Monday, June 30, 2008

The latest craziness in Brtain's socialized medicine

Nurses to take charge of surgeries

The government will take on the medical profession this week by pressing ahead with reforms that will see greater power being transferred from doctors to nurses. Alan Johnson, the health secretary, is expected to follow up plans to introduce at least 150 large health centres, known as polyclinics, by announcing an expansion of surgeries run by nurses. The centres will replace lone GPs, many of whom the government believes are unable to provide evening surgeries or other modern patient services.

This is likely to escalate a row between the government and doctors over reform. Lord Darzi, the health minister in charge of a review of the National Health Service, has accused some doctors of being “laggards” and protecting their “professional boundaries”. Darzi has already said he wants to see nurses doing minor surgery in hospitals. This week he is expected to lay out proposals for more nurses to set up surgeries. They will be encouraged to establish not-for-profit firms to run the practices by being allowed to opt out of the NHS without losing pension rights.

Darzi will also outline plans to publish the death rates of hospital doctors so patients can compare their chance of survival according to who treats them. Death rates at NHS hospitals are available for heart surgery. Success rates for about 50 other conditions are expected to be published on the internet to allow patients to shop around.

Patients are also expected to be given personal health budgets and will decide how the money is spent on treating long-term conditions, such as diabetes and heart disease.

An “NHS constitution” will set out patients’ rights and responsibilities, including the right to be told why they have been denied a drug a doctor recommends.

Johnson has admitted that access to NHS drugs is a lottery and will order the National Institute for Health and Clinical Excellence (Nice), the government’s rationing watchdog, to assess drugs more quickly. He said: “What we have heard from patients is that one of their major concerns is the perceived ‘postcode lottery’ in access to drugs. “The draft constitution will address this by making it explicit that patients have the right to Nice-approved drugs and treatment if clinically appropriate. “We will also speed up the national process for appraising new drugs. If a decision is then taken not to fund a drug then your local NHS will have to explain that decision to you.”

Hamish Meldrum, chair of the British Medical Association, suggested the government’s plans for nurses to run surgeries would have limited impact because patients would choose to be treated by doctors. Meldrum said: “There are obviously certain things that only doctors can do. “It is all very well saying patients should have choice about where they are treated but there are certain treatments nurses cannot do, so there will be a limited choice. Patients usually prefer to see doctors.”

Peter Carter, general secretary of the Royal College of Nursing, said increasing numbers of nurses would run local surgeries in future. Carter added: “We never want to get into confrontations over territory. However, good progressive doctors recognise there are roles for nurses who do highly complex work.”


Sunday, June 29, 2008

Founding Father of Canada's Socialized Medicine Rejects the Monster He Helped Create

If we follow Canada over the edge and into the abyss of socialized medicine, it won't be because we weren't warned of the consequences:
Back in the 1960s, [Claude] Castonguay chaired a Canadian government committee studying health reform and recommended that his home province of Quebec — then the largest and most affluent in the country — adopt government-administered health care, covering all citizens through tax levies.

The government followed his advice, leading to his modern-day moniker: "the father of Quebec medicare." Even this title seems modest; Castonguay's work triggered a domino effect across the country, until eventually his ideas were implemented from coast to coast.

Four decades later, as the chairman of a government committee reviewing Quebec health care this year, Castonguay concluded that the system is in "crisis."

"We thought we could resolve the system's problems by rationing services or injecting massive amounts of new money into it," says Castonguay. But now he prescribes a radical overhaul: "We are proposing to give a greater role to the private sector so that people can exercise freedom of choice."

Castonguay has been forced to reverse his views because authoritarianism has made such a mess of healthcare in Canada, people enter lotteries to win a doctor's appointment. Fortunately Canadians are still able to cross the border to a free country, where all you have to do to get medical attention is be willing to pay for it. But if Democrats have their way, that won't be the case for much longer.

Freedom works. Socialism doesn't work. Yet socialism means more power for the authorities, so we will have to keep fighting it off, no matter how many times it has been exposed as fundamentally dysfunctional.


Saturday, June 28, 2008

IVF severely limited in the home of IVF

Lots of women outside Britain have 10 or more treatments to get a baby. And infertility is a very common disorder

Thousands of infertile couples are being denied IVF that should be funded by the NHS because only 9 of 151 health trusts are offering the recommended level of therapy. A total of 94 per cent of primary care trusts in England are still not providing the three free cycles of IVF that should be available under national guidelines issued in 2004, government figures have revealed.

The survey of IVF provision last year also showed that all but a few trusts have imposed tough criteria for free fertility treatment, rejecting patients who smoke or who already have children, including those from previous relationships. Most of those that offered treatment paid for one cycle, and four trusts provided none at all. The results - the first to incorporate figures from every trust in England - were published yesterday by the Department of Health. They show that a postcode lottery for IVF is flourishing despite guidance from the National Institute for Health and Clinical Excellence (NICE).

The NHS financial watchdog recommended in 2004 that three cycles should be available to infertile couples in which the woman is aged between 23 and 39. Women's chances of conceiving are considerably better when more cycles are offered, to the extent that NICE identified three cycles as cost-effective. The advice is not binding, and the Government has provided no extra funds for it to be put into effect. The Department of Health has asked trusts to provide at least one cycle, and to move towards implementing it in full.

About one in six couples is affected by infertility. Almost 45,000 cycles of IVF are performed in the UK each year, but the level of NHS provision means that more than 30,000 of these are conducted privately, at an average cost of about 2,000 pounds per cycle.

The new figures were published as doctors prepare to celebrate the 30th birthday of Louise Brown, the world's first test tube baby, who was born in Oldham on July 25, 1978. Oldham is one of the nine trusts - all in the North West of England - that provide three cycles.

Susan Seenan, of the patient support charity Infertility Network UK, said: "Thirty years after the inception of IVF treatment, in the country that pioneered IVF, and four years after the NICE guideline, it is a complete disgrace that only nine PCTs are offering three free cycles. "We are also disappointed that some PCTs are still offering no cycles at all, and that most are adding social criteria that make it difficult and unfair for patients to access the treatment they need. "There is a real need for a standard set of eligibility criteria that operate nationwide."

The survey was published on the Department of Health's website in response to a parliamentary question from Sally Keeble, the Labour MP for Northampton North. It does not include data from Scotland, Wales or Northern Ireland. It found that seven PCTs offer three cycles - Heywood, Middleton and Rochdale; Bury; East Lancashire; Stockport; Tameside & Glossop; Traf-ford; and Blackburn with Darwen. Central Lancashire offers two or three cycles, and Oldham "a maximum of three". The four PCTs that have suspended free IVF treatment were North Lincolnshire, North Staffordshire, North Yorkshire and York, and Stoke on Trent, though the latter has since resumed provision.

About two-thirds of the trusts (100) offer one cycle, while 35 offer two, and three did not provide full information. More than half (86) specify that a couple must have no children, while another 46 impose other restrictions such as no children from the current relationship, or not more than one child. The survey found that 35 trusts specify no smoking, 30 say that patients must be in a stable relationship, and 33 impose age restrictions beyond those in the NICE guidelines.

A spokeswoman for the Department of Health said: "We recognise that there are local variations in the provision of IVF and that this does cause distress to many childless couples who feel that they are not getting the treatment they need. "NICE published their guide recommendations that trusts provide up to three cycles of IVF in February 2004. But NICE and the Department of Health realised that this could not be immediately implanted and so trusts were encouraged to use this as a goal they move towards. The first step is for all PCTs to offer at least one cycle of IVF and the vast majority do so, with almost a third already offering more than one cycle."


Australia: New ambulance computer system still cactus

Maybe they did not oil it enough. See my second post of the day on 23rd for background

For the second time in a week Emergency Services' $6 million computer system has crashed, forcing operators to log jobs on a "big whiteboard". The Emergency Services Computer Aided Dispatch system failed without notice at 11:30am for no apparent reason. It was back online fairly quickly - unlike last week's 90 minute outage - which was blamed on a maintenance issue.

The expensive new computer system went "live" in Brisbane on May 1 despite the concerns of fire service communications operators. Officers who contacted The Courier Mail expressed fears problems experienced in the southwest region would be repeated in the busy metropolitan area with serious consequences. The problems included delays in the system and unexplained outages, like today's crash.

Emergency Services management has previously stated its complete confidence in the escad system which was initially delayed to provide officers with extra training.


Friday, June 27, 2008

NHS hospital pronounces ten-month-old girl dead -- despite her being alive

An investigation has begun into how a ten-month-old girl, feared drowned in the Thames, was wrongly pronounced dead by hospital staff. It was believed that the child had died after she fell in during an outing to feed the ducks with her mother and three-year-old sister. She was airlifted to John Radcliffe Hospital, Oxford, but after efforts to resuscitate her, doctors declared her dead. Police confirmed the tragedy at 11am, more than an hour after officers were first called to the scene on the towpath at Goring-on-Thames, Oxfordshire, yesterday morning.

A faint heartbeat was discovered later, and the girl remains in hospital in a critical condition. Neither the hospital nor the police would give details of how long it took hospital staff to discover that the child was still alive, nor could they confirm how the child got into difficulty in the water.

A spokeswoman for John Radcliffe Hospital said: “A full paediatric clinical team immediately attempted to resuscitate the child in the emergency department of the John Radcliffe. “After a lengthy period of resuscitation, a unanimous decision was made by the clinical team to stop treatment, in the best interests of the child. [It's in her best interests to be dead?????]

“Subsequently, the child showed very fragile signs of life. This does occasionally happen and the child was moved to the paediatric intensive care unit of the hospital. She remains there in an extremely serious and critical condition.”


