Tuesday, December 08, 2009

If NHS hospital had listened to me, Baby Peter would still be alive’, says consultant

A thoroughly evil bureaucracy

A consultant from the NHS clinic that sent Baby P home to die has broken her silence to allege that managers from the world-famous Great Ormond Street Hospital bullied her and tried to buy her off to cover up their “appalling failure” to protect vulnerable children.

In an exclusive interview with The Sunday Telegraph, Dr Kim Holt told how she and all three of her senior colleagues raised concerns — more than a year before 17-month-old Peter Connelly came to the clinic in summer 2007 — that it was “falling apart” and that a child would die if action was not taken. “We were at our wits’ end,” she said. “We knew that a case like Baby Peter was going to happen.”

Instead of taking action, she said, Great Ormond Street, which employed the doctors, forced her out of the clinic on “wholly spurious grounds” and later offered her a six-figure sum to “buy my silence”.

Dr Holt was one of four permanent consultants at the paediatric clinic, at St Ann’s Hospital, Haringey. Of the other three, two left in disgust and one went sick for a period. By the time Peter became a patient at the clinic, none of the four was in place. He saw Dr Holt’s replacement, an inexperienced temporary locum — who sent him home after allegedly failing to notice he had a broken back. Two days later, the 17-month-old was found dead in his bloodstained cot with eight broken ribs, severe lacerations to his head, a tip of a finger missing, broken teeth, missing nails, and scores of cuts.

After Peter’s death, Dr Holt said, Great Ormond Street approached her and offered her a sum rising to £120,000 to leave her job and stay silent. Documents supporting this claim have been seen by The Sunday Telegraph. “They were in a panic [after Baby P],” she said. “They said I had to withdraw my allegations or the money was off the table. They wanted me to sign a statement saying that all my concerns had been addressed. I refused because it would have been a lie. They were trying to buy my silence.”

Because of her refusal to sign, Dr Holt, 50, who has 25 years’ experience and three medical degrees, has been prevented from returning to the clinic. “I am not going to be gagged,” she said. “I must speak about this because it is so wrong. “I believe that if our concerns had been taken seriously at the time we raised them, then we could have prevented the death of Baby Peter. Several of the failings found by the inquiries into his death were 100 per cent the same as the failings we complained about the year before he died. Sharon Shoesmith, the director of the social services side in Haringey, lost her job. But there was a total failure of leadership on the health side as well.”

In spring 2006, Dr Holt and her three colleagues, Dr Sethu Wariyar, Dr Haitham el-Bashir and Dr Sukanta Banerjee, signed a joint letter of complaint to Great Ormond Street and Haringey management.

In it they said that understaffing, difficulty in getting appointments for patients and poor record-keeping posed a “very high risk” to patient safety at the clinic and complained that managers were “trivialising” their concerns. Dr Holt said: “That letter is extremely strong. It was very unusual for four consultants to write like that. We only did it because we were at our wits’ end. We had a professional and moral obligation to raise our concerns. The children had no one else to speak up for them except us and we felt passionately that we were letting them down. “The response of management was hostile and bullying. One manager threatened me with the sack.” She was advised to take a month’s break, which she did, but said she was not allowed to return.

A secret assessment of Dr Holt’s case by NHS London, leaked to The Sunday Telegraph, found that she had done “nothing wrong” and described her as “highly committed, efficient and effective”. It did not find that she had been “directly targeted” for complaining but said that her and her colleagues’ concerns were “genuine and well-founded” and that Great Ormond Street had not done enough to address them.

Instead of acting on the concerns raised, Great Ormond Street and the co-manager of the service, Haringey Primary Care Trust, actually cut the number of consultant posts at the clinic, from four to three. An assessment done after Baby Peter’s death found that the clinic needed nine.

