ABSURD PUBLIC HOSPITAL PRACTICES KILL LITTLE GIRL
Queensland Health has been accused of ignoring a top-level report that might have saved the life of a 10-year-old girl. Elise Neville died two days after being seen and sent home by a junior doctor in charge of Caloundra Hospital's emergency ward in January 2002. The State Liberals said this was contrary to a special report delivered to Queensland Health in 2001 which said that senior doctors – not junior doctors on their own – should work in emergency wards. The Liberals said yesterday that the report was not only ignored by the department, but had been kept secret. Details were obtained this week by Liberals deputy leader Bruce Flegg through Freedom of Information.
The Review of Emergency Services, Sunshine Coast Health Service District, was written by Dr Bill Rodgers, former medical superintendent at Nambour Hospital. Its recommendations were not implemented and when Elise Neville went to Caloundra Hospital after a fall from a bunk, inexperienced junior doctor Dr Andrew Doneman was in charge and 20 hours into a 24-hour shift. Dr Doneman did not admit the young girl to hospital or perform tests that would have shown she had a serious head injury. She was sent home after some minor treatment, and died two days later from internal bleeding and swelling of the brain.
Dr Doneman pleaded guilty in the Health Practitioners Tribunal in November 2004 to unsatisfactory professional conduct. He was sacked by the Government, though he was later allowed to practise after an appeal to the Medical Board. The Australian Medical Association and College of Emergency Medicine said at the time Dr Doneman had been made a scapegoat for Queensland Health's "unsafe practices" of making staff work dangerously long hours.
Dr Flegg, the Liberals' health spokesman, yesterday accused the State Government of a blatant cover-up of information in the Rodgers report which was relevant to Elise Neville's death. He said that if the report, which examined emergency medicine arrangements at Caloundra and other Sunshine Coast hospitals, had been acted on instead of covered up "the result would have most probably been quite different". The report said: "The population of Caloundra mandates an emergency department capable of dealing with emergencies and principal house officer (senior) level staffing is considered appropriate." Dr Rodgers recommended that until Queensland Health could recruit principal house officers, senior medical officers should maintain 24-hour duty cover for the department. His main recommendation was: "Caloundra Hospital appoint five principal house officers to staff the emergency department at all times."
However, Dr Flegg said that one year after the report was written a junior doctor with less than two years' experience was on duty in the emergency ward when Elise Neville was taken in. "Not only were these recommendations hidden from the public, they were ignored," he said. Dr Flegg said the Queensland Health report was never made available to the Medical Board tribunal, the Coroner, the Neville family, their lawyers, or Dr Doneman. "It seems that the Government would have left this report under wraps, as they failed to produce it," he said.
Queensland Health said a decision was made in October 2001 to recruit five senior doctors for the emergency ward, but the first did not come on board until early 2002. Five principal house officers, plus two emergency specialists, were working there now. Health Minister Stephen Robertson said he was unaware of the document but would investigate.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Monday, December 19, 2005
Sunday, December 18, 2005
AUSTRALIA: A COUNTRY MEDICAL SCHOOL TO ENCOURAGE COUNTRY PRACTICE
Townsville [a small regional city in Queensland] is set to revolutionise health services in country Australia after a $3 million federal grant was awarded to James Cook University yesterday. Health Minister Tony Abbott travelled to Townsville to announce a new rural medical school at JCU. The Federal Government will inject $3 million over two years to establish the landmark clinic at the university. He said the rural clinic would allow more students to study in Cairns, Atherton and Mackay, getting hands on experience in rural and remote communities. "The Government's initiative will give more future doctors an experience of rural and remote medicine, plus the skills to deliver the best possible health care when they get there.
Mr Abbott said training doctors in the country was important, because country trained doctors were more likely to practice in regional areas. Mr Abbott said the Government was trying to increase rural training at universities across the country and he listed JCU as a leader in the initiative. "It's particularly important at universities like James Cook, as the first non-metropolitan medical school in Australia." The minister's visit was scheduled to coincide with JCU's first medical class graduation ceremony. "It's actually a pretty important day for country Australia as this is the first graduating class from a non metropolitan medical school," he said.
Mr Abbott said Australia's health services were going through a period of positive change, with non-state capital city medical schools being established in Canberra, Woolongong, west Sydney and Fremantle. "There are a lot of changes happening but James Cook has been a flagship of change when it comes to trying to get medical graduates in country areas." Mr Abbott said there were 11 rural clinical schools across Australia, and as a result, a quarter of the nation's medical students were spending at least a year training in remote areas.
The executive dean of the JCU faculty of medicine, health and molecular sciences, Professor Ian Wronski, welcomed the additional funding. "We have always wanted to train doctors in the North, for the North, and the rural clinical school will give us more facilities and more teachers in communities across the region."
More here
Australian health boss pisses into the wind: "Greed should not be the motivator of the nation's doctors, and highly paid specialists such as anaesthetists should not get more money from Medicare unless they guarantee to pass the savings on to patients. Health Minister Tony Abbott has revealed he understands why doctors walk out of the "chaotic" public health system in disgust, but has warned that an exodus could undermine public confidence in the profession. Pledging extra payments to GPs who undertake procedures, he warned the Government would not give more money to anaesthetists because they were likely to pocket the cash, not pass on the savings to patients. "Notwithstanding legitimate grievances about the scheduled fee and indexation, the Government is very reluctant to increase rebates for comparatively high-earning specialities such as anaesthesia, in the absence of binding undertakings from the profession that the money will go to patients," he said".
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Townsville [a small regional city in Queensland] is set to revolutionise health services in country Australia after a $3 million federal grant was awarded to James Cook University yesterday. Health Minister Tony Abbott travelled to Townsville to announce a new rural medical school at JCU. The Federal Government will inject $3 million over two years to establish the landmark clinic at the university. He said the rural clinic would allow more students to study in Cairns, Atherton and Mackay, getting hands on experience in rural and remote communities. "The Government's initiative will give more future doctors an experience of rural and remote medicine, plus the skills to deliver the best possible health care when they get there.
Mr Abbott said training doctors in the country was important, because country trained doctors were more likely to practice in regional areas. Mr Abbott said the Government was trying to increase rural training at universities across the country and he listed JCU as a leader in the initiative. "It's particularly important at universities like James Cook, as the first non-metropolitan medical school in Australia." The minister's visit was scheduled to coincide with JCU's first medical class graduation ceremony. "It's actually a pretty important day for country Australia as this is the first graduating class from a non metropolitan medical school," he said.
Mr Abbott said Australia's health services were going through a period of positive change, with non-state capital city medical schools being established in Canberra, Woolongong, west Sydney and Fremantle. "There are a lot of changes happening but James Cook has been a flagship of change when it comes to trying to get medical graduates in country areas." Mr Abbott said there were 11 rural clinical schools across Australia, and as a result, a quarter of the nation's medical students were spending at least a year training in remote areas.
The executive dean of the JCU faculty of medicine, health and molecular sciences, Professor Ian Wronski, welcomed the additional funding. "We have always wanted to train doctors in the North, for the North, and the rural clinical school will give us more facilities and more teachers in communities across the region."
More here
Australian health boss pisses into the wind: "Greed should not be the motivator of the nation's doctors, and highly paid specialists such as anaesthetists should not get more money from Medicare unless they guarantee to pass the savings on to patients. Health Minister Tony Abbott has revealed he understands why doctors walk out of the "chaotic" public health system in disgust, but has warned that an exodus could undermine public confidence in the profession. Pledging extra payments to GPs who undertake procedures, he warned the Government would not give more money to anaesthetists because they were likely to pocket the cash, not pass on the savings to patients. "Notwithstanding legitimate grievances about the scheduled fee and indexation, the Government is very reluctant to increase rebates for comparatively high-earning specialities such as anaesthesia, in the absence of binding undertakings from the profession that the money will go to patients," he said".
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Saturday, December 17, 2005
PUBLIC HEALTH FAILURE WITH AIDS
To put it as bluntly as possible, the main reason that AIDS is spreading to its current deadly dimensions around the world is this: We are practicing the social and political equivalent of laissez-faire when dealing with a killer-virus. And while "hands off" is usually the best approach for generating economic growth, if a virus, on the contrary, gets the equivalent of a free hand, it will also flourish -- but that's the kind of explosive growth we don't want.
Two decades ago, American AIDS activists came up with the slogan, "Silence = Death." But the issue, in practice, wasn't talking about AIDS, but rather doing something about AIDS. So the American slogan became, in effect, "Behavior Change = Life." And the biggest single life-saving change, back then, was behavioral restraint. Gay bathhouses were shut down, and millions of Americans, many of them gay, changed their sexual patterns: They got serious about condoms, safe sex, or outright abstinence. Were these changes tough to live by? Sure. But they beat the alternative. Let's face it: Just as quarantining worked in the past -- remember leper colonies? -- so the same basic idea, of separating oneself from the threat, works today.
Currently in the U.S., it is common for gay men -- especially as one moves up the ladder, in terms of education and health-consciousness -- to say things like, "I don't know anybody who has died of AIDS in five or ten, or even fifteen years." That is, in their medically aware circle -- after the initial wave of deaths in the 80s -- people got the message. And of course, thanks to medical breakthroughs, many of those who are HIV positive can carry on functional lives for the long term.
Today in America, a few incredibly unlucky people get AIDS through freak accidents. But the blunt reality is that AIDS mostly afflicts those who can be diagnosed as terminally reckless. An example is junkies using dirty needles -- or any needle at all. How does society realistically save the life of someone who holds his or her own life in such obvious contempt? As with smoking, drinking, over-eating, gun-playing and drag-racing, some behavior choices simply defy life-saving. Or to take another example, it's recognized by now that anal sex without condoms, known as "barebacking," is widely recognized as a death trip, and yet plenty of people still seem to do it, with the full complicity of modern marketing. At some point, confronted by the lethal combination of lust and greed, even the best-intentioned American public-health advocates have to throw up their hands in defeat.
That's the U.S., where at least the problem has been isolated to a few hard-to-reach, albeit seemingly suicidal, sectors. Around the world, the situation is far worse. And so, on World AIDS Day, it's time for some honest talk: AIDS, having already killed 15 million, having infected 40 million more, is spreading -- because too many people, and too many governments, have been unwilling to change their behavior, and their policies.
We might consider, as an ominous indicator, this recent article, entitled, plainly enough, "HIV Is Spreading Via India's Highways." The Associated Press' Margie Mason reports, "Just as in Africa two decades ago, truckers and the sex they buy have helped fuel India's spread of a disease that revolves mainly around sex and injecting drugs." Now let's think about that: 20 years after it became obvious that sex-working (known less politely as prostitution) was a major AIDS vector in Africa and elsewhere, India seems to be doing little to put a stop to those same deadly practices. Oh sure, no doubt any number of Indian government agencies and NGOs are busy "working" on the problem, but with more than five million Indians infected, it's obvious that they are not working effectively.
So what would AIDS effectiveness look like? Most obviously, it would begin with a stern, even fierce, crackdown on the sex and drug trades. Such fierceness explains why Singapore, to name a healthy counter-example, doesn't have this widescale problem.
Which do we prefer? India or Singapore? The AIDS Establishment has made its choice apparent to all: It puts freedom, most obviously sexual freedom, ahead of strict public health measures. That is, the preservation of the Sexual Revolution matters more than people's lives. That disturbing reality came clear to me last summer at the World AIDS Summit in Bangkok, in which brazen sexual braggadocio overwhelmed modesty, let alone safety. And yes, it does seem that AIDS activists are better at announcing holidays and staging summits than stymieing the disease; if media-savvy showmanship were the same as public-health stewardship, the world would be well. But instead, the Band Plays On, at the modern equivalent of a Masque of the Red Death.
The AIDS Establishment argues that it's simply not reasonable to demand that Africans and Indians, or anyone else, for that matter, change their behavior patterns. If people wish voluntarily to change their behavior, that's OK, but never, ever, should serious suasion or sanction be applied -- no matter how many lives might be saved. And so it is that the dubious values of the American Civil Liberties Union are being applied to the whole world....
And extreme cynicism, of course, is the obvious result of, first, "do your own deadly thing," and, second, "let others make a good living off of your dying." After a quarter century, many in the AIDS Establishment must know that they are facilitating the disease, not eradicating it. But they have carved out a good living for themselves, financially, as well as a high status for themselves, morally.
This arrangement is working, on its own cynical terms, and working well. It's working so well, in fact, that top figures from around the world are visibly prostrating themselves before the putative pieties of the AIDS Establishment. Earlier this week Jim-yong Kim, director of the HIV Department at the World Health Organization, actually apologized for his failure to implement WHO's "3 by 5" program. As with so many other AIDS-related efforts, "3 by 5" had a catchy title, but never the prospect for success. And since the WHO-crats should know that by now, their apology, absent profound changes in their methods, should not be accepted. Although, of course, failure, now and forever, won't stop the WHO from receiving more funding, for as far into the future as the eye can see.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
To put it as bluntly as possible, the main reason that AIDS is spreading to its current deadly dimensions around the world is this: We are practicing the social and political equivalent of laissez-faire when dealing with a killer-virus. And while "hands off" is usually the best approach for generating economic growth, if a virus, on the contrary, gets the equivalent of a free hand, it will also flourish -- but that's the kind of explosive growth we don't want.
Two decades ago, American AIDS activists came up with the slogan, "Silence = Death." But the issue, in practice, wasn't talking about AIDS, but rather doing something about AIDS. So the American slogan became, in effect, "Behavior Change = Life." And the biggest single life-saving change, back then, was behavioral restraint. Gay bathhouses were shut down, and millions of Americans, many of them gay, changed their sexual patterns: They got serious about condoms, safe sex, or outright abstinence. Were these changes tough to live by? Sure. But they beat the alternative. Let's face it: Just as quarantining worked in the past -- remember leper colonies? -- so the same basic idea, of separating oneself from the threat, works today.
Currently in the U.S., it is common for gay men -- especially as one moves up the ladder, in terms of education and health-consciousness -- to say things like, "I don't know anybody who has died of AIDS in five or ten, or even fifteen years." That is, in their medically aware circle -- after the initial wave of deaths in the 80s -- people got the message. And of course, thanks to medical breakthroughs, many of those who are HIV positive can carry on functional lives for the long term.
Today in America, a few incredibly unlucky people get AIDS through freak accidents. But the blunt reality is that AIDS mostly afflicts those who can be diagnosed as terminally reckless. An example is junkies using dirty needles -- or any needle at all. How does society realistically save the life of someone who holds his or her own life in such obvious contempt? As with smoking, drinking, over-eating, gun-playing and drag-racing, some behavior choices simply defy life-saving. Or to take another example, it's recognized by now that anal sex without condoms, known as "barebacking," is widely recognized as a death trip, and yet plenty of people still seem to do it, with the full complicity of modern marketing. At some point, confronted by the lethal combination of lust and greed, even the best-intentioned American public-health advocates have to throw up their hands in defeat.
