NHS bureaucracy spending doubles

Government spending on central bureaucracy in the health service has more than doubled in five years, research has found.

Opposition politicians said the figures demonstrated that the NHS had become a "bureaucratic black hole" under Labour, with money diverted away from the front line to pay an increasing army of administrators. The analysis by the Conservative Party shows that funding for the Department of Health, its quangos and regional authorities reached more than £12 billion last year, a rise of 103 per cent since 2003.

The £12.6 billion budget for central administration was seven the amount spent on either maternity services or dentistry, which each received £1.8 billion, or Accident and Emergency departments, which received £1.7 billion. Billions more was spent on administration at hospitals and primary care trusts across the country, for which specific administration figures are not compiled.

Mike Penning, the shadow health minister, said he was horrified by the findings of the report, which was drawn up by the Conservatives' research team. He said: "I am absolutely appalled, particularly at a time of such economic difficulty, by the Government's continued failure to deliver value for money for the NHS."

The report found that while staff numbers rose by 18 per cent in five years, the amount spent on them rose by 48 per cent. The rise in the number of administrators outstripped the rise in numbers of doctors and nurses. Mr Penning described the report as evidence of a "bureaucratic black hole" which was attracting billions away from patient care. "It appears that the further staff are away from the patient, the more costs rise," he said.

Government figures show there are now more than twice as many bureaucrats as midwives, and 5,000 more managers than hospital consultants. Last year the number of managers rose by nine per cent while nurse numbers increased by just 2 per cent. The average pay for a chief executive running a foundation hospital trust reached £157,000 last year.

Katherine Murphy, from the Patients Association, said: "Of all the billions poured into the NHS, it is just sickening to see how much of it has been soaked up by this ever-expanding bureaucracy, particularly these quangos and authorities who have proved unable to prevent appalling patient care seen in the scandals at Stafford Hospital, or the hundreds of deaths from Clostridum difficile at Maidstone Hospital and at Stoke Mandeville Hospital before that."

The dozens of NHS quangos funded by the taxpayer include NHS Professionals, which was set up in 2004 with a remit to reduce the amount spent on agency nurses. It spent more than £1 million employing two senior managers in just two years. The agency paid a private company £1,700 a day for chief executive John Faraguna and £1,150 a day for director of operations Stephen Dangerfield, even though body was created in order reduce the amount of money wasted by the NHS on private agencies.

Other agencies include NHS Connecting for Health, in charge of the long-delayed programme to computerise health records which has caused repeated problems in the hospitals which have tried to introduce it.

The DoH, which employs more than 2,000 civil servants, has created dozens of "arms-length" agencies and committees, including a Cosmetic Surgery Steering Group, Advisory Board on Registration of Homeopathic Medicines, Alcohol Education and Research Council, Herbal Medicines Advisory Committee, Independent Advisory Group on Sexual Health and HIV, and the Leadership and Race Equality Action Plan Independent Panel. Eleven regional health authorities are responsible for managing performance at 200 hospital trusts and 150 primary care trusts.

Mark Wallace, campaign director for the TaxPayers' Alliance, said: "The figures demonstrate that the only boom this country is enjoying is in NHS bureaucracy, and I think people are fed up with paying increasing taxes to fund a succession of quangos and back office functions when the money is needed at the front line."

The DoH described the Conservatives' interpretation of figures comparing spending on the DoH, its "arms length agencies" and health authorities in 2003 and 2008 as "fundamentally flawed" because the central budgets included some services that directly benefited patients, such as funding for childhood vaccinations and grants for social care. A spokesman said the 2008 figures also included £2.5 billion passed on to hospitals to subsidise a system of "payment by results" for operations carried out. He added: "Administrative and clerical staff form only eight per cent of the NHS workforce of over 1.3 million, and are essential to the day-to-day running of the organisation."

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Australia: An IVF baby is priceless, but who pays?



ISABELLA Zogopoulos is a gorgeous $70,000 miracle that we all helped to create. The 13-month-old was conceived after her mother, forklift driver Theona Zogopoulos, endured 10 cycles of IVF at a personal cost of $30,000. Taxpayers chipped in the rest via the Medicare safety net scheme, making the long-held dream of parenthood a reality for Ms Zogopoulos and her council worker husband, Chris. "I call her my little miracle on ice," the besotted mother says. "She was on ice for 18 months."

But without the 80 per cent rebate on the IVF procedure — the family also had other medical expenses — it's doubtful the Zogopouloses, who took out a $20,000 bank loan to cover their costs, would have been able to afford so many IVF cycles. Now, as the Federal Government scrapes for savings ahead of the May 12 budget, it is looking again at publicly funded IVF and obstetric services, which cost taxpayers $141 million a year through the safety net scheme.

The Zogopouloses fear such a move would render their dream of giving Isabella a brother or sister financially impossible. "It is very disappointing," Ms Zogopoulos, 37, says. "There are plenty of other things that the Government can look at and cut money from."

The issue of tampering with public funding for fertility services is politically fraught, as the previous Howard government discovered, because the area of assisted reproduction is emotionally charged and access to IVF is now widely accepted as a right in Australia. It is a right that is increasingly expensive: the safety net scheme, which has leapt 28 per cent since 2007, now costs $319 million a year, 44 per cent of it IVF and obstetric services.

How much taxpayers should subsidise assisted reproduction, and whether it should be means tested, remains controversial. When the Howard government tried to rein in the public cost in 2005 by limiting funding to three cycles a year for women up to the age of 42, or three in total for older women, it was a disaster. But with Labor's economic strategists now considering ways to pare back the safety net scheme, the IVF industry fears rebates on fertility and obstetric services are again at risk. Options being considered by the Government are believed to include capping the number of (now unlimited) publicly funded cycles available, means testing, and restricting access on the basis of age.

In the lead-up to the 2007 election, Health Minister Nicola Roxon pledged there would be no move to tamper with the safety net, introduced by the Howard government in 2004 to cover 80 per cent of out-of-pocket medical costs above $1111.60 in any given year (or $555.70 for low-income earners). Yesterday, Ms Roxon declined to "engage in speculation ahead of the May budget" with The Sunday Age.

But Access Australia, which represents IVF consumers, is taking no chances. It has been encouraging its members to flood the offices of Prime Minister Kevin Rudd and Treasurer Wayne Swan with angry emails. Sandra Dill, Access chief executive, argues that infertility is a medical condition like any other funded through Medicare and should not be singled out. Means testing or restricting public funding would make IVF affordable only for the wealthy, even though fertility issues affected as many as one in six Australians, she said.

IVF is now the preferred treatment for infertility, and the number of babies born with the help of assisted reproductive technology has trebled since 1995, to 11,000 a year.

"I find it curious that on the one hand the Government recognises the economic benefit of having children … and yet for another group of people who are trying to have them who need medical help they are threatening to make that even more unaffordable," Ms Dill said. She did not believe access to IVF should be restricted on the basis of age because individual doctors made decisions on a case-by-case basis and were unlikely to recommend IVF to women who had a low probability of success.

In Ms Zogopoulos' case, each of the 10 IVF cycles involved an upfront cost of $5300. The usual cycle costs $4400, but she was also using the ICSI technique, in which sperm is injected directly into an egg. Should she attempt IVF again, she will need to have a $3280, non-Medicare rebatable procedure in which cells from her embryos would be tested each cycle, to check for any genetic abnormality. The test could help avoid the previous nightmare of repeated failed implantations. But it will add to the overall cost and if rebates are cut, could mean the Zogopouloses cannot afford to try for a second baby.

Ms Zogopoulos believes the only fair cut would be a means test, by which wealthier people get smaller rebates. "I feel sorry for people just starting out on IVF. It is always very stressful financially," she said.

The extraordinary 28 per cent blow-out in the safety net bill since 2007 has been linked to the rise in gynaecologists' fees, which, according to one estimate, have increased by more than 400 per cent since the scheme was introduced in 2004. A senior Government source said the safety net had blunted competition in the health sector, allowing obstetricians to raise fees. But the president of the National Association of Specialist Obstetricians and Gynaecologists, Dr Andrew Pesce, denied that charging for IVF in Australia was spiralling out of control, saying costs were relatively low by world standards. He said the increase was due to IVF becoming the treatment of choice for infertility, whereas previously it was one option among several, including surgery.

Federal MP Tony Abbott, who as health minister in 2005 tried to implement the disastrous attempt to limit public funding for IVF, concedes now that: "If you are a fortysomething woman who is desperate to have a baby and the Government decides that the rules are going to be changed to make it harder for you to pay for this, you get very, very unhappy."

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America already has a big problem with socialized medicine

Last week, when Congress passed the largest deficit spending budget in American history, it included more than $720 billion for an exponential expansion of Medicare and Medicaid. It also included an additional $634 billion “reserve” fund to be used, according to the White House, “over 10 years to finance fundamental reform of our health care system that will bring down costs and expand coverage.”

In short, the fund was Mr. Obama's down payment on the government takeover of America's health care industry. And, as is so often the case when politicians bloviate, it was built on a deliberate deception.

What the politicians know full well—and bend over backwards not to admit—is that the more government spends to subsidize and socialize the health care industry, the more health care costs are going to escalate, and the less quality service will be available.

The fact is—again, as the politicians know full well—the primary reason medical costs are already out of sight is that subsidies are already out of control. And that's because medical bills themselves are largely works of fiction.