Dr Holt said she had taken her case to Jane Collins, the chief executive of Great Ormond Street, Baroness Blackstone, the current chairman of the board and Sir Cyril Chantler her predecessor, but had not been satisfied with their responses. “The Great Ormond Street managers were obsessed with Government targets. We were just supposed to process the children and not care about their lives. The world knows Great Ormond Street as this beacon of the care of children. But the case of Haringey shows its reputation is misplaced. “There is something which is not right at the heart of this hospital. There are many wonderful doctors there, but the ethos has been undermined by a core of people who are failing in their duty.”

The NHS London assessment of Dr Holt’s case is expected to be published later this week. Dr Holt, who now has a part-time role at Great Ormond Street, said: “I have signed a confidentiality agreement... and I am not allowed to talk about what it contains, but I can say what it does not contain. “I do not believe the report properly addresses the key issue at the heart of what went wrong, namely staffing. Great Ormond Street will say that they have made changes now, but the fact is that a child had to die before they did so.”

A spokesman for Great Ormond Street Hospital denied that the discussions about a payoff were an attempt to “gag” Dr Holt and claimed that they took place before any specific concerns were raised by her about child protection. The spokesman added: “We do not accept much of her version of events. The NHS London report finds that substantial efforts were made to resolve the issues raised. It does make some measured criticisms which we will act on. The issue of workload is a matter of funding, over which we have little control.” [Rubbish! What about firing some of their useless "administrators" and hiring doctors instead?]


The stubborn British bureaucracy partially coming to its senses?

Twelve billion (BILLION) pound NHS computer project could be scrapped at last. They sure take a lot of convincing that they are on the wrong track. An off the shelf database program would probably have done most of what they wanted at negligible cost -- but they knew better, of course

The multibillion-pound national progamme to overhaul NHS computer systems could be cancelled in this week’s Pre-Budget Report, Alistair Darling has said. The National Programme for IT (NPfIT), parts of which are already running four years late, aims to create a single electronic records system for 50 million patients in England, as well as providing electronic prescriptions and other services.

The Chancellor said the “quite expensive” programme, which has been running since 2002 and has an estimated budget of more than £12.7 billion, could be postponed to save cash. Mr Darling told The Andrew Marr Show on the BBC: “It is necessary for me, on Wednesday, to indicate areas where we are going to cut spending and where we are not going to spend as much as we were. “For example, the NHS has quite an expensive IT system that, frankly, is not essential for the front line. That’s something we do not need to go ahead with just now.”

The programme — reputed to be the largest non-military IT project in the world — has previously been criticised over delays to the proposed database of medical records and concerns that the system will not be secure. Fewer than 20 hospital trusts in England have installed electronic medical records under the project, despite an initial deadline for the whole country to have done so by 2010.

Ministers had previously defended the system, insisting that it could save the NHS £1.14 billion by the revised deadline of 2014. But the Government may have to pay out millions to break existing contracts if it cancels the project. At least £400 million of public money has been spent on the project, with four regional contractors — BT, Accenture, Fujitsu and CSC — initially being awarded contracts to provide systems in different regions of England.

Tough contracts mean that software manufacturers and suppliers are paid only when the required systems are delivered and working, meaning the project is still largely on budget.

After the withdrawal of Accenture and Fujitsu from the project due to spiralling costs in 2006 and 2007, hospital trusts in the South of England have recently been encouraged to buy systems “off the shelf” from a list of other suppliers.

The National Audit Office has said that the Government underestimated the challenges involved in the project, pointing to the “serious delays” in applying new software to individual trusts.

The Conservatives have called for a moratorium on Government IT projects, should they win the next election. Andrew Lansley, the Shadow Health Secretary, said today: “After seven years Labour have finally acknowledged what we’ve said for years, that the procurement for NHS IT was costing billions and not delivering. The opportunity cost to the NHS also measures billions of pounds. “This is another government IT procurement disaster. It just shows you can’t trust Labour on spending efficiency.”

Norman Lamb, the Liberal Democrats’ health spokesman, added: “This whole programme has been disastrously flawed from the start. “It has held back the development of IT at a local level, cost billions and is running years behind schedule. “Labour has been in denial for years and this is a belated and partial recognition of the scale of their failure. “The truth is that the national programme should be abandoned in its entirety, subject to existing contractual obligations, and instead we should start building from the bottom.”

