Sunday, May 31, 2009

NHS Doctors have cashed in on new bonus scheme but it 'has not helped patient care'

A lucrative bonus scheme for GPs has done nothing to improve patient care, a study claims. Performance-related pay could even be detrimental to the NHS, with GPs chasing targets 'at the cost of the quality of care given to patients'. The bonus scheme was included as part of GPs' 2004 contract, which has seen pay rocket by 55 per cent to almost £108,000.

Ministers introduced the scheme, which accounts for a third of doctors' salaries, with the aim of driving up the quality of care. But a study in the British Medical Journal indicates that in some cases it has made no difference whatsoever - despite costing taxpayers millions.

Researchers at Birmingham University compared the level of diabetes care at 147 surgeries covering one million patients across the country. They found that while there were significant improvements every year in the three years up to the start of the bonus scheme, these improvements then stagnated after it began. It is suggested this could be because GPs stop trying for further improvements once they have achieved the maximum amount of money allocated to diabetes patients.

Under the scheme, known as the Quality and Outcomes Framework, points are awarded for the management of diabetes, including targets for controlling blood pressure, cholesterol and blood glucose levels. There are 1,000 points available annually for each practice, covering a wide range of different illness achievement targets. Each point is worth up to £124 and is then shared between GPs in that practice.

But experts say it is too easy for GPs to gain the maximum number of points and suggest targets need to be more challenging if patients are to see better care. Last year 96.8 per cent of doctors gained the maximum number of points and more than 600 practices achieved 100 per cent.

Dr Melanie Calvert, lecturer at Birmingham University's college of medicine and dentistry, said: 'Our work and that of others highlights the potential unintended consequences of the scheme and raises concerns that it may not have been as efficient in reducing inequalities in health in diabetes as was hoped. 'Although the management of patients with diabetes has improved since the 1990s, the impact of the pay-for-performance initiative on care is not straightforward.' She went on: 'If anything, improvements in care appear to have plateaued since the introduction. 'This may reflect increasing difficulties in target attainments in poorly- controlled patients, but could also suggest that targets for practices need to be more challenging if patients are to benefit.'

Last year a study by the Civitas think-tank found some GPs were putting more effort into treating conditions, including asthma and high blood pressure, that attract points while neglecting dementia and osteoporosis, which do not. Dr Calvert said: 'There is a risk that doctors are focusing on patients they can achieve incentives with and are not focusing on things like osteoporosis which isn't captured in the QOF. 'There is a risk GPs are focusing on tick boxes to meet targets but not focusing on other aspects of care.'

A Department of Health spokesman said: 'Independent research has shown that care for people with diabetes improved more rapidly after the introduction of the QOF. 'We want to see continuous improvements in QOF to support GPs in delivering high quality care for patients.'


Tasmania, Australia: Nasty Health Dept. bureaucrat trying to destroy a popular and hard-working family doctor

Bureaucrat George Cerchez tried to get the doctor for wrongly treating 4 patients but when that failed Cerchez suddenly came up with another 19 allegations. No patients have complained and the other doctors in the area disown all knowledge of the complaints. It's just Georgy boy at work. A fine example of government regulation at work

PAUL McGinity is an old-style country doctor, so dedicated to his 3000 patients that he is berated by colleagues for working too hard, never refusing a home visit in the early hours and taking too few holidays. After 32 years of service to the rural community around Scottsdale, a timber town in Tasmania's northeast, Dr McGinity's career has come to a humiliating halt.

He has been linked to the death of seven patients after complaints to the Medical Council of Tasmania, which has suspended the general practitioner's registration pending an investigation. However, far from being treated as a pariah, Dr McGinity has the unwavering support of his patients, including at least one whose treatment forms the basis of a key allegation.

What's more, Dr McGinity is turning the tables on what he claims are "vexatious" accusers. He claims his chief accuser -- Department of Health and Human Services primary health adviser George Cerchez -- has a potential conflict of interest. Dr McGinity and his supporters claim his only crime is to be a thorn in the side of plans for a new $1.2 million clinic for Scottsdale.

A recording of a telephone conversation obtained by The Weekend Australian reveals DHHS secretary David Roberts saying Dr Cerchez was "not acting for the department" -- casting doubt on comments made in parliament by Health Minister Lara Giddings. While most politicians would run a mile from a doctor facing such serious allegations, the state Opposition said there was such a "stench" about the case that it should be subject to an independent review.

There are complaints against Dr McGinity relating to 23 patients, but unusually none is made by them or their families. Dr McGinity has been led to believe that all but four complaints were submitted by Dr Cerchez. Dr McGinity was notified of the further 19 cases at the same time his suspension over the first four was being successfully challenged on a technicality in the Supreme Court. The suspension was later reinstated.

Dr Cerchez, with whom Dr McGinity has a history of dispute, is also on the board of local doctors' group GP North. GP North has obtained federal funding of $500,000 to build a $1.2million medical complex in Scottsdale. Dr McGinity is not interested in joining the new clinic, preferring his old style of solo operation. The other four complainants are GPs at Scottsdale's other practice, despite their insistence yesterday that they had "nothing to do with" the allegations. It is expected the four will move to the new medical centre, which -- if Dr McGinity loses his registration -- will take his 3000 patients.

The 68-year-old told The Weekend Australian he was confident he had not made "any mistakes". And while accepting the medical council's obligation to investigate the complaints, he believed there should be an inquiry into the manner in which the allegations were made. He was "very concerned that there is an ulterior motive behind this" and that Dr Cerchez had a potential conflict of interest: "There are three factors: he is on the board of GP North; GP North wants to build a clinic; I've got lots of patients -- 3000; they haven't asked me to join the clinic but they need those patients." He said he also had a long history of "disagreements" with Dr Cerchez, including a dispute over the management of a case at the Scottsdale hospital in February last year. Dr Cerchez had transferred a patient against his direction, undermining his position, he said.

In the recording of his conversation with Dr McGinity, Mr Roberts says Dr Cerchez was "absolutely ... not" acting for the department in making the allegations. This appears to be a direct contradiction of advice given by Ms Giddings to parliament that Dr Cerchez "made the complaints as the longstanding medical adviser". Yesterday, Ms Giddings deferred to Mr Roberts, who said he had never meant to suggest Dr Cerchez was not acting for the department's primary health section. Instead, he had simply meant to convey that the "central department", which had to be divorced from such operational matters, was not involved. "The department is not trying to distance itself from Dr Cerchez ... I have been strongly supportive of the actions George has taken," he said.

Questions to Dr Cerchez were answered by DHHS deputy secretary Alice Burchill, who suggested concerns about a potential conflict of interest were "without foundation". "Dr Cerchez ... does not practise in the northeast and cannot personally benefit from the development," she said. "There is no underlying professional dispute between Dr McGinity and Dr Cerchez."

The Weekend Australian has a document naming the four GPs from Scottsdale's Victoria Street surgery who raised allegations against Dr McGinity: Linda Clow, Jim Wilson, Natalie Burch and Gretchen Stone. However, when asked to comment yesterday, Dr Clow said on behalf of the practice, they had "nothing to do with" the issue. "I don't know where you got that idea from, but we've got no comment," she said. "On behalf of the whole practice, we have not and will not make any comment. We've got nothing to do with this and we want to stay out of it." She would not say whether she and the other doctors at the surgery intended to shift to the new medical centre.

GP North chief executive Phil Edmondson would not say whether the four Victoria Street doctors had indicated a willingness to join the new medical complex. Nor would he say how many patients the new centre required to be viable. When asked whether he was confident the allegations against Dr McGinity were not related to plans for the new centre, he said: "I have no knowledge of the nature of the complaints against Dr McGinity. From the perspective of GP North, there is absolutely and categorically no link whatsoever between the matters."

The medical council, negotiating with Dr McGinity on conditions under which he might be allowed to return to practise while the allegations are investigated, could not be contacted yesterday. However, it has previously insisted its handling of the case has been appropriate.

Opposition health spokesman Brett Whiteley said Ms Giddings should address the "possible conflicts of interest" and order an independent review. "They came up with 19 new allegations -- they didn't say they came from one bloke, and they said 'they include seven people who died'," he said. "How alarmist is that? Who are these dead people? When did the first person die? Were there inquests? And if there were, why didn't the coroner report them? This whole decision needs a new set of eyes cast over it."


Saturday, May 30, 2009

New cost-cutting NHS guidelines on back pain 'will lead to more surgery'

Thousands of patients could undergo unnecessary spinal operations because of new NHS guidelines on treatments for lower back pain, warn experts. Dozens of hospital consultants say the ‘cost- cutting’ restrictions mean more patients will end up having major surgery. They claim less risky procedures using spinal injections have been wrongly dismissed as ineffective, even though they help hundreds of thousands of patients with chronic back pain each year.

Guidelines issued earlier this week by the National Institute for Health and Clinical Excellence (NICE) set out permitted treatments for patients whose back pain has lasted for at least six weeks but less than a year. They endorsed widespread use of ‘alternative’ therapy, letting patients opt for a three-month course of acupuncture, manual therapy such as physiotherapy, or exercise.

Described as a ‘sea-change’ for back pain sufferers, the guidelines also told doctors not to recommend therapies with ‘little evidence’ to support them, controversially including injections of small amounts of steroids into the back, MRI scans, X-rays and ultrasound. Now, many patients who fail to respond to initial treatment could miss out this intermediate stage and proceed straight to risky spinal fusion operations.

NICE estimates the NHS will make annual savings of £33million on back injections and £11million on MRI scans. However, it will spend £24million extra on acupuncture and £16million extra on manual therapy, making the cost-cutting aspect negligible.

