Sunday, February 14, 2010

NHS managers numbers rise at twice rate of doctors, report finds

Hopefully they do something useful but spending the money on doctors and nurses would surely do a lot more good -- considering the constant stories of insufficient medical personnel -- see the story after this

Numbers of senior managers in the NHS have almost doubled in a decade compared with a 35 per cent increase in doctors and nurses as 'fixation' with the market means health service is bogged down in red tape, a report said.

The British Medical Association highlighted the figures as it launched a campaign to 'Look after our NHS' and end the commercialisation of the health service, with treatments contracted out to independent healthcare providers.

Official data shows that since 1995 the number of senior managers has increased by 91 per cent while the combined numbers of doctors and nurses rose by just 35 per cent. Other 'market driven' health care policies have wasted around £220 million since 2003 as private companies were given contracts to carry out operations on NHS patients which included clauses that they would be paid for a set number of procedures even if they were not carried out....

NHS trusts have been ordered to cut management costs by 30 per cent this year as the health service faces reduced growth funding and is faced with cost savings of £20 billion to find over the next five years. However, Health Service Journal published its own research showing NHS organisations which increased the number of senior managers scored highly on quality scores.

The magazine found that the average trust which received a weak rating on quality of services from the regulator had lost four managerial posts while trusts with an excellent rating gained 12 managers.

Mike O'Brien, the Health Minister, said: "We oppose the privatisation of the NHS. The government is committed to an NHS funded by taxation, with equal access to care, free at the point of use, based on clinical need and not ability to pay. We want to ensure that patients receive the best quality care and tax payers the best value for money. "Independent and third sector organisations were used successfully to get down waiting lists for operations and can make a contribution to this by helping to add capacity and increase patient choice."


Dozens of British children's wards must close

Dozens of children’s wards in Britain will have to close under European rules limiting doctors’ working hours, and because of the need to save money, the President of the Royal College of Paediatrics has said. The combined impact of the European Working Time Directive and the £20billion savings the NHS must make to plug its budget deficit over the next five years mean some children’s in-patient wards will have to close and merge with others, Prof Terence Stephenson told The Daily Telegraph.

He said there was already a shortfall of about 600 consultant paediatricians and 200 top-level trainees before the directive came into force last August, and now the workforce was under “unsustainable pressure”.

Junior doctors are limited under the directive to a 48-hour week, making it harder to ensure proper staffing levels in the wards at all times, Prof Stephenson said. Too many small hospitals provide in-patient children’s services and some of these should close so that doctors can staff the rest round the clock, he added. He also warned that the Department of Health had cut the number of trainees entering hospital specialities by five per cent this year to push more doctors into GP training. The latest figures show that 230 hospitals provide children’s in-patient services.

Michael Summers, vice-chairman of the Patients Association campaign group, said: “Far too many hospital services are closing to save money. It leaves patients having to travel vast distances.”

A Health Department spokesman said a Royal College of Paediatrics and Child Health survey last year indicated more than 100 extra paediatric consultant posts were created as a Working Time Directive solution, adding: “Service levels are constantly under review. Changes should only happen when they deliver quality improvements for patients.”


Could trillion dollar debt kill Obama health care reform?

It seems the President’s spending habits have finally caught up with him, threatening to kill a government overhaul of health care. Though President Obama and congressional Democrats continue to insist that health care reform is on the horizon, the increasing national concern over the rising public debt presents an undeniable obstacle.

James Capretta, a Fellow at the Ethics and Public Policy Center, outlines why this is the case in a recent article for Kaiser Health News. First of all, President Obama is responsible for raising the debt to unprecedented levels. Capretta explains, “From 1789 through 2008, the U.S. government borrowed a total of $5.8 trillion. In 2009, the federal budget deficit exceeded $1.4 trillion. The administration now expects the 2010 deficit to break that record, topping $1.6 trillion. And in 2011, it would only fall to about $1.3 trillion. Thus, in just three years, the debt will have jumped an astonishing $4.2 trillion.”

This outlook will making passing a budget-buster like the Senate health care bill difficult. By 2020, the President’s budget would raise the federal debt to $18.6 trillion. This includes the adoption of a health care bill, which falsely relies on $150 billion in budget deficit reductions between now and 2019. The only problem is that the bill would not reduce the deficit at all—rather, it would add to it substantially. A recent letter from the Congressional Budget Office to Senator Jeff Sessions (R-AL) explains this.

