Friday, August 31, 2007

Crazy government healthcare in the USA

U.S. Sen. Robert Menendez has a question for a local Jersey City health clinic: Why no doctors? Reacting to a story in Friday's editions of The Jersey Journal, the Hoboken Democrat dashed off a letter the next day to Catherine Cuomo-Cecere, the chief executive officer of the Metropolitan Family Health Network in Jersey City, a federally funded health clinic.

"I read with great concern and disappointment reports in yesterday's Jersey Journal that the Metropolitan Family Health Network has turned away patients this week because there were no doctors available to see them," Menendez wrote. "This is simply unacceptable," Menendez added.

As of last night Menendez had not received a response, according to a member of his staff. Cuomo-Cecere couldn't be reached for comment.

"I was even more surprised (there were no doctors), given that the last update my office received from you in March was that you had been in negotiations and were working on new contracts with the doctors who had left, and you were optimistic that two or more would be back within days or weeks," Menendez added.

According to City Councilwoman Viola Richardson, the medical staff at the clinic, located at 935 Garfield Ave., plummeted from six doctors to two when doctors were told they couldn't maintain their private practices and work at the clinic. A secretary at the clinic confirmed last week that Dr. Patrick Beaty, the clinic's medical director, had been on vacation.


Australia: Making an ambulance service "free" has caused huge over-use

How surprising! Result: Really urgent cases are slow in being attended to

FRUSTRATED ambulance officers say lives are still being put at risk despite taxpayers pumping more than $400 million into state coffers through a levy on electricity bills. The crisis, which has been exacerbated by a massive increase in the number of call-outs, is so severe that ambulances with less urgent patients on board are diverting to more serious cases.

One northside paramedic, who defied a media ban to speak out, revealed it took almost 20 minutes to answer a recent top priority call-out. And he claimed one major Brisbane station was left unattended on a Sunday night because of staff shortages. "I don't want people to get hurt or die," he said. He said it was not unusual for several stations to be unattended on any given night.

Taxpayers hand over $97.99 a year for a special levy, collected through electricity bills, which replaced an old subscription service that raised about $80 million in its final year. The levy raised $99 million in its first full financial year, in 2003-04, but the total ambulance budget that year rose by only $27.8 million.

Emergency Services Minister Neil Roberts said QAS funding had grown significantly in recent years. "The ambulance levy replaced a very unreliable subscription scheme," he said. Both ambulance officers and the State Government say the situation has been exacerbated by a huge jump in demand. Overall, call-outs have increased about 10 per cent every year since the introduction of the ambulance levy in 2003, with a record set this year.

Queensland Ambulance Union's Steve Crow confirmed response times were getting longer as crews struggled to attend as many as 700 code-one call-outs a day. "It used to be 68 per cent of cases took under 10 minutes, but now it's more like 62 per cent and that figure's even worse in the regions," he said. Prebs Sathiaseelan, president of the Emergency Medical Service Protection Association, which represents paramedics, said the ambulance levy was behind a jump in trivial calls. "We go to things like stubbed toes," he said. "People have got an appointment at the doctor's - they want the ambulance because it is covered under this levy. It's being abused." But Mr Sathiaseelan said the levy was not behind code-one increases. He blamed that increase on an ageing population and "phenomenal growth" in Queensland.

Mr Roberts also blamed Queensland's "growing and ageing population" for the increased demand for services. "In the 2006-07 financial year, the Queensland Ambulance Service attended 10,757 (or 9.7 per cent) more code one incidents than for the 2005-06 financial year," he said. But he said the extra demand was being addressed with the recruitment of 250 new ambulance staff this year and the purchase of 16 new vehicles. He was not concerned that some stations were unattended at night, describing the QAS as a "mobile service delivered by paramedics in vehicles".


Thursday, August 30, 2007

Desperate Brits going to Malta

Medical tourism is a new and rapidly growing development where prospective patients from rich Western countries go overseas to combine treatment and recovery in a holiday setting. This can also be done at a fraction of the cost they would incur for treatment at home.

A number of health service agencies have realised the market potential and more and more countries are jumping on the bandwagon to offer people competitively-priced elective surgery, cosmetic surgery and dentistry abroad. It is, therefore, not surprising that the Malta Tourism Authority is eager to tap this new market. It seems to be employing the expertise of an Indian-based company, Sahara Medical Tourism, that facilitates overseas surgery for patients from the UK, Europe and the USA and is now promoting Malta as a destination for medical tourism.

Due to lengthy NHS waits and concerns about the high risk of MRSA infections in NHS hospitals, a growing number of Britons are taking advantage of affordable, high-quality private healthcare abroad, combining it with a relaxing holiday. They save thousands of pounds compared with having the treatment done privately in the UK. Already, many British patients travel to Belgium, Hungary and Poland and even further afield to countries such as India and Brazil.

Malta offers obvious advantages. It is a close, traditional tourist destination, boasts a high standard of medical and dental care and has well-run private hospitals. With the prospective commissioning of Mater Dei Hospital, the government will have an impressive array of services on offer in a first-class environment. Added to that, Maltese medical professionals have a well-deserved high reputation and very often have post-graduate qualifications from the UK. The fact that English is easily spoken is another advantage.

To cope with their intractable waiting lists, the NHS of the UK is also seriously considering Malta as a location for its patients to travel for surgery. It seems a winning formula for all concerned. Not least, it will provide an incentive for Malta's medical, dental and paramedical professionals to remain in their own country.

It is of paramount importance that the MTA does its homework properly and gets things right from the outset. No amount of marketing will compensate for a botched or inadequate scheme. Lost reputations are not easily regained. The government has to make sure standards are rigorously upheld and only allow hospitals, clinics and operators that fulfill stringent requirements to participate. Meanwhile, it still has to be seen what impact such schemes will have on the services offered to the local population. This applies particularly if the government is an active participant in health tourism.

It is imperative that the Maltese people will not become second-class patients in their own country as paying cases from overseas are given priority. There is nothing to suggest this will happen, but as St Luke's Hospital waiting lists amply illustrate, the government-run medical service is already finding difficulty meeting the needs of its own, especially where elective surgery is involved. Will the adequate funding of the new hospital service depend to a critical extent on health tourism? As has been repeated so often, there is more to a medical service than a state-of-the-art building and equipment. Health tourism can be a godsend but mismanaging it will lead to a dual and unequal service that will prove socially and politically unacceptable.


Australia: Bureaucrats want to curtail cardiac surgery in private hospitals

Even though there are no nearby government hospitals to do it! They hate private hospitals because the private hospitals show them up

The Gold Coast's 600,000 residents could be stripped of any cardiac surgery services, forcing locals with heart conditions to travel to Brisbane for treatment.

Queensland Health has advised the Coast's two private hospitals it could withdraw their approval to offer cardiac services. Queensland's chief health officer Jeannette Young is considering withdrawing approval because neither hospital performs the amount of work required under official guidelines to maintain staff competency and patient safety. Residents will not be able to turn to the public system because the local hospital has not been funded for cardiac surgery.

Health Minister Stephen Robertson said while no decision had been made, the review was about ensuring cardiac services were safe and sustainable.


Wednesday, August 29, 2007

Amazing Socialist New Zealand: Extra hospital money ALL went on bureaucracy

(See here for the iconic case of NZ medicine)

If there's one thing that everyday New Zealanders are scared of, it's the prospect of getting sick and having to depend on the public health system to take care of them - or even save their life. Why? Because it's common knowledge now that our health system is a shambles; a chaotic mess. For instance, we now know - thanks to a Treasury report that the Government tried to keep quiet - that, despite that despite Labour spending an extra $4.5 billion a year on health, there are no extra health services. Not that we need secret internal reports to tell us that. All we have to do is ask one of the tens of thousands of Kiwis who are waiting for health treatment.

So what's the money being spent on - $4.5 billion a year is a lot, after all. Well, some of it has gone on staff. But not doctors and nurses; no, the new staff has largely been made up of pen-pushers - staffing levels at the Ministry of Health's head office has increased by around 40 percent under this government, and DHB and PHO bureaucracies now cost us more than $40 million a year. A lot of money has been spent ... but what has been achieved? Absolutely nothing, according to another Treasury report when it stated that: ". increased staff numbers have not led to higher outputs."

In plain and simple language - layman's terms, if you will - that means that there has not been a single extra operation, no extra services. As ACT's Health Spokesman I've spent a lot of time looking into the failings of the public health system, and thought there was nothing more about it that could shock me - but even I was left speechless when I found out that there are now more bureaucrats in the health system than there are hospital beds. That's right: if every single bureaucrat in the health system fell seriously ill today, there wouldn't be enough beds to treat them all - let alone anyone else.

Our health system has become a joke ... but no one's laughing. How could anyone laugh when people are living in pain and misery because they aren't being treated in a timely manner? When people are languishing on waiting lists and dying on Active Review?

Here's another sick joke: Six years ago the Labour Government set up a Health Workforce Advisory Committee (HWAC), to the tune of $3.5 million, which failed to produce a single practical recommendation. Last year it received almost one million dollars. In that year it produced one press release and six publications - one of which was its annual report. What is most telling about those reports is what they DIDN'T tell us. They didn't tell us that a third of General Practitioners are looking to change jobs within five years.

Can you blame them? While the health workforce - the doctors and nurses who do the work that matters - is stretched facing the daily nightmare of struggling to care for the country's sick, there's an entire army of bureaucrats busily monitoring each other's outputs. Outputs! - How about some input? How about patients being able to see a specialist and get the treatment they need? This, of course, is the hard question. Labour answers with what the media politely refers to as 'spin'. Out in the real world, we see it for what it really is: lying.

