AUSTRALIA'S MEDI-MESS

Four more recent reports below

Cash boost no health cure

ABOUT 4000 people on Queensland's elective surgery waiting lists will have their treatment fast-tracked by a Rudd Government cash injection. But it could be weeks before anyone determines who will benefit from the extra money, the first tranche in the delivery of Federal Labor's election campaign health pledges. Under the plan thrashed out between the federal and state governments in Brisbane yesterday, Queensland will receive the $27.6 million it asked for to help shift its backlog of 35,000 patients waiting for elective surgery.

State Health Minister Stephen Robertson said the first of the extra surgeries would begin within a month and include ear, nose and throat, neurological, ophthamological, orthopedic, urological and vascular procedures. But the Australian Medical Association cautioned there were 8600 people waiting longer than they should.

The funding to tackle Queensland's notoriously stubborn surgery waiting lists is part of $150 million offered by Treasurer Wayne Swan yesterday as a downpayment on the Rudd Government's four-year, $600 million health funding plan. It is also the fifth attempt since November 2005 to clear waiting lists by injecting extra funds into the public hospitals system.

But Federal Health Minister Nicola Roxon said "fruitful negotiations" yesterday provided new hope and she was "very confident, if today is any sign, that we will be able to work well for the benefit of all of the country"....

Queensland Treasurer Andrew Fraser said the funding would be used to target those patients waiting longer than clinically recommended for their elective surgery. The latest quarterly public hospitals performance report shows 35,061 patients sitting idle on elective surgery waiting lists.

AMA Queensland president Dr Ross Cartmill cautiously welcomed the announcement. "It is more expensive to treat people in the private sector, so fewer people will be able to be treated," Dr Cartmill said. "It is good news that there is the potential to treat around 4000 people but we should bear in mind we are still talking about a small number."

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Nurses offered cash to come back

No word about improving their absurdly overstretched working conditions

QUALIFIED nurses no longer working in the health system will be given financial incentives in a bid to lure them back to work, Prime Minister Kevin Rudd has said. The $87 million scheme aims to attract 7750 of the 30,000 nurses across Australia not currently working back to the profession within five years. Under the plan, cash bonuses of $6000 will be available to nurses who return to the health workforce after being out for more than a year. They will be paid an extra $3000 after six months back on the hospital ward and a further $3000 after 18 months. Hospitals will also receive a contribution of $1000 for each nurse to assist with retraining costs.

Mr Rudd outlined the scheme at Sydney's Royal Prince Alfred Hospital today, saying the move would go some way towards assisting the predicted shortfall of 19,000 nurses across Australia by 2010. "This will not be the end of our announcements on this matter but is a solid start in dealing with what is an impending shortfall in the overall supply of nurses," Mr Rudd said. He said the Federal Government would now write to state and territory governments and hospital representatives to outline the administrative arrangements for the plan. He said the government was committed to a similar scheme for nurses in residential aged care facilities.

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Pass all nurse trainees, teachers told

LECTURERS at a Brisbane nursing college were instructed to pass all of their students regardless of their performance. The investigation by the Queensland Nursing Council into Shafston College last year found that the college's Head of School of Nursing, Gay Carran, gave a directive to teachers that "no student should fail".

One witness, who was a senior nursing lecturer at Shafston from January 2004 to June 2006, told David Price, who undertook the investigation for the council, that students who had failed an occupational health and safety exam were allowed to re-sit the test two more times. She said in one re-sit exam, she and a colleague were told by Ms Carran to "mark students' work on the spot, immediately return unsatisfactory papers to students, and coach them until they obtained correct answers".

Ms Carran, who was also interviewed by Professor Price, denied she had given the directives but was reported as saying: "You always have to err on the side of ... let's be fair to the student. Ms Kemp (a Shafston nursing teacher) used to be black and white. If a student didn't pass, they were failed. We spoke to Ms Kemp about this as 'you can't do this because students are paying good money for the course'."

Five other former teaching staff at the college who were interviewed as part of the investigation supported the existence of the "no-fail" directive from the college management. Professor Price's investigation also found the college allowed some incompetent students with poor English to graduate with a nursing diploma last year, qualifying them to become enrolled nurses.

The college came under scrutiny after a graduate told a former Shafston lecturer she felt "unsafe" as an enrolled nurse at Brisbane's Prince Charles Hospital. Details of the investigation were submitted to the Queensland Supreme Court as part of the case brought by Shafston Nursing against the Queensland Nursing Council.

The council has not renewed the college's accreditation, which expired on December 31. The council has also placed restrictions on the activities of graduates from Shafston College. Shafston has since cancelled its nursing course, which was scheduled to begin in three weeks, and has suspended teaching for continuing students, some weeks away from graduating. About 500 students - of whom about half are from overseas - are being directed to a similar course offered by a South Australian private educator or to nursing programs at TAFE.

Professor Price's investigation was conducted in July last year and involved interviews with five former teaching staff, current senior staff and an inspection of the Shafston Nursing campus at Brisbane's Spring Hill. Students were charged up to $16,000 for the 55-week course. In its defence, Shafston claimed in documents submitted to the court that the witness statements were flawed because the former staff did not necessarily understand exam re-sit requirements. The college also rejected the idea it had allowed incompetent students or those with poor English skills to pass. The QNC has imposed strict restrictions on Shafston students who graduated in the last trimester of last year. Shafston and two of its graduates have separately taken the QNC to the Supreme Court in an attempt to have the restrictions lifted.

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Ambulance patients waiting too long in NSW

CRITICALLY ill patients are being forced to wait a combined 718 days a year on trolleys outside hospital emergency departments, figures from the NSW Ambulance Service show. The statistics, for P1 category patients such as road accident, stroke and stabbing victims, monitor the time those rushed to hospital by ambulance have to wait before being admitted. Across the state's public hospital one million minutes - or 718 days - were lost to the delays in 2006-07, News Ltd says. Gosford, Royal Prince Alfred, Wollongong, Royal North Shore and Liverpool Hospitals were the worst offenders.

Dr Sally McCarthy, vice-president of the Royal Australian College of Emergency Medicine, blamed the blockages on a lack of emergency beds. "This reveals the true problem about what is wrong with our health system and how the State Government is refusing to listen," she said. An unnamed ambulance officer said "people on death's door" were waiting for treatment.

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California confusion

Arnold Schwarzenegger said in an address this week that California must end its "binge and purge" budget process -- his way of kicking off a binge worthy of Imperial Rome in its decadent late period. Yep: As his state reels from one of its recurrent fiscal crises, the Governor is making some headway on his "universal" health-care plan. California is carrying a $14 billion budget deficit and Mr. Schwarzenegger is suggesting across-the-board spending cuts. So perhaps it's unwise to introduce a new government entitlement that costs north of $14.4 billion a year. But then, you have to understand the Kremlinology of liberal health-care reform: This effort has as much to do with politics as public policy.

Mr. Schwarzenegger devoted more than a year to health feuding with Sacramento. He strafed his own party for opposing tax increases. Meanwhile, many Democrats (and most labor unions) fought the Governor's agenda because the subsidies weren't extravagant enough. Desperate, the Governor brokered a last-minute bargain with Assembly Speaker Fabian Nunez in December.

Thus Mr. Schwarzenegger's ambitions didn't die -- but for now, maybe call them the living dead. The negotiators rushed to patch together a policy framework before 2007 ended, but they didn't have the votes to actually pay for it. A two-thirds majority in the state legislature is required for tax increases, and Mr. Schwarzenegger alienated the Republicans he needed. So if this scheme is to become reality, new taxes on tobacco, hospitals and business must be ratified by voters in a November ballot initiative.

Assuming that the bill reaches Mr. Schwarzenegger's desk at all. His plan may hit a wall in the state Senate, where President Pro Tem Don Perata, a Democrat, has qualms about the plan's cost in the midst of a budget meltdown. Apparently, Mr. Perata is one of the few adults in Sacramento. Mr. Schwarzenegger and his collaborators insist their proposal is revenue neutral and requires no new spending after the start-up costs. But the numbers are flimsy. When the bill moved out of the Assembly hopper, the financing fine print remained unresolved and legislators were practically working off the back of an envelope. Mr. Perata is leery of potential consequences for the state's general fund.

With good reason -- these health plans are always more expensive than predicted. But that's what happens with governance via political ego. Having invested himself so fully in the congratulations for "doing something" about health care, Mr. Schwarzenegger wanted a plan, anything to claim victory. He's spinning it as "post-partisan" pragmatism. At least he's not calling it a "free market" solution, as did Mitt Romney after he pioneered a similar plan.

Like Massachusetts, Mr. Schwarzenegger's program is built around the "individual mandate," which requires that everyone acquire insurance or else pay penalties. While bumping up subsidies for the uninsured, California would also lay down more severe insurance regulations, instituting price controls and compelling companies to offer policies to all applicants without regard to age or health condition. Such mandates have all but devastated the insurance markets in every other state where they've been tried, but then all this is the triumph of politics over experience anyway.

In addition to hiking state levies on cigarettes to $1.75 a pack and imposing a 4% tax on hospital revenues, there are new taxes on business. Companies must either spend a certain amount on covering their employees or pay a tax sliding between 1% and 6.5%, depending on the size of the payroll. If Mr. Perata is watching out for his state's bottom line, such taxes may drive businesses to Nevada or Arizona -- or simply lead them to dump their health-care liabilities on the state and pay the 6.5%.