Crass Australian public hospital management kills little girl

Exhausted doctor didn't notice brain bleed. What was the hospital management thinking of to assume that a doctor did not need sleep? It's a wonder this sort of disaster does not come to light more often. The hospital manager should be sued for manslaughter

DOCTOR fatigue and the safety of bunk beds are among the issues being probed by an inquest into a girl who died hours after she was sent home from hospital. Elise Neville, then 10, struck her head in a fall from a bunk bed while on a family holiday at Caloundra, in Queensland, in January 2002. Bleeding in her brain went unnoticed by Dr Andrew Doneman, who was in the 20th hour of his 24-hour shift at Caloundra Hospital. The hospital had a policy of not admitting children and the Toowong, West Brisbane, schoolgirl was discharged.

She went to sleep on her parents' bed in Caloundra but was critically ill when her family woke at 7am. An unconscious Elise was flown to Brisbane for treatment. and died days later.

The court was told that in 2004, Dr Doneman pleaded guilty to unsatisfactory professional conduct but the issue of fatigue was raised. Health Practitioners Tribunal judge Debbie Richards said then that it seemed "extraordinary" that anyone should be working such long hours. "If this tragedy does nothing else, it should lead to the abolition of such brutally long shift hours," she said.

Queensland Health's acting director of medical workforce advice Suzanne Le Boutillier said an "alert doctors" strategy was being rolled out to help make doctors aware of fatigue. "Focusing solely on the hours of work does not make patients safe," she said. "There are a whole range of other factors that contribute to fatigue." Ms Le Boutillier said the strategy had gained support among doctors. "The great successes are where doctors drive this on the ground," she said.

The safety of bunk beds will also come under the scope of the inquest and how future deaths might be prevented.

Outside court, Elise's parents Gerard and Lorraine, said they hoped the inquest would identify and improve deficiencies in the health system. "There's been changes, that's great, but I need to see more," Mr Neville said. He said many Queenslanders lived in places removed from Brisbane and the bigger centres and they needed care too. "We were only one hour from Brisbane - one hour - and this is what happens," he said. Mrs Neville said: "I want people to see how beautiful she was and she's just always going to be a part of our lives. "We're Elise's voice and we'll see it through."


Thursday, June 26, 2008

What's at Stake in the Medicare Showdown

A friend recently asked me for advice on how to protect her father. He wants to stay in his own apartment as he recuperates from hip surgery. But the Medicare program that covers him requires that he head off to a costly nursing home. My friend was so desperate that she has also consulted a health-care lobbyist for advice.

At stake in the presidential election is whether we will all need to consult lobbyists to have our medical issues heard by a remote, bureaucratic Medicare program. Medicare's staff, members of Congress and Barack Obama are all moving to expand government influence over the medical choices we make. As early as today, the House will vote on legislation that aims to cut Medicare Advantage - a program that allows millions of seniors to use federal dollars to buy private health insurance.

Democrats hate Medicare Advantage and have been trying to cut it for quite some time, because they don't like health-care markets. Sen. Obama promises to cut $150 billion out of it in the coming years. The Senate has been haggling over cuts to the program for weeks. Why cut? For all the talk about finding health-care savings with painless "reforms" like better information technology or disease management, the only way to really control costs under our current health-care model is to control access to drugs, devices and services.

The crucial question is where the controls should be - with patients working through private plans or with government agencies. While private health insurance is imperfect, there's a misguided faith in Medicare's superiority that rests on flawed assumptions.

First, there's a mistaken belief that Medicare is better staffed than private plans, and can therefore make better decisions about patients' clinical circumstances and the access to new therapies they should have. Yet at any time, Medicare has about 20 doctors and 40 total clinicians (including nurses) inside the coverage office, and fewer than a dozen in the office that sets the rates that doctors are reimbursed for the care they provide. Private insurers employ thousands of doctors, nurses and pharmacists, many experts in new technologies.

Aetna has more than 140 physicians and about 3,300 nurses, pharmacists and other clinicians across its health plans. Wellpoint has 4,000 clinicians across its different businesses, including 125 doctors and 3,180 nurses. That works out to one clinician for every 9,000 people covered. United Healthcare employs about 600 doctors and 12,000 clinicians across all of its health plans and various health-care businesses.

Private plans use clinically trained people to establish access to new technologies and services, but they also consult with doctors on a case-by-case basis, determining whether a product or service should be covered. Competition for beneficiaries means private plans need to provide better access for appeals, modern services and more personal considerations than what's offered by Medicare, a monopoly supplier.

Recent data from Price Waterhouse Coopers found that private plans spend roughly four times more than Medicare on "consumer services, provider support, and marketing," which includes money spent answering the telephone to adjudicate individual issues. Smaller health plans use one clinician for every 10,000 beneficiaries. Medicare would need 4,500 clinicians to keep pace.

One place where the clinician disparity is most obvious is the delivery of cancer benefits. Medicare doesn't have a single oncologist on staff, yet since the year 2000 the program issued, by my count, 165 restrictions and directives on the use of cancer drugs and diagnostic tools.

A second common refrain is that Medicare is more efficient than private plans, spending less money per beneficiary to administer health services. But a lot of the money that private plans spend is on clinical specialists charged not only with reviewing individual cases, but also with ensuring that doctors and beneficiaries comply with plan contracts. Far from a selling point, not having these functions is one of Medicare's shortcomings.

Medicare doesn't need to hire doctors to weigh individual medical cases because it uses formulaic rules made in Washington to set broad and inflexible restrictions on medical practice. Nor does the program need to hire clinical staff to monitor compliance. It passes costs for that on to the broader health-care system by backing up its rules with the threat of costly civil and even criminal sanctions. Providers and medical product developers spend hundreds of millions of dollars on systems, personnel and paperwork to ensure compliance with Medicare's sticky morass of regulations - tasks made more expensive by the fuzziness of the program's regulations and the arbitrary way they are enforced.

This brings us back to Medicare Advantage. Many in Congress assume that private insurers are driven by greed, and only a government-run health program can ensure adequate access to services. But Medicare Advantage plans offer prevention and wellness benefits, care coordination and alternatives to hospitals at the end of life that traditional Medicare does not provide. The clinical staff of Medicare Advantage plans isn't just there to handle appeals, but to offer personalized services that reflect the care people want rather than benefits defined by remote staff at a monopoly supplier.

If Democrats have their way these plans could be in for big cuts. If Congress does nothing before July 1, doctors in Medicare will take a 10.6% cut in their pay. To stop that from happening Congress will likely raid Medicare Advantage and use the money saved by cutting that program to cushion the blow to doctors. What terrifies members is facing constituents over the July 4 break who will be upset about rising co-pays and uncertainty about their coverage. The question is how big of a bite the House and Senate will take out of Medicare Advantage. But cut they will, because Medicare Advantage plans enable competition that serves as a model for shaping Medicare into a privately run system.

Mr. Obama has been honest about his intentions. He wants to cut from Medicare Advantage to pay to expand "fee-for-service" Medicare programs. For those not yet eligible for Medicare, he also proposes to saddle private plans with new regulations and create a subsidized, Medicare-like public plan to "compete" against the private health-insurance market for the under-65 crowd. The idea is that the Medicare-like alternative would eventually displace a dwindling number of private plans, after many are driven away by costly new government rules. His endgame is to leave the government-administered Medicare program in a position to set decisions for the entire health-care system.

Will we stick with a "defined benefit," where everyone is promised the same government services? Or will we move toward a "defined contribution" system (favored by John McCain), where seniors can buy private health insurance? It's a fundamental question we are being asked in November.

In the end, my friend's father was transferred to a nursing home. Patients covered under Medicare Advantage have their own discomforts, but at least they can always change plans and appeal decisions. And they don't need to consult a lobbyist.


Wednesday, June 25, 2008


Three articles below from just one day!

Doctor numbers nosedive in Australia

When there are heaps of people wanting to get into medical schools this is just plain government negligence. Why is money being spent on useless "postmodern" courses when funds for medical education are so limited?

AUSTRALIA'S doctor shortage is becoming critical, with new figures revealing a plunge in the number of GPs. A report to be released today shows the number of practising GPs fell 9 per cent between 1997 and 2005.

The release of Australia's Health 2008 will reignite tensions between doctors and the Rudd Government. Health Minister Nicola Roxon said GPs should rethink their roles as medical "gatekeepers" in light of the finding. "Why, when families struggle to see their GP, when people often end up in their local hospital because they can't get frontline care from their local doctor, do we need gatekeepers?" she said.

The Australian Medical Association argues that doctors must be the gatekeepers of the health system to ensure patient safety


Dud medical regulator to be sued

RAPE victims of a deviant doctor are planning to sue Victoria's peak medical watchdog for failing to act on sex assault complaints. The women have engaged Slater & Gordon to investigate suing the Medical Practitioners Board for failing to suspend dermatologist David Wee Kin Tong after two patients said he molested them. Dr Tong was jailed in March for at least 5 1/2 years for sexually assaulting 14 patients. His last victims were assaulted three years after the first complaints were made.

The women claim inaction by the profession's watchdog left Dr Tong free to abuse up to 12 more unsuspecting victims. It is believed the board, a statutory body charged with investigating complaints and protecting the public, did not hold a formal hearing into the allegations after an investigation into Dr Tong. A second complaint to the board in 2005 led to Dr Tong being reprimanded. The board is not required to pass complaints on to police.

After a victim went to police in 2007, investigators were initially refused access to the board's records on Dr Tong and were forced to serve a warrant for the material to be released. Victoria Police's sexual crimes squad raided the board's headquarters, but had to fight a legal challenge in court to use the files. The board has since apologised publicly for its handling of the complaints, but a police source says that the board's actions were tantamount to a "cover-up".