That's the U.S., where at least the problem has been isolated to a few hard-to-reach, albeit seemingly suicidal, sectors. Around the world, the situation is far worse. And so, on World AIDS Day, it's time for some honest talk: AIDS, having already killed 15 million, having infected 40 million more, is spreading -- because too many people, and too many governments, have been unwilling to change their behavior, and their policies.
We might consider, as an ominous indicator, this recent article, entitled, plainly enough, "HIV Is Spreading Via India's Highways." The Associated Press' Margie Mason reports, "Just as in Africa two decades ago, truckers and the sex they buy have helped fuel India's spread of a disease that revolves mainly around sex and injecting drugs." Now let's think about that: 20 years after it became obvious that sex-working (known less politely as prostitution) was a major AIDS vector in Africa and elsewhere, India seems to be doing little to put a stop to those same deadly practices. Oh sure, no doubt any number of Indian government agencies and NGOs are busy "working" on the problem, but with more than five million Indians infected, it's obvious that they are not working effectively.
So what would AIDS effectiveness look like? Most obviously, it would begin with a stern, even fierce, crackdown on the sex and drug trades. Such fierceness explains why Singapore, to name a healthy counter-example, doesn't have this widescale problem.
Which do we prefer? India or Singapore? The AIDS Establishment has made its choice apparent to all: It puts freedom, most obviously sexual freedom, ahead of strict public health measures. That is, the preservation of the Sexual Revolution matters more than people's lives. That disturbing reality came clear to me last summer at the World AIDS Summit in Bangkok, in which brazen sexual braggadocio overwhelmed modesty, let alone safety. And yes, it does seem that AIDS activists are better at announcing holidays and staging summits than stymieing the disease; if media-savvy showmanship were the same as public-health stewardship, the world would be well. But instead, the Band Plays On, at the modern equivalent of a Masque of the Red Death.
The AIDS Establishment argues that it's simply not reasonable to demand that Africans and Indians, or anyone else, for that matter, change their behavior patterns. If people wish voluntarily to change their behavior, that's OK, but never, ever, should serious suasion or sanction be applied -- no matter how many lives might be saved. And so it is that the dubious values of the American Civil Liberties Union are being applied to the whole world....
And extreme cynicism, of course, is the obvious result of, first, "do your own deadly thing," and, second, "let others make a good living off of your dying." After a quarter century, many in the AIDS Establishment must know that they are facilitating the disease, not eradicating it. But they have carved out a good living for themselves, financially, as well as a high status for themselves, morally.
This arrangement is working, on its own cynical terms, and working well. It's working so well, in fact, that top figures from around the world are visibly prostrating themselves before the putative pieties of the AIDS Establishment. Earlier this week Jim-yong Kim, director of the HIV Department at the World Health Organization, actually apologized for his failure to implement WHO's "3 by 5" program. As with so many other AIDS-related efforts, "3 by 5" had a catchy title, but never the prospect for success. And since the WHO-crats should know that by now, their apology, absent profound changes in their methods, should not be accepted. Although, of course, failure, now and forever, won't stop the WHO from receiving more funding, for as far into the future as the eye can see.
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Friday, December 16, 2005
MEDICAL MISHAPS AS SYSTEM FAILURES
Post lifted from the Adam Smith blog
Star speaker at the Adam Smith Institute House of Commons breakfast yesterday was Sir Liam Donaldson, the NHS Chief Medical Officer, talking about patient safety. Though the papers (and lawyers) seem to like to go after individual doctors when mistakes happen, Donaldson's view is that most of the problem is down to human error right enough, but human error in a weak system.
"Patient safety has not been a priority," he told the 60 or so guests, senior figures from private and public healthcare, journalism and politics. "Control systems are too weak for the high-risk industry that we are in." They just wouldn't be allowed in transport, for example - 2004 was the safest year in airline history, and 2005 looks like ending up even safer. In 2000, the NHS killed more people through infusion pump errors than died in the Hatfield crash that year: the difference is that Hatfield led to huge changes in safety procedures.
Bad teamwork and poor communication with patients and other healthcare professionals both kill patients. But traditionally, doctors have seen their role as applying medical knowledge, and have not regarded communication and teamwork as core skills. That at least is now changing, said Sir Liam.
But he was still skeptical about the way that medical accidents are dealt with. The General Medical Council, the Crown Prosecution Service and the media always like to pin the blame on specific doctors, when really it is NHS systems that are to blame. And most official inquiries into medical accident "result in no learning whatsoever" because few take a systems view of the problem.
So it's not surprising that doctors are reluctant to report accidents or near-misses. But I think that we would have much more confident in our doctors if they did - a point confirmed by another speaker, Jim Johnson of the Dana-Faber Cancer Institute in Boston. "We listed all our mistakes over the last decade in the Boston Globe," he said. "It actually made our competitors angry, because everyone thought, if we are big enough to own up to our mistakes, we've probably made efforts to fix things, and we're probably safer than everyone else." A lesson for doctors here, perhaps?
Too many choices : "The new Medicare prescription drug plan will save senior citizens billions of dollars, so why are so many of them afraid to sign up for it? You wouldn't think such a beneficent program would have to put a metaphorical gun to people's heads (in the form of a 1 percent per month premium penalty) to get them to enroll now. Yet that is what seems to be happening. Senior citizens are confused. The government has turned the insurance companies loose, with the result that in some states there are more than 50 plans to choose from -- all of them complicated -- and nowhere is there a simple metric that people can use to determine which plan is best for them. Befuddled seniors are clutching their heads and asking someone, anyone (their pharmacists, their kids, AARP) for help."
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Post lifted from the Adam Smith blog
Star speaker at the Adam Smith Institute House of Commons breakfast yesterday was Sir Liam Donaldson, the NHS Chief Medical Officer, talking about patient safety. Though the papers (and lawyers) seem to like to go after individual doctors when mistakes happen, Donaldson's view is that most of the problem is down to human error right enough, but human error in a weak system.
"Patient safety has not been a priority," he told the 60 or so guests, senior figures from private and public healthcare, journalism and politics. "Control systems are too weak for the high-risk industry that we are in." They just wouldn't be allowed in transport, for example - 2004 was the safest year in airline history, and 2005 looks like ending up even safer. In 2000, the NHS killed more people through infusion pump errors than died in the Hatfield crash that year: the difference is that Hatfield led to huge changes in safety procedures.
Bad teamwork and poor communication with patients and other healthcare professionals both kill patients. But traditionally, doctors have seen their role as applying medical knowledge, and have not regarded communication and teamwork as core skills. That at least is now changing, said Sir Liam.
But he was still skeptical about the way that medical accidents are dealt with. The General Medical Council, the Crown Prosecution Service and the media always like to pin the blame on specific doctors, when really it is NHS systems that are to blame. And most official inquiries into medical accident "result in no learning whatsoever" because few take a systems view of the problem.
So it's not surprising that doctors are reluctant to report accidents or near-misses. But I think that we would have much more confident in our doctors if they did - a point confirmed by another speaker, Jim Johnson of the Dana-Faber Cancer Institute in Boston. "We listed all our mistakes over the last decade in the Boston Globe," he said. "It actually made our competitors angry, because everyone thought, if we are big enough to own up to our mistakes, we've probably made efforts to fix things, and we're probably safer than everyone else." A lesson for doctors here, perhaps?
Too many choices : "The new Medicare prescription drug plan will save senior citizens billions of dollars, so why are so many of them afraid to sign up for it? You wouldn't think such a beneficent program would have to put a metaphorical gun to people's heads (in the form of a 1 percent per month premium penalty) to get them to enroll now. Yet that is what seems to be happening. Senior citizens are confused. The government has turned the insurance companies loose, with the result that in some states there are more than 50 plans to choose from -- all of them complicated -- and nowhere is there a simple metric that people can use to determine which plan is best for them. Befuddled seniors are clutching their heads and asking someone, anyone (their pharmacists, their kids, AARP) for help."
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Thursday, December 15, 2005
GERMANY HAS HUGE TAXES BUT ITS DOCTORS ARE STILL POORLY PAID
The money goes on bureaucracy instead
Native [German] doctors (clinical doctors) are going out on strike these days to get a 30% pay increase. No, not 3%, not 13%, that’s right; 30%. Sound outrageous? Of course it’s outrageous. But they are just a Produkt ihrer Umwelt (a product of their environment), because the real outrage is how they are being paid right now.
These doctors work their 50 or even 60 hours a week just like everywhere else in the world (I guess) but get paid roughly 25% that of what an American doctor gets for doing the same job. They’re actually earning 7% less (proportionally) than they were in 1993. They’ve become a new type of Wirtschaftsflüchtling (economic refugee) and are leaving the country in droves (3000 German doctors have gone to England, for instance) and nobody wants to become a doctor in this country anymore. It’s said that only about 60% of the native medical students complete their studies here and a quarter of the ones who do go into pharmacy or insurance or some other medical-related field.
The new government’s Minister of Health (she was also the Minister of Health under the old government so she must be really good) says however that she has alles im Griff (everything under control) and won’t be blackmailed or led astray and her rigid cost-control measures (ha, ha) will continue and there will most certainly not be any increase in the outrageously high insurance payment rate all native workers have to pay here each month. Right. In six months tops they're going to raise that rate again and everybody knows it.
And that makes one wonder. Hmmmm. If the doctors aren’t getting all of this money that everybody has to shell out every month, who is? The hundreds of Krankenkassen (Health Insurance Agencies) for all of their redundant administrative costs (Japan has just one, for instance)? The Hospitals? They wouldn’t be pocketing all of this cash, now would they? And a native [German] would never go to a doctor if he didn't need to, right? And what about the pharmaceutical industry? Naah, not them. Forgive me. I don’t know what I was thinking just now.
Excerpt from here
The truth about WHO and AIDS: "If you're like most people I know, World AIDS Day passed you by last Thursday with scarcely a nod. And for good reason, because the World Health Organization, which sponsors the observance, is keeping a low profile these days. And well it should. Any way you look at it, the WHO effort to stop AIDS has been a dismal failure. In fact many believe the World Health Organization is actually making things worse. It was June 1981 when U.S. public health officials first reported a strange illness that afflicted six homosexual men. Who would have believed that nearly 25 years later, the deadly virus would be infecting 5 million new persons each year, and that a staggering 40 million persons -- 70% of whom live in Africa -- are now HIV-positive?"
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
The money goes on bureaucracy instead
Native [German] doctors (clinical doctors) are going out on strike these days to get a 30% pay increase. No, not 3%, not 13%, that’s right; 30%. Sound outrageous? Of course it’s outrageous. But they are just a Produkt ihrer Umwelt (a product of their environment), because the real outrage is how they are being paid right now.
These doctors work their 50 or even 60 hours a week just like everywhere else in the world (I guess) but get paid roughly 25% that of what an American doctor gets for doing the same job. They’re actually earning 7% less (proportionally) than they were in 1993. They’ve become a new type of Wirtschaftsflüchtling (economic refugee) and are leaving the country in droves (3000 German doctors have gone to England, for instance) and nobody wants to become a doctor in this country anymore. It’s said that only about 60% of the native medical students complete their studies here and a quarter of the ones who do go into pharmacy or insurance or some other medical-related field.
The new government’s Minister of Health (she was also the Minister of Health under the old government so she must be really good) says however that she has alles im Griff (everything under control) and won’t be blackmailed or led astray and her rigid cost-control measures (ha, ha) will continue and there will most certainly not be any increase in the outrageously high insurance payment rate all native workers have to pay here each month. Right. In six months tops they're going to raise that rate again and everybody knows it.
And that makes one wonder. Hmmmm. If the doctors aren’t getting all of this money that everybody has to shell out every month, who is? The hundreds of Krankenkassen (Health Insurance Agencies) for all of their redundant administrative costs (Japan has just one, for instance)? The Hospitals? They wouldn’t be pocketing all of this cash, now would they? And a native [German] would never go to a doctor if he didn't need to, right? And what about the pharmaceutical industry? Naah, not them. Forgive me. I don’t know what I was thinking just now.
Excerpt from here
The truth about WHO and AIDS: "If you're like most people I know, World AIDS Day passed you by last Thursday with scarcely a nod. And for good reason, because the World Health Organization, which sponsors the observance, is keeping a low profile these days. And well it should. Any way you look at it, the WHO effort to stop AIDS has been a dismal failure. In fact many believe the World Health Organization is actually making things worse. It was June 1981 when U.S. public health officials first reported a strange illness that afflicted six homosexual men. Who would have believed that nearly 25 years later, the deadly virus would be infecting 5 million new persons each year, and that a staggering 40 million persons -- 70% of whom live in Africa -- are now HIV-positive?"
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Wednesday, December 14, 2005
UTTER GARBAGE ABOUT HOMEOPATHY
'New study is boost to homeopathy' trumpets the BBC News headline on 21 November. According to the pull quote from Dr David Spence, 'These results clearly demonstrate the value of homeopathy in the NHS'.
The news release from the British Homeopathic Association is even more upbeat, claiming that 'Homeopathy improves health of 70 per cent of patients in hospital study' and quoting Dr Kim Jobst as saying that 'These are response rates with which any orthodox NHS medical health provider or pharmaceutical company would be justly pleased' .
Homeopathy, according to the British Homeopathic Association's website, ' works on the principle that "like treats like". An illness is treated with a medicine which could produce similar symptoms in a healthy person. The active ingredients are given in highly diluted form.. Prescribing is based on all aspects of a patient's condition. The patient's personality and lifestyle are important' (3). Critics say that the process of dilution with water means, in the British Homeopathic Association's own words, that 'it is highly unlikely that any single molecules of the original substance remain' in a given dose. The mechanism by which homeopathy is supposed to improve a patient's health remains mysterious.
Dr Kim Jobst is editor-in-chief of the Journal of Alternative and Complementary Medicine, which published the new study, a long-term observational study of over 6000 patients attending Bristol Homeopathic Hospital over six years (4). At each visit following the initial consultation, they were asked if they felt worse (or slightly worse, or much worse), better (or slightly or much better) or felt there had been no change. Only 23 per cent said there had been no change, with a total of 3.1 per cent feeling worse. Just over 50 per cent reported feeling 'better' or 'much better'.
But is this really conclusive proof that homeopathic treatment works? Every person in the trial had agreed to be referred to the homeopathic hospital, so all of them started with some belief that homeopathy could help them. There is no indication of how patients who had stopped attending felt about the treatment - and, let's face it, if you felt a treatment wasn't working, would you go back and say so, or would you just stop going? Especially in Bristol, where admitting you'd hurt a homeopath's feelings is the social equivalent of wearing fur at a vegetarian dinner.
More fundamentally, the study had no control group - that is, there is nothing against which to measure the results of the homeopathic treatment. It's as if you had a theory that feeding children nothing but cheese made them grow taller, so you fed all your children cheese, measured them after a year and said 'There - all of them have grown taller - proof that cheese works!'