None of this is what California's cooling economy needs -- to say nothing of the damage that such a plan would do to the insurance markets, or the national precedent it would set. Mr. Perata supports comprehensive health reform but seems to be leaning toward prioritizing the budget deficit. If Mr. Schwarzenegger's stunt collapses only because of fiscal reality, that's good enough.

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400,000 people 'still waiting more than a year for NHS treatment'

Almost 400,000 patients are still waiting more than a year for NHS treatment, a think tank claimed today. Government figures showed a rise in the number of patients being admitted for treatment within the 18-week target from referral. The latest figures, for October 2007, showed 60 per cent were treated in that timeframe, up from 57 per cent the previous month.

But right-wing think-tank Civitas warned the figures were concealing a high number forced to wait far longer. It said 713,513 (or 18 per cent) of patients needing elective treatment were waiting longer than 36 weeks, with 387,152 (10 per cent) of those having waited over a year. Despite improvements, current rates are not enough to ensure the Government hits its target for all patients to be treated within 18 weeks by the end of the year.

Civitas also warned of a postcode lottery, with 33 per cent of patients at Hastings and Rother Primary Care Trust (PCT) treated within 18 weeks, compared with 82% in Blackpool PCT and Telford and Wrekin PCT. James Gubb, director of the health unit at Civitas, said: "Instead of political targets, performance should be driven by choice and competition - a self-sustaining and much more positive mechanism for change. "If this means more patients choosing to have their treatment in the independent sector or the better NHS hospitals, then these should be allowed to expand in response. "As is the case elsewhere, it is the ability of patients to compliment, complain and ultimately take their business elsewhere that will drive providers in the NHS to improve. "GPs must be in the driving seat, offering patients real choice and ensuring this mechanism is available."

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A Different 'Right to Life' -- one being denied

Today the Supreme Court will consider a petition to hear a case raising profound issues regarding the right of individuals to make their own health-care decisions. The case is Abigail Alliance for Better Access to Developmental Drugs v. von Eschenbach. The suit claims that FDA violates the due process rights of terminally-ill patients, who have exhausted all approved options and are unable to enter a clinical trial, by prohibiting access to promising investigational drugs.

Consider the plight of such patients. They search for clinical trials of new drugs that might extend their lives. Nearly all are ineligible. Of the few who do qualify, many learn the trial is fully enrolled and closed, or too far away. Others face a 50-50 chance of getting a placebo (a sugar pill) under blinded conditions (meaning neither they nor their doctors know what they are getting). Many are allowed to die without being told about or offered the active drug.

The FDA commonly insists on statistically comparing the timing and severity of the deaths of untreated (placebo) patients with those of patients who receive the potentially effective drug. This renders the FDA's vaunted "science" for drugs intended to treat terminal illnesses little more than a crude measurement of the height and accrual rate of two piles of bodies. There are better, less ethically challenged trial methods available to test drugs, but the FDA has consistently refused to accept them.

The FDA has ignored our Citizen's Petition for more than four and a half years. This petition is the FDA's administrative mechanism for public challenges of its decisions and policies. It is little more than a cruel joke for the sick. The agency is required to respond to a petition within six months but rarely does, and often never responds at all. One's only recourse is to sue and then fight the inevitable FDA motion for dismissal claiming the plaintiff hasn't exhausted all administrative options -- meaning the FDA hasn't yet acted on the Citizen's Petition.

If the suit survives, the plaintiffs find that lower courts have so rarely allowed a patient to challenge an FDA decision or policy that they have no legal basis to get to trial -- as was recently learned by a group of cancer patients challenging the FDA's mishandling of a new therapeutic vaccine called Provenge for terminal prostate cancer. The federal judge in that case dismissed all parts of the suit directed at FDA's decision to delay the drug for years because patients had no "right" to challenge a decision the FDA claimed was not yet "final." The judge's decision will be lethally final for thousands of men with prostate cancer.

No terminal patient has the time needed to wrestle with the FDA in court if they first have to establish a right to do so. Consider that the Abigail Alliance case was filed in 2003. Over the ensuing years, it has carried the names of three defendants, tracking the musical-chairs nature of the highly-politicized job of FDA commissioner. At every turn the FDA stalled, then claimed we had lost our standing because the patients named in the original suit had died. The appeals court didn't buy that cruel argument, but it took months to resolve. During this slow dance choreographed by the FDA, more than 2.4 million Americans have died from cancer alone.

The majority opinion of the appeals court suggested that this is an issue for Congress to solve. A great idea if one has a full lifetime to work on it. In the last session, a bill called the Access Act designed to fix some of the problems was introduced in Congress with multiple sponsors, but any significant reform takes years to enact. The stopgap FDA reform bill passed last year contained none of the Access Act provisions, addressing only the more politically expedient and high-profile issues swirling around FDA's handling of drug safety. The omission was in part the result of the difficulty faced by terminal patients when they try to get the attention of Congress. They simply don't live long enough to connect and organize into a political force.

No matter one's judicial philosophy, it is inconceivable that the framers of the U.S. Constitution intended unelected, tenured career bureaucrats to hold absolute power over American lives without prospect of challenge in the courts. The framers understood that the pursuit of life is an inalienable right that should not be abridged without due process of law. The FDA and a majority of the D.C. Circuit Court of Appeals think terminally-ill Americans are excluded from the fundamental right to pursue life. The Supreme Court now has the opportunity to take this case and correct those egregious misjudgments.

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British dentistry meltdown

The crisis in NHS dentistry is rapidly worsening because dentists are switching thousands of patients to private treatment, figures show. NHS treatment is in free fall with a 16 per cent collapse in the proportion of dentist's earnings made from the NHS from the years 1999-2000 to 2005-06. The figures, published by the NHS Information Centre, highlight the challenge facing the NHS after a survey, disclosed in The Independent yesterday, revealed that dentistry in England was the most expensive in Europe. The fall in NHS earnings has accelerated in the past two years and is most pronounced among young dentists who are the future of the profession.

NHS incomes fell by over 20 per cent in a single year from 2004-05 to 2005-06, as a proportion of total earnings, among dentists aged under 35. Young dentists now earn on average only just over a third of their income (36 per cent) from the NHS.

Patients' organisations said the decline in NHS dentistry was alarming and could lead to the eventual collapse of the NHS dental service. Surveys show patients are having increasing difficulty in finding an NHS dentist and the Government admitted last year that two million patients who wanted access to an NHS dentist had failed to get it. Anthony Halperin, chairman of the Patients Association and a practising dentist in London, said: "There is no question that dentists are switching patients to private treatment where they can because they feel it is the long-term future for them. They don't want to do run of the mill work, they want to do quality work and that is very difficult under the NHS."

The NHS Information Centre's report into dentists' pay showed that dentists in multi-partner practices who own their surgeries earned 114,000 pounds on average in 2005-6 from NHS and private work. Single-handed practitioners with their own practices earned 94,000. Dentists earned 58.2 per cent of their income from the NHS in 1999-2000 but that fell to 41.9 per cent in 2005-06. Among those under 35, the proportion of earnings from the NHS fell from 63.8 per cent to 36 per cent in the same period, a decline of more than a quarter in six years.

Dr Halperin said the new dental contract introduced in April 2006 had made matters worse. The contract replaced the fee-for-item payment system with three payment bands to encourage a preventive approach. "Dentists are really unhappy about the new contract. They are worried they are going to be asked to do more work for less money. If the contract turns out to be uneconomic, they will switch more patients to private work because it is a safer option and if that happens it will lead to the collapse of NHS dentistry."

The British Dental Association said the decline in NHS incomes reflected a wider malaise in the profession. Peter Ward, chief executive, said: "The dental workforce as a whole is looking to a future in which they feel less and less able to rely on the NHS and are adjusting the balance of their work accordingly." Implementation of the new contract had resulted in up to 1,000 dentists leaving the NHS and 266,000 fewer patients accessing NHS dentistry, the association said. Mr Ward said: "These statistics offer further evidence that the Government's reforms to NHS dentistry aren't achieving their stated aims. This contract has failed to improve access for patients and failed to allow dentists to deliver the kind of modern, preventive care they believe their patients deserve."

The Department of Health rejected suggestions that NHS dentistry was in decline. A spokesman said: "It would be wrong to take this shift in the share of income as evidence that dentists are turning their backs on the NHS. It simply reflects the ever-increasing demand for purely cosmetic dental work which, quite rightly, is not provided on the NHS." He added: "Access to dentistry has remained broadly stable in the past two years and we are doing all we can to make further improvements."

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Boston mayor says the only good medicine is government medicine

I'm betting that he does not line up in emergency rooms very often

Mayor Thomas M. Menino embarked on a highly public campaign yesterday to block CVS Corp. and other retailers from opening medical clinics inside their stores, an effort that exposed a rift between Menino and the state's public health commissioner, a longtime ally. Menino blasted state regulators for paving the way Wednesday for the in-store clinics, which are designed to provide treatment for sore throats, poison ivy, and other minor illnesses.

The decision by the state Public Health Council, "jeopardizes patient safety," Menino said in a written statement. "Limited service medical clinics run by merchants in for-profit corporations will seriously compromise quality of care and hygiene. Allowing retailers to make money off of sick people is wrong."