Simply put, the price most patients pay for medical treatment today is a far cry from the actual cost of the procedure. Built into each bill is a substantial surcharge to help pay for the hospital's overhead—which is sent through the ceiling because so many patients already fail to pay their own way. And, it gets even worse.

Since there's a limit to how much hospitals can add onto the cost of any given procedure, even the padded payments fail to cover the free riders' exorbitant bills. And who makes up the difference? You guessed it: the American taxpayer. In fact, by some estimates, taxpayers are already paying some 85 percent of unpaid hospital bills.

For those who remain skeptical of the cost of subsidized—i.e., socialized—medicine, a quick glance at the average emergency room is in order. Public law now demands that emergency room treatment be administered regardless of whether the recipients can pay all—or, in fact, any—of the bill. The result of such misguided utopian altruism is that many “underprivileged” Americans now consider the ER their family doctor.

And who foots the bill for such outrageous abuse? Take a look in the nearest mirror.

So, now comes Barack Obama and his querulous gaggle of cloying quacks to tell us that the way to reduce medical costs is to increase subsidization—the facts of the matter (and the burgeoning deficit) notwithstanding. And when no one is any longer able to afford either subsidization or the true costs of actual treatments (on the rare occasions when they will still be available), well, there go the actuarial charts and in walks the Grim Reaper.

Actually, of course, the way to reduce medical costs is to end subsidization altogether. Does this mean that some people will not be able to go to the emergency room for a band aid or a bottle of aspirin? Probably. In fact, it may even mean that some people will not be able to charge others (as in, you) to cover the costs of their catastrophic illnesses.

But for most people, it will mean that America's health care system will continue to be the best this side of Shangri-La. And it will also mean that, though nobody lives forever, those who are willing to work hard and pay their own way will have a fighting chance to top the charts. As fortunate as that may be.

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Pharmaceutical evolution

Innovation is the lifeblood of the pharmaceutical industry. Over the last century, that industry has been responsible for thousands of new drugs, based on hundreds of thousands of smaller incremental innovations. The breakthrough “blockbuster” drugs taken by millions of patients today were not produced from thin air. Most represent the combined weight of seemingly small improvements achieved over time. The advantages of incremental improvements on existing drugs are paramount to overall increases in the quality of health care. As the pharmaceutical industry developed, classes of drugs—those with similar chemical composition and which treat similar conditions—have grown to provide physicians with the tools they need to treat diverse patient groups.

Still, critics have been highly condescending about what they call “Me-too” drugs—drugs within the same chemical class as one or more others already on the market—which they claim add little or no therapeutic value and are nothing more than an opportunity for pharmaceutical companies to fleece unsuspecting consumers. While some claim that there are too many similar drugs, and that pharmaceutical industry research and development could be more profitably directed toward developing entirely new classes of medicines, drugs based on incremental improvements generally represent advances in safety and efficacy. They also provide new formulations and dosing options that significantly increase patient compliance—both of which lead to improved health outcomes. From an economic standpoint, adding new drugs to a class of medicines also offers the possibility of lower drug prices as competition between manufacturers increases. Additionally, pharmaceutical companies depend on incremental innovations to provide the revenue that will support development of the riskier, capital-and research-intensive blockbuster drugs.

When critics refer to Me-too drugs, they do not mean exact generic copies of already existing drugs, or illegal counterfeits. Instead, Me-toos have a similar chemical composition to one or more others on the market, and have similar biological effects. But, in order to be approved, Me-too drugs must undergo the same extensive clinical testing as other new drugs to determine their safety and efficacy because they are chemically different. In addition, these differences, even if small, typically must represent a medical advancement—such as fewer side effects or improved efficacy for patient sub-populations—in order to attract a portion of the market away from the first approved drug in the class. Nevertheless, many drug industry critics have called for federal policies to inhibit the development and marketing of such incrementally improved medicines. But policies that curb incremental innovation will ultimately lead to a reduction in the overall quality of existing drug classes and could arrest the creation of truly novel drugs.

Research in any industry is a building process. Few scientists develop groundbreaking drugs from no prior research. Most work within, and respond to, existing knowledge—reading the same medical literature, and reacting to new technological breakthroughs at the same time. It is not hard to imagine, therefore, that many different companies would be working on similar drugs. In fact, it is often the case that the only reason why one drug is called novel and another a Me-too analogue is the speed at which each moves through the regulatory process.

Like other technological and value-added industries, the pharmaceutical industry depends on small steps for the creation of blockbuster drugs, which often result from a long series of small innovations. It also depends on these steps for the creation of drugs that provide slight, incremental improvements on existing drugs—thereby adding to a drug class, increasing competition among drugs, and incentivizing further innovation. As the National Research Council has observed, “the cumulative effect of numerous minor incremental innovations can sometimes be more transforming and have more economic impact than a few radical innovations or ‘technological breakthroughs’.” The net effect of increasing the number of drugs through innovation leads to advances in safety, efficacy, selectivity, and utility of drugs within a specific class.

Importantly, providing physicians with a variety of prescription options within a given therapeutic class is paramount to the provision of optimal health care. This is especially true for some drug classes, such as those relating to the central nervous system, for which overall response rates can be as low as 50 percent. For unknown reasons, certain patients respond differently to different drugs within a single class. If physicians have many options at their disposal, they can calibrate their prescribing patterns to better address the needs of specific patients. The existence of multiple similar molecular agents also provides backup in situations where the novel drug in a class is found to have unacceptable side effects and is thus removed from the market. As patients come to depend on a particular class of drugs, it is essential to make sure that they do not lose access to needed medication as a result of regulatory action.

One of the most vehement criticisms made against Me-too drugs is that they siphon money away from research that could be devoted to the creation of novel breakthrough drugs. This assumption is incorrect for a host of reasons, the most important of which is the fact that the pharmaceutical industry depends on selling the products of incremental innovations to provide the revenue for research and development of breakthrough drugs. Additionally, while it is unrealistic to presume that every incremental innovation leads to cost savings, the sum of all drug innovations can result in cost savings by reducing overall treatment costs, shortening or obviating hospital stays, increasing worker productivity and reducing absenteeism, and lowering drug costs through increased competition among manufacturers.

Ideally, every new drug would represent an unprecedented breakthrough and lead to the creation of a completely novel treatment. This, however, is not the reality of the pharmaceutical industry, or of any other development-based industry. Creating drugs based on incremental innovations provides pharmaceutical companies with a secure stream of revenue, which can be directed to higher-risk, potential blockbuster-yielding research. Policies aimed at reducing the industry’s ability to obtain revenues from incremental innovations could be self-defeating, as those industries will then have less revenue to reinvest in R&D for new drugs. Put simply, limiting incremental drug innovation is analogous to limiting competition. The ultimate result could have devastating consequences for the future of the pharmaceutical industry and for the millions of patients who depend on it.

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Aged care funding via vouchers now being considered in Australia

A good move

FUNDING could be stripped from Australian aged care homes and vouchers of up to $50,000 handed directly to residents in a radical aged care overhaul being examined by the Federal Government. Under the proposal, vouchers would go directly to Australian seniors and their families, allowing them to decide what sort of care they wanted. The proposal has been floated by Warren Hogan, author of a landmark report on aged care funding for the previous Howard government.

It has the backing of mainstream facilities - including one of Queensland's largest providers, TriCare, which wants a more consumer-focused approach to an industry facing "the perfect storm of an ageing demographic and a declining number of aged care beds".

A spokesman for Minister for Ageing Justine Elliot yesterday confirmed the minister was looking at the issue of "consumer-directed care". "This is a radical area of policy development and we would need to proceed cautiously," he said. "In addition, we would have to ensure that there were strong safeguards to protect the frail aged."

Professor Hogan - along with the Productivity Commission and the National Health and Hospitals Reform Commission - expressed deep concern about the nation's ageing demographic. All are pushing for aged care facilities to be more responsive. Professor Hogan said central planning at the core of existing policy strategies introduced inefficiencies and rigidities, sparking a retreat by providers and "regulated scarcity". He said allowing government aged care funding to be directed to users of services and their families could be arranged just as readily as sending the money to providers. "By issuing vouchers to residents and potential residents for the value of the care to be met by government, these users could determine in discussions with the provider of their choice the type of services suited to their needs as specified by an Aged Care Assessment Team."

Care subsidies paid annually to providers range from $3000 to $50,000 a year, with more than 60 permutations and calculations in between. But, generally, a high-care provider receives between $30,000 and $50,000 a year to care for a resident.

Jim Toohey - the spokesman for the national Aged Care Alliance and who also heads up TriCare - said the idea was one of a range of proposed new funding models which appeared to have merit. "Establishing a relationship with the consumer in which the consumer has power is the way towards innovation in the aged care sector," Mr Toohey said. He said good-quality providers would welcome removal from a situation where they relied on a government subsidy to one allowing the market to determine what services they should provide. Mr Toohey said the proposal, in practical terms, could allow ageing Australians to opt out of an aged care facility altogether.

A Brisbane resident in a $700,000 home who required aged care could choose to opt for a reverse mortgage on the home, collect the government voucher, and use the funds to arrange for private aged care inside the home. Alternately, seniors wanting a high quality of life could opt to top up their voucher with their own money for more luxurious care.

