Why Socialized Medicine Leads to the Prohibition of Private Medicine

A post lifted from George Reisman

An article in today’s (Feb. 20, 2006) New York Times makes clear that Canada’s much ballyhooed system of socialized medicine, in addition to being plagued by interminable waits for treatment, has prohibited competition from private medicine. But now, as the result of a ruling last June by Canada’s Supreme Court, limited forms of private medical care are apparently in process of being allowed to appear, at least in some provinces. In The Times’ article’s words: “The cracks are still small in Canada's vaunted public health insurance system, but several of its largest provinces are beginning to open the way for private health care eventually to take root around the country.” [See full Times article.]

The Canadian Supreme Court’s decision was the outcome of a lonely and courageous struggle conducted at great personal cost in time and money by a Canadian physician, Dr. Jacques Chaoulli. Dr. Chaoulli went to court with the case of a chemical salesman who had been forced to wait a year for a hip replacement and who at the same time was prohibited from paying for private surgery. As described in an earlier Times article, Dr. Chaoulli argued

that regulations that create long waiting times for surgery contradict the constitutional guarantees for individuals of “life, liberty and the security of the person,’' and that the prohibition against private medical insurance and care is for sick patients an “infringement of the protection against cruel and unusual treatment.''

To most Americans it may come as something of a shock simply to learn that all is not well with health care in Canada. That’s because Canada’s system has continuously been held up as the model for the United States to follow. Sometimes it seems that every ignoramus with a graduate-school diploma is ready to pontificate on how wonderful medical care is north of the border and that to solve our problems with medical care, all we need do is adopt that wonderful, single-payer Canadian system.

I could stop here, with the satisfaction of conveying knowledge that the system of socialized medical care in Canada is in fact so unwell that the door to its replacement with private medical care has been opened. But there is a deeper point I want to make, which will help to establish why socialized medicine is a profoundly evil and immoral system, that should never be implemented anywhere.

And this is the fact that the prohibition of private medical care that has existed in Canada is not some inexplicable accident but, on the contrary, follows logically from the very nature of socialized medicine. The connection is this:

Socialized medicine is advocated as the means of making medical care free or almost free, thereby enabling even the very poorest people to afford all of it that they need. Unfortunately, when medical care is made free, the quantity of it that people attempt to consume becomes virtually limitless. Office visits, diagnostic tests, procedures, hospitalizations, and surgeries all balloon. If nothing further were done, the cost would destroy the government’s budget. Something further is done, and that is that cost controls are imposed. The government simply draws the line on how much it is willing to spend. But so long as nothing limits the office visits, requests for diagnostic tests, etc., etc., waiting lines and waiting lists grow longer and longer.

Then the government seeks to limit the number of office visits, tests, procedures, etc., etc., by more narrowly limiting the circumstances in which they can occur. For example, a given diagnostic test may be allowed only when a precise set of symptoms is present and not otherwise. A hospitalization or surgery may be denied if the patient is over a certain age.

As part of the process of cost control, the government controls and sometimes reduces the compensation it allows to physicians and surgeons. For example, in the present fiscal year, in the United States, the fees paid to physicians by Medicare are scheduled to fall by four percent. (The New York Times, Feb. 4, 2006.)

Now all one need do to understand why socialized medicine leads to the prohibition of private medicine is simply to hold in mind the combination of deteriorating medical treatment and controlled physician incomes under socialized medicine and ask what would happen if an escape from this nightmare exists in the form of private medicine. Obviously, physicians who want to earn a higher income and to have the freedom to treat their patients in accordance with their own medical judgment will flee the socialized system for the private system and leave basically only the dregs of medicine for what will remain of the socialized system. That is what the government’s prohibition of private medical care is designed to prevent. This was confirmed in arguments before the Canadian Supreme Court. The Times article on the subject reported that

Various medical experts, government representatives and union leaders argued in court that privatization of insurance and services would bring an exodus of medical talent from public to private practices, and make waiting times even longer.

And there you have it. Socialized medicine destroys the quality of medical care and dare not allow the competition of private medical care. To prevent that competition, it must prohibit private medical care and establish a legal monopoly on medical care.






Another Queensland Health bungle plays itself out

They sure know how to hire good staff. At least this guy did not kill anyone so I guess that is progress

An overseas health bureaucrat has had his contract terminated by the State Government in a deal that is likely to cost taxpayers in excess of $100,000 for only five weeks' work. Royal Brisbane and Women's Hospital clinical CEO Dr Thomas Ward left the job yesterday following an incident when he tried to sack the hospital's executive director of nursing services, Lesley Fleming. The Canadian medical bureaucrat was forced into an embarrassing backdown during which he was forced to reinstate Ms Fleming and issue a humiliating apology after action by senior nurses and their union.

Premier Peter Beattie announced Dr Ward's departure yesterday, but would not be drawn on the specifics. "I think it is fair to say we've obviously had negotiations with the doctor concerned and we're keen for everybody to move on," Mr Beattie said. "He has decided to return to Canada and we support that decision. I think he would have been relieved and we support his relief." Mr Beattie said he had approved a termination payment to Dr Ward of three months' pay, an amount which he said was "fairly normal in the circumstances".

Opposition health spokesman Bruce Flegg said senior medical staff had confirmed to him that Dr Ward had been pushed rather than resigned. "When he came back from a meeting on Wednesday morning someone asked him what was wrong and he only said 'I am devastated'," Dr Flegg said. "He was shoved on a flight at 9.30am this morning (Thursday) as part of settlement to get him out of the country so he couldn't be interviewed."

Queensland Nurses Union state secretary Gay Hawksworth said nurses from the Royal Brisbane Hospital attending the QNU conference yesterday greeted the news of Dr Ward's demise "with applause". "I went to a meeting last week and he admitted he had made a huge error - that he had got bad advice and that he knew he was now two years behind where he would want to be because he knew he had lost the confidence of nurses, and that made his position untenable," Ms Hawksworth said.

A media release issued by Mr Beattie and Health Minister Stephen Robertson when Dr Ward was employed in Queensland had described him as "an internationally respected health care systems manager, strategist and planner".

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.

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The NHS long wait



Hidden waiting lists for NHS treatment, revealed for the first time, indicate that patients wait an average of seven weeks for diagnostic tests. Until now the Government has measured only how long patients wait for their first consultant appointment and then for treatment. Waits for vital diagnostic tests have been ignored.

The promise that all patients will be treated within 18 weeks of referral by a family doctor has obliged the Department of Health to start measuring these diagnostic waits. The results indicated large variations by area and by test - but also that the ambitious 18-week target was achievable, Andy Burnham, a Health minister, said yesterday.

About half of patients were being seen within the target time, officials said, but less than 1 per cent were waiting more than two years. Three quarters of tests are carried out within 13 weeks, the interim target the NHS is aiming for across the service by April 2007.

By April 2008 the target will be six weeks and by the end of that year the entire "patient journey" should be no more than 18 weeks. A small minority is expected to experience longer waits, either for clinical reasons or out of choice. But the department has yet to decide how much "wriggle room" to allow for these patients.

Every month the NHS does 50 million tests. Of the 15 key tests for which waits were measured, slightly more than 200,000 were taking more than 13 weeks to complete. A census of trusts that looked at 500 less common tests found roughly another 250,000 of these were taking more than 13 weeks. That means that, at present, 450,000 tests are taking longer than the target set for next April. This is not a large proportion of the total number of tests done, making next April's target look achievable.

The department's calculations of average waits indicate that the longest are for hearing tests, with colonoscopy taking almost as long. But the department also published data suggesting that waits for MRI and CT scans had fallen sharply since October 2005, when choice was introduced for patients who did not have a scan scheduled within the next 20 weeks.

The data indicate that allowing patients to choose where to go for their scans has cut the number waiting longer than 26 weeks from almost 16 per cent to less than 1 per cent. Andrew Lansley, the Shadow Health Secretary, said that the figures did not give the whole story.

"We know that some patients are forced to wait longer than 26 weeks, but we do not know the maximum wait," he said. "Some patients are waiting longer than two years for crucial diagnostic tests. Any significant wait for diagnosis is unacceptable. It would be an entirely alien concept to a patient in France, Germany, the United States and many other countries that they should have to wait for any diagnostic tests. It should be the same here."