Around 50 specialists belonging to the Interventional Pain Medicine Group of the British Pain Society are writing to NICE, claiming it has dismissed good evidence about spinal injections, which do not cure pack pain but give a period of relief from chronic pain. Dr Ron Cooper, past chairman of the group and a consultant pain specialist in Northern Ireland, said: ‘I have never known so many pain medicine specialists to be so furious. More patients will end up having more expensive surgery, which is unnecessary, risky and has worse results.

‘NICE made it difficult for us to submit evidence to a committee on which there was not one experienced pain physician. [Very suggestive of a non-medical agenda] ‘The guidelines will make us the laughing stock of Europe, Australia and the U.S. where pain specialists will continue to have full access to a wide range of treatments.’ Dr Raj Munglani, a consultant in pain medicine at West Suffolk Hospital, Bury St Edmunds, said: ‘There could be as many as 400,000 patients (a year) who will be eligible for spinal fusion – when it should be a last resort. ‘There is a lot of concern that this is actually a way of banishing waiting lists for some procedures, because they will no longer be available.’ Dr Serge Nikolic, a chronic pain specialist at Bart’s hospital in London, said any savings made from the guidelines would be a false economy if they led to more spinal surgery.

A NICE spokesman said: ‘The guideline sets out... those approaches which either don’t work as well as alternatives, or for which there is little evidence of benefit. ‘The guideline recommends that new research is needed to decide if injections into the back are, or are not, effective.’


Australia: There is some accountability in government health systems after all

Nurse fired over baby left at Airport, though it seems that the aircraft pilot was also partly to blame. Any repercussions for him? None that we know of

A NURSE has been sacked and another has resigned over leaving a five-day-old baby with a stranger at regional airport in South Australia. In January, The Advertiser revealed the two nurses were suspended after they left the premature baby with a young woman at the Port Augusta Airport instead of delivering him to the hospital. The baby's father, Shahzad Hassan, said at the time that it had happened on Christmas Eve because the nurse was "in a hurry" to get back to Adelaide.

The baby, Rayaan, was left for about 10 minutes before hospital staff arrived. He was born six weeks early, which put him at risk of a range of complications and he had been sent home to Port Augusta by plane with the nurse while his parents drove.

The Government Investigation Unit confirmed last night that the nurse had resigned, while her superior – who gave her permission to leave the baby and return to Adelaide – was dismissed.

Child, Youth and Women's Health Service chief executive Gail Mondy said the staff had failed to follow proper procedures for the transfer of a baby, putting it at risk, and that they had apologised to the parents.

"We've taken steps to learn from this serious incident," she said. "We have apologised to the baby's parents and we very much regret that on this occasion the two staff involved failed to follow the hospital's and the Department of Health's patient-transfer procedures, which are designed to protect patients' safety and wellbeing."

When the plane landed in Port Augusta at about 7.40am, there was no one to meet the nurse accompanying the baby and the pilot told the nurse he needed to return to Adelaide immediately. The nurse became upset, at which point a young woman – believed to be a teacher – offered to mind the baby.

Mr Hassan said he welcomed the resolution of the case. "I can't really say anything else," he said. "I can only say that they did what they thought was right." Asked whether he was upset at the five months it took to finalise the case, he said: "I think they had to make sure of what they were doing."


Friday, May 29, 2009

Providing Coverage For All Americans Through Private Health Insurance

The United States is unique in the developed world in that the majority of Americans have private health insurance that they receive through the workplace. This is not the result of a deliberate decision but rather policy that evolved as the unintended consequence of a World War II ruling. Factory owners were competing to lure and keep good workers and wanted to offer health insurance as a benefit, but they needed the government’s assurance that this wouldn’t violate wartime wage and price controls.

The Office of Price Administration allowed the benefit, and this has evolved into a policy that later was codified into the Internal Revenue Code allowing employers to offer health insurance as a tax-free benefit.

This system of tying health insurance to employment has worked tolerably well for half a century during a time when people had stable jobs and health costs were manageable. Now, it is breaking down in an economy where people change jobs much more often and where rising health costs are straining company budgets.

But there are many other reasons to rethink the current system of subsidizing health insurance through the workplace to see if it is adequate for a 21st century economy. Tying health insurance to the workplace leaves out an estimated 45 million people because they don’t receive or can’t afford coverage at work. And, most importantly, it provides very generous subsidies for the most affluent workers and little or nothing for those at the lower end of the income scale.

There is a better way. We could provide direct subsidies to individuals to purchase health insurance of their choice – policies that they can own and keep with them as they move from job to job. This would give them continuity of coverage and more control over selecting health policies that fit their needs, pocketbooks, and values.

How the current subsidy works: When people get health insurance through their jobs, the part of their compensation package that they receive in the form of health benefits is exempt from federal, state, and payroll taxes.

The open-ended tax subsidy for employment-based health insurance is now the largest single tax break in the federal budget. Edward Kleinbard, the top economist for the Joint Tax Committee in Congress, says that tax subsidies for private health insurance now total more than $300 billion a year.1 These subsidies are invisible to most people, and they lead people to believe that health insurance is a gift from their employers. That provides incentives for people to demand more and more generous health insurance policies, generally at the expense of higher cash wages.

Why it isn’t working any more: Four in ten workers change jobs every year, according to the Labor Department.2 Tying health insurance to the workplace means that more and more people lose their health insurance when they lose or change jobs. An estimated 45 percent of the uninsured are without insurance for four to six months,3 largely because they are between jobs or have not yet qualified for insurance at their new place of work. This situation will only get worse in a faltering economy.

Providing people with other options for portable insurance would go a long way toward solving the problem of the uninsured. A survey by the Council for Excellence in Government found that 78% of Americans say they want portable health insurance that they can take with them from job to job.

But the current subsidies for job-based health insurance are unfair in other significant ways, particularly in the way they discriminate against those with lower incomes.... As Senate Finance Committee Chairman Max Baucus (D-MT) wrote in a recent policy paper, the current system gives “larger subsidies to higher-income workers, instead of to the lower-income Americans who need more help buying insurance.”

Further, this invisible tax preference for generous insurance for the most affluent workers drives up the cost of health insurance, often pricing it out of range for people of more modest means who must purchase insurance on their own with after-tax dollars.

Next steps: Much of the action in Congress and the incoming Obama administration will be around expanding access for lower-income uninsured Americans to government health programs such as Medicaid, Medicare, and the State Children’s Health Insurance Program. But that leaves decisions about health care in the hands of politicians and bureaucracies, not individuals and families. As we have seen, that means they will be in public programs that pay for contraception, sterilization, and abortion.

Other proposals involve forcing employers to provide and pay for health insurance for their workers, likely causing marginal companies even greater economic distress and surely forcing many to lay off workers rather than provide health benefits they can’t afford.

Providing greater access to health insurance doesn’t have to involve mandates on employers or putting more people into government programs where politicians and bureaucrats, not patients and families, are making health care decisions. There is a better way.

What we should do instead: Congress and the new administration could dramatically expand access to private health insurance that protects freedom of conscience and that allows people to select policies that are in keeping with their beliefs and values. It involves three key steps:

1. Providing new subsidies to individuals to purchase private health insurance and achieving universal coverage

2. Creating new markets for affordable, portable insurance

3. Protecting those with pre-existing conditions so they can purchase and maintain insurance coverage.

Much more here


Three current articles below

Publicity squeezes some decency out of NSW Health

NSW Health will pay for the accommodation costs of a Melbourne family forced to quarantine themselves in a Sydney high-rise apartment at $300 a night.

The D'Arcy family were on board the Pacific Dawn, which berthed in Sydney on Monday despite suspicions two young boys on board had the swine flu virus. The ship is now en route to Port Douglas, after skipping scheduled stops in the Whitsundays. Passengers will be unable to disembark until test results are known.

Nicholas D'Arcy, 6, was diagnosed with influenza A while on board the vessel, but was allowed to disembark with his family on Monday with other cruise passengers despite the possibility he had swine flu.

At 8.30pm (AEST) that day his parents Fiona and John were eventually told by NSW Health that Nicholas had the A(H1N1) virus - after a day spent taking in Sydney tourist attractions such as the Opera House, Chinatown and Paddy's Markets.

The family of four are now quarantined in their World Square apartment in central Sydney, where they have complained of having to pay the $300 a night bill and $150 for room service. NSW Health had refused to help them, the family told The Daily Telegraph.

However, NSW Chief Health Officer Kerry Chant apologised to the D'Arcys today for their treatment, and offered to pay for the next four nights. “Last night we had contacted the family to indicate that we would pay for the next four nights accommodation,” Dr Chant said. “(We said) we would obviously pay for room service or groceries, and that we'd also look into some special requests in relation to toys for the young child.”

NSW now has a total of 18 confirmed swine flu cases, with a further 265 people awaiting test results. NSW health authorities are under fire for letting passengers disembark from the Pacific Dawn. Eighteen swine flu cases have now been recorded from that cruise ship, including six Queensland residents who have returned home.


Broke NSW government hospitals

SOME of Sydney's largest public hospitals frequently run out of medical supplies because they have debts of millions of dollars and the consultants PricewaterhouseCoopershave been called in to help stop the problem deteriorating. The authority running western Sydney's public hospitals owes suppliers nearly twice as much as previously acknowledged, according to internal figures that reveal for the dire state of its true financial position.

Doctors say unpaid bills mean hospitals frequently run out of supplies such as pathology chemicals and glucose tests for pregnant women, putting further stress on overworked staff. As of Tuesday, the troubled Sydney West Area Health Service - which runs Westmead, Nepean and other hospitals across western Sydney and the Blue Mountains - owed $43.7 million in invoices unpaid for at least 30 days. This included $14.6 million invoiced 90 days or more earlier, according to the figures obtained by the Herald.