In a separate letter, Menino urged members of the city's Public Health Commission to consider barring the clinics from Boston. CVS executives said they plan to open 25 to 30 MinuteClinics in Greater Boston before the end of the year, although they have not specified how many of those will be within the city's limits.

The Boston Public Health Commission spent nearly an hour discussing the impending arrival of the clinics and ways they could potentially be stopped. The panel took no action, but instructed the health agency's attorney to investigate whether it could adopt regulations forbidding stores with clinics from selling tobacco products, forcing them to make an untenable financial choice. The city says 31 CVS stores and 56 other pharmacies in Boston have city-issued licenses to sell tobacco.

In a statement issued last night, executives of MinuteClinics said they "would be happy to talk to Mayor Menino about any of his concerns." "We at MinuteClinic are committed to providing convenient, affordable access to quality health care," the statement said.

By issuing a broadside against the clinics and the state's approval of them, Menino placed himself squarely in opposition to a former longtime deputy, John Auerbach. Before becoming the state's public health commissioner last year, Auerbach spent nine years as executive director of the Boston Public Health Commission.

Auerbach's state agency yesterday released a statement defending its decision on the clincs: "The members of the Public Health Council were deliberative and thoughtful in their review of the limited service clinic regulation. We believe these types of clinics, operated either as part of a retail operation or in a nonprofit setting, can provide the public access to safe, convenient, and quality care for minor health issues."

The clinics are not designed to treat chronic diseases such as cancer or diabetes or serious emergencies. The facilities will be staffed with nurse-practitioners who are trained to spot patients with more severe illnesses or in need of specialized care and send them to a doctor or an emergency room. The regulations apply to any retail company, hospital, or community health center that wants to open a limited-service clinic outside traditional settings.

Members of the Public Health Commission acknowledged many of the mayor's concerns yesterday, but they also said a solution needs to be found for patients who can't get easy access to primary-care doctors or who spend hours waiting to have routine illnesses treated in emergency rooms. Commission member Hortensia Amaro, a Northeastern University professor, said her own experience trying to make an appointment illustrates the crisis. "It's almost impossible to get a primary-care doctor in Boston," she said. "I've waited nine months to get an appointment, and I have great insurance."

Still, members of the commission said clinics inside retail stores might only exacerbate long-standing problems in the healthcare system. Dr. Paula Johnson, a board member and physician at Brigham and Women's Hospital, said episodic visits to a drug store clinic could defeat efforts to provide patients with a reliable continuum of care. "We could be setting ourselves up for some real problems," she said.

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NHS 'now four different systems'

There are now four different NHS systems operating in the UK since devolution, according to health chiefs. As the NHS enters its 60th year, NHS Confederation boss Gill Morgan has told the BBC the health service is now in a unique position in its history. Ms Morgan said while the underlying principles of free health care still stand, patients in the UK's four nations are getting different services. Patient groups said the situation was breeding envy.

Ms Morgan, whose organisation represents NHS trusts and health boards, said there was no longer a universal system across the UK, as there had been when it was set up by the Atlee government in the summer of 1948.

England - NHS market created whereby hospitals and community services have to compete with the private sector for patients, resulting in big falls in waiting times

Scotland - Doctors have much more of a say in services, with limited involvement from the private sector. Meanwhile, patients enjoy free personal care, unlike the means-tested systems elsewhere

Wales - Close working relationship between the NHS and local government, which has meant more innovation on public health, but less emphasis on waiting times

Northern Ireland - Somewhat hamstrung by political situation, but re-organisation of trusts pushed through and good integration between social care and NHS

She told the BBC News website: "We basically have four different systems albeit with the same set of values. "This period [since devolution] has been unique in the history of the NHS as it was essentially the same across the UK before devolution. "We have had a complete split in philosophy. "The model in England is about contestability and choice driving service improvements. Outside organisations have been brought in and patients can shop around. "That model has been rejected by the other three."

In Scotland, where people have been given free personal care - unlike the means-tested systems elsewhere - Ms Morgan said there has been much more consensus. She described the approach as the "collectivist model". "They have very little contestability. "They have been slower to improve waiting than England, but much less tension between doctors and managers. "In Northern Ireland there has been very big structural change and more integration between health and social care." And in Wales, which has received praise in England for introducing free prescriptions, she said the close working relationship between local government and the NHS had had an impact on public health.

She said it was too early to say which was more successful and in the coming years the differences would become even "greater". "All we can say is that patients are experiencing different systems, each one has its advantages and we will have to wait to see what happens."

But Joyce Robins of Patient Concern said the differences were "breeding envy". "Patients are increasingly looking across national borders and wondering why they are not getting the care others are getting. "I am not sure that is good for the NHS."

Michael Summers, vice chair of the Patients Association, said England was lagging behind the rest of the UK. "England - for some reason - seems to have been the poor relation." And Professor Chris Ham, a former government adviser and Birmingham University heath expert, said the NHS had proved an important battleground since devolution. "Health is the most important service devolved governments have power over."

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NHS patients told to treat themselves

Millions of people with arthritis, asthma and even heart failure will be urged to treat themselves as part of a Government plan to save billions of pounds from the NHS budget. Instead of going to hospital or consulting a doctor, patients will be encouraged to carry out "self care" as the Department of Health (DoH) tries to meet Treasury targets to curb spending. The guidelines could mean people with chronic conditions:

* Monitoring their own heart activity, blood pressure and lung capacity using equipment installed in the home

* Reporting medical information to doctors remotely by telephone or computer

* Administering their own drugs and other treatment to "manage pain" and assessing the significance of changes in their condition

* Using relaxation techniques to relieve stress and avoid "panic" visits to emergency wards.

Gordon Brown hinted at the new policy in a message to NHS staff yesterday, promising a service that "gives all of those with long-term or chronic conditions the choice of greater support, information and advice, allowing them to play a far more active role in managing their own condition". The Prime Minister claimed the self-care agenda was about increasing patient choice and "personalised" services. But an internal Government document seen by The Daily Telegraph makes clear that the policy is a money-saving measure, a key plank of DoH plans to cut costs.

Critics claimed the plan would provide doctors with an excuse for ignoring the elderly or those with debilitating, but not life-threatening long-term conditions, and would not work without significant investment in community health services. The Arthritis Research Campaign said it risked providing health managers with "an excuse for neglecting elderly patients". Jane Tadman, a spokesman for the charity, said: "Arthritis is already too low down the priority list and the fact that this is being mooted as a money-saving measure is very worrying. "Some GPs don't take arthritis seriously enough, and the result of this could be to give them another excuse to tell arthritis patients just to go away and take their tablets."

The Patients' Association welcomed more moves to empower patients, but warned against using self-care systems to save money. "We are all for better-informed patients," said Katherine Murphy, a spokesman. "But it is a concern that financial pressures will take precedence over clinical needs."

Peter Weissberg, the medical director of the British Heart Foundation, said: "People affected by heart disease need specialist care. Whilst we support changes that empower people to look after their own health, we would be very concerned if they led to any reduction in the availability or quality of expert care for those who need it."

After years of record spending, the health service is facing a sharp slow-down as Mr Brown tries to curb soaring government borrowing. In the Comprehensive Spending Review last year, it was announced that the health budget will grow by four per cent a year over the next three years, down from the seven per cent annual growth rate between 2002 and 2007.

The Treasury also demanded that the DoH achieves three per cent "efficiency savings" over the next three years, equivalent to o8.2 billion. The department's "Value for Money Delivery Agreement" - an internal document drawn up with the Treasury and circulated to NHS trusts over the Christmas holiday - sets out how the NHS will meet the savings target. In a section on chronic conditions, it says the key to greater efficiency in the management of patients with long-term illnesses is a reduction in the need for "expensive" interventions by the NHS. "Reductions in the use of NHS (GP consultations, outpatient appointments, inpatient admissions, length of stay, emergency care and prescribing) can be achieved through increased support for self care (for example through education and skills training, information prescriptions, or self care devices)," it says.

The DoH has told the Treasury that NHS officials are drawing up "good practice guidance on care planning including support for self care". The advice is expected to be published next month. The emphasis on self care was inspired by the success of the Expert Patients Programme, an NHS pilot scheme that offers a six-week training course for people with chronic or long-term conditions. About 30,000 people have completed the course and reduced their hospital attendances by up to 16 per cent, a result NHS managers hope to repeat across the service.

Health budgets face pressure from the cost of caring for people with chronic conditions, including 8.5 million with arthritis, 3.4 million with asthma, 1.5 million diabetics and 500,000 with heart failure. Opposition politicians questioned whether the Government could save money without reducing services. But an Asthma UK spokesman said: "Our focus is on the clinical benefits of self-management. "If the Government implements procedures to ensure more self management and save money, we would support that."

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Australia: Another deadly government hospital

One of the main reasons for putting people in these hospitals is to keep them safe -- from themselves and others!

A 22-year-old woman has been found dead in her room at the controversial mental health facility Ward 1E at the Launceston General Hospital. The death came just a day after an independent reviewer commented that the ward was overcoming a "very negative" culture which included bullying and harassment.

Director of Mental Health Services Associate Professor Des Graham said attempts by staff to resuscitate the woman on Wednesday night were unsuccessful. "The death of a client in an acute mental health facility is a rare and tragic occurrence and in line with Mental Health protocols it will be investigated," he said. Health Minister Lara Giddings said the case would be investigated and action taken if shortcomings in the treatment were found.

