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31 July, 2008

The Price of RomneyCare

Gearing up for 2009, liberals are eager to claim Massachusetts as a Valhalla of health reform. Their enthusiasm is apparently evidence-proof. Even Mitt Romney, who should know better, took to these pages recently to proclaim, "Health-care reform is working in Massachusetts." Shortly after Mr. Romney's self-tribute, Governor Deval Patrick wheeled out a new $129 million tax plan to make up for this year's health spending shortfalls. Yet partisans are cheering the cost overruns as a sign of success.

Supporters are exultant because 350,000 people are newly covered since former Governor Romney's parley with Beacon Hill Democrats in 2006; this cuts the state's uninsured rate by about half. That's not the promised "universal" system, but never mind. The ominous news is that only about 18,000 people -- or 5% of the newly insured -- have taken advantage of the "connector," which was supposed to be the plan's free-market innovation linking individuals to private insurers.

Most of this growth in coverage has instead come via a new state entitlement called Commonwealth Care. This provides subsidized insurance to those under 300% of the poverty level, or about $63,000 for a family of four. About 174,000 have joined this low- or no-cost program, a trend that is likely to speed up.

As this public option gets overwhelmed, budget gaskets are blowing everywhere. Mr. Patrick had already bumped up this year's spending to $869 million, $144 million over its original estimate. Liberals duly noted that these tax hikes are necessary because enrollment in Commonwealth Care is much higher than anticipated. But of course more people will have coverage if government gives it to them for free. The problem is that someone has to pay for it.

Thus the extra tab of $129 million, which may need to go higher because it relies on uncertain federal funds from Medicaid. For now, Mr. Patrick wants one-time (yeah, right) charges of $33 million on insurers and $28 million on providers, plus some shuffling of state funds. The balance comes from an estimated $33 million boost in the state's "pay or play" tax: If businesses don't offer "fair and reasonable" insurance to their employees, they get hit.

This is a textbook example of how business taxes evolve into "pay or pay," the first recourse of state-funded health systems. Politicians love levies on business because they disguise the overall bill from voters. But such taxes are merely passed along to workers in the form of reduced take-home pay, since all health costs are part of compensation.

The main reason people are uninsured is because coverage is too expensive. Massachusetts didn't have many options for reforming the way health dollars are laundered in the third-party payment system created by the federal tax code. But it could have helped make insurance cheaper by reforming its private market before defaulting to public programs.

The Bay State has long served up coverage-specific insurance mandates, such as for fertility treatments, which raise costs. Yet in a just-deserts twist, Massachusetts health planners are now reviewing ways to trim mandates because the state is footing more of the bill, even if they didn't care when imposing them on individuals and small business. A state-sponsored study shows that total spending on mandates was $1.32 billion in 2005, or 12% of premiums. The study is devastating despite its pro-mandate slant.

Not that such practical lessons have stopped liberals from joining the Massachusetts parade. They have to gussy up the state's model because the extravagant claim that led to its creation -- that health care will be less expensive if everyone is covered -- is being relentlessly discredited. It's the same claim they want to make when they try to pass a similar plan for the whole country in next year's Congress.

Source




Poor NHS nutrition 'harming patients'

The number of errors relating to poor nutrition in NHS hospitals has almost doubled in two years, figures obtained by the Tories show. The number of incidents rose 88% between 2005 and 2007, from 15,473 to 29,138 across England. Such errors are reported by NHS staff to the National Patient Safety Agency and relate to incidents "which could have or did lead to harm for one or more patients receiving NHS care".

The figures showed big regional variations, with a 248% rise in the North East Strategic Health Authority (SHA) and a 178% jump in the West Midlands SHA. The rise was lower at 46% in the North West SHA and 63% in the Yorkshire and the Humber SHA.

A poll last year from the Royal College of Nursing found that patients are at risk of malnutrition because there are not enough nurses to make sure they are properly fed. Almost half (46%) of nurses said there were not enough staff to help patients who may need help with eating and drinking. A similar number (42%) said they do not have enough time to make sure patients ate properly.

A report in 2006 from the charity Age Concern revealed that 60% of older patients - who occupy two thirds of general hospital beds - are at risk of becoming malnourished or seeing their health get worse. Those aged over 80 are particularly at risk, having a five-times higher rate than the under-50s.

The figures were released in a parliamentary answer to the Conservatives by health minister Ann Keen. Shadow health minister Stephen O'Brien said: "This is a further disgraceful statistic from a Government which has failed patients and the public. "People go to hospital expecting to get better, yet in 2007, 29,000 people suffered unnecessary and completely avoidable harm from poor nutritional care."

Source





30 July, 2008

British doctors criticise surgery bonuses

Doctors' leaders have warned that plans to pay bonuses to surgeons based on the outcomes of operations could discourage doctors from treating high-risk patients. The country's largest hospital trust, Imperial College Healthcare Trust in London, is discussing a pilot scheme in which doctors would be rewarded financially for operations that are particularly successful.

But the British Medical Association, the professional association which represents doctors, warned that this could deter doctors from carrying out complex surgery or operations on frail and elderly patients. It added its voice to other critics of proposals to extend NHS cash reward schemes to reflect performance against a number of quality indicators such as mobility after surgery. Dr Jonathan Fielden, chairman of the BMA's consultants committee, said: "The outcome of an operation is based on multiple factors ... Other members of the medical team would also have fundamental roles in the care a patient receives and the outcome achieved."

A spokesman for the Imperial College trust would not say which operation the scheme would apply to, but he added: "It's about rewarding excellence." Katherine Murphy, from the charity the Patients Association, said: "Patients will be horrified."

Source




Australia: Public hospital bungle covered up

A whistleblower was bullied and information was covered up when a crucial cancer treatment went wrong, critics say. On Friday, SA Health revealed a radiation machine at the Royal Adelaide Hospital, used to treat 720 people between July, 2004, and July, 2006, was delivering the wrong dose.

Yesterday, the hospital was accused of bullying and harassing an employee who tried to expose the error, and of covering up the mistake, which only came to light last week. While working as the Employee Ombudsman, Gary Collis said he dealt with a hospital employee who was bullied after taking his concerns to management. The whistleblower also said up to three machines were not working properly. Mr Collis said whistleblowers in this situation had "very little protection". "Until there is genuine protection the individuals are going to think more about their own survival careerwise rather than just keep on banging their heads against the wall," he said.

SA Health chief executive Dr Tony Sherbon said RAH management discovered the error in 2006 through a quality assurance check but chose not to inform the department, prompting accusations of a coverup from the State Opposition. Dr Sherbon was only made aware of the problem on July 16 this year after someone filed a formal complaint.

"In 2007, the Central Northern Adelaide Health Service completed an investigation of an allegation of bullying and harassment," he said. "It found there was no bullying. This person suffered no retribution." He added that as far as he knew only one machine was affected.

The calibration error meant people received a dose up to 5 per cent lower than prescribed by their doctor. It is not clear what effect, if any, this would have on their survival. SA Health has launched a review into the error and has contacted all patients affected.

Source





29 July, 2008

California Legislature: More Uninsured, Please

Californians struggling to provide for their family's healthcare needs share a common frustration: it's very expensive. Unfortunately, one of the bills making its way through the California legislature will add frustration -- and expense -- to their struggle.

For some, finding health insurance coverage can be as simple as participating in an employer-sponsored plan bought in California's group insurance market. Older Americans receive coverage from Medicare, while those with disabilities and few resources use a state program like Medicaid. But for workers in companies that can't afford to provide coverage, for self-employed and small business owners, for people working part-time or who stay at home to care for children or an ailing parent, health insurance is available through California's individual insurance market.

The individual market allows people to pay monthly premiums, just like employer-sponsored group coverage. The difference is that individual plan premiums are much lower than group plan premiums.

California has imposed so many regulations on the group market that its premiums are often twice as expensive as those of individual plans. For families, group plans now average nearly $12,000 per year, compared with about $3,900 for families buying coverage on the individual market. As much as $2.59 of wages for every hour worked pays for employer-sponsored health plans (2007 California Healthcare Foundation). Higher pay for workers is sacrificed to fund a form of health coverage that is expensive and over-regulated.

In contrast, individual plans in California are far less regulated and-not surprisingly-far more affordable. As of March 2008, individual health plans in California are among the least expensive in the U.S. Health insurance premiums in states that heavily regulate the individual market have predictably skyrocketed-like in Massachusetts, in which much-heralded recent "reforms" contributes to Boston residents paying TRIPLE what San Franciscans do for identical coverage.

That difference in affordability may be disappearing. AB 1962 would impose a mandate for every individual health insurance policy to cover maternity benefits regardless of whether the person needs, wants or can afford this coverage. The bill would force the following Californians to pay for comprehensive pregnancy coverage:

Women who have had a hysterectomy

Men

Post-menopausal women

Couples who can't have children

Men after vasectomy

Women after tubal surgery to prevent pregnancy

If AB 1962 were enacted, it would become illegal in California for an insurer to try to sell an individual health insurance policy without obstetrical coverage. This mandate was examined by the independent California Health Benefits Review Program. Its analysis revealed that forcing these policies to cover pregnancy will add $74.5 million to the premiums paid by those trying to buy individual health insurance.

The net result of making individual health insurance less affordable? 2,300 more Californians will become uninsured when they lose the ability to buy any coverage at all when the only policies sold are priced to include maternity benefits. Increasing the number of uninsured Californians isn't what our state needs. If you oppose making insurance MORE expensive, please ask your state representatives to vote no on AB 1962.

Source




Australia: NSW Ambulance staff dread return of boss

Vicious "Health" bureaucrats at work again. They seem to be as bad in NSW as they are in Qld.

The former boss of an ambulance station in western NSW is being returned there as an officer despite an external investigation largely substantiating more than 50 allegations of bullying and harassment made against him over the past 10 years. Several former officers at Wellington station have either resigned, transferred or gone on stress leave, saying they could no longer work there while Rodney Althofer, 63, was manager. The Herald understands a six-month external investigation by Kamira Stacey Consulting found more than 50 allegations against him were mostly substantiated.

Today marks the final hearing day of a parliamentary inquiry into the NSW Ambulance Service, which has been inundated with submissions on bullying and harassment and complaints about poor handling of grievances. Investigators interviewed about a dozen officers who had worked at Wellington for the report, which was completed midway through last year. However, the service has kept that report secret and did not act on the matter until last week. The chief executive of the service, Greg Rochford, has also refused to release to staff the service's response to the report.

The Herald spoke to seven former and serving Wellington ambulance officers, as well as the partners of two others, all of whom alleged bullying by Mr Althofer. Three alleged that he told them not to bother buying property in the area because he would run them out of town. The officers described Mr Althofer, a warrant officer in the navy for 20 years, as a "military-style", micromanaging authoritarian who screamed at, and publicly humiliated, staff. They are also furious at management for failing to deal with the problem for so long.

They were devastated to learn at a staff meeting on Tuesday that Mr Althofer would be returning within two weeks - although as an ambulance officer and not in his original job as station manager. They were told an external mediator would be available to work through any problems. One ambulance officer immediately went on stress leave upon hearing the news and another is seeking a transfer. There are only six full-time ambulance officers at the station.

An email from a former western division officer, sent to the parliamentary inquiry last month, said it was "one of the most investigated and documented accounts of bullying and harassment that I have seen in my experience". The email, which has been seen by the Herald, said "[The manager] has previously been stood down for harassment of staff over the years and has also been sent to anger management courses, this you will find in the [Kamira] report". The Herald understands the Kamira investigation was prompted after the service received three formal complaints of bullying in one week in late 2006 - two from Wellington officers and one from a doctor at the local hospital.

A former officer, who worked there for 18 months until mid-2000, said he went on workers' compensation due to stress from being bullied by Mr Althofer. The final straw was when Mr Althofer "chased me across the road yelling at me . in the main street of Wellington", he said. "They found that he needed to attend an anger management course and he refused to do it." Another former Wellington officer said Mr Althofer would hide behind trees near the station on his days off and check what time staff turned up for work.

Mr Althofer denies any bullying and harassment of staff. "I've always tried to get ambulance officers to do what they are supposed to do and because of the culture of the ambulance service they simply don't do what they're supposed to do. "They breach the code of conduct on a daily basis and all I ever did was to try and get people to do what they're supposed to do," he told the Herald. He said he offered to return as an ambulance officer, and not the manager, because of "all the stress of trying to manage people who don't want to do their job". "I was bullied and harassed," Mr Althofer said.

The service would not comment except to confirm there had been an investigation at Wellington "involving interpersonal dealings between colleagues".

Source





28 July, 2008

American Cancer Care Beats the Rest

You don't want socialized medicine if you're really sick

"Your accomplishment of [universal access] is the envy of every U.S. citizen who understands what you've done," Sen. Edward Kennedy (D., Mass.) told a Canadian audience in 1996. This week, a major international study confirms that Mr. Kennedy is right to stay at home for his own cancer care: U.S. medicine bests the cancer treatment available to people in 30 other countries.