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Putting you in charge of your own health care

Americans are ready for change in the way they receive and pay for health care. Surprisingly, it may not be the changes that most politicians, big businesses, insurance companies and special interests are pushing. Americans are ready to take back control of their health care. They are ready for a change from unaffordable insurance that comes only from an employer they may prefer to leave -- insurance that seems to provide more of a hassle than convenient protection from unexpected expenses. They are sick of sitting for an hour to see a doctor, then seeing a nurse for 10 minutes and the doctor for three and often left to wonder about what happened. They are burdened by high taxes for government programs that seem to provide health benefits for everyone but them while the same government clamors to cover even more in financially unsustainable programs. They have heard enough of empty promises from politicians who care only about getting re-elected and having more power. Yet even with all these and other problems, many Americans have given up and figure that it is up to the government to solve the problem. They wonder if the government solution will still allow them rapid access to high quality health care they deserve.

The current proposals for reform are cloaked as big changes, but as it turns out, they are actually more of the same. They can be summed up in this way: turn more control over to the government and insurance companies while politicians and special interests jockey for credit and work behind the scenes to benefit -- at the expense of individual Americans. Albert Einstein once defined insanity as doing the same thing over and over and expecting different results -- but that is what is being proposed today. While most American want more individual control over their own lives, the health reform proposals will expand the control over health care held by third party payers (insurance companies and government). This would make matters worse for Americans.

The story of how we got to where we are today is long but has its roots in the World War II era policy that stated that a tax deduction could only be applied to health insurance provided through a job. That lead to employers control of health insurance purchase and removed the consumer from the decision -- decisions they make every day for auto, homeowners and life insurance (products that are affordable). Insurance companies then sold to employers -- not to consumers. Insurance products then began to expand from "accident and sickness" policies, to "health" insurance. Thus they cover every minor expense except for a token deductible from patients.

While this seems desirable on the surface, in the end it leads to little control over demand for medical tests and treatments and drives up the cost of health care and insurance for all. Instead of asking your doctor, "Do I really need another pill" or an MRI, or a surgery, consumers take the "free" benefit. Unfortunately, doctors often do more tests and treatments to survive government-fixed prices through high volume services and to protect themselves from lawsuits. This leads to what the government and insurance companies call "over-utilization", the boogeyman they seek to kill by having more control over what kind of care every patient can be authorized to receive. Authorized by someone else besides the patient through cookbook medicine and rationing of care. That is the same thing that happens in socialized medicine in other countries.

There are many other problems created by government: requiring that young and healthy people pay the same high insurance rate as older and sicker patients, allowing anyone to buy insurance (even after they are sick or injured!), mandating that every insurance policy cover some things that not everyone wants to buy insurance for (like hair prosthesis, acupuncture, chiropractic care, maternity care for men and Viagra for women).

So what solutions do politicians like Barack Obama, Senator Max Baucus, Tom Daschle, and groups like the AARP, Families USA, big insurance and big business propose? They want to mandate that everyone buy the same expensive insurance that many can't afford (with a tax if you don't buy) - a plan that is failing in Massachusetts. They would create a "Health Care Fed" that would create cookbook medicine and rationing protocols and force your doctor to follow them under the threat of lower pay or a phony report card score that has nothing to do with quality and has everything to do with how much third-party money was being "wasted" on actual patient care. This would be enforced through a mandate to enter your health data into a computer that would be forward to the government where it would be subject to loss or accidental exposure of private health information. They would expand the Medicare program, which is scheduled to bankrupt its own trust fund next decade, to people who are 55 years old. They would put more children in government health programs even though such a plan failed in Hawaii after only 7 months -- leaving many children previously insured privately without coverage!

The way we pay for health care must change. It is clear that the politicians are making more promises that they can't keep and will resort to "bailout" mode with high taxes and lower quality health care when it fails. The good news is that there is a better way. Instead of expanding control of third party payers -- the same parties responsible for our current mess -- we can put the control of health care financing right where it belongs: into your hands.

Right now, you can buy a low cost health insurance package and fund your own private health savings account with tax free money. You can use that account to bargain for lower prices from hospitals and demand that your doctor spend more time with you and explain how you can be managed without every test and treatment they can provide. Your insurance will provide 100% coverage for preventive care and for true medical catastrophes that occur rarely in our lives. You can ask for your right to have a tax break when you buy insurance on your own (outside your employer). You can demand that the government stay out of the patient-physician relationship and not institute cookbook medicine and rationing. You can require that your politicians reserve government assistance for the poor and those who have no other means for health care -- not expand that care to everyone merely to get re-elected on an empty promise.

There are reform plans that will put you back in the driver's seat with your doctor at your side as your advisor and partner. They are proposed by people like Senator Tom Coburn, Representative Tom Price, Representative Tom Shadegg and Representative Paul Ryan. However, they will be very difficult to pass through Congress. It will require that you demand changes that empower you economically as individuals. Demand that you be able to have an individual tax benefit when you purchase insurance outside of employment. Demand that you be able to purchase insurance from another state. Ensure that Health Savings Accounts remain an option and grow in scope and size. Fight against expanded public saving for health care. Make sure that Government committees like the Comparative Effectiveness Coordinating Council don't create rationing protocols. In short, demand that you be in charge of your own health care financing and decision making. When you are in charge of your own health care, the politicians will not decide what kind of medical care you receive. Only you will.

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Britain: Hospitals have never needed Chaplains more

A&E departments are a war zone. There could not be a worse time to get rid of their chaplains

There is no way of telling how many prospective doctors and medical students watched The Hospital on Tuesday night, but we should, for all our sakes, pray it was a low number. The first part of Channel 4's fly-on-the-wall series, which runs for another two weeks, looked into the modern world of emergency medicine. This wasn't ER or Scrubs, this was ugly reality - wave upon wave of young people, drunk, regardless, violent and rude, brought in with various terrible injuries as a result of intoxication.

It was some of the most powerful documentary television I've seen: the young people were both victims and propagators of alcoholic mayhem; the doctors were dead-eyed, high-pay-grade streetsweepers.

We would be sensible to regard it as a modern morality play, especially in a week when the National Secular Society called for the NHS to stop funding hospital chaplains. The society estimates that £40 million a year is spent on giving religious groups a presence in hospitals. In many areas secularism has much to recommend it. In this instance they are wrong and mean-spirited. There has never been a greater need for a spiritual presence in hospitals.

What was so interesting about The Hospital, apart from its shock appeal, was the moral landscape it painted of our society. Here was a stage, you realised, where everyone had become brutalised. The patients showed a total lack of responsibility for their actions. They swore at staff, they smirked, they were abusive, complaining, obstructive, hysterical and completely unapologetic. As for gratitude, why, it's a free service, isn't it? What's to be grateful for? There was an almost total lack of the embarrassment or thanks that former generations would have displayed.

Even when approached, sober, for their reflections they were not given to remorse. Rather they were insouciant. Danielle, a 19-year-old mother of two, who had arrived at A&E after being trapped under a taxi, her shattered legs bent up over her shoulder, was oblivious of any moral subtext. After she had spent a month in hospital she was asked if she had paid a high price for her drinking. Nah, she joked, I only spent £20 and got a free taxi.

Equally you could see the impact on the battle-fatigued staff. Like military mercenaries, their moral values had either ceased to exist or they had been buttoned away for fear of revealing disgust.

I've encountered exactly the same dead eyes in big city A&E departments. Once, at one of these hospitals, notorious for dealing with relentless violence and knife crime, I attended my child who had been rushed there with a suspected neck injury. Fortunately it turned out just to be a torn muscle, but I found it an unnerving experience, and not for the obvious reason.

The doctor, a young man with empty eyes and a hard-drinking face, did not engage with us. He spoke as if we were five miles away. For all he was utterly professional and faultless, I felt as if something had died inside him. He was almost like an addict: I wondered if he was so hooked on the adrenalin of coping with stab wounds and fights that nothing less than that stirred him.

You see the same look in abbatoir workers' eyes. They shut down all feeling, all judgment. The patients, deserving or not, have become lumps of meat to them. Monica Garnsey, the maker of the documentaries, believes that what patients want most is the sense that their doctor is sympathetic. But their patience has been stretched too far.

So maybe a little moral panic would be a good thing; maybe we need more chaplains, if only to check the growth in this new amoral, compassion-neutral transaction, where the drunk and feckless not only waste billions of pounds but leave hospital as ignorant and unreformed as they went in. Maybe we need to be a bit more judgmental, for all our sakes.

In a world sometimes scarily lacking in values, chaplains have a vital symbolic role as well as a practical one. Chaplains, in my experience, do not proselytise; they simply afford patients the kind of time, care and compassion that medical staff can no longer give them. No, they cannot cure binge drinking, but they do stand for something resolutely good and wise.

The secularists have missed the point completely. They contacted 233 acute and mental health trusts, which spent £26.72 million on chaplains. This money, they say, could be used to employ 1,300 nurses or 2,645 cleaners, which is as facile as saying that we could save £3 billion plus in A&E budgets by banning booze. Terry Sanderson, the president of the society, even claimed that people in hospital should seek visits from their own vicar, priest, rabbi or imam if they needed religious support.

What an arrogant man he sounds. It is non-religious people, lost in a crisis, who need chaplains the most. Look at Jade Goody, married and blessed as she was dying. Look at the tragic, chaotic lives of some of the young people lying in A&E with no family to phone. It is the injured, the dying and the bereaved, who seek, not necessarily God, but a little kindness and succour at their time of greatest need.