Source






Australia: Mammogram incompetence in Queensland's socialized medicine system

There are increasing concerns about Queensland Health's breast cancer screening service after it emerged yesterday that 9300 women's mammograms had to be reviewed last year. The review was ordered after three of the five radiologists contracted to BreastScreen in Cairns failed to detect the expected number of small cancers in the 2004-2005 financial year. All films taken during that year were checked in the review, which took the service's most experienced radiologist almost five months to complete.

From the checks, 83 women were recalled to repeat their tests and two were found to have ductual carcinoma in situ, a non-invasive form of breast cancer. Two Gold Coast women this week launched legal action against Queensland Health alleging negligence after their aggressive cancers were not detected from their mammograms.

Opposition health spokesman Bruce Flegg accused the Government of a cover-up for not publicly announcing the review, but the Government asserted the review showed quality assurance processes were working. Queensland Health senior director of cancer screening services Jennifer Muller said the review was part of the normal quality control processes. "It's not an unusual event that we would want to do a review because we're committed to providing a high quality service," Ms Muller said.

Health Minister Stephen Robertson said BreastScreen was continually undertaking quality control measures, which led to the "exhaustive review" of the Cairns service. "No service is perfect but when you consider the number of women now using the service throughout Australia we will provide a world-class service," he said. "What we've seen over the last couple of days is experts from that service coming out and saying that we provide a service that identifies nine out of 10 cancers - it's not perfect. "The important thing is when we find problems or the service hasn't met appropriate standards . . . we fix it, and that's what we've done in the Cairns case."

But Dr Flegg accused the Minister of a cavalier approach to public health. "I think it raises some pretty serious issues when they knew there was a quality problem with readings in Cairns," he said.. "I think it does cast a doubt in the minds of patients as to how reliable the reading at BreastScreen Queensland is."

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.

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NHS CAN'T HANDLE PREMMIES

Premature babies are being sent hundreds of miles to be placed in intensive-care units, an audit has indicated. The UK has the highest rate of premature births in Western Europe, and one of the poorer records in treating premature babies, Bliss, the charity which commissioned the audit, said.

An average of three babies a day have to be transferred. Many are moved more than 100 miles, and the longest recorded journey was 286 miles, Rob Williams, the charity’s chief executive, said. Since the first audit of services last year, things had worsened, he added. Despite a government commitment in 2003 of 70 million pounds to improve care, it still fell short of an acceptable standard. “The money was welcome but nothing like enough to achieve what is needed. The service is overstretched, under- resourced and slow to respond to promising initiatives. “Ninety-five per cent of units are working at overcapacity, and 78 per cent of intensive and special-care units had to close their doors to new admissions, up from 72 per cent in 2004.”

Most importantly, he said, hospitals failed to apply to babies the same nursing care that would be provided to adults. In adult intensive-care units, there was, on average, one nurse for every patient — but only 3 per cent of baby intensive-care units achieved the same standard. Neonatal care for babies is provided by 22 networks of hospitals. But the survey found that transfers outside networks were common. Parents were often poorly informed and not told that their babies might need special care.

Sarah Skates, from Crayford in Kent, gave birth to twins after 26 weeks of pregnancy. One child was transferred to a hospital in Norwich, and the other to a hospital in Surrey, a two-hour journey in the opposite direction. The twins’ father went to stay in Norwich while their mother stayed at home to look after her older child. It was, she said, “the hardest time of my life”.

The research was carried out for Bliss by the National Perinatal Epidemiology Unit at Oxford. The report says that the Department of Health should require intensive-care units to have a nurse for every baby. A spokeswoman for the Department of Health said: “On average, a quarter of neonatal intensive-care cots are empty at any given time, so the creation of local neonatal networks has helped local areas assist each other when demand is greatest. “These provide as much of this care locally as is possible, but there will always be occasions when transfer to a more specialist unit outside the network may offer better outcomes.”

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.

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THE GOOD OLD GENEROUS AMERICAN TAXPAYER

The recent state budget debate over whether California should provide health insurance for children who are undocumented immigrants largely overlooked one key fact: The government already spends almost $1 billion a year for some health care services for the undocumented through Medi-Cal.

Amid a renewed national focus on illegal immigration, health services for undocumented immigrants in California returned as a political flash point this year for the first time since debate over Proposition 187 roiled the state in the 1990s. Republican lawmakers persuaded Democrats and GOP Gov. Arnold Schwarzenegger to drop $23 million for new insurance coverage for undocumented children. But almost no one was talking about the programs that Proposition 187 was intended to cut before it was blocked in court in the late 1990s: prenatal care, nursing home care and other services funded by Medi-Cal for undocumented immigrants.

Over the past decade, those services have grown by 50 percent into a $1 billion annual program serving hundreds of thousands of people each year. Spending growth has been slower than in the Medi-Cal program overall, which went up more than 100 percent in the past decade, to about $35 billion annually. Both the number of people receiving services and the cost of those services have risen: The number of undocumented women giving birth covered by Medi-Cal rose almost 25 percent from 85,000 in 1995 to 105,000 in 2004. Meanwhile, the overall costs of those births rose by about 135 percent during that time.

State officials say the increases are largely due to inflation in health care costs and to a change in the rules allowing more people to qualify for Medi-Cal. Republican lawmakers say the fight over Proposition 187 has limited their ability to try to cut existing programs. So they're focusing on trying to stop any efforts to expand services to the undocumented. "We've realized our hands are pretty much tied by the fact that the Proposition 187 appeal was dropped in court," said Sen. Dennis Hollingsworth, R-Murietta, one of the lawmakers leading this year's budget fight.

More here






U.K.: NHS FAILURES GO RIGHT TO THE TOP

Poor leadership, bad management and inadequate board members are the main reasons for hospitals and primary care trusts running up deficits, the Audit Commission has found. While managements tend to blame the system, the fault lies not in their stars but in themselves, the commission says. In 2005-06, the commission published 25 public interest reports, in which local auditors were sufficiently alarmed about the financial state of NHS bodies to make their concerns public.

Now the lessons of these reports have been gathered in a single document, Learning the Lessons from Financial Failure in the NHS. Last year the NHS ran up a large deficit, even though it is mandated to balance its books. Although the majority of NHS organisations did so, a minority failed, some by huge margins.

Steve Bundred, the chief executive of the commission, denied that parts of the NHS were underfunded. He said that organisations that ran into difficulties had been warned but had failed to make changes. Of 25 trusts examined the total deficit in 2005-06 was 173.6 million pounds, in spite of “financial support” from other parts of the NHS worth 86 million pounds.

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.

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RAPE IN BRITISH "NATIONAL HEALTH" HOSPITALS

Can you imagine the litigation if these were private hospitals? Handwringing is all you get from government hospitals

Women were the victims of more than 100 incidents of rape, sexual assault and sexual harassment in NHS mental health units over two years, according to a confidential report being held by the Government. The Times has learnt that the report, which gives details of more than ten rapes and, in a single year, three unwanted pregnancies, has yet to be published eight months after it was received by the Department of Health. The findings bring into question the Government’s claim to have set up single-sex wards that are safe and ensure personal dignity across the health service. The pledge, made by Tony Blair in 1996, was supposed to have been met by the end of 2002.

Mental health campaigners said the report confirmed growing fears that the Government was compromising patient safety in some of the country’s mental health trusts and psychiatric wards in district general hospitals. Ministers are accused of not tackling the problem as a matter of urgency despite having the information to alert them. Incidents in mental health settings appeared to be a far lesser concern than those in other hospital environments such as cancer wards, campaigners said, even though psychiatric patients were likely to be the worst affected by such experiences.

Details of the report, leaked to The Times by Whitehall sources, come from data collected by the National Learning and Reporting System, a monitoring programme set up in November 2003 by the National Patient Safety Agency (NPSA). All healthcare organisations were linked to the system by the end of 2004, including the country’s 84 mental health trusts, and the first national report was published in July last year. However, such was the concern over sexual assault in mental health settings that a separate study — the Mental Health Observatory Report — was commissioned. Most of the recorded incidents took place in the 12 months to October 2005 as most mental health trusts were among the last organisations to join the reporting programme. It is understood to include both patient-on-patient and staff-on-patient incidents and ranges from men exposing themselves to women, physically assaulting them and committing rape.