Treasury officials stressed that only part of the IT programme was on the line and it would not be scrapped altogether. "The Chancellor and the Secretary of State for Health have examined options for savings on the NHS IT system and more details will be set out in due course," a spokesman said.


Obama urges Dems to pass health care overhaul

Casting health care overhaul as a legacy for the American people and failure as politically unthinkable, President Barack Obama on Sunday rallied Senate Democrats to deliver on their party's half-century quest to expand the social safety net by providing access for all.

At the Capitol during a rare Sunday session of the Senate, Obama delivered a closed-door pep talk to the fractious Democratic caucus that lasted about 45 minutes. Deep divisions remain over abortion coverage, but there was hope for compromise on whether the government should directly offer health insurance in competition with private companies. "They're going to get it done," Obama said as he left. He avoided specifics in the meeting with senators and took no questions.

The health care legislation _ Obama's signature domestic policy goal _ would provide coverage to more than 30 million additional people over the next decade with a new requirement for nearly everyone to purchase insurance. There would be new marketplaces where people could shop for and compare insurance plans, and lower-income people would get subsidies to help them afford coverage. The federal-state Medicaid program for the poor would be expanded, and there would be a ban on unpopular insurance company practices such as denying coverage based on medical history.

Senate Majority Leader Harry Reid, D-Nev., who had invited Obama, sounded confident. Republicans "want this to be, as one senator said, President Obama's Waterloo," Reid told reporters. "And it's not going to be."

White House spokesman Bill Burton said Obama thanked lawmakers for their work and encouraged them to move ahead on "this historic opportunity." Democrats are keenly aware of former President Bill Clinton's failure to pass health care legislation in 1994, and their repudiation at the polls that November. Obama said this is "the most significant social legislation in decades _ so don't lose it," said Sen. Joe Lieberman, I-Conn. Obama was accompanied by Vice President Joe Biden and other senior administration officials. Obama "pledged to work with us in any meaningful way that he can," Reid told reporters.

Reid has 58 Democrats and two independents in the Democratic caucus. He may be able to get one or two Republican votes, at the most. He is still short of the 60 votes he needs to shut off debate and move to a final up-or-down vote on the bill.

At Reid's request, moderate and liberal lawmakers are trying to find a compromise on the government insurance plan that could also potentially attract Sen. Olympia Snowe, R-Maine, the one Republican to vote for the Democrats' health bill in committee. A new idea under discussion involves national nonprofit insurance plans that would be administered by the Office of Personnel Management, which oversees the popular Federal Employees Health Benefits Program. Snowe called the possible compromise "a positive development" because it would give consumers more options for buying insurance. Underscoring the chase for 60 votes, and the possibility that she could break ranks with the GOP, Obama met with Snowe at the White House on Saturday.

"Progress is being made and that's not just talk," Reid said. After three hours of negotiation Sunday evening, Sen. Charles Schumer, D-N.Y., said "we're not there yet," but he was encouraged.

At least one moderate Democrat was unpersuaded by Obama's appeal. Sen. Ben Nelson, D-Neb., objects to Reid's provisions on abortion coverage, to a government insurance plan now in the bill, and to a new long-term care insurance program. "For those who have made a decision to be supportive, I think (Obama) was persuasive," Nelson said. "There are still issues that have to be resolved." Nelson said he expects a vote Tuesday on his amendment, which would restrict abortion coverage to cases of rape, incest or where the life of the mother is in danger. It is similar to language passed by the House last month. The Senate bill now would allow insurance plans operating in a new federally supervised health insurance marketplace to cover abortion, provided they use only funds from premiums paid by beneficiaries.

Win or lose, Nelson's amendment won't be the end of the abortion debate. Republicans who are nearly unanimous in their opposition to the health care bill said there was plenty of raw political pressure. "The Democrats are trying to squeeze every one of their members to swallow a very bitter pill for the American people," said GOP Leader Mitch McConnell of Kentucky.