What else could you possibly call it when the Government cuts patients from the waiting list without treating them and then tries to claim it has solved the waiting list problem? But that's what this Government has done, and what it will continue to do. Former Health Minister Annette King did it; now current Minister Pete Hodgson has done it too, telling DHBs to send people on the waiting list back to their GP. How do we know this? We got it from a document leaked from Waitemata DHB, which was threatened with a $3 million penalty if it didn't send 800 people on its waiting lists back to their GP.

So what, exactly, are people waiting for on the waiting list? A common misconception is that they're waiting for treatment when, in reality, they're waiting to be referred back to their GP. 800 patients just wiped from the waiting list without treatment, and that's just in Waitemata. The same thing is happening in every town and city throughout New Zealand - patients are being sent back to their GPs - who have already determined they need a second opinion or specialist care. It would be laughable if it weren't so tragic.

This isn't spin; this is cruelty. The Government is culling the waiting list so it can put a 'healthy' face on its incompetence and disregard for the sick and vulnerable. But these patients aren't just numbers that Labour can manipulate; they're people; they're hard-working, taxpaying Kiwis who deserve to be treated in a timely manner. The Government might not see this, but everyone else does - is it any wonder that so many doctors are moving on? For that matter, is it any wonder that so many Kiwis live in dread of getting sick? Kiwis should be asking Mr Hodgson why he's so desperate to hide the real numbers waiting for treatment; why he's bullying DHBs into making him look good by dropping desperately sick people from their waiting lists. The only thing that's truly sick in all of this is Mr Hodgson and his Government's behaviour.

A democracy is judged by the way it cares for its least fortunate. Making people wait for health care - worse, denying those people even exist - is an outrage we should all be ashamed of, even if the present Government isn't.

Bit it needn't be this way. DHBs are only too happy to send people to private hospitals, but they can't - Labour's ideological opposition to the private sector in health means that DHBs' use of private hospitals is sorely restricted. DHBs are instructed to care for patients on waiting lists 'in-house' - in public hospitals - or taken off the lists all together. Thus, Labour's philosophical opposition to the private sector means that people - including Labour voters - suffer and wait, rather than being treated in a private hospital.

The blame however doesn't rest at the Government's feet, of course. No, government says the fault is the DHBs, the doctors, the nurses - the over-worked health professionals struggling at the coalface. So there we have it: tens of thousands of Kiwis are currently waiting for health treatment while Labour pours money into the hiring of bureaucrats who make no improvement in real service. ACT knows this is wrong. That's why we would tear down the wall - and every other obstacle - that Labour has erected between public and private healthcare; that's why we would ensure that billions of your dollars are not spent with nothing to show for it.

ACT policy will ensure that people who need treatment receive it in a timely manner - and that if they can't get it from a public hospital, they'll get it at a private one. Who knows? Maybe one day we'll live in a country where we're no longer afraid of getting sick.


Dental desperation in Scotland

Desperate North-east dental patients could be bumped down the NHS waiting list if they go private. NHS Grampian has now admitted it has a policy of pushing people down the waiting list if they discover the person has signed up for private care. This follows Evening Express revelations last week that the waiting list in Grampian now stands at 25,000 (the equivalent of a 13-mile queue), meaning it could take years before an NHS dentist is available. The one big hope appears to be the proposal to build a new surgery in Tillydrone which could take 12,000 people, as reported by the Evening Express yesterday.

One North-east patient, who wants to remain anonymous, was told that by signing on for Denplan he would be shoved down the waiting list. Denplan is a form of private health insurance for teeth which gives people a guaranteed two check ups a year for a minimum monthly fee of 10 pounds. He lost his NHS dentist when he went completely private and was forced to join the long waiting list.

"As I was in need of fillings I signed up for Denplan, seeing no other option," he explained. "However, I kept my name on the waiting list as I'll be a pensioner quite soon. "When I phoned to ask how far up the list I was, I was shocked to be told that by signing up for Denplan I would drop well down."

An NHS Grampian spokeswoman said the policy existed as those who could not afford private care had to take precedence. But she added: "We do have a helpline for people who need emergency treatment and can usually fit them in within 24 hours. "The waiting list is based on time waited and need. Need is seen to be greater if somebody cannot afford private dental care."


Tuesday, August 28, 2007

Dunkirk war veteran killed by superbug in 'dirty' NHS hospital

A Second World War veteran who survived the Dunkirk evacuation died after contracting a superbug at a NHS hospital following a routine operation. His daughter says he was dismayed by the dirty conditions he faced at the hospital in the weeks leading to his death. Former Coldstream Guard Joseph Nixon, 87, survived the battlefields of France and Belgium. But after a bowel operation he caught pneumonia and superbug clostridium difficile at Maidstone Hospital in Kent at the end of last month.

Mr Nixon, who was also a Met Police officer after the war and a "tireless" campaigner for alcoholic support groups for prisoners, was appalled at how overworked nurses were and the dirty conditions at the hospital. After spending three weeks in the hospital daughter Jackie Dixon said "hour by hour his soul was being stripped". She took the war veteran to their home in Maidstone to live his last days in comfort. He died last Friday.

Jackie said: "Joseph was just so miserable. "One time he was really sad and said 'What did I do that was so evil that I'm trapped in this awful place'. "I said to him, 'I want to stop this, I want to stop this happening to other people'. "It was one of the only times he smiled."

She felt she had to act to stop him lying in a bed with dirty sheets, saying: "I just went and got the bedding and changed him myself. "After two weeks people thought I was staff - one woman asked me if I was a nurse. "I saw one of the nurses leaning on a trolley of soiled stuff and she just said, 'I can't do any more'. "They need more people to clean up." Food was just left by his bedside as he was too weak to feed himself.

A spokesman for Maidstone and Tunbridge Wells NHS Trust said: "We are very sorry that Mr Nixon's care did not meet the family's expectations and we will be undertaking a full investigation into the issues that have been raised. "The trust takes concerns about nursing care very seriously and is actively recruiting more nursing staff."


Monday, August 27, 2007

Health Care Lie: '47 Million Uninsured Americans'

Michael Moore, politicians and the media use inflated numbers of those without health insurance to promote universal coverage

Michael Moore was wrong about health insurance. So were President Bush, Sens. Barack Obama (D-Ill.) and Hillary Clinton (D-N.Y.), presidential candidates former Sen. John Edwards and Gov. Mike Huckabee and The Washington Post, New York Times, Los Angeles Times, People magazine and Time magazine, as well as CNN, CBS and ABC.

Each of these people and media outlets incorrectly claimed the number of uninsured to be 40 to 50 million Americans. The actual total is open to debate. But there are millions of people who should be excluded from that tally, including: those who aren't American citizens, people who can afford their own insurance, and people who already qualify for government coverage but haven't signed up. Government statistics also show 45 percent of those without insurance will have insurance again within four months after job transitions.

Accounting for all those factors, one prominent study places the total for the long-term uninsured as low as 8.2 million - a very different reality than the media and national health care advocates claim.

Breaking It Down: Who's Uninsured? The number of the uninsured who aren't citizens is nearly 10 million on its own, invalidating all the claims of 40+ million "Americans" without health insurance. "It's really indefensible that we now have more than 45 million uninsured Americans, 9 million of whom are children, and the vast majority of whom are from working families," said Sen. Hillary Clinton in a May 31 speech. It was typical spin and easy to find. ABC medical expert Dr. Tim Johnson cited the incorrect data as he praised a "bold" and "politically brilliant" universal coverage plan on the April 26 "Good Morning America." "It's bold because it does propose to cover all Americans, including the 47 million now who are uninsured, within five years," said Johnson.

In his propagandumentary "SiCKO" that favored the socialist health care systems of Canada, Britain, France and Cuba, Michael Moore made the fantastic claim that almost 50 million Americans are uninsured. "SiCKO: There are nearly 50 million Americans without health insurance," quoted Moore's Web site. However, the Census Bureau report "Income, Poverty, and Health Insurance Coverage in the United States: 2005," puts the initial number of uninsured people living in the country at 46.577 million.

A closer look at that report reveals the Census data include 9.487 million people who are "not a citizen." Subtracting the 10 million non-Americans, the number of uninsured Americans falls to roughly 37 million. Moore should have paid attention to that fact, since he agrees that being "an American" matters to get health insurance. "That's the only preexisting condition that should exist. I am an American. That's it," said Moore in footage aired by ABC's "Nightline" on June 13.

That isn't the only problem with the numbers currently being used. Recently, CNN's Dr. Sanjay Gupta accused Michael Moore of "fudging" some numbers in his recent film "SiCKO." This sparked a temper tantrum by Moore who threatened to become the network's "worst nightmare" if they didn't apologize and recant. CNN did "correct and apologize" for one transcription error, but stood by Gupta's statement "CNN's numbers and Moore's numbers aren't far off, but we believe ours are a fairer comparison."

In his film and television appearances, Moore left out quite a bit of information about the uninsured. On his Web site, Moore claimed the Census Bureau had "underreported" the number of people without health insurance. But Cheryl Hill Lee, a co-author of the Census Bureau study Moore was citing, told the Business & Media Institute that the data showed the exact opposite of what Moore said. The Census "underreported" the number of people covered by health insurance - meaning that more people have insurance than the report suggests. The Census also underreported the number of people covered by Medicare and Medicaid.

They Can't Afford Insurance .

Many of the same people pushing the incorrect numbers of uninsured Americans also claim that these people cannot "afford" insurance. "And when you've got 47 million people in this country with no health insurance, they don't go to the doctor because they can't afford it," Moore said on CNN's "Larry King Live" July 10. Katie Couric echoed those sentiment on the CBS "Evening News" May 23. "The number of Americans with no health insurance is continuing to grow as more and more employers say they can't afford to offer group insurance . People who try to buy insurance on their own often find the price beyond their reach," said Couric as she introduced a two-part "investigation of the health insurance industry."