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Starved by the NHS: 242 patients die from malnutrition in a single year

Malnutrition killed more than 240 patients on NHS wards in 2007, the highest toll in a decade, figures show. The appalling statistics reveal that the number of men and women starving to death in hospitals has risen by 16 per cent since Labour came to power. Since 1997, 2,311 hospital patients have died from malnutrition and the effects of hunger. There were 209 cases in 1997, when Tony Blair was elected under a pledge to save the NHS. Ten years later the toll was 242. In one area the number of deaths from malnutrition rose by more than 50 per cent.

The figures also show that over the past decade 55 patients have starved to death in council-run care homes.

Conservative health spokesman Stephen O'Brien said: 'Malnutritionhas been a growing problem during Labour's time in charge of our NHS. 'There can be no excuses, the least that patients should be able to expect is to be fed properly when they go into hospital for treatment. 'But unfortunately NHS frontline staff are often overburdened by red tape and paperwork and are consistently being spread too thin and too wide across the service. 'They must be released to do the job that they are there to do, to help people, or risk yet more unnecessary and needless deaths.'

The Daily Mail's Dignity for the Elderly Campaign has highlighted the scandal of old people not being fed properly in hospital. Food is often so unappetising that patients do not eat - and 11million meals are taken away untouched every year. Sometimes food is placed out of patients' reach and taken away untouched, because nurses claim they are too busy to help patients eat.

The starvation statistics cover the ten years to 2007 and were obtained by the Tories from a parliamentary question. They show that the poorest performing regions were the West Midlands, where 409 people died from malnutrition, and the South East, where 388 died. The biggest jumps in hospital deaths from malnutrition in the decade were in the East Midlands (up 55 per cent), the South East (up 27 per cent) and the North West (23 per cent).

Some of the patients would have been suffering from malnutrition when they entered hospital. However, the figures come just weeks after it was revealed that more patients are discharged from hospital with malnutrition than are admitted with the condition - and the overall figures are rising. In 1997, 70,658 patients were admitted with malnutrition and 75,431 discharged from hospital with it. By 2007, these figures had jumped to 130,594 admitted and 139,127 discharged.

A spokesman for the Department of Health said: 'The majority of patients are satisfied with the food they receive in hospitals, and the Dignity in Care campaign is working to drive standards of care further. 'It is crucial that everyone in care is always treated with dignity and respect, including during mealtimes.'

Michelle Mitchell, charity director for Age Concern and Help the Aged, said: 'It's scandalous to see that malnutrition is still a huge problem in our hospitals and care homes. 'Nutritious food and help with eating is an essential part of basic care which must be recognised by all staff. 'Malnutrition and dehydration can be very serious for older people as it often leads to a delay in recovery from illness and in some extreme cases can lead to loss of life.'

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Australian public hospitals a turnoff for expectant mothers

THE death of four Sydney babies involved in home births in the past nine months has obstetricians asking what they have to do to improve women¿s confidence in a hospital birth. It has also raised questions about what might happen next year when it could become illegal for midwives to attend such births.

Australia is one of the safest countries in which to give birth or be born but these statistics cover up a growing discontent with our impersonal maternity system. It is this discontent that is behind some women’s decision to opt for a riskier home birth. The recent tragic outcomes of that choice have put a spotlight on the need for reform.

A Government review of maternity services that reported in February called for a major overhaul of the system to give midwives a greater role.

Fears about the nation’s high caesarian rate, a lack of access to birth centre services and some women’s distaste for turning what is a natural process into a clinical nightmare drives the choice for a home birth.

Obstetricians said overcrowded and overworked public hospitals where the care is impersonal was also a factor. The Australian College of Midwives said there was no continuity of care for pregnant women using public hospitals. They may never see the same midwife or obstetrician twice and can often wait for up to five hours for a quick pre-birth check up. As a result many women approach labour with fear, College president Professor Pat Brodie said.

Most women turned off by a hospital birth who choose to have their baby at home have positive birth experiences. But Westmead Hospital clinical director of women’s health Andrew Pesce said the safety of home births had been taken for granted. Those advocating them do not do enough to acknowledge the risks involved, he said.

Australian studies showed the chances of a baby dying in a home birth were three times greater than in a hospital setting. “There are one or two extra deaths per 1000 home deliveries and we wish people would acknowledge that,’ he said. Dr Pesce was also alarmed that in the past nine months there were eight “very bad outcomes” from home births that he knew of. Four of those babies died and four of them may have brain damage.

While mothers have a right to choose how they give birth, there were concerns that sometimes decisions were being made for ideological reasons without the clinical risks being properly assessed. Older mothers, those who have previously had caesarians, those undergoing a breech birth who have higher risks attached to their births were choosing sometimes to go it alone. “When it leaves the realm of health science and becomes politics and ideology you’re not thinking clinically, you’re thinking ideologically,” Dr Pesce said.

He said some of the coronial inquiries into home birth deaths in New Zealand showed midwives refusing to do vaginal observations on women in labour in case they distress her with news of slow progress. “They are only reacting to disaster at the last minute when the only way to minimise deaths is to minimise the risks,” he said.

Home birth advocates counter with claims about the damage hospital births often inflict on the mother and baby. Home births represent a very small number of all births that take place in Australia each year - 0.25 per cent. In 2006 there were 708 babies delivered in a home birth out of 277,436 babies born. More than 97 per cent of babies were born in a hospital. Even in New Zealand, where home birth is government-funded, only 2.5 per cent of mothers go ahead with a home birth.

Home births in Australia could get even riskier from next July when a new national registration scheme for health professionals kicks in. From then health professionals will need indemnity insurance to gain the registration they need to practise. Midwives working outside the hospital system have been refused insurance since the indemnity crisis of 2001. Unless the Government offers to pick up the indemnity bill, they will be unable to practice home births from next year.

Professor Brodie said if women were unable to get a midwife’s help for a home birth they would be forced to go it alone and “that is completely unacceptable”. But Dr Pesce questioned whether the government should be indemnifying higher-risk home births.

Both obstetricians and midwives want the maternity system reformed. They agreed women needed continuity of care, a link with a midwife or doctor they know and trust for the entire pregnancy. Dr Pesce hoped such a system might make a hospital birth a more appealing option for those women he now calls refugees from our health system.

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‘NHS culture and lack of cash delay stem-cell hopes’

The promise of stem-cell research to deliver new therapies for conditions such as diabetes, Parkinson’s, heart disease and paralysis is being held back by funding problems and the NHS’s institutional culture, a report suggests. Although British academic stem-cell science is internationally competitive, a lack of commercial investment and NHS support is hindering its potential to help patients and create profits, scientists at the University of Nottingham have said.

Paul Martin, of its Institute of Science and Society, who led the research, said: “While the Government has identified regenerative medicine as a national priority and the US has lifted its ban on stem-cell therapy, urgent public policy action is needed if it is to become a reality.” His report, co-authored by Emma Rowley, is published as scientists gather in Oxford today for the UK Stem Cell Network’s annual conference, organised by the Biotechnology and Biological Sciences Research Council.

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Desperate Australian mothers turn to home births

Meltdown of public hospital obstetrics in NSW. Sounds a lot like Britain

MIDWIVES in New South Wales public hospitals are supervising the labour of up to three women simultaneously because staff numbers have not kept up with the nation's baby boom. Overcrowding, lack of birth options and the closure of many rural obstetric services is forcing women into home births.

The Daily Telegraph reported yesterday at least four babies had died during home births in the last nine months and another four suffered possible brain damage. One of those babies was born without the assistance of a doctor or a midwife in contravention of NSW policy which requires two midwives to be present at a home birth.

The Australian College of Midwives said chronic understaffing had turned maternity departments into factories where women were left alone in labour as midwives ran between birthing suites. The overcrowding and inability to constantly monitor women giving birth has increased the intervention and caesarean rate, spokeswoman for the college Associate Professor Hannah Dahlen said. Thirty one per cent of babies in Australia were delivered by caesarean compared to the OECD average of 22 per cent. In private hospitals the rate is 41 per cent.

The college said the factory-like treatment of women in labour was one reason they were turning to home births. Clinical director of women's health at Westmead Hospital Dr Andrew Pesce said pregnant women must get continuity of care from the same doctor or midwife through pregnancy. This option was available to just 3 per cent of pregnant women in NSW.

Meanwhile, crucial maternity services are being cut across regional NSW forcing expectant mothers to choose alternative birthing methods including home births.

Heavily pregnant women are being forced to travel up to two hours for antenatal care or for birth as many services have either being downgraded or have closed their doors across the state. There are plans to cut four midwife positions at Port Macquarie while antenatal classes could be axed at Kempsey after more than 20 years under a staffing review of the North Coast Area Health Service.

On the Far South Coast, Pambula Hospital is closing its maternity service and merging with Bega, which had caused community anger. In the Southern Highlands, there are plans to downgrade maternity services at Bowral Hospital. Blue Mountains Hospital is constantly opening and closing because it cannot get an obstetric anaesthetist.

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Number of NHS tooth extractions soars by 30% in four years

Very primitive

Thousands of Britons are having teeth needlessly pulled out, it was claimed yesterday. The number of extractions has soared by 30 per cent in four years, according to figures obtained by the Liberal Democrats. The party claims this demonstrates how much dental care has deteriorated under Labour, leaving thousands missing out on treatment that could save their teeth. More than 175,000 Britons had their teeth extracted under general anaesthetic in 2007/08, up 40,000 on the 2003/04 figure, a parliamentary answer revealed.

