls between $335,000 and $510,000 in today's dollars. Note that in pitching this "pay or play" tax today, Democrats claim that most small businesses would be exempt. But because it isn't indexed, this tax will whack more and more businesses every year. The sales pitch is pure deception.

As for the Senate, instead of the 5.4% surcharge, the Finance Committee bill raises taxes on "high-cost" health care plans. But this too uses the inflation ruse. The Senate bill indexes its tax proposal for the inflation rate plus one percentage point. But that is only about half as high as the rate of overall health-care inflation, i.e., the rate of increase in health-care premiums. So the Joint Tax Committee has found that a Senate tax that starts in 2013 by hitting 13.8 million Americans will hit 39.1 million by 2019.

The return of the inflation tax demonstrates once again the stealth radicalism that animates ObamaCare. In the case of inflation indexing, Democrats would repeal a 30-year bipartisan consensus that it is unfair to tax unreal gains in income, thus hitting millions of middle-class Americans over time with tax rates advertised as only hitting "the rich." Oh, and the House vote on this exercise in dishonest government will come as early as Saturday


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