But according to the same Census report, there are 8.3 million uninsured people who make between $50,000 and $74,999 per year and 8.74 million who make more than $75,000 a year. That's roughly 17 million people who ought to be able to "afford" health insurance because they make substantially more than the median household income of $46,326. On the July 13 "Larry King Live," Gupta did make that point, providing more context than Moore and most journalists about the affordability of health insurance.

Subtracting non-citizens and those who can afford their own insurance but choose not to purchase it, about 20 million people are left - less than 7 percent of the population. "Many Americans are uninsured by choice," wrote Dr. David Gratzer in his book "The Cure: How Capitalism Can Save American Health Care." Gratzer cited a study of the "nonpoor uninsured" from the California Healthcare Foundation. "Why the lack of insurance [among people who own homes and computers]? One clue is that 60 percent reported being in excellent health or very good health," explained Gratzer.

A Lie that Promotes Big Government

Moore, Clinton and Obama have used the lie about 40-some million uninsured Americans to promote universal health insurance plans. Moore asserted in his film that providing health insurance to everyone is a moral and even religious obligation. The mainstream media have played along, championing "ambitious" universal coverage plans and referring to the U.S. system as "deeply flawed." "California's ambitious plan to make health insurance available to almost everyone in the state is getting a lot of attention all over the country, and here's why. According to the latest figures, the number of uninsured Americans has grown to more than 46 million," said Katie Couric on the "CBS Evening News" January 9.

Journalists' failure to question that high figure has furthered the cause of nationalized care. "Proponents of universal health care often use the 46-million figure -- without context or qualification. It creates the false impression that a huge percentage of the population has fallen through the cracks," Gratzer told BMI. "Again, that's not to suggest that there is no problem, but it's very different than the universal-care crowd describes."

Dr. Grace-Marie Turner, a BMI adviser and president of the Galen Institute, agreed that "the number [on uninsured] is inflated and affects the debate." Turner also pointed out that "45 percent of the uninsured are going to have insurance within four months [according to the Congressional Budget Office]," because many are transitioning between jobs and most people get health insurance through their employers.

So what is the true extent of the uninsured "crisis?" The Kaiser Family Foundation, a liberal non-profit frequently quoted by the media, puts the number of uninsured Americans who do not qualify for current government programs and make less than $50,000 a year between 13.9 million and 8.2 million. That is a much smaller figure than the media report. Kaiser's 8.2 million figure for the chronically uninsured only includes those uninsured for two years or more. It is also worth noting, that, 45 percent of uninsured people will be uninsured for less than four months according to the Congressional Budget Office.


Sunday, August 26, 2007

Health Care Vouchers: a Market-Based Approach that Would Cost Nothing

How much does the US already spend on health care for the poor? In 2005 wrote:

"The extension of taxpayer-funded Medicaid to the working poor has led to the largest expansion of a government entitlement since the Great Society was launched in the 1960s.

"The soaring costs of Medicaid - which will more than double this year to close to $330 billion since 1999 - is largely due to legislation that extended Medicaid coverage to many Americans who have low-paying jobs."

Medicaid does not include Medicare, health insurance for the elderly, so it understates health cost transfers. According to the Census Bureau, there are 302,648,273 Americans as of this writing, so let us assume 305 million this year. Thus, very conservatively, Americans spend $330,000,000,000/ 305,000,000 = $1,081 per capita on health care for the poor. If we add Medicare, which according to the Heritage Foundation will cost $454 billion in 2008, America now spends more than $784 billion on health care for the poor and elderly, or $2,570 per capita in cost ($784 billion/305 million), compared to Cuba's $250 per capita on health care for everyone.

The Cuban per capita cost for national health insurance amounts to only 10.28% of the per capita cost of current American contributions to the poor and elderly. Yet, the Democrats and Michael Moore argue that we contribute too little money to health care for the poor. Of course, much of US health care costs is due to mismanagement, unnecessary operations regarding prostate cancer, cardiac bypass and heroic end of life treatments. More fundamentally, providers and health care professionals enjoy a combination of artificially induced monopoly through licensure and other entry restrictions coupled with artificially stimulated demand. There is probably ample corruption and abuse arising from the regulated and third-party-financed system.

Four months ago I called the Cigna Insurance Company in New York and learned that Cigna offered New Yorkers individual coverage coverage for $198 per month ($2,376 per year), with family coverage costing roughly twice as much. We are already paying for a version of national health insurance that is mismanaged so that it does not include all Americans, but it costs enough that it ought to. As Phil Orenstein of Democracy Project has blogged, Rudolph Giuliani has proposed tax incentives of $7500 in exemptions to individuals and $15,000 to families to help pay for the costs of private health coverage that they choose themselves. Tax credits could be paid for via the termination of Medicare, Medicaid, government employee plans and through avoidance of double counting via the termination of corporate health insurance deductibility. A tax credit or dollar for dollar tax abatement or voucher would replace Medicare, Medicaid, government employee plans and corporate tax deductions. For individuals who pay less in federal taxes than the voucher amount, a reverse or negative income payment could cover it. This would not cost taxpayers a dime because Medicare, Medicaid, government employee plans and the corporate tax deduction exceed the total cost of a tax credit that would cover everyone. Even if average costs are $7,500 per person, and exceed savings from terminating Medicaid, Medicare, government employee plans and corporate tax deductions, additional savings could accrue by encouraging insurance schemes that limit payments for unnecessary treatments and bureaucracy.

The cost and coverage problems associated with health insurance are primarily managerial. They could be solved through market competition and redistribution of the monies already expended on health care, much of which is wasted and mismanaged. The waste and mismanagement could be reduced because the vouchers could be set at a level for a plan that excludes various kinds of waste, such as unnecessary operations and futile end of life care.


NHS Doctors to be replaced by nurses

Back to the past for childbirth in Britain

The Health Secretary has approved plans to close “vital” hospital services, which will cost lives, an MP has said. A long-running review of NHS services in Greater Manchester and Cheshire ended yesterday with Alan Johnson’s endorsement of an independent panel’s recommendation to close maternity units at Fairfield in Bury, Rochdale Infirmary, Trafford and Salford Hope. Salford will also lose its neonatal intensive-care unit. The Independent Reconfiguration Panel has also backed plans to down-grade Rochdale’s accident and emergency unit and end emergency surgery at Fairfield Hospital. The changes are expected to happen within five years and are likely to mean more home births and deliveries in units staffed by midwives.

Paul Rowen, the Liberal Democrat MP for Rochdale, accused Mr Johnson yesterday of “wielding the axe” in Greater Manchester in a cost-cutting exercise. Tens of thousands of people had signed a petition against the closure of the hospital’s maternity unit, he said. “I am furious that we have been ignored.”

The reconfiguration panel said that local NHS trusts should consider creating stand-alone midwife-led units at Bury, Salford and Trafford. But the Royal College of Midwives said that midwifery staff might not cope with the work demands. Margaret Morris, chairwoman of Salford Royal Hospitals NHS Trust, said that she was bitterly disappointed. “While we have always supported the principle of having fewer, larger maternity units and developing three major neonatal units, we believed that Greater Manchester would benefit more by retaining and developing services at Salford Royal,” she said.

Ministers defended the changes. Hazel Blears, the Communities Secretary and MP for Salford, said that she was “very pleased” that her constituency was in line to have a stand-alone midwife-led unit. In December Ms Blears joined picket lines to protest over proposals to close the maternity unit at Hope Hospital, despite supporting the national policy on maternity changes. She said yesterday: “As a local MP I have made representations at every stage to ensure that babies can still be born in Salford, and this is still the case.”

The Department of Health said that the changes to the region’s emergency services would be supported by investment of 38 million. An additional 60 million will be invested in maternity, the department added.

Andrew Lansley, the Conservative Shadow Health Secretary, called on the Government to put the hospital cuts on hold until it could “produce the evidence to justify them”. He said: “These cuts have been justified on the basis of what are safe staffing levels, but in other areas similar-sized units are allegedly under no threat. Doctors said yesterday that the changes could save up to 30 babies a year, while NHS managers denied cost-cutting, saying that new services would require more investment, not less.


Saturday, August 25, 2007

Why the U.S. Ranks Low on WHO's Health-Care Study

The New York Times recently declared "the disturbing truth ... that ... the United States is a laggard not a leader in providing good medical care." As usual, the Times editors get it wrong.

They find evidence in a 2000 World Health Organization (WHO) rating of 191 nations and a Commonwealth Fund study of wealthy nations published last May. In the WHO rankings, the United States finished 37th, behind nations like Morocco, Cyprus and Costa Rica. Finishing first and second were France and Italy. Michael Moore makes much of this in his movie "Sicko." The Commonwealth Fund looked at Australia, Canada, Germany, New Zealand, the United Kingdom and the United States -- and ranked the U.S. last or next to last on all but one criterion. So the verdict is in. The vaunted U.S. medical system is one of the worst. But there's less to these studies than meets the eye. They measure something other than quality of medical care. So saying that the U.S. finished behind those other countries is misleading.

First let's acknowledge that the U.S. medical system has serious problems. But the problems stem from departures from free-market principles. The system is riddled with tax manipulation, costly insurance mandates and bureaucratic interference. Most important, six out of seven health-care dollars are spent by third parties, which means that most consumers exercise no cost-consciousness. As Milton Friedman always pointed out, no one spends other people's money as carefully as he spends his own.

Even with all that, it strains credulity to hear that the U.S. ranks far from the top. Sick people come to the United States for treatment. When was the last time you heard of someone leaving this country to get medical care? The last famous case I can remember is Rock Hudson, who went to France in the 1980s to seek treatment for AIDS.

