Friday, February 05, 2010

Scathing British report rules foreign doctors will have to undertake English tests before becoming out-of-hours GPs

Foreign doctors should face tough English tests before being allowed to become an out of hours GP, a scathing report will rule today. They should receive basic training on how the NHS works and what drugs are commonly used in Britain before they are allowed to practise here. The report will add that some primary care trusts are so bad they are breaking the law and in future they will be ordered to inform all other trusts if they find a doctor does not come up to scratch - something that does not always happen at the moment.

The landmark study - written by leading doctors and commissioned by health minister Mike O'Brien - will lay bare the failings which have led to the creaking out of hours system that puts patients at so much risk. It is expected to say that many health trusts entered into contracts with out of hours providers and did not bother to set minimum quality standards. Often, local GPs play no part in the decision-making - meaning it is left to managers, who have more interest in cost than quality of care, to choose which company to employ.

Mr O'Brien was forced to condemn unacceptable variations in out of hours care after the Daily Mail revealed this week that, in some areas, doctors only make home visits in one in 50 cases.

Last night the Tories demanded wholesale reforms to the out of hours system....

PCTs have been in charge of commissioning private companies to provide out of hours care after the vast majority of GPs opted out of responsibility. Once a company has been taken on, the report will say PCTs are not good at reviewing their performance - so they do not take action if the quality is poor.

One of the biggest criticisms will be that trusts are not doing enough to ensure foreign GPs can speak English properly. Language tests are mandatory for doctors from outside the European Union - but not for doctors within it. The report will say that language tests should be put in place for all foreign GPs, and will call for better training and so they know about how the NHS works, what the area they will be working in is like, and which drugs are used.

The Tories blamed the GP contract of 2004 which allowed doctors to opt out of responsibility to patients in evenings and weekends. Tory health spokesman Mark Simmonds said: 'For too long the out of hours GP service provided by bureaucrats has let families down. For the sake of patients we must return responsibility for out of hours care back to GPs.'

The Department of Health said ministers would accept all of the report's 24 recommendations. A spokesman added: 'The quality of out of hours care for most people is better than it was in 2004, but some PCTs are not meeting their legal obligations. 'The department is determined to tackle this.'


Barbara Mizen would be alive today if she had not been wrongly diagnosed by an out of hours doctor, says her husband. Retired Eric Mizen says his 65-year-old wife had severe chest pain - the classic sign of a heart attack - when he called their GP out of hours medical service Thamesdoc. But instead she was diagnosed with a stomach upset by a doctor providing temporary cover for the couple's home area of Haslemere, Surrey. Two days later the retired auxiliary nurse was rushed to hospital, but died later of a heart attack.

Mr Mizen, 73, has won a legal claim for 'tens of thousands' of pounds but says nothing can compensate him for the loss of his wife. He said: 'I have no doubt Barbara would be alive today if the out of ours doctor had picked up on the problems.'

Mr Mizen's solicitors, who won a settlement from the insurers of Thamesdoc's Dr Mukhtar Hussain, said it was achieved without any admission of liability on the part of the doctor or the Medical Protection Society.


NHS kills another oldster

Hospital nurses did not help a dying man after they were given wrong information about whether he should be resuscitated. Peter Clarke, 86, lay for an hour before the error was realised and doctors tried in vain to restart his heart. On Tuesday Derby Hospitals NHS Trust apologised to Mr Clarke’s family and said that stringent measures had been put in place to prevent a repeat.

Mr Clarke, who suffered from heart disease, was a patient at the former Derby City General Hospital in January last year experiencing flu-like symptoms when he suffered cardiac arrest.

Ward staff told an inquest into his death that guidance provided to them in a hand-over note stated that a Do Not Attempt Resuscitation order had been made for clinical reasons.

Ann Proctor, a nurse, said that it was between 45 minutes and one hour before she discovered that there was no mention of such an order in Mr Clarke’s medical records, and that a blank Do Not Resuscitate form, which had been placed in the folder as a matter of routine by clerical staff, had not been filled in.

Dr Paul Webb, who was the first doctor on the scene, told the hearing: “I asked the nurses at the station what time he had collapsed and they said around 9am. “I said ‘do you mean 10am?’ and they said ‘no, 9am’.”