The Concord study compares five-year cancer survival rates for several malignancies: breast cancer in women; prostate cancer; colon and rectal cancer in women and men. Combining the efforts of some 100 researchers, drawing data from almost two million cancer patients in 31 countries, the study, to be published in the August issue of The Lancet, is groundbreaking.

Who's on top? Arguably Cuba, which records the best overall outcomes for breast cancer and colorectal cancer (in women), and seems to beat U.S. health care in three out of the four categories. The study's authors -- who apparently hold higher standards than filmmaker Michael Moore -- disregard these results owing to data quality issues.

The study finds that the U.S. leads in the field of breast and prostate cancer. France excelled in women's colorectal cancer and Japan in men's colorectal cancer. The news isn't all good here: great discrepancies exist between white and African-Americans. That said, the United States clearly leads other nations in overall survival.

These results aren't completely surprising. Though international comparisons are hard to make, Lancet Oncology published last August a comparison of American and European care, and the U.S. fared better in 13 of the 16 cancers studied.

Americans don't usually hear good news stories about health care. Mr. Moore favorably reviewed British, French and even Cuban health care in the movie "Sicko," showing satisfied patients and happy, chic docs. Paul Krugman wrote last year in the New York Times that: "there's very little evidence that Americans get better health care than the British." Cancer care there is different than here. Take for instance the country whose health-care system Mr. Krugman likes so much. The Lancet Oncology study finds that five-year survival rates for cancer in men, for example, are 45% in England (slightly higher in Wales, lower in Scotland) but 66% in the U.S.

Why do the British lag behind American survival rates? Screening standards are different. In the United States, internists recommend that men 50 and older get screened for colon cancer; in the National Health Service in the United Kingdom, screening begins at 75. And British patients wait much longer to see specialists. A Clinical Oncology study of British lung cancer treatment found in 2000 that 20% "of potentially curable patients became incurable on the waiting list." Novel drugs offered here often aren't available there; for instance, Avastin, a drug for advanced colon cancer, is prescribed more often in the U.S. than in the UK, by some estimates as much as ten-fold more.

A drug called Temodal is the U.S. standard of care for Sen. Kennedy's type of brain cancer. In Britain, a government body charged with funding decisions -- the euphemistically named NICE, or National Institute for Health and Clinical Excellence -- ruled in 2001 that Temodal wasn't worth the money as a first-line treatment; in 2007, they partially lifted the prohibition. Patients can still get the drug, they just need to pay out of pocket -- for all their cancer care. The National Health Service recently ruled that if patients opt out of one type of care (say by getting Temodal), they opt out of all publicly funded care.

Two cheers, then, for American health care and better cancer outcomes. Rising costs, however, threaten to undermine the economy. Not surprisingly, our debate is shifting to a discussion of getting better value from our health dollars. Just last week, the U.S. House of Representatives held hearings on this topic (full disclosure, I was a witness). Former Sen. Tom Daschle and his co-authors speak at length about "value" in their new book, "Critical: What We Can Do About the Health-Care Crisis." Given his potential role in a future Democratic administration, the book may lay out the first outline of ObamaCare.

What's to be done? Mr. Daschle talks up the idea of a federal health-care board charged with "recommending coverage of those drugs and procedures backed by solid evidence. It would exert influence by ranking services and therapies by their health and cost impacts." The inspiration? Mr. Daschle cites Britain's NICE. The Congressional Budget Office is slated to release a paper on this topic later this year.

Given the Concord results, the CBO may want to hold off on that effort. Value -- like in the other five-sixths of the economy -- will come from competition and choice, not a government committee. But the federal government can take a leadership role in promoting competition. How? By creating greater transparency of prices, releasing more Medicare information on complications and outcomes, encouraging hospitals and clinics to standardize their health records, and slashing regulations that discourage competition. Together, these efforts would make it easier for American patients to seek out excellence. And that seems as American as apple pie and good cancer care.

Source




British hip and knee patients face delays due to emphasis on cheap cataract surgery

Thousands of patients could be facing unnecessary delays for hip and knee operations because the NHS is concentrating too much on cataract surgery, an expert has warned. More fiddling in response to targets. Cost instead of clinical need becomes the criterion for doing a procedure

The eye surgery has made up almost one fifth of all "extra" operations carried out using the additional cash ministers have pumped into the health service in recent years, figures show. As a result there has been a significant fall in waiting times for the procedure. But recent evidence suggests that surgeons could be carrying out cataract operations unnecessarily early on some patients, according to The King's Fund, the independent health think tank which collated the statistics.

Waiting times for other operations, in particular hip and knee replacements, have not fallen so fast, said John Appleby, the organisation's chief economist. "In reducing these waiting times we have done the easier operations and left the more difficult ones to last," he said.

The King's Fund calculates that of an estimated 605,000 "extra" operations carried out between 1998 and 2005, 115,000 were for cataracts. "I think that if you looked back from 1998 to now that many people would be surprised just how many of these extra procedures have been one operation, cataracts," Mr Appleby said. "Although the number of other operations being performed have increased as well, the figures show they have not risen nearly as much as cataract operations." He added: "There is also evidence that now some people are being admitted with rather good vision who would normally not be admitted for the operation so soon."

The think tank estimates that while a cataract operation costs the NHS around $1200 to $1400, the cost of a hip or a knee replacement is around 10 times that, at between $12,000 and $14,000.

Although cataracts can ultimately cause blindness some patients do not require surgery for months or even years after their initial diagnosis. Ministers have set a target that no patient should wait more than 18 weeks for treatment by the end of this year. Government spending on the NHS has more than doubled to $180 billion since the turn of the century.

A spokesman for the Department of Health said: "In England, by the end of December 2008, no patient will have to wait more than 18 weeks from the time they are referred by their GP for any treatment unless they choose to do so, or it is clinically appropriate. "Latest figures show the majority of patients are already being seen within 18 weeks and that the NHS nationally has achieved its milestones for March 2008.

"The increase in supply of cataract services has enabled the NHS to massively reduce waits for cataract surgery. Average waiting times for cataract operations 10 years ago were as long as 2 years, now it is around 3 months. The number of cataract operations have also nearly doubled in the last ten years. Ultimately, commissioning decisions are a matter for local primary care trusts."

Source





27 July, 2008

THE CONTINUING PUBLIC HOSPITAL WOES IN AUSTRALIA

Two articles below:

Surgeons pulling out of pennypinching public hospital system

SURGEONS are pulling out of public hospitals' on-call rosters because of the "pathetic" pay - leaving patients waiting days for operations. Royal Australasian College of Surgeons president Ian Gough, himself a Queenslander, said Queensland surgeons were increasingly reluctant to be on-call because they felt under-valued - and that included pay issues.

Queensland surgeons say the issue is putting increasing pressure on public hospital beds and nursing staff because some patients, particularly those with trauma-related injuries, are having to wait longer for operations.

Professor Gough said that under Queensland Health's visiting medical officer agreement, the hourly on-call rate was between $7 and $11, depending on the frequency of on-call rostering. "During that time you may receive lots of telephone calls and have interrupted sleep. It has an effect on your family and social life," he said. "There has been a great deal of disenchantment among some surgeons and as a consequence, an unwillingness to continue to be on-call."

If a surgeon in Brisbane is called back to the hospital, the hourly rate increases to between $186 and $212 and relates to a doctor's seniority. Those working outside Brisbane receiver higher rates.

Professor Gough conceded that on-call surgeons were remunerated "reasonably well" when they were called back to hospital. However he said the overall on-call rates were insufficient incentive for many surgeons and called for a fee-for-service system to be considered. He said Queensland Health was relying on surgeons' altruism to be part of on-call rosters. "Surgeons don't have any incentive to be on-call other than their goodwill and wanting to care for the patients," Professor Gough said. "The money that's offered is actually very poor."

His comments were echoed by Royal Brisbane and Women's Hospital trauma services director Cliff Pollard, who said that not paying surgeons sufficiently for being on-call was a false economy. "It's a big cost in terms of beds," he said. "Surgery can be delayed and patients spend longer in hospital. "We're not talking about time-critical patients, they get treated in Australia very well. "But with things like single limb fractures, you may have to wait sometimes a few days (to be operated on)."

An RACS spokeswoman said about 60 per cent of all surgeons in Australia operated only in the private sector. "The more who leave the public sector, the more pressure there is on the people who stay," she said.

Professor Gough raised the issue with Queensland Health reform and development division executive director Stephen Duckett at the RACS's annual Queensland branch meeting at Coolum recently. Professor Duckett accepted at the Sunshine Coast meeting that public hospital surgeons had "punishing" on-call rosters and said the pay issue was being examined. He said yesterday that Queensland Health did not have central data that reflected whether senior surgeons were pulling out of on-call work at public hospitals. Professor Duckett said Queensland Health was about to enter into enterprise bargaining with public hospital medical staff over pay rates. "Details of Queensland Health's position are not yet finalised," he said.

Source




Some patients have to wait just to get on a hospital waiting list

More than 33,000 sick Victorians are waiting just to get on an official waiting list for treatment at public hospitals, the Opposition claims. They are in addition to almost 40,000 people already waiting for elective surgery on the State Government's official waiting lists. Documents obtained by the Opposition under Freedom of Information, and seen by the Herald Sun, show that in December last year 33,869 Victorians were waiting for an outpatient appointment. People must be assessed in hospital outpatient clinics before they can be put on a waiting list for surgery - meaning those who are yet to be assessed do not show up on the official elective-surgery waiting lists.

Liberal health spokeswoman Helen Shardey said public hospitals were being forced to manipulate waiting lists to avoid being penalised by the Government. "There are literally tens of thousands of patients languishing on the Government's secret outpatient waiting lists and thousands more who don't have appointments who are waiting to get on to these lists to see a doctor," she said. "We are now in the unconscionable position of having people waiting to get on to these lists in order to join the queue for elective surgery. In many cases these people are waiting years." The documents show that the "secret waiting list" grew by 8722 patients in just three months leading up to December 2007.

Source





26 July, 2008

Qualified British GPs forced to drive taxis due to lack of work as doctors

Socialist Britain sure knows how to manage its health workforce. This amid frequent claims of a doctor shortage and long waits to see a doctor

One fully qualified GP is driving a taxi because he cannot find enough work as a doctor despite Government pledges to increase access to primary care and extend surgery opening hours. Next week 2,500 doctors will qualify as GPs and the vast majority have not found full time jobs and will have to live 'hand to mouth', the British Medical Association has warned.

It costs the taxpayer around $500,000 to train each graduate to junior doctor level and many are considering travelling abroad or working in another speciality even though there is predicted to be shortage of GPs.

Dr Alex Smallwood, chairman of the GP trainees sub-committee at the British Medical Association said the problem was rife and was a 'huge betrayal' of junior doctors who had been encouraged into general practice. He said: "Doctors will be stacking shelves, cleaning and driving taxis to make ends meet. If they can't get work as a doctor they have got to do something."

Dr Smallwood said the general perception of GPs earning anything from $200,000 to $500,000 was nowhere near reality for many. He said there are huge numbers of under-employed GPs who can only get one and half or two days work a week. Under the new GP contract there is little incentive for a partner in a practice to take on another partner to expand the practice or replace one who leaves. Instead, in order to maintain their own income and that of the practice, the partners take on a salaried doctor on around $100,000 to $120,000 full time, but most are employed only part-time and earn significantly less. Other practices are based in such old premises that they physically do not have the room for more doctors. The problem is risking the future of general practice as the best and brightest candidates either enter other specialisms or leave to work as a GP abroad, he said.

Some areas of the country are worse than others, with virtually no partnerships on offer in London whereas the situation is not so bad in poorer areas in the North of England.

Dr Smallwood said: "I can't say it is greed but there is an element of being unfair to younger colleagues. There is a certain amount of protectionism from some doctors. "There are vast numbers of people who can't get full time work and it is not just about getting a partnership it is about getting any job. There is a panic." He said the trend of taking on salaried part-time GPs will affect patient care as it will mean they are less likely to see the same doctor with whom they can build up a trusting relationship. Dr Smallwood said it is vital that a scheme where the upfront costs of taking on a partner are paid is reinstated.

Source




Australia: War hero's tragic wait

Insufficient capacity for emergencies set aside. Cairns has lots of ambulances but most were acting as glorified taxis. Sending one down the mountain range from far-away Kuranda is absurd

A World War II Digger had to wait more than two hours for an ambulance the day he died this week. Changi prison camp survivor Bob Mutton, who lived in the city on Sheridan St, endured a two-hour-and-five-minute wait on Monday while he struggled to breathe. He died hours after finally arriving at Cairns Base Hospital.