So what's wrong with the WHO and Commonwealth Fund studies? Let me count the ways. The WHO judged a country's quality of health on life expectancy. But that's a lousy measure of a health-care system. Many things that cause premature death have nothing do with medical care. We have far more fatal transportation accidents than other countries. That's not a health-care problem. Similarly, our homicide rate is 10 times higher than in the U.K., eight times higher than in France, and five times greater than in Canada. When you adjust for these "fatal injury" rates, U.S. life expectancy is actually higher than in nearly every other industrialized nation. Diet and lack of exercise also bring down average life expectancy.

Another reason the U.S. didn't score high in the WHO rankings is that we are less socialistic than other nations. What has that got to do with the quality of health care? For the authors of the study, it's crucial. The WHO judged countries not on the absolute quality of health care, but on how "fairly" health care of any quality is "distributed." The problem here is obvious. By that criterion, a country with high-quality care overall but "unequal distribution" would rank below a country with lower quality care but equal distribution.

It's when this so-called "fairness," a highly subjective standard, is factored in that the U.S. scores go south. The U.S. ranking is influenced heavily by the number of people -- 45 million -- without medical insurance. As I reported in previous columns, our government aggravates that problem by making insurance artificially expensive with, for example, mandates for coverage that many people would not choose and forbidding us to buy policies from companies in another state.

Even with these interventions, the 45 million figure is misleading. Thirty-seven percent of that group live in households making more than $50,000 a year, says the U.S. Census Bureau. Nineteen percent are in households making more than $75,000 a year; 20 percent are not citizens, and 33 percent are eligible for existing government programs but are not enrolled. For all its problems, the U.S. ranks at the top for quality of care and innovation, including development of life-saving drugs. It "falters" only when the criterion is proximity to socialized medicine.


Don't have a stroke in Britain

Patients who suffer strokes receive worse treatment in Britain than anywhere else in Western Europe. More die and more are left disabled, a leading expert says in this week's British Medical Journal, even though Britain spends as much as, if not more than, other countries on stroke care. The gap is wide, according to Hugh Markus, of St George's University of London medical school. One study showed that 15 to 30 per cent more stroke patients were left dead or disabled in Britain than in other countries.

Professor Markus identifies several possible reasons for the failure. European countries with better results tend to focus more on the care of patients immediately after a stroke, while in Britain the vast majority of money is spent on nursing and hospital overheads, and little on investigations or treatments. Stroke care is a "Cinderella subject" in Britain, falling between neurology and general and geriatric medicine, he says, whereas elsewhere it is an integral part of neurology. This lack of interest may have led to underinvestment and, therefore, poor outcomes.

New treatments that can help patients to recover from a stroke make the failings even more significant. In strokes caused by clots blocking the blood supply to the brain (ischaemic strokes) the use of clot-busting drugs is effective, but patients must first be scanned to determine what sort of stroke they have suffered. All hospitals have scanners, but struggle to scan stroke patients within 24 hours. For a patient to be treated with clot-busting drugs, the scan must be performed within three hours.

In many countries in Europe, and in North America and Australia, 20 to 30 per cent of patients get these drugs. In Britain the figure is less than 1 per cent. Britain also treats fewer patients in dedicated stroke units than other countries, though setting up such units costs nothing and there is abundant evidence that they improve outcomes.

The audit by the Royal College of Physicians found that fewer than two thirds of stroke patients were treated in stroke units, and only a little more than half spent more than half of their stay in such a unit. The benefits include early rehabilitation, access to physiotherapy and staff experienced in stroke care.

Jim Whyte, who had a stroke ten years ago at the age of 55, spent 27 weeks in hospital - only the last five in a specialist unit. Mr Whyte, from Enfield, North London, was treated at Chase Farm Hospital. "Once I got into the specialist unit I had physiotherapy twice a day, speech therapy and training on how to manage for myself." The best help he gets these days, he says, comes from a local stroke club, whose members help one another with advice. He said: "That's something the NHS didn't think of. When I left hospital I was given nothing in the way of information, about how to avoid a second stroke, that sort of thing. Things may have got better since, but we've still got a long way to go."

A significant challenge, Professor Markus says, is to change the perception of stroke among doctors and the public. Scanning units should be available 24 hours a day, and to achieve this regional specialist centres may be needed. Such changes have been achieved for heart care, so it is not impossible, he says, but it calls for commitment and a reorganisation of services, which have so far been lacking.

Joe Korner, director of communications at the Stroke Association, said that the present situation was unacceptable. "For many years the Stroke Association has been concerned about the UK's poor record in stroke care compared to other countries," he said. "That is why we have been campaigning hard to try to improve stroke services. "The Government, with a new stroke strategy in development, has shown a commitment to improving the future of stroke care across the UK. But it is vital that stroke gets the priority and investment it needs. "Without investment hundreds will die needlessly. Public awareness of stroke also needs to be increased so that people can recognise the warning signs."

Dawn Primarolo, the Health Minister, said: "In the last ten years the treatment of stroke in the NHS has progressed rapidly - more patients than ever before are being seen by stroke specialists, numbers of stroke deaths are falling and advancing medical understanding gives every prospect for a real revolution in stroke treatment over the next few years. "The National Stroke Strategy - setting out proposals for modernising stroke prevention, treatment and care - is currently out to consultation. "It was developed with the Stroke Association and stroke survivors and carers, and was debated by Parliament. It follows 20 million pounds invested in improved research into stroke and additional tools and support for hospitals on stroke prevention. "Although we have more improvement to make to the numbers of people given clot-busting thrombo-lytic drugs, there are hospitals, such as King's College, that are matching the best in the world."


The Australian Leftist solution to health-service shortages: More bureaucracy

Kevin Rudd has started to show his interventionist side. The toon below notes that the State governments would be glad to unload responsibility for their problematical hospital systems onto the Feds

VOWING to take personal responsibility for fixing Australia's public hospital system, Kevin Rudd has given away his administrative bent, backing it up with a small carrot and a big stick. In dollar terms, a pledge to spend an extra $2billion over four years is small change in the context of the total healthcare budget. The potential meat in Labor's plan is the establishment of a National Health and Hospitals Reform Commission to sort out the cross jurisdictional healthcare mess that allows each level of government to blame the other for its shortcomings. The proposed reform commission will negotiate a framework to clearly define the state and federal responsibilities in healthcare.

On one hand, the Opposition Leader's plan could amount to no more than an election-year promise that lacks substance and is designed to foil John Howard's opportunistic pledge to prop up a small Devonport hospital in Tasmania as part of a strategy to muscle up against Labor state governments. On the other hand, Labor's plan could represent the first concrete evidence of the highly interventionist style we could expect from Mr Rudd.

Mr Rudd has a history of heavy involvement shaking up health and education bureaucracies from his time as former Queensland premier Wayne Goss's top public servant. As well as cutting back public sector spending, Mr Rudd helped create a 10-year plan to refurbish Queensland's major hospital buildings. His process-driven reform pedigree is showing in the proposed reform commission, to be established in the first 100 days of a Labor win. Labor has pledged to provide financial incentive payments to state and federal governments who deliver better outcomes to patients. The big stick is the threat of a commonwealth takeover of Australia's 750 public hospitals if state and territory governments can't agree to a national reform plan by mid-2009.

Mr Rudd has proposed a referendum to secure a public mandate for any takeover, after which local communities would have a direct say in management of public hospitals with responsibility for the quality of patient care and funding resting with the commonwealth. In a Whitlamesque refashioning of commonwealth responsibilities, states would effectively be cut out of the loop on health. Mr Rudd says this would put an end to the blame game between Canberra and the states on health and hospital funding.

Mr Rudd has taken personal responsibility for the plan, declaring that as prime minister the buck would stop with him. While Queensland Premier Peter Beattie was quick to welcome a commonwealth takeover of what has been a continuing political train wreck for his Government, other state leaders were not so quick to embrace it. West Australian Premier Alan Carpenter rejected the plan, saying he did not believe the federal Government could do the job better than the states. South Australian Premier Mike Rann pledged to work with Mr Rudd to eliminate duplication and plug gaps in service delivery but stopped short of endorsing a commonwealth takeover of responsibility. So did Victorian Premier John Brumby, who said it was a good plan but a takeover would not be necessary. NSW Premier Morris Iemma said he welcomed a more results-based funding system.

While another bureaucracy is the last thing Australia's already cumbersome public health industry needs, properly focused, a reform commission might well be necessary to find what has proved to be an elusive solution to an obvious problem. As it is, the commonwealth is accused by the states of avoiding its responsibilities in aged care, leaving elderly people stranded in public hospital beds. The states are accused of shunting hospital costs from hospital budgets onto commonwealth-funded GPs. The public is wise enough to know that however healthcare is delivered, the full cost comes from the public purse.

The sensible thing is to make the healthcare system as streamlined and efficient as possible. This includes encouraging those who can afford it to take out private hospital insurance to take pressure off the public system. It includes making sure the public properly understands that the Medicare levy at its present level funds only a small fraction of the total healthcare bill and that, because of the enormous sums involved, no system will ever be capable of providing full treatment on demand for any ailment.

No one understands the political ramifications of taking the eye off the public hospital ball more than Mr Beattie, which probably explains why he was quick to support Mr Rudd's plan for a commonwealth takeover of responsibility. Queensland's health dilemma is made more acute by the fact it has a rapidly growing population, including many retirees to remote coastal locations where few if any health services are available. The reluctance of other state leaders to lose direct control will hopefully ensure they will co-operate with the reform commission process.

Traditionally, health is recognised as a strong suit for Labor. Mr Rudd appears to have embraced the challenge and deserves encouragement to get it right. It would be disappointing, however, if Labor's promise turned out to be little more than the creation of a new body designed primarily to strengthen Canberra's hand when it comes to indulging in the blame game with the states over health.