Compare this to the standard of testing that we would expect for a new drug. A pharmaceutical company that wanted to put a new treatment on the market would first have to prove, not only that it was reasonably safe and that they were capable of manufacturing it to consistent levels of quality, but also that it worked. Tests would have to show, Richard Ley of the Association of the British Pharmaceutical Industry (ABPI) (5) tells me, that 'there is a scientifically measurable improvement in the patient's condition. A double-blind trial is very frequent, when neither the subjects nor the researchers know which is the placebo (6), so they cannot be influenced in their reading of the condition by their belief in the treatment'.
Much more here
PACIFIERS THE ANSWER TO SIDS!
Parents who give their sleeping babies dummies [pacifiers] during their first year of life cut the risk of cot death by more than 90 per cent. A study has found that using a dummy also seemed to counteract other factors linked to increased risk of sudden death, such as sleeping face-down or on their side, or parental smoking. The findings suggest dummies provide a much bigger protective effect than previously thought. However, dummies remain controversial.
Experts have warned previously that while dummies may reduce SIDS deaths, that benefit must be weighed against potential detrimental effects, including problems with breastfeeding and increased ear infections.
For the latest study, published online yesterday by the British Medical Journal, Californian researchers compared the sleep habits of 185 babies thought to have died from SIDS with 312 randomly selected other infants. The study found that using a dummy was associated with a 92per cent lower risk of death, regardless of the baby's sleeping position. Thumb-sucking was also associated with a 57 per cent lower risk. The authors of the study said the findings could not prove dummies caused the reduction, but the protective effect might stem from the bulky handle of dummies, which might help prevent suffocation by preventing the airway being blocked by soft bedding...
However, Terry Dwyer, one of Australia's leading experts on SIDS and director of Melbourne's Murdoch Childrens Research Institute, cautioned that the study was less relevant to Australia because advice that babies should sleep on their backs had been followed much more widely here than in the US. Ensuring a correct sleeping position remained the priority, he said. Fewer than 5 per cent of Australian babies now slept in other positions, and SIDS deaths had plunged from about 500 a year in 1991 to about 70. "We have already achieved this big effect - we do not need to look for alternatives the way they (the Americans) are," Professor Dwyer said.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
'New study is boost to homeopathy' trumpets the BBC News headline on 21 November. According to the pull quote from Dr David Spence, 'These results clearly demonstrate the value of homeopathy in the NHS'.
The news release from the British Homeopathic Association is even more upbeat, claiming that 'Homeopathy improves health of 70 per cent of patients in hospital study' and quoting Dr Kim Jobst as saying that 'These are response rates with which any orthodox NHS medical health provider or pharmaceutical company would be justly pleased' .
Homeopathy, according to the British Homeopathic Association's website, ' works on the principle that "like treats like". An illness is treated with a medicine which could produce similar symptoms in a healthy person. The active ingredients are given in highly diluted form.. Prescribing is based on all aspects of a patient's condition. The patient's personality and lifestyle are important' (3). Critics say that the process of dilution with water means, in the British Homeopathic Association's own words, that 'it is highly unlikely that any single molecules of the original substance remain' in a given dose. The mechanism by which homeopathy is supposed to improve a patient's health remains mysterious.
Dr Kim Jobst is editor-in-chief of the Journal of Alternative and Complementary Medicine, which published the new study, a long-term observational study of over 6000 patients attending Bristol Homeopathic Hospital over six years (4). At each visit following the initial consultation, they were asked if they felt worse (or slightly worse, or much worse), better (or slightly or much better) or felt there had been no change. Only 23 per cent said there had been no change, with a total of 3.1 per cent feeling worse. Just over 50 per cent reported feeling 'better' or 'much better'.
But is this really conclusive proof that homeopathic treatment works? Every person in the trial had agreed to be referred to the homeopathic hospital, so all of them started with some belief that homeopathy could help them. There is no indication of how patients who had stopped attending felt about the treatment - and, let's face it, if you felt a treatment wasn't working, would you go back and say so, or would you just stop going? Especially in Bristol, where admitting you'd hurt a homeopath's feelings is the social equivalent of wearing fur at a vegetarian dinner.
More fundamentally, the study had no control group - that is, there is nothing against which to measure the results of the homeopathic treatment. It's as if you had a theory that feeding children nothing but cheese made them grow taller, so you fed all your children cheese, measured them after a year and said 'There - all of them have grown taller - proof that cheese works!'
Compare this to the standard of testing that we would expect for a new drug. A pharmaceutical company that wanted to put a new treatment on the market would first have to prove, not only that it was reasonably safe and that they were capable of manufacturing it to consistent levels of quality, but also that it worked. Tests would have to show, Richard Ley of the Association of the British Pharmaceutical Industry (ABPI) (5) tells me, that 'there is a scientifically measurable improvement in the patient's condition. A double-blind trial is very frequent, when neither the subjects nor the researchers know which is the placebo (6), so they cannot be influenced in their reading of the condition by their belief in the treatment'.
Much more here
PACIFIERS THE ANSWER TO SIDS!
Parents who give their sleeping babies dummies [pacifiers] during their first year of life cut the risk of cot death by more than 90 per cent. A study has found that using a dummy also seemed to counteract other factors linked to increased risk of sudden death, such as sleeping face-down or on their side, or parental smoking. The findings suggest dummies provide a much bigger protective effect than previously thought. However, dummies remain controversial.
Experts have warned previously that while dummies may reduce SIDS deaths, that benefit must be weighed against potential detrimental effects, including problems with breastfeeding and increased ear infections.
For the latest study, published online yesterday by the British Medical Journal, Californian researchers compared the sleep habits of 185 babies thought to have died from SIDS with 312 randomly selected other infants. The study found that using a dummy was associated with a 92per cent lower risk of death, regardless of the baby's sleeping position. Thumb-sucking was also associated with a 57 per cent lower risk. The authors of the study said the findings could not prove dummies caused the reduction, but the protective effect might stem from the bulky handle of dummies, which might help prevent suffocation by preventing the airway being blocked by soft bedding...
However, Terry Dwyer, one of Australia's leading experts on SIDS and director of Melbourne's Murdoch Childrens Research Institute, cautioned that the study was less relevant to Australia because advice that babies should sleep on their backs had been followed much more widely here than in the US. Ensuring a correct sleeping position remained the priority, he said. Fewer than 5 per cent of Australian babies now slept in other positions, and SIDS deaths had plunged from about 500 a year in 1991 to about 70. "We have already achieved this big effect - we do not need to look for alternatives the way they (the Americans) are," Professor Dwyer said.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Tuesday, December 13, 2005
Gutless officialdom again -- and deaths result
This nonsense should have been knocked on the head immediately but what bureaucrat ever knocked anything on the head?
A stoush [fight] between ambulance Triple-0 operators has left critically ill patients to die, according to paramedics. The battle between call centres over who should take emergency calls has led to several Queensland Ambulance Service staff being disciplined and fined, following a long external investigation.
Problems began when the ambulance communications centre at Maroochydore had to answer overflow Triple-0 calls from Brisbane. Maroochydore staff were meant to take details and send the jobs back to Brisbane for an ambulance to be dispatched. But paramedic sources say Maroochydore staff became angry that Triple-0 calls were not answered by Brisbane colleagues at meal time and shift changes. In turn, Brisbane staff - upset because they claimed more resources went to the Sunshine Coast centre - deliberately diverted some Triple-0 calls to Maroochydore. That had led to a "tit-for-tat battle" between the regions, with calls not being answered promptly by either centre.
The problem surfaced last year and Maroochydore staff became the focus of a QAS investigation. A source said three staff were recently demoted and fined. "The penalty is way outside anything ever handed down before," the source said. But no Brisbane staff, nor management in either centre, were seriously criticised - angering many within the ambulance service. "It is a disgrace how the people of Brisbane are dealt with," one frontline paramedic, who declined to be identified, told The Sunday Mail this week. "We know of cases where people have died before an ambulance reached them in time because Brisbane communications are so inefficient. "It is a shocking state of affairs . . . patients are at risk."
The informant said a lack of funding for ambulance communication centres had also contributed to the problems. "Workload goes up continuously, extra paramedics are promised by government for road duties, but communication centres are being driven into the ground."
A spokesman for Ambulance Commissioner Jim Higgins confirmed disciplinary action was being taken against officers involved in the communications problem. He said QAS became aware in December 2004 of "discrepancies" in Triple-0 overload calls from Brisbane going to Maroochydore. "The disciplinary process is ongoing so it is inappropriate to comment further." The spokesman could not say how many patients in Brisbane had not been treated appropriately because of ambulance delays. He said QAS dealt with complaints against management but would not discuss individual cases because of confidentiality provisions. Emergency Services Minister Pat Purcell had not been briefed on the issue, but his predecessor Chris Cummins knew of the problems.
Opposition Leader Lawrence Springborg said: "This case puts in serious doubt the Government's on-going claims over impressive response times for emergency calls." Media reports last month said thousands of Triple-0 calls to Queensland police were unanswered each year because of an outdated communications system.
Source
In Medicare, $170 million savings for Raytheon: "Raytheon Co. will save $170 million by using a new Medicare plan to shift some expenses for retirees' prescriptions to taxpayers. The change also will provide savings to retirees. Many retirees found out last week that their monthly premiums for health coverage will drop. The decline is expected to amount to more than 50 percent, to $60 from $125. The Waltham defense contractor said that under its new benefits package, retirees will receive prescription coverage primarily through the new Medicare drug plan, which is scheduled to take effect on Jan. 1. ... 'There's a reduction in the cost because somebody else is paying for the drug benefits,' said Ched Miller, the company's manager of retiree benefits. 'Not the retirees, and not Raytheon.'"
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
This nonsense should have been knocked on the head immediately but what bureaucrat ever knocked anything on the head?
A stoush [fight] between ambulance Triple-0 operators has left critically ill patients to die, according to paramedics. The battle between call centres over who should take emergency calls has led to several Queensland Ambulance Service staff being disciplined and fined, following a long external investigation.
Problems began when the ambulance communications centre at Maroochydore had to answer overflow Triple-0 calls from Brisbane. Maroochydore staff were meant to take details and send the jobs back to Brisbane for an ambulance to be dispatched. But paramedic sources say Maroochydore staff became angry that Triple-0 calls were not answered by Brisbane colleagues at meal time and shift changes. In turn, Brisbane staff - upset because they claimed more resources went to the Sunshine Coast centre - deliberately diverted some Triple-0 calls to Maroochydore. That had led to a "tit-for-tat battle" between the regions, with calls not being answered promptly by either centre.
The problem surfaced last year and Maroochydore staff became the focus of a QAS investigation. A source said three staff were recently demoted and fined. "The penalty is way outside anything ever handed down before," the source said. But no Brisbane staff, nor management in either centre, were seriously criticised - angering many within the ambulance service. "It is a disgrace how the people of Brisbane are dealt with," one frontline paramedic, who declined to be identified, told The Sunday Mail this week. "We know of cases where people have died before an ambulance reached them in time because Brisbane communications are so inefficient. "It is a shocking state of affairs . . . patients are at risk."
The informant said a lack of funding for ambulance communication centres had also contributed to the problems. "Workload goes up continuously, extra paramedics are promised by government for road duties, but communication centres are being driven into the ground."
A spokesman for Ambulance Commissioner Jim Higgins confirmed disciplinary action was being taken against officers involved in the communications problem. He said QAS became aware in December 2004 of "discrepancies" in Triple-0 overload calls from Brisbane going to Maroochydore. "The disciplinary process is ongoing so it is inappropriate to comment further." The spokesman could not say how many patients in Brisbane had not been treated appropriately because of ambulance delays. He said QAS dealt with complaints against management but would not discuss individual cases because of confidentiality provisions. Emergency Services Minister Pat Purcell had not been briefed on the issue, but his predecessor Chris Cummins knew of the problems.
Opposition Leader Lawrence Springborg said: "This case puts in serious doubt the Government's on-going claims over impressive response times for emergency calls." Media reports last month said thousands of Triple-0 calls to Queensland police were unanswered each year because of an outdated communications system.
Source
In Medicare, $170 million savings for Raytheon: "Raytheon Co. will save $170 million by using a new Medicare plan to shift some expenses for retirees' prescriptions to taxpayers. The change also will provide savings to retirees. Many retirees found out last week that their monthly premiums for health coverage will drop. The decline is expected to amount to more than 50 percent, to $60 from $125. The Waltham defense contractor said that under its new benefits package, retirees will receive prescription coverage primarily through the new Medicare drug plan, which is scheduled to take effect on Jan. 1. ... 'There's a reduction in the cost because somebody else is paying for the drug benefits,' said Ched Miller, the company's manager of retiree benefits. 'Not the retirees, and not Raytheon.'"
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Monday, December 12, 2005
N.S.W. (Australia) public hospitals: Health rebels' charter to save lives
More than 70 prominent doctors and nurses have joined forces to push for sweeping changes in the public hospital system. The rebels say many hospitals in NSW are unsafe, understaffed and dying because they are unaffordable in their current state. They say the problems are now so bad they are prepared to defy the State Government and force a public debate on the thorny issue of the viability of emergency departments in small hospitals.
The Hospital Reform Group, made up of some of NSW's most senior and respected clinicians, believes the Government has accepted the system is unsustainable but will not admit it for fear of a voter backlash. Today the rebels take their manifesto directly to the public, saying the public's expectations of health care have been unreasonably raised by politicians more intent on retaining seats than dealing with reality. Their plan to save the system requires drastic changes, such as a reclassification of jobs in the hospital sector and the possible closure of some small emergency departments, which will bring them into conflict with the public, the Government and the Australian Medical Association.
The rebels say bandaid solutions are no longer an option if hospitals are to provide safe and accessible services. One of their demands is the assessment of smaller emergency departments for either closure or revamping as GP-style care clinics, so resources can be better spread throughout the system. "We need to address unrealistic and unaffordable expectations with honesty, transparency and creativity. There is not enough money to meet the community's expectations of health care," their manifesto says. "The provision of all available hospital services in all areas of the state is no longer possible, or in the best interests of the community."
One of the rebels, Kerry Goulston, a gastroenterologist and emeritus professor at Sydney University, said: "We can't keep 35 emergency departments going in greater Sydney, staffing them as we think they should be staffed, and we have to tell the public that. Very few people have stood up and said, 'Hey, we have one of the best health systems in the world but it exists on the goodwill of the people working in it.' "
Another rebel, Brad Frankum, director of medicine at Campbelltown and Camden hospitals, said the public had to face reality. "The argument that 'we have had a hospital in that town for 100 years, we do not want to see it close' is really a sentimental argument, rather than one focused on caring for sick people. The reality of public hospitals is harsh; the over-reliance on locum staff is an unavoidable issue, and until there is political will to start moving resources out to the west and south and developing areas, we are better off not having a facility than having an unsafe, understaffed one."
The reform group says hospitals should be better integrated with primary and community care and other health services. Governments and health departments must also develop ways of stemming the steady flow of clinicians from the public to the private sector. The group says human resources are spread too thinly and too unevenly and that staff shortages are only going to worsen.....