Stretched to the limit, the Queensland Ambulance Service dispatched a vehicle from Kuranda, 25km northwest of Cairns, after Mr Mutton's first ambulance was diverted to a "higher priority case" of a man having a seizure. It took 54 minutes for the first ambulance to be dispatched to 88-year-old Mr Mutton. The crew was then diverted four minutes into the job. After another 71 minutes, the nearest available ambulance arrived from Kuranda.

"We're appalled . to have to wait more than two hours for an ambulance can't be acceptable," an upset friend, who did not want to be named, said yesterday. "The sort of duress Bob would have been under waiting all that time doesn't bear thinking about. "This man served his country (and) spent three and half years in Changi prisoner of war camp. He paid his taxes right up to the end and he gets treated like this."

Queensland Ambulance Service assistant commissioner Peter Cahill yesterday confirmed the long wait, blaming it on the number of ambulances delivering patients to Cairns Base Hospital on Monday morning. "The remaining ambulances in the region were dealing with higher priority call-outs," Mr Cahill said. "An ambulance was unable to be dispatched until 11.38am. However, four minutes later this ambulance was diverted to a higher priority case."

Mr Mutton's doctor rang the Far Northern Ambulance's communications centre on a patient transport line at 10.44am, saying Mr Mutton was "frail, delirious, with laboured breathing". A worried friend rang the ambulance about 45 minutes later, saying Mr Mutton still had "rather rattly breathing" and asking when help would come. Mr Cahill said the Kuranda ambulance had to be stood down from another job to finally get to Mr Mutton.

Disgusted friends said their mate had been "pretty crook". "We'll never know whether a quicker ambulance would have saved him," one friend said. "But we know he wasn't treated right. And we'd hate for someone else and someone else's friends and family to go through that." Cairns RSL sub-branch president Peter Turner described the long wait as unacceptable. "It upsets me that this would happen to anyone, veteran or no veteran," Mr Turner said. "Delays like that are a huge concern."

Source





25 July, 2008

AUSTRALIAN AMBULANCE WOES CONTINUE

Articles from two States below

The NSW ambulance disgrace continues

Government bureaucrats running a health service are not only a disaster; Some of them are downright nasty -- as we see below:

Some ambulance officers had resorted to getting apprehended violence orders against colleagues because management had dealt so poorly with allegations of bullying and harassment, a parliamentary inquiry was told yesterday. Officials of the Health Services Union said members had no confidence in how the NSW Ambulance Service handled grievances. Some even accused it of being so aggressive towards complainants that it was itself harassing them.

The union officials were giving evidence at the inquiry into the management and operations of the service, which has been inundated with submissions about bullying, harassment and inadequate handling of complaints. The union's industrial manager, Dennis Ravlich, told the inquiry that some officers had been "reduced to seeking AVOs on an ambulance station".

Outside the inquiry, Mr Ravlich told the Herald he knew of "at least three or four" officers who had taken out AVOs against colleagues at their stations in the past five years because they felt so frustrated by a lack of action by management. "It's difficult to comprehend that the workplace had become that dysfunctional," he said. Another union official, Raymond Tait, told the inquiry that an eight-year complaint had only just been concluded but was now the subject of an unfair dismissal action before the Industrial Relations Commission. He told the Herald a complainant had been unfairly sacked last month over an unrelated matter.

Mr Tait said the service had kept secret its 2006 report into the eight-year-old complaint of alleged bullying. The complainant could only read the document but not keep a copy of it. And there was a condition that the person did not reveal its contents.

Mr Tait had told the inquiry earlier that the service's professional standards and conduct unit was "judge, jury and executioner" and rejected too many complaints, hoping they would just go away. The inquiry has received several submissions criticising the unit. It has been called an "absolute joke", likened to the NSW Supreme Court in terms of time delays, and referred to as "pathetic standards and cover up".

Mr Ravlich told the inquiry he was unsure whether bullying and harassment were more prevalent than in other comparable organisations. But he said that in dealing with complainants, the unit took "a rather aggressive approach towards staff . almost to the point of being harassing itself". In other evidence, the union told the inquiry it was not unusual for ambulance officers to work up to 14 hours without a meal break.

The officers' appearance before the committee followed a mass demonstration of more than 200 ambulance staff and paramedics who marched through Martin Place to Parliament House. The protesters demanded the State Government employ another 300 paramedics to ease pressure on staff. One officer at the rally, Warren Boon, of Camden station, said that in 2006-07, NSW ambulance staff had dealt with 1,052,000 cases. "The workload has gone from intense to nigh impossible," he said. "Fatigue is a chronic problem for staff and the shortage is affecting services to the public." He cited a recent incident in which he narrowly saved a cardiac arrest patient. "But if it had occurred any time in the previous six weeks, he would have probably died because of a lack of resources," Mr Boon said.

Ambulance officers were also having to work overtime to boost their modest salaries, he said, which were between $900 and $1000 a week for staff with 15 years' service.

Source




Qld.: Fire engines sent to cover for ambulances on many occasions

FIRE engines are being forced to respond almost daily to ambulance call-outs with 250 assigned in the past year, according to Emergency Services. Emergency Services Minister Neil Roberts said 250 fire-engines were sent to triple-0 ambulance calls last financial year. Firefighters provided first aid or CPR at 208 of the cases while the remaining 42 cases involved assisting invalids.

Mr Roberts said fire service crews were not used as automatic first responders in ambulance call-outs. He said the cases represented only 0.4 per cent of all fire call-outs. "The reality is, however, that they are very often the first on scene where people have been injured," he said.

The figures were revealed in a parliamentary estimates hearing under questioning from Opposition emergency services spokesman Ted Malone. Mr Malone said every Queenslander paying the $100-a-year ambulance levy deserved to see a Queensland Ambulance Service staffer if they called for medical assistance.

Source





24 July, 2008

No antibiotics for cough, colds and ear infections in Britain

Patients are to be refused antibiotics for coughs, colds and ear infections, under strict new guidance to doctors. This is right in theory but will undoubtedly lead to deaths among patients with meningococcal infections.

The drugs are not necessary in most cases, do not work against many of the infections and contribute to the spread of lethal hospital superbugs like MRSA, experts said. Family doctors routinely prescribe antibiotics for common respiratory infections such as sore throats. But GPs claim they often feel under pressure from patients who are angered if they are refused treatment.

Now the NHS drugs rationing body, the National Institute for Health and Clinical Excellence (NICE), has issued new guidance to doctors telling them not to prescribe antibiotics to patients who are suffering from minor illneses such as an ear infection, sore throat, tonsillitis, a cold, sinus infection, cough or bronchitis. Instead, doctors will advise them to stay at home and rest while taking painkillers. The move comes after Health Secretary Alan Johnson launched a $540 million advertising campaign earlier this year telling patients that the drugs will not help with a cough or cold.

Sir Liam Donaldson, the Chief Medical Officer, said inappropriate use of antibiotics was fuelling superbug infections as it encourages infections to become resistant to the drugs. Treatment with antibiotics also leaves people vulnerable to gut infections like Clostridium difficile, which can also be fatal particularly in the elderly. Last year 38 million prescriptions for antibiotics were written by GPs at a cost to the NHS of $350 million. Prescriptions to treat respiratory illnesses currently accounting for almost two thirds of all antibiotic prescribing in GP surgeries

The new guidance - which may dismay those who have grown to expect treatment for routine illnesses - says patients should be reassured that antibiotics are not needed immediately because they will "make little difference to symptoms and may have side-effects". They should be told to return to the doctor if they get worse or it does not clear up on its own. Alternatively doctors could issue a prescription for the patient to cash in at a later date if their symptoms get worse or go on for more than a week. Experts say this 'delayed prescribing' works well and doctors say few of the prescriptions are cashed in showing that patients do follow the instructions.

The guidance was welcomed by Professor Steve Field, chairman of the Royal College of GPs, who have been campaigning on the issue. He said: "It costs an absolute fortune. I have always said there is no shortage of money in the NHS - we just need to spend the money on things that are useful. "It can be very difficult being a GP having a consultation with a patient who expects antibiotics. It has become ingrained in them but because the infection gets better anyway, people think it was the antibiotics."

The guidance says doctors should consider giving antibiotics to children under the age of two who have an ear infection in both ears, children who have discharge from the ears and patients who have tonsillitis along with other problems. Antibiotics or further testing should be offered immediately to patients who have symptoms that suggest a serious illness or complications such as pneumonia, or if they are at high risk of complications. This would apply to those who already have a serious condition such as cystic fibrosis, severe heart, lung, kidney or liver disease or whose immune system is compromised.

Patients who are aged over 65 and have a cough should immediately be prescribed antibiotics or sent for further testing if they also fulfill two of the following criteria - having been admitted to hospital in the last year, having diabetes, suffering heart failure or using certain medications. Patients over the age of 80 with a cough need only fulfil one of the other criteria.

Dr Gillian Leng, who was in charge of developing the guidelines and is Deputy Chief Executive of NICE, said: "This is the first practical guideline which will help all healthcare professionals to assess adults and children with respiratory tract infections to decide whether their condition will improve by taking antibiotics. The guidance will also ensure that they can be followed up by the right people, at the right time and within the right healthcare setting."

Mike Sharland, a consultant paediatrician who helped develop the guidelines, said: "Every year, over five million antibiotics are prescribed for children in the community - the great majority for upper respiratory tract infections which are nearly always viral. This guideline describes the evidence base for prescribing antibiotics in children with an upper respiratory tract infection and gives clear and concise recommendations for their use."

Anne Joshua, Associate Director of Pharmacy at NHS Direct, who also helped draw up the guidelines, added: "This short clinical guideline brings together everything we know on targeting antibiotics to those who really need them. It sets out very clearly the information that should be provided by healthcare professionals when they are assessing children and adults presenting with respiratory tract infection symptoms in order to reassure them that they are receiving the most effective course of treatment, based on the most up-to-date evidence."

Source




Australia: Public hospital emergency power fails

This is pretty disgraceful. Emergency systems should be tested regularly. This one obviously was not

Doctors and nurses had to ventilate patients by hand during a Sydney hospital blackout but its manager says no patients were at risk. Concord Hospital, in Sydney's inner-west, lost power for over an hour on Saturday and emergency generators for the intensive care unit and emergency department failed to kick in. However, the hospital's general manager Danny O'Connor said no patient treatment was compromised.

"Concord Hospital has a comprehensive emergency power supply system. Unfortunately in this instance a component of the system failed," Mr O'Connor said in a statement. "This led to power being interrupted to several wards for about one hour. "Patient treatment was not compromised while the interruption was resolved." Mr O'Connor said the faulty component had been replaced following the incident and the system had been retested and was functioning correctly.

Opposition Leader Barry O'Farrell said Health Minister Reba Meagher needed to explain how such a "catastrophic failure" could occur in one of NSW's largest hospitals. "How is it possible for a contingency electricity supply to fail in the most crucial parts of the hospital - the intensive care unit and the emergency department," Mr O'Farrell said in a statement. "It's a tribute to the outstanding staff that no one died during this major failure."

The NSW opposition wants the government to review all emergency back-up electricity generator systems in public hospitals statewide. NSW Health declined to make any comment saying the statement from Mr O'Connor should explain what happened.

Source





23 July, 2008

Outcry at British drug watchdog's plan to cut arthritis treatments

Tens of thousands of arthritis sufferers will be denied powerful drugs on the NHS under a controversial decision by the Government's rationing body

Patients' groups have reacted angrily to new guidelines which will mean 40,000 people with rheumatoid arthritis will have possible treatments withdrawn. Without the drugs the patients will suffer more pain, the possibility of more surgery and long-term disability, it is claimed. The decision amounted to a "prescription for pain", experts warned.

The National Institute for Health and Clinical Excellence (Nice), today issues a final appraisal document - the last draft before definitive guidance is issued - stating that patients who do not respond to one powerful drug cannot try another of the same type. Currently doctors are able to try patients on three variants of a drug type which work by blocking the action of a chemical. If one does not work or its effectiveness wears out over time, sufferers can switch to another, prolonging the period they can remain fit and active. But the drugs are very expensive, with even the cheapest costing around $200 a week per patient.

Many rheumatoid arthritis patients live with the disease for decades. They argue that cutting down the options will leave them needlessly living in agony for years. Cutting access to the drugs will speed their decline, meaning they are less able to work for a living and will have to rely more on benefits and care, campaigners say. Ailsa Bosworth, Chief Executive of the National Rheumatoid Arthritis Society, said: "This decision is another nail in the coffin for the treatment of rheumatoid arthritis in England and Wales. "Nice is re-writing the rules of rheumatoid arthritis treatment in this country ignoring the clinical effectiveness of drugs and ignoring the views of patients and clinicians."