The amount is far in excess of the $27 million a spokeswoman said remained unpaid at the end of April. About 400 suppliers are understood to have negotiated arrangements with the service, allowing them to be paid later than normal 30-day trading terms.

PricewaterhouseCoopers had been appointed to "provide financial management support", an area spokeswoman acknowledged yesterday, in a sign that administrators' are struggling to control their budgets.

The medical equipment supplier Synthes, which provides plates and pins for orthopedic surgery, the heart device supplier Medtronic and medical imaging company Olympus, are understood to be owed hundreds of thousands of dollars, and in one case more than $1 million. None of the companies would comment yesterday. A Medical Technology Association of Australia spokeswoman confirmed Sydney West was still paying 54 per cent of its invoices after the 30-day due date - compared to a 43 per cent state average - though this had improved since January, when the Government ordered all area health services to reduce their debts.

The appointment of external financial management is in addition to an external inquiry into the management of Westmead Hospital and the area health service, ordered by the Government after doctors complained their clinical expertise was being overridden by bureaucrats. According to a submission to that inquiry by Westmead's medical staff council, obtained by the Herald, staff morale was "at its worst point in the 30-year history of Westmead" as doctors and nurses distrusted management and were excluded from high-level decisions.

Andrew Pesce, chairman of Westmead's medical staff council, said the hospital frequently ran out of important supplies, such as reagent chemicals for diagnostic tests and bottles of glucose to test for diabetes in pregnant women, after unpaid suppliers refused new orders. "There's no more fat left in the system. We can't make any more progress by trimming here and there and drawing out creditor payments," Dr Pesce said.

Nepean Hospital was forced to suspend elective surgery yesterday morning when it ran out of supplies of essential anaesthetic equipment. But the area spokeswoman said this was caused by, "inadequate stock management" that did "not relate to the withholding of stock by suppliers." An inadequate supply of props to hold open patients' airways during surgery led doctors to halt surgery, resulting in several operations being delayed and one cancelled.

Dr Patrick Cregan, Nepean's clinical director of surgery, said the hospital was operating, "on paper-thin margins". Supplies of equipment necessary for patient safety were constantly on the verge of running out and doctors were unable to get authorisation to order new stock, he said.


Go to hospital. Catch swine flu

Queensland Health in its usual fine form

POTENTIAL swine flu victims are mingling with other out-patients at the first specialist clinic set up by Queensland Health to deal with the H1N1 flu crisis. The clinic, which opened yesterday at the Gold Coast's Robina Hospital, is in an area separated from the main accident and emergency ward only by a room divider.

While medical staff and paramedics wear full bio-suits and protective masks when dealing with potential swine flu victims, general outpatients enter through the same door as those visiting the flu clinic and are not issued with masks. The flu clinic waiting area is only a few metres from the outpatient waiting room. Queensland Health yesterday refused to let the media film inside the flu clinic because of the risk of infection.

Lee Daley, who was taking her 11-year-old daughter Taleea to the ward to have a broken arm checked, was frightened they could be exposed to swine flu. "I just think the clinic should be in an isolated room, not in the accident and emergency ward where people who might have swine flu are mixing with other outpatients," she said. "Everyone knows how germs can be spread through air-conditioning." Mrs Daley and her daughter opted to wait outside the hospital and were given face masks only after they requested them.

Queensland's Chief Health Officer, Dr Jeannette Young, said the clinic had been established to take the concentration of people with flu-like symptoms away from the Gold Coast Hospital emergency department. Dr Young said individuals will be asked to go to separate waiting rooms when presenting with flu-like symptoms. She said the clinic's waiting room was "appropriately signed to ensure individuals presenting with flu-like symptoms are in a contained area".


Thursday, May 28, 2009

NHS negligence: Thousands of medical records lost

Tens of thousands of medical records have been lost by the NHS (National Health Services) due to a series of data security leaks. The health organization has been asked by the Information Commissioner now to tighten their data security. This year, 140 security breaches took place in NHS between January and April, which exceed the total number of cases put together from the local authorities and the central government.

14 NHS institutes have been observed to have broken the data regulations. According to Mick Gorrill, assistant information commissioner, NHS has offended laws by losing such confidential information. In one instance, the database of 10,000 people was downloaded onto an insecure laptop and the laptop was said to have been stolen from the home of the NHS employee.

In another such case of negligence, a memory stick, which was carrying medical histories of ex-inmates of Preston prison and other 6,360 prison patients, was lost earlier. The password for obtaining the data was written on the device itself.

Gorill said that it is a matter of great concern that the data has been lost. It would cause obvious distress to the patients since the data is a confidential piece of information. Plus, he added, many insurance companies sometimes hire private detectives to find out vital information about the policy holder’s medical history etc. He said that it is well understood what may happen if the data falls into the wrong hands.

According to Gorill, since the loss of data is inexcusable, the body will be fined accordingly for such incidences.

To examine how the medical data is stored in various hospitals in Britain, Richard Thomas, the information commissioner, plans to send a crack team of inspectors. Thomas has written a letter to a senior civil servant in the Department of Health for taking necessary steps for improvements. A spokesperson of the department said that they will soon reply to Thomas’s letter.


Swine flu family slams treatment at an Australian government hospital

A GOLD Coast family struck down by swine flu has slammed Queensland Health's handling of their plight as "Third World". Newlyweds Nik and Kiralea Campbell, who contracted the disease on the P&O cruise ship Pacific Dawn during their wedding voyage, said the Gold Coast Hospital was "totally unprepared" for the 13 suspected swine flu patients who arrived on Monday night. "Dogs would have received better treatment," Mrs Campbell said last night from her Oxenford home where she and her family were under quarantine.

She hit out as it was revealed the number of swine flu cases in Australia doubled to 50 in just 24 hours.

The Campbells fell ill on the cruise the day after they were married in Vanuatu last week. They flew home to the Gold Coast on Monday after the Pacific Dawn docked in Sydney and were later taken by ambulance to hospital as the Pacific Dawn swine flu crisis deepened. Mr and Mrs Campbell, their sons Trae, 2, Jordan,15, and Josh, 16, and Mr Campbell's mother Gloria, 67, were put into a small room at the hospital with one bed and a chair.

"They were totally unprepared for us – we were given no blankets, no food or medication," Mrs Campbell said. "Our three sons had to lay on the floor. It was terrible, especially the way we were feeling. Queensland Health should have been far better prepared."

Mrs Campbell said they were "filthy" that P&O had allowed them and other passengers to leave the cruise ship. "We were tested for swine flu on board but no one stopped us leaving," she said. Mr Campbell feared his sons and mother also had swine flu but had to wait until today for results. His Gold Coast friend Stephen Till and three members of his family, had also tested positive for swine flu after also going on the cruise.

Queensland Health yesterday said the five who had tested positive for swine flu at Gold Coast Hospital were all passengers on Virgin flight DJ531 from Sydney to Coolangatta on Monday and advised other passengers on that flight to call 13Health (13 432584) for advice.


Wednesday, May 27, 2009

NHS criticised by Harley Street doctor for 'missing Jade Goody's cancer diagnosis'

A Harley Street consultant who treated Jade Goody has attacked the NHS for allegedly failing to spot her cancer earlier. Jade Goody died in her sleep at home on Mother's Day

Dr Ann Coxon, a doctor introduced to Goody last year was said to be "very angry" over an alleged failure to spot her illness earlier. Dr Coxon will speak in the E4 documentary Jade: As Seen On TV to be broadcast on Thursday night, according to Max Clifford, her publicist.

He said "Her doctor was very upset and very angry with the way the NHS looked after her and failed to diagnose the cancer that was growing for such a long time," he said. Goody, who died on Mother's Day earlier this year, was given a diagnosis of cervical cancer while taking part in the Indian version of Celebrity Big Brother last August.

The mother-of-two and former dental nurse, who was originally from Bermondsey, south London, first came into the public spotlight in 2002 when she appeared in the third series of the Channel 4 reality programme Big Brother.

In an interview in September, Goody said she had no plans to sue the NHS hospital she claimed was late in diagnosing her illness. "They (the hospital) should have actually spotted that there was something wrong a long time ago," she said. "I don't hate them, I'm not angry with them. Sorry - I don't hate them, I don't want to start suing them or stuff like that, because personally I don't think it's morally right to sue an NHS hospital. "All that's gonna do is take more money out of it and then more people are gonna suffer." She added: "I just think: it's not going to get my womb back, it's not going to get my health back. So what's the point?"


Australia: NSW government hospital chaos as man lay dying

An inquiry has been launched into how a patient died while one of the nation's most experienced emergency doctors was in a nearby office and junior doctors attended a training session and were not available to help clear the crowded emergency department.

Distressed nurses at the Prince of Wales Hospital, Randwick, told the Herald they pleaded for registrars attending an educational talk to help them after the department reached capacity last week, with all beds full, 23 people waiting to be seen and 11 ambulances in the waiting bay. They say the doctors were not available, forcing them to beg the department head, Sally McCarthy, to put the hospital on "code yellow" to stop more ambulances arriving.

The nurses also claim Dr McCarthy, who is the president of the Australasian College for Emergency Medicine, was not available and could not leave her office immediately. [No doubt she had a lot of important paperwork to do] The elderly man, thought to be dehydrated and suffering a severe infection, had arrived conscious at about 3.30pm last Wednesday, but given the busy state of the emergency department he had to wait "some time" in the bay and later became unresponsive, nurses said. He could not be resuscitated.