The woman's family was notified and met with senior staff. Her body was found about 7.20pm. Detective-Inspector Mike Otley said there were no suspicious circumstances. The woman from Launceston is believed to have been in the facility for a couple of days.

Prof Graham said an interstate team would be called in to head a serious incident investigation. "It is normal practice with serious incidents of this nature for a panel to be established to review the treatment and care provided," he said. The investigation would be in addition to an inquiry by a coroner. Investigations would include an analysis of whether the skill mix and number of staff was adequate and what the documentation about the client's mental state said. Prof Graham said family, staff and other patients on the ward have been offered counselling.

The recently concluded Santangelo inquiry also found that allegations of sexual assault were sometimes ignored because of perceptions about the mental state of complainants. An investigation by the Health Complaints Commission released in 2005 found three cases of sexual assault. Ms Giddings said the death was tragic and distressing. "I extend my sincere condolences to her family," she said.

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Shocking NHS figures show mothers and babies are at risk due to chronic shortage of midwives

Mothers and babies are being put at risk in NHS hospitals because midwives are so overstretched, shocking new figures show. Midwives are being forced to oversee more births than they were six years ago, meaning they can not give women the support they need to ensure they stay safe.

In some parts of the country midwives are in charge of 25 per cent more births as they were in 2001, according to the official figures obtained by the Liberal Democrats. The average midwife is now overseeing 33 births a year - well in excess of the guidelines which state they should deal with no more than 28 births. The desperate shortage means thousands of women are giving birth terrified and alone in NHS maternity units, while many are being forced to have children in filthy wards.

Over Christmas two women died at the same hospital from the same infection - raising fresh concerns about hygiene standards in the NHS. The Royal College of Midwives said last night that the figures proved that NHS maternity services were "crumbling", with many units are under threat.

Liberal Democrat health spokesman Norman Lamb said: "These figures show that our maternity services are under huge strain around the country. "There simply aren't enough midwives to deliver on the Government's promises of one-to-one maternity care. "With the birth rate rising and many midwives set to retire over the next decade, the situation is set to get worse. "A chronic shortage of midwives could also force the closure of small childbirth centres across the country. "The Government needs to stop burying its head in the sand and launch a national review of capacity in maternity services."

Official guidelines, published in 2006 by the Royal College of Obstetricians and Gynaecologists, say that midwives should oversee no more than 28 births a year. The figures, revealed following a parliamentary question, show that across England in 2001, the average midwife oversaw 31 births. By 2006 that had risen to 33 - a rise of seven per cent. ....

Experts say fewer midwives per birth leads to increasing risks for mothers and babies. Belinda Phipps of the National Childbirth Trust said: "As the number of birth per midwives rise, the risk of a woman being in labour without a midwife by her side rises. "This is not just a 'nice to have' but is clinically important and makes a difference to a woman's labour and birth. "You would not expect to go into hospital for an operation and have the hospital tell you your anaesthetist will be running between three patients in different operating theatres. "It is not acceptable for women in labour to be expected to have their midwife running between several women also in labour.

"At the moment the only way you can be sure to have a midwife with you throughout your labour is to have your baby at home. "Women who choose to give birth in hospital also need to be assured they will have a midwife with them throughout their labour. "Using a hospital's emergency facilities to rescue women who have not had the full attention of a midwife is not acceptable practice."

Louise Silverton, deputy general secretary of the Royal College of Midwives, said: "While we support the Government's plans for maternity services, we have real concerns about their ability to deliver because there are simply not enough midwives. We need 5,000 more full-time midwives by 2009. "The birth rate is rising, midwife numbers are dropping, but the maternity services budget is falling and the maternity service is crumbling. "Ultimately it will be women and their babies who suffer a poor maternity service, and midwives will be left underresourced and overstretched. "Women report to us that because the midwives are so busy, they do not ask questions for extra support. "Women are being short changed by the shortage of midwives."

The increasing ratios have occurred because the Government has not employed increasing numbers of staff to keep pace with rising birth rates. Since 2001 the birthrate has shot up by 12.5 per cent, from 564,871 babies born to 635,679 in 2006 - a bigger rise than Government actuaries had expected. Midwife numbers have increased by just 5 per cent since Labour came to power in 1997, from 18,053 to 18,862 in 2006 - with 2006 seeing a drop in numbers on the previous year.

Fewer new midwives are being trained every year - down 16 per cent in the last two years; and newly-qualified midwives are struggling to find jobs because many trusts still have financial problems. And the RCM warns the problem could get worse, with half of midwives planning to retire within the next decade.

The amount being spent on maternity services has fallen from 1.7 billion in 2005/06 to 1.6 billion pounds last year. The shortage of midwives will make it all the more difficult for the Government to meet its pledge that by the end of 2009, all women will be supported by one named midwife throughout her pregnancy and afterwards. The Conservatives claim that more than 30 maternity units across the country are under threat of closure.

A spokesman for the Department of Health said: "England remains one of the safest places to have a baby either in hospital or at home. "The number of midwives is increasing. Between 1997 and 2006, the (headcount) number of midwives employed in the NHS has increased by 2,084 (9 per cent), which represents a whole time equivalent (WTE) increase of 809 (5 per cent). "There has also been a 20 per cent increase in the number of students entering training to become a midwife. "Through increased investment in training staff and finding ways for midwives to come back to work in the NHS, we expect to see further increases in the midwifery workforce. But we are not stopping there. "In some parts of the country, we must and will do more, like developing more training places, bringing in flexible working and finding innovative ways to fill hard to fill vacancies."

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NHS negligence kills young mother

A woman died while giving birth after a clerical error left her without specialist medical care, despite both her mother and her aunt having been killed by the same rare condition at exactly the same age, an inquest was told yesterday.

Kelly Hutchings, 22, of Fareham, Hampshire, suffered a brain haemorrhage during the birth of her daughter, Nikita, on November 16, 2005. When Ms Hutchings became pregnant for the first time that spring, no appointment was made for her to see a consultant obstetrician despite her family's "significant medical history" and referrals by her doctor and a midwife. Her need for specialist care was then overlooked by midwives and doctors on up to six further occasions, the inquest in Southampton was told.

Keith Wiseman, the coroner, said that it was "incredible" that a case like hers had slipped through the net, describing it as "like going through six or seven red lights and not realising".

The inquest was told that Ms Hutchings's mother, Shirley, had died at the age of 22 while giving birth to Kelly's brother, Mark, who is now 20. Her aunt, Sue Hickmott, had died in 1982, at the same age and from the same condition, known as deep cerebral venous thrombosis, which causes brain haemorrhage during childbirth.

However, an administrative error by Portsmouth Hospitals NHS Trust meant that an appointment for Ms Hutchings to see Marwan Salloum, a consultant obstetrician, never happened. She was seen finally by a specialist was when she fell seriously ill towards the end of her pregnancy. She was admitted to Southampton General Hospital complaining of dizziness and headaches, but her condition deteriorated and, just over 30 weeks into her pregnancy, she went into labour.

Ms Hutchings, who also suffered from cerebral palsy, was kept alive on a life-support machine while Nikita was delivered by Caesarean section. Her daughter, who has severe disabilities including blindness, cerebral palsy and brain damage, is being raised by her partner, Lee Blyth.

Donna Ockenden, head midwife for Portsmouth Hospitals NHS Trust, explained that Dr Peter Smith, Ms Hutchings's GP, had first made a referral for an appointment with a consultant. But this was "overridden" and downgraded to a midwife appointment because he had not provided any reason for the request.

A request with details of the family history, was made by June Brown, Ms Hutchings's midwife. It was approved by Mr Salloum, but Mrs Ockenden said that a "clerical error" meant the appointment was not made because the interview with the midwife was already in place. She added: "Although the history was clearly visible on the front of Kelly's notes, it was not picked up that it was a high-risk issue." Mrs Ockenden said that procedures at the trust had since been changed.

Mr Salloum told the inquest that he considered Ms Hutchings a high-risk case. "The referral that came to my attention had a box that said Kelly was anxious that her mother and her aunt both died in childbirth from a brain haemorrhage. I would like to at least discuss that with the patient."

Dr Smith said that Ms Hutchings had made no reference to her family history when she came to see him. Her stepmother, Merissa Hutchings, 41, said that she was not a "forceful girl" who would have raised concerns on her own behalf.

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Cancer patients fight to stop NHS withholding care

CANCER patients have launched a legal action to prevent the NHS from withdrawing care if they seek to improve their chances of recovery by paying privately for an additional drug. The patients say the NHS will be breaching their human rights if it withdraws the treatment they are receiving. Two of the patients, Colette Mills, 58, a former nurse from near Stokesley, North Yorkshire, and Debbie Hirst, 56, from St Ives, Cornwall, who both have breast cancer, have been told they will be made to foot the entire 10,000 pound monthly bill for their care if they attempt to pay privately for an additional drug, Avastin.

Ministers claim that to allow patients to pay for top-up drugs would be unfair to those who cannot afford them and lead to a two-tier NHS. The health department has issued guidance to NHS trusts warning that such co-payments are not allowed. However, the patients' solicitor, Melissa Worth of the Manchester law firm Halliwells, said NHS trusts would be breaching several articles of the 1998 Human Rights Act if they withdrew chemotherapy treatment. Worth also argued that in withdrawing treatment NHS trusts would undermine the National Health Service Act of 1977. She said: "In light of the indisputable obligations of the trusts to provide life-sustaining treatment when there is a known, real and immediate risk to life, there is no legal justification for the trust threatening to withdraw all free treatment should our clients wish to maximise their chances of survival by complementing the treatment they are receiving by receiving Avastin."