The Herald Sun has learned the wealthy doctor tried to divest himself of his Toorak mansion before it could be confiscated to pay his victims' compensation. Victoria Police restrained Dr Tong's Toorak property, which he had sold for $2.35 million, only days before settlement. The proceeds of the sale were later confiscated. Already gone were antiques and paintings, many of which Dr Tong bought at Sotheby's and Christie's auctions.

Dr Tong, 40, pleaded guilty to seven counts of rape and seven counts of indecent assault involving 14 patients at clinics at Clifton Hill, Malvern, and Preston. The offences occurred between October 2001 and 2007 during examinations. He also lost his right to practise medicine. Another two women have since come forward with allegations against Dr Tong.

During a search of Dr Tong's home, police found 120 pictures of naked women -- some of them patients -- placed in small photo albums. Dr Tong told many of the women, aged between 22 and 34, they could get moles on their genitals and required a full-body examination.

Kay, who was the first victim to come forward, said although compensation was an issue, she wanted the board to change its investigation procedures to ensure the safety of others. "I was the first, but they just didn't follow up," she said. "I felt really violated and they (the board) hadn't listened to anything I said to them and took his word for it."

The MPB has since reviewed cases involving potential sex offences and apologised to victims. "Why the hell didn't they stop it back in 2004 when we complained," Kay said.


Public hospital and its head surgeon facing negligence lawsuit

MELBOURNE'S The Alfred Hospital and its former head of trauma, Thomas Kossmann, are facing legal action alleging medical negligence. Law firm Slater & Gordon has told The Australian it is preparing several cases against the hospital, and possibly Professor Kossmann, for allegedly negligent surgery performed on trauma patients.

The cases come in the wake of a damning peer review into Professor Kossmann's surgical and billing practices, which were first revealed in The Australian in April. The review alleged he had exaggerated his experience on his CV, conducted risky and unnecessary surgery, and rorted government insurance agencies, including the Transport Accident Commission. It also alleged he had put lives at risk with bungled surgery that involved grave errors in more than half of the 24 cases that were examined.

Professor Kossmann has denied any wrongdoing and attributed complaints from doctors about his surgery to competitive jealousy. He condemned the peer review, led by orthopedic surgeon Bob Dickens, as a "witch-hunt", and several of his former patients have come forward to praise his surgical performance.

When the review was released last month, Jennifer Williams, the head of Bayside Health, which operates The Alfred, absolved the hospital of any legal responsibility. But Slater & Gordon medical negligence specialist Paula Shelton said her firm was preparing several cases involving allegedly unsuccessful or unnecessary surgery performed by Professor Kossmann at The Alfred. "They are all people who have got significant problems," she said. "There are certainly a couple of them that I think are serious. It's fair to say they relate to poor (surgical) outcomes." For the cases to succeed, the victim must prove at least 5 per cent physical impairment and that the surgery done was poorer than could be reasonably expected at the time. Slater & Gordon is still investigating the cases and expects to obtain the medical records from the hospital and launch action within a few months if independent advice confirms the alleged negligence.

A spokeswoman for Professor Kossmann said the surgeon was not aware of any claims against him and therefore could not comment. Ms Shelton said she was unable to give details of the cases, but The Australian has spoken with one of Professor Kossmann's patients who is not among the existing cases, but is considering joining any action against the hospital.

The patient, who declined to be named, claimed he had complications after Professor Kossmann operated on him in 2004 following a car accident. He claimed he suffered a post-operative infection following the original surgery. "At the time I found him to be very professional and thought the complications which arose both in the short term and long term just came with the territory; however, reading the reports coming out now makes me wonder about that," he said. "About a year or so later, my leg played up again so I went to a doctor to have a look at it and they found deep-vein thrombosis, which he attributed to the original injury ... X-rays showed that a titanium screw placed in my knee ... had snapped during that surgery and had been left there."


Tuesday, June 24, 2008

British doctors dubious about new treatment protocols

Nurses doing surgery?? I think I'd be dubious too

The minister in charge of a review of the NHS has accused some doctors of being “laggards” for obstructing the introduction of new treatments. Lord Darzi, who continues to work as a surgeon, says some senior medical staff are so determined to protect “professional boundaries” that, 14 years after his own practice began using nurses to do minor surgery, others have yet to follow.

He said: “In all areas of healthcare you have innovators, people who really want to change things for the better, and you also have, in other areas of the healthcare system, people who are lagging behind and need to catch up. “They will eventually catch up once they know that, if you start thinking about what really matters to patients, how you can improve the care you provide, you get over all these different obstacles.”

Darzi, who has been in bitter conflict with doctors over the introduction of polyclinics, is backed by Sir Liam Donaldson, the chief medical officer. This weekend, Donaldson accused some surgeons of obstructing changes that would make operations safer because they objected to their “professional autonomy” being eroded. He said: “The culture of medicine has been one of clinical autonomy. Doctors are trained to take decisions, to feel they are in charge, to lead teams. They want to do what they feel is best and anything that suggests that they should standardise their practice in any way is sometimes seen as degrading of their professional ethos.”

Donaldson, who as chairman of the World Health Organisation world alliance for patient safety will this week launch an airline-style danger checklist for surgeons, added that one British doctor told him such checks would reduce consultants to “factory workers”. Donaldson said: “I was talking about a way in which standard operating procedures are used in the airline industry and he said: ‘Well, if you bring that into medicine, we might as well go and work in factories.’ “I think it is a new idea for some traditional people holding traditional attitudes in medicine and I think we need to break those down and get people thinking and learning from other industries.”

Darzi, who will publish his review on the NHS at the end of this month, also says doctors and nurses must treat patients as customers. He says that if patients don’t like the quality of care they are receiving they should go elsewhere. His report will include proposals to routinely invite patients to grade the quality of nursing care they receive during their hospital stay, including how comfortable they were made to feel on the ward and if they were treated in a kind and compassionate manner. Results of these questionnaires will be published so that patients can shop around for the hospital with the most compassionate nursing care.

Darzi, who still practises his keyhole surgery specialism two days a week at St Mary’s Hospital in London, said he recently had a patient who requested a referral to his unit from outside its catchment area. He said more details of the most advanced surgery will be made available to patients as part of his review. This will make it easier for patients to find out where the latest technology is used.

Darzi said: “Have patients been treated as customers? When you go to a restaurant you look at a website and find out exactly what people said about that restaurant. In future I want to show which hospitals, doctors and nurses are actually bringing innovation into their healthcare.” Darzi is to set up a new website featuring all the latest innovations in medicine to encourage hospitals to adopt new treatments more quickly.


Not again! Another government computer system fails

And a dangerous one: The system for an Australian ambulance service. My local Yellow cabs and Pizza Hut have great computer systems for managing customers and Bill Gates sells programs that are a thousand times more elaborate. What's wrong with the bureaucratic boneheads? Nobody gives a damn. That's what's wrong. The system was "innovative", of course. Governments should only buy tried and tested systems. They bungle anything else

A $6 MILLION computer system crashed within hours of being turned on last week, leaving Emergency Services staff using pen and paper to dispatch ambulances and fire engines. The Queensland Ambulance Service computer-aided dispatch system, known as VisiCAD, went down for six hours on Wednesday and communications centre staff said patient lives were put at risk across the state.

"Once the crash occurred the computers froze . . . Many other dangerous technical difficulties then occurred," a QAS employee told The Sunday Mail yesterday. The informant said that in the chaos and confusion, two patients with non-life-threatening conditions who had requested ambulances were overlooked. "No one died, but it definitely put lives in danger," the employee said.

He said the Queensland Fire and Rescue ESCAD system crashed for 2® hours at the same time. Queensland's Emergency Services has spent millions of dollars in the past decade trying to find a suitable computer-aided dispatch system. Sources said the new model was rushed in without being properly road-tested.

A QAS spokesman played down the system crash. "The Department of Emergency Services is currently implementing one of the nation's most innovative dispatch systems, called VisiCAD," he said. "The new system will link all QFRS and QAS communications centres with a single state-of-the-art computer-aided system." He said the cause of the "outage" of about 90 minutes late on Wednesday was related to a maintenance issue ["maintenance"? How do you maintain a computer program? Do you oil it?], not the system. "There have been no reports of any significant impact on service delivery." The spokesman said senior management was unaware of any evidence to indicate lives were put at risk.


Monday, June 23, 2008

Cancer pair win fight with NHS for top-up drugs

Two women suffering from cancer have won legal battles for the right to pay privately for life-prolonging drugs without having their National Health Service treatment withdrawn. Several hospital trusts have also broken ranks to allow dying patients to pay immediately for the additional drugs that their doctors have said they need.

The moves are a sign that the government’s ban on so-called co-payments is beginning to crumble. In the face of a campaign led by The Sunday Times, Alan Johnson, the health secretary, has already announced a review of the policy which is due to report in October.

Melissa Worth, a solicitor at the law firm Halliwells, who is representing eight patients fighting for the right to co-pay, said: “Many more NHS trusts are finding different ways of allowing patients to pay for cancer drugs. “The government has now publicly acknowledged there is a problem and people are realising that what is most important is that patients get the best possible care.”

Andrew Haldenby, director of the think tank Reform, which includes Doctors for Reform, a group of 1,000 doctors campaigning for change, said: “This is a victory for common sense. It has become clear that many doctors have rejected the bureaucratic rules of the NHS to act in the best interests of patients. They deserve praise for looking beyond the guidance to act in a way which shows the true values of medicine. These cases also show the government had to order a review as its position is unsustainable.”