Of these, 44,300 were aged between six and 18 and 14,200 were under five years old. LibDem health spokesman Norman Lamb said: 'The extraordinary number of people needing their teeth extracted under general anaesthetic could well be the result of the appalling access to NHS dentistry.' He pointed the finger at the general difficulty in finding a Health Service dentist since the Government introduced a 'botched' contract in April 2006.

Designed to increase access to NHS dentistry, the deal actually saw hundreds of dentists leave the NHS. The number of patients seeing a dentist fell by 1.2million, leaving thousands without the treatment that could have stopped their teeth getting so bad that they had to be pulled out. But dentists' salaries have soared by 11 per cent since the change – to an average of more than £96,000.

Mr Lamb added: 'The dental contract was supposedly designed to improve the situation, but the staggering rise in tooth extractions proves the massive failures of thisbotched initiative. The crisis in NHS dentistry is one of this Government's most shameful legacies.'

Although the rate of extractions increased throughout the four-year period following April 2003, it gathered pace after the new contract for NHS dentists was introduced. In 2005/06, the year before the new contract, the number of extractions stood at a little more than 149,100. Two years later it had risen to just over 175,400 – an increase of 18 per cent.

The contract also changed how dentists were paid. Experts have warned that the incentives it offers make it more profitable for dentists to take a tooth out than to try to save it with complex treatments such as crowns or bridges. A patient has to pay £45.60 for a tooth to be taken out, and £198 for crowns, bridges or dentures. Before the contract dentists were paid per procedure, but after it came in they were paid to provide a specific rate of procedures in the coming year. With the money already in the bank, the fear is that some dentists may feel less inclined to carry out complex and expensive procedures and instead choose the cheaper option of taking the tooth out.

Last year MPs concluded that patients were having teeth pulled out unnecessarily as a result of the dental contract. The Commons health select committee found that the number of complex treatments such as crowns, bridges and dentures had plummeted by 57 per cent since 2006, at the same time as the number of extractions were rising. It said this happened because dentists had no financial incentive to give appropriate treatment. In Scotland, which did not bring in the new contract, the number of complex operations has gone up.

The British Endodontic Society said the contract provides dentists with a 'financial incentive to persuade a patient to have a decayed tooth extracted rather than undergo the more complex procedure of restoring it'. The soaring number of extractions under general anaesthetic comes even though the British Dental Association advises that such strong anaesthetics should only be used in hospitals.

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Australia: Public hospital bed shortage as deadly as road toll

HOSPITAL emergency department overcrowding is responsible for at least as many deaths every year as occur on Australian roads, doctors say. In a damning series of reports in the Medical Journal of Australia, emergency medicine specialists suggest about 1500 Australian deaths could be avoided each year. The specialists say caring for patients waiting for a hospital bed represents about 40 per cent of the workload in major emergency departments, and up to 70 per cent in some.

They are critical of politicians and bureaucrats who deny that hospital overcrowding has major adverse effects on patient care. Ideally, for a hospital to function effectively, the doctors say occupancy should be no more than 85 per cent to allow for fluctuations in demand. But the Australian Medical Association says hospitals such as Townsville, in Queensland's north, operate at more than 100 per cent capacity "most of the time".

Australia has 2.6 hospital beds per 1000 people - far short of the average of 3.9 per 1000 for countries in the Organisation for Economic Co-operation and Development. A snapshot of overcrowding in accredited Australian emergency departments at 10am on June 2 and September 1 last year, found more than half the patients in non-NSW emergency departments were waiting to be admitted, three-quarters of them for more than eight hours.

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NHS Hospitals granted foundation status despite a plethora of failings

More than 20 hospitals which failed to meet basic health care standards have been awarded "foundation trust" status allowing their bosses to take massive pay rises, an investigation has revealed. Ministers promised that only the best hospitals would be given the freedom to run their own affairs, including setting salary levels which have brought huge pay boosts for senior managers.

Yet investigations by this newspaper show that 22 hospital trusts in the past three years have been given the coveted status despite a range of serious failings including high rates of superbugs, delays treating cancer and heart attack victims, long waits in Accident and Emergency (A&E) departments and lack of proper care for the elderly and the mentally ill.

Patients groups described the revelations as "a shocking exposure" of a regulation system which they said was failing to protect patients or provide the public with any reassurance about where good hospital care could be found.

In a separate development, an investigation has been launched into care standards at a foundation trust which suffers from the highest death rate in England. External consultants have been called in by Basildon and Thurrock University Hospitals NHS Foundation Trust, in Essex, which was among the first wave of trusts awarded foundation status in 2004, but which last year had a mortality rate 32 per cent above expected. The trust believes the high rate is due to data errors, a lack of local hospice places and a high incidence of heart and respiratory disease among local residents.

When Labour introduced foundation trusts, then-health secretary Alan Milburn said that winning the status would be a challenging process "even for the best performing hospitals" who would have to demonstrate high standards of care. Those awarded the status include Mid Staffordshire Foundation trust, which runs Stafford Hospital, where hundreds of people died amid conditions which left dehydrated patients forced to drink out of flower vases while others were left lying in soiled linen. Board papers reveal that the regulators who granted the license to give the trust "foundation" status were aware of a litany of failings in patient care in Mid Staffordshire. At the point the authorisation was made, the trust was missing government targets to reduce MRSA, had long waits in A&E, and for clot-busting treatment for heart attack victims, the documents from Monitor, the regulator, show.

A further 21 trusts were also given the coveted status despite concerns about the quality of the care they provided. As Monitor sent the letters of authorisation it simultaneously issued the trusts with "side letters" highlighting the problems with patient care.

At the point the trusts were awarded the status, 18 were missing or about to miss targets to reduce levels of the superbug MRSA; three had long delays for cancer patients; and four were unable to give urgent treatment to heart attack victims who required clot-busting drugs. Two had been assessed as providing "weak" services for the mentally ill, one had been criticised for staff shortages in paediatric wards, and one was found to be failing to look after frail and elderly patients.

Three of the trusts, including Mid Staffordshire, had high death rates which were discussed during Monitor's board meetings. The documents identify Medway trust in Kent – granted foundation status in October 2007 – as being in the worst 10 per cent of trusts for mortality. Blackpool Fylde and Wyre trust had above-average mortality rates in 2005/6, the documents show, but Monitor granted it foundation status in Dec 2007 after being assured the rates were reducing. Since then, they have risen.

When United Bristol Healthcare trust was granted foundation status last May it had failed the latest annual targets to reduce MRSA, it had high levels of the infection Clostridium difficile, and its patients faced long waits in A&E.

Foundation trusts have more autonomy to run their own affairs and set their own levels of pay. The average pay for their chief executives is now £157,000 – 18 per cent more than that received by those running standard NHS hospitals.

Katherine Murphy from the Patients' Association said the failings identified in the authorisation process undermined claims by foundation trusts that they could offer the best care. "The public has been given the impression that these hospitals are the best. When hospitals are given foundation status despite all these failings, the term just becomes a way for trust boards to give more pay to senior managers," she said.

Norman Lamb, the Liberal Democrat health spokesman, added: "It is really worrying, especially given what we have found out recently about Stafford Hospital, to see that the threshold for foundation status appears to be lowering. "It is absolutely critical that quality of care is the priority when these trusts are being assessed," he added.

A spokesman for Monitor said the regulator would only authorise a trust's application if it had robust action plans to improve its performance, and said the issuing of "side letters" did not represent a lowering of the bar for applicants, but a mechanism to ensure that their performance was closely monitored.

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One in three Brits can't find an NHS dentist - and half can't afford one

Despite Government promises to improve access, research reveals that 35 per cent of adults are struggling to get the dental care they need - up from 23 per cent the year before. In some parts of the country, half the adults said they cannot see an NHS dentist - forcing them to go without treatment or to pay privately.

The credit crunch is also having an impact on the nation's dental health. The poll revealed that almost 50 per cent of the population say they are put off going to the dentist over fears of the cost. Last year the figure was one in five.

Abby Bowman from Simplyhealth, the private dental provider which carried out the survey, said: 'The NHS dental contracts introduced three years ago were supposed to give more people access to dentists, but as our research shows this is only getting worse.'

The survey of 1,700 people indicates that Plymouth is a leading NHS dentistry blackspot, with 51 per cent unable to find a dentist; followed by Southampton on 45 per cent and Manchester on 45 per cent.

The credit crunch is having the greatest effect in the capital, with 54 per cent in London saying they would be put off from visiting a dentist because of cost worries.

Dental charges have risen since the introduction of the new contract for dentists in 2006. Prior to this contract, the average cost of a basic NHS checkup was £5.54, and the price of a filling about £10. Under changes introduced in 2006, individual charges for NHS treatments were replaced with a system of bands with a maximum charge of £198. A check-up costs £15.90 and a filling £43.60. The contract was designed to improve access to the NHS, but around 500 dentists left the Health Service, claiming they were not being paid properly.

Figures released last autumn showed that the number seeing a dentist has plummeted by 1.2million in two years, so that fewer than half of all adults saw a state-funded practitioner. The situation has led to some patients being forced to pull out their own teeth because they cannot afford to go private. Others have turned up at hospital casualty departments for emergency dental work.

Even though dentists are seeing fewer patients their pay has soared - up 11 per cent since the start of their new contract to an average of more than £96,000. Yesterday the Government said dentists would receive a pay rise of 0.21 per cent - effectively a pay cut because of inflation.