The report’s findings reached the Department of Health last November. It is understood that the hold-up has occurred at the NHS “gateway”, a system set up to disseminate inspection information efficiently [!!!!] throughout the service.

Paul Farmer, chief executive of Mind, the leading mental health charity, described the data as “extremely concerning”. With an estimated 22 per cent of safety incidents in the NHS going unreported, the full picture could be even worse, he said. “We are talking about the care of some of the most vulnerable patients. I think people will rightly be appalled by these findings.”

Spending on mental health has increased by 600 million pounds since 2000, with funding for extra nurses, teams in the community and high-security units. But concerns remain that inpatient services — which care for a range of conditions, from severe depression to self-harm and suicidal tendencies — have been overlooked and are likely to suffer further. Health leaders say that the recent deficits are having a severe effect on mental healthcare, with cuts in staff and bed numbers adding to the problems of providing single-sex wards. Estimates from the Conservatives suggest that more than half of NHS trusts have been forced to close wards. The Government says that only 11 trusts have been affected.

Asked about the Mental Health Observatory Report in the House of Lords last month, Lord Warner, the Health Minister, said in a written answer that it would be released later this year. A Freedom of Information request, submitted by Mind in April, was rejected by the NPSA on the grounds that the material was in the process of being published. The agency accepted that it had had the information since the previous November and said it had the “definite intention to publish in the near future”. The Department of Health said yesterday that it did not comment on leaked documents. A spokesperson said that some data needed further analysis before the report could be published

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.

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NHS KNOW-NOTHINGS

Thousands of lives are being put at risk every year in the NHS because of the Government's failure to set up an effective system to monitor patient safety and prevent mistakes recurring, an influential cross-party committee said yesterday. A report by the Committee of Public Accounts, the parliamentary spending watchdog, describes the performance of the National Patient Safety Agency, which was set up to improve safety in health settings, as "extremely weak" and "dysfunctional".

In 2004-05 there were more than 1.2 million safety incidents and near-misses, half of which could have been avoided if health trusts had learnt from past mistakes. The report, which is based on work by the National Audit Office and evidence from the Department of Health, the safety agency and the Chief Medical Officer, concludes that a culture of secrecy and inadequate safety regulation is preventing error reduction in the NHS.

A total of 974,000 incidents were reported to the agency in 2004-05, but these represented only about three-quarters of the actual total, the committee found. It said that an average of 22 per cent of incidents go unreported, most of which were medication errors and incidents leading to serious harm.

Edward Leigh, chairman of the committee, said that arguably the most worrying finding was the apparent inability of the health service to reduce avoidable and recurring mistakes. "These statistics would be terrifying enough without our learning that there is undoubtedly substantial under- reporting of serious incidents and deaths . . . The NHS simply has no idea how many people die each year from patient safety incidents," Mr Leigh said. "What this points to are two related and deep-seated failures. One is the failure of the NHS to secure accurate information on serious incidents and deaths. The other is the failure on a staggering scale to learn from previous experience."

The report, A Safer Place for Patients: Learning to Improve Patient Safety, said estimates that one in ten patients admitted to hospitals in developed countries is unintentionally harmed showed the urgent need for an effective system. The errors are costing the health service about o2 billion a year in extra bed days and o400 million in settled clinical negligence claims. The report said that the safety agency had "provided only limited feedback to NHS trusts on solutions to reduce serious incidents". Underreporting by staff, particularly doctors, also remained a problem.

It added that "few trusts have formally evaluated their safety culture" and "insufficient progress" had been made on achieving targets set out by the Department of Health. The report also refers to data showing that less than a quarter of trusts routinely inform patients involved in a reported incident and 6 per cent do not involve patients at all. It noted that the size and complexity of the NHS workload, which treats a million people every 36 hours, meant that errors were inevitable. Peter Walsh, of the patient safety charity Action against Medical Accidents, called for urgent action as a result of the report.

Susan Williams, joint chief executive of the safety agency, said that progress had been made, but more was needed to ensure "even safer healthcare".

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.

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A WONDERFUL STORY BUT NO CREDIT TO THE NHS

Will he ever be told that government doctors intended to kill him?



When doctors turned off James Smart’s life-support machine after he had spent ten days in a coma, his mother believed that her two-year-old son could not survive. But, against all odds, James started to breathe on his own and is on his way to a full recovery. Yesterday he played at home in Wakefield, West Yorkshire, as his mother, Ellie Craven, 21, told how he came back from the brink of death.

James had shown no sign of life after contracting pneumococcal meningitis. Doctors feared that if he survived he would be in a vegetative state for the rest of his life. But, two months after being released from hospital, he continues to amaze medical staff.

James began to feel unwell in February and his mother took him to the doctor. Despite having a high temperature, freezing hands and a sore throat, all that was suspected was a throat infection. Less than 24 hours later meningitis was diagnosed and the boy went into a coma. Ms Craven was in labour with her second child when James was rushed to hospital. He was placed on a life-support machine as medical staff drained fluid from his brain. After ten days, with no sign of progress, he was taken off it. “Nobody could believe it when he started breathing,” Ms Craven said. James suffered a small amount of brain damage, but after nine weeks in hospital, where he underwent intensive physiotherapy and speech therapy, he returned home.

Source

In the USA, coma patients are often kept alive for years. In Britain's "caring" socialized medicine system, this little boy was allowed only 10 days. Personal note: This story moved me to tears

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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.

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Demeaning the dead -- the NHS continues its downhill slide

By Melanie Phillips

People say that you can measure how civilised a country is by the way it treats its dead. Judging by that yardstick, it would seem that parts of Britain are not very civilised at all. At Queen's Park hospital in Blackburn, the bodies of patients who have died have been left on hospital wards overnight, apparently because a funding crisis has resulted in a shortage of night porters who are needed to move them to the mortuary.

The East Lancashire Trust in charge of the hospital - which subscribes to an NHS scheme entitled `pursuing perfection' -says that because it is under pressure to save 11.6 million pounds by next April, it can't afford to replace four night porters who are off sick or who have resigned. Since it takes two porters to move and lift a body, when staff are left alone overnight it is therefore impossible for them to move from the wards patients who have died. One porter at the hospital has claimed that last week, three bodies were left on the wards for more than eight hours.

This is sickening and revolting. Leaving the bodies of patients in their beds like this is utterly unacceptable. It shows a total lack of respect for the dead, and the likely distress caused to other patients needs no imagination. The NHS budget now runs to a massive annual total of more than 80 billion. Yet the service cannot even afford to treat a dead body with elementary respect. Yes, we all know that despite the astronomical sums being poured into the NHS it has nevertheless managed to get itself into a 500 million deficit and is in a permanent state of crisis as a result.

Yet there is still money to pay the salaries of the serried ranks of bureaucrats, who have helped reduce the NHS to its current parlous state of mismanagement. The East Lancashire Trust itself is currently advertising on its website for a Director of Strategy and Implementation at an annual salary of 95-100,000 pounds. This exalted figure will get the `chance to transform services and improve the patient experience.' It is also advertising for something called a Supply Chain Director, at a salary of 75,000 pounds, a post which is apparently essential to ensure `we obtain maximum value from our 500 milion-plus annual spend within Cumbria and Lancashire.' Is it really `improving the patient experience' or `obtaining maximum value' for patients to find they are sharing their ward with a corpse that has been left in the next bed for hours on end? Isn't there something dramatically wrong with the Trust's priorities here?

Our health service is spending ever increasing sums on cutting-edge medical technology. As a country we are moving into the brave new world of designer babies, face transplants and cloning. These advances are held to be evidence of the superiority and prowess of our civilisation. Yet we seem to be no longer capable of observing even the basic decencies of a civilised society. The way we treat the dead is of the greatest possible significance not just to the health service but to society at large. For if we do not show respect to the dead, we will not show it to the living.

The rituals around our treatment of dead people signify the respect we have for human life itself. That's why the desecration of graves or cemeteries is so shocking. That's why we close the eyes of the deceased, or cover their faces with a sheet; it's why we prepare them decently before we bury them. We treat a dead body with this kind of reverence because to do otherwise would be to show that we have no intrinsic respect for our common humanity and for what it actually means to be a human being. We reaffirm this common bond even towards the physical remains of a life that has departed, precisely to signal that to be human is to be more than a mere assembly of working parts and that we are not just a lump of flesh. If we don't do this, if we treat a dead body as if it were no more than an inanimate thing, we dehumanise not just the person who has died but ourselves and our fellow human beings too.