Source
Is Big Brother planning to tag and track drugs?: "Since the federal government now is the largest payer for health care in the United States, it has the ability to coerce physicians into implementing anti-privacy practices they might not set up in a truly free-market system. Citizens should watch to make sure the federal government does not use its Medicare muscle to apply financial penalties to physicians who do not write electronic prescriptions. All told, a national mandatory (or coerced) electronic prescribing system would make it much easier for Big Brother to tag and track citizens' use of prescription drugs."
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
More than 70 prominent doctors and nurses have joined forces to push for sweeping changes in the public hospital system. The rebels say many hospitals in NSW are unsafe, understaffed and dying because they are unaffordable in their current state. They say the problems are now so bad they are prepared to defy the State Government and force a public debate on the thorny issue of the viability of emergency departments in small hospitals.
The Hospital Reform Group, made up of some of NSW's most senior and respected clinicians, believes the Government has accepted the system is unsustainable but will not admit it for fear of a voter backlash. Today the rebels take their manifesto directly to the public, saying the public's expectations of health care have been unreasonably raised by politicians more intent on retaining seats than dealing with reality. Their plan to save the system requires drastic changes, such as a reclassification of jobs in the hospital sector and the possible closure of some small emergency departments, which will bring them into conflict with the public, the Government and the Australian Medical Association.
The rebels say bandaid solutions are no longer an option if hospitals are to provide safe and accessible services. One of their demands is the assessment of smaller emergency departments for either closure or revamping as GP-style care clinics, so resources can be better spread throughout the system. "We need to address unrealistic and unaffordable expectations with honesty, transparency and creativity. There is not enough money to meet the community's expectations of health care," their manifesto says. "The provision of all available hospital services in all areas of the state is no longer possible, or in the best interests of the community."
One of the rebels, Kerry Goulston, a gastroenterologist and emeritus professor at Sydney University, said: "We can't keep 35 emergency departments going in greater Sydney, staffing them as we think they should be staffed, and we have to tell the public that. Very few people have stood up and said, 'Hey, we have one of the best health systems in the world but it exists on the goodwill of the people working in it.' "
Another rebel, Brad Frankum, director of medicine at Campbelltown and Camden hospitals, said the public had to face reality. "The argument that 'we have had a hospital in that town for 100 years, we do not want to see it close' is really a sentimental argument, rather than one focused on caring for sick people. The reality of public hospitals is harsh; the over-reliance on locum staff is an unavoidable issue, and until there is political will to start moving resources out to the west and south and developing areas, we are better off not having a facility than having an unsafe, understaffed one."
The reform group says hospitals should be better integrated with primary and community care and other health services. Governments and health departments must also develop ways of stemming the steady flow of clinicians from the public to the private sector. The group says human resources are spread too thinly and too unevenly and that staff shortages are only going to worsen.....
Source
Is Big Brother planning to tag and track drugs?: "Since the federal government now is the largest payer for health care in the United States, it has the ability to coerce physicians into implementing anti-privacy practices they might not set up in a truly free-market system. Citizens should watch to make sure the federal government does not use its Medicare muscle to apply financial penalties to physicians who do not write electronic prescriptions. All told, a national mandatory (or coerced) electronic prescribing system would make it much easier for Big Brother to tag and track citizens' use of prescription drugs."
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Sunday, December 11, 2005
HOW MODERN-DAY BRITAIN TREATS ITS HEROES
One of the most decorated British fighter pilots of the Second World War has sold his medals, diaries and other memorabilia partly to pay for a hip replacement operation for his wife who faced at least a six-month wait on the National Health Service. Sqn Ldr Neville Duke, 83, the Royal Air Force's top-scoring ace in the Mediterranean theatre who set a world air speed record of 728 mph in 1953, put the collection up for auction rather than subject his wife Gwen to months of pain and discomfort while she waited for an operation.
The standard waiting time for hip replacements in the orthopaedic department at the Royal Bournemouth Hospital, one of the nearest facilities to the Dukes' home, is six months. Mrs Duke, who has been in pain with her hip for eight months, was told by her chiropractor that the wait might be 15 months.
Before the sale Mrs Duke, 85, explained: "It is very likely I will need a new hip and that is something we just cannot afford. If I went on a NHS waiting list I would have to wait forever, and at my age that's no good. 'By selling Neville's things we will be able to pay for the hip. We pulled out of BUPA because they practically doubled the rate when we reached 60. "There are other important reasons, such as security, for selling. He's very upset about it." In the event, the auction at Dix Noonan Webb in Mayfair raised œ138,000, some œ8,000 of which would be required for an operation. The medals went to a private British collector.
Sqn Ldr Duke's DSO, awarded in the field after he shot down seven enemy aircraft in seven days, DFC and two bars, Air Force Cross and OBE for his achievements as a test pilot for Hawker form one of the finest collections of medals accrued by a pilot of his generation. The lots also included the ripcord he pulled when he baled out for the second time in the war and came near to drowning in an Italian lake after almost falling out of his harness. Sqn Ldr Duke said the decision to sell the medals was a hard one but had been forced upon him by worries about his wife's condition, security at the family home following three burglaries, the cost of insuring the collection and the desire to keep it together, the couple having no children....
Still an active pilot after 65 years, Sqn Ldr Duke flew 485 sorties in the war, shooting down 27 aircraft and sharing two more kills, a performance that placed him in the league of pilots such as "Bob" Stanford Tuck and second only to "Johnnie" Johnson. During his tour in North Africa he was shot down by the Luftwaffe ace Otto Schulz, but managed to crash land. In September 1953 he took the world air speed record from the Americans when his all-red Hawker Hunter reached 728 mph over Tangmere, Kent.
More here
Queensland public hospitals: Negligent health bureaucrat forced out
Another bureaucrat at the centre of Bundaberg's Dr Patel scandal may escape disciplinary action after resigning from Queensland Health. Peter Leck quit his position as Bundaberg district health manager on Wednesday. He had been facing misconduct charges for ignoring concerns about Indian-trained surgeon Jayant Patel, who was found to have contributed to at least 13 deaths at Bundaberg Base Hospital.
Mr Leck is the second bureaucrat to quit his post after having adverse findings made against him. Darren Keating, the hospital's former director of medical services, left Queensland Health last month.
However, the Davies report into the saga, handed down last week, recommended he still face criminal charges. A Crime and Misconduct Commission spokeswoman said the body was considering its options over Mr Leck. But it was not pursuing Dr Keating, she said.
Bundaberg victims support group spokeswoman Beryl Crosby said Dr Patel's former patients would be angry if Mr Leck escaped charges. "We rollercoaster ride all the way through this but they were really, really coming to terms the other day that justice was seen to be done," she told ABC Radio today. "But they're going to be very, very upset if he gets off scot free out of this."
Opposition Leader Lawrence Springborg said he was not surprised Mr Leck had also resigned. "He slipped through the net now because he will not be able to be prosecuted for official misconduct, or any of those provisions that you would expect public servants to be ... disciplined for," he said.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
One of the most decorated British fighter pilots of the Second World War has sold his medals, diaries and other memorabilia partly to pay for a hip replacement operation for his wife who faced at least a six-month wait on the National Health Service. Sqn Ldr Neville Duke, 83, the Royal Air Force's top-scoring ace in the Mediterranean theatre who set a world air speed record of 728 mph in 1953, put the collection up for auction rather than subject his wife Gwen to months of pain and discomfort while she waited for an operation.
The standard waiting time for hip replacements in the orthopaedic department at the Royal Bournemouth Hospital, one of the nearest facilities to the Dukes' home, is six months. Mrs Duke, who has been in pain with her hip for eight months, was told by her chiropractor that the wait might be 15 months.
Before the sale Mrs Duke, 85, explained: "It is very likely I will need a new hip and that is something we just cannot afford. If I went on a NHS waiting list I would have to wait forever, and at my age that's no good. 'By selling Neville's things we will be able to pay for the hip. We pulled out of BUPA because they practically doubled the rate when we reached 60. "There are other important reasons, such as security, for selling. He's very upset about it." In the event, the auction at Dix Noonan Webb in Mayfair raised œ138,000, some œ8,000 of which would be required for an operation. The medals went to a private British collector.
Sqn Ldr Duke's DSO, awarded in the field after he shot down seven enemy aircraft in seven days, DFC and two bars, Air Force Cross and OBE for his achievements as a test pilot for Hawker form one of the finest collections of medals accrued by a pilot of his generation. The lots also included the ripcord he pulled when he baled out for the second time in the war and came near to drowning in an Italian lake after almost falling out of his harness. Sqn Ldr Duke said the decision to sell the medals was a hard one but had been forced upon him by worries about his wife's condition, security at the family home following three burglaries, the cost of insuring the collection and the desire to keep it together, the couple having no children....
Still an active pilot after 65 years, Sqn Ldr Duke flew 485 sorties in the war, shooting down 27 aircraft and sharing two more kills, a performance that placed him in the league of pilots such as "Bob" Stanford Tuck and second only to "Johnnie" Johnson. During his tour in North Africa he was shot down by the Luftwaffe ace Otto Schulz, but managed to crash land. In September 1953 he took the world air speed record from the Americans when his all-red Hawker Hunter reached 728 mph over Tangmere, Kent.
More here
Queensland public hospitals: Negligent health bureaucrat forced out
Another bureaucrat at the centre of Bundaberg's Dr Patel scandal may escape disciplinary action after resigning from Queensland Health. Peter Leck quit his position as Bundaberg district health manager on Wednesday. He had been facing misconduct charges for ignoring concerns about Indian-trained surgeon Jayant Patel, who was found to have contributed to at least 13 deaths at Bundaberg Base Hospital.
Mr Leck is the second bureaucrat to quit his post after having adverse findings made against him. Darren Keating, the hospital's former director of medical services, left Queensland Health last month.
However, the Davies report into the saga, handed down last week, recommended he still face criminal charges. A Crime and Misconduct Commission spokeswoman said the body was considering its options over Mr Leck. But it was not pursuing Dr Keating, she said.
Bundaberg victims support group spokeswoman Beryl Crosby said Dr Patel's former patients would be angry if Mr Leck escaped charges. "We rollercoaster ride all the way through this but they were really, really coming to terms the other day that justice was seen to be done," she told ABC Radio today. "But they're going to be very, very upset if he gets off scot free out of this."
Opposition Leader Lawrence Springborg said he was not surprised Mr Leck had also resigned. "He slipped through the net now because he will not be able to be prosecuted for official misconduct, or any of those provisions that you would expect public servants to be ... disciplined for," he said.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Saturday, December 10, 2005
WHAT HAPPENS WHEN THE GOVERNMENT IS YOUR HEALTH INSURER: TREATMENT CAN BE DENIED IF YOU ARE "BAD" IN BRITAIN
Of course it is all dressed up as a claim that treatment would be "ineffective" for you
Smokers, drinkers and the seriously overweight may be denied medical treatment if their lifestyle makes it ineffective, the Government’s treatment watchdog said yesterday. The National Institute for Health and Clinical Excellence (NICE) said that doctors who considered that a particular treatment might not be effective, or cost-effective, because of the lifestyle of the patient, may be entitled to withhold it. However, doctors should not discriminate on the ground that a disease was self-inflicted. Even those who had brought their problems on themselves deserved treatment. It makes clear, to the delight of campaigners, that discrimination on the ground of age alone is equally unacceptable. However, when a patient’s age affects the chances that a treatment will work, it can be taken into account.
The new guidance seems certain to be cited in cases such as the recent ruling by three primary care trusts in East Suffolk that obese patients could not have hip or knee transplants. The trusts were widely criticised, but could now use the NICE guidance in their defence — arguing that operations are less safe for the obese, and that for such patients hip and knee implants are less effective as they wear out sooner. The guidance could also be cited when heavy drinkers seek liver transplants, or when smokers need heart bypass operations. In each case, the intervention would be rendered less effective by the habit.
The NICE guidance, which is still in draft form, was developed by its citizens council, a group of people who offer advice on a wide range of social issues. But it was finalised by the NICE board. Vivienne Nathanson, the head of science and ethics at the British Medical Association, said that the guidance reinforced what had always been good medical practice. “I am delighted that NICE has not proposed a blanket ban on some treatments for some groups of people,” Dr Nathanson said. “That would have been wholly unacceptable. It would also be wrong if this guidance were to be used to ration healthcare. The judgment should always be, ‘Does this person need treatment?’ and ‘Will this treatment be of benefit?’ Every case should be considerd on an individual basis.”
The NICE report said that it could be difficult to determine whether someone’s illness was self-inflicted or not. There was no way of knowing, for example, whether smokers who had a heart attack would have suffered one had they not smoked. As a result, it said, NICE should avoid discriminating against patients with conditions that are, or may be, self- inflicted. But it added: “A patient’s individual circumstances may only be taken into account when there will be an impact on the clinical and cost-effectiveness of the treatment.”
The report, Social Value Judgments: Principles for the Development of NICE Guidance — considered whether social background, age or lifestyle choices should ever influence the care provided by the NHS. It concluded that clinical guidance should recommend a treatment for a particular age group only where there was clear evidence of a difference in the treatment’s effectiveness for that age group
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Of course it is all dressed up as a claim that treatment would be "ineffective" for you
Smokers, drinkers and the seriously overweight may be denied medical treatment if their lifestyle makes it ineffective, the Government’s treatment watchdog said yesterday. The National Institute for Health and Clinical Excellence (NICE) said that doctors who considered that a particular treatment might not be effective, or cost-effective, because of the lifestyle of the patient, may be entitled to withhold it. However, doctors should not discriminate on the ground that a disease was self-inflicted. Even those who had brought their problems on themselves deserved treatment. It makes clear, to the delight of campaigners, that discrimination on the ground of age alone is equally unacceptable. However, when a patient’s age affects the chances that a treatment will work, it can be taken into account.
The new guidance seems certain to be cited in cases such as the recent ruling by three primary care trusts in East Suffolk that obese patients could not have hip or knee transplants. The trusts were widely criticised, but could now use the NICE guidance in their defence — arguing that operations are less safe for the obese, and that for such patients hip and knee implants are less effective as they wear out sooner. The guidance could also be cited when heavy drinkers seek liver transplants, or when smokers need heart bypass operations. In each case, the intervention would be rendered less effective by the habit.
The NICE guidance, which is still in draft form, was developed by its citizens council, a group of people who offer advice on a wide range of social issues. But it was finalised by the NICE board. Vivienne Nathanson, the head of science and ethics at the British Medical Association, said that the guidance reinforced what had always been good medical practice. “I am delighted that NICE has not proposed a blanket ban on some treatments for some groups of people,” Dr Nathanson said. “That would have been wholly unacceptable. It would also be wrong if this guidance were to be used to ration healthcare. The judgment should always be, ‘Does this person need treatment?’ and ‘Will this treatment be of benefit?’ Every case should be considerd on an individual basis.”