One woman, who took legal action against Weston Area Health NHS Trust in Weston-super-Mare, Somerset, has been told she can pay for Avastin, the bowel and breast cancer drug, in the hospital’s private wing while receiving the remainder of her care on an NHS ward. The trust, which runs Weston General hospital, said: “This patient is having complete treatment on the NHS and has chosen to purchase separate treatment as well. Because the hospital has a unit for private patients on site, it has been agreed that the patient can receive Avastin on that unit.”

Another woman, who has bowel cancer and is taking legal action against the Royal Marsden NHS Foundation Trust in London, has been advised that she will also be able to pay for Avastin without being denied NHS care. The woman’s husband, who does not wish to be named, said the trust had told them it would not object, “provided we were not getting treatment in the private [wing] and on the NHS in the same episode of care, on the same visit. Effectively, we have won the right to pay.” The Royal Marsden has declined to comment on the case.

The Velindre NHS Trust in Cardiff faces a judicial review after refusing to allow a woman to buy a cancer drug.

Nottingham University Hospitals NHS Trust, ABM University NHS Trust in Bridgend and University Hospital Birmingham NHS Foundation Trust are also allowing some of their NHS patients to pay for additional drugs.

Many dying patients are still being denied the chance to spend their savings on cancer drugs, however, because their trust plans to retain the ban until the government review ends. Sue Matthews, 57, a former physiotherapist from Buckinghamshire and the wife of an NHS orthopaedic surgeon, says this could be too late for her. Matthews, a mother of two with bowel cancer, wants to be able to pay for the drugs Avastin or Erbitux without losing her NHS care. She said: “It could all be too late for me. “If the government turned round now and said, ‘We realise it has been happening in other areas of the NHS and we are prepared to accept it now’, that might be of some use to me. But he [Alan Johnson] is just trying to placate people and for those in my position it doesn’t help at all. “Some of these reviews go on for years. I will be dead by then.”

Another cancer patient, Jonathan Chapple, a retired company chairman from Kingston, southwest London, was asked by an NHS trust to pay £55,000 upfront for all of his cancer care when he asked to top up with the drugs that doctors said would give him the best chance. Like Matthews, Chapple, 69, was told by doctors that Avastin or Erbitux, which are not routinely funded by the NHS, were most likely to extend his life. His oncologist at the Royal Marsden told him that he could not continue to receive NHS care while paying for the drugs, however, and he was advised to transfer to the hospital’s private wing. Chapple said: “Having paid all my life for NHS services, to be put in this position feels immoral.” He is now travelling to a private clinic in Germany for treatment.

The Royal Marsden said: “In line with all private providers, we do ask for a deposit upfront and this is judged on the individual patient and their treatment pathway.”


Sunday, June 22, 2008

Doctorless Canadians

Over the four times Dawn Beharry has been stricken with the same, persistent infection since January, she has had one wish: that she could see a family doctor who would remember her. She can't find one. "I've settled on coming here to see whomever, randomly," she said, referring to the Doctor's Office walk-in clinic at Bay and Dundas Sts. she has visited over the past three years.

Beharry, 26, is one of 4.1 million Canadians aged 12 or older who are without a family doctor, according to the 2007 Canadian Community Health Survey, which questioned more than 65,000 Canadians about their health. The report was released yesterday. Among its worrying statistics: Recent immigrants, the poor and the young were all more likely than the bulk of Canadians not to have a regular doctor. Only 65 per cent of immigrants who have been in Canada for five years or less have access to a family physician, compared to 85 per cent for the whole country, according to the study.

Income level, gender and age also play a role. Of the 20 per cent of Canadians with the lowest incomes in the country, 82 per cent see a family physician. Men were nearly twice as likely as women not to see a regular doctor. And the probability of having a primary doctor increased with age.

So what do Canadians without regular physicians do when they get sick? The survey found that among those who have no regular physician, 64 per cent chose to go to walk-in clinics, 12 per cent visited a hospital emergency room, and 10 per cent visited a community health centre.

In the past year, Beharry has visited both walk-ins and even the emergency room at Mount Sinai Hospital, where it was three hours before she saw a doctor. "It just really sucks," she said. She thinks that if she had been seeing the same doctor regularly, her chronic bladder infections might have been cured by now. Beharry used to have a family doctor as a child, she said, but no more. "He's at Bayview Ave. and Sheppard Ave.," she said. "I live in the east end." To find a doctor in Canada, she reflects, "you have to go through people you know."

Sylvain Tremblay, an analyst who worked on the Statistics Canada study, was careful to note that the majority of Canadians who don't have a doctor haven't looked for one. Most of those people, he said, are also young and in good health. But the number of us who, like Beharry, have made an effort to find a family doctor and failed – 6 per cent – is statistically significant, he added.

Torontonians can consider themselves lucky: 88 per cent of us have access to a family doctor – three percentage points higher than the national estimate. The percentage of Canadians who do not have a regular doctor is slightly higher – by three points – than it was in 1996.


Australia: Hospital Emergency Dept. 'like war zone'

South Australia: Flinders Medical Centre's emergency department "is frequently overwhelmed and resembles a war zone", the hospital's general manager has admitted. The comments were made in a letter of apology to a patient who had made a complaint to the department. The letter is from Flinders' general manager, Associate Professor Susan O'Neill, and apologises on behalf of Dr Di King for any distress the patient, Kathryn Gibbons, of Encounter Bay, had suffered. Dr King was one of several doctors to see Mrs Gibbons that night.

"Your comments regarding the level of overcrowding and strain on the ED at the time Dr King totally agrees with," it says. "Regrettably, the ED is frequently overwhelmed and resembles a war zone. "Staff struggle to maintain basic patient comforts and service, however patient safety is our highest priority and this was maintained." Mrs Gibbons suffers a rare and severe form of asthma, known as "brittle asthma".

In January, she went to Flinders to seek treatment for her asthma but, after a long and frustrating wait during which she felt her needs were ignored, she drove back to Victor Harbor to get treated.

In May, she wrote a letter of complaint to Flinders. On June 13, she received the letter from Associate Professor O'Neill, which goes on to assure Mrs Gibbons that she was in no danger and that her treatment was appropriate.

Southern Area Health Service chief executive Cathy Miller, speaking on behalf of Associate Professor O'Neill, said the letter was paraphrasing Mrs Gibbons' own words. She added that the emergency department was getting busier and putting additional pressure on workers. "There's no doubt the EDs are busy places and we've experienced an increase of 5 per cent from last financial year to this financial year, which is an additional 3000 patients," she said. "It is an emotive place to work and people are passionate about what they do. It can become a busy place (and) it can look quite chaotic."

Ms Miller said they were having success with new measures to improve patient flows and that the redevelopment of the department would also help. "It is the time lag between demand going up and other processes kicking in," she said.

The letter's release comes in the middle of a bitter and prolonged dispute over pay and conditions. Up to 85 per cent of the emergency specialists from the state's public hospitals have handed in their resignations, effective on Friday. FMC emergency medicine senior consultant Dr David Teubner said the doctors were resigning because the overcrowding in emergency department was risking the safety of patients. "It is impossible to practice safely in an overcrowded environment (and) the majority of the time there are more patients than there is space for them," he said. "It's undignified, it's just an awful environment in which to work. It's just soul-destroying. "To deal with (the overcrowding) we need adequate numbers of senior staff and we're unable to attract such people from interstate because of the pay."

Dr Teubner also said this year was the worst it had ever been, and that it would get even worse with winter. "The hospital is doing an enormous amount . . . to make things better but we're busier than ever and there's pressure from the Department of Health to close beds to save money," he said.

Health Minister John Hill said there was a "huge increase" in presentations at Flinders, but the State Government was working to address the issues. "We know thousands more people are going to FMC every year seeking help in the ED. Our ageing population and the shortage of GPs in the south are resulting in this huge increase in presentations," he said. "And the State Government is addressing this through the $153 million redevelopment of FMC, including building a brand new ED with increased capacity. "The expanded and redeveloped emergency department will include 21 additional treatment cubicles, to cater for an extra 14,000 people seeking treatment every year."

Mr Hill added that a GP Plus Health Care Centre at Marion and extra staff being employed by the Government would also help. Doctors and the State Government met again at the Industrial Relations Commission last night to discuss the enterprise bargaining agreement. Industrial Relations Minister Michael Wright said a new offer to the state's public doctors had been put on the negotiating table. He said talks were "progressing well", and they would possibly continue over the weekend. SA Salaried Medical Officers Association senior industrial officer Andrew Murray said there were still "significant issues" to be resolved.


Saturday, June 21, 2008

Australia: Doctors old, foreign and busy

This is pretty absurd. There is no shortage of people wanting to get into Australian medical schools. I sure am glad that my GP has a similar background to mine. It makes visits a lot more pleasant

MORE than half of the GPs working in Australia were born overseas, with one in seven GPs in Queensland having only arrived in the country since 2001. An analysis of data from the 2006 census shows Australia is increasingly relying on overseas-born, ageing and overworked doctors - a situation condemned by a leading health expert as "an absolute crisis" and a risk to patients' lives.

According to the census figures, more than 50 per cent of Australia's 35,000 GPs were born overseas, compared with 22 per cent of the general population. At the time of the census, one in 10 of Australia's GPs - and 15 per cent of those in Queensland - had lived in the country for less than six years. Among specialists, 41 per cent were born overseas, with about 9 per cent here for less than six years at the time of the census. Of those medicos arriving in Australia in the previous five years, one in five GPs and nearly a quarter of specialists came from India.

The figures also show Australia has more older doctors in the workforce, with 12 per cent of GPs and 14 per cent of specialists aged 60 or over. And Australia's doctors are working long hours, with city-based GPs working an average of 49 hours a week.