Friday, August 24, 2007

Don't get cancer in Britain

Cancer patients in almost all European countries survive longer after diagnosis than those in the UK. Only Eastern Europe does worse. The results are bad news for the NHS Cancer Plan, implemented in 2000. Some of the latest results include patients treated after the plan began, but fail to show significant changes in relative success rates. The Lancet Oncology, in which the new data is published, does not pull its punches. "So has the cancer plan worked?" it asks. "The short answer is seemingly No."

The new information comes from a group called Eurocare, which organises the largest cooperative study across Europe of cancer patients. In The Lancet Oncology, the group publishes two analyses, one covering patients whose disease was diagnosed between 1995 and 1999, and the second covering those between 2000 and 2002. In general, five-year survival (generally a proxy for "cure") is highest in Nordic Countries and Central Europe, intermediate in southern Europe, lower in the UK and Ireland, and lowest of all in Eastern Europe.

Countries that spend more on health generally do better, but Denmark and Britain have lower survival rates than other countries that spend comparable amounts. The study finds that the gaps have narrowed since the last survey but they remain significant.

Europe's survival rates are lower than in the US, where 66.3 per cent of men and 62.9 per cent of women survive for five years, compared with 47.3 per cent of European men and 55.8 per cent of women. These figures may represent earlier diagnosis.


Healthcare reform Hillary voted against

Karl Rove took a stab at Hillary Clinton on Sunday. He points out that Hillary's vision of healthcare reform is to "let the government do it all." Here's a recent list from Rove, outlining all of the positive reforms Hillary has voted against ... simply because it takes power away from government and gives it to the individual.

* She voted against providing seniors with a prescription drug benefit.

* She voted against allowing people to save tax free for their out-of-pocket medical expenses.

* She voted against medical liability reform so that docs are not forced out of practice by junk lawsuits.

* She opposes leveling the playing field so that people who pay for health insurance out of their own pocket get the same tax break the big corporations get for providing health care benefits to their employees.

* She's against allowing people to shop for health insurance across state lines like we do with auto insurance so the consumers would have more choices and there'd be competition to get your business, give you more for less.

* She's voting for penalizing seniors who have those private health care plans through Medicare.

Take a look at the list. Think about all of those items. Every one of those reforms would have empowered the people. Every one of those reforms would have allowed people to take a bit more responsibility for their own health care. That is precisely why Hillary voted against each and every one of them. As on most issues, Democrats are anti freedom control freaks. They don't trust the market and they keep pushing things to make the market not work.


Australia: Patients walking out of government hospital emergency rooms untreated

After many hours of waiting. Some are just too ill to sit it out any further

PATIENTS are more likely to leave the Sunshine Hospital's emergency department before treatment than any other Melbourne ER. Figures tabled in State Parliament show 4657 patients walked out of the Sunshine emergency department last year, a rate of 7.6 per cent. The average across Melbourne during 2006 was 5 per cent, or 31,437 people. This was an increase from 30,152 patients in 2005. The official figures show fewer than 1 per cent of patients walk out, against medical advice, after treatment has started.

Opposition health spokeswoman Helen Shardey said Melbourne's major hospital emergency departments were not coping. "People are giving up and walking out," Ms Shardey said. "Of more concern is the fact we don't know what happened to these people." Ms Shardey said the figures were in contrast to claims by Health Minister Daniel Andrews that Victoria had a first-class health system. "He is failing to recognise that Victorians are just not getting the treatment they deserve in urgent situations because our major hospitals are simply not coping," Ms Shardey said.

Australian Medical Association Victorian president Doug Travis said hospitals lacked the resources to cope with demand. "(Patients) wait half an hour, one hour, two hours, and they walk out," Dr Travis said. "What we need is a commitment from the Government to understand the fact we don't have enough capacity in the system."

A spokesman for the Health Minister said Victoria's emergency departments were rated as the best in Australia. "More than half of all patients were seen by a doctor or nurse in a Victorian hospital within 19 minutes of arrival compared to the national average of 24 minutes," spokesman Tim Pigot said. [What amazing bull! The wait is 3 to 8 hours]


Thursday, August 23, 2007

The gravely ill man who beat the NHS

But only with the dedicated help of his wife. Excerpt:

And what she does is extraordinary. Right, she says to herself, 14 of the country's top neurologists have given up on Nigel. I'll find one who won't. And bugger me she does.

6am, Heathrow airport, a few days later: Michele is waiting for the man considered to be the world expert on brain diseases, Dr Patrick Kelly, to arrive from New York. He is flying to Stockholm to pick up some prize from an obscure body called the Nobel Institute, but after one telephone call from Michele he's agreed to see her during his stop-over at Heathrow to examine my notes and scans instead of wandering off for a cup of coffee and a bagel.

In the process, of course, Michele has come up against good old British jobs-worth work-to-rule, we-do-it-our-way-whoops-another-one-for-the-body-bag bureaucracy. The hospital wouldn't let her have my notes or scans. They weren't her property, they were theirs. So ya-boo sucks. Turns out they were worried she might lose them.

She was dumbfounded. Lose them? The details on her husband's condition? The stuff they needed to keep him alive? The hospital bosses held their legally correct, morally disgusting ground. [Fear of their incompetence and negligence being exposed. Better for the patient to die] By this point it was 8pm. Kelly's plane was due to land in 10 hours. So she nicked [stole] them. And at around midnight she crashed into the drunken, dying embers of a dinner party at the only friends of ours who had a photo-copying machine, to copy them - before heading off to the airport at around 4am. My uncle drove, partly out of kindness, partly because as an ex-copper he was keen to keep death off the roads.

So there they are, at the gate, watching the New York redeye disgorge its tired passengers. By now the plane is almost empty and Michele has bobbed up to a dozen startled men in smart suits, all of whom have backed away from this crazed little blonde thing. Then there is a tap on her shoulder. A leprechaun in a flat cap stands before her, barely reaching her chin. His stubby little hands jab at the notes. "Are they for me?"

So, by the light of the Avis rent-a-car sign this little, slightly railroaded surgical genius makes two pronouncements: 1. This is not a tumour. 2. If I'm wrong, and it is, it's not inoperable. I'll prove it by operating.

They shake hands; he says good-bye and scuttles off to get the next flight to Stockholm and sanity. The effect of his diagnosis on me is magical. It is the first good news. And there is a galvanising effect on the medical team. Blimey, I am worth saving. WE'RE entering the realms of experimental medicine now. Science fiction, almost. The machine that's wheeled in looks more like a tea trolley, the love child of a milk float and an Austin Allegro. They've bought it off Del Boy, surely. They can't really expect me to get hooked up to this piece of - oh. They've hooked me up to it. Via ugly, bloody tubes going into my groin.

Not to be too scientific, I think the idea is to calm down my hyperactive white cells by taking them on the equivalent of a holiday to Center Parcs. The entire procedure takes just under an hour. The first bottleful is removed/ replaced okay. There's a slight ache in my left side. Shell and my uncle are here and I try not to upset them by going Ouch too much. The second bottleful makes my left side stiff and sore. I can take it. The third bottleful and I stop telling jokes. I start to shake. I snatch a look at Michele. She's biting her lip....

I have six more of these procedures over the next couple of months. I always stop after the fifth bottle. Instead of taking yet another predictable daily turn for the worse, I wake up one morning to find - Ha! The fingers on my left hand are freer. Okay, it's not ideal - my fingers are bending the wrong way for a kick-off, but I've finally got their attention!

FOUR months later: another hospital, but this time I'm not the patient, although by the time I get there I probably should be. It's two days since I moved back home. I'm not better: I live on 500ml batches of Jevity ("Complete, balanced, isotonic liquid with mixed fibre and FOS") from a drip.

More here

Wednesday, August 22, 2007

Medicare wises up

Medicare is adopting the Pottery Barn Rule for doctors and hospitals: You break it, you bought it. The federal health insurance plan for people 65 and older no longer will reimburse doctors and hospitals for fixing the mistakes they make on patients. Hallelujah.

Medicare will stop paying the costs of treating infections, falls, objects left in surgical patients and other things that happen in hospitals that could have been prevented. The rule change announced this month is among several initiatives that the administration says are intended to improve the accuracy of Medicare's payment for hospital patients who receive acute care and to encourage hospitals to improve the quality of their services. "Medicare payments for inpatient services will be more accurate and better reflect the severity of the patient's condition," Herb Kuhn, the acting deputy commissioner of the federal Centers for Medicare and Medicaid Services, said in a statement.

The rule identifies eight conditions - including three serious types of preventable incidents sometimes called "never events" - that Medicare no longer will pay for. Those conditions are: objects left in a patient during surgery; blood incompatibility; air embolism; falls; mediastinitis, which is an infection after heart surgery; urinary tract infections from using catheters; pressure ulcers, or bed sores; and vascular infections from using catheters.

The Centers for Medicare and Medicaid Services said it also would work to add three more conditions to the list next year. "Our efforts in this arena and in other payment rules are to ensure that CMS is an active puchaser, not passive payer, of health care," Jeff Nelligan, a spokesman for the agency, said Saturday. He said the rule "underscores our drive toward quality, efficiency and integrity in the hospital setting."

Hospitals in the future will be expected to pick up the cost of additional treatment required by a preventable condition acquired in the hospital. "The hospital cannot bill the beneficiary for any charges associated with the hospital-acquired complication," the final rules say.

Congress in 2006 gave the Centers for Medicare and Medicaid Services the power to prevent Medicare from giving hospitals higher payment for the extra costs of treating a patient when infections and other preventable conditions occur during a hospital stay.

Hospitals are to begin reporting secondary diagnoses present on the admission of patients starting with discharges on October 1. Then, starting exactly one year later, cases with these conditions would not be paid at the higher rate unless they were present on admission, the agency said.