The NICE report said that it could be difficult to determine whether someone’s illness was self-inflicted or not. There was no way of knowing, for example, whether smokers who had a heart attack would have suffered one had they not smoked. As a result, it said, NICE should avoid discriminating against patients with conditions that are, or may be, self- inflicted. But it added: “A patient’s individual circumstances may only be taken into account when there will be an impact on the clinical and cost-effectiveness of the treatment.”
The report, Social Value Judgments: Principles for the Development of NICE Guidance — considered whether social background, age or lifestyle choices should ever influence the care provided by the NHS. It concluded that clinical guidance should recommend a treatment for a particular age group only where there was clear evidence of a difference in the treatment’s effectiveness for that age group
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Friday, December 09, 2005
POMPOUS FOOL IGNORES THE PROBLEM OF METASTASIZING BUREAUCRACY IN BRITISH HEALTH
THE National Health Service is not "unravelling", its chief executive insisted yesterday. Despite staff layoffs, mounting deficits and an official policy of delaying operations to save money, Sir Nigel Crisp presented an upbeat report on NHS performance. But, acknowledging the financial squall that the service was facing despite six years of unprecedented cash increases, Sir Nigel admitted that deficits could get bigger if action were not taken now to control them. "When you are introducing change you will inevitably have some degree of turbulence," he said. "The underlying picture here is that 70 per cent of the NHS has got its finances under control. Certain areas need to control finances better."
Last year the NHS finished with a deficit of 250 million pounds, and this year is heading for a 620 million pound shortfall. But by the end of the financial year Sir Nigel expected it to be nearer 200 million. "The most important thing we need to do in the short term is to get to grips with [the deficit] because it could get bigger," he said.
His remarks came after Patricia Hewitt, the Health Secretary, defended the policy adopted by some trusts of delaying treatments until the last minute to reduce spending. Sir Nigel said that this merely meant that there would be a slowing in the rate at which the NHS was getting better. "It is not unravelling at all," he said.
However, there are some signs of a loss of nerve. Three strategic health authorities - those covering Hampshire, Surrey, Oxfordshire, Berkshire and Buckinghamshire - have partially suspended "payment by results", a central plank in the current reform platform. They fear that paying hospitals for how many patients they treat will cause further instability. Hampshire and Isle of Wight Strategic Health Authority projects a 24 million pound deficit, Surrey and Sussex 41 million. Payment by results is due to apply to 80 per cent of hospital procedures by next April. On January 1, another potentially destabilising policy, patient choice, will be introduced across the NHS.
"Waiting lists are continuing to fall, absolutely on target," Sir Nigel said. "More patients are being treated, and 190,000 more frontline staff. It is a turning-point." Sir Nigel also claimed to have improved quality and value for money, reduced overheads and encouraged innovative ways of offering treatment. So why, in the seventh year of above-inflation increases, was it necessary to make cuts to balance the books? His explanation was that in some areas increasing capacity had got ahead of the capacity to pay for it.
The opposition parties saw the situation differently. Andrew Lansley, the Shadow Health Secretary, said: "The reality on the ground is very different. Across the country, frontline services are being cut and waiting times extended because of deficits. Yet the chief executive's report fails to acknowledge this. "People across the NHS are delivering to the best of their ability, but hampered by targets, bureaucracy and deficits."
Steve Webb, the Liberal Democrat spokesman on health, said: "These cuts are a direct consequence of the Government's market reforms causing financial instability." Niall Dickson, chief executive of The King's Fund, said that the NHS faced real financial problems and that patient services would suffer unless the Government dealt with hospital failures better
Source
A FRANKER ASSESSMENT
The emergence of huge deficits in the NHS after eight years in which funding has more than doubled, to 72 billion pounds, will inflame concern over whether ministers are securing the promised "bang for the billions" being injected into public services. Yet official government statistics show that the vast extra resources pumped into health, education, transport and the rest have produced only modest improvements in the measured delivery of services.
By the end of this financial year, public spending will have breached the 500-billion pounds-a-year barrier for the first time, rising from 330 billion when Labour came to power. It will have leapt in real terms by 13 per cent in only three years. But official estimates show that much of the new cash has been eaten up in increased costs as public sector inflation has climbed far faster than that in the rest of the economy, while productivity has steadily declined.
This resulted in a flurry of new assessments of public sector performance after an inquiry led by Sir Tony Atkinson, Warden of Nuffield College, Oxford. These more rigorous methods of calculation have demonstrated that output of public services is estimated to have risen faster than demonstrated in original assessments. For example, from 2001 to 2003, output of health services rose 3.7 per cent - up from 2 to 2.5 per cent a year that was previously reported.
Yet for every 100 pounds of extra funding going into the NHS, for example, between 52 and 56 pounds has been taken up by higher pay and costs, between 3 and 9 pounds has disappeared in diminished efficiency as productivity has fallen, and only the remaining 35 pounds or so has fed through into real increases in services to the public. Health service productivity is estimated to have tumbled by between 3 and 8 per cent since 1995.
Thus, on the highest figure, if the NHS were as efficient as a decade ago it could produce the same results for patients this year with a budget about 6 billion lower than what will actually be spent. The Office for National Statistics is pressing ahead with efforts to improve the calculations. But the pattern of declining productivity, rising costs and limited return on public cash invested is repeated across the public sector, including in education.
Ministers can argue that while much of the extra money has gone in higher pay and costs, increased pay for key frontline workers in health and education was a necessary part of the prescription of improved services. However, critics argue that the Government has not always imposed sufficient reforms to ensure that higher pay goes hand in hand with improved performance. Official figures also show that 66 per cent more support and administration staff have been hired in the NHS since 1998
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
THE National Health Service is not "unravelling", its chief executive insisted yesterday. Despite staff layoffs, mounting deficits and an official policy of delaying operations to save money, Sir Nigel Crisp presented an upbeat report on NHS performance. But, acknowledging the financial squall that the service was facing despite six years of unprecedented cash increases, Sir Nigel admitted that deficits could get bigger if action were not taken now to control them. "When you are introducing change you will inevitably have some degree of turbulence," he said. "The underlying picture here is that 70 per cent of the NHS has got its finances under control. Certain areas need to control finances better."
Last year the NHS finished with a deficit of 250 million pounds, and this year is heading for a 620 million pound shortfall. But by the end of the financial year Sir Nigel expected it to be nearer 200 million. "The most important thing we need to do in the short term is to get to grips with [the deficit] because it could get bigger," he said.
His remarks came after Patricia Hewitt, the Health Secretary, defended the policy adopted by some trusts of delaying treatments until the last minute to reduce spending. Sir Nigel said that this merely meant that there would be a slowing in the rate at which the NHS was getting better. "It is not unravelling at all," he said.
However, there are some signs of a loss of nerve. Three strategic health authorities - those covering Hampshire, Surrey, Oxfordshire, Berkshire and Buckinghamshire - have partially suspended "payment by results", a central plank in the current reform platform. They fear that paying hospitals for how many patients they treat will cause further instability. Hampshire and Isle of Wight Strategic Health Authority projects a 24 million pound deficit, Surrey and Sussex 41 million. Payment by results is due to apply to 80 per cent of hospital procedures by next April. On January 1, another potentially destabilising policy, patient choice, will be introduced across the NHS.
"Waiting lists are continuing to fall, absolutely on target," Sir Nigel said. "More patients are being treated, and 190,000 more frontline staff. It is a turning-point." Sir Nigel also claimed to have improved quality and value for money, reduced overheads and encouraged innovative ways of offering treatment. So why, in the seventh year of above-inflation increases, was it necessary to make cuts to balance the books? His explanation was that in some areas increasing capacity had got ahead of the capacity to pay for it.
The opposition parties saw the situation differently. Andrew Lansley, the Shadow Health Secretary, said: "The reality on the ground is very different. Across the country, frontline services are being cut and waiting times extended because of deficits. Yet the chief executive's report fails to acknowledge this. "People across the NHS are delivering to the best of their ability, but hampered by targets, bureaucracy and deficits."
Steve Webb, the Liberal Democrat spokesman on health, said: "These cuts are a direct consequence of the Government's market reforms causing financial instability." Niall Dickson, chief executive of The King's Fund, said that the NHS faced real financial problems and that patient services would suffer unless the Government dealt with hospital failures better
Source
A FRANKER ASSESSMENT
The emergence of huge deficits in the NHS after eight years in which funding has more than doubled, to 72 billion pounds, will inflame concern over whether ministers are securing the promised "bang for the billions" being injected into public services. Yet official government statistics show that the vast extra resources pumped into health, education, transport and the rest have produced only modest improvements in the measured delivery of services.
By the end of this financial year, public spending will have breached the 500-billion pounds-a-year barrier for the first time, rising from 330 billion when Labour came to power. It will have leapt in real terms by 13 per cent in only three years. But official estimates show that much of the new cash has been eaten up in increased costs as public sector inflation has climbed far faster than that in the rest of the economy, while productivity has steadily declined.
This resulted in a flurry of new assessments of public sector performance after an inquiry led by Sir Tony Atkinson, Warden of Nuffield College, Oxford. These more rigorous methods of calculation have demonstrated that output of public services is estimated to have risen faster than demonstrated in original assessments. For example, from 2001 to 2003, output of health services rose 3.7 per cent - up from 2 to 2.5 per cent a year that was previously reported.
Yet for every 100 pounds of extra funding going into the NHS, for example, between 52 and 56 pounds has been taken up by higher pay and costs, between 3 and 9 pounds has disappeared in diminished efficiency as productivity has fallen, and only the remaining 35 pounds or so has fed through into real increases in services to the public. Health service productivity is estimated to have tumbled by between 3 and 8 per cent since 1995.
Thus, on the highest figure, if the NHS were as efficient as a decade ago it could produce the same results for patients this year with a budget about 6 billion lower than what will actually be spent. The Office for National Statistics is pressing ahead with efforts to improve the calculations. But the pattern of declining productivity, rising costs and limited return on public cash invested is repeated across the public sector, including in education.
Ministers can argue that while much of the extra money has gone in higher pay and costs, increased pay for key frontline workers in health and education was a necessary part of the prescription of improved services. However, critics argue that the Government has not always imposed sufficient reforms to ensure that higher pay goes hand in hand with improved performance. Official figures also show that 66 per cent more support and administration staff have been hired in the NHS since 1998
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Thursday, December 08, 2005
More babies die in larger Australian public hospitals
Babies born in large city hospitals are more likely to die in their first month than those born in smaller rural centres, a comprehensive analysis of Australian births has revealed. The findings have prompted experts to call for a "complete rethink" of maternity service planning across the country. The researchers for the study, which was reported yesterday in an international journal, say the findings prove smaller centres are safe - and undermine fears about quality that have led state governments to close scores of small maternity units nationwide in the past decade.
Study co-author Sally Tracy, a senior research fellow at the National Perinatal Statistics Unit at the University of NSW, said that over the past 10 years "at least half" of the smaller rural maternity units across the country had been closed on safety grounds. "Big does not necessarily mean better ... it is time for a complete rethink about maternity service planning," she said. The study found 98.5per cent of 146,422 "multiparous", or non-firstborn, babies born in large hospitals were alive after 28 days, compared with 99.2per cent in very small units.
But Dr Tracy said while this was an expected result - because very high-risk or complicated cases would naturally be referred to the biggest hospitals - the real point was that death rates were no higher in smaller units. "All women do not need the very intense medical care that's available in these large tertiary hospitals," Dr Tracy told The Australian. "At this point, the policy in Australia is just to keep on closing these small units, and leaving rural women stranded to give birth on the side of the road." Rural doctors have also backed the findings.
For the study, published online by the British Journal of Obstetrics and Gynaecology, Dr Tracy and colleagues examined data from more than 702,000 women who gave birth from January 1, 1999, to December 31, 2001 - representing more than 90per cent of all births in that time. The researchers grouped hospitals into five bands, based on how many babies they delivered each year. They also looked at the risk status of the mother, what interventions she required - such as epidurals and emergency caesarean sections - and whether the baby was alive after 28 days.
Among firstborns, 98.9per cent of the 4483 born in small units with fewer than 100 births annually were alive after 28 days, compared with 98.4per cent of the 115,940 born in the largest hospitals. Looking only at births considered low-risk - a more meaningful comparison - smaller units also saw slightly lower death rates, but because of the low numbers involved in the small units the difference was not statistically significant. As expected, higher levels of interventions were also recorded in bigger hospitals.
Queensland GP Ross Maxwell, president of the Rural Doctors Association of Australia, said the findings showed "low-risk delivery in small hospitals is very safe". "In rural Australia, we certainly need a strong rethink and more work to maximise the current workforce," he said.
Christine Tippett, vice-president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said the findings had to be interpreted with caution and did not support the claim small units were safer for low-risk women.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Babies born in large city hospitals are more likely to die in their first month than those born in smaller rural centres, a comprehensive analysis of Australian births has revealed. The findings have prompted experts to call for a "complete rethink" of maternity service planning across the country. The researchers for the study, which was reported yesterday in an international journal, say the findings prove smaller centres are safe - and undermine fears about quality that have led state governments to close scores of small maternity units nationwide in the past decade.
Study co-author Sally Tracy, a senior research fellow at the National Perinatal Statistics Unit at the University of NSW, said that over the past 10 years "at least half" of the smaller rural maternity units across the country had been closed on safety grounds. "Big does not necessarily mean better ... it is time for a complete rethink about maternity service planning," she said. The study found 98.5per cent of 146,422 "multiparous", or non-firstborn, babies born in large hospitals were alive after 28 days, compared with 99.2per cent in very small units.
But Dr Tracy said while this was an expected result - because very high-risk or complicated cases would naturally be referred to the biggest hospitals - the real point was that death rates were no higher in smaller units. "All women do not need the very intense medical care that's available in these large tertiary hospitals," Dr Tracy told The Australian. "At this point, the policy in Australia is just to keep on closing these small units, and leaving rural women stranded to give birth on the side of the road." Rural doctors have also backed the findings.
For the study, published online by the British Journal of Obstetrics and Gynaecology, Dr Tracy and colleagues examined data from more than 702,000 women who gave birth from January 1, 1999, to December 31, 2001 - representing more than 90per cent of all births in that time. The researchers grouped hospitals into five bands, based on how many babies they delivered each year. They also looked at the risk status of the mother, what interventions she required - such as epidurals and emergency caesarean sections - and whether the baby was alive after 28 days.
Among firstborns, 98.9per cent of the 4483 born in small units with fewer than 100 births annually were alive after 28 days, compared with 98.4per cent of the 115,940 born in the largest hospitals. Looking only at births considered low-risk - a more meaningful comparison - smaller units also saw slightly lower death rates, but because of the low numbers involved in the small units the difference was not statistically significant. As expected, higher levels of interventions were also recorded in bigger hospitals.
Queensland GP Ross Maxwell, president of the Rural Doctors Association of Australia, said the findings showed "low-risk delivery in small hospitals is very safe". "In rural Australia, we certainly need a strong rethink and more work to maximise the current workforce," he said.
Christine Tippett, vice-president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, said the findings had to be interpreted with caution and did not support the claim small units were safer for low-risk women.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Wednesday, December 07, 2005
More money, worse care?