Founder of the Australian Health Care Reform Alliance, Professor John Dwyer, said the statistics showed the national health system was in a dire state. "At the moment, patients are being very much short-changed," he said. "Definitely lives are at risk." He said the situation was even more worrying in Queensland, with the census figures showing a shortage of doctors compared with other states. Only Western Australia has fewer GPs per head of population than Queensland and only the Northern Territory has fewer specialists per head of population. Data from the Queensland Medical Board showed more than 5000 oversea- trained doctors are registered to work in Queensland.

Incoming Australian Medical Association president Dr Mason Stevenson said many regional and remote areas were heavily reliant on foreign-trained medical officers. "You actually have some hospitals that are manned 80 per cent by overseas doctors," he said. "In fact, outside of southeast Queensland, 50 per cent of GPs are overseas-trained doctors - not just overseas-born, overseas trained. They are indispensable to fill the void."

A meeting of the National Health and Hospitals Reform Commission in Brisbane yesterday heard calls for a 100 per cent Medicare rebate for doctors in rural and remote areas. The Brisbane-based Need More GPs support group also told the commission it should be easier for overseas doctors to move into GP roles.


Universal Health Coverage --- Call It Socialized Medicine

This article is from some time back but still seems applicable

One of the biggest myths being propagated today is the absurd notion that "people can't see a doctor without having insurance." The truth is office visits are relatively cheap, well within the means of most people. The problem is most people don't budget anything for their annual medical care. And, then when a problem arises, any expense greater than zero "isn't in the budget."

The other problem is that insurance really isn't insurance anymore. It is pre-paid health care. True insurance is intended to prevent financial disaster in the face of an unlikely event. Most people, however, have come to expect first dollar coverage for everything including very common and likely events like routine doctor office visits. "Covered'' employees don't realize it's their money going to pay for this "wonderful" non-bargain of first dollar coverage. It's not a "free" benefit provided by their employer as most employees believe. These costs are essentially hidden from employees. Money their employer wastes in purchasing first dollar coverage or inferior managed care coverage for the employee is money which would have been the employee's salary to spend as they choose.

The reason most people obtain their health insurance from their employer is because of tax discrimination. During World War II, our government enacted wage and price controls. Employers couldn't attract better workers by offering higher wages, but were allowed to offer health insurance as an untaxed benefit. Although World War II ended 54 years ago, this same tax discrimination policy remains in effect today.

This atrocious policy discriminates against the working poor, part-time employees, employees working for small businesses that don't offer health insurance, and the self-employed. Those who obtain their health insurance through their employer, purchase their coverage with pre-tax dollars. On the other hand, those who purchase their health insurance on their own, purchase it with after-tax dollars --- a huge difference. In fact, the uninsured actually end up paying what amounts to a tax penalty for being uninsured.(1) It is estimated that "a family in the bottom fifth of the income distribution pays about $450 more in taxes than insured families at the same income level. For families in the top fifth of the income distribution, the tax penalty is $1,780."(1) The analysis goes on to say that "on the average, uninsured families pay about $1,018 more in federal taxes each year because they do not have employer-provided insurance. Collectively, the uninsured pay about $17.1 billion in extra taxes each year because they do not receive the same tax break as insured people with similar income. If state and local taxes are included, the extra taxes paid by the uninsured exceed $19 billion per year."(1)

Where, we must ask, is the compassion for these overtaxed, hard-working people? This is clearly a government-created problem. What we don't need is more government (nationalized health care) to "fix it." What we need is to get government out of our wallets so people can have their own money needed to purchase and own their own health insurance. The other thing the pro-socialist "crisis mongers" fail to tell people is that only one-third of the uninsured are chronically uninsured.2 For the other two-thirds, it is only a short, temporary condition, "half of all uninsured spells will last less than six-months. Three-fourths of them will be insured within 12 months. Only 18 percent of all last for more than two years."(2)

Those who brandish the "crisis" of the uninsured to promote socialized medicine also often fail to tell people that uninsured doesn't necessarily mean poor. In fact, the National Center for Policy Analysis (NCPA) tells us that "a third of the uninsured households earn more than $30,000 a year and 10 percent earn more than $50,000."(2) That's at least 40 percent of the so-called "uninsured" that could well afford a $45 office visit or health insurance.(2) We need to get away from the concept that "someone else," big government or insurance, needs to take care of our every need.

The other adverse consequence of this tax discrimination is that it led to cost inflation of medical care. Everyone came to believe that we were spending "other peoples' money" (OPM). And, when you're spending OPM, the sky is the limit. Patients have been told that they are getting "free" insurance from their employer and quite naturally came to expect everything they wanted or desired, whether of marginal benefit or not, would be "fully covered." Likewise, the physician who "participated" in insurance and was paid directly by the insurance company for everything with OPM, had no disincentive to hold down costs. The patients came to view these "participating" physicians as "good" and "compassionate" because the physicians would accept their insurance and the patient would have to pay little or nothing out of pocket, not realizing that OPM was actually their money all along.

Both patient and participating physician, therefore, contributed to this disrupted market where both buyer and seller were insulated from costs thus leading to uncontrollable cost inflation. The problem of cost inflation was further compounded by the cost of government regulation. Government mandates increase the costs of health insurance tremendously, and the mandates are often for things that most people don't want or need. Yet, they are forced to pay for the "coverage." "These mandated benefits included wigs for bald-headed women (Minnesota), pastoral marital counseling (Vermont), and community sperm bank services (Massachusetts).(3) In New York state, most health insurance premiums doubled as a result of state-mandated community rating. This has made health insurance especially hard to afford for the young and healthy who are, in effect, punished by the state for being young and healthy and for not engaging in unhealthy behavior. State mandates, which were purportedly instituted to "help" people, have thus had the effect of pricing many people out of the health insurance market. This, however, is predictably what happens when we look to big government to "help" us.

Indeed, "universal coverage," nationalized health care, or socialized medicine, regardless of what you choose to call it, is not the same as medical care. All of the citizens of Canada, for instance, have "universal coverage." What they often don't have, however, is the medical care that they need when they need it. That is why we see Canadians crossing the border into the United States in droves to obtain the health care that they can't get when they need it in their own country. Their government rations access to health care and thus attempts to control costs by making MRI scans, radiation oncology, bypass surgeries and many other health services largely unavailable to their own people. Is this the egalitarian's view of compassion and social justice?

We Get More of What the Government Subsidizes

Government programs also breed highly destructive dependence. How destructive? Well, I once took care of an alcoholic patient who bragged that his government disability checks allowed him to purchase better quality whiskey than he could afford to buy when he wasn't considered disabled because of his alcoholism. The government thus subsidized his alcoholism.

During his hospital stay, I pointed out his government subsidized habit had damaged his liver, his pancreas and his brain. He was slowly but surely killing himself with alcohol, bought and paid for by the government. After much discussion with the patient, I convinced him to give up alcohol, but there was a problem. Although the patient was willing to give up alcohol, he wasn't willing to give up the government checks. You see, if he gave up alcohol, he would lose his disability status, and would have to do something drastic like work to obtain money. But, he reasoned, why work when the government will give him the money to spend doing something that he liked to do? This spontaneous "experiment" in addiction medicine proved one thing beyond a shadow of a doubt. As powerful as addiction to alcohol is, it pales in comparison to the addiction to government money.

Yes, we need health care reform, but it needs to be based upon the principles of individual freedom and individual responsibility. And, there are many options out there. Most people could purchase a high deductible indemnity insurance policy at a lower price than they would pay for monthly managed care premiums. That's right --- a much higher quality of health care at a lower price! Imagine, having the freedom to choose the doctor or hospital you want to go to, being able to go to specialists without denials, delays, and gatekeepers. And, the money saved by purchasing a high-deductible catastrophic policy could be set aside in a special savings account to pay for deductibles. The money saved by purchasing a high-deductible policy could also be used to pay for the insurance premiums.

Medical Savings Accounts (MSAs) allow people to put money aside and take a tax deduction for keeping and controlling their own money. The MSA earns interest year after year tax free and if not spent by retirement age can be converted into a pension fund. Think of all the money you and your employer have turned over to insurance companies since you started working, and how much a young worker would have accumulated after 45 years of investment in a MSA. Those in favor of nationalized health care, of course, don't want to give you control of your own money. Government elites feel that they can better spend your money for you. This is the real message that they don't want you to hear.

And, last but not least, there is charity. No hospital ever turns any patient away because of lack of funds. Hospitals and the physicians on call at those hospitals are required by law to treat all patients presenting to the emergency department irrespective of ability to pay. And we do it all the time. It's a total myth that you can't come to the hospital because you "don't have insurance" or "can't pay." Charity is something that should involve churches, not big government. What big government does, confiscating money from all, including the minimum wage earner, and redistributing it based upon some social engineering scheme, isn't charity. It's legalized plunder. True charity comes from the heart, not from forced "contributions." Most churches and charitable agencies understand the dependency trap of big government programs. They understand that it does no good in the long run to give a man fish for his dinner. This does not help him. To help a man, you must teach him to fish. The goal should be to help a man back to his feet so he can support himself and his family, not to trap them in a cycle of dependency. That is what dignity and self-esteem are all about. That is what true compassion is all about. The Amish don't have "insurance coverage," yet they have existed for centuries via a charitable tradition of voluntarily sharing others' burdens and medical expenses. This same concept has been implemented via other churches and religious organizations in conjunction with MSAs and has been proven by AAPS members like Dr. Alieta Eck and associates to be a much more affordable alternative to traditional health insurance.