Yet that is just what was done at the Queen's Park hospital, where dead people were treated with no more thought than bags of refuse waiting to be collected. It is simply no excuse to say there wasn't enough money. It suggests rather a breakdown in some pretty basic codes of decency. It appears that this scandal only came to light when a porter who was unable to move a body from a ward because he was alone wrote an incident report to the management. But what about the other hospital staff who must have noticed that a dead patient had been left for hours on a ward? What about the nurses who were seeing to other patients on these wards? Why didn't they immediately do something about it? Didn't they care? Did they even notice?

Unfortunately, the financial black hole is by no means the worst thing that has happened to our health service. Far more serious and disturbing is the loss of something much more fundamental than money, even though it is more intangible. What has disappeared in distressingly large measure is the ethic of care, at the heart of which is recognition of the dignity of every human being and the intrinsic respect to which that gives rise.

Of course, there are many nurses, doctors and other NHS staff who provide magnificent and sensitive care, particularly where sick children, patients in intensive care or relatively young people suffering life-threatening diseases are concerned. But in too many areas, respect for human dignity has been cast aside. Take mixed-sex wards, for example, which, despite many government promises to phase them out, still exist. These wards cause untold distress to many patients, particularly to elderly people. And it is the elderly who have suffered most of all from this erosion of respect within our health service. In too many of our hospitals, the treatment of elderly patients is simply inhumane. They are neglected so that some who are too frail to feed themselves are left without food. Others have their lives ended altogether by the withdrawal of food and hydration on the grounds that their lives are no longer worth living.

A recent survey found that up to 5,000 frail and elderly patients die each year because they are not put in intensive care beds for monitoring after their operations, having been written off because they are old. Such contempt for old people surely has its roots in the widespread erosion of religious belief, which has resulted in a loss of respect for the innate value of human life. Instead, respect is now afforded in proportion to the presumed usefulness of that life. Dead people, of course, are no longer useful at all - so much so that in some quarters they are not even being regarded as people but as useless objects. The shocking revelations from Blackburn suggest that the NHS is suffering not merely from a financial crisis but a moral one, too - and one that reflects upon all of us.

Source

One of my readers who is a public-hospital medical specialist in the USA wrote to Melanie regarding the above article as follows:

"I was touched like never before by your column on Demeaning the Dead. It was like being at the dentist when he is drilling and he hits a nerve. In a small space, you put into words what is wrong with society. A while ago, some woman was rescuing dogs disposed of in a city dump in South Africa. They were left to die. At first I thought this was extreme on her part. But then my wife said something wise - she said that, in a society that treats animals this way, how do you think they treat people? Likewise, how they treat the dead DOES reflect on how they treat the living.

The motive here is NOT economic. Someone can ALWAYS be recruited in a hospital - supervising nurses, who would have to be coerced to get their hands dirty hauling a body to the morgue. Security personnel, phone operators, cafeteria workers, even doctors. There is ALWAYS SOMEBODY. Leaving a body in a room with a living patient is just a passive aggressive stab at "the system".

And it's not good economics to leave a dead person in a hospital bed. As busy as hospitals are, economic efficiency would be greater with live patients rather than dead patients occupying beds".






The downward spiral continues in Queensland public hospitals

A shortage of nursing staff has forced Queensland's largest public hospital to cut back elective surgery for the next three months. More cuts are likely to limit operations to fewer than 1800. A leaked memo from the hospital revealed that since March "there have been ongoing elective operating sessions cancelled due to insufficient nursing and anaesthetic technical staff to provide safe patient care". "In addition, demand for emergency surgery is exceeding the current emergency OR (operating room) capacity," the memo says.

In the past year, the staffing shortages and additional demand for emergency operations have meant patients have faced last-minute cancellation of elective surgery. Several people who contacted The Courier-Mail said they had operations cancelled after they had been prepared and wheeled into the operating theatre.

Queensland Health Central Area Health Service acting general manager Terry Mehan said planned cuts in elective surgery were more appropriate than making last-minute cancellations to elective surgery lists. Mr Mehan said the hospital usually conducted 30 to 32 elective surgery sessions each day and the new roster would reduce that to 24 or 26 sessions each day. "Emergency surgery is exactly that. It is surgery that cannot wait. And this new roster system developed by the clinicians at the coalface aims to ensure emergency cases will not have to wait," he said. "We believe this will be a great improvement on ad hoc last-minute elective surgery cancellations. Last-minute cancellations result in stress and inconvenience for patients." Mr Mehan said demand for elective and emergency surgery was increasing throughout the state. "And there is a shortage of nursing staff, particularly of nurses with operating theatre skills," he said.

Australian Medical Association Queensland president Zelle Hodge said last-minute cancellations of elective operations had been "going on for some time" at RBWH. Dr Hodge said the shortage of beds meant Queensland's public hospitals were operating at full capacity and had no room to move should there be a disaster or seasonal fluctuations. "Ideally hospitals should plan to run at 85 per cent capacity to deal with these fluctuations," Dr Hodge said. "But we know the RBWH is constantly running at about 130 per cent capacity. This means patients with serious cancers have to wait. They are being significantly disadvantaged in our public hospital system."

Opposition health spokesman Bruce Flegg said that previously a lack of doctors had been blamed for cancellations. "Now it is a lack of technical staff and nurses to open operating theatre," he said. "This is the same government which has recently spent millions of taxpayers' money on promoting how things have changed inside our public hospitals because of its successful recruitment programs for doctors and nurses."

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.

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YOUR REGULATORS WILL PROTECT YOU (1)

20% of U.S. Transplant Centers Are Found to Be Substandard

About a fifth of federally funded transplant programs fail to meet the government's minimum standards for patient survival or perform too few operations to ensure competency, a Los Angeles Times investigation has found. The U.S. Centers for Medicare and Medicaid Services has allowed 48 heart, liver and lung transplant centers to continue operating despite sometimes glaring and repeated lapses, the newspaper's review found. There are 236 approved centers nationwide.

Although many of the substandard programs treat small numbers of patients, their collective failings carry a significant toll. Consider the latest available statistics, for transplants performed between 2002 and 2004. Nine lung programs failed to meet the minimum Medicare standards for survival, number of surgeries or both. These hospitals accounted for 21 more deaths than would be expected, based on a government-funded analysis of how all patients fare nationwide within a year of surgery. It is adjusted for the condition of the patients and the organs. Three dozen heart transplant programs didn't meet federal standards for survival or volume. They accounted for 43 more deaths than expected. Altogether, the programs examined by The Times had 71 more patients die than expected within a year of transplant.

"The bottom line message is that there are too many programs in the United States that need to be shut down," said Dr. Mark L. Barr, a cardiothoracic transplant surgeon at USC and president of the International Society for Heart and Lung Transplantation.

The disclosure of Medicare's failings follows a series of reports in The Times detailing dangerous lapses in oversight of the national transplant system. Three transplant centers in California have closed since September after their problems came to light. Medicare, which funds most of the nation's transplant centers, requires programs to perform a minimum number of transplants and to achieve a specific survival rate to be certified for funding. The benchmarks vary by organ, and there are none for kidney transplants. Should the programs later fall short, Medicare rules mandate no sanction, only that the programs turn themselves in.

The agency has the authority to pull certification - and therefore funding - from any center that does not meet its standards. But it rarely does. It has cut off funding to 11 centers since 2000. In nearly all of those cases, it moved only after the programs had voluntarily ceased operations, according to federal documents reviewed by The Times. In one case, its decertification came eight months after the program shut down.

Only recently, after The Times began asking detailed questions, did the agency step up its scrutiny. In March, it sent letters to all its approved programs, asking for information about their staffing and performance. It already has found about 25 programs that are "seriously out of compliance" with Medicare standards, said one agency official who spoke on condition of anonymity because the findings are preliminary. Some programs have problems so severe that the agency is considering immediate decertification, the official said. That could force closure.