Senators weary from months of debate said Obama made an impression. Sen. Frank Lautenberg, D-N.J., said senators were moved to "deep reflection, and even some tears." "He talked about how this would be a legacy, that each of us could look back to having been part of, 10 or 20 years from now," said Sen. Kent Conrad, D-N.D., a fiscal conservative.

While negotiations continued behind the scenes, the Senate rejected an amendment sponsored by Sen. Blanche Lincoln, D-Ark., to limit the tax deductions insurance companies take for what they pay their top executives. The vote was 56-42 on a measure that needed 60 votes. Lawmakers also voted down a measure by Sen. John Ensign, R-Nev., to limit plaintiff lawyers' fees in medical malpractice cases, a politically fraught issue that pits Republicans against Democrats. That vote was 32-66.


The End of Health Savings Accounts

Harry Reid wants to kill consumer-driven health care

About the best that can be said about the Senate health-care bill that Harry Reid revealed this week is that it's marginally less destructive than the House monster. By a hair. Its $1.2 trillion cost (more like $2.5 trillion if you discount the accounting gimmicks), multiple and damaging new taxes, and new regulations will make health insurance more expensive for most Americans while reducing the quality of medical care.

We'll dissect the damage in the days to come. But for today let's focus on the damage the bill would do to consumer-driven health plans—the kind that give individuals more control over their health dollars and insurance choices. The 2,074-page bill crushes them with malice-aforethought.

Start with its attack on flexible spending accounts that are an important part of many employer plans. Flex accounts let employees set aside some portion of their pre-tax pay for out-of-pocket costs or medical services that their insurance plan doesn't cover, such as a child's orthodontics or testing supplies for diabetics. The Reid bill caps these now-unlimited accounts at $2,500 per year and imposes new restrictions on qualifying medical expenses, raising some $5 billion by exposing income above the non-indexed cap to taxes.

Democrats say flex accounts encourage wasteful spending, because an arbitrary "use it or lose it" rule doesn't allow balances to roll over year to year. But they really hate them because they give consumers a more active role in managing spending, instead of having the government decide.

The Reid bill also assaults health savings accounts, or HSAs, which allow individuals to accumulate tax-free funds for future medical expenses when coupled with low-premium, high-deductible insurance. The Reid bill changes tax provisions to make HSAs less attractive, but the real threat comes via increased regulation.

These insurance products will likely be barred from the insurance "exchanges" that will demolish and supplant today's individual market. Employers will also find them more difficult if not illegal to offer once the government has new powers to "define the essential health benefits" that all plans must eventually offer. Plans that focus mainly on catastrophic health expenses, instead of routine procedures, aren't generous enough for Democrats.

Liberals claim people who choose these options aren't helping as much to finance a common pool and may encourage adverse selection if too many young or healthy people opt out. While all insurance involves some degree of risk-sharing, Democrats want to impose true social insurance a la Europe by obliterating the flexibility of insurers to design products that are tailored to suit different individual needs.

In fact, about 40% of tax filers with HSAs earn under $60,000, according to the IRS. The Employee Benefit Research Institute reports that 4% of adults with private insurance have an HSA this year—up from 1% in 2006—and about 9% are enrolled in some form of consumer-directed health plan. It also found that beneficiaries are evenly split between those with health problems and those without.

The Blue Cross Blue Shield Association, whose members dominate the HSA market, says that enrollees are more likely than those with traditional insurance to be better consumers. They're more likely to track expenses (63% to 43%), save for the future (47% to 18%), and search for information on physician quality (20% to 14%). They're also more likely to participate and see results from wellness programs like weight loss, fitness and smoking cessation. This makes intuitive sense: They've got skin directly in the game.

David Goldhill, a media executive, recently wrote in the Atlantic Monthly that if a 22-year-old starts at his company today earning $30,000 and health costs grow at 3%, by the time he retires he'll have paid out $1.77 million in premiums, lower wages, out-of-pocket costs and both sides of the Medicare payroll tax.

If all that money were instead available via an HSA, including by borrowing against future contributions, "wouldn't you be able to afford your own care?" Mr. Goldhill asks. "And wouldn't you consume health care differently if you and your family didn't have to spend that money only on care?"