NHS chief executives, the Patients Association, Doctors for Reform and Saga, the organisation for the overfifties, have all backed Mills and Hirst since The Sunday Times highlighted their plight last month. This weekend they were joined by one of Britain's leading breast cancer consultants. Professor Ian Smith, head of the breast cancer unit at the Royal Marsden NHS Foundation Trust, said: "I am very sympathetic to the case of these patients. We are looking after patients with life-threatening diseases and it is difficult enough telling them they cannot get the drug on the NHS without needing to then say: `Even if you are prepared to pay for it, you still cannot have it.' This creates a very emotionally fraught situation and seems very harsh."

Politicians have also pledged to campaign for a change in policy. John Baron, a Conservative MP and former shadow health minister, said: "It is absolutely wrong for the NHS not to allow tax-paying patients to top up their treatment if they so wish. Why shouldn't patients make that extra payment for a drug that could be life-saving? This is unfair and the government should be ashamed."

The health department said: "It is a fundamental principle of the NHS, supported by all the main political parties, that treatment should be free at the point of need. Co-payments would undermine this."

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HillaryCare v. Obama: The Left's health-care spat

Once Hillary Clinton got roughed up in Iowa, she was bound to strike back against Barack Obama. Her first line of attack debuted at the Democratic debate over the weekend, and a big part of it concerns health care. Their differences are more political than substantive, but the debate does tell us something about current policy ambitions on the American left.

"Universal" health care is of course a major Democratic issue, and Mr. Obama laid out a proposal in May, Mrs. Clinton in September. Both plans create a public insurance option managed by the government. Both plans impose more stringent regulations on insurance companies, and both institute new taxes on business.

The main substantive difference is that Mrs. Clinton's plan would dictate that everyone have health insurance, while Mr. Obama's would only require the coverage of children. This so-called "individual mandate" has become the preferred liberal health policy tool after Mitt Romney introduced it in Massachusetts. In theory, such a law would force everyone to sign up for health insurance--either through their employers, a private plan or a government option--or otherwise pay penalties.

That Mr. Obama's mandate is limited to kids has led to a primary catfight that runs back several months, and Mrs. Clinton is pressing the issue especially hard now to attract liberals who think Mr. Obama is the better bet for "change." She said on Saturday that Mr. Obama "proposed a health-care plan that doesn't cover everybody." Mr. Obama counters that the reason many people aren't insured is because they can't afford it. Supposedly he is "echoing right-wing talking points," but he is more accurately echoing reality.

Massachusetts has exempted almost 20% of uninsured adults who don't qualify for subsidies from mandated coverage because it is too expensive. (No thanks to the state's health-care regulations, which Mr. Romney now prefers not to mention.) The logic of the individual mandate is that welfare programs will be necessary to achieve truly universal coverage. Thus it is in practice less an individual, and more a government, mandate.

In any case, these health-care plans aren't worth the white papers they're printed on, because Congress would carve them up along the way. Rather, they speak to aspirations. For "progressives," Mr. Obama's lack of a mandate is a kind of betrayal. Their political goal is to use incremental steps to gradually achieve a government-run health-care system--and Mr. Obama's steps aren't grand enough.

At least by comparison to Mrs. Clinton. Her attacks are intended to appeal to liberals because they highlight one of the few cases where her triangulating produced a policy position more ambitious, and more leftward, than Mr. Obama's. They also highlight her history as an agent of "change," if you consider Mrs. Clinton's calamitous 1994 failure with HillaryCare to be helpful experience. She's betting that Democratic primary voters will give her credit for having tried.

The new liberal consensus is that her 1994 effort got the policy right but botched the politics. Now a progressive agenda will only be ushered in by "confronting" Republicans. That's why Mrs. Clinton--and John Edwards--posits insurance and pharmaceutical companies as villains who must be vanquished for liberal reform to prevail. By contrast, Mr. Obama says a genuine health-care overhaul must be negotiated at a "big table" including industry. Such feints toward bipartisanship and reconciliation don't appeal to today's angry left.

However it turns out, this less than Grand Guignol ought to provide a warning to Republicans. Whatever the minor policy differences among Democrats, their major domestic ambition this campaign season is the government takeover of the health-care market. The Republican nominee will need a free-market alternative, and a way of explaining it that is more concise and compelling than we've heard so far.

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Ninth Circuit to Upend Nation's Healthcare?

In what may be the most momentous judicial decision since Roe vs Wade or One-Man-One-Vote, and possibly directly affecting far more Americans, the US Ninth Circuit may be heading toward greasing the legal skids toward nationalized healthcare. The case involves the employer mandate fees included in San Francisco's universal care scheme. As I discussed here, "Such a fee upon employers violates the 1974 ERISA law which ensures employer choice as to whether and how to provide healthcare benefits." Not a single court has decided against ERISA's preemption of such schemes. (More about ERISA here.)

Most recently, both Maryland and Suffolk County, NY decided not to appeal court decisions against their universal schemes' employer mandates, because they violate ERISA. Nonetheless, a three-judge panel of the Ninth Circuit appears to be heading toward ignoring ERISA, what a close observer likens to "jury nullification."

Federal district judge White, consistent with every other precedent in the country, decided the San Francisco employer mandate violated ERISA. San Francisco's appeal appears to have found friendly ears in the Ninth Circuit Appeals Court, from three judges with a history of extremely liberal decisions, often overturned by the Supreme Court. They have not yet issued their formal decision, but if it follows from their opinions expressed during the hearing it may seek to ignore ERISA's prohibition.

What happens next? An appeal to the entire Ninth Circuit panel and/or to the Supreme Court. That will take time. Meantime, San Francisco and California, and other states, may rush to enact similar employer mandates as part of universal care schemes. The result may be a fait accompli of a major step toward nationalized healthcare, along with hugely increased government budget deficits requiring additional taxes upon all. (Massachusetts' is already running deeply in the red, and California's proposed system is likely to double the already $14-billion+ deficit's drain upon taxpayers.)

The private healthcare market in which most Americans are enrolled, and which polls of patients consistenly shows 70-90% satisfaction, would be so severely disrupted as to not be able to recover or be seriously weakened, leaving a government-run program as the default option. That is exactly what the proponents of nationalized healthcare desire, and what is at stake in this case.

Don't think judges matter, or that presidential appointments of judges don't matter? Think again, and look closely at what presidential aspiirants have done in their past and how reliable their promises may be now.

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Colossal British stupidity: 3 times more doctors educated than Britain can employ

JUNIOR doctors will face even tougher competition for jobs this year with close to three applications expected for each position, National Health Service managers have warned. NHS Employers, the agency responsible for staffing the health service, has warned that a Court of Appeal ruling means doctors trained in Britain will need to compete for posts to train as consultants alongside doctors from around the world who want to practise in the UK. If the juniors do not obtain a training post, they will not be able to become hospital consultants or GPs.

Sian Thomas of NHS Employers said: "There are about 9,000 posts for around 23,000 estimated applicants - that's what the Department of Health has told us. "One could argue that the more competition you have, the better quality you will get. It is a good thing for patients that there is competition for jobs - it should mean they get the best doctors wherever they live." She admitted, however, that taxpayers' money would be wasted if junior doctors trained in Britain decide to take consultant posts overseas.

The British Medical Association blames the health department for continuing to recruit medics from overseas at the same time as increasing the number of medical graduates from British universities.

Meanwhile, patients are suffering from a postcode lottery of drug prescription eight years after the government set up a body to get rid of the problem, a report by a parliamentary committee will say this week. The health select committee is expected to say that the National Institute for Health and Clinical Excellence (Nice) has failed to ensure that medicines available in one area are not denied in neighbouring districts.

An inquiry by the committee of MPs is also expected to say that the NHS, which spends about o90 billion a year, should not need to withhold life-saving medicines. It is likely to say that restrictions on drugs to treat cancer or Alzheimer's could be avoided. The MPs are expected to recommend that Nice gets greater powers to force NHS trusts to make drugs it has approved available to all patients

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Follow-up: ANOTHER bureaucracy!

The running of doctors' training must be taken out of the hands of the Department of Health after its chaotic mismanagement of funding and job applications, an influential report will say today. The report by Sir John Tooke, ordered last year after thousands of highly qualified junior doctors were left without training posts, recommends that the Government be stripped of control of postgraduate medical training. Instead, it recommends that the cash needed to train the next generation of specialists should be ring-fenced to prevent the NHS from spending it on something else, and managed by a new body, to be called NHS Medical Education England.

The recommendations, seen by The Times, are expected to be made today by the inquiry, which was set up by the department last year after a series of failures. Incidents included thousands more doctors applying for posts than were available, and problems with a computer system designed to shortlist applicants, which resulted in severely underqualified doctors turning up for job interviews.

Sir John Tooke, Dean of the Peninsula School of Medicine in Plymouth, was asked to chair an inquiry into what to do next. His interim report was published in October, and has been overwhelmingly backed by doctors. His final report, out today, is a stunning vote of no confidence in the department. Last year's crisis "could and should" have been predicted, he told The Times yesterday. The appointments system that failed was "rushed and poorly planned".