But the hospital's general manager, Andrew Bernard, yesterday disputed the nurses' claims, saying the man had left the bay and had undergone blood tests and cardiac monitoring before dying 2½ hours later. Dr McCarthy has refused to comment.

There is no suggestion the man would have survived if the department had not been busy, but nurses who contacted the Herald said they felt traumatised. "Several nurses contacted us and all were very distressed," the general secretary of the NSW Nurses Association, Brett Holmes, said yesterday.

An investigation into the incident has been ordered by the hospital. A spokesman for the Ambulance Service said no more than seven ambulances should have been at the hospital at the time.


Tuesday, May 26, 2009

Brit NHS Loses Thousands of Medical Records

(London, England) The British National Health Service (NHS) has lost tens of thousands of medical records due to a series of 140 data security breaches between January and April 2009.
14 NHS institutes have been observed to have broken the data regulations. According to Mick Gorrill, assistant information commissioner, NHS has offended laws by losing such confidential information.

In one instance, the database of 10,000 people was downloaded onto an insecure laptop and the laptop was said to have been stolen from the home of the NHS employee.

In another such case of negligence, a memory stick, which was carrying medical histories of ex-inmates of Preston prison and other 6,360 prison patients, was lost earlier. The password for obtaining the data was written on the device itself.
To correct the problems, the information commissioner, Richard Thomas, has dispatched "a crack team of investigators" to analyze how data is stored at various hospitals. Additionally, Thomas wrote a letter to a "senior civil servant in the Department of Health" to take steps necessary to improve the situation.

Sadly, the writing of letters is arguably about the harshest punishment meted out by the government to state bureaucracy employees. It's sort of an official hand slap. One seldom hears of bureaucrats being canned.

Fortunately, this type of error may not be a problem when the United States imposes government-run health care. As I understand, Obama's plan will just put all medical records on the Internet so the loss of a memory stick would likely be a minor problem. Medical records on the Internet will naturally be as secure as bank records or Los Alamos weapons secrets and we know those things are suck-pucker tight. Heh.
Insane: NHS practices quack medicine but denies patients drugs that do work

There have been several well-controlled studies which show that acupuncture has placebo effects only

Acupuncture is to be made available on the NHS at a cost of ?1.4bn a year despite little scientific evidence that the 'mumbo jumbo' medicine works. The Government's rationing watchdog NICE will also announce on Wednesday that patients can demand other unproven treatments like osteopathy and chiropracty. This is despite the fact that NICE has turned down drugs for people with cancer and dementia, describing them as 'not cost effective'.

Experts have slammed the new ruling as tantamount to the official endorsement of 'mumbo jumbo' medicine which works no better than a placebo. It is the first time the rationing body has backed the use of alternative therapies on the NHS. Their guidance comes just weeks after a large scientific study found that the traditional Chinese practice of acupuncture was no better at relieving pain than simply sticking toothpicks in different parts of the body.

The research, by the Centre for Health Studies, in Seattle, found that 60 per cent of patients given acupuncture for back pain felt better a year after treatment, compared with 40 per cent of those who were not given the treatment. But the trial found that a third group of patients given 'simulated acupuncture' using toothpicks which did not penetrate the skin, was just as effective as when needles were used. Professor David Colquhoun, pharmacologist at University College London, said this indicated that all acupuncture did was create a 'theatrical placebo', which fooled recipients into believing their condition had improved.

He said of the new guidance: 'This is an official endorsement of mumbo jumbo and the implications of that are terrible, for the NHS, and for the taxpayer. 'We will not only be subsidising an industry of acupuncturists and chiropractors, but worse still spending money on standards and regulation of something which I do not believe the evidence supports.'

On Wednesday, NICE will tell GPs to offer patients with back pain courses of complementary therapies costing the NHS at least 400 pounds a time, as an alternative to exercises they can carry out on their own or in class. The draft guidance says up to 10 sessions of acupuncture, worth between 35 and 50 pounds a session, or nine visits to an expert in 'spinal manipulation' - osteopaths, chiropractors and physiotherapists - should be offered.

Four million people consult their GP about back pain every year and if all of them took up acupuncture or chiropracty, it would land the NHS with an annual bill of more than 1.4 billion.

The guidance says anyone whose pain persists for more than six weeks should be given a choice of several treatments, because the evidence of what works best is so uncertain. There were no randomised controlled trials which showed the benefit of exercise, while on complementary therapies the evidence was mixed, with some showing small benefits. Therefore, any decision on which treatment to try should be left with the patient. NICE say that no one should be referred for X rays or MRI scans until other treatments have been tried.

Supporters of acupuncture say it works because needles are inserted into points in the body identified as 'meridians' through which 'energy' flows. But there is no anatomical basis for belief in 'meridians', and acupuncturists cannot state what the 'energy' they claim to be harnessing actually is.

Paul Robin, chairman of the Acupuncture Society, said the therapy worked 'fantastically well' in relieving back pain. He said the mystery about how acupuncture worked made it difficult for trials to demonstrate that its results were not caused by a placebo effect. Mr Robin said: 'There have not really been enough studies into acupuncture. For example, we know that it works even when the needles are not in the right places, which could be because the needles themselves create an endorphin effect, which gives pain relief. 'That doesn't mean acupuncture doesn't work.'

Chiropracty, invented in the late nineteenth century, works on the unscientific principle that diseases are caused by faulty alignment of the bones. Practitioners manipulate the spine in an attempt to relieve pain.

NICE's green light for alternative medicine comes despite the fact that two years ago it turned down drugs for people with moderate Alzheimer's disease, costing just 2.50 a day. It also turned down bowel cancer drugs Avastin and Erbitux. Ian Beaumont, campaigns director of Bowel Cancer UK, said: 'We hope NICE is not funding complementary therapy at the expense of mainstream drugs which have a more proven benefit - but often are not made available to patients on the NHS.'

Neil Hunt, chief executive of the Alzheimer's Society, said: 'We have consistently stated that NICE's decision to deny people with dementia access to drugs in the moderate stages of the condition is unethical and based on flawed calculations. NICE must tackle these flaws to ensure people with dementia can get access to effective treatments.'


Monday, May 25, 2009

Dozens of NHS patients left to repeat surgery after botched work by Swedish doctors

An interesting commentary on the quality of treatment Swedes receive from THEIR socialized medicine system

Dozens of elderly people were left in pain and requiring further surgery after botched work by Scandinavian surgeons brought in to reduce NHS waiting lists, an investigation has found. An audit of hundreds of patients sent to the "flying doctors" for knee operations found that one in three suffered a poor outcome, with one in five cases so bad that the operation needed to be redone.

Lawyers are considering at least six cases involving patients treated at a centre in Weston-super-Mare, Somerset, which hired surgeons from Sweden, Denmark and Finland and to cut waiting times for orthopaedic procedures.

The review of their treatment comes amid increasing concern about the risks posed by EU laws which allow medics to work in any member state, without checks on their competence or language skills. Earlier this month, the case emerged of a [black] German doctor who killed a Cambridgeshire pensioner by administering ten times the required dose of painkillers. Dr Daniel Ubani said he was not familiar with diamorphine, a drug commonly used by GPs in this country.

Under an EU directive passed in 2004, doctors can work in any member state without tests of their language skills or clinical competence. Since then, the number of EU doctors registered to work in Britain has risen by 4,000 – an increase of 24 per cent – at a time when the number of UK-trained doctors fell. Meanwhile, the amount of serious disciplinary action taken against European medics by the General Medical Council has doubled.

Last year, 30 were struck off, suspended, given a warning or had conditions imposed on their practice, compared to 15 cases in 2005. But under current rules the GMC is unable to demand information from its counterparts abroad showing whether a doctor has been previously disciplined or struck off in another country.

The Somerset treatment centre, run by Weston Area Health Trust, hired surgeons from Scandinavia in order to cut local waiting lists, and boost the trust's income by attracting patients who faced long delays elsewhere. Patients from Wales were among those encouraged to travel to the centre, despite concerns from local orthopaedic specialists that they could not guarantee the quality of the doctors, who had been contracted from a private company in Sussex.

Now, an audit of more than 200 patients who underwent knee surgery between 2004 and 2006 has revealed that the number of operations which were botched was ten times the national average.

The paper, published in the Journal of Bone and Joint Surgery, found that 37 per cent of the knee operations carried out on 224 patients had an unsatisfactory result, with dozens of patients left in pain. Twenty two per cent of the operations to replace knees were so bad that they had to be redone – a rate ten times the normal figure in NHS hospitals – while the review warns that yet more patients might need surgery redone in the future.

Orthopaedic surgeon Stephen Cannon, former president of the British Orthopaedic Association, attacked the Government's use of foreign doctors to fill gaps in locum services, and achieve waiting targets. "These guys were brought in as carpenters," he said. "They didn't see their patients postoperatively. They flew in to do the operations, and the doctors in South Wales were left to pick up the pieces."

South West Strategic Health Authority is due to publish a review of the outcomes at the centre, which is no longer staffed by doctors from Scandinavia. The inquiry, ordered in January 2007, will compare results for all patients sent to the centre with national data on outcomes.

Dr Paul Callaghan, medical director of Scanloc, the recruitment company which provided the surgeons, said it examined their surgical outcomes in their own countries before they were hired, and found results similar to those in this country. "We are a recruitment bureau, and we were not responsible for how the centre was set up. The doctors were experienced knee surgeons who had shown good results when they came to us."

Mr Cannon attacked the legislation giving "equivalence" to medical qualifications from 27 EU member states, despite the fact each country's medical education is tailored to its health care system. "The systems are very different in each country – for example, there are countries like Italy where doctors qualify while barely seeing a patient," he said.