Rheumatoid arthritis, which differs from osteoarthritis, is an auto-immune disease in which a person's joints are attacked by their body's own defences. It affects 400,000 people of all ages in the UK. Most suffer with a mild form that can be controlled with ordinary painkillers. However, tens of thousands needed the stronger drugs, called anti-TNFs as they block the action of a chemical called tumour necrosis factor (TNF). Between 20,000 and 40,000 people in England and Wales are taking an anti-TNF at any time, and 50 per cent have needed to switch treatments at least once. The anti-TNF drugs currently available on the NHS are Enbrel (its generic name being etanercept), Humira (adalimumab) and Remicade (infliximab).

Scientists are not sure why one anti-TNF drug might stop working over time but doctors and patients agree being able to switch between them can be highly beneficial. Once arthritis patients have exhausted the anti-TNF options, under NHS rules they can move on to another drug called rituximab, a 'biologic' which works by modifying the immune system. Until recently they would have then been able to try a separate drug called abatacept, but in April Nice quashed that option, saying it was not cost effective. Consequently campaigners say Nice has reduced the treatment options for people with the disease from five to two.

Professor Rob Moots, Professor of Rheumatology at Liverpool University, said: "It's almost impossible to know which anti-TNF will work for a patient at the outset. Before this decision we could try patients on each of the three treatments in turn to find one that was effective for them - now we only have one shot at success. "This flies in the face of clinical judgment. Many patients will be left in astonishing pain, while knowing we haven't explored all the options for them."

Ros Meek, Director of the Arthritis and Musculoskeletal Alliance, added: "Rheumatoid arthritis is a debilitating disease and living with it is an extremely painful experience. Nice's decision takes away access to a normal and independent life for the many thousands of people battling with the condition. It also totally contradicts Lord Darzi's pronouncements in his recent review of the NHS - in particular his focus on patient choice and patient empowerment. It's a prescription for pain."

A spokesman for Nice said: "Having taken all the available evidence of clinical and cost effectiveness into consideration, together with the views of patients and clinicians, the independent Appraisal Committee was not persuaded that TNF -? inhibitors, when used after the failure of a previous TNF - inhibitor, would be an appropriate use of NHS resources. "However, the Committee agreed on the importance of further research that examines the comparative effectiveness of all possible options for treating people with Rheumatoid Arthritis". "People currently receiving adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis after the failure of a previous TNF -alpha inhibitor should have the option to continue therapy until they and their clinician consider it appropriate to stop."

Nice's final guidance is expected in September but campaigners hope their appeals will lead to a last minute U-turn. In April, following public outcry, Nice changed its prescription guidance for Lucentis, a drug which slows down onset of the severe eye condition macular degeneration. And in May the Court of Appeal ruled that Nice must explain how it reaches its decisions on whether or not to recommend drugs, in an ongoing battle over the Alzheimer's treatment Aricept. However, it has never lost a case regarding its guidance in court.

Source





22 July, 2009

Nasty British health bureaucrats refuse to treat dying patient

Bosses in the National Health Service have refused to administer a drug to a patient with advanced kidney cancer even though the medicine is being provided free.

Barrie Clark, 61, was told in May that he could receive a free supply of a new kidney cancer drug on compassionate grounds from the pharmaceuticals company that makes it. Clark was then astonished to be told by the NHS that he could not take up the offer at his local hospital because it was against management policy. He could receive the drug, which has been approved as safe, only by paying for nurses to administer it privately.

Clark is in a similar predicament to patients being denied NHS care if they choose to pay for drugs that the health service does not fund. Campaigners are outraged that the ban on allowing NHS patients to pay for private drugs has now extended to letting them receive additional medicines for free.

In a letter of complaint to NHS Grampian, which runs Aberdeen Royal Infirmary where Clark is being treated, the father of four said: "I have been denied a free drug for a long time when there was no alternative treatment. "We find this appalling and demand that the drug be offered free of charge immediately. How many other people has this happened to? You have jeopardised my life and caused great anguish to me and my family. That is disgraceful."

The medicine, temsirolimus, which has the brand name Torisel, was granted a licence for the European Union in November. The European Medicines Agency (EMEA) has ruled that its benefits outweigh the risks. Dozens of NHS patients have received it on compassionate grounds from Wyeth, the manufacturer, in advance of its commercial launch in Britain. The National Institute of Health and Clinical Excellence (Nice) is assessing whether Torisel is cost-effective enough to be prescribed on the NHS.

Managers at NHS Grampian told Clark that he could not receive it because it was not yet on its list of prescribed drugs, known as the hospital formulary. The trust says it will not be placed on the formulary until it is assessed by Nice or the Scottish Medicines Consortium.

Clark, a manager in the oil industry, has been helped by Kate Spall, a cancer drugs campaigner with the Pamela Northcott Fund. Spall said: "I have never heard such rubbish. They are saying this medicine cannot be given because it is not on a drug list, but patients elsewhere across the country are getting it. Are we now in a position where a terminally ill patient is denied a free medication?"

Cancer professors dismissed the explanation as "bureaucratic nonsense". Will Steward, a consultant oncologist at Leicester Royal Infirmary, said: "I really do not understand the decision not to allow a free drug to be administered from the hospital. We do this frequently. "Many trusts have allowed this in the past and this decision is perverse."

Jonathan Waxman, a consultant oncologist at the Hammersmith hospital in London, added: "This is an effective treatment. This shows the mess we are now in." After Clark told the hospital he was going to speak to the media, managers said he could pay to have the drug administered privately. He would need to pay about œ1,000 a month as it is taken intravenously.

Clark said that, although appalled at his treatment by the NHS, his own oncologist had done his best. NHS Grampian declined to comment on the individual case. The Sunday Times has been campaigning to end the ban on NHS patients paying for private drugs that the state does not fund. Last week two patients won appeals to receive cancer drugs on the NHS after they featured in the Sunday Times Right to Pay campaign.

Sheila Norrington, 59, a cancer patient from Maidstone, Kent, was denied NHS care after paying privately for Erbitux, which costs about œ3,000 a month. After the paper highlighted her case, the Peggy Wood Foundation, a charity, agreed to pick up the bills, but last week West Kent Primary Care Trust reversed its decision.

Barry Humphrey, 59, from North Walsham, Norfolk, was told that if he paid for Nexavar, the only available treatment for his advanced liver cancer, he would be billed for his NHS care. His local trust refused to fund the drug but neighbouring Suffolk Primary Care Trust has recommended that the NHS should provide it.

The British Medical Association and the NHS Confederation, which represents hospital managers, support a patient's right to co-pay for cancer drugs without losing NHS care.

Source





21 July, 2009

Australia: Queensland hospitals administration turns lawyers on its staff

This organization is never out of trouble. It is clearly totally out of control. It should be abolished and started again with none of the old administrative staff rehired

QUEENSLAND Health is spending hundreds of thousands of taxpayers' dollars for law firms to fight complaints by hospital staff. State Government sources said high-powered barristers and solicitors were engaged in an attempt to get "intimidated and bullied" employees to back down. Some legal eagles cost up to $5000 a day to appear in courts and tribunals.

It was also revealed in Parliament last week that Queensland Health had spent more than $8 million on legal fees and settling claims made by staff and patients during the past two years. Another 274 claims were outstanding.

The department insider said staff who lodged complaints about minor matters, mainly related to pay and conditions, found themselves on the end of an expensive legal battle. Brisbane lawyer Susan Moriarty obtained documents under Freedom of Information that showed Queensland Health had paid almost $115,000 in legal fees in three recent cases. Ms Moriarty, who has represented several Royal Brisbane Hospital staff with claims or complaints, said Queensland Health was hiring private law firms to deal with complaints that should be dealt with by staff. "There are plaintive cries for more and more funding for hospitals, yet they have plenty of funding to go after their own employees," she said.

Leading law firm Corrs Chambers Westgarth was paid $53,000 to represent Royal Brisbane Hospital Health Services District against a female hospital cleaner who was claiming $3500 in an impairment discrimination case. Ms Moriarty said the woman was seeking to cover the economic loss of losing weekend penalty shifts when she returned to work after surgery. After failed attempts at conciliation, the case was referred to the Anti-Discrimination Tribunal, before settling confidentially.

Another leading law firm, Clayton Utz, was paid $44,000 to investigate several allegations by a junior nurse who claimed she had been bullied by Royal Brisbane Hospital supervisors. Ms Moriarty said the woman's union advised her to lodge a complaint after she was asked to do work she was not trained to do. "Instead of conducting an internal investigation, they initiated an external investigation conducted by a private law firm," Ms Moriarty said. The six-week investigation ran to 18 months. Queensland Health eventually sacked the nurse.

In the third case, a Royal Brisbane Hospital cleaner, who had studied medicine overseas and had worked as a theatre wardsman interstate, claimed race and age discrimination after his applications for permanent theatre positions were rejected. Queensland Health has paid Corrs Chambers Westgarth $18,000 so far, with the matter still to be heard in the Anti-Discrimination Tribunal. "The big law firms have become nothing other than de facto human resources advisers to Queensland Health, at about $400 an hour," Ms Moriarty said.

Opposition health spokesman John-Paul Langbroek said he was aware of cases where Queensland Health had become heavy-handed with its own staff. "It's Big Brother . . . a lot of issues could be resolved by normal staff negotiations and relationships," he said.

Source




Australia: Moronic response to overstretched hospitals in NSW

What about paring down the army of health bureaucrats and using the money saved to hire more medical staff? Does anyone NOT already know about GPs? People don't go to GPs because it is generally dearer and not available after hours

The New South Wales State Government has launched an advertising campaign aimed at reducing the pressure placed on hospital emergency departments. The Government says the initiative has been designed in consultation with emergency department staff.

They hope the program will encourage people to seek treatment from their GP, for non-urgent medical conditions, so hospitals can give priority to people needing emergency care. They have cited figures which show an 8 per cent rise in emergency department admissions with 2.3 million people attending emergency department in the past year. Only 34 per cent of those attending believed they really needed hospital care.

The Government hopes the initiative will help people consider how serious their condition is, and make the right decision about where to find treatment.

Source





20 July, 2008

Counterproductive NHS pennypinching

When you've got an army of clerks to feed day in and day out, you cannot do your best for the patients

The Department of Health may have saved more than $36 million a year by choosing a cervical cancer vaccine that does not protect against genital warts. The decision to use GlaxoSmithKline's Cervarix rather than Merck's Gardasil for the vaccination campaign for 12-year-old girls was announced last month. It was criticised by experts who said that Gardasil was a better vaccine. Dr Colm O'Mahony, a consultant in sexual health at Chester Foundation Trust, said: "All the clinical evidence pointed to Gardasil and instead they have chosen a vaccine suitable for the Third World."

A new analysis published in the British Medical Journal says that a vaccine that does not protect against genital warts needs to be $26-$42 cheaper per dose to be as cost-effective. The study, by health economists at the Health Protection Agency, used the economic model employed in the tendering process. The agreed price is confidential, but if the department saved less than this it made a poor choice.

In an editorial accompanying the study, Professor Jane Kim, from the Harvard School of Public Health, said that the Department of Health seemed willing to forgo health benefits in return for the lower cost of Cervarix. "Assuming 80 per cent coverage of current 12-year-old girls in the UK with the full three-dose vaccine series, this price differential translates to savings of $23 million to $37.2 million from the vaccine price alone in the first year of the programme."

A spokeswoman for GlaxoSmithKline said that the Health Protection Agency's model assumed that the human papilloma virus (HPV) vaccines were equal in quality and duration of protection against HPV strains 16 and 18. It also assumed that protection must last ten years or longer. There were no data for either vaccine over such a long period, but data on GlaxoSmithKline's vaccine had demonstrated prevention of pre-cancerous lesions and strong immune response for 6.4 years. "This is the longest duration of protection reported for any vaccine against HPV 16 and 18," she said.

Natika Halil, director of information at the FPA, said the charity was disappointed that Gardasil had not been chosen. Choosing Cervarix, she said, "has cost the UK a rare opportunity to protect an entire generation of its young women against genital warts. "Genital warts is very common, easily transmitted, but can be stubborn to treat and young women are in a high risk group for this infection. We reiterate our disappointment that Gardasil wasn't chosen. "Genital warts has its own financial cost to the NHS which spends $44 million a year treating it, so it will be interesting to see how this has been factored into the cost analysis."

Lisa Power, of the Terrence Higgins Trust, said: "The Government has made a decision which appears to be cost-effective but not health-effective. They think it's cheaper to let people get genital warts and treat them than to prevent them. The cost of human misery has not been considered."

Source





19 July, 2008

NHS chasing its tail over superbugs

They beat down one problem and another pops up

A big drop in MRSA infection has brought the NHS within reach of the Government's target of halving rates by this year - but infections caused by Clostridium difficile have risen . In 2007-08 the number of MRSA cases fell to 4,438 - 588 above the target, Health Protection Agency data show. However, in the first quarter of this year a trend of falls in C. difficile bloodstream infections was reversed, with a 6 per cent rise: there were 10,586 cases of C. difficile blood infections in patients aged 65 and over.