And then there is the question of how President Obama will tackle the nation’s impending fiscal crisis. The President’s plan is to pass health care reform and address deficit spending later through a weak and likely inconsequential bipartisan deficit reduction commission. This commission would present its proposals to Congress for a vote after the 2010 election, meaning voters’ decisions at the polls would not affect the fate of this vital legislation. This is unlikely to satisfy Americans’ concerns over the sustainability of federal spending.

Congress’ last possible plan is to pass the Senate bill in the House, accompanied by a second bill of amendments to appease House members. The Senate would use reconciliation to forego a filibuster which could kill the bill thanks to newly-seated Senator Scott Brown (R-MA). But, as Capretta puts it, “Reconciliation measures are supposed to address budgetary matters. How could amendments to something that is not yet in law change outlays or revenues in any rational way?”

Capretta points out that, in general, the release of a new budget marks the start of a fresh legislative session. It will be difficult for Congress and the President to backtrack to include health care reform in its plans for 2010, as the Congressional Budget Office will have reset its baseline and the congressional budget committees with have already begun to write new budget resolutions.

Because of all this, not to mention the myriad of unintended consequences the Senate bill would unleash on health care, the economy, and every American family, President Obama should wipe the slate clean and start afresh in reforming health care. This time, the President should work with both sides of the aisle and embrace step-by-step reforms that all can agree will have a positive affect on lowering costs and covering the uninsured.


Bend It Like Obama

Can the government control health care inflation through subsidies?

First President Obama said critics of his health care plan had no ideas worth considering. Then he said he never said that. Now he says he is eager to hear those previously unacknowledged ideas.

Taking Obama at his word (always a risky thing to do), is there any realistic prospect that the meeting he plans with legislators from both parties later this month will, as he suggests, produce “some agreements” on how to proceed with health care reform? Not if he continues to ignore the conflict between his approach to expanding medical coverage and the other major goal he says must be addressed by any serious reform proposal: bringing health care spending under control.

Obama wants to cover the uninsured by expanding Medicaid and providing various other subsidies: to small businesses that buy insurance for their employees, to individuals who buy policies from a government-created “insurance exchange,” and to high-risk patients with pre-existing conditions. That last group would be subsidized not only by taxpayers but by younger, healthier policyholders who would be forced to pay higher premiums or to buy insurance they otherwise would have gone without.

The Senate health care bill would spend $1.8 trillion during the first decade after it fully takes effect in 2014 to cover some 30 million people (out of an estimated 46 million without insurance), and that’s leaving aside the unfunded mandates imposed on states, employers, and individuals. Yet in his interview with CBS News anchor Katie Couric on Sunday, Obama said “the package that we've put together” will “start bending the cost curve on health care” and “cut the deficit by a trillion dollars.” How is that possible?

The $1 trillion figure, which Obama misleadingly attributed to the Congressional Budget Office (CBO), is highly speculative. The CBO estimated that the Senate bill would reduce the deficit by $130 billion in the first decade after it was enacted through a combination of higher taxes and Medicare cuts. The CBO also more tentatively projected that if Congress retains its planned reductions in the growth of Medicare payments to providers (instead of rescinding them, as it always has in the past), the savings could amount to between 0.25 and 0.5 percent of gross domestic product in the second decade. Using generous assumptions, the Obama administration converted that highly uncertain estimate into a nice round figure of $1 trillion.

Still, restraining the growth of Medicare, which will swallow a bigger and bigger share of the federal budget as baby boomers retire, will be necessary to avoid crushing payroll taxes and/or sudden, drastic benefit cuts. That’s one possible area of bipartisan agreement, although Republicans have dimmed the prospects by demagogically accusing the Democrats of trying to take away Grandma’s health care.

But note that Obama’s plan to restrain spending has nothing to do with his proposals to expand coverage, which would have the opposite effect, contributing to health care inflation by increasing subsidies. By contrast, market-based reforms that seek to expand coverage by making it more affordable also help to “bend the cost curve.”

Obama has made gestures of support for a couple of these ideas. His proposed excise tax on especially expensive medical benefits is a roundabout, half-hearted attempt to address the tax incentive that encourages employers to offer health coverage in lieu of higher pay, which insulates consumers from prices and retards competition. At the same time, however, Obama would contribute to the problem by requiring employers to provide insurance.

Similarly, Obama says he is open to the idea of fostering interstate competition in the health insurance market. Yet he insists it cannot be allowed to happen without federal coverage mandates that would boost premiums and undermine the benefits of such competition.

Pressing Obama to confront the contradictions in his own proposals—between spending restraint and huge new subsidies, between amplifying and blocking price signals, between promoting choice and impairing competition—might not yield agreement. But it could produce a little clarity.


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