Some transplant surgeons say Medicare has been too permissive, continuing to support poor-performing programs abandoned by private insurers. "This is a continued artificial bolstering of the programs that shouldn't exist," Barr said. To decertify such programs, he said, "would have been the natural Darwinian process to occur. The weakest in the herd get weeded out." The records of these centers are no secret. The Times identified the 48 programs by examining the total number of transplants performed in 2005 by each Medicare-approved center, as well as the latest survival statistics made public in January by government-funded transplant researchers. All of the information is available on the websites of the United Network for Organ Sharing and the Scientific Registry of Transplant Recipients.

More here






YOUR REGULATORS WILL PROTECT YOU (2)

Rapist doctor back to work in Australia

The Medical Board of Queensland is set to renew the practising rights of a doctor convicted and jailed four years ago for violent criminal offences, including rape. James Samuel Manwaring's probable reprieve under strict conditions imposed by the registration body has appalled his former employer, original complainant Dr Bruce Flegg, and stunned his victim.

Dr Manwaring, who graduated as a medical student from the University of Queensland in 1985, had a history of drug addiction which compromised the care he provided in jobs in Australia, the US and the United Kingdom. He committed his most serious offences in 2000 against a woman, who suffered serious physical injuries and mental trauma. After pleading guilty in late 2002 to rape, attempted rape, deprivation of liberty and assault, Dr Manwaring was told by District Court Judge Brian Hoath that nothing could "excuse your involvement in these offences". "During the course of your sexual assault on the complainant, she suffered multiple bruises and the aggravation of pre-existing degenerative changes in her jaw," Judge Hoath said.

Medical board head Jim O'Dempsey declined to be interviewed late yesterday, but confirmed in a written statement that Dr Manwaring "has met the stipulation of the Health Practitioners Tribunal to be eligible to apply for re-registration". Dr Manwaring could not be contacted late yesterday. The board's statement said that 24 conditions, including the testing of his hair for traces of drugs, would be closely monitored. "It should be noted Dr Manwaring cannot start practice as there are a number of the conditions imposed by the tribunal where he requires board approval prior to commencement of practice," the statement said.

Sources close to the medical board said it had not used its power and discretion to reject Dr Manwaring "despite the inescapable grounds that the man is a convicted and violent criminal with a shocking history as a practitioner".

Dr Flegg, who owned a medical practice before becoming a Liberal Party state MP, yesterday slammed the board's decision as reckless and irresponsible. "Serious violent criminal offences are not compatible with professional standards. I believe the board has been weak and feeble in not wanting to be legally challenged," Dr Flegg said yesterday. "Manwaring is a violent convicted criminal and a serious professional offender. "The board is supposed to be the guardian of standards and public confidence."

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.

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CALIFORNIA PANDERS TO THE MERCURY FREAKS

Probably wise if it lifts vaccination rates

Vaccines containing a mercury-based preservative are now largely off-limits to children under 3 and pregnant women in California. The only exception to the new state law, which took effect on Saturday, is the vaccine against Japanese encephalitis virus, a deadly mosquito-borne illness endemic to certain parts of Asia. The new law, by Fran Pavley, D-Agoura Hills, was aimed at reducing the risk of neurodevelopmental problems such as autism, which many parents believe can be traced to exposure to thimerosal, long used as a preservative in many vaccines.

Several large federal studies have shown no link between childhood vaccines and autism, but additional research is continuing. The U.S. Public Health Service and the American Academy of Pediatrics in 1999 began to advocate the elimination of thimerosal from vaccines because some infants who received them were exposed to mercury at levels that exceeded Environmental Protection Agency guidelines. Except for trace amounts, which are allowable under the new law, thimerosal has been removed from childhood vaccines.

The flu vaccine had been an exception. But concerns about its safety re-emerged in 2004, after the federal government recommended that babies between 6 months and 2 years be added to the list of those who should get annual flu shots. Aventis Pasteur, the company that manufactures the lion's share of flu vaccine, has increased the supplies of its thimerosal-free version in response to demand. "Based on what we know, we anticipate there will be an adequate supply of thimerosal-free flu vaccine for pregnant women and children under 3," said Department of Health Services spokesman Ken August.

The state has ordered 684,480 doses of flu vaccine to be distributed to counties for the upcoming season. The total includes 50,000 doses of thimerosal-free vaccine for children ages 1-3 and 15,000 doses for pregnant women. In addition, the state ordered 10,000 doses of FluMist, also thimerosal-free, for use in healthy people ages 5-49.

Aventis had opposed the Pavley bill, citing in a statement concerns that the ban could "undermine public confidence in immunization and ultimately deprive children of access to needed influenza vaccine." In response to industry worries and related concerns cited by the American Academy of Pediatrics, the legislation ultimately was amended to give the industry more time to stock up on thimerosal-free flu vaccine. The new law also allows for exceptions when no other alternatives are available or during public health emergencies.

August said Kim Belshe, health and human services secretary, issued an exception for the Japanese encephalitis virus vaccine: "Given the absence of a mercury-free vaccine against Japanese encephalitis virus and because the risks of fatal disease or brain injury far exceed any risk of mercury in the vaccine, the secretary is exercising her authority and temporarily exempting the vaccine from the provision of the law for a 12-month period." About 50,000 cases of the disease are reported annually in Asia. There is no cure, and up to 25 percent of those infected die from the disease.

August said that California distributes about 32,000 doses of the three-dose vaccine annually. Last year, 19,000 went to the military and the rest to people traveling to certain parts of Asia. It is unknown how many of those doses went to very young children or pregnant women.

Source






Bad bill of health for Queensland

Services provided by Queensland public hospitals have deteriorated during the tenure of the Beattie Government, and new national data rates the performance of the state's hospitals as among the worst in Australia. Released yesterday, the State of Our Public Hospitals June 2006 Report measures each state against its performance in 1998-99 and 2004-05.

Premier Peter Beattie said yesterday that he had not seen the report, but dismissed the findings, saying they were based on old figures. Mr Beattie said his Government had increased funding in October's mini-Budget and again in this year's Budget. "We've dramatically increased funding . . . $9 billion extra over the next five years," he said.

However, the report does provide a report card on the first seven years of his Government, according to the state Opposition and the Australian Medical Association. When Mr Beattie was elected in 1998, the number of people being admitted to public hospitals was above the national average. In 2004-05, the number admitted was 9 per cent lower than the national average. Public hospital beds reflect a similar trend. In 1998-99, Queensland had more hospital beds than the national average. But by 2004-05, it was below the national average. In terms of funding, in 1998-99, public patients in Queensland received only 81 per cent of the national average. This had declined to 79.8 per cent by 2004-05. Even the area of elective surgery, in which Queensland was rated the best in the country, has recorded a similar fall -- from 16 per cent above the national average in 1998-99 to just above the national average in 2004-05.

Federal Health Minister Tony Abbott was critical of the information provided by Queensland on elective surgery. "The report is only as good as the quality of the information provided by the states. If the states give us dodgy information then we will get a dodgy result," Mr Abbott said.

AMA Queensland president Zelle Hodge acknowledged that the report had come out before the recent mini-Budget which increased public hospital funding. In spite of this, she said the report showed Queensland still had "a very, very, very long way to go". Dr Hodge said most of the recent health funding increases had gone in salaries and did not address the critical shortage of beds which was now affecting the provision of services in public hospitals.

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.

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BRITAIN NOW HAS A "SURPLUS" OF NURSES (AS WELL AS DOCTORS)

Because the overspent NHS has now sacked so many of them and cannot afford to hire as many as are needed

Nurses from outside the EU will require work permits to take up jobs in the NHS, in a move designed to give homegrown nursing graduates a better chance of getting a job. Nearly 11,500 foreign nurses came to Britain from outside the EU in 2004-05, the last year for which complete records are available. India supplied the most, followed by the Philippines and Australia. Now it will be difficult for others to come, because a work permit will be granted only if a job cannot be filled by British or EU applicants. The rule removes nurses from the Home Office shortage occupation list and applies to nurses in bands 5 and 6 — those who have between a few months and 18 months’ experience.