This is precisely the future liberals fear because it would make health care less susceptible to political control. The Reid bill makes it impossible for people to choose better reform alternatives, the ones that can only be discovered through innovation and competition in a dynamic marketplace.

Not that any of this seems to matter at this stage of the health-card debate. The polls show the public opposes the Democratic bills, President Obama is below 50% job approval in the Gallup poll, and business and medical providers are increasingly horrified at what reform will do to consumers and patients. But so what? This is about putting government in charge of health care, whether Americans like it or not.


Healthcare is not a right

President Obama argues that his party’s health care reform proposals are about “bending the price curve” However, the Democrats’ health care agenda is really about nationalizing health care, based on the concept that health care is a right, and therefore must be secured by the state. This claim is misleading for several reasons, but most fundamentally because of its conflation of “rights” and “needs.” Obamacare opponents need to address this emotional appeal. After all, who can be against basic “rights”?

Lying on a bed in an emergency room this week following a cardiac scare, one of us had an opportunity to think this through. He had a need for healthcare, one which was being met, but to what extent was it meaningful that he had a right to healthcare?

A right, in both a legal and practical sense, is simply an entitlement due to an individual that other people are obliged to respect, with a failure to comply typically resulting in some sort of sanction. Because rights entail claims on other people, they are necessarily negative in their construction and limited in their definition. Constitutional rights such as freedom of speech and religion and the right to property can be clearly defined in accordance with John Stuart Mill’s harm principle—act as you will so long as you do not directly harm others.

In contrast, the expansive “rights” demanded by liberals—like the right to “affordable health care” or to a “decent standard of living”—are not rights but positive demands that require others to hand over some of the property to the claimant. Whereas genuine rights protect citizens from state coercion, the “right to health care” serves to justify state coercion against a particular part of the population: those who pay taxes. Moreover, by their very nature, such positive demands cannot be clearly defined and hence are capable of infinite expansions. As one need is satisfied, others arise.

Consistent with this distorted view of “rights,” the defining characteristic of the health care “public option” is its coercive quality: the taxes imposed on insurance companies, the burdensome individual mandate, the requirement that employers provide health insurance (subject to government approval), the loss or reduction of individual choice over treatment options, and the list goes on.

As the legendary British political thinker Edmund Burke made clear, the question of how to address needs is not moral, but economic. “What is the use of discussing a man’s abstract right to food or to medicine?” he posited. “The question is upon the method of procuring and administering them. In that deliberation I shall always advise to call in the aid of the farmer and the physician, rather than the professor of metaphysics.”

Indeed, man’s basic needs are best managed by the free market, which can coordinate supply and demand through the price system, placing decisions in the hands of individuals and specialized experts. In the case of health care, the government injecting billions of dollars into the market will lead to the warped economic scenario of higher education today. It will discourage consumers from exercising restraint in their use of a scarce resource and encourage providers to inflate their prices, while absorbing capital that could be used more effectively elsewhere.

Far from saving money and helping out the little guy, a health care “public option” would further increase costs and reduce individual liberty, while creating a subject client class that has an incentive to lobby for further handouts.

That's why, while facing a potentially life-threatening emergency last week, Iain was glad he was being treated via the free market. A voluntary exchange whereby doctor, patient and insurance company facilitator all stood to gain something they desired was surely better for all of us than an arrangement in which one or more parties was being effectively coerced.

President Obama has sought to claim the high ground in the health care debate through his use of lofty moralizing language designed to delegitimize any opposition. In order to be effective, Obamacare opponents need to go beyond opposing particular items on the president’s agenda. They must retake the high ground by arguing that the welfare state actually violates individual rights, and hurts the very people it claims to help. As Alexis de Tocqueville put it so well: “It’s not an endlessly expanding list of rights—the ‘right’ to education, the ‘right’ to health care, the ’right’ to food and housing. That’s not freedom, that’s dependency. Those aren’t rights, those are rations of slavery—hay and a barn for human cattle.”


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