An amendment making it mandatory for countries to share information will be put to the European Parliament next month, but the British Government plans to block the move. Professor Sir Donald Irvine, former president of the GMC said a "gaping hole" had now been revealed in the protection of patients. He criticised the Government for failing either to block the original EU laws which had created dangers to the public, or adapt British regulation systems to ensure more rigorous assessment for every doctor before they were allowed to work.

Sir Donald said: "This is an unsafe system; the holes in it are gaping. The problem is the starting point always seems to be 'What do the lawyers say?' – not 'What is best for patients?'"

The Department of Health said it did not believe the legislation being discussed next month, covering the rights of patients in Europe, was an "appropriate mechanism" to introduce changes making information sharing between regulators mandatory. A spokesman said the Government had no plans to press for changes by any other route, and said a voluntary scheme was already in existence.


The Obamacare to come

Drip by painful drip, the details of the Democratic health-care-reform plan have been leaking out. And from what we can see so far, it looks like bad news for American taxpayers, health-care providers, and, most important, patients.

The plan would not initially create a government-run, single-payer system such as those in Canada and Britain. Private insurance would still exist, at least for a time. But it would be reduced to little more than a public utility, operating much like the electric company, with the government regulating every aspect of its operation.

It would be mandated both that employers offer coverage and that individuals buy it. A government-run plan, similar to Medicare, would be set up to compete with private insurers. The government would undertake comparative-effectiveness and cost-effectiveness research, and use the results to impose practice guidelines on providers. Private insurance would face a host of new regulations, including a requirement to insure all applicants and a prohibition on pricing premiums on the basis of risk. Subsidies would be extended to help middle earners purchase insurance. And the government would subsidize and manage the development of a national system of electronic medical records.

The net result would be an unprecedented level of government control over one-sixth of the U.S. economy, and over some of the most important, personal, and private decisions in Americans' lives. Let's look at some of the most troubling ideas in detail.

An employer mandate. Employers would be required to insure their workers through a "pay or play" mandate. Those who did not provide "meaningful coverage" for their workers would pay a penalty, equal to some percentage of their payroll, into a national fund that would provide insurance to uncovered workers. Such a mandate is, of course, simply a disguised tax on employment. As Princeton University professor Uwe Reinhardt, the dean of health-care economists, points out, "[That] the fiscal flows triggered by mandate would not flow directly through the public budgets does not detract from the measure's status of a bona fide tax." Estimates suggest that an employer mandate could cost 1.6 million jobs over the first five years.

An individual mandate. As is the case with an employer mandate, an individual mandate is essentially a disguised tax. It is also the first in a series of dominoes that will lead to greater government control of the health-care system.

To implement an insurance mandate, the government will have to define what sort of insurance fulfills it. As the CBO puts it, "an individual mandate . . . would require people to purchase a specific service that would have to be heavily regulated by the federal government." At the very least, deductible levels and lifetime caps will have to be specified, and a minimum-benefits package will likely be spelled out. This means the oft-repeated promise that "if you are happy with your current insurance, you can keep it" is untrue. Millions of Americans who are currently satisfied with their coverage will have to give it up and purchase the insurance the government wants them to have, even if the new insurance is more expensive or covers benefits the buyer does not want.

A "public option." The government would establish a new universal-health-care program, similar to Medicare, that would compete with private insurance. Regardless of how it is structured or administered, such a plan would have an inherent advantage in the marketplace because it would ultimately be subsidized by taxpayers. It could, for instance, keep its premiums artificially low or offer extra benefits, then turn to the U.S. Treasury to cover any shortfalls. Consumers would naturally be attracted to the lower-cost, higher-benefit government program.

A government program would also have an advantage because its tremendous market presence would allow it to impose much lower reimbursement rates on doctors and hospitals. Government plans such as Medicare and Medicaid traditionally reimburse providers at rates considerably below those of private insurance. Providers recoup the lost income by raising prices for those with private insurance. It is estimated that privately insured patients pay $89 billion annually in additional insurance costs because of cost-shifting from government programs. If the new public option would have similar reimbursement policies, it would result in additional cost-shifting of as much as $36.4 billion annually. Such cost-shifting would force insurers to raise their premiums, making them even less competitive with the taxpayer-subsidized public plan. Lewin Associates estimates that as many as 118.5 million Americans, nearly two out of every three people with insurance, would shift to the government program. The result would be a death spiral for private insurance.

Given that many of the most outspoken advocates of the "public option" have, in the past, supported a government-run single-payer system, it is reasonable to suspect they support a public option precisely because it would squeeze out private insurance and eventually lead to such a system. President Obama himself has said that if he were designing a health-care system from scratch, his preference would be a single-payer system "managed like Canada's." He has also said that, while his proposal is a less radical approach, "it may be that we end up transitioning to such a system."

Comparative- and cost-effectiveness research. In an attempt to control health-care costs, the government would undertake research to determine which health-care procedures and technologies are most effective and, more ominously, cost-effective. Of course, there is a great deal of waste in the U.S. health-care system, and if the government's goal were simply to provide better information there would be little cause for concern. But there is every reason to believe such research would be used to impose restrictions on how medicine is practiced. For example, some reform advocates have said that when an insurance company fails to comply with government practice guidelines, workers should no longer be able to exempt the value of that company's plans from their taxable income.

There is no doubt that other countries use comparative-effectiveness research as the basis for rationing. For example, in Great Britain, the National Institute on Clinical Effectiveness makes such decisions, including a controversial determination that certain cancer drugs are "too expensive." The U.K. government effectively puts a price tag on each citizen's life — about $44,305 (£30,000) per year, to be exact, under NICE's guidelines. That's just a baseline, of course, and, as NICE chairman Michael Rawlins points out, the agency has sometimes approved treatments costing as much as $70,887 (£48,000) per year of extended life. But such treatments are approved only if it can be shown they extend life by at least three months and are used for illnesses that affect fewer than 7,000 new patients per year.

The final health-care-reform bill is likely to include a number of other bad ideas: a host of new insurance regulations that will drive up costs and limit consumer choice (under one leaked proposal, Americans would be limited to a choice of four standardized insurance plans); subsidies for middle-class families (a family of four earning as much as $83,000 per year would receive subsidized care under one proposal); and government preemption of private investment and research into health IT. All of this would come at a cost to taxpayers of at least $1.5 trillion over the next ten years.

The American people are right to demand health-care reform. The current system is broken. But taken individually, most of the ideas currently being considered by Congress would make the problems we face even worse. Taken together, they amount to a complete government takeover of the American health-care system. That is not the type of reform most Americans seek.


Sunday, May 24, 2009

Coroner's fury as great-grandfather, 86, dies after being dumped on NHS emergency trolley for 19 hours TWICE

Oh no! NOT a Royal Marine. How disgusting. The neglect below should not happen to anybody but Royal Marines are heroic men who should be treated with special honour

A Normandy veteran died after being abandoned on a hospital trolley for 19 hours - on two separate occasions. Walter Gibson, 86, suffered an agonising death from infected bedsores caused by his ordeal. Yesterday a coroner condemned the 'gross failings' and 'neglect' that contributed to the great-grandfather's death.

Mr Gibson, who had Parkinson's disease, was admitted to Queen's Hospital in Romford, Essex, in December 2007 with a chest infection. But the flagship £200million, three-year-old hospital did not have enough beds to accommodate him, an inquest heard. Instead Mr Gibson was left on an A&E trolley - designed to be used for up to 12 hours - for 19 hours. By the time he returned to his care home after treatment Mr Gibson had developed painful bedsores.

Days later, on New Year's Day 2008, he was admitted to the hospital again with pneumonia. Astonishingly, he was forced to endure another agonising 19 hours on a trolley as he waited for a bed. When Mr Gibson was finally seen by locum consultant physician Dr O A Elegbe, it was clear the bedsores - also called pressure sores - had become far more severe and were infected. One of the sores had developed into a 'grade four' ulcer - deep enough to expose tendon and bone. The wounds were dressed, but it was another 12 hours before he was moved to a ward where he could be placed on a pressure-relieving mattress.

By then, however, it was too late. Mr Gibson died on January 12 of septicaemia as a result of the open bedsores. Bronchial pneumonia was also found to be a contributing factor in his death. Yesterday coroner Dr Fiona Wilcox passed a verdict of death by natural causes, contributed to by neglect.

Dr Wilcox told Walthamstow Coroner's Court in East London: 'It is quite clear from the evidence I've heard that the length of time Mr Gibson waited at A&E both the first and second time - the second time added insult to injury to a man already completely dependent - made a significant contribution to his death.' She added: 'He was at very, very high risk of pressure sores and he should have been provided with appropriate protection against worsening of the pressure sores.'

Mr Gibson's wife Pheobe, 82, lives in a care home in Dagenham. The couple had three daughters, six grandchildren and six great-grandchildren. Mr Gibson served as a Royal Marine during the Second World War and was involved in the D-Day landings.

Two of his daughters, Jacqueline With and Kay Newton, and his granddaughter Vicky Newton were in court to hear the coroner's criticisms of the hospital. Mrs With, 62, said after the inquest: 'We were angry and upset when we found out that the bedsores were a factor in his death, they had got infected and he got septicaemia. 'If he hadn't had to wait so long on the trolley he wouldn't have got the bedsores and may have survived longer.' She added: 'I know hospital A&E is a busy place but I feel the elderly should be fast-tracked through. 'It's a hard task for the doctors and nurses trying to treat people but something needs to be done. More money needs to be put into emergency care or there should be a specialist unit for the elderly.'