Post lifted from Daniel Weintraub
This study that came out last month should be required reading for anyone who thinks competition can't lower the cost of medicine and improve care. The authors not only found wide variations in the cost of treating the same conditions in California hospitals but concluded that the biggest cost driver was the availability of resources. In other words, more doctors or more hospital beds lead to higher costs, but not better care. An excerpt from the California Health Care Foundation:
The study finds significant variation in Medicare spending for chronically ill patients in California. For example (as shown in Figure 1), hospitals in Los Angeles received an average of 60 percent more for inpatient reimbursement for Medicare patients during the last two years of life than Sacramento-area hospitals. In fact, Medicare paid some hospitals in the state as much as four times more than other hospitals to care for patients with similar conditions.
Yet the additional care provided did not improve medical outcomes or patient satisfaction. Rather, as the volume of care increased, the quality of care and patient satisfaction actually declined.
The comparisons suggest that savings could be achieved by improving efficiency with no impact on quality. For example, Medicare could have saved $1.7 billion in the Los Angeles area alone if medical practice patterns there, the most expensive region, resembled those of Sacramento, the least expensive.
And this:
The study found that the higher use in California reflected a delivery system in which services were driven not by patient need, but by the supply of medical resources. In regions that have more hospitals, more ICU beds, more physicians, and more specialists, patients receive significantly more services at greater cost, but with no improvement in outcomes.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Post lifted from Daniel Weintraub
This study that came out last month should be required reading for anyone who thinks competition can't lower the cost of medicine and improve care. The authors not only found wide variations in the cost of treating the same conditions in California hospitals but concluded that the biggest cost driver was the availability of resources. In other words, more doctors or more hospital beds lead to higher costs, but not better care. An excerpt from the California Health Care Foundation:
The study finds significant variation in Medicare spending for chronically ill patients in California. For example (as shown in Figure 1), hospitals in Los Angeles received an average of 60 percent more for inpatient reimbursement for Medicare patients during the last two years of life than Sacramento-area hospitals. In fact, Medicare paid some hospitals in the state as much as four times more than other hospitals to care for patients with similar conditions.
Yet the additional care provided did not improve medical outcomes or patient satisfaction. Rather, as the volume of care increased, the quality of care and patient satisfaction actually declined.
The comparisons suggest that savings could be achieved by improving efficiency with no impact on quality. For example, Medicare could have saved $1.7 billion in the Los Angeles area alone if medical practice patterns there, the most expensive region, resembled those of Sacramento, the least expensive.
And this:
The study found that the higher use in California reflected a delivery system in which services were driven not by patient need, but by the supply of medical resources. In regions that have more hospitals, more ICU beds, more physicians, and more specialists, patients receive significantly more services at greater cost, but with no improvement in outcomes.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Tuesday, December 06, 2005
Australian public health care on verge of a breakdown
An article by Clive Hadfield, a specialist physician
At last, Geoffrey Davies's report of Bundaberg mark II, the Queensland Public Hospital commission of inquiry, has been released. The conclusion: that an adequate and safe level of services is not being provided in Queensland hospitals and probably not in those of other states. A fundamental question is whether it would be possible to do so within Australia's free health system.
Queensland Premier Peter Beattie is the most recent premier to be bruised by his state health service. He has expressed the view that the Australian health system will fall apart by 2015. He has called for a national health summit. So what are the problems? Health care lies uncomfortably at the intersection of market capitalism and social care. Much dissatisfaction stems from this tension. A product promising relief from pain and long, if not eternal, life can extract a premium price. Doctors and pharmaceutical companies have always done well. However, public, often salaried, medical care expanded as part of a social ideal from the 1950s.
Nevertheless, there was no wholesale medical surrender of market power. Quite the contrary. The power given to professional colleges to maintain standards was used by some to restrict supply. They effectively priced themselves out of the public health system. Many an elderly man dies with a tube in his bladder after waiting years for prostate surgery. Professional groups who do not use strong market tactics such as cancelling operating lists are in a vicious cycle of decline, unable to attract trainees as their workloads grow. All the same, universal health care is seen as an important aspect of our society, a strong egalitarian glue.
The public hospital system is one of the last socialist enterprises and it is very large. It has its equivalents of butter mountains with no bread. The state health minister and premier are joint chief executives of a multi-billion-dollar enterprise and have no chance of understanding it. Every citizen has an interest in it. It is therefore highly political and impossible to administer. Absolute central control is the perceived solution but good health department policy guarantees only political wrath. Some powerful group will be upset.
As a politically run enterprise the state health system is full of inequity. The large city hospitals are a comfort to the 70 per cent to 80 per cent of the population within easy access and have great political power. Accessible services should be based in suburban hospitals but they wither. Provincial and rural hospitals stand little chance. Aboriginal health care is even more politicised and unfair. It attracts many studies but few salaries for standard Australian caregivers: general practitioners, specialists and nurses. Where the medical market is in play it is distorted by heavy and perverse federal government incentives. The federal Government's Medicare encourages turnover by subsidising every transaction so demand is high. There is no attempt at fair distribution. There is no incentive for doctors to take a share of the hard work in public hospitals and little incentive to work in rural and outer suburban areas.
Medicare reinforces public perception of value in scans and interventional procedures. Medicare will subsidise the placement of a stent in a coronary artery by $1500. The more time-consuming specialist assessment of a complex frail medical patient with multiple systems in disorder attracts $111. It is hardly surprising that the thinkers are thin on the ground, overworked and politically weak. Envy is strong in a system where no one knows what they have paid for so assumes they have paid for everything medically possible.
So what would a system that took these factors into its design look like? The two basic requirements of a health system in Australia are safety and universal coverage. Ensuring these is the rightful place of government. Provision of health services perhaps is not.
Efficiency and fairness have so far eluded government services in most consumer fields. Government's role in safety would be similar to its role in the aviation industry. A bad record would be as commercially harmful in the health industry as it is for airlines. There would be no more indiscriminate cost-cutting.
Universal coverage could be achieved by distributing health tax dollars to the individual, who would be obliged to choose a licensed health insurer as they now choose a superannuation fund or local member of parliament. The health tax dollars from those who did not choose could be allocated on rota to the competing funds. Level of cover available for the health tax dollar would be spelled out. Prolonged good health would advantage the fund through continued premiums. A healthy lifestyle would advantage the citizen financially through bargaining power for level of cover. Extra cover could be bought.
Transparent fairness would take a lot of the politics out of health. The electorate may well agree to much higher funding than at present if they knew it would be used efficiently for health care. A new system would recognise the market for medical care but open it up to competition. Nurses could learn and demonstrate competence in many procedures such as endoscopy of the throat, lungs, gut, joints and bladder. Radiographers could demonstrate competence in interpreting X-rays and scans as well as taking pictures. The chief marketing tool of doctors would then properly be their breadth and depth of training and wisdom in making complex decisions.
Government licensing power could no longer be ceded to parties that could take market advantage, such as the colleges. Hospitals could be commercial enterprises or they could be community-run. The latter would allow citizens to be more involved and encourage local philanthropy. The introduction of a new system could be piecemeal. A functional provincial area with an easily defined population may be a good place to start.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
An article by Clive Hadfield, a specialist physician
At last, Geoffrey Davies's report of Bundaberg mark II, the Queensland Public Hospital commission of inquiry, has been released. The conclusion: that an adequate and safe level of services is not being provided in Queensland hospitals and probably not in those of other states. A fundamental question is whether it would be possible to do so within Australia's free health system.
Queensland Premier Peter Beattie is the most recent premier to be bruised by his state health service. He has expressed the view that the Australian health system will fall apart by 2015. He has called for a national health summit. So what are the problems? Health care lies uncomfortably at the intersection of market capitalism and social care. Much dissatisfaction stems from this tension. A product promising relief from pain and long, if not eternal, life can extract a premium price. Doctors and pharmaceutical companies have always done well. However, public, often salaried, medical care expanded as part of a social ideal from the 1950s.
Nevertheless, there was no wholesale medical surrender of market power. Quite the contrary. The power given to professional colleges to maintain standards was used by some to restrict supply. They effectively priced themselves out of the public health system. Many an elderly man dies with a tube in his bladder after waiting years for prostate surgery. Professional groups who do not use strong market tactics such as cancelling operating lists are in a vicious cycle of decline, unable to attract trainees as their workloads grow. All the same, universal health care is seen as an important aspect of our society, a strong egalitarian glue.
The public hospital system is one of the last socialist enterprises and it is very large. It has its equivalents of butter mountains with no bread. The state health minister and premier are joint chief executives of a multi-billion-dollar enterprise and have no chance of understanding it. Every citizen has an interest in it. It is therefore highly political and impossible to administer. Absolute central control is the perceived solution but good health department policy guarantees only political wrath. Some powerful group will be upset.
As a politically run enterprise the state health system is full of inequity. The large city hospitals are a comfort to the 70 per cent to 80 per cent of the population within easy access and have great political power. Accessible services should be based in suburban hospitals but they wither. Provincial and rural hospitals stand little chance. Aboriginal health care is even more politicised and unfair. It attracts many studies but few salaries for standard Australian caregivers: general practitioners, specialists and nurses. Where the medical market is in play it is distorted by heavy and perverse federal government incentives. The federal Government's Medicare encourages turnover by subsidising every transaction so demand is high. There is no attempt at fair distribution. There is no incentive for doctors to take a share of the hard work in public hospitals and little incentive to work in rural and outer suburban areas.
Medicare reinforces public perception of value in scans and interventional procedures. Medicare will subsidise the placement of a stent in a coronary artery by $1500. The more time-consuming specialist assessment of a complex frail medical patient with multiple systems in disorder attracts $111. It is hardly surprising that the thinkers are thin on the ground, overworked and politically weak. Envy is strong in a system where no one knows what they have paid for so assumes they have paid for everything medically possible.
So what would a system that took these factors into its design look like? The two basic requirements of a health system in Australia are safety and universal coverage. Ensuring these is the rightful place of government. Provision of health services perhaps is not.
Efficiency and fairness have so far eluded government services in most consumer fields. Government's role in safety would be similar to its role in the aviation industry. A bad record would be as commercially harmful in the health industry as it is for airlines. There would be no more indiscriminate cost-cutting.
Universal coverage could be achieved by distributing health tax dollars to the individual, who would be obliged to choose a licensed health insurer as they now choose a superannuation fund or local member of parliament. The health tax dollars from those who did not choose could be allocated on rota to the competing funds. Level of cover available for the health tax dollar would be spelled out. Prolonged good health would advantage the fund through continued premiums. A healthy lifestyle would advantage the citizen financially through bargaining power for level of cover. Extra cover could be bought.
Transparent fairness would take a lot of the politics out of health. The electorate may well agree to much higher funding than at present if they knew it would be used efficiently for health care. A new system would recognise the market for medical care but open it up to competition. Nurses could learn and demonstrate competence in many procedures such as endoscopy of the throat, lungs, gut, joints and bladder. Radiographers could demonstrate competence in interpreting X-rays and scans as well as taking pictures. The chief marketing tool of doctors would then properly be their breadth and depth of training and wisdom in making complex decisions.
Government licensing power could no longer be ceded to parties that could take market advantage, such as the colleges. Hospitals could be commercial enterprises or they could be community-run. The latter would allow citizens to be more involved and encourage local philanthropy. The introduction of a new system could be piecemeal. A functional provincial area with an easily defined population may be a good place to start.
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Monday, December 05, 2005
DELIBERATE DELAYS IN BRITAIN'S NHS
Hospitals have been told to delay operations to reduce debts faced by primary care trusts, according to reports. The trusts involved are said to be trying to postpone paying for operations until the new financial year begins in April.
But the Government has washed its hands of the practice, saying it was an "operational issue for the local NHS". It comes just two days after Health Secretary Patricia Hewitt admitted the health service could be facing a deficit of œ620 million.
A letter leaked to the Times reveals hospitals within Harrow Primary Care Trust, which is reportedly facing an œ8-12 million deficit, have been told to delay surgery. The document, written by Dr Ken Walton, chairman of the trust's professional executive committee, tells GPs it has "reluctantly" asked hospitals to "do the minimum required to meet national targets". It says: "This means that patients sent for outpatient appointments will only be seen at 10-13 weeks (national target 13 weeks) and elective surgery will be delayed until the sixth month (national target six months)."
In a statement, the trust defended its policy. It said: "Harrow PCT is taking action to control its expenditure that will not affect the quality of care given to its patients. "All patients in Harrow will be seen within national targets." Similar practices are also reported to be taking place to save money at trusts elsewhere in the country.
Source
PERKS FOR SCOTTISH HOSPITAL BUREAUCRATS WHILE HOSPITALS CUT HEALTH SERVICES
An island NHS board with debts of o1.5 million has been criticised for shutting hospital wards while continuing to pay senior managers 50,000 pounds to cover their travel expenses. The Western Isles NHS Health Board, which runs some of Britain's most remote hospitals, is also paying locum consultants 11,000 popunds a week for working in Stornoway, on the isle of Lewis, because of difficulties attracting full-time staff. At a public meeting this week, islanders joined local councillors and health workers to express anger that while the Hebrides will be forced to take swingeing hospital cuts, including weekend ward closures and the loss of on-site theatre night nurses, no expense is being spared to cover the travel costs of managers who do not live on the islands.
Dick Manson, the health board's chief executive, who is presiding over o1.3 million cuts, returns from Stornoway to his home in Glasgow almost every weekend at taxpayers' expense. He is one of five senior managers at Western Isles NHS Health Board who live on the mainland and whose travel expenses and accommodation costs during the week are met from the public purse to the tune of 10,000 pounds each, the board admitted yesterday. One manager recently had the curtains changed at her rented accommodation in Stornoway, at NHS expense, because they did not meet in the middle, the board confirmed.
Yesterday Angus McCormack, vice-convenor of Western Isles Council, said: "This is a scandal. They have no commitment to the Outer Hebrides and its people. They are trying to cover a huge financial gap which has arisen through mismanagement, through an increase in administration staff, five of whom live on the mainland and fly back and forth each week. We think that is a huge waste of public resources."
A public meeting was called this week by Mr McCormack and Unison, the health workers' union whose members claim they have not been properly consulted over the "unworkable" health service changes proposed for the Hebrides. One of the health board plans, outlined at a second public meeting in Stornoway last night, is to close one ward at Western Isles Hospital, in Stornoway, on Lewis, and a second ward at weekends, which would save 500,000 pounds. There will no longer be a night nurse on duty on site to cover the operating theatre in the event of an emergency.
Councillors and health workers are demanding an external review of the financial arrangments and governance of the Western Isles NHS Health Board by the Audit Commission Scotland. "Following the huge amount of public disquiet, we want the board to look again at what they are doing, to take a step back and respond to the demands of local people," Councillor McCormack said. Yesterday a health board spokesman denied there had been a lack of consultation over the service changes, which are part of a recovery plan which aims to put the board back in the black within three years. He claimed there had been health forums held over the past 18 months which were open to the public. He said that patients would not suffer from ward closures because 30 per cent of the bed spaces were unoccupied; a claim disputed by the unions, who said yesterday that, earlier this week, only four beds in the hospital were free
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Hospitals have been told to delay operations to reduce debts faced by primary care trusts, according to reports. The trusts involved are said to be trying to postpone paying for operations until the new financial year begins in April.