Last year, Mark McClellan, then director of the Medicare and Medicaid programs, said the government could save hundreds of millions of dollars a year if the Medicare program stopped paying for medical errors such as operations on the wrong body part or mismatched blood transfusions. Medicare provides coverage for about 43 million elderly and disabled people. The Medicare program's expenses totaled about $408 billion in 2006; costs are expected to rise rapidly in coming years.

Well good for the government. Physicians have raked in plenty over the years from Medicare. They didn't all use to drive Mercedes. And doctors earn the money as most of them put in long hours. But dang, surgeons are paid too much money to leave instruments inside patients.


Long ambulance trips kill people

But the British government plans to make the trips longer

People are more likely to die in emergencies if they have to endure long ambulance journeys to hospital, research suggests. As plans to close some accident and emergency departments and district hospitals in favour of larger but fewer specialist units come under increasing attack, a study finds that patients with breathing difficulties have more chance of dying the longer they stay in the ambulance.

A team from the University of Sheffield traced the results of more than 10,000 life-threatening 999 calls and concluded, in a report in the journal Emergency Medicine, that the longer the distance, the greater the likelihood of death. The risk of death for people who were unconscious, not breathing or suffering chest pain rose by one percentage point for every 6.2 miles (10km) travelled. The researchers said that the findings could affect government plans to reconfigure emergency care into a limited number of specialist centres.

The research, which is published today and is based on data taken between 1997 and 2001, coincides with the launch of a Conservative campaign against the closure of maternity services and A&E units. Promising a "bare- knuckle" fight with the Government, David Cameron, the party leader, said yesterday that people did not understand why these services were being shut down when emergency admissions and births were rising.

Previous research, cited in government reports backing the shift to bigger, specialist emergency units, failed to find any evidence that taking patients further by ambulance had an effect on survival. The new study, by contrast, finds that they do. Those most likely to be affected are patients with severe breathing problems. Their chances of dying were 13 per cent if the distance to hospital was between 6 and 12 miles, but 20 per cent if it was more than 12 miles.

The Sheffield team, led by Professor Jon Nicholl, traced the outcome of calls to four ambulance services. Using the grid references of the call and the hospital to which the patient was taken, they worked out the straight-line distance between the two, and then compared that with the outcome for each patient. The distance to hospital varied from less than one mile to as much as 36 miles. The median was just over three miles. Of the 10,315 patients traced, 644 had died. The results show that deaths increase with distance. Overall, 6.2 per cent of the patients died, but for the shortest journeys - fewer than six miles - the death rate was lower, at 5.8 per cent. For distances between seven and twelve miles, 7.7 per cent died, and for distances of more than 13 miles the figure was 8.8 per cent.

Other factors need to be included in any decision to relocate A&E services. For example, bigger specialised units might make up for the greater distance travelled by offering better care on arrival. Professor Nicholl said: "Decisions regarding reconfiguration of acute services are complex and require consideration of many conflicting factors. Our data suggests that any changes that increase journey distances to hospital for all emergency patients may lead to an increase in mortality for some."


Tuesday, August 21, 2007

British mother forced to give birth alone in toilet of 'flagship' NHS hospital

A young mother had to deliver her own baby in the lavatory of a flagship hospital because there were no trained midwives available. Surveyor Catherine Brown had made the agonising decision to undergo a chemically-induced abortion after being told her 18-week pregnancy was risking her life. But when the time came to give birth she was on an ear, nose and throat ward and had only her mother to help her through the ordeal. Her premature son Edward died in her arms minutes later.

The traumatised mother-of-one said: "I just howled and howled. I remember sitting there looking at him and thinking, 'What do I do next?'. I just sat there on the toilet looking at my dead baby. "It was dreadful - a terrible nightmare. Then I started crying my eyes out and repeating, 'I'm sorry baby, I'm so sorry'. I still can't believe the hospital had no trained staff who could help me." To compound Miss Brown's agony, the body of her child was almost discarded with hospital waste.

Her MP has called for an independent review of what he called "one of the most harrowing medical cases I have ever had to deal with". The catalogue of errors unfolded at the 238million pound Queen's Hospital in Romford, Essex, which opened last December. Eleven weeks into her pregnancy, Miss Brown, 30, started suffering abdominal pains. She was told she was suffering from a urinary infection which would not affect her pregnancy. But on the evening of February 21 she started bleeding and was rushed into hospital.

Her condition was stabilised with intravenous antibiotics and in the early hours of the following morning she was moved to a mixed-sex ear, nose and throat ward where a bed was available. She was placed in a doorless annexe of the ward and told to expect a scan in the morning. By 5pm that evening she had still not had a scan. The procedure was only arranged at 7pm after her mother, Sheila Keeling, 51, threatened to make an official complaint. Doctors discovered there was no amniotic fluid around the baby, meaning his chances of survival were minimal. Miss Brown was told her own life was threatened by her condition and, following a consultant's advice, she took the devastating decision to undergo a chemically-induced abortion late that evening, after which she was moved into a private room.

At 4am on the following morning she went into labour but complained she had to wait an hour for gas and air to help with the pain. With no professional help available, she decided to go to her en suite bathroom and stand over the toilet, which had a disabled bar for support, because she had given birth to her son, 18-month-old Matthew, in an upright position. Her mother spoke of her fears that she was going to lose her daughter as well as her grandson, because she was bleeding so heavily. "I was running around frantically trying to find gas and air for her and pleaded with nurses, who seemed very matter of fact, to assist," she said.

"The staff I did find told me they did not have the training to help. Catherine was left to deliver the baby alone with just me for help before cleaning herself up and going back to bed. It was horrific."

But their trauma was still not over. Miss Brown said staff almost took Edward's remains away for disposal despite her informing the hospital she wanted to hold a funeral. "They didn't even record the details of Edward's birth. But he did exist. And more than that, he was a very special little boy. "Hopefully he has made sure that other families won't have to go through what we did. We'll never forget him."

Tests later revealed Miss Brown had septicaemia, possibly caused by the placenta failing to implant properly. Miss Brown, who lives in Hornchurch and has split with Edward and Matthew's father, said the mental and physical toll of her experience meant she had to stop work as a utility surveyor and is only now close to recovering.

Fighting back tears, her mother said: "It was really hard watching my daughter go through that. No one was there to reassure us and make us think they knew what they were doing."

Miss Brown's MP, Conservative James Brokenshire, said: 'The catalogue of errors and blunders is quite disturbing. There appear to have been systemic issues and potentially issues about individual members of staff. "While changes have been made by the hospital it is such a horrific story I want everything to be closely scrutinised. "This has to be one of the most harrowing medical cases I have ever had to deal with. "Catherine almost died and she later discovered the baby had nearly been disposed of with medical-waste."

Queen's Hospital was opened at the end of last year, taking over maternity services from Oldchurch Hospital in Romford. Women more than 20 weeks pregnant who experience complications are seen by A&E and sent to the maternity unit if necessary. Those under 20 weeks also go through A&E but are referred to gynaecology if problems continue. However, there was not a dedicated gynaecology unit when Miss Brown was admitted, meaning patients were sent to a ward where a bed was available.

The Barking, Havering and Redbridge Hospital NHS Trust offered its "sincere condolences" to Miss Brown. A spokesman said: "We have now established a separate gynaecological A&E service, staffed by gynaecological, medical and nursing staff with access to the Early Pregnancy Assessment Unit. "From the end of this month, there will be a dedicated gynaecological ward, with the Early Pregnancy Assessment Unit situated within it. This will ensure dedicated and appropriate care."


Australia: Urgent need for nurses in government hospital

Tiny babies endangered

THE agonising wait is over for the parents of four-week-old Ryan Kelly, who last week received lifesaving heart surgery after two operations were cancelled. The Prince Charles Hospital blamed bed and intensive care nursing shortages for the delay.

But Ryan's father, Damien, said he was angry at the abusive treatment he witnessed towards hospital staff, who were bearing the brunt of public frustration. "It's ridiculous. Yesterday, I saw a nurse getting abused by a relative of one of the patients," Mr Kelly said. "I walked out with this nurse . . . and she burst into tears. Why should these people cop it for bed shortages? It shouldn't be directed at them. Let's direct it at the Premier (Peter Beattie) and his Health Minister (Stephen Robertson)."

As Ryan lies in intensive care after nine hours of surgery, eight-month-old Elijah Nganeko is still waiting for a bed. Elijah, who goes blue when he cries, was born with a hole in his heart. He's been on the waiting list for almost three months. His mother, Jackie, said without surgery, her only child would die, but doctors at the Prince Charles Hospital had been unable to say how long they would have to wait. "They said it could be days, weeks or months," Mrs Nganeko said. "The reason he hasn't had his surgery yet is a lack of intensive care nurses. "They're doing the emergency cases first and then the children that basically come after that."

Mrs Nganeko said the uncertainly over Elijah's operation was putting huge stresses on her and her husband Aaron. "We just don't let him cry at all. I don't get much sleep," she said. "If he cries, within a minute of starting he'll be blue." Despite the strains, Mrs Nganeko said she was not asking for Elijah to jump the queue. "We're saying that we want other people in the same situation to come forward so that Peter Beattie knows how bad it really is," she said.

Prince Charles Hospital acting medical services director Don Martin said children were prioritised for surgery on the basis of medical need. Last week Matthew Kuhne received surgery after a wait of nine days at the Princess Alexandra Hospital with severe spinal injuries also because of nursing shortages.


Monday, August 20, 2007

Canada's 'universal' health care

We finally have good operating understanding of "universal" health care: somewhere in the universe there may be a place for you to get treatment. And if you are lucky enough to live near the United States before Hillary Care II takes hold, you may even get treated.

Canada welcomes the birth of the newest set of quadruplets born to proud Canadian parents. Karen and J.P. Jepp. However, the Jepp quads will be eligible to run for the presidency of the United States when they reach the age of 35, having been born in Benefis Hospital in Great Falls, Montana, 325 miles from their home in Calgary, capital of the Canadian oil industry.