There are two important changes to the interim report's recommendations. One is the formation of NHS Medical Education England, which Sir John and his colleagues say will be able to articulate the principles of postgraduate training and implement it successfully - something that the department "is in no way capable of doing", he said. The report also gives warning that training could suffer when the European Working Time Directive comes fully into force next year.

The limit on doctors' working hours will mean that there is not enough time to train them to the skill levels needed, he cautioned. A way needs to be found in which doctors can continue to work legally more than 48 hours a week - perhaps by separating work on the wards from training time. But the most urgent problem is one that Sir John cannot solve - making sure that last year's debacle over training appointments, when 30,000 junior doctors applied for 20,000 posts, is not repeated. The evidence is that the pressure on places will be more intense this year, with about three applicants for every training place, and 20 to 1 in the more popular specialties.

Sir John said that the Government had failed to reconcile two of its policies: expanding medical school places in Britain and the "open door" policy towards graduates from overseas. Unless further training places were made available this year, he said, British graduates would be disadvantaged compared with those of earlier years. There will be a bulge in applications for higher training, caused by a growing number of British graduates, applications from those who won only a one-year post last year, and the uncontrolled number of applicants from abroad.

Last week, the British Medical Association gave warning that the process could go as badly as it did last year. Applications opened on Saturday for training posts in England that start in August this year. Ram Moorthy, chairman of the BMA junior doctors committee, said: "Our concern is that without adequate planning, the levels of competition could result in a lottery."

Sir John said that unless changes were made to protect the rights of British-trained doctors to at least one year of postgraduate training, a situation could arise in which students graduate from medical school but could not practise as doctors because they had not completed their year in hospital.

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Patients left to starve on NHS wards

The number of NHS patients suffering from malnourishment as they leave hospital has nearly doubled, new figures show. Around 140,000 patients were discharged after being inadequately fed on NHS wards last year, statistics obtained by the Conservatives reveal. The number released from hospital suffering from malnutrition, nutritional anaemia, or other nutritional deficiencies has risen by 84 per cent in the decade since Labour came to power, from 74,431 in 1997 to 139,127.

The vast majority arrived in hospital suffering from these conditions. But the Department of Health figures also show the nutritional condition of at least 8,500 patients actually worsened while they were in hospital in the last year. National Institute for Health and Clinical Excellence guidelines say all patients should be screened for signs of malnutrition on admission to hospital and treated accordingly. Campaigners complain that elderly people in particular are not given enough help to eat in hospital.

There has also been a rise in the number of patients being admitted to hospital suffering from malnutrition to 130,594, up from 70,658 a decade ago. The figure rose by 12 per cent in the last year alone. The shadow health minister Stephen O'Brien, who obtained the statistics, described them as a "scandal". He said: "Malnourished patients are more prone to infections, have more complications after surgery, and have higher mortality rates - yet the Government allows more than 130,000 patients to enter hospital in the state. "If patients are at risk of malnutrition, then they should be offered extra support before going into hospital, and they should be cared for better whilst they are in hospital. Nurses need to be given the time and equipment to get on with the job of caring for our most vulnerable patients. "It is a scandal that in 21st-century Britain, we allow vulnerable patients to be let out of hospital in a malnourished state, and it is even worse that we allow thousands of patients to get more poorly while they are in hospital."

The worst area in the country for malnutrition was the Pennine Acute Hospitals Trust in Greater Manchester, where 4,947 patients were discharged suffering malnourishment, followed by the University Hospitals of Leicester NHS Trust, with 2,771, and the Newcastle upon Tyne Hospitals NHS Foundation Trust. They were among nearly 50 hospital trusts around the country that discharged more than 1,000 malnourished patients last year.

Meanwhile, it is estimated that the poor quality of hospital food is putting patients off to the extent that 13 million meals are thrown away each year, at an average cost of 2.65 pounds each.

Last year, the health minister Ivan Lewis admitted patients were being starved on wards, with some elderly people given little more than a scoop of mashed potato for lunch. Others were "tortured" by having meal trays placed out of reach, which they were too weak to pull towards them. Age Concern has protested that elderly people are often given non-pureed food, which they cannot chew or swallow. Michael Summers of the Patients' Association said: "Families tell us that when visiting elderly relatives in hospital in particular they noticed how malnourished they are. "Nurses are so rushed off their feet that it is no surprise that patients end up malnourished. "We have heard stories of elderly people who haven't had a meal all day because they have just been overlooked. The food is just taken away when the patient hasn't been able to eat any of it. "It is a scandal in the 21st century - it ought never to happen."

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Deaths of two new mothers at same hospital WERE probably linked, says expert

Two mothers have died from an identical infection after giving birth at the same hospital on the same day. An expert said it was "extremely unlikely" that their deaths were not linked. Amy Kimmance, 39, and Jasmine Pickett, 29, had their babies at the Royal Hampshire County Hospital in Winchester on December 21. Within 72 hours they had both died from complications linked to streptococcus A infection - known as Strep A - which normally causes sore throats.

Winchester and Eastleigh Healthcare NHS Trust insisted investigations so far showed their deaths were coincidental. A spokeswoman said Mrs Kimmance developed fatal toxic shock syndrome as a result of a group A streptococcal infection while Mrs Pickett died from a sudden onset of severe pneumonia, likely to have been caused by a group A streptococcal infection.

However, Mark Enright, professor of molecular epidemiology at Imperial College, London, said: "It's extremely unlikely in my view that they are not linked." Professor Enright said he believed a member of staff had been carrying the infection in their throat, got it on to their hands and passed it on. He said he would be interested to see the results of laboratory tests on the women to see if the identity of the bacteria was the same.

The deaths raised fresh concern over hygiene and infection control practices in Health Service hospitals. Earlier this week David Cameron said hospitals would face hefty fines for each patient who catches a superbug if the Conservatives win power, saying infection levels of MRSA and C.diff, which cause several thousand deaths a year, were "unacceptable".

Mrs Kimmance, a teacher at St Swithun's independent school for girls in Winchester, went home with her new daughter Tess to husband David and their two other children on the day she gave birth. Her condition suddenly deteriorated and she was readmitted to hospital on December 23 where she died of fatal toxic shock syndrome triggered by Strep A infection.

A day later, on Christmas Eve, Mrs Pickett died after suddenly developing severe pneumonia, almost certainly caused by the same infection. She had given birth to her first child, a boy named Christopher. Both babies survived....

Streptococcus A is not a superbug, which means if an individual has a sore throat it can be eradicated with antibiotics. But it can cause aggressive infections if it gets into the bloodstream. There are about 1,200 bloodstream infections linked to Strep A reported to the Health Protection Agency each year, some of which lead to death. The trust spokesman said that the maternity unit had remained open as there had been no results directly linking it or the staff with the cause of the fatalities.

But she added that extensive swabbing of staff and the unit had been carried out as a precaution. She refused to confirm whether antibiotics had been given to staff and the families of the dead women, which would eradicate the infection. She added that a full investigation was taking place. The Royal Hampshire County Hospital missed its target for reducing MRSA last year and had 191 cases of the potentially deadly stomach bug C.diff between April 2006 and March. Its kitchens were severely criticised last year and as a result it now has to submit to six-monthly inspections.

Around 100 mothers die in the UK each year giving birth or shortly afterwards, about two a week.

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Britain: That marvellous government "planning" shows its worth

Nil worth. Closing hospitals just when lots of people are getting ill is something only a government plan could lead to

A fifth of the country's hospitals have wards that have been shut as the winter vomiting virus strikes staff and patients. Cases of the virulent nororvirus bug are expected to peak at about 200,000 a week over the next month. The disease, which causes two or three days of violent vomiting and diarrhoea, is at its highest level for five years. Doctors have warned patients to stay at home to avoid spreading the bug. Hospitals are especially vulnerable and anyone who has been ill with the bug recently is asked not to visit relatives for fear of taking the highly contagious infection on to wards.

A survey by The Daily Telegraph found that 30 hospital trusts in England had closed wards to new patients as staff struggled to contain the bug and many other hospitals had recently suffered outbreaks. The reporting system is voluntary so the number of closures could be higher.

NHS Direct reported yesterday that 1.2 million people asked its staff for advice over the extended Christmas period. Vomiting was the second most common complaint after dental pain. Norovirus is the most common cause of infectious stomach upset and although extremely unpleasant it is not normally dangerous, although it can lead to complications in vulnerable, elderly or very young patients. Hospitals in the North West and South West have been hit hard in this winter's norovirus season.

One of the hospitals worst affected is the Royal Oldham Hospital in Greater Manchester, where 66 cases were reported. Fin McNicol, the hospital's spokesman, said that strict infection control measures and a ban on all but essential family visits had brought infection numbers down to 40 and bed closures down from 40 to 26 yesterday. "Everyone knows someone that's poorly just now," he said. "In terms of the virus's effects on the hospital, it does appear to be more than normal but we have tried and tested prevention measures in place."

The Royal United Hospital in Bath has seven wards closed. Francesca Thompson, director of nursing at the hospital, said: "We do have a significant number of wards closed and are taking the situation very seriously. "We want to keep these wards closed for the time it takes to get rid of the infection and we will only reopen when it is safe to do so." She added: "We want to encourage anyone with symptoms of vomiting and diarrhoea to seek advice from their GP first. "People are still turning up at the hospital which could cause serious capacity issues. "We need sufficient beds to cope with serious cases and would like to ask the public to offer us their continued support."