A total of 966 cases of MRSA were reported - an 11 per cent drop on the previous quarter and an average of 322 cases a month. In 2004 John Reid, as the Health Secretary, said that infections of methicillin-resistant Staphyloccocus aureus should be cut to a monthly average of 321. At the time that was said to be unachievable. Even within the Department of Health, leaked documents last year showed there was serious concern it would not be met. But the recent fall in cases suggests that high-profile initiatives such as the "deep clean" of all hospitals and introduction of a mandatory "hygiene code" may have had the desired [temporary] effect.

MRSA and C. difficile are carried by some healthy people, but the bacteria can cause illness when they grow unchecked, elderly hospital patients being particularly at risk. Annual figures showed a decline for both infections.

Alan Johnson, the Health Secretary, described the decreases as a remarkable achievement. "Our strategy is clearly having an impact, with our challenging target now within touching distance, but this is not an issue we can be complacent about and we will continue to focus our efforts on reducing infections further," he said.

Graham Tanner, chairman of National Concern for Healthcare Infections, said: "It should be remembered that over four years, more than 20,000 patients have suffered an MRSA infection, and in excess of 200,000 contracted C. difficile."

Andrew Lansley, the Conservative Shadow Health Secretary, said that the Government would not have met its MRSA target had it measured the yearly rates to March. To achieve half of the 7,700 MRSA infections in 2003-04, the NHS would have had to limit rates to just 3,850 cases this financial year, he said. "Every case of a hospital infection is one too many, but in four years Labour hasn't even been able to halve MRSA rates, he said. "They have only got round to admitting they have missed the target by moving the goalposts. This shows just how much they've dithered and delayed over tackling hospital infections."

Murray Devine, Safety Advisor for the Healthcare Commission, the NHS regulator, added: "This is great news for patients. There's no question that there has been a very significant turn around, but the challenge isn't over. This improvement has got to be sustained and infection rates brought down further."

Source




Huge public medicine failure in Australia: Children wait years for ear, nose and throat procedures

HUNDREDS of Queensland children are waiting up to four years for ear, nose and throat surgery, surgeons say. ENT specialists say the long wait puts them at serious risk of behavioural and learning problems. Specialists say the wait for an outpatient's appointment at Mater Children's and Royal Children's hospitals in Brisbane is about two years. Queensland Health's own figures show that as of April 1 this year, 400 children were waiting for category 3 ENT surgery at the two hospitals.

Research has found children who have untreated ear infections in their early years are at risk of becoming truants and doing badly at school. Yet they can be easily treated by inserting grommets - tiny tubes that give the middle ear a chance to recover from recurrent infection. Other children require operations to remove tonsils or adenoids to improve sleeping and concentration at school.

ENT surgeon Chris Perry conceded the State Government had started to make inroads into elective surgery waiting lists for children through its Surgery Connect program public operations performed in private hospitals. Queensland Health figures reveal Surgery Connect has cut the waiting list by about 10 per cent. The Government expects the program to be able to treat about 45 children with ENT problems each month.

However Associate Professor Perry said Surgery Connect was only a BandAid solution. "I don't want to embarrass the Government," he said. "I think they're trying to do something about it. "But we think Surgery Connect is counter-productive to the development of public hospitals. "They should be spending the money to fix up public hospitals."

Professor Perry said he had a "duty to help these kids" by operating on them via Surgery Connect but he hoped Queensland Health did not intend to make the program permanent. "It's work that needs to be done at night time, when everybody's tired, including surgeons, or on weekends, and that cuts into family time," he said. Surgeons would prefer to see the Government set up elective surgery theatres in public hospitals to "quarantine" non-urgent cases from emergencies. Because of the huge increase in demand on public hospital emergency departments, elective surgery lists are sometimes cancelled because of the more urgent cases.

Specialists raised the issue with Queensland Health Minister Stephen Robertson at the Royal Australasian College of Surgeons' annual state meeting at Coolum, on the Sunshine Coast, at the weekend. Mr Robertson acknowledged the Government needed to do better by treating children in a more timely manner. "I want to see an improvement in wait times for children," he said. He said he would consider creating elective surgery only theatres for children but he said Surgery Connect was probably here to stay. "My personal view is that it would be irresponsible ... where we can identify capacity in the private sector, not to use that capacity if it means that we increase our throughput," Mr Robertson said.

Source

But there's plenty of money for the health bureaucracy

QUEENSLAND Health bureaucrats have spent more than $800,000 travelling the world over the past two years, a budget estimates committee heard. The hearing was today told non-clinical staff made 69 overseas trips in 2006-07 at a cost of $364,546, and 67 trips between July 1, 2007 and May 31, 2008, at a cost of $464,809. The trips included five senior bureaucrats taking an $80,000 two-week visit to US and UK hospitals in November 2006, and a $50,000 trip for two senior bureaucrats to join Health Minister Stephen Robertson on a tour of facilities in the US and Canada in August 2007.

Opposition health spokesman John-Paul Langbroek said Queenslanders on hospital waiting lists were entitled to ask why they didn't come first. "With such an urgent need for new hospital beds to be delivered and for waiting lists to be tackled, Queenslanders will be wondering why senior health bureaucrats are spending so much time touring hospitals in other countries," Mr Langbroek said in a statement.

Mr Robertson said overseas travel arrangements were under review to ensure taxpayers got value for money from health staff attending conferences and recruitment fairs. "I think it's appropriate every now and then to review that travel budget to ensure it is being used appropriately," he told reporters in Brisbane today. "I'm always worried when I see expenditure going into areas that don't have a direct effect on good patient outcomes. "Just as I look at travel every now and then, I look at other areas of administration to see if there are ways that we can save money and redirect those funds into front-end services."

Source





18 July, 2008

Bigoted Leftist hater of drug companies

A comment on "Side Effects" by Alison Bass

Prozac improved the nation's mood when it came on the market in 1987. Earlier antidepressants had caused many side effects and were potentially lethal in overdose. Prozac appeared to be both a godsend and a blockbuster. It was effective, easy to administer and less likely to be used by depressed patients as a means to commit suicide. It was a boon to the bottom line of its manufacturer, Eli Lilly, but it also became a cautionary tale for the drug industry—of pharmaceutical success inspiring suspicion, controversy and backlash.

Soon enough a Harvard professor, Martin Teicher, published reports of six patients who developed suicidal thinking while taking Prozac, and the Church of Scientology campaigned against it. By 1990 stories about the purported dangers of Prozac screamed from the headlines and fell from the lips of Hugh Downs on "20/20." Was Prozac causing patients to commit suicide?

In 1991, the Food and Drug Administration convened a committee of experts to study the matter. As it turned out, Mr. Teicher's six patients had been deeply depressed for years, medicated with multiple drugs and in several cases had attempted suicide before they first ingested Prozac. The Scientologists rested their arguments on anecdotes, not data. The committee concluded that Prozac did not trigger suicides in adults.

But the matter was not put to rest. For nearly two decades a worry over the "hidden" effects of antidepressants—and not just Prozac—have become a kind of cultural reflex. Thus the FDA has convened more committees and analyzed more data. The facts are not easily resolved, because the underlying illness (depression) is itself a risk factor for the adverse event (suicide), and the adverse event is mercifully rare. The latest evidence suggests that, for adults age 25 and older, antidepressant use is not associated with increased suicidality. A pooled analysis of nearly 100,000 patients, conducted by the FDA in 2006, showed no increased suicidality for adults ages 25 to 64.

In "Side Effects," Alison Bass recasts this history of debate and analysis as one of corporate greed. She extends the "lessons" of Prozac to the antidepressant Paxil, lambasting GlaxoSmithKline, its manufacturer, for supposedly concealing inconvenient information. Her narrative is filled with you-are-there moments, in which heroic researchers challenge Paxil's efficacy and safety and heroic prosecutors from the office of Eliot Spitzer, New York's attorney general, prepare a 2004 lawsuit against the company.

In the event, GlaxoSmithKline settled out of court and, as soon as the matter of transparency was raised, published online all of the studies of Paxil that had been submitted to the FDA, including those that showed no significant difference between the effects of Paxil and a placebo. The question of study-publishing is a fraught one: Most companies leave it to the FDA and its populous staff to subject their studies to scrutiny, determining which ones are significant, which inconclusive—that is, to weigh the totality of the results. Ms. Bass, like other crusaders against Big Pharma, assumes that a manufacturer is trying to mislead doctors and defraud the public if some of its studies are not published in the scientific literature.

It is a question of point of view. For Ms. Bass the judgment of researchers, together with their data and claims, are untrustworthy if they have received money from drug companies to finance clinical trials. She is particularly hard on a professor of psychiatry from Brown University who has defended Paxil. But if the drug companies didn't pay for such trials, who would? And why shouldn't companies seek advice from the best scientific minds and pay them for their efforts?

Most odd of all, Ms. Bass treats the FDA as a shill for industry—despite its having thoroughly reviewed the suicide matter and required warnings on products labels where it saw fit. She makes the usual complaint that the FDA has reduced its time frame for approving new drugs: "That sprint came with a price tag. A flood of questionable drugs was unleashed on the market, many of which," like Vioxx, "would later have to be recalled."

But she says not a word about how society suffers when the FDA approves new drugs too slowly, depriving patients of life-improving and life-saving medicines. Nor does she mention the studies showing that more rapid drug approval timelines in the European Union have not led to more drug-safety withdrawals. There are two sides to this story; Ms. Bass tells only one.

That tendency is on display elsewhere in "Side Effects." In a matter as hard to determine as the effect of an antidepressant on the suicidal tendencies of depressed patients, Ms. Bass nowhere mentions the exculpatory adult data. As for pediatric patients: In April 2007 the Journal of the American Medical Association published an analysis of more than two dozen studies. It found that for children and adolescents on antidepressants, as The Wall Street Journal reported, "the risk of suicidal thinking or behavior is smaller than previously thought" and that "antidepressants were more effective than placebos in treating children and teens for major depression" and other disorders.

"Side Effects" belongs to a genre of investigative journalism that involves talking to plaintiffs, their lawyers and their expert witnesses, taking their stories as gospel and denigrating the opposing view because corporate money (apparently less pure than money from the plaintiffs' side) supposedly has a corrupting effect. Ms. Bass admires David Healy, for example, a British psychiatrist and expert witness whom the drug companies have been "unable to discredit." Surely a more even-handed account—since corporate fees are routinely cited—would mention the fees that Dr. Healy has collected for testifying for a dozen or more plaintiffs. She does not mention either that a court in 2002 rejected his testimony because of "glaring, overwhelming and unexplained" errors in his analysis.

"Side Effects" is lively and well-written, but readers should be warned that they may have an adverse reaction: a deep disquiet that only half the story has been told.

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17 July, 2008

Government Funded Science Inherently Politicized: Chinese Herbal Remedy Edition

Over in the Science Based Medicine blog, Wallace Sampson is expresses outrage that the National Institutes of Health has announced an initiative to fund “research” into Traditional Chinese Medicine:

I have pointed out that scientific characteristics were never a part of TCM. It lacked objective observation, consistency of observation, classification of observed phenomena, information storage, rationality and logic, consistent written transmission, objectively descriptive language, and a method for analysis or for interpretation. The system of elements , q’i, and yin/yang did not include a method for developing theories or independent natural conepts. TCM depended on empiricism, unreliable observation, was plagued by post hoc reasoning and causality error. It lacked a concept of error and a system for self-analysis to correct error. In fact, the culture discouraged analysis and criticism, considered to be bad form and disrespectful. TCM depended on individuals who rarely communicated in a formal, direct, manner. Add to that a system that accepted manipulation to suit the mood and concept of the observer or authority. I conclude that there is nothing in TCM to study scientifically. So now they want to develop scientific criteria to apply to their observations? Proteomics? On what? Actions of herbs? Words again fail me at the glaring presumptuousness and ignorance required to conceive such a project....

nothing but a jangling confusion of borderline and conflicting findings will result from further study. Unless they appoint people with critical analysis experience, a wide reading knowledge of the history and use of TCM, and a scientific view, their research conclusions will be indeterminate over the next 10 years or more. They will continue to rely on ideologues, advocates, self-deluded practitioners, and politically correct academics for advice and pronouncements.

They will probably exclude scientific or skeptical analysts, so there is no way they will develop a credible commentary on how best to integrate TCM and improve the health of the American and Chinese people. Well, they got it backwards again. It’s China that has to integrate scientific medicine over there. Their scientists and physicians clamor for it. The Chinese can begin with public health principles like inhibiting spitting in the streets, cleaning up their air (finally but it took the Olympics) personal hygiene, cleaning their toilets, improving their food handling methods, and other systematic changes...

