Sunday, January 31, 2010

More Britons die as lone NHS GPs cover thousands after hours

SOME parts of Britain are relying on just one out-of-hours GP at night to serve more than 240,000 residents. An investigation by The Sunday Times into the inadequacy of round-the-clock cover has established two further deaths, including that of a three-year-old boy, after failures in the system.

Brighton, Bolton and Wigan are among the areas where a lone doctor is responsible for dealing with late-night emergencies. The news follows revelations last weekend that just two GPs provide cover for Suffolk and its 600,000-strong population on some nights.

Mark Simmonds, the Tory health spokesman, said repeated warnings about out-of-hours cover had gone unheeded by ministers: “It’s disgraceful that the government hasn’t taken action over this before.”

Brighton and Hove primary care trust (PCT) has one GP to cover an area with 248,000 residents on most nights. It claimed the doctor can receive as few as 10 calls each evening. However, in one case involving the trust, a three-year-old boy from Hove died from blood poisoning after the failure of the out-of-hours service. The frantic parents of Joseph Seevaraj phoned the duty doctor at 11pm on a Sunday and asked whether they should take their son to hospital because he was vomiting and suffering from diarrhoea. Joseph was already taking antibiotics for tonsillitis and the doctor advised his parents, Jean and Nicola, to wait for those to take effect. They watched over the toddler closely, but he died a few hours later.

A consultant in paediatric intensive care later said she believed the child would have survived if his parents had received proper advice from the out-of-hours service. “He needed basic medical attention,” said Veronica Hamilton-Deeley, the coroner, at the inquest. “The failure to provide it was gross failure.” South East Health, which provides round-the-clock services for Brighton and Hove PCT, said it had learnt from the incident in January 2008.

This weekend it emerged that only one GP serves 310,000 residents in the Wigan area on most nights, while 270,000 residents in the Bolton area also have to routinely rely on a single out-of-hours doctor. In North Somerset there is just one GP for 200,000 residents on a week night. Cambridgeshire has three GPs at night, Norfolk has four and Cumbria has six.

Such skeleton cover was introduced when GPs negotiated new contracts in 2004, boosting their average salary to more than £100,000 and allowing them to opt out of providing round-the-clock care.

This week a coroner is expected to conclude the inquest into the death of David Gray, a 70-year-old from Manea, Cambridgeshire. Gray died in February 2008 after being given a massive overdose of diamorphine by Daniel Ubani, a locum doctor from Germany who had flown in for his first out-of-hours shift.

While some PCTs say that just one or two GPs can adequately cover a population of more than 250,000, others have more doctors available for home visits. Under South Birmingham PCT there are 11 doctors on overnight duty, each covering an average population of about 35,000. Hampshire has 13 GPs on duty at night and Devon has eight, working at medical centres across the county.

Patients are often unaware if their local service is in crisis because most trusts do not publish performance reports. NHS Bristol said last week that a report on the quality of its out-of-hours GPs’ service was “confidential” and “commercially sensitive”.

Most round-the-clock services struggle to fill shifts with local GPs. Instead they use doctors from other parts of the country or foreign GPs who fly in for their shifts. A parliamentary debate was told last week of a case in Cornwall in which a patient had been confronted with a foreign doctor who used “an electronic word converter” to communicate. Other patients have complained of waiting eight hours for a doctor to arrive.

There have also been complaints that out-of-hours GPs do not have access to patient notes and sometimes fail to diagnose serious conditions. In one case, a doctor working as a duty GP in West Yorkshire was suspended from the General Medical Council register after he failed to examine an elderly patient properly. She died the next day. Dr Krzysztof Robak, 62, commuted more than 175 miles from Surrey, where he worked for a diet clinic, to his Yorkshire employer, Local Care Direct. When he visited the 86-year-old patient, he failed to check her blood pressure or take her temperature and did not consider her seriously ill.

Robak said yesterday that he had drunk two bottles of wine four days earlier and was suffering from the medication he took for his gout. He told the family of the woman: “Look what two bottles of wine can do to you” — a comment they considered inappropriate. Robak said he had told his employer he had been feeling unwell. “I felt guilty because I failed this woman,” said Robak. “I did not refer her to the hospital because she appeared to be over the crisis.”

He said he felt he had been treated harshly over the mistake and plans to appeal against his suspension. Local Care Direct, a nonprofit organisation which provides out-of-hours care services for 2.5m people in Yorkshire, said it had vetted Robak rigorously before employing him. It said it did not consider that he had contributed to the patient’s death in July 2007, but it had raised concerns about his conduct.


Australia: Patients in Queensland government hospitals malnourished

Just like government hospitals in Britain. And the solution is very British too: More bureaucracy. That it's more nurses that are needed to help feed the elderly is beyond their tramtrack socialist comprehension

ONE in three patients in Queensland public hospitals is suffering from malnutrition, according to a State Government report. The Queensland Health briefing paper says malnutrition is "highly prevalent" in hospital patients and residents in aged care facilities. It said malnutrition could be costing Queensland more than $13 million a year. It was blamed for extended hospital stays, causing illness and disease, and exposed the department to legal action.

Liberal National Party health spokesman Mark McArdle said he was concerned that the Government had slashed health budgets by cutting patient food services. Health sources said hot meals in some hospitals had been reduced from three to one per day. "This is Third World . . . this is seriously affecting patients' recovery and ultimately tying up desperately needed hospital beds," Mr McArdle said.