The coroner urged Queen's Hospital to increase training for nurses, step up risk assessment of patients likely to develop pressure sores and provide more air mattresses.

Mrs With, of South Ockendon, Essex, said: 'I genuinely hope the recommendations go through so that no one else has to suffer the terrible way my poor dad did.' The Daily Mail's Dignity For The Elderly campaign has highlighted how vulnerable older patients are sometimes not given the care they deserve in hospital.

A spokesman for Barking, Havering and Redbridge University Hospitals Trust, which runs Queen's Hospital, said: 'Our sympathies are with Mr Gibson's family at this difficult time. 'Over the past year, the trust, in partnership with the primary care trusts, has reviewed and streamlined the processes for patients attending A&E to ensure that they can be admitted and cared for in the right setting to meet individual needs. 'A list of recommended actions from the coroner will be submitted to the trust for implementation and response. 'The trust takes very seriously what lessons can be learnt in order to prevent a similar occurrence in the future.' [Bullsh*t, Bullsh*t, Bullsh*t]


Australia: Rapist Indian doctor still allowed to practice in Victoria!

It is acknowledged that he has a mental illness so who knows what else he may do? Is Australia so short of doctors that the government has to take a risk on this guy?

VICTORIAN Health Minister Daniel Andrews is examining the case of rapist doctor Sabi Lal after he was permitted to continue practising. But Mr Andrews won't say if he has the power to overturn the decision.

Dr Lal retained his registration after the Court of Appeal upheld a ruling by the Victorian Civil and Administrative Tribunal (VCAT) allowing him to treat patients. The doctor was refused registration by the Medical Practitioners' Board because of prior sexual assault convictions and appealed to VCAT.

VCAT granted Dr Lal registration on the condition he see only male patients aged over 16. The tribunal ruled that he had a low moral culpability because an obsessive compulsive disorder contributed to his offending.

"This is a complex matter, it's a serious matter, I'm getting advice from my department in relation to the ruling of the Court of Appeal," Mr Andrews said today. He said he was yet to read the judgment but would take "action appropriately" once he had been briefed. Mr Andrews said he planned to meet with the head of the Medical Practitioners Board, Dr Bob Adler.

"I believe that the vast majority of medical practitioners...across our Victorian community do a fantastic job, have the best interests of their patients at heart and act in a totally appropriate way. "There is a system for those that do not."


Friday, May 22, 2009

Rich Democrat Uses Private Healthcare to Put Cancer in Remission. Doesn’t Want You To Do Same

Senator Edward Kennedy’s cancer is in remission. Through the wonders of the American healthcare system — the finest on earth — Senator Kennedy was able to seek life saving treatment and, through that treatment, have his cancer go in remission. The sad and tragic irony is that when Senator Kennedy returns to work, he will actively work to deny you the access to treatment he himself had. We are not supposed to be so impolite to say such things, but the truth must be spoken.

We know, from what was publicly reported, that Senator Kennedy’s condition was extremely serious. We also know that Senator Kennedy’s compatriot, Senator Jay Rockefeller, said that under Senator Kennedy’s and the Democrats’ healthcare plan the government is going to weigh the cost/benefit of healthcare choices and deny you access to treatment if the cost outweighed the benefit.

Given media reports of Senator Kennedy’s health, we can postulate that, had Senator Kennedy had access to healthcare under the system he intends to design, he would not have gotten the treatment that put his cancer in remission. We can also postulate one other thing — when Senator Kennedy does design the Democrats’ healthcare system, they will make sure people like Senator Kennedy are not subjected to it. Just you and me.

But don’t worry. People like Arlen Specter will continue raising campaign cash off the plight of those stricken with cancer even while denying those people treatments they want but the government thinks would be wasted.


NHS kills thousands. Compensation paltry

Thousands of haemophiliacs who contracted HIV and hepatitis C from infected blood have “only had their anguish compounded” by a new Government statement on compensation, the head of the inquiry into the scandal said today. Lord Archer of Sandwell, who conducted a two-year review of how haemophiliacs were given NHS transfusions of contaminated blood, said the response from ministers was “deeply disquieting”.

Dawn Primarolo, the public health minister, announced today that haemophiliacs who contracted HIV from infected blood will receive annual payments of £12,800, double the current sums paid through trusts set up to support victims. Some 4,670 haemophiliacs who received blood transfusions in the 1970s and 1980s were infected with hepatitis C, of whom 1,243 were also infected with HIV.

However Ms Primarolo said that The Skipton Fund - which provides lump sum payments to people infected with hepatitis C - will receive no extra funding. She added that ministers will review the situation again in 2014.

Responding to the announcement, Lord Archer said: “The Government response is a faltering step that only compounds the anguish of the afflicted and bereaved. “It is difficult to avoid the conclusion that humanitarian impulses have come a bad second to Treasury constraints.” He branded the new funding for patients with HIV, “paltry” and said the failure to increase help available to victims with Hepatitis C and to offer payment to their dependants was, “sadly lacking both in understanding and in compassion”.

For years the NHS used imported blood from the US to treat haemophiliacs. It was often collected from paid “skid row” donors such as prison inmates who were more likely to have HIV and hepatitis. Nearly 2,000 people have died as a result of exposure to the tainted blood.

The Archer inquiry heard evidence from Lord Winston describing the blood contamination as “the worst treatment disaster in the history of the NHS”. Lord Archer suggested a Government apology, a statutory advisory panel and compensation at least equal to that paid to patients in Ireland where those infected with HIV from contaminated blood received up to 101,000 euros and those who contracted hepatitis C were paid on average 853,636 euros.

But the Government rejected campaigners’ demands for substantial compensation payments, instead announcing a slight increase of funding for the Macfarlane and Eileen Trusts to allow annual payments of £12,800 to each HIV infected person. Both trusts will also be given more funding so they can make higher payments to the families and dependants of victims. Spouses of those who die as a result of the infection will still not get any financial help from the Government.

The minister also rejected calls by Lord Archer for a government advisory committee on haemophilia. Instead she said the Department of Health will invite the Haemophilia Alliance - a group of patients, haemophilia doctors, and those involved in their care - to meet with the Government twice yearly. Ms Primarolo also pledged £100,000 each year for the next five years to the Haemophilia Society. She said: “I thank Lord Archer for his very thorough report. The Government has the greatest sympathy for those who have been affected and deeply regrets that these events came about following NHS treatment."

Chris James, chief executive of the Haemophilia Society, said the Government had tried to “water down” and “ignore” Lord Archer’s recommendations and presented “a collection of half-measures”. He said he would write directly to Prime Minister Gordon Brown, Tory leader David Cameron and Lib Dem leader Nick Clegg asking for an urgent meeting because the Department of Health, he said, “have shown themselves to be incapable of the simple human compassion and understanding required to deal with the victims of this disaster”. No health minister attended the two-year inquiry, despite repeated requests. “The Government claims to accept the moral case for action but then, by not implementing the recommendations in full, it shows its contempt for the victims.”

Norman Lamb, the Liberal Democrat health spokesman, said: “The Government’s response is deeply disappointing and underlines how appallingly it has behaved over this issue. This is one of the most serious tragedies in the history of the NHS.”


Thursday, May 21, 2009

How the world really works

Is it a good idea to have medical records stored in electronic form rather than paper? Maybe. One argument is that if there are stored electronically, it will help us find the "best" treatments because we will have all kinds of data. This optimism may be warranted. Against it, is the consideration that "best" is often unclear, depends on the individual, depends on the cost, and is subject to political manipulation if the determination of the "best" treatment is a government decision.

Another argument often advanced for electronic records is cost-saving. It will prevent needless duplication. But of course mobilizing the medical profession to do something they don't seem to think worthwhile doing on their own will have its own costs as well.

This article in the Washington Post deserves to be read in its entirety. It explores how implementing electronic records became part of the stimulus bill. Not because it's a great idea but because the people who would profit from it lobbied like crazy. It may be a great idea. Suffice it to say that the evidence is highly biased. At the center of this picture is the proposed savings in costs of $77 billion. But as the Post reports:
The stimulus bill suggests that the government will recoup about a third of the spending allocated for electronic health records over the next decade, an assumption that some health-care observers question, in part because of a critical analysis by the Congressional Budget Office last year.

The CBO, then led by Orszag, examined the industry-funded study behind the $77.8 billion assertion, among other things, and concluded that it relied on "overly optimistic" assumptions and said much is unknown about the potential impact of health information technology.

A CBO analysis of the stimulus bill this year projected that spending on electronic health records could yield perhaps $17 billion in savings over a decade.

This is how the world really works. When Obama says that electronic record-keeping is a crucial way to control costs, it seems like a really cool idea. It may be. But I doubt it. And the real reason we're going this route isn't because a wise President sees a cost-saving opportunity. It's a lot uglier than that.

As for this being part of the stimulus plan, what a joke. The main thing that will be stimulated are the bank accounts of the people who make the products that help computerize the records.


Why is the NHS killing so many with drugs?

An extraordinary rise in the number of patients killed by drugs given out by the Health Service has led to calls for an investigation. The figure has more than doubled since Labour came to power, rising from 520 in 1998 to 1,299 last year. Official figures also show that the number of such deaths last year was up by more than a quarter on the figure of 1,030 recorded in 2007.

Liberal Democrat health spokesman Norman Lamb, who obtained the statistics following a parliamentary question, said: 'The Government needs to urgently investigate this extraordinary rise. 'The public needs to know why these adverse reactions are happening more frequently and why the trend appears to be increasing so much. 'Patient safety is being compromised. Ministers must ensure that better information on prescription drugs is available for patients and doctors.'