What is HHS doing, using a cover of medical science and for what? The government doesn’t do such things without pressure from some group or perceived self-interest in negotiation. In this case, what are the respective interests? There could be several.

For China, the most apparent is awakening the American population to the hidden miracles of TCM - and the marketing of supplements. Ka Kit Hui, a practitioner in Santa Monica, Calif., been promoting TCM herbs for several decades. I debated him on the subject at Stanford in 1995 or so at which time he extolled the undiscovered miracles in TC herbal medicine. Again in a letter to the editor to JAMA in 1997 he predicted that TCM herbals would be the prime economic product of the 21st century. I dismissed the statement in a response, but here we are, nearly 1/10th the way through the century, and here is TCM herbalism making inroads. China must see a large market, a population at least a third of their’s, and in view of the differences in income, living standard, and disposable income, a market that is at least as large in dollars/yuens as China has at home - probably greater.

What motivates the US? For one, TCMers may be behind the effort. They are on a path toward legitimizing the OMD degree and licensing of TCM practice. They already have acupuncture licensure in a plurality of states. They have a dozen or more schools of TCM. The California state legislature several years ago dropped an attempt to standardize teaching in the California schools - a first step to a standard exam and thus an academic standard for licensure. But they will be back. It took naturopaths over 15 years to get their licensure and degree recognition - another history familiar to Kim Atwood and others. The rest of the ulicensed hordes are following through an accompanying though crippled series of Access to Medical Treatment Acts. They persist - getting bits here and there and then, in an alignment of the planets minute, achieving passage of licensure legislation that imprints their initials in gold.

The formation of the NCCAM was a major step for TCMers. Now an HHS officially- sanctioned 2 day conference opens the plausibility of studying more TCM just as acupuncture systematic reviews are showing indeterminacy to ineffectiveness, herbs are being found more dangerous than helpful, and products from the PRC being found adulterated with metals and with standard pharmaceuticals. A fly on the wall of certain congressmen and senators and of HHS director Leavitt could tell us a lot. (Here we go again with a FOI request.)

As for government sourced motives, as Ms. Woeckner suggested, we probably had to pay a price for the stationing of FDA offices in Chinese cities. I still fail to see what they can do about adulteration of products, much of which could be shifted to way stations in Taiwan or in the US.

While insightful, Dr Sampson fails to dig down to the real sources of the problem:

If the NIH wastes money on quackery, its officers do not suffer a loss. They don’t have to justify their spending to donors or shareholders. The money extracted at gunpoint from the citizenry will continue to flow in regardless of the junk science the NIH produces. In fact, inconclusive junk science can benefit NIH officials - larger staff and larger budgets will lead inevitably to higher salaries for managers - with no end in sight to the enterprise.

Furthermore, by having the government license medical treatments and practitioners, the medical industry has fatally undermined the ability of people to have reliable mechanisms to root out quackery. Again, publicly funded licensure boards will continue to be funded regardless of how bad a job they do. Their presence will inhibit the formation of private enterprises that are dependent on donor perceptions of effectiveness to continue operations - just as the creation of the FDA ended the drug testing research of Consumer Union. The public looks at a government license as a mark of quality - and there is no one to tell them otherwise. Suspicions allayed, most people in the market for medical care will accept advertising at face value.

The sad fact is that when the AMA was founded in the late 19th century, most doctors made a deal with the devil. The state licensure boards - which were successful in their mission to keep competition low and prices high - not only created a pool of underserved consumers for quacks to prey upon, it also created traditions and political framework that quacks and junk scientists can use to provide cover for their fraudulent activities.

So long as proponents of quality in medical care continue to pin their hopes on an organization that can extract money by force regardless of how crummy a job it does, they are doomed to failure.

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16 July, 2008

From here to (better) maternity: A long road for Britain

The experience of giving birth is getting worse. Mothers need greater choice, not bigger hospitals

In between the tea ceremonies, the cruises and learning to fold kimonos, the wives at the G8 summit in Lake Toya have been campaigning against maternal mortality. It's the perfect choice for the spouses, a subject surely as uncontentious as gazing at waterlilies. No one wants mothers to die in childbirth. Everyone must be shocked that a woman dies every minute giving birth and that there is a global shortage of four million midwives. Yet no one does anything about it.

The British should know. We are increasingly bad at giving birth. In the past ten years spending on maternity services has gone up by a quarter in real terms. Yet the satisfaction rates have plummeted, Britain's maternal death rate is one of the highest in Europe at 7.3 per 100,000 births compared with an average of 6.8, and the free-market think-tank Reform says that maternity care now accounts for more than half of all negligence claims against the NHS.

According to a study into maternal care published by the Healthcare Commission yesterday, most units do not have enough beds or showers and two thirds of trusts still offer no choice of how to deliver baby, leaving women feeling powerless. But the real problem is that the money has been directed at building projects rather than people. The proportion of the NHS workforce represented by midwives has dropped from 2.1 per cent to 1.7 per cent in ten years and some midwives are now in charge of a quarter more births than they were in 2001.

When I had my first child, in 2000, I gave birth in the cramped Queen Charlotte's Hospital in London in the same room where I had been born. The paint was peeling off the radiators, the blinds were stuck in a June heatwave and you had to import your Jaffa cakes from the local garage. Yet the system worked. You had your own midwife who followed your every twinge and came to celebrate your baby's first birthday. “This is not a hotel,” the midwives would say when you asked for more than one piece of toast on the ward, but they had the time to teach mothers how to feed their babies and change their nappies.

When my second baby was born two years later, the hospital had moved to a gleaming new site overlooking Wormwood Scrubs, with cappuccinos in the canteen - but the experience was harrowing. The midwives appeared as exhausted as the patients and rotated faster than the fans. They had to follow a raft of directives rather than their intuition. I got down on my knees just minutes after the birth to clean the floor before my parents arrived because nobody else had time to clear up the mess.

When my fourth child arrived, I brought in a bucket and brush but I didn't need it. The hospital was so overstretched that I was sent home within two hours of giving birth.

The postnatal experience has deteriorated even more rapidly. Terry, my first health visitor, had been looking after new mothers for more than 20 years. While she made us both tea, she was quietly working out whether I was elated or depressed and how many bottles of wine were stacked in the bin. But she had given up by the time I had my second child because she couldn't stand the doubling of her workload. She never saw the same mother twice; instead her job was to collate information on the religion and ethnicity of every baby. Our last health visitor spent an hour filling out forms and never touched our baby, which is presumably why she registered my son as a girl on every document.

Although under Lord Darzi of Denham's plans more money will be spent on building new supersize units, in recent years 41 small maternity units have been closed or are now under threat. Yet Britain already has the biggest maternity units in Europe, and these have shown no improvement on maternal mortality. The bigger the unit, the more impersonal and daunting the service will become. There may be more consultants for emergencies but most women will never see one. The Government has promised it will solve this by returning to one-to-one midwife care but there is already a shortage of 5,000 midwives and there isn't the money to fund such a specialised system.

It's easy to think that pregnant women don't matter: they are not ill (as I was constantly told) and they are not going to come back often. Very few actually die in childbirth or of postnatal complications, so all they need is a building, a nameless face shouting “push” and an ability to cross their legs until they actually make it - sometimes miles away - to their nearest super-hospital.

But for many women this is the first time they have ventured into a hospital since they were born and the weeks after their baby's birth can be crucial in helping them to cope with motherhood. Instead of queueing up to drop their children in supersize baby battery farms, they need to feel that someone cares about this new life. So let women go free-range and choose the type of care they want - whether in smaller units, at home or in a larger hospital with a consultant on hand - and give them a friendly face to guide them through the process.

Source




Insane medical working hours in Australia: One in three medicos risks patients' lives

ONE in three doctors admits they have put patients at risk by working exhaustive hours to prop up Victoria's ailing health system. And more than 80 per cent say medicos in general work too many hours and are under so much stress that the safety of patients and doctors is being compromised. A Herald Sun survey of Victorian doctors also revealed half had considered quitting due mainly to stress, long hours and excessive workloads.

Almost 90 per cent of doctors said there were not enough of them to adequately care for the health needs of Victorians. "We are dangerously tired, overworked and stressed, and patients are suffering and dying from errors borne of pure exhaustion," one doctor said. Another said: "Hours are ridiculous. Working 12 days straight is idiotic and guarantees serious medical errors with fatal consequences." The findings are based on the responses of 1787 doctors who took part in the Herald Sun poll.

The survey also revealed:

MOST doctors believe hospital emergency departments are in crisis.

MORE than 90 per cent say it is unacceptable that more than 45,000 patients were left waiting on hospital trolleys for more than eight hours during the last six months of 2007.

ABOUT 80 per cent say already swollen hospital waiting lists for elective surgery will get longer before they get shorter.

SEVEN out of 10 doctors say patients are losing faith in the public health system.

MORE than 80 per cent say public hospitals will continue to fail their performance targets unless they receive a massive injection of cash from the Government.

The poll showed 47 per cent of Victorian doctors work more than 50 hours a week and 8 per cent work more than 70 hours. Thirty-one per cent of doctors admit they have compromised the care and safety of patients by working excessive hours. And 47 per cent of doctors who work more than 70 hours a week admit to putting their patients at risk.

The strain drove one doctor to write: "I constantly reconsider my options. You asked whether I have considered leaving the medical profession in the last three years - of course. Daily. And unless things change soon, I most likely will."

About 40 per cent of doctors seeking counselling from the Victorian Doctors Health Program are struggling with issues of stress and fatigue. "When you are fatigued, you can't see the wood for the trees to make decisions," director Dr Kym Jenkins said. "I know a significant proportion of the people I see here who are stressed are worried they might have made a mistake. "When people feel they might be compromising patient care it can be anything from not having done their paperwork before the knock-off, to being worried about a major incident."

Australian Medical Association state president Dr Doug Travis said the Herald Sun survey brought to the public's attention the every-day realities encountered by doctors. "We do not have the capacity in our public health-care system to give Victorians the care they need right now, today. That is beds, nurses, doctors and emergency departments," he said.

Health Minister Daniel Andrews said the Government was negotiating a new enterprise bargaining agreement with the AMA to balance increased doctors' pay while leaving enough money to improve the health system. "We value the feedback of our hospital doctors and recognise the vital work they do in making the state's public health system one of the world's best," he said.

Opposition Leader Ted Baillieu said the Government must confront issues raised by the survey. "The huge pressure on our doctors is further proof that Labor has abandoned Victorian public hospitals," he said.

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15 July, 2008

British GPs’ skin cancer operations could prove fatal

Government promoting GP surgery but growths not being removed properly, say specialists

Patients with skin cancers are receiving poor treatment from family doctors, a series of studies has shown. Up to half of cancers were removed incompletely when the operation was done by GPs. This means that the cancer is likely to recur and require a second operation. In the case of the deadliest cancer, melanoma, failure to remove it all could mean that the cancer will spread and make it much harder to treat. In the worst case, a patient will die who could have been saved if the initial operation had been performed competently.

The audits are important because the Government’s policy is to encourage more GPs to undertake minor surgery, such as removing skin cancers. The belief is that this will be cheaper than referring patients to consultants, more convenient to patients and no less safe. “The issue is one of patient safety,” said Dr David Shuttleworth, clinical vice-president of the British Association of Dermatologists. “This is not a trade war. We have no problem with GPs treating skin cancers, so long as they produce results as good as hospital consultants. But these studies show that a significant number are not very competent. GPs say they are fine. But they don’t all collect their evidence, they don’t measure results and they don’t count the times they go wrong. The surveys show they are not good at diagnosis, and that they operate on things they don’t understand.”

At a meeting of the Association of Dermatologists in Liverpool, nine studies were presented that showed failings in operations carried out by GPs. These included the worst results for removal of basal cell carcinomas (BCC): in a countywide study in Cornwall, 54 per cent were removed incompletely, compared with 11 per cent in hospitals. The quality of skin surgery is measured from samples removed and sent to hospitals, These are sliced up and tissue at the edges of the sample examined for cancer cells. If the cancer has been excised correctly, the cells at the edge of the specimen should be healthy. If they are cancerous, not enough has been removed.

Dr Helena Malhomme dela Roche, who carried out the study, said: “The incomplete excision rates for patients with high-risk BCC managed by GPs is unacceptably high at 54 per cent.” Dr Elisabeth Fraser-Andrews, one of the authors of a study of BCC surgery in Essex, said: “The proportion of BCCs excised in primary care is low, showing that patients receive sub-optimal treatment in primary care compared with secondary care. “These findings support recommendations in the guidance from the National Institute for Health and Clinical Excellence (NICE) and the Department of Health and indicate that it is imperative for GPs who wish to carry out surgical treatment of skin cancer in primary care to be adequately trained, audited regularly and accountable to a clinical govenance structure.”