In documents obtained by the Opposition under Right to Information laws, it was revealed that Queensland Health first examined the problem in 2003, but did nothing about it until 2008. A July 2009 report for Director-General Mick Reid warned of the dangers of malnutrition. "Due to the emphasis placed on the high and increasing prevalence of obesity and related disorders, there is little awareness of the existence and extent of the other extreme, malnutrition," the report said.

Queensland Health's Patient Safety Centre conducted a six-month investigation in 2008. It found that 30 per cent of hospital patients and 50 per cent of aged care facility residents suffered from malnutrition. It was estimated to have cost taxpayers $13 million in 2002-03.

The centre recommended the establishment of a malnutrition prevention manager within Queensland Health, to be paid $120,000 a year.


Congress’ New Secret Plan to Pass ObamaCare – The Nuclear Option

Leaders in the House and Senate have a new secret plan to pass President Barack Obama’s sweeping health care plan using strong arm tactics and no transparency.

I wrote back in September that Congress had a plan to ram through ObamaCare by the end of the year, but the American people stopped that plan. Public outrage was amplified by Rush Limbaugh and others in the media who took up the cause to educate Americans about Congress’ plan to railroad the unpopular bill through Congress with little debate and no opportunity for dissent. Cooler heads prevailed and Congress stopped efforts to sneak the bill through Congress.

On January 19, the proponents of ObamaCare suffered a big setback. When little-known State Senator Scott Brown scored a shocking upset in a special election for Senate in Massachusetts campaigning as an opponent to ObamaCare, moderates in the Senate and House put the brakes on ObamaCare. The left had to retool their strategy, because there was no will in the Senate to take up and pass ObamaCare again. The only way proponents of Obamacare can win now is if they change the way the game is played, and liberals seem to be prepared to change the traditional rules of the Senate by triggering a legislative Nuclear Option in an effort to pass Obamacare by the end of February.

This is a Nuclear Option, because the left is preparing a strategy to obliterate the filibuster rule — the rule that requires 60 votes to shut off debate on legislation, for the purposes of passing multiple pieces of legislation that add up to ObamaCare. They will either use reconciliation to pull an end around the filibuster rule or they may be bold enough to merely use a simple majority of Senators to exterminate the filibuster rule from the Senate rule book.

Sources on Capitol Hill tell me that liberals in the House and Senate are a handful of votes away from a scenario where they can get ObamaCare to the President’s desk by the end of February. Here is the way it works. According to The Hill, “House Democrats are readying a series of smaller ‘sidebar’ healthcare provisions to introduce by mid-February even as they push for using reconciliation rules to move a broader healthcare package, according to leadership aides.” So the plan is to try to pass a few smaller issues and to prepare a so called “reconciliation measure” to make changes to the Senate passed ObamaCare bill awaiting action in the House.

The reconciliation plan would be done by “using budget reconciliation rules to pass parts of the healthcare package (and) would require only 51 votes in the Senate. But those rules can only be used to move provisions affecting the federal budget.” If they can pass smaller portions of ObamaCare with Republican support, then they jam a reconciliation measure through the Senate with only 51 votes containing ObamaCare tax provisions. Next the House would take up and pass the Senate passed 2,700 page ObamaCare monstrosity. If that happens, then the game is over and the will of the American people will be ignored again.

President Obama declared at the State of the Union, “here’s what I ask Congress, though: Don’t walk away from reform. Not now. Not when we are so close. Let us find a way to come together and finish the job for the American people. Let’s get it done. Let’s get it done.” This is a message from the President to Congressional liberals that he will support their efforts to ram through ObamaCare with all means at their disposal. The President showed his complete disconnect from the feelings of average Americans when he called for Congress to pass his health care proposal that has been rejected by the voters of liberal Massachusetts. Real Clear Politics has the President’s plan with the approval of an average of 37.4% and an opposition of 54.4% – that is an average poll deficit of 17% for ObamaCare, yet the President forges forward.

Liberals can use the Nuclear Option to pass at least some part of ObamaCare and it allows them to deal with the tax or revenue aspects of health care reform. Then they will pull the trigger and force the House to pass the 2,700 page ObamaCare bill which is one House floor vote away from a Presidential signing ceremony. This is a multi-bill strategy. The reason why House members may vote for the Senate ObamaCare bill is because they may have their concerns addressed with the small bills and reconciliation measures that will have passed before this historic vote. This scenario also provides cover for moderate Democrats in the Senate who can vote against the reconciliation measure and claim to constituents that they were, in the end, against ObamaCare.

This procedure is an indication that Congress understands that even the people of liberal Massachusetts hate ObamaCare, so they need to pass this bill as fast as possible and with little transparency to try to minimize the participation of the American people in this process. A rational politician would see the terrible polling numbers for ObamaCare and the results in Massachusetts as a sign that the bill should be scrapped. The problem today is that the American people are dealing with an elite class of politicians in Washington that don’t care what the American people think about ObamaCare.

These elites make fun of people who participate in Tea Parties. They have distain for those that show up at Town Halls to voice opposition to the bill. They denigrate protesters who come to Washington, D.C. to demonstrate against a government takeover of health care. They laugh at all the poll numbers that indicate they are going in the wrong direction. They are ignoring the voters and their own constituents to further the cause of President Obama’s vision of a de facto government run health care system.

This is one of those unique moments in history where a minority number of Members of Congress are protecting the will of a majority of the American people – the big question is who will win?


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