The move is a reaction to a growing surplus of nurses, which has made it harder for many British graduates to find a job; but the Royal College of Nursing (RCN) was critical. Dr Beverly Malone, general secretary of the RCN, said: “International nurses have always been there for the UK in times of need and it beggars belief that they are now being made scapegoats for the current deficits crisis. “Removing nursing from the list of recognised shortage professions is short-termism in the worst possible sense. We know that the vast majority of international nurses are employed in bands 5 and 6, the very bands which are going to be affected. “If this goes ahead, I guarantee that the effects will be far-reaching and immediate. Over 150,000 nurses are due to retire in the next five to ten years and we will not replace them with homegrown nurses alone.”

Lord Warner, the Health Minister, said that large-scale recruitment of international nurses was only ever intended to be a short-term measure. Extra investment in training meant that there was no longer a need to hire junior nurses from abroad, he said. The change does not affect nurses already working in Britain and there would still be specialist nursing vacancies.

Last week a survey of 20 universities by the Council of Deans showed that more than 80 per cent of nurses qualifying this summer have yet to find a job, compared with 30 per cent at this time last year. The council, which represents the universities who train nurses, said that the situation was very serious. It showed, for example, that only a quarter of students who have already graduated from one London university have found work, while just 5 per cent from a midwifery faculty in the North East have secured a post. Andrew Murrison, the Shadow Health Minister, said: “This move is presumably designed to save the Government’s blushes as hospitals cut jobs and freeze nursing posts in a desperate attempt to resolve deficits.”

Source





PAIN IN GERMANY

With the country distracted by the prospect of tomorrow's World Cup semi-final against Italy, Angela Merkel's Government quietly announced the most painful reform yet of the national health system. The overhaul - immediately denounced as suspect, inadequate and antisocial by the opposition - came after all-night negotiations between the Christian Democrats and the Social Democrats, the two governing parties.

The health reforms provide for compulsory health insurance for all children - at an extra cost next year of 1.5 billion Euros - which has been a long-standing aim of the Social Democrats. However, Frau Merkel, the Chancellor, insisted that this could not be financed through yet another tax increase. So health insurance contributions for the whole nation will go up by 0.5 per cent from next year.

The reforms were vehemently criticised by the state insurers, patients' associations and by employers. Big business argues that it will become even more expensive to hire new employees.

The fundamental aim of the change is to give more choice to patients and to meet the huge costs of prescribed medicines.

Economists predict that from January next year domestic demand in Germany is likely to dribble away as consumers are squeezed by higher taxes. Political analysts predict that the Government will run into trouble in the second half of the year. "I don't see how this current line-up can hope to last the course," Herr Westerwelle said.

More here

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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.

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British medical bungling good for Australia

Recruiters plan to target an oversupply of more than 11,000 British doctors to fix Australia's chronic doctor shortage. Health officials and representatives from the national GP training scheme will travel to Britain this year to woo doctors who fear they will be left in dead-end jobs after planned changes by the Blair Government. Recruiters hope the availability of a well-trained pool of doctors may also reduce the chance of a safety scandal akin to events at Bundaberg Base Hospital in Queensland, where surgeon Jayant Patel was accused of harming patients.

The British Medical Association is up in arms over Mr Blair's changes. It claims 21,000 qualified doctors would compete for fewer than 10,000 training posts that lead to medical consultant roles - the top tier of specialists. Those who miss out on one of the 10,000 training posts may end up in hospital roles that offer negligible opportunities for better pay or career advancement, or even out of work.

Some doctors, such as Stephen Byrne, 27, are emigrating. After two weeks as a neurosurgery registrar at Flinders Medical Centre in Adelaide, he said his work here was more interesting than in Britain, he received better training and he was not worried his career would be stifled. "I made the decision (to apply for work in Australia) at the end of February. I was looking to go into a career in neurosurgery but I didn't see much point in hanging around the UK trying to chase one of a dwindling number of jobs," he said.

No official estimate of Australia's doctor shortage exists, but a federal Government study on general practice last year found a nationwide shortage of between 800 and 1300 GPs. Senior health bureaucrats in NSW, Queensland, South Australia and Western Australia agreed that the British oversupply offered a significant opportunity to cut doctor shortages. Queensland Premier Peter Beattie went to London last year to recruit 1200 health staff, including 300 doctors and 500 nurses. Since then, 849 doctors had expressed interest, and 10 had started work, with another 15 appointed.

Source






Billions of extra government spending on health buys you this:

Queensland eye patients in limbo after closure

The temporary closure of the Queensland Eye Bank means patients with failing eyesight face an indefinite wait for their vision to be restored, Opposition health spokesman Bruce Flegg said today. Dr Flegg said the Eye Bank, at Princess Alexandra Hospital in Brisbane, could no longer supply eye tissue to surgeons who operate on around 500 Queenslanders a year. He said staff resignations meant the Queensland Health facility had been closed for six weeks and there was "no light at the end of the tunnel". "Queensland currently is the only state in Australia not offering a cornea transplant service," Dr Flegg said. He said the situation shows the "falsity" of Premier Peter Beattie's claim of Queensland Health having hundreds of extra clinical staff. Dr Flegg said it would take only weeks to train nursing staff to harvest the cornea donations and keep them in a suitable condition at the Eye Bank for surgeons to use.

A Queensland Health spokeswoman said it was hoped the Eye Bank would reopen by the end of July. Some corneas have been imported from interstate for emergencies.

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.

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Hilarious: Trying to use bureaucracy instead of incentives as a "hurry up"

You don't see many government employees hurrying!

Surgeons who dawdle over operations are to be identified in an official ranking system intended to monitor the performance of every consultant. Charts to be issued this week will assess surgeons working in the 10 most common specialisms, including general surgery, paediatric medicine, geriatric medicine and cardiology. The system of "performance indicators" will be announced this week by ministers, seeking to boost NHS productivity. A recent report from the King's Fund, an independent advisory body, said patients had not benefited from a 340 milion pound salary increase for consultants.

NHS trust managers will be able to use the data - which will not be made public - to tell slow surgeons to copy the methods of faster colleagues. Ministers point to the example of a specialist who more than doubled his output at a Norfolk hospital by using "production line" techniques learnt in France, which ensure he is never kept waiting for his next patient. John Petri, an orthopaedic specialist, radically increased the number of patients treated using a technique he calls "dual surgery". While he is operating on one patient, anaesthetists prepare the next, ensuring no time is wasted before the patient arrives in theatre. His technique cleared his waiting list at the James Paget trust in Great Yarmouth.

However, the plan has dismayed consultants, who warn that such pressure could foster "conveyor-belt" surgery. Similar rankings will be introduced this autumn to monitor spending on agency nurses, unnecessary emergency admissions and whether patients are being kept on wards unnecessarily. Andrew Burnham, a health minister, said: "This is not a big stick with which to beat consultants. It's a positive tool to help them make the best use of their time. If they do, then consultants, patients and taxpayers benefit." Burnham said consultants had "quite rightly" seen significant pay increases but must now demonstrate that the public was "getting value for that money".

The Department of Health says consultants are now paid 68% more in cash terms than they were in 1997, with those on the minimum salary scale earning an annual 70,823 from November 2006. A few of the most successful earn up to 165,000 in the NHS and many supplement their salaries with private work.

Ministers accept that most surgeons are "multi-taskers" who also care for inpatients, teach juniors and carry out research, making it difficult to judge their performance. Dr Jonathan Fielden, the deputy chairman of the British Medical Association's consultants' committee, said: "We don't see patients as cans of beans on a production line. If people are pressing us to push patients through in a factory-style manner, that would be opposed." He said most consultants wanted to improve their output and would work with managers if the data were used positively. "Unfortunately, with the financial pressures in the NHS, there has been a deterioration in relationships in some trusts." An analysis of surgeons' time sheets by the University of Birmingham, has revealed that some consultants were performing nearly six times as many operations as others.

Source






Queensland health sure know how to hire the good guys

Nobody seems to be steering the ship and they lurch from one crisis to another

The new head of Queensland's biggest hospital has lost the support of nursing staff after the bungled sacking of a senior nurse. Queensland Health director-general Uschi Schreiber met the Royal Brisbane and Women's Hospital's new clinical chief executive officer Thomas Ward and director of nursing Lesley Fleming yesterday.