But the Government has washed its hands of the practice, saying it was an "operational issue for the local NHS". It comes just two days after Health Secretary Patricia Hewitt admitted the health service could be facing a deficit of œ620 million.
A letter leaked to the Times reveals hospitals within Harrow Primary Care Trust, which is reportedly facing an œ8-12 million deficit, have been told to delay surgery. The document, written by Dr Ken Walton, chairman of the trust's professional executive committee, tells GPs it has "reluctantly" asked hospitals to "do the minimum required to meet national targets". It says: "This means that patients sent for outpatient appointments will only be seen at 10-13 weeks (national target 13 weeks) and elective surgery will be delayed until the sixth month (national target six months)."
In a statement, the trust defended its policy. It said: "Harrow PCT is taking action to control its expenditure that will not affect the quality of care given to its patients. "All patients in Harrow will be seen within national targets." Similar practices are also reported to be taking place to save money at trusts elsewhere in the country.
Source
PERKS FOR SCOTTISH HOSPITAL BUREAUCRATS WHILE HOSPITALS CUT HEALTH SERVICES
An island NHS board with debts of o1.5 million has been criticised for shutting hospital wards while continuing to pay senior managers 50,000 pounds to cover their travel expenses. The Western Isles NHS Health Board, which runs some of Britain's most remote hospitals, is also paying locum consultants 11,000 popunds a week for working in Stornoway, on the isle of Lewis, because of difficulties attracting full-time staff. At a public meeting this week, islanders joined local councillors and health workers to express anger that while the Hebrides will be forced to take swingeing hospital cuts, including weekend ward closures and the loss of on-site theatre night nurses, no expense is being spared to cover the travel costs of managers who do not live on the islands.
Dick Manson, the health board's chief executive, who is presiding over o1.3 million cuts, returns from Stornoway to his home in Glasgow almost every weekend at taxpayers' expense. He is one of five senior managers at Western Isles NHS Health Board who live on the mainland and whose travel expenses and accommodation costs during the week are met from the public purse to the tune of 10,000 pounds each, the board admitted yesterday. One manager recently had the curtains changed at her rented accommodation in Stornoway, at NHS expense, because they did not meet in the middle, the board confirmed.
Yesterday Angus McCormack, vice-convenor of Western Isles Council, said: "This is a scandal. They have no commitment to the Outer Hebrides and its people. They are trying to cover a huge financial gap which has arisen through mismanagement, through an increase in administration staff, five of whom live on the mainland and fly back and forth each week. We think that is a huge waste of public resources."
A public meeting was called this week by Mr McCormack and Unison, the health workers' union whose members claim they have not been properly consulted over the "unworkable" health service changes proposed for the Hebrides. One of the health board plans, outlined at a second public meeting in Stornoway last night, is to close one ward at Western Isles Hospital, in Stornoway, on Lewis, and a second ward at weekends, which would save 500,000 pounds. There will no longer be a night nurse on duty on site to cover the operating theatre in the event of an emergency.
Councillors and health workers are demanding an external review of the financial arrangments and governance of the Western Isles NHS Health Board by the Audit Commission Scotland. "Following the huge amount of public disquiet, we want the board to look again at what they are doing, to take a step back and respond to the demands of local people," Councillor McCormack said. Yesterday a health board spokesman denied there had been a lack of consultation over the service changes, which are part of a recovery plan which aims to put the board back in the black within three years. He claimed there had been health forums held over the past 18 months which were open to the public. He said that patients would not suffer from ward closures because 30 per cent of the bed spaces were unoccupied; a claim disputed by the unions, who said yesterday that, earlier this week, only four beds in the hospital were free
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Sunday, December 04, 2005
SUPERBUG (CLOSTRIDIUM D) SPREADING
Disease resistance is one phenomenon where government controls could theoretically help. But -- suprise! -- it's not happening
A lethal bacterium which surfaces in people being treated with antibiotics is spreading in North America and has grown resistant to drugs, according to two studies published in the New England Journal of Medicine. According to one of the studies, a new, virulent and resistant strain of the bacteria Clostridium difficile broke out in eight US hospital centres between 2000 and 2003.
Provoked by antibiotics inside the intestines of hospital patients, the bacteria showed an ability to mutate and increase its resistance to drugs, the report said. Moreover, the bacteria, which infects the colon causing severe diarrhoea and colitis, a severe inflammation of the intestine, has begun showing up in patients not taking antibiotics or visiting hospitals. Symptoms include watery, malodorous diarrhoea and cramps.
A second study of 1703 patients in 12 hospitals in Quebec, Canada, demonstrated the lethality of the bacteria. Over 13 years the incidence of the bacteria grew fourfold in Quebec, and in 2004 it caused the deaths of 117 people in the first month after they were diagnosed. All of the victims were elderly. "Hospitals need to be conducting surveillance and implementing control measures. And all of us need to realize the risk of antibiotic use may be increasing," warned epidemiologist Clifford McDonald of the US Centres for Disease Control.
Scientists were concerned that Clostridium difficile -- so-named because of the difficulty in detecting it -- had become very resistant to fluoroquinolone antibiotics usually used to treat such infections. "If this epidemic strain continues to spread (...) it will be important either to reconsider the use of fluoroquinolones or to develop other innovative measures for controlling C. difficile-associated disease," said McDonald.
Source
SUPERBUG (MRSA) DISASTERS IN SCOTTISH PUBLIC HOSPITALS
The full extent of Scotland's superbug crisis was spelled out yesterday in a report that showed a fifth of people who die following surgery were infected by bacteria such as MRSA. Latest figures show that of the 1,854 people who died after an operation, 376 of them were infected by a superbug such as methicillin-resistant Staphylococcus aureus (MRSA).
The figures will send a worrying message to the Executive. It has launched a campaign to eradicate such bugs, which cost the NHS in Scotland an estimated œ186 million annually for treatment, extended hospital stays and control of infections. Andy Kerr, the health minister, said last night that the number of surgical deaths from superbugs was "concerning".....
Superbug rates in Scottish hospitals have stayed consistently high since 2001, despite attempts to bring the drug-resistant infections under control. Staphylococcus is a common bacterium that lives harmlessly in the nose or on the skin of about 25-30 per cent of the population. Certain strains have become resistant to conventional antibiotics and collectively have been termed MRSA, or methicillin-resistant Staphylococcus aureus, the superbugs that can prove fatal. Experts have uncovered 17 strains of MRSA, with differing degrees of immunity to antibiotics, although two - clones 15 and 16 - are thought to be responsible for 96 per cent of the infections in the UK.
Symptoms of infection vary depending on where the infection strikes. It may attack surgical wounds, burns, catheter sites, eyes, skin and blood. The risk to hospital patients is greater because wards tend to have a higher concentration of sick, old or weaker people than the general populace, and the environment provides ideal conditions such as communal wards, warm temperatures and shared toilets, for its spread. While rates of MRSA in Scotland are comparable with the rest of the UK, the incidence of the superbug in Britain is among the highest in Europe.....
The SASM report made clear that fewer patients are dying during and after surgery. The report, which reviews all deaths in hospital under the care of a surgeon whether or not an operation has taken place,- shows the number of people who died after being recommended for surgery in Scotland in 2004 was 4,091, compared with 4,478 in 2003. Of the 2004 figure, 1,854 had undergone surgery, while the remainder had died before an operation could be carried out.
Alexandra O'Neil, 57, was admitted to Edinburgh Royal Infirmary in July 1999 after falling down a flight of stairs and shattering her ankle. She died in agony nine months later from the MRSA bacteria, which is believed to have entered her body during a routine operation to place metal pins in her ankle. Mrs O'Neil's family were granted legal aid and are suing Lothian University Hospitals NHS Trust for œ100,000, claiming the hospital was negligent because it failed to prevent the spread of the MRSA infection. Doctors operated on Mrs O'Neil, of Lochend, Edinburgh, several times after they realised she was suffering from MRSA....
Mr Butler said the family had decided to take legal action because they believed the case would force hospitals throughout the UK to take drastic action to improve their levels of cleanliness......
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Disease resistance is one phenomenon where government controls could theoretically help. But -- suprise! -- it's not happening
A lethal bacterium which surfaces in people being treated with antibiotics is spreading in North America and has grown resistant to drugs, according to two studies published in the New England Journal of Medicine. According to one of the studies, a new, virulent and resistant strain of the bacteria Clostridium difficile broke out in eight US hospital centres between 2000 and 2003.
Provoked by antibiotics inside the intestines of hospital patients, the bacteria showed an ability to mutate and increase its resistance to drugs, the report said. Moreover, the bacteria, which infects the colon causing severe diarrhoea and colitis, a severe inflammation of the intestine, has begun showing up in patients not taking antibiotics or visiting hospitals. Symptoms include watery, malodorous diarrhoea and cramps.
A second study of 1703 patients in 12 hospitals in Quebec, Canada, demonstrated the lethality of the bacteria. Over 13 years the incidence of the bacteria grew fourfold in Quebec, and in 2004 it caused the deaths of 117 people in the first month after they were diagnosed. All of the victims were elderly. "Hospitals need to be conducting surveillance and implementing control measures. And all of us need to realize the risk of antibiotic use may be increasing," warned epidemiologist Clifford McDonald of the US Centres for Disease Control.
Scientists were concerned that Clostridium difficile -- so-named because of the difficulty in detecting it -- had become very resistant to fluoroquinolone antibiotics usually used to treat such infections. "If this epidemic strain continues to spread (...) it will be important either to reconsider the use of fluoroquinolones or to develop other innovative measures for controlling C. difficile-associated disease," said McDonald.
Source
SUPERBUG (MRSA) DISASTERS IN SCOTTISH PUBLIC HOSPITALS
The full extent of Scotland's superbug crisis was spelled out yesterday in a report that showed a fifth of people who die following surgery were infected by bacteria such as MRSA. Latest figures show that of the 1,854 people who died after an operation, 376 of them were infected by a superbug such as methicillin-resistant Staphylococcus aureus (MRSA).
The figures will send a worrying message to the Executive. It has launched a campaign to eradicate such bugs, which cost the NHS in Scotland an estimated œ186 million annually for treatment, extended hospital stays and control of infections. Andy Kerr, the health minister, said last night that the number of surgical deaths from superbugs was "concerning".....
Superbug rates in Scottish hospitals have stayed consistently high since 2001, despite attempts to bring the drug-resistant infections under control. Staphylococcus is a common bacterium that lives harmlessly in the nose or on the skin of about 25-30 per cent of the population. Certain strains have become resistant to conventional antibiotics and collectively have been termed MRSA, or methicillin-resistant Staphylococcus aureus, the superbugs that can prove fatal. Experts have uncovered 17 strains of MRSA, with differing degrees of immunity to antibiotics, although two - clones 15 and 16 - are thought to be responsible for 96 per cent of the infections in the UK.
Symptoms of infection vary depending on where the infection strikes. It may attack surgical wounds, burns, catheter sites, eyes, skin and blood. The risk to hospital patients is greater because wards tend to have a higher concentration of sick, old or weaker people than the general populace, and the environment provides ideal conditions such as communal wards, warm temperatures and shared toilets, for its spread. While rates of MRSA in Scotland are comparable with the rest of the UK, the incidence of the superbug in Britain is among the highest in Europe.....
The SASM report made clear that fewer patients are dying during and after surgery. The report, which reviews all deaths in hospital under the care of a surgeon whether or not an operation has taken place,- shows the number of people who died after being recommended for surgery in Scotland in 2004 was 4,091, compared with 4,478 in 2003. Of the 2004 figure, 1,854 had undergone surgery, while the remainder had died before an operation could be carried out.
Alexandra O'Neil, 57, was admitted to Edinburgh Royal Infirmary in July 1999 after falling down a flight of stairs and shattering her ankle. She died in agony nine months later from the MRSA bacteria, which is believed to have entered her body during a routine operation to place metal pins in her ankle. Mrs O'Neil's family were granted legal aid and are suing Lothian University Hospitals NHS Trust for œ100,000, claiming the hospital was negligent because it failed to prevent the spread of the MRSA infection. Doctors operated on Mrs O'Neil, of Lochend, Edinburgh, several times after they realised she was suffering from MRSA....
Mr Butler said the family had decided to take legal action because they believed the case would force hospitals throughout the UK to take drastic action to improve their levels of cleanliness......
More here
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Saturday, December 03, 2005
YOUR GOVERNMENT HEALTH SERVICE WILL LOOK AFTER YOU
In fact, nobody gives a damn -- and it shows
A coroner has concluded that the life of a mother who died of an infection six days after giving birth, could have been saved if she had been sent back to hospital earlier. Jessica Palmer, 34, died as a result of a common infection on June 30 last year, having developed an infection when she gave birth to her healthy daughter Emily. A two-day inquest heard evidence from a midwife who admitted making a "gross mistake" in not raising the alarm, a GP who thought she had sciatica, and a doctor who allowed her home from hospital without taking her temperature.
The Deputy Coroner for West London, Elizabeth Pygott, cast doubt on the "honesty" of one doctor's evidence and highlighted the midwife's mistake but stopped short of formally finding neglect, recording a verdict of natural causes. She told the court that in this case, despite the failure of midwife Karen O'Connor to read the warning signs - a fever and a hot red patch on Mrs Palmer's skin - and tell a GP, she accepted that there had been a "full examination".
Speaking after the hearing, Mr Palmer, an IT consultant, said he was "astounded and surprised" by the fact that the coroner had not recorded neglect. He said: "My wife lost her life in June of last year at a time that should have been filled with joy and expectation for her, for me and our children, and for our families. "Many lives have been shattered by a tragedy that I believe could and should have been avoided."
Miss O'Connor saw Mrs Palmer on June 27, two days before her death, when, had a doctor been told of her symptoms, her condition could still have been treated. The deputy coroner said, based on the evidence of a microbiologist: "Had Mrs Palmer been readmitted on June 27, it is likely she would have been treated with antibiotics and that the death would not have occurred." The hearing was told that Mrs Palmer was deemed well enough to be discharged from Kingston Hospital in south-west London on June 25, the day after giving birth, despite earlier abnormalities in her temperature and blood pressure. Senior house officer Dr Lan-Anh Le concluded Mrs Palmer was "fit and well" without taking her temperature, relying on readings which were already four hours old.
But when Mrs Palmer's husband, Ben, took a reading shortly after she got home, her temperature had soared to almost 40 degrees Celsius and she went to bed feeling "shivery". Mrs Palmer then spent four days at home in a fever with crippling pain in her limbs and back despite speaking to medical staff about her condition, the inquest heard. On the following Tuesday she was finally rushed back to hospital suffering group A streptococcal septicaemia, but it was already too late. By then Mrs Palmer was in septic shock and died of multiple organ failure as doctors prepared to do an emergency hysterectomy.