The NICE guidance was published in 2006, and will come into force fully next March. Among other things, it calls for all those carrying out minor surgery to be fully accredited. The GP committee of the British Medical Association has objected to the guidance. Dr Laurence Buckman, chairman of the committee, said: “Other surveys do not show the same results as these, but I’m not going to defend GPs who do it badly.

“The problem with the new guidelines is that they are so tightly drawn that GPs won’t be able to do any surgery at all. GPs weren’t involved in drawing up the guidelines, and they are unworkable. The only people who could qualify are specialists. ”

Source




Another huge public hospital disgrace in Australia

W.A. hospital ignores teen with severed fingers. He should have gone into surgery immediately!

A TEENAGER whose fingers were severed in a workplace accident waited 28 hours for a bed at Royal Perth Hospital's emergency department. McKenneth Atkinson, 19, an apprentice mechanic from Pinjarra, was brought to RPH by ambulance about 3pm on Thursday. He waited in the emergency department with parts of his severed fingers on ice until Friday night. And after more than a day he was finally given a ward bed and prepared for surgery, only to have that delayed.

He was finally transferred to the Mount Hospital for surgery at about midday on Saturday. The teenager's father, Colin Atkinson, told The Sunday Times he was upset by the delay. "He had been waiting in emergency for about 28 hours before they shifted him into the hospital,'' Mr Atkinson said. "I couldn't believe how pathetic our public health system can be. He was taken down to theatre late Friday night and they had him all prepped and ready to go. "Then they had another trauma (victim) come in and he got pushed back into the ward.''

A spokesman for RPH apologised for the delay. "The hospital is sorry about Mr Atkinson's wait for a ward bed,'' he said. "The patient was not able to be moved to a ward sooner because the hospital was experiencing heavy demand for beds. [A heavy demand that happens EVERY WINTER!!! So there is no excuse for not being prepared] "On Thursday, we experienced a very high number of surgical cases at that time, but all the time he was with us in the emergency department his condition was monitored.''

On Thursday, Sir Charles Gairdner Hospital was forced to make a similar apology when it was revealed a blind war veteran waited almost a day for a bed. Edward Webster, 80, waited more than 17 hours at the hospital despite having a letter from his GP saying he needed urgent treatment.

Australian Medical Association spokesman David Mountain was not surprised by reports of emergency patients waiting more than 24 hours for a bed. "It's symptomatic of how congested and overcrowded our departments are and how long people have to wait to get to a definitive bed,'' Dr Mountain said. "These sorts of cases, or very long delays, are extremely frequent in our departments now.'' Dr Mountain said emergency patient care was being jeopardised by the long delays.

Source





14 July, 2008

Dirty British hospital kills patient

A patient died during an outbreak of the Clostridium difficile bug that affected six at a Glasgow hospital, it emerged today. Nicola Sturgeon, the Health Secretary, said that the patient died on June 24 and confirmed that C.diff was a contributory factor. The death, at the Victoria Infirmary, comes after an outbreak of the same bug at the Vale of Leven Hospital in Alexandria, West Dunbartonshire, affected more than fifty people and killed nine.

Ms Sturgeon announced details of the death in response to a Scottish parliamentary question from Jackson Carlaw, the Conservative public health spokesman. She said that an outbreak control team was reviewing the circumstances and would prepare a full report. Ms Sturgeon also said that six patients at the infirmary had been affected by a C.diff outbreak in October last year. The cause of that outbreak could not be determined.

Mr Carlaw said: “This really is not acceptable. The Scottish NHS needs to usher in a new era of openness, and fast ... we need to know who is being held to account.”

Source




Australia: Disastrous NSW ambulance management

After a distinguished 30-year career, which included bringing Kerry Packer back to life, Bill Taylor quit the NSW Ambulance Service in 2006, fed up with an entrenched culture of bullying and discrimination. He personally knew five officers who committed suicide and one who attempted suicide, and he had the grim task of arranging funerals for others.

Last week, as a NSW parliamentary inquiry into the strife-torn service got under way, Mr Taylor said of his fallen colleagues: "They see no other way out because of the lack of support by the persons appointed by the service who are supposed to look after its members. "I used to organise the funerals for officers who died in Sydney either from suicide or accidents. [The Ambulance Service] would make a show of caring by paying for the funeral and getting the band to play but then it's swept under the carpet."

The upper house inquiry, chaired by Liberal MLC Robyn Parker, has received more than 100 submissions from officers alleging bullying and harassment within the service. Some, citing victimisation by colleagues, have linked their personal mistreatment to forced stress leave, resignations, clinical depression and, in several cases, suicide attempts of their own. Almost without exception, the officers insist their complaints, warnings or cries for help fell on deaf ears or were swept under the carpet by senior management. "The majority are about terrible bullying and harassment that has gone on for years and is driving people to do terrible things. Their psychological health is damaged. For some their whole lives are damaged," Ms Parker said.

The inquiry heard Christine Hodder, 38, endured years of torment at her station in Cowra before she hanged herself in 2005. Her former supervisor, Phil Roxburgh, has accused management of being "grossly negligent and dismissive" of her plight, while the service's professional standards unit found no one accountable for her death. The Sun-Herald has learned that the officer sent to Cowra to replace Ms Hodder also complained of being bullied after he revealed the two had been high school mates in the state's north. He left work on stress leave in August, 2006 and remains on leave. Chris Pollard, the senior Newcastle officer posted to Cowra as Mr Roxburgh's replacement in January, 2006, lasted several months before he too moved on, allegedly after being subjected to intimidation.

Mr Taylor - who used a defibrillator to revive Mr Packer after he suffered a heart attack at a polo match in 1990 - made a submission to the inquiry. He said he was bullied from his first day of training at a station, with the older officers telling him, "We don't like you. We're going to fail you." The final straw was the incompetence and bullying by a male officer at Tanilba Bay, which contributed to two officers taking stress leave. "I would take sickies so I didn't have to work with him and then I decided I had to retire," Mr Taylor said.

The Health Services Union has backed the claims, pointing to widespread disaffection with the Ambulance Service's internal investigations, many of which it says are "prejudicial in nature, inconsistent in application and protracted in duration". It has also called for a comprehensive plan to make sure all ambulance workplaces are free of persecution.

At an openly hostile statewide meeting last September, 500 officers had expressed "absolutely no confidence" in senior management "and in particular, the current chief executive", union chief Michael Williamson said. Testifying before the inquiry, NSW Ambulance Service chief executive Greg Rochford acknowledged there had been strong criticism of the service's ability to resolve disputes and address workplace behaviour issues. He said much was being done to simplify and speed up procedures and improve interaction between managers and front-line staff.

NSW Director-General of Health Deborah Picone said the service had a zero-tolerance policy on bullying and harassment. More than 400 managers were expected to be retrained in its implementation by the end of next year and a taskforce had been set up.

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13 July, 2008

Overstretched NHS maternity units put mothers and babies at risk

Women giving birth are being admitted to maternity wards short of doctors and midwives as well as basic medical facilities, a review concludes today. “Significant weaknesses” persist in maternity and neonatal services across England, putting mothers and babies at risk despite years of sustained criticism from watchdogs, the Healthcare Commission said. Medical errors and poor standards of care have contributed to the deaths of at least six women in England in recent years, inquests have found.

Consultants did not always spend enough time on wards and not all staff received adequate training on safety issues, the review of 150 NHS trusts found. The pressure on maternity and neonatal wards is such that newborn babies are being turned away from some units regularly as there are no cots available, it suggests. More than half — 56 per cent — of neonatal units closed their doors to newborns in the six-month period to March 2007, in some occasions for more than three months. The average length of closure was two weeks, meaning that vulnerable babies would be shuttled between hospitals until one was found to take them.

The birthrate in England has risen over a decade to nearly 670,000 a year in 2006, with new figures for 2007 expected to show a further increase today. However, choice over where and how women give birth remains limited because of staffing issues, the review concludes, despite government assurances that all women should receive one-to-one care from a dedicated named midwife by 2012.

Sir Ian Kennedy, chairman of the commission, said that the NHS had no excuses for poor maternity care and the death of women giving birth. “I don’t want to be at the wrong end of another investigation report describing the deaths of babies and mother,” he said. “I have been there too many times. There’s no reason we should see that any longer.” He called for an end to the “tribal allegiances” that set obstetricians against midwives and criticised the “staggering” absence of statistics on maternity services in 17 per cent of trusts. “How can they know what they are doing? This is not how a modern, 21st-century large enterprise should conduct itself,” he said.

In a review that surveyed more than 26,000 women and 5,000 staff, the commission examined all aspects of maternity care, from neonatal checks to the final contact with a midwife, usually ten days after a birth. While a majority of women were happy with their care, in some hospitals more than one baby was being born in each bed every day — raising fears that mothers were being hurried out of the labour suite after birth.

The median number of delivery beds per 1,000 births per year was 3.6, equivalent to each bed being used for 0.7 births per day, but some trusts have as few as two beds per 1,000 births per year, meaning that each was used for 1.4 births per day. “This seems excessive and there is clearly a need to increase the capacity of delivery beds in these units,” the report concludes. In addition, roughly half of trusts need to “examine their staffing levels urgently” to achieve more than 31 midwives and 6.6 obstetric doctors per 1,000 births or greater, it says.

About one in ten new mothers rated the care received before and during the birth as “poor” or “fair” but this rose to one in five when assessing the quality of postnatal care. There was also an inadequate number of bathrooms in delivery suites, with relatively few units (16.5 per cent) having as many as one bath per delivery room, and only half reported having one or more baths for every four delivery rooms. “Shower facilities are more common and more than a third of trusts (38 per cent) reported one shower per delivery room, with just over half of units reporting one shower or more for every two delivery rooms. “Ideally, all delivery rooms should have a bath or shower room en suite, but there is clearly a long way to go before this position is reached.”

The mortality rate among mothers, taken from pregnancy until six weeks after birth, has remained between 13 and 14 per 100,000 over the past six years. Researchers say that there are several reasons why the death rate has not declined, including a rising number of women choosing to have babies later in life, which increases the risk of complications. However, of the 295 deaths of new mothers between 2003-05, half were attributable in part to substandard care, according to the official Confidential Enquiry into Maternal and Child Health.

One of the Government’s key aims is to give every woman choice over where to have her baby, with more home births and deliveries in local units staffed by midwives, rather than consultants, expected as a result. “[But] in practice, the choice of types of maternity unit is currently very limited, because our review found that about two thirds of trusts (65 per cent) had only obstetric units,” the commission found. “The remaining trusts had combinations of obstetric and midwife-led units; either alongside the main unit, or midwife-led units in separate freestanding premises. A few trusts had all three kinds of unit. Two acute trusts had midwife-led units only.”

Ministers have promised $660 million extra funding for maternity services over the next three years and 4,000 more midwives by 2012. But the Royal College of Midwives said that these would equate to fewer full-time posts and that at least 5,000 were needed “as soon as possible”.

Sabaratnam Arulkumaran, president of the Royal College of Obstetricians and Gynaecologists, said that women who experienced complications or who required emergency attention would still need to see a specialist. At least 1,000 extra maternity consultants were needed, with at least 500 needing to be recruited “in the next two to three years”.

But the Conservatives gave warning of potential mergers or closures of maternity units across the country. Anne Milton, a Tory health spokeswoman, said: “Labour talk about more choice for pregnant women but the reality is that women now have less choice. It’s worrying that many more maternity units are set to be downgraded in the next few years and that so many neonatal units are set to shut.”

Norman Lamb, of the Liberal Democrats, added: “This unacceptable level of care must be addressed as a matter of priority. Staff shortages are putting midwives under an increasing amount of pressure and many women are not receiving good enough care.”

In the absence of formal standards, the review set performance benchmarks for maternity for the first time. In December it rated 22 per cent of maternity services as “fair performing” (32 trusts) and 21 per cent as “least well performing” (31 trusts). Twenty-six per cent of trusts were “best performing (38 trusts) and 32 per cent were “better performing” (47 trusts).

The review was prompted by concern over the quality and safety of maternity units in 2005 after Northwick Park Hospital in North London was put on special measures while the deaths of several women were investigated. Other investigations took place at New Cross Hospital in Wolverhampton and Ashford St Peters Hospital in Chertsey, Surrey.

A spokesman for the Department of Health said: “As part of the NHS review, each region has prioritised improving maternity services and will be developing plans to improve frontline midwifery care, develop leadership capacity and enhance quality of care.”

Source




Infection alert as dangerous superbugs hit South Australian public hospital

SUPERBUGS are on the rise at Royal Adelaide Hospital and some patients are carrying two different strains. Fifteen patients are now colonised with vancomycin-resistant enterococci, three times as many as there were in May. Four more patients have two different strains of antibiotic-resistant bugs, VRE as well as MRSA or golden staph. VRE has forced ward closures interstate, while golden staph kills about one person in five. SA Health confirmed the cases yesterday.