It has not been made public how or why the order was given not to resuscitate Mr Clarke on the hand over note, given that no such order existed on his medical records.

Offering Mr Clarke’s family the hospital’s “sincere apologies,” Alison Fowlie, the Trust’s Medical Director, said: “It was found that the cause of the mistake, for which we're very sorry, was the 'Do Not Attempt Resuscitation' instruction on the nurses' hand-over sheet and that it should not have been there.”

The inquest was told that that Mr Clarke's heart was so badly damaged that he could have suffered cardiac arrest at any time, and that he was in heart failure. Dr Alistair McCance, a heart specialist, told the hearing in Derby that even if staff had tried to resuscitate him immediately, the chances of saving his life would have been "very low".

Mr Clarke’s son, Keith, 57, from Belper, Derbys, said: “They said it was unlikely that he could have been revived but we’ll never know. “I think my dad was badly let down by the NHS.” Adding that it was “too late in the day for my father”, he said he hoped that changes in hospital procedures would protect other patients.


Leftist health reform proving rocky in Australia too

In America, Obamacare seems to have stalled -- JR

AN OPPOSITION'S lot in life is a thankless task; there are the long hours, minimal resources and they spend most of their time hitting brick walls. But sometimes there are small victories. As the Federal Government was taking the wraps off the third Intergenerational Report – a road map to 2050 on the challenges of the ageing population – the Coalition was forcing Labor into a backdown that would help older Australians now.

The win came on cataract surgery, and unless you are waiting to get your eyes fixed and face being out-of-pocket, it might seem like a loose-change victory. But Opposition health spokesman, Queenslander Peter Dutton, was able to force Health Minister Nicola Roxon to limit the cut in rebates for cataract surgery to 12 per cent instead of the proposed 50 per cent.

Dutton points out that for the three months before Roxon and specialists striking a deal, patients who needed their cataracts rectified had to pay hundreds of dollars or go to the public hospital system. Ophthalmology has the longest waiting times of any surgical speciality.

Backdowns from this Government are rare, but the win on cataracts illustrates that Labor has chinks in its armour on health. Dutton is also adept at attacking state governments on their health policies.

Despite all the hot air on climate change in Canberra as federal politicians returned for the unofficial start of the federal election, voters remain concerned about the here and now of improved health and hospital care and getting a decent education for their kids.

Prime Minister Kevin Rudd and Roxon argue they have put money back into the hospitals system. Rudd repeatedly argues the former Howard Government took $1 billion from health and his administration has put $5 billion back in and helped reduced elective surgery waiting lists – but voters cannot actually see new beds with plaques on them or shorter waiting times to visit a GP.

Rudd's bold election promise to fix the nation's ailing hospital system and consider a federal takeover is still in the limbo-land of consultations. He has invested a lot of political capital in the issue, and his pledge that the buck would stop with him resonated with voters. But the Government has found it is far easier to say it will build super-GP clinics than actually get the construction off the ground, and massive reforms to the hospital system means having to navigate around state interests.

Roxon is now facing defeat again on the Government's budget measure to means test the 30 per cent private health insurance rebate. If it goes down a second time in the Senate, it hands the Government another double dissolution trigger.

Rudd argues the Intergenerational Report, prepared by Treasury, showed the Opposition's blocking of the scheme would rip about $100 billion out of the Budget by 2050.

But Dutton's detective skills from his former career as a policeman are still in good working order and he pointed out the figure was not in the actual report. It was instead provided to the Government in some briefing papers. Which brings us back to cataracts.

Dutton has also made mileage out of highlighting seemingly penny-pinching decisions by Rudd and Roxon such as the initial plan, before they reconsidered it, to cap the Medicare Safety Net for people seeking IVF treatment and the postponed proposal to reduce funding for chemotherapy drugs.

The Opposition is making inroads on health but they have a long stretch ahead in the lead-up to the federal election.