The precious gift of American citizenship comes to the Jepp Quads because there were no hospital facilities anywhere in Canada able to handle 4 neonatal intensive care babies. Not in Calgary, a city of over a million people, the wealthiest in Canada, or anywhere else in Canada. Local officials looked. However, Great Falls, a city of well under one hundred thousand people, apparently had no problem with unusual demand for such facilities.

As Don Surber points out, the United States functions as Canada's back-up medical system, enabling it to run with less investment in facilities. America's evil, heartless private medical care system saved the day. In any capital-intensive field, whether it be electric power generation or medicine, gearing up for peak demand costs a lot of money. California discovered this a few years ago when it started to experience rolling blackouts in the wake of bungled partial deregulation of power.

America spends significantly more on medical care than Canada. Socialized medicine advocates frequently claim that this shows we are getting a bad deal: less care for more money. But the fact is that illegal alien mothers walk into hospital emergency rooms and give birth to babies requiring intensive neonatal care costing hundreds of thousands of dollars on a regular basis, and it makes no headlines. We do not send them over the border to Canada or Mexico and use their medical systems as a back-up, even when the mother might be a citizen of that country. We treat them, and pick-up the bill, too, without so much as a citizenship check or a call to immigration officials.

Steven M. Warshawsky demonstrates today on AT that there is no such thing as "free" medical care. Having the government pay means having other people pay your medical bills, and that leads to endless demand, which leads to rationing, which leads to insufficient capacity to handle peak demands, like, say, the birth of quadruplets. If and when Hillary Care II comes, of course there will be no back-up capacity available for Americans (unless you believe Michael Moore and think Cuba's medical system can provide anything to anyone).

Canada's vaunted socialized medical system depends on America for more than peak capacity back-up, of course. When was the last time you heard about a new drug being developed by a Canadian pharmaceutical company? Under the price control system in Canada it makes no sense to develop drugs there. Canada lets the United States bear the major burden of drug development (and so does the rest of the world). Our high drug prices and federal research subsidize the world's medical R&D.


Australian patients going private in emergency

MORE patients are turning to private hospitals for emergency treatment as pressure on public hospitals mounts and queues to see GPs lengthen. Although there are only a handful of private hospitals in each state with emergency departments -- which usually charge between $150 and $200 per visit -- many say they are busier than ever, with patient numbers rising 10 per cent or more in the past three years. In one case, numbers rose by nearly 30 per cent in five years. The increases are evident in the "graveyard shift" from 10pm to 6am, when many better-off patients are willing to pay extra to avoid having to wait for hours in a public emergency department while staff attend to more urgent cases.

The Howard Government's report on public hospitals, published last month, found patient numbers at public emergency departments were soaring. The percentage of patients seen within recommended times fell in five of the eight jurisdictions. At the same time, GPs are abandoning after-hours services, with more than half referring patients to a deputising service or emergency departments. Although 24-hour GP clinics were common 10 years ago, a clampdown in the late 1990s on the Medicare rebates they could charge reduced profitability, and many folded or cut their hours.

Andrew Singer, president of the Australasian College for Emergency Medicine, said the increase in private emergency patients was caused by the combination of difficult access to after-hours GP services and the problems people experienced when they attended public emergency departments. "In the main, private hospitals provide a pretty good service -- there's usually a lot less waiting, and you usually get a reasonably experienced doctor, if not a specialist-level doctor," Dr Singer said. "Patients tend to prefer it, if they can afford it. "I know people who work in private emergency departments, and a lot of them think things are getting busier these days," he said. "The reality is that all EDs are getting busier."

A spokeswoman for Brisbane's Greenslopes Private Hospital -- the biggest private hospital in the nation, with 580 beds -- said its emergency attendances had risen 10 per cent in 2004-05 on the previous year. They rose a further 8 per cent in 2005-06, and a further 5 per cent in 2006-07. The spokeswoman said the latest increase would have been even higher had the figure not been artificially lowered by a change in the contracting arrangements for military veterans, which meant fewer received free treatment at the hospital.

A spokeswoman for Melbourne's 530-bed Epworth Hospital said it was "certainly seeing more patients", and that annual numbers had jumped from about 22,000 in 2002 to about 29,000 this year. And patient numbers at the emergency departments of the John Flynn Private Hospital on the Queensland Gold Coast and the Hobart Private Hospital have risen by about 10 per cent in the past three years. Numbers at Perth's St John of God, Murdoch Hospital have risen by more than 20 per cent, from 20,540 in 2004-05 to 24,898 in 2006-07, although numbers at its sister hospital in Ballarat, Victoris, have climbed only slightly.

Leon Clark, chief executive of the 452-bed Sydney Adventist Hospital on Sydney's upper north shore, said although numbers of emergency patients had remained stable over the past three years at about 20,000 patients annually, the doctors were much busier because patients coming in had more complex care needs. "Our staff are much busier than they were three years ago because of the increased complexity," Dr Clark said.


Sunday, August 19, 2007

Elderly people suffering abuse and neglect in British residential care homes

Elderly people are suffering from abuse, neglect and malnutrition in hospitals and care homes, according to a report by peers and MPs. The report, published today by the Joint Committee on Human Rights, calls for changes in the law to safeguard the care of older people, and for a "complete change of culture" in health and care services.

More than a fifth of care homes have been found to be failing basic standards for privacy and dignity, with the most vulnerable residents struggling to eat without proper help, being subjected to verbal and physical abuse or being left to lie in their urine or excrement.

Two thirds of NHS hospital beds are occupied by the over65s, while the number of older people in the population is growing such that, by 2050, there will be twice as many Britons aged over 80 as there are today. Although the committee was told that some patients received excellent care, it said "there are serious concerns about poor treatment, neglect, abuse, discrimination and ill-considered discharge".

It also found evidence of "historic and embedded ageism" within healthcare services, causing a failure to "respect and protect the human rights of older people". The report includes the example of an 80-year-old woman who was sexually assaulted by a fellow resident in a care home in 2004: "It was recorded in a log book but no action taken . . . It was only reported to the resident's daughter in July 2005. She reported the matter to the police."

Another woman, who had difficulty feeding herself, "appeared to be slowly starving to death" because visitors who could have helped her were discouraged from staying during meal times. In other cases, bed sores were not treated because staff said "it was not their job". The charity Age Concern estimates that 500,000 older people are subject to abuse at any one time, mostly in healthcare settings.

The committee's report adds: "In our view, elder abuse is a serious and severe human rights abuse which is perpetrated on vulnerable older people who often depend on their abusers to provide them with care. Not only is it a betrayal of trust, it would also, in certain circumstances, amount to a criminal offence."

It also cites problems with malnutrition, dehydration and the abuse of medication as a means of controlling older patients. The Alzheimer's Society said that up to 40 per cent of patients with dementia were being prescribed powerful sedative drugs, despite the risks to their health. Other examples of neglect included a lack of hygiene in some hospitals that encouraged potentially deadly infections such as Clostridium difficile.

Some 21 per cent of care homes failed to reach minimum standards for privacy and dignity last year, the Commission for Social Care Inspection told the committee. Problems included the use of mixed-sex wards and, a lack of confidentiality in discussing medical problems. Despite this, the committee was "alarmed" that the Government's planned new healthcare inspectorate would not be given powers to investigate individual complaints from patients or their families.

It criticised the Department of Health and Ministry of Justice for failing to "provide proper leadership" and guidance on the Act to providers of health and residential care. Local authorities are increasingly referring elderly patients to homes run by the private and voluntary sector, which are exempt from the Human Rights Act. The committee calls for care standards regulations to be amended so that all care homes are brought under the terms of the Act.

Ivan Lewis, the Minister for Care Services, said: "We recognise this anomaly and will continue to work closely with the Ministry of Justice and all other interested parties to ensure that people cared for by the NHS and councils have the protection of the Act." Kate Jopling, head of public affairs at Help the Aged, said: "The shocking examples highlighted by this report provide all the evidence this Government needs to justify urgent action."


Paramedics being used instead of doctors in New South Wales (Australia)

Another government health system downgrading its services because it cannot provide enough doctors and hospital beds

AMBULANCE officers will be trained to treat non-critical patients and take them to GPs or non-hospital services under a controversial plan. The shake-up of health care roles, kept secret by the NSW Health Department, is aimed at easing the workload of hospital emergency departments. It is part of a growing trend to generalise health care, as seen in the creation of practitioner nurses, community health and hospital-in-home teams.

A draft Ambulance Service of NSW document, obtained by the Herald, said ambulance officers could "safely assess and manage certain conditions in the home without the need to convey patients to hospital for care". Like regular ambulance officers, extended-care paramedics would respond to emergency calls and treat critical patients. However, they would also be required to administer simple drugs such as antibiotics and arrange x-rays and other diagnostic tests as well as make direct patient referrals to GPs and community nurses. "It is becoming increasingly recognised that the emergency department may not necessarily be the most appropriate . destination for the patient to have their health care needs met. However, [it] is often the only current option provided," the draft said.

But emergency experts say the plan is a stop-gap measure in a failing health system, while GPs are concerned the plan may add more pressure to practices.

Extended-care paramedics will be chosen from the ranks of the NSW Ambulance Service and undergo eight weeks of training. Program trials are due to start next month and will involve 12 ambulance officers from western Sydney, where attendance at emergency departments rose more than 9 per cent last year. About 20 per cent of NSW emergency calls attended by ambulances do not result in the patient being taken to hospital, according to the draft proof of the concept document.