I find it very sad in a country where men and women have died fighting to preserve our freedom and have died fighting off socialism and communism that some are now considering socialized medicine as a solution to improving access to health care.

Lenin once said that "medicine is the keystone in the arch of socialism,'' and I believe those who are promoting "universal coverage" via government-run and government-controlled medicine know this. What they hope is that the public won't find out the truth. There is nothing compassionate about socialism. This is why the AAPS gives a high priority to educating other physicians and the public about the truth of socialized medicine. That is why AAPS should be joined and supported by all physicians!


Friday, June 20, 2008

NHS reviewed

I am looking at a leaflet informing the public about the creation of the National Health Service, almost 60 years ago. The celebrations for this anniversary begin at the end of this month. There will be a party at Wembley Stadium, a service of celebration at Westminster Abbey, and countrywide events, most of it organised by the Department of Health in Whitehall.

Never underestimate the desire of politicians to lay claim to the NHS. For many years it was a “Labour” achievement, its strongest stick with which to beat the Conservatives. And when the next election comes, the NHS - the fate of the local hospital or GP surgery - will still account for far more votes than any esoteric arguments about 42 days' detention, or EU or climate change treaties.

Labour will suck every piece of political capital it can from the 60th anniversary party. By chance, as I write this, I receive a voicemail from Labour HQ asking whether I plan to write about the anniversary in the next fortnight. “Health ministers are very keen to start laying out where the NHS needs to go in the next few years” and one of them would be very keen to have a few words with me... The debate on polyclinics, the press officer adds, “is one very clear dividing line on modernisation”.

Poor old health service, batted from party to party, from election to election. I turn back to that leaflet from 1948: “Your new National Health Service begins on 5th July. What is it? How do you get it? It will provide you with all medical, dental, and nursing care.” And a very clear dividing line on modernisation in 60 years' time.

All medical, dental, and nursing care... you don't even need to ask the question to know that the NHS could never claim that today. NHS dental care is patchy at best, medical care is heavily rationed, and nursing care, as anyone who has spent time in hospital will tell you, is hit and miss. In part, this is due to greater demands on the health service. Whatever it offers, we want more: more treatments, more consultations, more medicine. More care. Demand has always taken the politicians by surprise: Nye Bevan estimated the initial cost of the NHS at 176 million pounds for 1948-49. Its first full year of operation came in at 437 million.

Today we want the service to meet an ever-expanding definition of health. We want it to make us happy as well as healthy, fertile as well as fit. One day we will expect it to make us beautiful, perhaps even successful too. No wonder it is still struggling on its 90 billion annual budget.

It isn't only the fault of the patients. The officials and the politicians who run the NHS have lost sight of what they are there for. Look at the current campaigns listed on the DoH website: “know your units”, “top tips for top mums” (including “top tips from Patsy Palmer” of EastEnders), and my favourite “Catch it, Bin it, Kill it”, a campaign to encourage the public to practise “correct respiratory and hand hygiene when coughing and sneezing”. The NHS waggles its finger at us, naughty children. Put your hand in front of your nose when you sneeze! It has turned into mum.

When it doesn't admonish, it consults: yesterday the department sent hospitals tens of thousands of surveys to track patient satisfaction with the patient choice programme. And when it doesn't consult, it issues edicts: June 12, 2008 - “The NHS Resilience and Business Continuity Management Guidance 2008: interim strategic national guidance for NHS organisations.” Poor guys. No wonder the best managers in the NHS are the ones who know which Whitehall edicts to file immediately in the bin.

Time after time patients tell the politicians that what they want from the NHS is what the NHS promised at the start: access to high-quality medical care (in clean premises) as and when they need it.

Now the greatest risk to the health of the NHS is approaching: the march of the alternative health industry. This week came the publication of the “Report to Ministers from the Department of Health Steering Group on the Statutory Regulation of Practitioners of Acupuncture, Herbal Medicine, Traditional Chinese Medicine and Other Traditional Medicine Systems Practised in the UK”. Otherwise known as twaddle. What it said is that government should regulate alternative therapies from acupuncture to Ayurveda.

It's the latest step by the alternative health industry, spearheaded by the Prince of Wales, towards official recognition by the NHS. Their problem: doctors see no scientific merit whatsoever in most of the “treatments”. Research by Edzard Ernst, a professor of complementary medicine, has found the majority of alternative therapies to be clinically ineffective, and many dangerous.

Regulate the practitioners - for safety, note, not for efficacy, as that is impossible to prove - and you give them official recognition. From recognition it is but a short hop to demand and then prescription: packet of Prozac, bit of yoga and a bag of dodgy herbs for you, sir. Britons already spend billions on alternative medicine; how much more could they spend when it is public money floating down the colonic canal? Free massages and maharishi ayurveda for all!

And imagine the bonanza in work for the Whitehall bureaucracy, as the British Association of Accredited Ayurvedic Practitioners grapple for dominance over the Maharishi Ayurveda Physicians' Association (none of these is made up). Question 10 of the consultation document preceding Monday's report read: “Would it be possible for the herbal medicine traditions of Kampo and Tibetan herbal medicine to be individually represented on Council?”

The Government responded on Monday - with a three-month consultation. So join in. Write to the Health Minister Ben Bradshaw at Richmond House, 79 Whitehall, SW1A 2NS. Write, on behalf of the NHS: “What I want for my 60th birthday is... the chance to provide medical, dental, and nursing care to all. And absolutely nothing else.”


Australia: Not enough medical staff to use badly-needed donated organs!

Dying Queenslanders desperate for transplants are missing out because the state's leading hospital is giving donated organs to interstate patients. At least twice this year interstate surgical teams have flown to Brisbane to retrieve organs turned away by Prince Charles Hospital. The fiasco has been blamed on staff shortages and surgeons with "large egos and voluminous hip pockets".

Queensland Health has confirmed organs donated by Queenslanders were being sent interstate because of the "unavailability of transplant service surgical staff with the appropriate specialised skills at the time of the offer". It refused to reveal whether anyone on the heart or lung waiting list had died after organs had been sent interstate. Under the national donor scheme, organs which become available in a state are meant to be offered to residents in that state first. In Queensland, two people are waiting for hearts, eight for lungs and two for heart/lung/liver transplants.

The stunning revelations have been exposed by Professor Russell Strong, the first surgeon to perform a liver transplant in Australia and medical director of Queensland Health's Queenslanders Donate. In a strongly worded letter to Queensland Health acting director-general Andrew Wilson, he argued Queenslanders had a better chance of a transplant if they lived interstate. "I wish to draw your attention to a situation that must be regarded as unacceptable and with the potential for severe repercussions," Professor Strong said in the April letter, obtained by The Courier-Mail.

He argued the hospital should be stripped of its transplant services. "It is highlighted by two events in the past three weeks (where) two young healthy males were involved in motor vehicle accidents, received traumatic brain injuries and became multi-organ donors," he wrote. "In the first case, the heart and lungs were offered to The Prince Charles Hospital (TPCH), were accepted for heart/lung bloc and two names given for a cross match. Within half an hour, TPCH rang back declining the organs due to a lack of surgeons to remove the organs and perform the transplant surgery. "The organs were offered interstate and an interstate team came to Queensland to retrieve the organs. "


Australian ambulance inquiry to hear of 'bullying and intimidation'

Bureaucracy stifles paramedics who try to blow the whistle

An inquiry into the NSW Ambulance Service is expected to hear evidence of deep-rooted problems of intimidation and bullying. But the parliamentary inquiry, due to start in less than three weeks, could suffer the same fate as previous investigations, with paramedics too afraid to speak publicly, fearing retribution from their superiors. Nurses recently gave evidence behind closed doors, during the Royal North Shore Hospital and NSW Public Hospitals inquiries, scared they would later suffer harassment from management. Almost all the submissions lodged by ambulance officers are either anonymous or cannot be published.

Upper House MP Robyn Parker, who is overseeing the inquiry, said there were already common problems evident from ambos who have submitted evidence. "Anecdotally we can see there is a high suicide rate among ambulance officers," she told The Daily Telegraph. "It also appears management are using rosters and the transfer system to bully officers. I will be probing the department on both those (issues) on the first day." Low morale is plaguing the service, which has been the subject of internal and governmental investigations.

Ms Parker said: "The officers need a place where they can air their grievances and I will be demanding answers from the (health) department. "But this will also be putting the Government on notice and hopefully they will act."

The Daily Telegraph recently reported the overstretched service was relying on firefighters to respond to medical emergencies. Trucks are equipped with trauma kits and defibrilators attending to patients when ambulance crews do not cover the area. One ambulance officer said some Sydney suburbs were completely without emergency medical coverage. "Many areas in Sydney are inadequately covered by ANSW due to a deficit of stations," the submission said. "In the areas known to me there are three suburbs Carlingford, Berowra and Galston, that are at best 15 minutes from an ambulance. For a first-world country in the 21st century, that's embarrassing."

Another anonymous worker said inexperienced junior staff were attending jobs unsupervised. "I cannot remember the last shift I worked where we stayed wholly in our station area," the submission said. "We constantly move resources and become stretched to the limit and some areas end up with no coverage. The fact the NSW Fire Brigade is covering ambulance jobs is testimony to this."


Thursday, June 19, 2008

Disgraceful act by British hospital

Mother was accused of kidnapping baby as part of hospital exercise

An unsuspecting mother was accused by hospital staff taking part in a security exercise of stealing a baby from a ward as she left the building with her new daughter. Clare Bowker, 37, was confronted by staff as she got into her car outside Good Hope Hospital in Sutton Coldfield, West Midlands. She was asked to accompany them to the maternity unit with Hannah, her seven-week-old baby, and her other daughter Holly, then four, where she was told a baby had been snatched. Mrs Bowker was questioned by police and her bag searched to verify her identity.