Some experts blamed the increase on failures in the training of hospital doctors and Labour's decision to hand greater prescribing powers to nurses.

The figures show that in 2008, a total of 25,424 reports of adverse reactions to drugs - both fatal and non-fatal - were made to the Medicines and Healthcare products Regulatory Agency, the government organisation in charge of drug safety. They were up by 17 per cent on 2007 and by 41 per cent in a decade. Of these patients, 4,487 had to stay in hospital for several days following side effects from medication - around the same as in 2007 but up by more than 50 per cent on 1998. The figures mainly cover drugs handed out on prescription, but they also relate to over-the-counter and herbal medicines.

Peter Walsh, of pressure group Action Against Medical Accidents, said: 'There are far too many complications resulting in harm or death. These numbers must be reduced, and it must be in the gift of a modern NHS to get them down. 'The true figure will undoubtedly be much higher, because not all incidents are reported [by hospitals and GPs]. And in many cases doctors simply do not know what caused a sudden deterioration or a death - the drugs or another cause. 'Problems with medicines are one of the biggest patient safety issues faced by the NHS.'

Mr Walsh said better reporting of adverse reactions could be the reason behind some of the rise. But there was also the problem of new drugs, and complicated therapies that include combinations of drugs. These 'cutting-edge' treatments often have unknown side effects. Adverse reactions can also occur where doctors do not know what other drugs a patient is taking, or about allergic reactions they suffer from. Errors in identifying patients - with drugs being given to the wrong patient - and in dosages, also cause numerous deaths, he said.

The Daily Mail revealed in January that the number of patients killed by hospital blunders has soared by 60 per cent in only two years. Official records show that 3,645 died as a result of outbreaks of infections, botched operations and other mistakes in 2007/2008, up from 2,275 two years before.

Critics say that the quality of NHS care has suffered as doctors and nurses come under pressure to meet Government waiting time targets. A spokesman for the MHRA said a number of factors are thought to have played a role in the rise in fatal adverse drug reactions including changes in pharmaceutical companies' reporting of the reactions and increased prescribing of drugs. 'It is not possible to pick out one single factor influencing this trend,' she added.


Wednesday, May 20, 2009

NHS doctors lied in their teeth to cover up their fatal negligence. But it's OK for doctors to lie and fabricate evidence in socialist Britain

One wonders how much of this goes on -- This only came to light because a father was savvy enough to have a clergyman witness his neglected son's medical records -- before the doctors changed them

By rights, Robbie Powell should have been celebrating his 30th birthday this year - still the apple of his daddy’s eye and almost certainly, like his two elder brothers, settled and raising a young family. But 19 years ago he died suddenly, apparently after developing a stomach complaint.

Many parents would have shut themselves away to grieve, but not Robbie’s father, Will. He vowed that he would discover what had gone so badly wrong - and has spent the past two decades trying to find out the truth. The effort has all but driven him mad, he says, as he’s battled against the cynicism and sheer indifference of officialdom. He’s been vilified as a fantasist and his family life has been destroyed - yet he has refused to give up. ‘The doctors involved believed they could wear me down - that I would give up, as most people eventually give up when making complaints about their doctors,’ he says. ‘But I didn’t.’

What he found is truly shocking. Not only did the GPs forge his son’s medical notes, but in their attempts to cover up what had happened, they also lied to an inquiry set up into Robbie’s death. Mr Powell’s investigation also unravelled a truly horrifying fact. For the story of the boy who never grew up has exposed British doctors’ best-kept secret - that they are under no legal obligation to tell the truth to a patient’s family about the circumstances surrounding a death. Indeed, it is not even clear whether doctors can be prosecuted for falsifying patients’ records.

This lack of legal obligation to tell the truth is unique in the developed world, and it may well have continued to go unnoticed were it not for Will Powell.

It would be difficult to overstate the terrier-like persistence with which the 55-year-old former car mechanic has painstakingly unpicked the doctors’ version of the events surrounding the death of his darling boy. At his semi-detached house in the small Welsh town of Ystradgynlais, near Swansea, he sits surrounded by a pile of meticulously ordered files and copies of the 2,000 and more letters he has written to the authorities.

He has turned for help to every relevant state organisation - beginning with a ten-year battle to get the coroner to hold an inquest into his son’s death, and involving local professional disciplinary bodies, civil courts, the European Court of Human Rights, the Welsh Office, the police and the General Medical Council (GMC).

What makes this story so alarming is that it exposes just how impotent families are when faced with doctors determined to cover up mistakes. Twenty years ago, the Powells were a happy, carefree family. Will, a Glaswegian, had moved to Ystradgynlais as a young man and married a Welsh girl, Diane. He became a keen angler and member of the local darts team, raising his three boys - Robbie, Justin, now 33, and Ian, 31 - in ‘an ordinary, working-class home where we worked hard to keep a roof over the boys’ heads’. Robbie was a popular, happy, outgoing little boy - ‘Someone who made you feel loved and special,’ recalls his father.

None of the children had ever had a serious illness until December 1989, when Robbie suffered a bout of stomach pain and vomiting that was so bad he was admitted to Morriston Hospital, Swansea. It later emerged that at least one hospital doctor suspected what proved to be true, that Robbie had Addison’s disease - a rare, but highly treatable disease of the adrenal glands - but he failed to tell Will and Diane, or to conduct the test that would have confirmed it. The hospital has since acknowledged this doctor was negligent.

However, it is what then happened in the weeks immediately before and after Robbie’s death that is most disturbing. Over three weeks, as the ten-year-old suffered vomiting, weight loss and stomach pains, he was seen seven times by five GPs from the local surgery. It has since been established that only one GP considered referring the boy back to hospital, but never did so. The others did not read the boy’s notes, perform a blood test or even take his blood pressure. One tried to test his blood sugar, but found his kit was out of date. None recognised that they were dealing with a very sick boy in need of urgent transfer to hospital - instead telling his distraught parents there was nothing wrong with him.

In the final two days of his life, two of the five GPs saw Robbie, but failed to refer him to hospital - even though, at the time, he could not walk and was severely dehydrated. The afternoon of his death,15 days after he’d first fallen ill, a third GP was called to his house after he had been carried to the bathroom by his mother, where he collapsed, his lips blue and his pupils dilated.

‘We didn’t know it at the time, but he was already dying,’ says Will. Yet the GP told the family that a throat infection diagnosed the day before had spread to his chest, and refused to refer him to hospital. When the parents called the surgery again an hour later, the GP returned, but refused again to send Robbie to hospital, had an argument with Will, relented, scribbled a referral note and walked angrily out of the house - leaving the parents to drive their son to hospital.

‘I remember telling Robbie over and over again to stay awake because I didn’t want the doctors to think he was just sleepy,’ says Will. In fact, his son was lapsing in and out of consciousness. When the family arrived at the hospital, staff immediately called the crash team. As they later told the family, Robbie was ‘desperately ill and close to death’ and ‘looked like someone from a concentration camp’ because he was so dehydrated. He died as they tried to revive him.

Will grasped quite quickly that his son’s death could have been avoided. ‘Addison’s disease prevents the adrenal glands from pumping vital hormones around the body, reducing blood pressure and eventually causing a heart attack. ‘It’s like a car running out of petrol - and I knew well enough from my knowledge of engines that the damage could have been halted.’ Indeed, hydrocortisone and intravenous fluids can bring an emergency Addison’s disease patient back to normal health in less than an hour.

‘I extended my compassion to the GPs who had let my son die. I felt they must be suffering, too,’ says Will. ‘But I think they misunderstood. I believe they saw me as someone with no education and thought I posed no risk to their reputations.’ When he asked the senior partner to carry out an investigation into what had gone wrong, the doctor refused point blank.

Shortly after Robbie’s death, Will had asked to see his son’s medical records - and, realising their significance, had them witnessed by a local vicar. Seven months later, when he was formally served with the paperwork for the first inquiry into Robbie’s death by the West Glamorgan family health service authority, he was alarmed to discover the notes had been changed, and that at least one letter had disappeared. Several years later, forensic tests carried out during an investigation by the Crown Prosecution Service, confirmed that some of the notes had been written at a much later date than the GPs claimed.

What is more, the magistrate who headed the West Glamorgan inquiry has said on record to the police that the GPs lied when giving evidence to the inquiry. Nonetheless, this inquiry concluded the doctors had acted correctly - apart from issuing a verbal warning to Robbie’s GP for failing to call an ambulance.

After this, Will recalls months of near-suicidal despair. ‘Diane carried on with the housework and looking after the boys, thank goodness. I took to the bedroom for weeks on end. ‘I did nearly lose my mind back then. I was making allegations of dishonesty about the local GPs. That’s a difficult position for anyone to be in - and especially someone like me who left school with no qualifications and can’t even do joined-up writing.’

The GPs put up a notice in the surgery that claimed that Will’s allegations were ‘distortions and fantasy’ - resulting in one of Britain’s longest-running defamation trials, concluded in Will’s favour just four years ago. Over the next ten years, he contacted every official body he could think of to find out what had happened to his son, and then to find out why nobody would investigate the case. Perhaps the most telling aspect of his epic campaign is that all this time, Will was being viewed as a troublemaker by the official bodies from which he sought help. Under the Data Protection Act, he has found out that the Welsh Ombudsman called him ‘vindictive’, ‘an alley cat’, ‘a caveman’ and ‘bully’.

Hardly surprising, then, that Will and Diane suffered emotionally. ‘I’ve been suicidal on more than one occasion, and our family life all but disappeared,’ he says. ‘My personality changed. I barely went out, and I haven’t worked since Robbie died. We’ve lived on benefits for years and have had to remortgage the house. ‘I was lucky to have a wonderful wife, who loved Robbie and loved me, and we’ve managed to stick together. But my relationship with my other two sons has suffered irreparable harm over two decades. Though we can talk now, that damage is permanent.’