Conservative health spokesman Mike Penning said: ' Perhaps this will finally persuade Labour ministers to scrap their ludicrous contract and to take real action to improve outcomes for patients.'

Susie Sanderson, chairman of the British Dental Association, said the problems facing NHS dentistry were well documented. But health minister Ann Keen said: 'These findings do not reflect reality. 'Thanks to over £2billion investment in NHS dentistry, recent official statistics show that access has actually increased and there's 655 more dentists than the year before.'

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ANOTHER birth in an Australian public hospital toilet

A WOMAN gave birth to a stillborn baby in the toilets of Bankstown Hospital after being told by two doctors that she was just constipated. Health officials have confirmed that the woman, aged 21, went to the hospital unaware she was pregnant, after consulting two local general practitioners. It is the fifth serious incident to have occurred in the toilets of a NSW hospital since a miscarriage at the Royal North Shore in September 2007 prompted the State Government to open a special commission of inquiry into the health system. The Garling commission handed down its 139 recommendations just last week.

Complaining of pains in her stomach on Thursday night, the woman was taken for X-rays, a process that can be harmful for pregnant women. The results confirmed she was heavily pregnant, but the woman wandered off from the radiology section of the hospital before she was informed.

While she was in the hospital toilets, her waters broke and she gave birth to the child in a toilet bowl. It is understood the baby had a pulse and hospital staff rushed to try and resuscitate the child, but were unsuccessful.

A Sydney South West Area Health Service spokesman said the details of the events were still being investigated. "[The woman] gave birth to a baby that sadly did not survive," he said. "These are very unusual and upsetting circumstances for the patient and hospital staff. The woman is receiving ongoing support and care. "The family have requested no further details be released. This is now a matter before the coroner and it is inappropriate to comment further."

A spokesman for the Health Minister, John Della Bosca, said he was first alerted to the incident by a media report, but confirmed it would be referred to the coroner to be investigated. "[Mr Della Bosca's] very concerned about this. He has already made phone calls to make sure that woman involved gets the support she needs," the spokesman said.

The Opposition health spokeswoman, Jillian Skinner, describing the incident as "horrific" and "unbelievable", said Mr Della Bosca needed to show some leadership and extend the coroner's powers. She said the incident had echoes of the Vanessa Anderson case. Her death in November 2005 highlighted systematic failings of the health system.

"A coroner looks at death, a coroner doesn't look at the system and how it has let this mother and her child down," she said. "I expect a coronial inquiry, but we also need to know what else in this whole process went wrong …" "This is more than a death, it's about a whole systemic failure to address what went wrong, and this woman has been subjected to error after error after error." It is the fourth time a woman has lost a child in a NSW hospital toilet since September 2007.

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Regulator orders 21 NHS hospital trusts to clean up their filthy hospitals

Warnings about substandard levels of hygiene and infection control have been issued to twenty-one NHS trusts, including four flagship foundation hospitals. The Care Quality Commission (CQC), the new “super-regulator” for health and social care that started work on Wednesday, said that the trusts had failed to meet standards on cleanliness.

All 21 have had strict conditions placed on their registration with the commission, which is a legal requirement. Hospitals that fail to act to improve hygiene levels could be issued with warning notices and fines, or face prosecution or closure.

The CQC rulings, issued today, show that ten acute hospital trusts, six primary care trusts, four mental health care trusts and one ambulance trust have registration conditions as a result of failing to meet the criteria fully. The four trusts with foundation status — a supposed marker of excellence — are Kettering General Hospital, Leeds Partnerships, Medway and Alder Hey Children’s.

Fears over the regulation of foundation trusts were raised last month after it became clear that Mid Staffordshire NHS Foundation Trust had been awarded the status despite concerns over its death rates. The Healthcare Commission, the CQC’s predecessor, published a damning report on “appalling standards” of care at the trust. Between 400 and 1,200 more people died there than would have been expected between April 2005 and March 2008.

Today’s data shows that some trusts have been given a deadline for taking action to meet hygiene standards while others have conditions on their registration, such as the need to keep wards clean. Examples include ensuring that the decontamination of surgical equipment is satisfactory and developing tighter policies to tackle infections such as MRSA, Clostridium difficile and legionella.

Overall, 388 NHS trusts have been registered with the CQC, which replaces the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission.

As part of their assessment, trusts declared whether they were compliant with national hygiene standards. The CQC also looked at other information, including patient and staff surveys, hygiene inspections carried out by the Healthcare Commission and MRSA and C. difficile rates. Of the 21 trusts, 13 declared non-compliance with some of the criteria set down by the CQC for registration.

In another eight cases, the CQC had evidence that the trust had repeatedly failed to achieve required standards for infection control, had a high infection rate and/or was identified by the Healthcare Commission as having substantial problems that could risk patient safety.

The CQC defended its decision not to issue a hygiene warning to East Sussex Hospitals NHS Trust, which runs the Eastbourne hospital where a strain of C. difficile last month was linked to the deaths of 13 patients. It said that a warning had been considered, but the trust was handling the outbreak efficiently and appeared to have been victim of the small chance all hospitals have of such an incident occurring, rather than as a result of poor hygiene.

Over the next year, up to half of all NHS trusts providing acute, primary care, mental health and ambulance services will be inspected by the CQC.

Baroness Young of Old Scone, the chairwoman of the CQC, said that recent decreases in rates of MRSA and C. difficile reflected how infection control was improving nationally. “Most trusts have stronger systems to protect patients from infection than a few years ago, and trusts’ boards are taking the challenges seriously. We commend them for that,” she said.

She said that registration of NHS trusts based on healthcare-associated infection marked the first step in a new system to drive further improvement and ensure patients’ safety. “This was an opportunity for trusts to let the public know that they are taking effective action to tackle these infections. The overwhelming majority of trusts provided the assurance needed to register. We will closely monitor their performance to ensure they continue to meet the regulations and make improvements when required.”

Of the 21 trusts that had fallen below the CQC standards, she said: “We have placed rigorous conditions on these trusts’ registration and will monitor them closely.”

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Overnight NHS hospital beds fall 10% in just three years

DESPITE a growing population

The number of overnight beds in NHS hospitals has plummeted by almost 10 per cent in just three years. Experts say the falls have exacerbated overcrowding on wards, which is putting patients at increased risk of infection. And the pressure to discharge elderly patients quickly because of the low number of beds was endangering their health, they warned.

The official figures show the number of beds remained virtually constant over the early years of Labour control, but began to fall in 2005 - the year of the financial crisis which engulfed the NHS and forced the closure of dozens of wards and the cutting of hundreds of jobs.

There were 198 overnight beds per 100,000 people in 2007/08. This is down from 219 per 100,000 in 2004/05, the year before the financial crisis, and 222 when Labour came to power.

Ministers say fewer overnight beds are needed because medical advances mean people are no longer kept in hospital for as long. But patients groups claim beds and sometimes entire wards are being shut for cost reasons, while doctors warned the NHS will be unable to cope in times of crisis such as a big flu outbreak. There are also concerns that low numbers of beds lead to high occupancy rates - putting people at risk of catching superbugs because there is not enough time to clean wards properly.

The pressure to free up dwindling numbers of beds has also led to fears that elderly people are being discharged too early, putting them at risk. Last year nearly 150,000 people over the age of 75 had to be re-admitted as emergency admissions within 28 days.

Liberal Democrat health spokesman Norman Lamb said: 'The loss of beds is putting hospitals under an impossible strain, with many seeing increases in emergency admissions. 'It is complete mismanagement to cut the number of NHS beds when the number of emergency readmissions and the number of cancelled operations are on the rise. 'Hospitals across the country are full to overflowing, and staff are being put under impossible pressure thanks to this Government's mistakes.'

Conservative health spokesman Andrew Lansley said the bed cuts would also make it harder for the Government to meet repeated pledges to eradicate mixed-sex wards. 'It is madness to cut beds when wards are overcrowded, when there aren’t enough isolation rooms to control hospital infections and patients are still placed in mixed sex accommodation,' he said. 'Labour’s complacent assumption that there would not be any more winter crises is now having disastrous consequences for patients. 'In 2000 Labour said that bed numbers needed to increase, but these figures demonstrate again how badly they have failed. The Government needs to explain why our hospitals have so many fewer beds than hospitals in other European countries.'

Michael Summers of the Patients Association said: 'In an ageing population we need a proper number of beds available, but what we are seeing is beds being cut to save money, leaving patients to suffer - as we saw in Mid Staffordshire. 'It can be no accident that the number of beds began to fall after the time of hospital deficits. 'Overcrowding in wards makes them more difficult to clean and encourages the spread of infections. It means the NHS will be less likely to be able to cope if there is a big outbreak of flu or something like that. 'And elderly people could end up being discharged earlier than is good for them, which is counter-productive. These bed cuts are silly, short term decisions by managers.'

A survey out earlier this year showed that the UK had far fewer beds than almost any other country in Europe, with less than half the number per head of population than Germany. The study in the Lancet found that overcrowding in hospitals was linked to superbug outbreaks, and 71 per cent of hospitals had occupancy rates of more than 82 per cent - a recognised safe level. Around a quarter of trusts exceeded 90 per cent.

The new figures, revealed in a parliamentary answer and published in Pulse magazine, show that in only one part of the country has the numbers of beds stayed constant over the past year. This was the South Central region, covering Oxfordshire, Hampshire and neighbouring counties, where there are 164 beds per 100,000 people - one of the lowest rates in the country.