Community midwife Miss O'Connor admitted in court that she had made a "gross mistake" in not raising the alarm to a GP on the Sunday when she visited Mrs Palmer, three days before her death. She had been told of her temperature and sore throat and seen an "unusual" red mark on her abdomen. "She was delightful, really delightful. We were laughing and joking. She just said she was very tired," Miss O'Connor told Ms Pygott. She also admitted that she had not taken Mrs Palmer's temperature because she "didn't have a thermometer" but had no major concerns.
GP Dr Sian Williams told how she had spoken to Mrs Palmer over the phone on the Monday morning but, based on what she had been told, believed that she was suffering from sciatica and prescribed a strong painkiller. Dr Williams said Mrs Palmer had described the pain in her back but they had not discussed her temperature. The full seriousness of her condition was not realised until a face-to-face meeting with Dr Carolynne Christie at her GP's surgery on the morning of Tuesday June 29, four days after she had been discharged from hospital. She was rushed to hospital and admitted through Accident and Emergency before ending up in intensive care. As doctors prepared to carry out an emergency hysterectomy she suffered a cardiac arrest in the operation theatre and died.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
In fact, nobody gives a damn -- and it shows
A coroner has concluded that the life of a mother who died of an infection six days after giving birth, could have been saved if she had been sent back to hospital earlier. Jessica Palmer, 34, died as a result of a common infection on June 30 last year, having developed an infection when she gave birth to her healthy daughter Emily. A two-day inquest heard evidence from a midwife who admitted making a "gross mistake" in not raising the alarm, a GP who thought she had sciatica, and a doctor who allowed her home from hospital without taking her temperature.
The Deputy Coroner for West London, Elizabeth Pygott, cast doubt on the "honesty" of one doctor's evidence and highlighted the midwife's mistake but stopped short of formally finding neglect, recording a verdict of natural causes. She told the court that in this case, despite the failure of midwife Karen O'Connor to read the warning signs - a fever and a hot red patch on Mrs Palmer's skin - and tell a GP, she accepted that there had been a "full examination".
Speaking after the hearing, Mr Palmer, an IT consultant, said he was "astounded and surprised" by the fact that the coroner had not recorded neglect. He said: "My wife lost her life in June of last year at a time that should have been filled with joy and expectation for her, for me and our children, and for our families. "Many lives have been shattered by a tragedy that I believe could and should have been avoided."
Miss O'Connor saw Mrs Palmer on June 27, two days before her death, when, had a doctor been told of her symptoms, her condition could still have been treated. The deputy coroner said, based on the evidence of a microbiologist: "Had Mrs Palmer been readmitted on June 27, it is likely she would have been treated with antibiotics and that the death would not have occurred." The hearing was told that Mrs Palmer was deemed well enough to be discharged from Kingston Hospital in south-west London on June 25, the day after giving birth, despite earlier abnormalities in her temperature and blood pressure. Senior house officer Dr Lan-Anh Le concluded Mrs Palmer was "fit and well" without taking her temperature, relying on readings which were already four hours old.
But when Mrs Palmer's husband, Ben, took a reading shortly after she got home, her temperature had soared to almost 40 degrees Celsius and she went to bed feeling "shivery". Mrs Palmer then spent four days at home in a fever with crippling pain in her limbs and back despite speaking to medical staff about her condition, the inquest heard. On the following Tuesday she was finally rushed back to hospital suffering group A streptococcal septicaemia, but it was already too late. By then Mrs Palmer was in septic shock and died of multiple organ failure as doctors prepared to do an emergency hysterectomy.
Community midwife Miss O'Connor admitted in court that she had made a "gross mistake" in not raising the alarm to a GP on the Sunday when she visited Mrs Palmer, three days before her death. She had been told of her temperature and sore throat and seen an "unusual" red mark on her abdomen. "She was delightful, really delightful. We were laughing and joking. She just said she was very tired," Miss O'Connor told Ms Pygott. She also admitted that she had not taken Mrs Palmer's temperature because she "didn't have a thermometer" but had no major concerns.
GP Dr Sian Williams told how she had spoken to Mrs Palmer over the phone on the Monday morning but, based on what she had been told, believed that she was suffering from sciatica and prescribed a strong painkiller. Dr Williams said Mrs Palmer had described the pain in her back but they had not discussed her temperature. The full seriousness of her condition was not realised until a face-to-face meeting with Dr Carolynne Christie at her GP's surgery on the morning of Tuesday June 29, four days after she had been discharged from hospital. She was rushed to hospital and admitted through Accident and Emergency before ending up in intensive care. As doctors prepared to carry out an emergency hysterectomy she suffered a cardiac arrest in the operation theatre and died.
Source
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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Friday, December 02, 2005
A BUREAUCRACY FINALLY IN THE GUN
Queensland's health system has been exposed as Australia's worst because of a long-running culture of government secrecy and an obsession with saving money. In a sweeping final report, Health Commission head Geoffrey Davies has recommended criminal charges against Dr Jayant Patel, the rogue surgeon whose botched operations at Bundaberg Hospital sparked the inquiry.
The Beattie Government's cover-up culture came in for extended criticism. Former health minister Wendy Edmond was blasted for being instrumental in the cover-up of information and her successor Gordon Nuttall's conduct in the job was described as "misleading, unreasonable and careless". Mr Davies, a retired Court of Appeal justice, also said two Bundaberg Hospital administrators who failed to take action, Darren Keating and Peter Leck, should be prosecuted. He found that Dr Keating's failure to adequately respond to complaints about Dr Patel had shown a gross dereliction of duty. Dr Keating had "persistently ignored or downplayed the seriousness of these complaints" and had been keen to describe them only as personality conflicts.
Mr Davies recommended the Crime and Misconduct Commission prosecute Mr Leck for official misconduct. He said Mr Leck had performed his duties carelessly or incompetently and his conduct should be referred to Queensland Health chiefs for discipline under the Public Service Act.
But the central criticism in yesterday's 538-page report was levelled at politicians and the health bureaucracy. Mr Davies said Queensland's whistleblower protections were inadequate and called for a central body to oversee public interest disclosures. He also recommended the Queensland Ombudsman's powers be widened to further protect whistleblowers. And he called for the establishment of a "one-stop shop" with investigative powers to handle complaints and weed out incompetent doctors.
On the political front, Mr Davies found that successive state governments followed a practice of concealment and suppression of elective surgery waiting lists and measured quality reports. "This in turn, encouraged a similar practice by Queensland Health staff," he said. "In my view it is an irresistible conclusion that there is a history of a culture of concealment within and pertaining to Queensland Health."
Mr Davies found that the Beattie Cabinet had led this concealment culture to protect its political fortunes. The former Coalition government had been guilty of similar offences. Mr Davies found that the suppression of material and the use of Cabinet to hide it -- by shielding it from Freedom of Information requests -- had been contrary to the public interest. He stopped short of recommending legislative change to halt the practice, but said it was clear that successive governments had abused the Freedom of Information Act.
Premier Peter Beattie's correspondence to the commission was also criticised as being untrue. Mr Beattie had written in part: "I am prepared to act to continue my government's record of openness and accountability." Mr Davies concluded that this had been "inconsistent with the facts".
Mr Beattie yesterday refused to change his Government's culture, saying after the release of the report that Queensland's freedom of information laws and whistleblower protections would not be overhauled. He also firmly backed his Cabinet colleague Mr Nuttall, who is now the Primary Industries Minister. Mr Nuttall said the attack on him was unwarranted and he would not be pressured into resigning from Cabinet. Ms Edmond declined to comment when approached at her Brisbane home, and later faxed a brief statement via her solicitor saying she was disappointed at Mr Davies's criticisms of her.
The Health Commission report said Queensland had Australia's lowest level of funding per head of population for its public hospital system. That underfunding had been exacerbated by several factors. These included the fact that Queensland was Australia's most decentralised state, that Queensland had the highest population growth, and that it had a lower than average number of medical practitioners.
Mr Davies labelled Dr Patel, the surgeon whose actions sparked the inquiry, as a medically incompetent liar whose clinical bungling and lack of judgment killed at least 13 people and injured many others. He recommended that Dr Patel, who had been Bundaberg Hospital's director of surgery, be investigated for manslaughter. Police plan to charge Dr Patel, believed to be living in the US, in about eight months.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Queensland's health system has been exposed as Australia's worst because of a long-running culture of government secrecy and an obsession with saving money. In a sweeping final report, Health Commission head Geoffrey Davies has recommended criminal charges against Dr Jayant Patel, the rogue surgeon whose botched operations at Bundaberg Hospital sparked the inquiry.
The Beattie Government's cover-up culture came in for extended criticism. Former health minister Wendy Edmond was blasted for being instrumental in the cover-up of information and her successor Gordon Nuttall's conduct in the job was described as "misleading, unreasonable and careless". Mr Davies, a retired Court of Appeal justice, also said two Bundaberg Hospital administrators who failed to take action, Darren Keating and Peter Leck, should be prosecuted. He found that Dr Keating's failure to adequately respond to complaints about Dr Patel had shown a gross dereliction of duty. Dr Keating had "persistently ignored or downplayed the seriousness of these complaints" and had been keen to describe them only as personality conflicts.
Mr Davies recommended the Crime and Misconduct Commission prosecute Mr Leck for official misconduct. He said Mr Leck had performed his duties carelessly or incompetently and his conduct should be referred to Queensland Health chiefs for discipline under the Public Service Act.
But the central criticism in yesterday's 538-page report was levelled at politicians and the health bureaucracy. Mr Davies said Queensland's whistleblower protections were inadequate and called for a central body to oversee public interest disclosures. He also recommended the Queensland Ombudsman's powers be widened to further protect whistleblowers. And he called for the establishment of a "one-stop shop" with investigative powers to handle complaints and weed out incompetent doctors.
On the political front, Mr Davies found that successive state governments followed a practice of concealment and suppression of elective surgery waiting lists and measured quality reports. "This in turn, encouraged a similar practice by Queensland Health staff," he said. "In my view it is an irresistible conclusion that there is a history of a culture of concealment within and pertaining to Queensland Health."
Mr Davies found that the Beattie Cabinet had led this concealment culture to protect its political fortunes. The former Coalition government had been guilty of similar offences. Mr Davies found that the suppression of material and the use of Cabinet to hide it -- by shielding it from Freedom of Information requests -- had been contrary to the public interest. He stopped short of recommending legislative change to halt the practice, but said it was clear that successive governments had abused the Freedom of Information Act.
Premier Peter Beattie's correspondence to the commission was also criticised as being untrue. Mr Beattie had written in part: "I am prepared to act to continue my government's record of openness and accountability." Mr Davies concluded that this had been "inconsistent with the facts".
Mr Beattie yesterday refused to change his Government's culture, saying after the release of the report that Queensland's freedom of information laws and whistleblower protections would not be overhauled. He also firmly backed his Cabinet colleague Mr Nuttall, who is now the Primary Industries Minister. Mr Nuttall said the attack on him was unwarranted and he would not be pressured into resigning from Cabinet. Ms Edmond declined to comment when approached at her Brisbane home, and later faxed a brief statement via her solicitor saying she was disappointed at Mr Davies's criticisms of her.
The Health Commission report said Queensland had Australia's lowest level of funding per head of population for its public hospital system. That underfunding had been exacerbated by several factors. These included the fact that Queensland was Australia's most decentralised state, that Queensland had the highest population growth, and that it had a lower than average number of medical practitioners.
Mr Davies labelled Dr Patel, the surgeon whose actions sparked the inquiry, as a medically incompetent liar whose clinical bungling and lack of judgment killed at least 13 people and injured many others. He recommended that Dr Patel, who had been Bundaberg Hospital's director of surgery, be investigated for manslaughter. Police plan to charge Dr Patel, believed to be living in the US, in about eight months.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
Thursday, December 01, 2005
Laughing gas unsafe, say doctors
The nitrous oxide gas used in most general anaesthetics is unsafe and should be discontinued, according to Australian doctors who have found it doubles the rate of serious vomiting and pneumonia after surgery and raises the risk of wound infections.
Their world-first study of 2050 patients also showed patients who had undergone surgery were slower to recover and likely to stay in hospital longer if the gases used to keep them unconscious included nitrous oxide as a base, rather than oxygen or oxygen and air.
Paul Myles, the director of anaesthesia at The Alfred hospital, said: "This is going to really surprise people... nitrous oxide is used in 80 per cent of anaesthetics. It's the foundation of anaesthesia and has been that way for 160 years." Professor Myles, who led the 20-hospital international study, said he had already stopped using nitrous oxide in his own practice, though "it possibly has a role in simple surgery for young, healthy patients".
Because it changed the way the body metabolised vitamin B12 and folate, it was also possible nitrous oxide could cause immune system and heart problems, nerve damage, cancer and birth defects, Professor Myles said. Those potential effects, combined with those demonstrated by the study, spelled "the end of nitrous oxide" in general anaesthesia, he added. But it would still have a role in securing fast pain relief, such as after injury or while giving birth.
The preliminary results will be presented in Auckland on Saturday to the Annual Scientific Meeting of the Australian and New Zealand College of Anaesthetists. Michael Cousins, the college's president, said a phasing-out of nitrous oxide would be good news for patients. "If we eliminate nitrous oxide from the equation, there will be a lot fewer people feeling very sick," he said.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
The nitrous oxide gas used in most general anaesthetics is unsafe and should be discontinued, according to Australian doctors who have found it doubles the rate of serious vomiting and pneumonia after surgery and raises the risk of wound infections.
Their world-first study of 2050 patients also showed patients who had undergone surgery were slower to recover and likely to stay in hospital longer if the gases used to keep them unconscious included nitrous oxide as a base, rather than oxygen or oxygen and air.
Paul Myles, the director of anaesthesia at The Alfred hospital, said: "This is going to really surprise people... nitrous oxide is used in 80 per cent of anaesthetics. It's the foundation of anaesthesia and has been that way for 160 years." Professor Myles, who led the 20-hospital international study, said he had already stopped using nitrous oxide in his own practice, though "it possibly has a role in simple surgery for young, healthy patients".
Because it changed the way the body metabolised vitamin B12 and folate, it was also possible nitrous oxide could cause immune system and heart problems, nerve damage, cancer and birth defects, Professor Myles said. Those potential effects, combined with those demonstrated by the study, spelled "the end of nitrous oxide" in general anaesthesia, he added. But it would still have a role in securing fast pain relief, such as after injury or while giving birth.
The preliminary results will be presented in Auckland on Saturday to the Annual Scientific Meeting of the Australian and New Zealand College of Anaesthetists. Michael Cousins, the college's president, said a phasing-out of nitrous oxide would be good news for patients. "If we eliminate nitrous oxide from the equation, there will be a lot fewer people feeling very sick," he said.
Source
***************************
For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?
Comments? Email me here. If there are no recent posts here, the mirror site may be more up to date. My Home Page is here or here.
***************************
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