She was recognised by her midwife who confirmed that Mrs Bowker had given birth to Hannah by caesarean section at the hospital seven weeks earlier. During the same exercise, it was arranged for another baby to be taken off the ward, with the father's consent, to make staff believe a baby had genuinely been lost.

A distressed Mrs Bowker was allowed to leave the hospital after 40 minutes, still believing the situation was real. It was only when she called the midwife a few hours later that she was informed she had been involved in a "staged" staff training event. She suffered post traumatic stress after the experience in December 2005 and underwent a year of counselling over what the hospital has called a case of "mistaken identity". The Good Hope Hospital Trust has agreed to pay her undisclosed compensation, believed to be a five-figure sum, to cover her suffering and loss of earnings.

Mrs Bowker, of Four Oaks, West Midlands, said: "It is an awful thing to be accused of and I want to make sure nobody else has to go through what I went through. "I think I am a strong person, but you can be quite vulnerable so soon after giving birth. If somebody in management had approached me on the day and asked me to take part in some kind of exercise, I probably would have done so. "Instead they targeted me and the 40 minutes felt like hours. They clearly made no risk assessment, they didn't use actors and they also put the staff members through a very stressful ordeal."

She gave up her job as a conference manager at Birmingham's Aston University and now works four hours a week as a support tutor at Sutton Coldfield College. Mrs Bowker added: "For a long time I was blaming myself for my reaction. I would burst into tears for no reason. I thought I was being silly for getting so upset. "Then I was told I had post-traumatic stress disorder."

A spokesman for Good Hope Hospital said they had apologised to Mrs Bowker for her experience. He said: "The safety of babies in our maternity unit is very important so we regularly carry out routine exercises to ensure our ward and security staff know what to do to prevent babies being unlawfully taken from the unit. "Unfortunately on one occasion in 2005, there was a case of mistaken identity in which a member of the public, Mrs Bowker, was caught up in an exercise. "A full investigation of the incident was carried out and we have apologised for this mistake and compensated Mrs Bowker for her inconvenience and embarrassment."

The Heart of England NHS Foundation Trust, which now manages the hospital, said it did not carry out such exercises and uses alternative methods to test security procedures.


More public hospital negligence in Australia

After all the publicity about meningococcal meningitis and its drastic outcomes, it's incomprehensible that it is not looked for as a first step. One suspects another underqualified immigrant doctor. Public hospitals employ almost any doctor at all and don't look too closely at their qualifications

A FAMILY is seeking a $7 million payout after their 10-month-old son was left blind, deaf, brain-damaged and disabled by an undiagnosed bout of meningitis. Jeremy Netherway, now 8, was diagnosed with a viral infection when his worried parents rushed him to Perth's St John of God Hospital in Subiaco on May 29, 2000. But the boy's parents, Nicola and Peter Netherway, claim the hospital and a doctor, Anita Cvitanovich, failed to recognise that Jeremy had pneumococcal meningitis.

They are suing the doctor and the hospital for $7 million, saying Dr Cvitanovich failed to carry out tests to confirm meningitis and delayed giving Jeremy antibiotics to treat the illness. They also claim the hospital failed to keep the doctor fully informed of Jeremy's condition.

The damages amount has already been agreed to by all parties but the doctor and hospital have denied liability and blame each other for Jeremy's condition. The liability issue is on trial in the District Court, with judge Shauna Deane presiding over the matter, which is listed for three weeks.

Giving evidence yesterday, Mr Netherway choked back tears as he described the day his son was rushed to hospital. "He was listless, he had his eyes shut, his head was tilted back. He was very, very pale," Mr Netherway said. His wife, Nicola, earlier told the court that Jeremy had been admitted to hospital for the night after Dr Cvitanovich diagnosed him as having a viral infection, saying he needed to be rehydrated. She said the doctor had told her meningitis was a possibility but that it was unlikely. But Ms Netherway said that after sleeping for two hours, her son's condition became progressively worse. He was suffering from a fever and vomiting constantly until he was dry-retching, she said.

By the time Dr Cvitanovich returned at 8am on May 30 to check on Jeremy's condition, the baby was grunting and breathing coarsely, Ms Netherway said. It was then that the doctor placed him on intravenous antibiotics and took blood before he was rushed toPrincess Margaret Hospital for Children.

Ms Netherway told the court she saw Dr Cvitanovich a few days later in the intensive care unit, where she was informed that Jeremy may suffer paralysis from his illness. He now requires full-time care.

The court has already heard that Dr Cvitanovich did not see Jeremy after 10.30pm on May 29 but had told nurses to contact her if Jeremy was vomiting, had not urinated or his temperature had risen above 38.5C. She did not return to the hospital until 8am the next day when Jeremy's condition had worsened considerably, Ms Netherway said.


Wednesday, June 18, 2008

Many NHS trusts fail to meet hygiene standards

More than a quarter of health trusts in England are failing to meet basic hygiene standards, official figures show today. The Healthcare Commission reports that no improvement has been made on a year ago. In total, 103 out of 391 trusts admitted they did not achieve the minimum requirements, brought in by the Government to help combat the hospital superbugs, MRSA and Clostridium difficile.
Patients groups and politicians said that it was "shocking" that one in four still did not meet the standards, despite ministers' pledges to tackle cleanliness.

More than 8,000 deaths were related to MRSA and C. diff. The report shows that 26 per cent of trusts failed to keep facilities clean, did not have adequate infection control or follow guidelines on decontaminating reusable equipment. Only 40 per cent of trusts claim to have met all the Governments standards, which include patient care and confidentiality as well as hygiene, a slight fall on last year.

The commission warns that even fewer trusts may be deemed to have met all the criteria by the time it finishes spot checks this year. The failings come despite a [stupid] 50 million pound "deep clean" of every hospital in England, designed to curb superbugs.

Despite the critical reaction, Ben Bradshaw, the health minister, said that he welcomed the fact that the number of trusts failing to comply with more than seven standards had fallen from 15. "This improvement is a great tribute to the hard work of NHS staff," he said. "We are also pleased that infection control is showing significant improvement."


Australia: Outcry over intensive care shortage for babies in Victoria

The state's most fragile newborns are being sent interstate because Victoria's neonatal intensive care units are stretched to breaking point. Over the past week, Victoria's 72 neonatal intensive care cots have been full, forcing dangerously premature babies or mothers with high-risk pregnancies to be flown interstate for life-preserving care. Four acute babies or mothers with high-risk pregnancies have been flown to Canberra or Adelaide in the past fortnight.

At the same time, the Brumby Government celebrated the opening of the new $250 million Royal Women's Hospital, which has been widely criticised for being too small to cope with a rising birthrate.

The Department of Human Services yesterday revealed that 12 newborns from regional areas, who would normally be treated at Melbourne hospitals, had been flown interstate for care in the past year. This was up from just three in 2005-06 and nine in 2006-07.

The new Royal Women's is equipped with 18 neonatal intensive care cots but can accommodate an extra two when stretched -- the same as the hospital it replaced.

Newborn Emergency Transport Service state medical director Dr Michael Stewart said the system was under pressure from a surge in demand. He said no babies had been harmed by the recent journeys. "It is obviously not ideal to have to do this, but we are looking at what is the safest and most effective for the whole system at the time as well as being very cognisant of the individual baby and their families," he said. "I don't think in the ideal world it is good to move an adult, a child or a baby from one hospital to another or out of the state if they need intensive care, but the reality is that is occasionally what we need to do. "These peaks can last for a few days to a week or so, sometimes they last several months, but the tip of the peak we hope just lasts for several days because that does get very difficult to manage."

The new $1 billion Royal Children's Hospital will have an increase in its number of neonatal intensive care cots when it is completed in 2011. Monash Medical Centre and Mercy Hospital for Women are the only other Victorian hospitals with units to sustain the dangerously premature newborns who need help to breathe.

Dr Stewart said the state usually coped with less than 60 babies needing intensive care at any one time and "cot-block" had improved since 2000 when there were just 48 Victorian neonatal intensive care unit cots. But Royal Australian and New Zealand College of Obstetricians and Gynaecologists president Christine Tippett said there were simply not enough neonatal intensive care cots to meet demand. "The four units are constantly running at or near capacity and the pressure on staff and equipment is at an unsustainable level," she said.

Department of Human Services spokesman Steve Pivetta said babies in border areas were often closer to interstate hospitals and denied a lack of resources was to blame.


Tuesday, June 17, 2008

Socialists retreat: Patients on NHS to be freed to use top-up drugs

Patients who pay for "top-up" drugs will no longer be denied free NHS treatment, the Government will announce next week. In a major reversal of policy, the Department of Health will review the present rules, which ministers regard as unfair and a penalty for people fighting life-threatening illnesses such as cancer.

It will announce an end to the "co-payments" system, in which those who buy drugs that the NHS has deemed too expensive are made to pay for the rest of their care. The move comes after it was disclosed that a patient who paid for a drug to treat bowel cancer died after being denied free NHS treatment. Linda O'Boyle, 64, from Essex, was told that her decision meant she was considered a private patient.

Ministers have been defending the policy for months, claiming that to scrap it would lead to a "two-tier" NHS in which the wealthy have access to better health care. But in recent weeks they are understood to have been persuaded that the NHS already contains "top ups", particularly in dentistry and in some hospitals, where patients can pay for private rooms. They also believe that the change will apply to a very small number of patients each year.

The Government is also desperate to back a popular policy in the face of recent setbacks. The announcement on the changes is expected to be made on Wednesday.