There were wide regional variations, with people in deprived areas like the North East having two thirds more beds per head of population than those in East Anglia - 245 to 151 per 100,000. Across the country, the rate was 222 per person in 1997/98, when Labour took office. It remained constant until 2004/05, when a financial crisis hit the NHS and dozens of hospitals were forced to make cuts to jobs and close wards to save money. From then on, the numbers started to fall.

Answering the parliamentary question, health minister Ben Bradshaw said the fall in the number of hospital overnight beds was the result of dealing with patients more efficiently and releasing them more quickly. 'Experts all agree this is the best way to deliver healthcare,' he said. 'Advances in medical technology and shorter stays for routine operations mean fewer beds are needed. This is part of a long-term downward trend in the average length of stay in hospital. 'But where the NHS needs more beds, there are more beds.' There were 47 per cent more day beds, he said.

However, Dr Jonathan Fielden, chair of the British Medical Association's consultants' committee, said funding cuts meant specialists were relying on already stretched GPs to pick up the slack. 'While we have hospitals with this limited capacity - as we saw this winter - we will have more delays in getting patients in and we will be much more reliant on our GP colleagues to look after patients a bit longer and take them that little bit earlier.'

Dr Paddy Glackin, a GP in north London, said primary care trusts were cutting costs and leaving GPs to pick up the pieces. 'It's a rolling door. Every day, GPs have to see patients who have been hurtled out of hospital too quickly. Every single Friday one local hospital is on an emergency beds system and we are fighting to get our patients accepted. We are under pressure continually to manage patients at home.'

Richard Hoey, deputy editor of Pulse, said: 'Moving patients out of hospital more quickly is great if it's genuinely justified on medical grounds, but it's certainly not acceptable just as a way of saving money. 'The Government must also ensure that if patients are increasingly managed in primary care, rather than in hospital, that there is a concurrent shift in resources. At the moment, hospitals continue to soak up too much of NHS funding.'

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Texas: Nine People Responsible for 2,678 Emergency Room Visits

(Austin, Texas) This report provides data indicating that one of the problems associated with overloaded emergency rooms is that people go to the ER when they really don't need to. The conclusions are hardly surprising.

In the past six years, eight people from Austin and one from Luling racked up 2,678 emergency room visits in Central Texas, costing hospitals, taxpayers and others $3 million, according to a report from a nonprofit made up of hospitals and other providers that care for the uninsured and low-income Central Texans.

One of the nine spent more than a third of last year in the ER: 145 days. That same patient totaled 554 ER visits from 2003 through 2008.

"We looked at frequent users of emergency departments ... and that's the extreme," said Ann Kitchen, executive director of the Integrated Care Collaboration, the group that presented the report last week to the Travis County Healthcare District board. "What we're really trying to do is find out who's using our emergency rooms ... and find solutions."

The health district, one of 26 members of the ICC, has long been concerned about overuse and crowding of ERs, a problem that has hit hospitals around the country.

The district is seeking ways to reduce the load on ERs by better managing where patients who don't have a real emergency go for care, CEO and President Patricia Young Brown said. In the past couple of years, the district has expanded hours at public clinics it oversees and has financed an urgent care center, where patients who don't have real emergencies can receive after-hours medical treatment at a lower cost to taxpayers than in an ER. [...]

The ICC, whose mission is to work with safety-net providers to improve access to and quality of care, has a database of 750,000 uninsured and underinsured Central Texas patients collected from its members. That database is confidential because of patient privacy laws. It found that 900 frequent users — people who visited an ER six or more times in three months — had 2,123 preventable visits in 2007, or 18 percent of 11,600 total visits to Central Texas ERs, which cost more than $2 million. Among those picking up the bill were hospitals and taxpayers, including government programs such as Medicare and Medicaid, Kitchen said.

Doing the math, each of the nine individuals averaged 50 ER visits per year or about one ER visit per week.

For comparison, I average one ER visit every ten years. I blame la vida loca.

Patients of Problem VA Clinics Infected

Viral infections, including hepatitis, have been found in 16 patients exposed to contaminated equipment at Veterans Affairs medical facilities, a department spokeswoman said Friday. So far, 10 colonoscopy patients from the VA medical center in Murfreesboro, Tenn., have tested positive for hepatitis, VA spokeswoman Katie Roberts told The Associated Press. In a later e-mail, she reported six patients at the VA's ear, nose and throat clinic in Augusta, Ga, tested positive for unspecified viral infections. The number of reported infections could rise.

More than 10,000 veterans were warned to get blood tests because they could have been exposed to contamination at those two facilities plus a medical center in Miami. All three sites failed to properly sterilize equipment between treatments, and the problems dated back for more than five years at the Murfreesboro and Miami hospitals.

Roberts said the department doesn't yet have results from most of the veterans it warned. A VA alert to patients said they "could have been exposed to body fluids from a previous patient."

Roberts said four Tennessee patients have tested positive for hepatitis B and six have tested positive for hepatitis C. No one has tested positive for HIV, she said.

Hepatitis is a viral infection of the liver. The most common form, hepatitis C, is potentially life-threatening and can cause permanent liver damage. Both the B and C forms are spread by contact with the blood or other body fluid of an infected person, according to the Centers for Disease Control and Prevention.

Roberts stressed that the source of the infections isn't known and may never be identified. "There's no way to scientifically, conclusively prove they contracted this due to treatment at our facility," Roberts said. But the VA will make sure those who tested positive "get the best possible treatment," she said.

The VA's inspector general office has started a review, spokeswoman Joanne Moffett said Friday. According to a VA e-mail, only about half of the Murfreesboro and Augusta patients notified by letter of a mistake that exposed them to "potentially infectious fluids" have requested department blood tests. Some veterans said they decided to seek tests from their private physicians, rather than the VA.

The public first became aware of problems in February, when the agency announced it had sent letters to about 6,400 patients who had colonoscopies between April 23, 2003, and Dec. 1, 2008, at Murfreesboro and to about 1,800 patients treated over 11 months last year at Augusta. Roberts said the problem in Tennessee was discovered in December and an internal alert was issued.

This week the VA announced it sent letters advising 3,260 patients who had colonoscopies between May 2004 and March 12 at the Miami Veterans Affairs Healthcare System that they also should get tests for HIV, hepatitis and other infectious diseases. "We feel that the risk of cross-contamination among patients is small, and many patients are at no risk whatsoever," Dr. William E. Duncan of the VA Health Administration said in an e-mail. "Since we cannot know which patients are at risk, we are notifying everyone we feel may possibly have been placed at risk."

Two weeks after a review of procedures and training at VA facilities nationwide, Roberts said the VA cannot yet say if patients at other locations were exposed to equipment that was not properly sterilized.

U.S. Rep Ileana Ros-Lehtinen, R-Fla., said VA officials told her and other members of Congress on Thursday that the Miami facility initially reported it was free from problems only to later backtrack. Ros-Lehtinen said the details were disclosed by the VA in a closed-door meeting convened by U.S. Rep. Steve Buyer, R-Ind., the top Republican on the House Committee on Veterans' Affairs.

Joe Davis, a spokesman for the Veterans of Foreign Wars in Washington, said he has notified his 20,000 newsletter subscribers about the situation. "We are obviously very concerned anytime anybody's health is at risk from going to see the doctor," he said Friday. "We believe the VA has done an adequate job in quickly notifying those veterans who might be affected."

SOURCE





UK: Mental services ’shut to elderly’

Older people are often denied access to the full range of mental health services available to younger adults, a watchdog has found. At four out of six mental health trusts examined in England decisions were based as much on age as clinical need, the Healthcare Commission found. Out-of-hours, alcohol and crisis services, and psychological therapies were often unavailable to the over 65s. A body representing trusts said new policies would benefit older patients.

Healthcare Commission chief executive Anna Walker called the findings "unacceptable".

The research showed that older people were often prevented from accessing care because of stretched services or a lack of age-appropriate care. Some staff said patient groups considered to be of high risk to the public or where government targets were applicable were often prioritised, leaving older people's services lagging behind with little funding.

Ms Walker said: "Trusts are not always providing appropriate mental health services to the over 65s. "It is truly unacceptable that out of hours and crisis services were often not available to older people. "There needs to be a fundamental shift towards providing care based on a person's clinical need rather than their age. "Considering a quarter of admissions to mental health inpatient services are over 65, this issue needs urgent attention."

Kate Jopling of Help the Aged said: "It's shocking to think that, despite the need, older people are routinely being denied treatment for mental health services. "The date on a birth certificate should not be the measure of whether or not someone receives the help they need for a mental health problem."

And Gordon Lishman of Age Concern said the services that did exist for older people were often chronically under funded and are not of the same quality to those offered to adults of working age. He said the situation was scandalous and urged the government to use laws to stamp out age discrimination.

Care Services Minister Phil Hope said any unfair discrimination against older people was unacceptable. "We are taking action and we expect NHS trusts to make improvements."

Steve Shrubb, director of the mental health network which represents the majority of mental health trusts said: "We have some of the best mental health services in Europe yet it is clear that there are still improvements to be made to mental health services especially to ensure that older people get access to the correct care when they need it." He said new policies, such as quality accounts, would put the needs of patients into sharper focus.

Meanwhile, a second study from the Commission of all 68 NHS specialist community mental health trusts in England, found that almost half of under 65s needing specialist mental healthcare still do not have an out-of-hours number if they are in a crisis. Half of people with schizophrenia have not been offered recommended psychological therapies, it suggested.