What looked like a breakthrough came ten years after Robbie died, in 2000, when an officer from West Midlands police, Detective Chief Inspector Bob Poole, brought in to review the case after intense lobbying by Will, uncovered evidence of gross negligence, forgery and conspiracy to pervert the course of justice by the GPs. His recommended charges for the GPs to answer ran to several pages. ‘It was as though a great weight had been lifted,’ says Will. ‘At long last, someone in authority was seeing these events from the same viewpoint - seeing the truth instead of accepting a mishmash of lies.’

The Crown Prosecution Service refused to press criminal charges on the grounds that the GPs had previously been assured they would not be prosecuted. The doctors also gained support from a High Court ruling that found they had no case to answer in civil law. When Will took this to the Court of Appeal in 1997, Lord Justice Stuart-Smith made the landmark ruling that doctors had no legal obligation to truthfully explain the circumstances of a patient’s death to bereaved relatives. ‘GPs can put a gloss on the cause of death without fear of litigation,’ said a GP leader, Dr Brian Goss, at the time. In some cases, honesty can be rather hurtful. You don’t necessarily want to point out to a relative that the patient would be alive if they hadn’t smoked so much.’

Will appealed to the European Court of Human Rights, but it also ruled that in Britain ‘doctors do not have to tell the truth or refrain from deliberately falsifying medical records’ - implying that they can falsify records without worry. Such a judgment seems incredible - yet the fact is, unlike doctors throughout Europe, there is no duty of candour for British doctors. ‘This is something few people realise - and yet far too many have experienced it,’ says Peter Walsh of the pressure group Action Against Medical Accidents.

In February, Mr Walsh’s charity was granted permission for a judicial review that could finally force the GMC to investigate Will’s allegations. For the past six years, the GMC has refused to investigate a formal complaint about the Ystradgynlais GPs on the grounds that too much time has elapsed since Robbie’s death.

Of course, the vast majority of doctors want to be open and honest, and many senior leaders in the NHS, including the Chief Medical Officer, have called for the medical profession to be obliged by law to tell the truth about any mistakes they make to patients or their relatives,’ says Walsh. Until as recently as two weeks ago, the NHS Litigation Authority was still warning doctors that ‘care needs to be taken in the dissemination of explanations [of what went wrong] so as to avoid future litigation risks’. This advice has only just been withdrawn from the authority’s website.

Former King’s College surgeon Tony Giddings, chair of the Alliance For The Safety Of Patients, says the culture of denial is a hangover from ‘the dark ages of medicine when so little could be done and the habit of protecting professionals and their position arose because we didn’t know any better. We do now. 'All the evidence from studies around the world has shown the importance of telling the truth if patients are to have a system they can trust, and doctors are to have the confidence of the public.’

Now, a campaign known as Robbie’s Law has just been set up by Action Against Medical Accidents to persuade the Government to introduce legislation that requires doctors to inform patients, or their next of kin, of errors or incidents in their healthcare that have caused, or may cause, harm.

For some local people, the fight has gone on too long. When the High Court ruling was reported on the local newspaper website last month, some villagers expressed the view that Will Powell should get on with his life and stop ‘persecuting’ the doctors. ‘These are people who would complain if the bus was five minutes late,’ says Will. ‘If the doctors had been honest about what had happened, we could all have got on with our lives, however painful Robbie’s death. How I wish that could have happened.’

For Will and Diane, at long last there seems a chance of happiness. ‘We’ve got three lovely grandchildren, which is a new start, and at least we’re talking as a family.’ But Will says he will never have a normal life again. ‘If they’d wanted this to be forgotten and put in the past, the GPs could have told the truth right at the beginning,’ he says. ‘Perhaps it would have helped me to move on, too. ‘But I’m stuck here, feeling Robbie’s death and the injustice of what they did as keenly as ever.’

Dr Keith Hughes, senior partner at the Ystradgynlais group practice, said the GPs had been advised not to make any comment. ‘We cannot make a statement with all these legal proceedings going on,’ he said.


Monday, May 18, 2009

The immorality of government health care

In the May 10 New York Times Sunday magazine, President Obama reflected on his elderly grandmother’s hip replacement. This episode, portrayed in a touching manner, turns out terribly enlightening about the hard questions all Americans face under his regime.

Obama’s grandmother had already been diagnosed with cancer, and the fall which broke her hip might have been caused by a mild stroke. Soon after the hip replacement, she went into serious decline, and passed away just two days short of seeing her grandson elected president. “I don’t know how much that hip replacement cost,” said Mr. Obama. “I would have paid out of pocket for that hip replacement, just because she’s my grandmother. Whether, sort of in the aggregate, society making those decisions to give my grandmother, or everybody else’s aging grandparents or parents, a hip replacement when they’re terminally ill is a sustainable model is a very difficult question.”

“Society,” of course, cannot make decisions. Only people can make decisions. So when the powerful want to absolve themselves of the consequences of their decisions, they blame “society.” If Mr. Obama were more forthright, he would have said: “I would spend as much of my own money as necessary to pay for my grandmother’s hip replacement. But because I intend to control all health care spending in this country, I (or people I appoint) will decide whether everybody else’s grandmothers will get hip replacements. The answer is ‘no.’”

Well, those are the breaks when you accept that other people should pay for your health care. Unfortunately, that’s the way most Americans think. Consider the results of a recent survey by Frank Luntz, a Republican pollster and campaign strategist. A full 58 percent of people agreed with the statement that “decisions about my healthcare should be between me and my doctor and no one else,” and 53 percent agreed that “I should have the right to choose the healthcare that’s right for me.” However, only 9 percent agreed that “my healthcare belongs to me,” and only 12 percent agreed that “the right to spend my own money for my own healthcare must be protected/preserved.” That simply does not compute.

If you are not willing to take control of your own health-care spending, you cannot expect the person who does control it not to interfere with your relationship with your doctor or the treatments you can use. Back in World War II, the government allowed employers to give health benefits as non-taxable compensation. Even today, a worker who would prefer to buy his own health-insurance policy, instead of accepting his employer’s, would have to use after-tax dollars.

The Wall Street Journal calls this the “original sin” of American health care and “sin” is an appropriate term for such discrimination. Most libertarian and conservative health reformers focus on the fact that health costs are out of control and quality uneven because the patients don’t control payment. Of course they are right. However, the status quo also infringes on our moral choices.

If the government changed the tax-code to free every American to buy health insurance of his or her choice, instead of one chosen by an employer or the government, Barack Obama would not hold the power to decide whether anyone else’s grandmother lives or dies due to the availability of medical options.

Health insurers would differentiate their policies according to beneficiaries’ values. Some people, happy in a managed-care setting, would pay high premiums but low co-pays and deductibles to insurers like Kaiser Permanente for integrated treatment. Others would pay doctors directly, and buy low-premium policies covering only catastrophically expensive diagnoses or accidents.

More critically, pro-life citizens would not have to worry about whether this president will revoke the previous president’s “freedom-of-conscience” permission for health-care providers to decline to participate in abortions. Instead, they would buy health-insurance policies that assured them that their “network” included only pro-life doctors and allied health professionals.

People who wanted the option of hip replacements until they draw their last breath would pay the higher premiums for policies promising such replacements. Others would spend less to buy policies with carefully defined conditions under which they would not expect heroic surgery, just painkillers to help them along.

Such decisions are not easy, but neither are most moral challenges. The most immoral decision of all is to surrender our own choices in health care to the power of the state.


As more and more public hospital horror stories emerge, more Australians turn to private insurance

Despite the economic downturn and the Leftist government's moves to make it more expensive. Health insurance in Australia is not employer-provided but "free" government hospitals are available -- if you are prepared to wait, and wait

AUSTRALIANS are flocking to take up private health insurance, with more than 4000 people joining each week, a surge likely to undermine claims that the private system is about to be king hit by changes announced in last week's budget. A leaked report obtained by The Sunday Age reveals that 225,000 more people took up private cover during the 12 months to March this year.

The report, from the independent but publicly funded Private Health Insurance Administration Council, shows that more than 9.7 million Australians are now covered for private hospital insurance, equivalent to 44.6 per cent of the population — the highest proportion since March 2002.

The surge came despite warnings from insurers and the Opposition that changes announced in last year's budget would force people to abandon private insurance, putting more pressure on the public system. Similar claims followed last week's budget, which announced plans to means test the 30 per cent private health insurance rebate for singles earning more than $75,000, and for families earning about $150,000. The rebate will phase out completely for couples earning more than $240,000.

Opposition Leader Malcolm Turnbull has pledged that the Liberals would vote against the plan, warning that it would lead to people dropping out of insurance schemes. Family First senator Steve Fielding and Independent Nick Xenophon have also expressed concern....

A spokeswoman for the Health Insurance Association said more people were joining because people were concerned about the state of the public system and that the 2008 budget changes had been watered down.

Health Minister Nicola Roxon yesterday accused the Opposition of plotting to force people on low incomes to pay private health insurance. "The reason that Mr Turnbull wants to get rid of private health insurance measures that the Government has proposed in the budget is because he believes, and has explicitly said, that every Australian should have private health insurance," Ms Roxon said. "What that means is that every pensioner, every veteran, every family, no matter what their income, should have private health insurance."

Mr Turnbull actually said that in "an ideal world, every Australian would have private health insurance". He said the Opposition strongly supported Medicare as a cornerstone of a health system that also encouraged self-reliance.