More of that brilliant government "planning"

Brand new Emergency Dept. building but not enough staff to man it. An almost British level of bureaucratic incompetence

The $22 million Redcliffe Hospital emergency department revamp is struggling to cope with demand, the Redcliffe Herald has been told by patients. Just weeks after the launch of the state-of-the-art extension, the ED came under fire from a Clontarf mother, who did not want to be named, who told the Herald her feverish 14-month-old son had to wait three hours for treatment. "He was taken there by ambulance with a 39 degree temperature and was mottled looking,'' she said.

"I was told to ask for his temperature to be taken every 30 minutes. After the first time it took three hours of me hounding them before they tested him again. I was told three doctors were off sick and there were too many patients.'' She eventually took the boy home and later consulted her GP. "It's a real slap in the face when they build all these nice and flash buildings but it's the same old problems. The needs basis is there and the shiny new Emergency Department isn't fooling me."

The Herald was also told of an 18-year-old man who, last month, waited about seven hours for surgery after being badly bashed at Scarborough. While the Herald has published a litany of complaints over the past three years about the ED, it has also received many letters of support from patients.

The new, larger ED has 41 treatment areas and a new five-station triage zone. It's capacity is expected to grow from 47,000 annual patient treatments to 50,000. At its opening Health Minister Stephen Robertson acknowledged the Peninsula had an "increased demand" for hospital services but said the new ED would help responses to the demand. State Member Lillian van Litsenburg, who is travelling overseas, previously said the new ED would "improve patient flow and in turn enhance the day to day running of the hospital"...

One mother, a former nurse, who had seen the Redcliffe ED full said the service was still being clogged up with unnecessary patients. ``There are lots of people who don't need to be there, but they won't pay $60-$70 to see a GP and they go to the hospital for a snotty nose,'' she said. She knew of people from northern Brisbane suburbs who saw Redcliffe hospital as the closest option for treatment. ``They look at Redcliffe compared to the Royal Brisbane as easier to get to,'' she said. ``But they need to consider Prince Charles Hospital as an option, which has an under-utilised ED.''

Queensland Health held a community forum last night to discuss the construction of a GP super clinic at the Redcliffe Hospital. It will be a 24-hour, bulk-billing service aimed at taking the pressure off the ED, by servicing less urgent medical issues.


Monday, June 16, 2008

NHS drugs cheaper but much less effective

The National Health Service is providing dying cancer patients with drugs that are five times less effective than those available privately and is refusing to treat them if they try to buy medicines themselves. One drug for kidney cancer, routinely available through public health systems in most European countries but not to British patients, can reduce the size of tumours in 31% of patients, compared with just 6% of those prescribed the standard NHS drug.

The growing row over “co-payments” has prompted the government to reconsider the ban. Alan Johnson, the health secretary, has promised a “fundamental rethink” of the policy. The shift comes as increasing numbers of cancer doctors defy the official Whitehall ban and allow patients to pay for drugs while still receiving NHS care. Doctors at the Royal Marsden hospital in London and consultants at the NHS trust in Swansea are offering patients NHS care while they pay to receive drugs that will prolong their lives. Last week The Sunday Times revealed that about 16 consultants in Birmingham are ignoring the government guidance.

Research presented at the American Society of Clinical Oncology found that kidney patients taking the new drug Sutent lived six months longer than those prescribed alpha interferon, the NHS treatment.

The failure of the NHS to make more effective drugs available to cancer patients has been condemned as “unethical” by leading doctors. John Wagstaff, professor of oncology at Swansea University, said: “This has created a very difficult situation for us. Having seen the latest data, I believe it is now pretty unethical to give many patients alpha interferon [rather than Sutent]. We are often forced to prescribe interferon because we do not have access to Sutent [on the NHS], but I am always upfront with the patients. I tell them what I think the most effective treatment is.”

Eight times as many patients in Germany and France receive Sutent as in Britain, according to figures held by Pfizer, the manufacturer. Sutent, which costs about 2,200 pounds a month compared with about 800 for the NHS drug, is one of a number of life-prolonging new drugs at the centre of the co-payments row.

In advanced kidney cancer, when the patient cannot be treated with any other drug, Nexavar, another medicine, can double the period when the disease is held under control. A trial of Nexavar, comparing the effect of the drug with a placebo, showed it to be so effective that the trial had to be halted early as it was considered unethical not to give it to all the patients in the test. Tumours were prevented from growing for an average of 5.5 months in patients taking Nexavar, against 2.8 months in those taking the placebo. Despite the findings, Nexavar is not routinely funded by the NHS.

Similarly, bowel cancer patients are up to four times as likely to see their tumour shrink if they pay for Erbitux than if they take irinotecan, the NHS-approved drug, alone. A study published in the New England Journal of Medicine in 2004 showed that 23% of patients experienced a reduction in the size of their tumour when they took Erbitux and irinotecan. Other studies showed that just 5% of patients have the same benefit from taking irinotecan alone. Those taking irinotecan alone had their bowel cancer under control for 4.2 months, but this rose to 8.6 months when Erbitux was added. Erbitux, costing about 3,000 pounds a month, is funded for bowel cancer in most European countries. Patients in France are 13 times, in Spain 10 times and in Germany nine times more likely to get the drug than Britons.

The drug Avastin offers similar benefits. Research presented earlier this year showed that patients who receive Avastin and routine chemotherapy before surgery are twice as likely to be alive two years later as those who receive only the chemotherapy available on the NHS.


South Australian hospital crisis

Penny-pinching socialist government needs to fire some of their precious bureaucracy and put the money into medical pay

DOCTORS in retirement and on holidays could be called back to work under contingency measures to combat SA's growing public hospital crisis. Health Minister John Hill said yesterday the Government was developing a plan to try and keep the hospitals functioning if as many as 115 emergency doctors and anaesthetists follow through on resignations by the end of next week. Mr Hill said other possible measures included recruiting doctors from interstate, nurses taking on additional duties and GPs being drafted into public hospital emergency wards.

Doctors are seeking a pay rise of up to $111,000 a year while the State Government said it was offering to incease the current annual package for emergency department consultants from about $313,000 to about $356,000. The State Government's packages include on-call allowances, leave loading and salary sacrifice benefits. Mr Hill revealed the measures under consideration yesterday as:

DOCTORS warned more will quit as part of a rolling campaign.

EMERGENCY doctors gave emotional accounts of overcrowded and under-staffed hospitals.

DOCTORS revealed they were starting rescue funds to help those planning to quit pay mortgages and bills.

QUEENSLAND said it would welcome disaffected SA clinicians, who are also being targeted by agencies recruiting for other states.

Mr Hill said the Government was considering a range of options to plug holes left by the resignations in the public health system. He said patients would face "very long waits". Some emergency wards could close, with less serious cases diverted to GP services. "We have to take them seriously and we are working through contingency plans now," Mr Hill said. "We are looking at how you'd bulk up the services; in the city we'd need to keep the spine hospitals - the Royal Adelaide Hospital, Lyell McEwin and Flinders - functioning.

"I am very worried about the circumstances if they do resign. "It might be that GPs come in to the emergency department; some nurses could come in and do the minor things; people who have retired, they might want to come back to work; doctors on leave might come back early . . . or those working part-time might do more work. "Those are the kinds of options we have to look at."

The doctor resignations have been prompted by an impasse in a bitter eight-month long pay and conditions dispute and are effective two weeks from lodgement. Doctors say they want pay parity with their interstate counterparts to attract more doctors as well as equality in a system where groups of doctors in the past have negotiated separate loadings.

SA Salaried Medical Officers Association senior industrial officer Andrew Murray baulked at the Government's contingency suggestions - and accused the Government of not having a plan. "If people who deal with the most seriously sick people that go to EDs suddenly aren't there, what's the contingency for that?" he said. "Does he really expect an old, retired doctor who hasn't practised medicine in five to 10 years to deal with a major road trauma? "As a first fallback, probably the most closely related specialists in dealing with people in trauma are intensive care doctors and anaesthetists . . . hang on, didn't someone tell me the anaesthetists are quitting tomorrow? They don't have a plan."

Mr Murray said the emergency doctors who had quit represented about 75 per cent of those available in the state, not 50 per cent as reported this week. RAH emergency consultant Dr Tony Eliseo said it would be "impossible" for the Government to replace their level of expertise at short notice. Yesterday, more doctors said they would quit over the industrial dispute - including the Women's and Children's Hospital's head of general medicine, Dr Christopher Pearson.

Dr Pearson, who started at the WCH in 1971, said his resignation was "for the future of health in SA". "Without a sufficient package, it will not be possible to attract the bright young minds who will become the senior consultants of the future," he said.

Dr Jane Edwards and Dr Terry Donald, forensic pediatricans in child protection at the WCH, also said they would hand in their resignations tomorrow. Dr Edwards said the pay inequality across specialties in SA was leaving doctors disenchanted. "By giving deals to small groups of doctors, the Government has introduced a cancer to the whole of the health system," she said. "It's festering and pitting doctors against each other; people become jealous and feel they are not worthy." Dr. Edwards also said the hospital was struggling to fill two positions in child protection because they could not compete with other states.

Another 70 anaesthetists also planned to resign tomorrow, but Mr. Hill said a child-protection expert earning a salary package between $198,000-$215,000 would go up to $324,000 under the Government's offer. He also said there were no vacancies in general medicine. Mr Hill said doctors needed to be consistent in their claims, as "the problem we are having is different pockets of people with different goals". "They say they need extra money to recruit and retain doctors; the offer we made would help us with that," he said. "Then they say they want extra money to put them (in line) with `intensivists'. "We had to put extra money into intensivists, that's what the market dictated. It's a different market in other areas."