How one man killed Obamacare

As most of Americans already know, Republican Scott Brown was elected to take over the “Kennedy seat” in the Senate, dispatching Democrat opponent Martha Coakley handily in Massachusetts’ recent special election. Thus ended Democrats’ filibuster-proof 60-vote majority in the Senate and prospects for ramming Obamacare through on a strictly party-line vote.

Yet had the House and Senate concurred earlier on a health care reform bill agreeable to both Brown’s election wouldn’t have mattered nearly as much. Instead, each body designed legislation to pass their own side and in the end the differences were irreconcilable.

House Speaker Nancy Pelosi finally threw in the towel, saying the one chance Obamacare had – passing the Senate bill as it was in the House – couldn’t draw the required 218 votes. A main sticking point was that the Senate bill lacked the prohibition on the federal government paying directly for abortions. That provision allowed the House to pass their bill with just two votes to spare and gave it the barest bipartisan fig leaf as GOP Rep. Joseph Cao of Louisiana was the lone Republican in favor.

Undeniably, part of Brown’s appeal was the prospect of killing Obamacare by being the 41st Republican vote and denying Democrats their supermajority. In the election’s aftermath, petulant Democrats threw losing candidate Martha Coakley under the bus for running a terrible, gaffe-prone campaign and openly spoke about changing the filibuster rules to allow Democrats to maintain their hammerlock, perhaps needing just 55 votes instead of 60. Decades ago, a compromise measure lowered the limit from a 2/3 majority of 67 Senators to the current 3/5 majority.

Cooler heads prevailed, though, and now the consensus on health care reform is to deliver it in a piecemeal fashion by removing some of the most objectionable portions and focusing on areas where broad agreement exists, such as eliminating the right to deny coverage for preexisting conditions. But gone will be the ability for Democrats to fashion closed-door deals such as the one exempting union workers from a tax on so-called “Cadillac” health insurance plans.


The Hidden Cost of the "Doc Fix"

The convoluted, politicized and hugely expensive issue of the "doc fix" is back in the spotlight after falling by the wayside along with health reform. Unlike health care reform, however, the “doc fix” will likely be passed through Congress without a blink, incurring a $82 billion expense to the U.S. taxpayer. The "doc fix" provides a stopgap to Medicare payments that give doctors less than market value for their services. It doesn't even provide doctors with the full market value; usually, it only covers it to about 80% of what the private sector would pay. But without the doc fix—with Medicare alone—that reimbursement rate would be somewhere near 60%.

Medicare reimburses at a rate that much lower because of 1997 balanced budget legislation, which prohibits medical expenses from rising faster than inflation. However, medical expenses have risen much faster than inflation. So while the standard Medicare reimbursements are kept at the unreasonably low rate, the "fix" bumps them up just enough to make doctors accept them.

What's curious about this year's “fix” is the lack of political attention given to the issue in the wake of vicious political battles over payment options for Obamacare. A version of the "doc fix" was surreptitiously excluded from the health reform bill because lawmakers didn't want to make the bill any pricier. But passing it separately is apparently not a problem for lawmakers, who see a vote against entitlements as political suicide. It's in no party's interest to take on both seniors and the medical lobby.

Michael Cannon, director of health policy studies at the Cato Institute, says he doesn't even like calling the stopgap a "fix" because it's not fixing anything. Instead, it's allowing Congress to continue living in their alternate reality, where medical expenses cost whatever they say they cost. "Because the government's price controls are set in the wrong place, and you're going to put a ‘correction’ in place to fix it? C'mon," said Cannon.

This year, the price will be higher than normal, because Congress is planning on a 5-year "fix" to their problem instead of their usual 1-year fix. The total is estimated at $82 billion, which will prevent doctors from suffering a 21% cut in fees.

The $82 billion 5-year plan is nothing compared with the $200 billion cost of a 10-year plan, or what legislators like to call "permanent." The only reason it's considered “permanent” is because the budget outlook for this issue only extends 10 years into the future.

National Center for Policy Analysis president John Goodman said that there isn't really isn't an end in sight to this issue because of the lack of political will, the inability for Congress to ever effectively address entitlement reforms and the wrong-headed approach that Congress takes to the practice of medicine as a whole. "It never works to have the payers tell the providers how to practice medicine," said Goodman.


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