Modern ambulance services were facing challenges which included an ageing population, the rise of chronic disease, unpredictable delays at hospital emergency departments and increased demand due to the reduced availability of after-hours GPs, the draft document said. Dr Tony Joseph, chairman of the NSW faculty of the Australasian College for Emergency Medicine, said the new system could put pressure on paramedics to keep patients at home or refer them to non-acute care instead taking them to hospital. "If you delay someone going to hospital who needs to go, when they do eventually get admitted . they are often sicker, they stay longer in hospital and there will be increased cost to the community," Dr Joseph said. "If we are going to do it right, do it the first time."

Dr Joseph said the program appeared to be another "stop-gap measure for a failing health system". The chief executive of the Nepean Division of General Practice, Michael Edwards, said the plan would "extend an already over-extended workload" for GPs.


Saturday, August 18, 2007

Canadian woman has to come the the USA to give birth to quads

A 35-year-old Canadian woman has given birth to rare identical quadruplets, officials at a Great Falls hospital said Thursday. Karen Jepp of Calgary, Alberta, delivered Autumn, Brooke, Calissa and Dahlia by Caesarian section Sunday afternoon at Benefis Healthcare, said Amy Astin, the hospital's director of community and government relations. The four girls were breathing without ventilators and listed in good condition Thursday, she said. ''These babies are doing grand,'' said Dr. Tom Key of Great Falls, the perinatologist who delivered the girls. The babies were born about two months early and were conceived without fertility drugs, he said. They weighed between 2.6 pounds and 2.15 pounds.

Jepp and her husband, J.P., declined to be interviewed by The Associated Press. ''The parents have been a little bit shy about the press. ... We agreed to handle it in a way they were comfortable with,'' Astin said. The couple have a 2-year-old son, Simon. J.P. Jepp works for Shell Oil Co., and both worked for nonprofit groups until recently, Astin said.

The chances of giving birth to identical quadruplets is about one in 13 million, Key said. ''This is a very big medical event,'' he said. ''Identical quadruplets are extremely rare.'' Medical literature indicates there are less than 50 sets of identical quadruplets, said Dr. Jamie Grifo, director of the NYU Fertility Center in New York. The last reported set were born in April 2006 to a 26-year-old Indian woman.

The Jepps drove 325 miles to Great Falls for the births because hospitals in Calgary were at capacity, Key said. ''The difficulty is that Calgary continues to grow at such a rapid rate. ... The population has increased a lot faster than the number of hospital beds,'' he said.

Two of the girls were to be transferred to a Calgary hospital later Thursday. The other two could be moved Friday if their conditions remain favorable, Key said. They will likely remain hospitalized for four to six weeks, he said. ''These quads are special,'' Astin said. ''The fact that she carried them 31 weeks and three days is excellent.''


Don Surber comments:

The Dionne quintuplets were born on May 28, 1934, to a humble, French-speaking couple in a farmhouse outside of Callander, Ontario, Canada. They were identical sisters and for the first 10 years of their lives, the five girls were the No. 1 tourism attraction in Canada. Then came free health care for all Canadians. Which is why the four identical Jepp sisters were born in Great Falls, Mont., instead of Calgary this weekend. The Canadian parents flew 325 miles to get to an American hospital.

Can you imagine being about to go into labor for four births, and then flying 325 miles to get to the hospital in another country? Incredible. Michelle Lang, Calgary Herald, reported:

Their mother, Calgarian Karen Jepp, was transferred to Benefis Hospital in Montana last week when she began showing signs of going into labour, and no Canadian hospital had enough neonatal intensive-care beds for all four babies.

73 years ago, a poor French Canadian mother was successfully able to give birth to five girls in a farmhouse in Ontario, but then the Canadian government took over the health system and - voila - Karen Jepp has to go to an American hospital 325 miles away.

It's not like Great Falls, Mont., is a teeming metropolis. With 56,215 people, it is slightly larger than Charleston, W.Va. Calgary has more than a million people. This is like being demoted from the Milwaukee Brewers to the Charleston Alley Cats. (OK, they changed the team's name to West Virginia Power.)

There is a difference between health care and health insurance. In capitalistic America, the concentration is on health. In socialistic Canada, the emphasis is on paying the bills. The story ended with how much the American hospital charged. Looks like a quarter-million bucks for a 5-day stay. Given that it was the quadruple birth of 2-pound babies two months premature, I'd say it was a bargain.

This is not to piss all over Canada. Nice nation. Great people. I'm sure most Canadians like their health system. Just remember, though, that Canada's backup system is in Montana. Americans spend 15% of their income on health care. That's why Great Falls has enough neo-natal units to handle quadruple births - and a "universal health" nation doesn't. After all, they didn't fly Mrs. Jepp to Cuba, did they?

Friday, August 17, 2007

Health insurance blues: Give choice a chance

The nation’s largest health insurer, UnitedHealth Group, wants to buy up Sierra Health Services in Nevada. The merger would give the new company a virtual monopoly over health insurance in the Silver State, reducing competition, which usually means increasing costs. Supporters, however, say the merger will actually reduce costs and improve service due to the efficiencies of scale the giant conglomerate will enjoy. Hmm. That doesn’t exactly seem to be the case when it comes to the publik skools now, does it?

Nevertheless, being a free-market kinda guy I haven’t yet heard any compelling reason for the government to block this merger of two private companies. And the fact that the self-serving Culinary Union is now in open opposition to the takeover tends to weather-vane me in the opposite direction.

No, the answer to legitimate concerns about giving UnitedHealth a virtual monopoly over the health insurance market in Nevada isn’t to block the takeover of Sierra Health Services, but to open Nevada’s market to interstate competition. In this age of Amazon and eBay, it makes no sense whatsoever that Nevadans are prohibited from buying health insurance from a company located in another state.

And yet, thanks to an anachronistic law passed in 1945, the McCarran-Ferguson Act, combined with the lobbying power of Big Insurance, there is no competitive interstate insurance market similar to the highly competitive interstate banking market. For example, Nevadans can deal with a relatively small local bank or choose to deal with a big interstate bank such as Bank of America or Wells Fargo. Both entities thrive in Nevada and consumers, armed with market choice, benefit greatly.

Not so when it comes to health insurance companies. Why not? Because state legislators want to retain the ability to force insurance companies to foot the bill and cover expensive benefits which they don’t have the guts to sock directly to taxpayers. These are called “mandates” - as in, the legislature makes it mandatory that the insurance company cover them or the insurance company doesn’t get to operate in Nevada. Yes, legal extortion.

Around the country, many states force insurance companies to cover benefits ranging from acupuncture to marriage counseling; from contraceptives to hearing aids to hairpieces; from podiatry to osteopathy; from chiropractors to even massage therapy. All in all, there are over 1,800 such mandates found across the country. And these mandates jack up the cost of insurance, creating a huge difference in premium costs between some states. For example, a recent study showed that a healthy 25-year-old male could pick up a basic health insurance policy in Kentucky for $960 a year. That same policy in New Jersey, however, would set the lad back a staggering $5,880 a year.

And the Wall Street Journal noted that the same study “found that a typical insurance policy - $2,000 deductible, 20% co-insurance – for a family of four could be had for as little as $172 per month in a reasonably regulated locality like Kansas City, Missouri. But in New York that family’s only option – managed care – would run $840 per month, and in New Jersey family policies run a whopping $1,200-plus.” Why shouldn’t a family in New York be able to purchase that far less expensive policy from the Missouri company?

If you want to shrink the ranks of the uninsured, perhaps it’s time to open the market and reduce the cost so that average people can afford basic coverage without all the government mandated frills. Instead of blocking the mergers of health insurance companies in one state, perhaps it’s time to open up the competition among all 50 states?

Rep. John Shadegg, Arizona Republican, has proposed just such legislation in Congress; however, Congress in the hands of pro-union/anti-free market Democrats and is unlikely to act favorably on such a common-sense, cost-free solution to the health care insurance problem. Which is why state legislatures should take the lead and open up their own markets without waiting for the feds. Let’s give choice a chance.


Filthy NHS kitchens

Nearly half of all hospital kitchens and canteens in England could be failing to meet basic standards of cleanliness and hygiene, according to official inspection reports. Cockroaches, medical waste on food-handling equipment, mouse droppings and poor hygiene among catering staff were all cited as problems.

The findings were revealed after a freedom of information request for health inspection reports from a quarter of all local authorities.Of the 377 hospitals included, 173 displayed poor cleanliness and 68 fell below the legal requirements for food storage. A total of 107 did not have correct food safety documentation, 66 stored food at incorrect temperatures, 25 had inadequate staff training and 57 had staff with poor personal hygiene.

Norman Lamb, the Liberal Democrats' Shadow Health Secretary, who collected the findings, said that they painted a shocking picture. "It is simply unacceptable that such terrible practices are taking place in an environment where hygiene and safety should be paramount," he said."The worst performers should be named and shamed - while those doing well would stand as an example to drive up standards."

In six hospitals, inspections high-lighted five or more areas of concern. The institutions were: Farnham Road Hospital in Guildford; Churchill Hospital in Oxford; Blackpool Victoria Hospital; Derby City General Hospital; Ipswich Hospital and Norfolk and Norwich University Hospital in Norwich. At the William Harvey Hospital in Ashford, "full-grown adult" cockroaches were found in kitchens according to the 2006 report. The 2007 report stated that there had been "regular reports of an infestation of oriental cockroaches in the kitchen". At the Countess of Chester Hospital in Chester, milk was found stored in the drug freezer in the radiology department and inspectors found a syringe on a supper tray at the May-day University Hospital in Croydon.

An official from the Department of Health said: "Failure to meet hygiene standards is unacceptable and where there are problems we expect the local authorities responsible for inspecting and enforcing food hygiene regulations to take action." The trust that runs Derby City General defended its hygiene regime, suggesting the report may have been based on out-of-date results. Julie Acred, chief executive, said: "Based on the report we have had most recently we don't have any significant cleanliness issues in the hospital."