The meeting was called after Dr Ward sacked Ms Fleming on Thursday and gave her five minutes to clear out her desk. She was reinstated several hours later and Dr Ward was forced to apologise and admit he did not have "a clear grasp of the industrial relations processes within Queensland Health". Dr Ward only started the job three weeks ago. After the meeting, Queensland Health said Dr Ward and Ms Fleming had "committed themselves to working together in a collaborative manner".

Queensland Nurses' Union state secretary Gay Hawksworth said RBWH nursing staff was still "very unhappy" with Dr Ward's actions. "Whilst they appreciate that the director of nursing is now back in the job, Dr Ward has shown his management style and they will be watching everything he does in the future," she said. Ms Hawksworth said Ms Fleming was not given a reason for her dismissal. "She had about a 30-second meeting with him and he handed her a letter and said 'your contract has been terminated, leave now'."

Shadow minister for health Bruce Flegg said Dr Ward's position was untenable. "Clearly, once you have this sort of tension operating at the most senior level, you have a dysfunctional situation," Dr Flegg said. He cast doubt on Dr Ward's credentials, saying he had not practised medicine for years and had not worked in Australia.

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.

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GIVING HEALTHCARE REAL COMPETITION

Anathema to the simplicity-dreamers of the Left

The Harvard Business School professor, often described as America's foremost business strategist, has never shied away from tackling intractable problems. Over the past two decades, for example, he has devoted considerable energy toward fostering economic development in American inner cities. But his latest challenge is one that has stumped the best and brightest business theorists, politicians, and policy makers: America's dysfunctional healthcare system. And Porter is staking his reputation on a prescription that calls for a healthy dose of competition.

In a long essay in the June edition of Harvard Business Review, the 57-year-old Porter argues for redefining healthcare competition on the level of specific diseases and treatments, rather than on the level of health plans, networks, or hospital groups. ''The wrong kinds of competition have made a mess of the American healthcare system," contend Porter and his coauthor, Elizabeth Olmsted Teisberg of the University of Virginia. ''The right kind of competition can straighten it out."

The article is significant not only for its critique, but also because it bears the Michael Porter stamp. One of only 15 ''university professors" (the highest designation for faculty members) at Harvard University, his 16 books on strategy, competitive advantage, and business clusters have made him among the most sought-after business thinkers in the world. Porter consults for corporations, regions, and even nations. He is an adviser to Governor Mitt Romney and a former instructor of President Bush. He runs his Institute for Strategy and Competitiveness from Ludcke House, his stucco neo-Georgian headquarters on Harvard Business School's campus. And his views can influence conventional wisdom in the corporate world and even in the public policy arena.

But healthcare may prove to be a tough sell, even for Porter. ''It may take a decade," said Dr. Toby Cosgrove, leader of the Cleveland Clinic Foundation, who applauds Porter's effort. ''How fast do you think anybody can move a fifth of the US economy?" Still, it is clear that when Michael Porter talks, people listen. ''Sometimes you need a fresh look at things," said Mary R. Grealy, president of the Healthcare Leadership Council, a health policy advocacy group in Washington representing a coalition of health plans, physicians groups, hospitals, health clinics, and pharmaceutical and medical device companies. ''What's different about professor Porter is that he understands other industries, and he's trying to translate some of their experiences into healthcare. He's not mired in the system."

What attracted Porter to the healthcare sector, in fact, was its standing as a competitive industry that seemed to defy the laws of competition. In properly functioning businesses, from personal computers to mobile phones, product and process improvements drive down prices and costs, quality rises, markets expand, and uncompetitive players go out of business. In healthcare, costs are forever climbing, services are restricted or rationed, many patients receive poor care, preventable medical errors persist, and there are wide discrepancies in costs and quality among providers and across geographic areas.

Porter and Teisberg have a deceptively simple diagnosis: Healthcare competition today works on the wrong level. The players -- health plans, payers, providers, and doctors -- engage in what the authors call ''zero-sum competition," dividing value rather than creating it. They seek to transfer costs onto one another, limit access to care, hoard information, and stifle innovation, all to the detriment of patients.

The right kind of competition should occur at the level of preventing, identifying, and treating patients' conditions and diseases, Porter and Teisberg assert. They call for collecting and disseminating information about the outcome of medical procedures, so patients can make intelligent choices about physicians and hospitals. They also recommend transparency in billing and pricing to reduce cost shifting, discrimination, and other inefficiencies. And they propose increased specialization by healthcare providers, resulting in more centers of excellence in conditions and treatments that compete for patients. ''There's only one kind of competition that's directly connected to healthcare value," Porter maintained in an interview. ''And that's the competition about who can do the best job of your prostate surgery, with the least complications and the best recovery records. That's where the competition needs to be. Yet that kind of competition has been all but eliminated in the system, in a misguided effort to save costs."

Most of the tried-and-failed healthcare reform efforts of the past decade have emphasized government playing a larger role, as it does in Canada, the United Kingdom, and other countries. By contrast, the Porter-Teisberg approach would be a largely private sector solution, with employers helping to instigate change by negotiating with health insurers and providers for quality, choice, and transparency.

Government would have a role, not as a ''single payer" or an insurer of last resort, but by blocking network restrictions, hospital consolidation, and multiple hospitalization bills, and helping to set a framework for reform through its Medicare program. The role of health plans, meanwhile, would be more akin to that of coaches and advisers, helping their members navigate the system and find the best care.

Even before this month's publication of their article, which they plan to expand into a book over the next six months, Porter and Teisberg shared their two years of research and analysis with groups of healthcare industry leaders. And a few already have begun to reexamine their role as employers. Merck & Co., the pharmaceutical giant based in Whitehouse Station, N.J., has formed a senior level management committee -- headed by Raymond V. Gilmartin, the Merck chief executive -- that is working with its human resources staff to change the company's approach to purchasing healthcare for employees. ''Senior management has not really engaged the issue of healthcare as an operational issue," Gilmartin said. ''They have looked at it as just a benefit, and often at how to reduce the cost of that benefit . . . It's been quite a while since we've had new thinking in the healthcare area."

Teisberg, an economist who began collaborating with Porter when she was at Harvard in the early 1990s, moved to the University of Virginia in 1996 to teach at its Darden Graduate School of Business Administration. She got interested in healthcare years ago when a family health issue gave her insight into both the good and bad aspects of the US healthcare system. Speaking of herself and Porter, she said, ''Neither one of us has come at this as a healthcare expert. We're out there talking to people because we care about this. It matters."

Porter and Teisberg both anticipate pushback from the parties invested in the current system. Employers and insurers may continue to focus on cost-cutting as a top priority. Doctors, health plans, and hospitals may resist publishing data on outcomes, arguing that such information could be misleading without the proper context because physicians and clinics with the best reputations tend to take on the toughest cases and therefore may have higher failure rates.

As for the health plans, Porter said flatly, ''I suspect they will have a bit of indigestion over this . . . They are used to saying, 'OK, I have this power and I can bargain down rates with certain providers.' We advocate that there shouldn't be price discrimination. That is, somebody shouldn't pay more just because they're insured by one health plan versus another. It doesn't make any economic sense."

Still, there is a broad consensus that the healthcare industry is overdue for reform. Grealy and Gilmartin said elements of what Porter and Teisberg are proposing already are being introduced or tested in pilot projects around the country. Health insurers in Massachusetts, for example, are moving toward enabling members to search the Web for the best-rated hospitals for specific surgeries or illnesses. And, the M.D. Anderson Cancer Center and Texas Heart Institute, both in Houston, are among a growing number of institutions developing their specialties rather than trying to be all things to all people; such sites increasingly are referring patients with related conditions to other specialty centers.

Such efforts still aren't widespread, but Porter is hoping his proposals can be a spur to new thinking, especially among physicians. ''What more thrilling thing to do as a doctor than to try to be the best?" the professor asked rhetorically. ''Isn't that why you went into medical school? . . . Well, how are you going to know if you're not competing with anybody, if there's no information, if there's no data collected?"

Porter's style, refined in countless lectures at Harvard Business School, is to overwhelm listeners with his energy and the sheer logic of his ideas. He is both intellectual and animated. On a recent visit to WBUR's radio studio, where he discussed his healthcare proposal with ''On Point" host Tom Ashbrook, Porter rocked from side to side in his swivel chair, traced arcs through the air with his hands, and seemed to be only warming up to his subject when the 50-minute taping drew to a close.