SOURCE

Did Canadacare kill Natasha Richardson?

By Michelle Malkin

Dr. Cory Franklin had a provocative piece in the New York Post yesterday exploring whether Canada’s government-run health care system contributed to the tragic skiing death of Natasha Richardson. He writes:

Richardson died of an epidural hematoma — a bleeding artery between the skull and brain that compresses and ultimately causes fatal brain damage via pressure buildup. With prompt diagnosis by CT scan, and surgery to drain the blood, most patients survive.

Could Richardson have received this care? Where it happened in Canada, no. In many US resorts, yes.
Between noon and 1 p.m., Richardson sustained what appeared to be a trivial head injury while skiing at Mt. Tremblant in Quebec. Within minutes, she was offered medical assistance but declined to be seen by paramedics.

But this delay is common in the early stages of epidural hematoma when patients have few symptoms — and there is reason to believe her case wasn’t beyond hope at that point.

About three hours after the accident, the actress was taken to Centre Hospitalier Laurentien, in Sainte-Agathe-des-Monts, 25 miles from the resort. Hospital spokesman Alain Paquette said she was conscious upon reaching the hospital about 4 p.m.

The initial paramedic assessment, travel time to the hospital and time she spent there was nearly two hours — the crucial interval in this case. Survival rates for patients with epidural hematomas, conscious on arrival to a hospital, are good.

Richardson’s evaluation required an immediate CT scan for diagnosis — followed by either a complete removal of accumulated blood by a neurosurgeon or a procedure by a trauma surgeon or emergency physician to relieve the pressure and allow her to be transported.

But Sainte-Agathe-des-Monts is a town of 9,000 people. Its hospital doesn’t have specialized neurology or trauma services. It hasn’t been reported whether the hospital has a CT scanner, but CT scanners are less common in Canada.

Actually, it has been reported that Richardson received a CT scan at Centre Hospitalier Laurentien. The hospital does have the equipment.

Defenders of universal health care think this ends the debate and accuse critics of Canada’s system of “exploiting” Richardson.

But health care blogger Dr. T points to the government-engineered lack of specialists in Canada:

Neurosurgeons are not so easy to find in Canada where subspecialization is not rewarded, and 50-60% of boarded neurosurgeons leave the country to practice somewhere else within 2 years of their certification.

The last good data I could find listed only 174 neurosurgeons in the entire country. In the U.S. we have 3,500. A study on the need of neurosurgeons listed the density of neurosurgeons in the U.S. to be about 1/55,000 people which means that an analogous number of neurosurgeons needed in Canada would be about 604.

It is true that neurosurgeons eschew emergency room coverage in the United States, but it is for completely different reasons than in Canada. Here, our ED’s don’t want to pay what it takes to hire a neurosurgeon for coverage; in Canada, no one wants to even be a neurosurgeon.

So, in a sense, the Canadian model for health care failed Natasha Richardson because of an artificially created shortage of subspecialists, which is a purposeful design meant to keep costs low in a taxpayer-funded-system. The U.S. would very much like to go in this direction and the plan is to broaden non subspecialized care options while reducing higher-tech procedures, diagnostics and physicians.

But as we go towards a single-payer system, we can all expect that when we need it most, the system will not be there for us, as it was not there for Natasha Richardson.

Additionally, Matthew Vadum and a top Montreal doctor point to Canada’s woeful lack of a medical flight system.
There’s no shame in asking what went wrong, how our health care system can minimize preventable deaths, and whether current proposals to radically alter our health care system would increase these tragedies.

It would be irresponsible to do otherwise.

***

Read this. Hat tip - Greg Pollowitz:

Connie and Donald McCracken were watching CNN one evening last week when they learned of the tragic death of actress Natasha Richardson from a head injury. Immediately, their minds turned to their 7-year-old daughter, Morgan, who was upstairs getting ready for bed.

An injured Morgan McCracken has benefited from awareness after Natasha Richardson’s death. Two days earlier, Morgan, her father, and brother had been playing baseball in the yard of their Mentor, Ohio, home when her father hit a line drive that landed just above Morgan’s left temple. A lump formed, but the McCrackens iced it down and the swelling subsided within an hour.

“For the next two days, she was perfectly fine,” Donald McCracken says. “She had no symptoms. She went to school both days and got an A on her spelling test as usual. There were no issues whatsoever.”

But after hearing about Richardson’s death, the McCrackens wondered if Morgan was really as OK as she seemed. After all, Richardson had been talking and lucid immediately after her fatal injury. When they went upstairs to kiss Morgan good night, she complained of a headache. “Because of Natasha, we called the pediatrician immediately. And by the time I got off the phone with him, Morgan was sobbing, her head hurt so much,” McCracken says.

The McCrackens took Morgan to the emergency room at LakeWest Hospital in neighboring Willoughby, where doctors ordered a CT scan and immediately put Morgan on a helicopter to Rainbow Babies and Children’s Hospital in Cleveland, with her father by her side. “I knew it was bad when she had to get there by helicopter in six minutes, instead of the 30 minutes it would have taken to get to Cleveland in an ambulance,” McCracken said.

When the helicopter arrived at Rainbow, the McCrackens were greeted by Dr. Alan Cohen, the hospital’s chief of pediatric neurosurgery. He whisked Morgan into the operating room, pausing for a moment to tell McCracken that his daughter had the same injury as Richardson: an epidural hematoma.

McCracken remembers standing in the emergency room, feeling like the life had just been sucked out of him. “My heart sank,” he says. “It just sank.”

Unlike Richardson’s, Morgan’s story has a happy ending.

SOURCE






Australia: Melbourne public hospital lied over waiting lists

THE Royal Women's Hospital has been systematically lying about its surgery waiting list for almost a decade, says a damning report that has forced the Government to overhaul Victoria's hospital funding system. Health Minister Daniel Andrews yesterday apologised to patients who waited months longer for surgery than the Women's has claimed since the late 1990s. He said an independent audit — commissioned after The Age earlier this month revealed the hospital had incorrectly reported data to the Government — confirmed the creation of a "second waiting list" that was disguising the hospital's real performance.

About 180 patients waiting for semi-urgent surgery every year waited an average of 95 days longer than the hospital was reporting, the audit found. This occurred in the context of inadequate scrutiny at the executive level. The finding comes after The Age revealed allegations last May that hospitals were manipulating data to meet benchmarks for bonus funding. Mr Andrews consistently denied the practice was taking place and refused to investigate.

In response to the audit's finding, Mr Andrews yesterday announced that:

* A long-standing $40 million bonus funding pool used to reward hospital performance would be scrapped.

* Six hospitals would be audited without warning every year.

* Patients would be notified in writing if their waiting-list status changed, so they could challenge any discrepancies.

Mr Andrews said he was furious about the audit results and put all Victorian hospital boards on notice that data manipulation was unacceptable. "Health services are accountable for their data and there is an expectation that they record and report it accurately," he said.

The audit of the Royal Women's Hospital found that although staff spoke of "two waiting lists" in front of senior and executive management, executives claimed they knew nothing of it. A "data-entry instruction sheet" revealed that when patients neared a benchmark for how long they should wait, they were put on a secret list, which effectively stopped the clock.

The Government rewards most hospitals with bonus funding if they meet performance benchmarks, but the Royal Women's is not on this list. Mr Andrews said it had previously been on the list and that data manipulation appeared to be a long-standing practice potentially motivated by the incentives. He said he had appointed a delegate to the board of the Royal Women's to ensure the fraud was eliminated. The secretary of the Department of Human Services had received the report and would take legal advice on what action could be taken against those involved, he said.

Royal Women's chief executive Dale Fisher said she had ordered a clinical review to establish whether patient care was affected by the list rorting. She said that, "on the face of it", there was no effect on patients because the list manipulation did not change the booking date of an operation, only the report of the patient's waiting time. "The people got treated at the next available opportunity," she said.

But Ms Fisher admitted it might have hurt the hospital's gynaecological department. "That's one of the disappointing things … that it did compromise our view of demand in gynaecology," she said. "We could have strategically allocated more resources." She said "appropriate disciplinary action" would be taken against staff involved in the practice. This could range from counselling to sacking — but no one had yet lost their job.

Ms Fisher defended her management of the hospital, saying there was no reason the executive team would have spotted the practice, because it was designed to "iron out" the kinds of peaks and troughs that drew management attention. "I am pleased that we found the problem and fixed the problem," she said.

But Ms Fisher said she may never have realised the seriousness of the issue if it was not for a report in The Age this month about waiting-list fraud in unnamed hospitals — a month after she knew about the list problem at her own hospital. "When I found this … I viewed it as a management problem that we needed to fix. The level of seriousness was raised as a result of that article … It was the issue of possible fraud (that) raised the level of seriousness." The hospital will centralise training of staff to get greater control over data reporting, and its internal auditors have been asked "to make sure we're not missing anything else".

The Victorian president of the Australian Medical Association, Doug Travis, welcomed the decision to scrap the bonus pool, saying it would allow hospitals to focus on patient care. "There has been a culture in Victorian hospitals to hit your (key performance indicators) no matter what," he said. "Our community needs to be assured that hospital funds and resources are directed where they are needed."

Shadow health minister Helen Shardey said the Government's response was inadequate because six random audits a year would allow a major hospital to go three years without being audited. "There should be an immediate independent audit of all hospital waiting lists," she said.

SOURCE