Some regions appear to have avoided ward closures including the East Midlands, London and the North East. A spokesman for the Health Protection Agency said: "It is not unusual to see outbreaks occurring in hospitals, as the virus quickly spreads in confined environments. "Taking action early in an outbreak by closing a ward to new admissions can help control outbreaks."

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Australia: Nurses turned off by disorganized government hospitals

A third of the experienced nurses lured back to NSW public hospitals under a Government program have left again. Three days after Premier Morris Iemma bragged about the recruitment of a record 1618 new registered nurses, internal government figures show Nursing Reconnect, which was designed to address a lack of experience, is floundering. The figures, obtained by the NSW Opposition under freedom of information laws, show 1647 nurses had returned to the public hospital system under the program since it began in 2002. But 479 of them subsequently left, for other employment or to take time out.

Opposition health spokeswoman Jillian Skinner said the Government had spent more than $6.5 million on Nursing Reconnect, meaning each returning nurse cost more than $4000 in refresher training and administration. "The Government spent $1.9 million recruiting people who subsequently left," Ms Skinner said. "Only 107 nurses have been recruited this year, compared to 807 in 2002. "The cost of Labor's recruitment program is rising while the number of nurses signing up is falling. Nurses won't want to come back to work while [Health Minister] Reba Meagher and the Iemma Government continue to mismanage our hospitals."

On Thursday, Ms Meagher announced the new recruits, saying that Nursing Reconnect had "attracted 1650 nurses back into the profession". But she failed to mention the high attrition rate. Yesterday Ms Meagher said the most common reasons why nurses had left were family commitments and to work elsewhere as nurses. The majority who had rejoined had stayed, she said.

NSW Nurses Association professional officer Annie Butler said improvements to conditions and pay were essential to retain nurses. Their workload had increased as ancillary positions were cut, and the frustration of seemingly minor challenges, like finding enough pillows, was immense.

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China Saves the World's Public Health Systems

A rather amazing story from China

Here in Suzhou there are at least 500 Indian and Pakistani students studying medicine. They study in English but learn a little survival Chinese as well. They are amongst 10,000 such students studying medicine in China.

At first there was a guarante their credentials would be recognised in India but it appears the Indian government may have reneged on that assurance. In place is a system of further examination, once they return, which will admit them to practice in Australia, the US or the UK. Just another hurdle.

In discussion with these students, I was rather negative about their opportunities for work in Australia. The AMA used to have extremely high standards for doctors and if you did not graduate from an Australian medical school, you were subject to a battery of examinations which replicated those standards.

But of course I was out of date. The advent of free health services in Australia massively increased the demand for medical services which the Australian schools were not able to handle without lowering standards.

The demand was especially high in public hospitals where the working conditions and pay were unattractice to doctors who had studied for nearly six years and who where the cream of the academic crop. As a result the Australian government has turned to 'foreign' doctors - mostly from the Subcontinent who have similar training regimes. They still require would-be doctors to sit for an admission exam to ensure quality but it has become manifest that they have become the mainstay of our public hospital system.

The recent failed London bombings had a sideshow in Australia where a relative of two of the bombers, a doctor in a Gold Coast hospital, was arrested and investigated under terrorism laws. Despite the bombers having a phone chip from the good doctor, a list of strange phone calls from India, and his attempt to leave Australia without notice to his employers with a one-way ticket to India, he was eventually returned to India and effectively absolved of any guilt in the plot.

The new government in Australia has declared they would not oppose his return. His old employers have said he would be welcome back although it is thought unlikely he will return there. This sideshow highlighted how dependent public hospitals are on imported third-world doctors and that, rather than be bemused at China's opportunism in offering medical training to so many aspiring doctors, we should be grateful for providing a source of cheap doctors to keep our public health system affordable.

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Human rights vanish in NHS

IF you need evidence that the NHS has badly lost its way, look no further than the treatment meted out to 58-year-old Colette Mills. The former nurse, from Stokesley, in North Yorkshire, has been diagnosed with breast cancer that has spread to the rest of her body. Her best chance of survival is to take the new "wonder drug", Avastin. But, because of waste and bureaucratic incompetence, the South Tees Hospitals NHS Trust says it can't afford to give her the life-saving drug. That fact alone helps explain why UK cancer survival rates lag so far behind our European neighbours - despite record amounts of taxpayers' cash being poured into the health service.

But it gets worse. Mrs Mills offered to pay the o4,000-a-month cost of Avastin out of her own savings. Fine, said the NHS, but if you do, you will be treated as a private patient and will be charged the full cost of all your treatment - about o15,000 a month, which Mrs Mills cannot afford.

So, Mrs Mills is trapped in a Kafkaesque nightmare - the NHS won't give her the drug for free, but it won't let her pay for it either. That's what you get when you allow a centralised, Soviet-style bureaucracy to run healthcare - an inflexible, lumpen, one-size-fits-all, style of treatment, not driven by patient need or any notion of fairness, but motivated by the sort of rigid, outdated ideology that should have been buried under the rubble of the Berlin Wall.

Patient choice, anyone? It is not as though allowing Mrs Mills to pay for the drugs would disadvantage anybody else. And the argument put forward by the Department of Health, that allowing patients to combine NHS care with private "top-ups" would create a "two-tier health service", is nonsense on stilts. There always has been a two-tier health service. I can't help thinking that a government minister's spouse would get Avastin in the blink of an eye if they were unlucky enough to be diagnosed with cancer.

And isn't it decidedly odd that when a normal taxpayer is discriminated against and bullied in this manner, there's not a peep from the usually vociferous human rights lobby. Don't ordinary people have human rights, too?

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A government impost that started out small in order to get it into law soon becomes much bigger -- surprise!

Penalties for Massachusetts residents who can afford health insurance but do not purchase it in 2008 could quadruple compared with the maximum penalty in 2007, according to draft regulations released by the Department of Revenue yesterday. The maximum penalty for those who flout the law and do not buy health insurance would be $912 a year, compared to $219 in 2007. The higher penalty is intended to get those who are on the fence to buy health insurance. For those wavering, it could make more sense to pay for insurance than to pay the penalty.

The proposed penalties also drive home the full impact of the health reform law's personal mandate principle. This approach makes buying health insurance a responsibility of all residents, similar to the way drivers are required to purchase auto insurance. The penalty was enacted to spur residents to purchase insurance rather than rely on the care hospitals are still required to provide to patients regardless of coverage or ability to pay. "We have worked hard to craft these penalties in a manner that is straightforward and easy to understand," said revenue commissioner Henry Dormitzer in a statement. "We hope they will encourage people who can afford health insurance to buy it."

In a statement explaining the penalties, the revenue department said, "These penalties apply only to adults who are deemed able to afford health insurance." Residents who cannot afford insurance, based on state standards, won't be penalized. Residents who face penalties can appeal.

Residents can comment on the proposed penalties until Jan. 15. The regulations will be finalized early this year. Residents won't face the proposed penalties until early 2009, when they file their tax returns for 2008.

The health reform law, signed by former governor Mitt Romney in April 2006, states that the penalty for 2007 would be the loss of an individual's personal income tax exemption. This will cost residents who didn't get coverage $219 when they file their 2007 state income tax return. Under the law, penalties for 2008 and beyond would be tied to the lowest-cost option of insurance coverage. But it was up to the revenue department to determine the precise formula. Under the formula issued yesterday, the amount an uninsured resident pays for 2008 varies by income and how long the resident goes without insurance. For instance, those 26 and younger who earn too much to qualify for low-cost insurance and who go the whole year without coverage would pay a $672 penalty. Those 27 and older would pay $912, the maximum. Those who have coverage for part of the year would pay a corresponding amount of the penalty. In addition, those who earn less than 150 percent of the federal poverty level, or $15,324 for an individual, won't face penalty.

The fees are based on half the cost of the least expensive insurance plan available to each resident but are capped to avoid excessive fees. Thus, a 60-year-old resident of Boston, who would pay more than $4,600 a year for health insurance provided by the state, could have been hit with a $2,300 penalty. But the maximum possible penalty is $912 for all residents. The draft regulations are available at the revenue department's website at mass.gov/dor.

It is still unknown how many residents will have to pay the $219 penalty for 2007, according to the Department of Revenue and the Massachusetts Health Insurance Connector Authority, which administers the new law. A spokesman for the Department of Revenue, said it would measure how many pay the penalty when 2007 tax returns are filed this spring.

The connector authority has said that about 290,000 residents have signed up for health insurance since the personal mandate went into effect July 1. That includes 160,000 residents who qualify for subsidized coverage, 70,000 who qualify for Medicaid, the government health plan for the poor, and 60,000 who purchased full-cost coverage through the state or their employers. The tally will be updated Jan. 10. Before the health law was implemented, the state estimated that about 400,000 residents lacked health insurance while the US census estimated the number of uninsured was 657,000.

John E. McDonough, executive director of Health Care for All, an advocacy group that helped craft the health insurance law, said he was pleased with the proposed penalties. The department "really listened, and we see a lot of our concerns reflected in this schedule," said McDonough. "It's fair, simple, and sensitive to the needs of residents."

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Some context for the above -- and a warning about where it is headed

Take the example of Social Security:

Franklin Roosevelt, a Democrat, introduced the Social Security (FICA) Program. He promised:

1.) That participation in the Program would be Completely voluntary,

2.) That the participants would only have to pay 1% of the first $1,400 of their annual incomes into the Program,

3.) That the money the participants elected to put into the Program would be deductible from their income for tax purposes each year,

4.) That the money the participants put into the independent "Trust Fund" rather than into the General Operating Fund, and therefore, would only be used to fund the Social Security Retirement Program, and no other government program, and,

5.) That the annuity payments to the retirees would never be taxed as income!