One question with which Porter is wrestling is how to get from the current dysfunctional state of healthcare to the model that he and Teisberg have layed out. Porter said he is committed to meeting with industry executives, and state and federal regulators, to lend his support to initiatives and reform efforts that move in the right direction. Porter also has his eyes on the presidential campaign where, he believes, ''the debate now is totally about cost shifting and not value creation" in healthcare. Could his proposal influence that debate? ''I hope so," Porter said. ''I would love to challenge both candidates to see what they're going to do to engage these issues."

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Billions fail to help health

In Queensland as in the U.K.

A leaked memo written by Queensland Health's chief has revealed the Beattie Government has failed to substantially reduce surgical waiting lists despite an unprecedented funding boost and the Premier's claims to have turned the corner on health. The memo, by Director-General Uschi Schreiber, also warns that the integrity of Queensland Health's budget is at risk because little attention is being paid to how the billions of dollars the Government has promised to fix the sector's problems is spent. The two-page document's message is in stark contrast to the glossy brochure on health - titled "Keeping our promise" - mailed out to every Queensland household at a cost of more than $300,000.

A letter from Peter Beattie accompanying the brochure promised the funding would lead to "more hospital beds, shorter waiting times and better health care". But on surgery waiting lists, Ms Schreiber's memo states: "Despite the additional funds in 2005-06, to date, the available data indicates no substantial improvement. This is disappointing. "The effective management of elective surgery is crucial because the public health system's performance is constantly being assessed by the community by reference to this area of service delivery."

Ms Schreiber has summoned top bureaucrats to a strategy forum next week, asking them to justify their existing programs and rein in spending as "there is no further additional funding available" for the 2006-07 financial year. In the June 9 memo, leaked to The Courier-Mail yesterday, Ms Schreiber expresses frustration that a core function of Queensland Health, elective surgery, is still lagging. "It has become apparent that the recent substantial increases in funding to the Queensland public health system has led to a lack of attention to maintaining budget integrity, to the detriment of current and future service sustainability. I am also concerned that the large increases in funding have not been translated into improvements in performance, particularly in relation to elective surgery."

In a further leaked memo dated June 28, Ms Schreiber warns that the growth in employment [As in Britain, the money has gone on bureaucrats] in Queensland Health had increased "beyond the targeted levels". "Our current projections indicate this level of increase in staff may not be sustainable within our current budget allocation," wrote Ms Schreiber, who was appointed to the top job a year ago after the sacking of Dr Steve Buckland.

Ms Schreiber said yesterday she had a mandate to look after health as well as taxpayers' funds and to remind doctors, nurses and administrators that there was not a bottomless well of money. "This is about ensuring that we don't go over budget," she said. "If I'm not careful in managing the place, it will flip the other way where people think there is no reason to keep looking at budget integrity. "We are doing more surgery than the Queensland Health system has ever done in its history. It indicates ever-increasing demand. We have to find a whole lot of new reforms for elective surgery."

The Schreiber warnings come as Mr Beattie reassures Queenslanders in an expensive advertising campaign that the biggest ever reforms to the health system are paying off. An extra $9.7 billion over five years has been pledged by Mr Beattie for "more doctors, nurses and allied health professionals, more hospital beds, shorter waiting times and better health care".

Health Minister Stephen Robertson and Mr Beattie yesterday defended the cost to taxpayers of the advertising blitz. "It's really important that we produce a report card which highlights exactly where the reforms are being done. Queenslanders are entitled to know how the system is improving," Mr Beattie said. But Opposition Leader Lawrence Springborg accused Mr Beattie of "spending $8 million on propaganda trying to convince Queenslanders they have turned the corner". "Despite all the glossy taxpayer-funded advertising and the self-congratulatory claims that they have turned the corner on health, the reality is that under Labor the waiting lists have grown by a further 13 per cent under the Beattie Labor Government," Mr Springborg said. "This is devastating news for those people forced to wait to get the health care they need."

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.

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NHS BEING PRIVATIZED?

The world’s biggest private health companies are being invited to bid for the chance to spend substantial chunks of the 80 billion pound NHS budget. A six-page “contract notice” placed by the Department of Health in the supplement to the Official Journal of European Union, and seen by The Times, encourages the private sector to apply for a wide range of roles in the control and running of primary care trusts (PCTs). The trusts are responsible for about 80 per cent of the annual 80 billion NHS budget. They not only fund GP surgeries but also commission hospital operations and have a large say over which drugs patients in their area can receive. Critics said that the move was like “putting the NHS up for sale”, while some also said it signalled the end of PCTs’ role as providers of clinical services.

Last night, after being contacted by The Times, the department suddenly withdrew the advertisement. It said that drafting errors in the document had given the “false impression” that clinical services provided by PCTs would be phased out in favour of the private sector. However, it insisted that plans to broaden use of “expert help” from the private sector for ailing PCTs remained accurate.

Health economists said that while the Government had tentatively suggested expanding the use of private firms as purchasers of care for NHS patients — one of the key roles of a primary care trust — the document went much farther. It invited tenders for a multitude of services, including “general management”, “financial management”, healthcare administration and human resources. Additional information, provided on request to potential applicants, revealed that candidates should have experience of managing 300 million-plus health budgets. The stipulation meant that only the largest insurers and providers, such as the American firms United Healthcare and Kaiser Permanente, were likely to be suit- able. The advertisement asked for tenders, or “requests to participate”, by July 17, with selected candidates due to have been notified by the beginning of August.

Policy experts and health campaigners questioned last night how an initiative with such major repercussions for the future of British healthcare could be introduced without public debate. Mark Hellowell, research Fellow at the Centre for International Public Health Policy, said that the document implied that the Government felt a lot of services run by PCTs were inadequate and would be more efficiently provided by the private sector. He added that it was not possible to know exactly what the Government’s intentions were, because there had been no public announcement or debate and the initiative did not appear in any manifesto. “The scope appears to go beyond commissioning care. It is the full gamut of PCT activities,” he said. “When a government comes out with a policy, it normally wants to shout about it. But it seems with this that they want to do it on the quiet.”

Private providers already supply a small but growing proportion of NHS operations, diagnostics and mental health facilities. The Department of Health is understood to be particularly keen to get independent firms involved in the purchasing of care, which would reassure commercial health providers that they will not fall victim to any NHS bias. Alex Nunns, spokesman of the campaign group Keep Our NHS Public, said that the move flew in the face of government insistence that it was not privatising the NHS by stealth.

Source






Firemen sent to medical emergency

This is the ambulance system that has supposedly been "fixed" by the Queensland government. A defibrillator might have saved the woman

A woman died from a heart attack after volunteer firefighters were sent to her home because no paramedic was available. Christine Matthews, 55, of Mungallala, near Mitchell, suffered cardiac arrest early on Friday. A Triple-0 call to the QAS from a family member had to be redirected to the Fire and Rescue Service.

Sources said the ambulance officer was on leave at the time and there was no replacement on duty. The call was put through to the volunteer firemen at Mungallala, about 600km west of Brisbane, who responded to the emergency, arriving at the woman's home at Tyrconnel Street at 5.14am.

The firemen, who only had the standard 20 minutes' supply of oxygen on their truck, arrived to find Ms Matthews had no pulse and they carried out resuscitation for 30 minutes. A Queensland Fire and Rescue Service spokesman said the part-time firemen did "a damn good job" trying to revive Ms Matthews.

A senior volunteer fireman at Mitchell commandeered the unused ambulance and picked up a doctor and director of nursing from Mitchell Hospital, driving them the 44km to Mungallala. They arrived at 5.41am and Ms Matthews was treated by the doctor and nurse with a defibrillator, but was pronounced dead.

A QAS spokesman said the firemen were the "closest available emergency unit". "In rural and remote areas, all emergency response agencies and staff co-operate at critical times to provide the best possible service to their local community," he said.

Opposition Leader Lawrence Springborg said it was another example of Queenslanders suffering, despite paying ambulance taxes. "This tragic case highlights just how the Labor Government has abandoned regional and rural Queenslanders," he said. Mungallala has also been without a policeman for some time after the previous officer transferred and no replacement was sent.

The article above appeared in the Brisbane "Sunday Mail" on June 25, 2006

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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.

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