Since many of us have paid into FICA for years and are now receiving a Social Security check every month -- and then finding that we are getting taxed on 85% of the money we paid to the Federal Government to "put & lt away"

You may also be interested in the following:

Q: Which Political Party took Social Security from the independent "Trust Fund" and put it into the General Fund so that Congress could spend it?

A: It was Lyndon Johnson and the democrat Controlled House and Senate.

Q: Which Political Party eliminated the income tax deduction for Social Security (FICA) withholding?

A: The Democrat Party.

Q: Which Political Party started taxing Social Security annuities?

A: The Democrat Party, with Al Gore casting the "tie-breaking" deciding vote as President of the Senate, while he was Vice President of the U S

Q: Which Political Party decided to start giving annuity payments to immigrants?

A: MY FAVORITE: That's right! Jimmy Carter and the Democrat Party. Immigrants moved into this country, and at age 65, began to receive Social Security payments! The Democrat Party gave these payments to them, even though they never paid a dime into it!

Then, after violating the original contract (FICA), the Democrats turn around and tell you that the Republicans want to take your Social Security away! And the worst part about it is, uninformed citizens believe it! Actions speak louder than bumper stickers





In just one year in one Australian State 4200 nurses quit

What happens when you overwork nurses in order to employ more and more of those lovely bureaucrats

NURSES are leaving public hospitals faster than the Government can replace them despite a record 2368 graduates starting this year. The NSW health system is haemorrhaging nurses at a rate of 10 per cent - 4200 positions - a year, leaving existing staff overworked. Premier Morris Iemma yesterday admitted, while visiting Royal North Shore Hospital, that it was difficult to recruit and retain nurses.

However, embarrassingly for the Government, Mr Iemma also conceded in front of his embattled Health Minister Reba Meagher that Royal North Shore Hospital needed to return "to the forefront". Ms Meagher has been under siege over the hospital's performance, since staff and patients revealed a series of horror stories about the hospital's performance last year. Continually forced to defend the hospital, Ms Meagher yesterday looked on as Mr Iemma did the talking.

"I have taken a number of small steps to address the issue here at Royal North Shore Hospital," he said. ". . . to restore the reputation of the hospital as well as continue to improve the health services. "There are challenges, as there are in any hospital. "We are taking extra measures to address that." The hospital will be allocated 128 nurses at the end of this month, one of the largest intakes in the state. However, it still needs another 22 experienced nurses to fill the hospital's current shortfall. But difficulties remain as bullying and harassment of nurses has tainted RNSH. Long-serving staff have complained publicly of being intimidated by senior management.

Trying to soothe the hospital's bruised reputation, Mr Iemma assured new recruits: "I can promise the graduates that anyone who intimidates . . . will be dealt with, and dealt with very strongly. "I guarantee these graduates there is no place for bullying."

Despite the Government's recruitment push, a global shortage of nurses is placing strain on hospitals. NSW Nurses Association acting president Judith Kiejda said an ageing work force was having an impact on the health sector. "Some (nurses) do leave for overseas, career changes but a lot of the losses come down to retirement," she said. "There are a lot of nurses who are coming up to retirement far more than we are bring in the new ones."

New graduate, Emma Bowen, 20, said she was not put off by the negativity surrounding RNSH. "I did my practice here (at Royal North Shore) and really enjoyed it," she said. "I had excellent support."

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Brit Doctors Lie on Death Certificates

In a scathing report in today's Daily Mail, British doctors and hospitals are accused of not recording the cause of death on certificates when a hospital-acquired infection is to blame.

Specifically, the true toll from hospital-acquired MRSA (methicillin-resistant Staphylococcus aureus) and C. diff (Clostridium difficile) bacteria is being hidden.

Since the prevalence of bacteria is a direct reflection on general cleanliness and sterilization processes in medical facilities, it's not surprising that there would be a reluctance to document high levels of bacterial infections, in particular, those resulting in deaths.

More here.

Revolt as 200,000 people demand to opt out of new NHS database scheme

Intimate details of the first 100,000 patients have been uploaded to the controversial new NHS database despite a mounting revolt by doctors and campaign groups. Around 20 GP surgeries have added 110,000 individual records to the scheme, which will contain details on patients' medical history, current medication and allergies. But the Daily Mail has learned more than 200,000 people have requested documents that allow them to demand their personal medical records are excluded from the system, which will "go live" in January.

There is growing concern about the security of the o12bn IT programme - the biggest civilian computer project in the world - which will ultimately contain the details of 50 million people. A poll showed that more than three-quarters of doctors are either "not confident" that data will be safe or "very worried" that it will leak once the system is up and running. Some senior medics are now encouraging a campaign of disobedience against the database by supporting a campaign to urge patients to opt out.

Activists in the British Medical Association (BMA) have produced a letter that people can send to their GP to stop their records going onto the database. The letter can be downloaded from the website of the Big Opt Out campaign, nhsconfidentiality.org. Critics fear patient records could be misused if they can be accessed by NHS staff across the country.

Campaigners also highlighted the Government's "appalling" record on data security, which saw the personal and banking details of 25 million child benefit claimants lost last year. Nine NHS trusts were forced to admit losing hundreds of thousands of health records.

So far, more than 550,000 patients in Bolton, Bury, Dorset, south Birmingham and Bradford and Airedale have been asked to register with the new NHS IT scheme. It will be rolled out across the country later this year, once the pilot sites have been evaluated. Patients were initially told they would have no choice over whether their information would be included on the database. But ministers were forced to offer concessions because of concerns over privacy and security.

Patients can now choose to opt out altogether - though they are warned this could compromise their NHS care. Alternatively, patients can choose only to allow access to NHS staff who have their explicit consent.

But NHS manager Helen Wilkinson, who is masterminding the opt out campaign, said patients were not being told of their rights. She launched her campaign in 2006 after discovering that she had been wrongly labelled an alcoholic after seeing a consultant about routine surgery. She has now forced the Health Department to wipe all of her records from NHS files. "My concern is that patients' records are being uploaded without their consent," she said. "The Government says every patient should be getting a leaflet setting out their options. But the reality we are finding is that many are not. "Even when they do, we are not satisfied that the literature is clear about the risks associated with this database. "The Government has demonstrated only too clearly that it cannot be trusted with this sort of personal information. "Its record on keeping data secure is frankly appalling."

Joyce Robins, of the campaign group Patient Concern, said: "Our main problem is that they are doing it on an opt-out basis - we think they should ask for consent before records go up." Dr Paul Cundy, chairman of the BMA's general practitioners IT committee, who helped compose the protest letter, said: "Some doctors are actively encouraging their patients to rebel. "This letter is an easy way for patients to express the rights that the BMA feels they ought to have by default."

Ministers insist that the current NHS records system, which relies predominantly on paper files, can lead to unnecessary delays and risks. Marlene Winfield, head of public engagement for the NHS IT programme, said: "Patients are always surprised that their records aren't already available in other parts of the NHS - they say we thought the NHS has been doing this for years. "Patients have to go through a security process before they can set up the record. "The NHS has always had a confidentiality culture as patient information is regarded by everyone as sensitive - it's in everyone's training and contracts." But a poll carried out by the Doctors.net.uk website showed that only a fifth of doctors believe the system will be secure.

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Australia: Public hospital negligence leads to tragedy again

A Traralgon couple is planning to sue the local hospital because their baby was born with severe brain damage after allegedly being deprived of oxygen. Tobias Vizard was not breathing at birth, but was resuscitated in a Latrobe Regional Hospital birthing room and spent two weeks on life support. His life expectancy is short, and his disabilities include cerebral palsy and possibly quadriplegia. Mum Julia Williams said she and her family pleaded for an emergency caesarean as her son's heart rate plummeted and he could not be pushed through the birth canal during labour on August 17 last year.

It was more than two hours after her waters broke that Tobias was delivered naturally but with a hypoxic brain injury, believed to be caused by a lack of oxygen. The pregnancy was in its 40th week and contractions started on Tobias's expected birth date, a fortnight after ultrasounds indicated there was nothing wrong. He is now living with brain damage more severe than that experienced by many very premature babies.

Tobias's father, Brian Vizard, is deaf and cannot hear his son struggling for air at night to know when his airways need to be cleared. However Ms Williams said they were determined to make the most of each day together. "He was dead when he was born. He was dolphin blue, and I didn't understand what was going on until I saw them resuscitating him in front of us," she said. "We don't ever wish this to happen to anyone. You don't know what it is like to have a newborn and they are saying he is not going to make it. "But he is beautiful to look at. He doesn't look handicapped, apart from the cerebral palsy in his hand."

The distressed parents are seeking legal advice from Maurice Blackburn lawyers. Latrobe Regional Hospital spokeswoman Jan Rees confirmed the hospital investigated the birth, but said she could not comment because legal action had started. The matter has also been referred to the Health Services Commissioner, but details of the investigation remain confidential. The commissioner can enforce a compensation payout following conciliation, provided that litigation does not proceed. The Royal Children's Hospital, which treated Tobias in the weeks after his birth, declined to comment because it did not want to influence potential legal action.

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