The other main metropolitan hospitals have no recorded cases of VRE, except the Queen Elizabeth Hospital, which has had one case. Communicable Disease Control Branch director Dr Ann Koehler said there were no ward closures in SA. "VRE and other bacteria such as MRSA are becoming more common causes of healthcare-associated infections in SA and other states across Australia," she said.

Dr Koehler said the department had infection control teams supporting hospital workers and patients, but emphasised visitors had a role to play in reducing infections. "We can't stress enough the importance of visitors to our hospitals to follow simple and effective hand hygiene steps to stop their spread," she said. SA Health has taken actions to control the infection spreading, such as:

DAILY meetings of a VRE response team, increased staff education and frequent communication with relevant staff.

ENHANCED cleaning in identified wards.

ENVIRONMENTAL monitoring and active surveillance of groups at risk of colonisation.

FOCUS on hand hygiene, and compliance with precautions such as single-use gloves and gowns.

VRE does not normally cause illness, so patients are said to be `colonised' rather than infected. It can be a risk to patients with compromised immune systems.

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12 July, 2008

ANOTHER DAY OF SOCIALIST MEDICAL MAYHEM IN AUSTRALIA

Three articles below: Just one day's worth

Nasty Leftist politician jealous of private PET scanner

Builders in the middle of installing a life-saving PET scanner were ordered to leave the Hobart Private Hospital or risk breaking the law. Health Minister Lara Giddings said the scanner did not have her approval. MIA Tasmania says it spent five years and several million dollars obtaining approvals and training specialists to use the Positron Emission Tomography scanner -- the only one in Tasmania. It has approval letters from the Department of Health's health physics unit and the Royal Hobart Hospital. The scanner is due to be ready for patients next month.

"On Monday we were told we had to get ministerial approval. The previous approval was retracted," said Mark Simpson, general manager of Regional Imaging which owns MIA Tasmania. He said Healthscope, which leases the building from the State Government, was forced to tell them to leave. "We intended this scanner for use for public and private patients statewide," Mr Simpson said.

Tasmania is the only state without a PET scanner -- which measures how far cancers have spread and helps determine whether to operate or not. Hundreds of Tasmanians each year travel to scanners interstate. PET can help diagnose Alzheimer's, epilepsy and heart disease. But the Federal Government promised late last year to buy a scanner for Tasmania -- right next door in the RHH. The public plan is expected to take three years or more.

However, Ms Giddings said the State Government had not approved the MIA scanner. "The Hospitals Act is designed to ensure the safety of patients is protected when additions or alterations are made in private medical establishments," she said. She told estimates hearings last month she had not issued the licence to MIA.

Mr Simpson said if such approval was required, it had not been so for all the other equipment they had brought in. PET is a sub-branch of nuclear medicine. MIA provides all the RHH's nuclear medicine reporting services.

"This move could deprive seriously ill Tasmanians of an important diagnostic tool and beggars belief," said Liberal health spokesman Brett Whiteley. Greens leader Nick McKim said Tasmanians needed access to PET scans sooner rather than later, something Ms Giddings should be facilitating.

Source




W.A.: Blind war vet, 80, 'waited 20 hours' for hospital bed



No capacity in the system for coping properly with upsurges in demand -- WHICH HAPPENS EVERY WINTER!

An 80-year-old war veteran was forced to wait nearly 20 hours overnight for a bed at Sir Charles Gairdner Hospital emergency department, his wife claimed today. Edward Webster from Bedford was brought to SCGH emergency department by ambulance yesterday afternoon about 3pm for a bone marrow test. It was at the urging of his GP.

His wife, 76-year-old Helen, said she left him at the hospital at 9pm. At the time he was still waiting in a wheelchair. When Mrs Webster returned early this morning she found out he had still not been admitted to hospital for a bed. He was yet to be given a bed at 10.30am today, but is believed to have been admitted into a ward just before 11am.

Mr Webster suffers from a leukaemia-like blood disorder known as myelofibrosis. He is also blind. "He is still in emergency right now," Mrs Webster told Perthnow just after 10am. "He has not been admitted to hospital."

SCGH executive director Dr Amanda Ling refused to comment on Mr Webster'r ordeal, but conceded there were a "significant number of patients" in the hospital's emergency department yesterday afternoon. She said a high demand for inpatient beds had caused delays for some patients. "We do not comment on individual patients -- all patients have a right to medical confidentiality," Dr Ling said. "On Wednesday evening, there was a significant number of patients in the emergency department including three patients with life-threatening conditions which meant patients with less serious conditions waited to be seen by a doctor. "Every patient who presents to the emergency department is triaged by a senior nurse when they arrive. Patients with serious conditions are treated ahead of those with less serious conditions.

"If a patient needs to be admitted to hospital, they will be transferred to a ward as soon as a bed becomes available. Every patient in the emergency department is monitored closely throughout their stay. "We are currently experiencing high demand for inpatient beds which has caused delays for some patients. "Our staff work very hard to ensure every patient receives the very best care throughout their stay. We are more than happy to fully investigate any concerns patients or their families have about their care if they alert us."

A frustrated Mrs Webster rang 6PR talkback radio station this morning to report the situation concerning her husband. She said she had now been told by hospital staff that her husband would most likely be transferred to Hollywood Private Hospital. "I'm angry and very upset," Mrs Webster said. "I'm not angry with the hospital. I am angry with the Government. He's a war veteran. For him to be treated like this is just not right." Mr Webster served in the peace keeping corps in Japan following World War II.

Source




Health levy plan to `hurt poorest'

The Catholic Church -- the nation's biggest operator of hospitals after state governments -- has warned Kevin Rudd that his move to lift Medicare surcharge levy thresholds will hammer the battlers he wants to help by choking already stressed public wards and lengthening surgical waiting lists. In a devastating critique of one of the Prime Minister's main 2008-09 budget initiatives, Catholic Health Australia has used government data to warn the change will lump public hospitals with a $400 million burden of providing an extra 200,000 procedures in the next 12 months, The Australian reports.

CHA also predicts elderly people seeking hip and knee replacements will be among the hardest hit and that the changes will trigger an unavoidable 10 per cent increase in private health insurance premiums next year. "The CHA review has found specific impact on low- and middle-income earners -- the group the proposed threshold changes were in fact designed to assist,'' says a submission the organisation lodged yesterday with the office of Wayne Swan. "Patients in both public and private sectors will be adversely impacted by the likely fall in private health insurance membership, but it is low- and middle-income earners who will bear the brunt of the new pressure that will be placed on the public health system.''

But the Treasurer last night defended the changes, saying the increase in thresholds was designed to provide relief for families facing the tax, originally introduced by the Howard government to target high-income earners but never indexed. In the budget handed down in May, Mr Swan announced an increase in the income thresholds at which people without health insurance face an extra surcharge worth 1 per cent of their income.

The income threshold at which single people would be liable to pay the surcharge will rise from $50,000 a year to $100,000. Couples will face the surcharge if their combined income exceeds $150,000 -- up from $100,000. Treasury modelling suggests the change will encourage 485,000 people to abandon their health insurance because they will no longer face the penalty of the surcharge. Legislation enshrining the changes was sent to a Senate committee by the Coalition-controlled Senate last month and will be reconsidered next month.

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11 July, 2008

AUSTRALIA'S UNENDING PUBLIC MEDICINE PROBLEMS

Two current articles below

NSW Ambulance bureaucracy indifferent to staff welfare

Not exactly a surprise

AMBULANCE management had been "grossly negligent and dismissive" in handling complaints by a female officer about bullying at Cowra before she eventually committed suicide, her former supervisor has told a parliamentary inquiry. The Herald has learnt that no women have been appointed to the Cowra ambulance station in the three years since the first and only female officer there, Christine Hodder, hanged herself in her backyard after allegedly enduring years of bullying and harassment by up to seven male colleagues.

An internal investigation by the NSW Ambulance Service after Mrs Hodder's death in 2005 recommended a male replace her and that no female be hired there for six months. There were 24 recommendations "to address better management of harassment and bullying" but no officer was disciplined after the investigation.

Mrs Hodder's former supervisor, Phil Roxburgh, said his complaints had fallen on deaf ears. He told the inquiry he was fed up with the "harassment, bullying, and intimidation which still continues unabated in the service, coupled with management's dysfunctional handling and empty posturing concerning these occurrences".

Yesterday Mr Roxburgh told the Herald he had received more than 100 emails of complaints after sending a group email in April expressing concern about bullying. "I couldn't do anything for Christine and myself - it's too late for that - but I'm hearing of people who have received some very bad outcomes from management," he said. "It's like water torture. You're left to hang and hang. I've got a couple of people who are on the verge of suiciding."

Mr Roxburgh had supported Mrs Hodder while she was at Cowra but he was also victimised and went on stress leave in October 2004, he told the inquiry. He said the professional standards and conduct unit "patently failed to respond in a timely and appropriate way" despite his warnings. He had also raised concerns with human resources, rehabilitation, and the state superintendent, and had even tried to speak to the CEO of the service, Greg Rochford, but "this fell on deaf ears". He accused the head of the conduct unit, Marion O'Connell, of being "very aggressive" when he criticised the internal investigation.

Mrs Hodder's mother-in-law, Carolynn Hodder, and Mr Roxburgh each told the inquiry that the then assistant operations manager leaked a complaint from Christine Hodder about a man whom she suspected had urinated "all over" her toilet. "Things at the station became explosive - [the accused person] became very verbally abusive towards her and he told Christine, 'See I told you. You have no chance seeking help from anyone above or the union as we will find out,' " Carolynn Hodder told the inquiry.

Mr Roxburgh told the inquiry the assistant operations manager had since been promoted. Christine Hodder had worked before as an ambulance officer at Canowindra and Grenfell and had got on well with her fellow officers. She had been an army medic for six years. Mr Roxburgh, who now works at Moruya ambulance station, said Mrs Hodder was victimised because she was a woman. "My colleague's problems were, first and foremost, that she was female and to exacerbate this she was intelligent, a good officer and her patients loved her," he wrote. "The constant harassment, bullying and intimidation by the staff, the callous indifference, inaction and abandonment by the service. all contributed to tipping the scales."

Source




Hospital urgent waiting list blows out

Gold Coast Liberal MP John-Paul Langbroek has blasted the State Government for not seeing the "sickest" patients first at the Gold Coast Hospital. Langbroek, member for Surfers Paradise, said Category One elective surgery patients, which are those requiring the most urgent attention on waiting lists, had almost doubled in the past 12 months. Figures released by Queensland Health indicate there were 25 people on the Category 1 waiting list last July and 58 in April this year.

"What this shows is our sickest patients are waiting far longer for treatment than they should be," Langbroek said. "The Gold Coast Hospital is struggling to cope with the demand." "As a result, our waiting lists are getting longer and patients are getting sicker as they are forced to wait for vital surgery."

However, a Government spokesman said the figures Langbroek was quoting were out of date and the latest figures, which will be released soon, show Gold Coast Hospital had only 23 patients on the Category 1 list. He did concede that numbers for Category 1 list at some hospital had risen. The figures show Category One patients almost doubled but there had been a decrease in categories 2 and 3. On July 1 2007, there were 205 Category 2 patients and 213 Category 3, while on April this year there were 176 and 168 respectively.

Langbroek said the Government was not making all categories a priority. "The bottom line is we shouldn't have to sacrifice one wait list for another, said Mr Langbroek. "The Government is spending record amounts on health. Patients should have no problem getting their surgery on time."

During the same period, Category 1 waiting lists numbers had increased at Bundaberg, Cairns Base, Caloundra General, Hervey Bay, Innisfail, Mackay Base, Maryborough Base, Nambour, Princess Alexandra, QEII, Rockhampton and Royal Children's hospitals.

Source





10 July, 2008

Health Care USA 2009

Washington is caught up in another one of its health-care spending burlesques, and liberals are belting out their favorite tunes. The GOP wants to "wipe out Medicare as we know it," sings Harry Reid. "The Bush Administration is perfectly happy to have billions of dollars going to insurance companies instead of Medicare beneficiaries," croons Pete Stark.

Republicans should be flogging themselves - for falling into this political trap. Doubly so because the theatrics are a preview of the health-care market if Democrats control both Congress and the White House. If John McCain needs another health-care red alert, here it is.

Every few months, Congress has a fire drill to prevent automatic cuts in the reimbursement fees that doctors receive for treating Medicare patients. The cuts - 10.6% this time around - have been scheduled for years, but Congress has made a habit of buying time with temporary fixes. The last one was in December; this one passed the House 355 to 59.

But it stalled in the Senate, by a single vote. Republicans are justifiably irked because the bill clips funds for Medicare Advantage, which lets seniors use federal dollars to buy private health coverage. Liberals despise Advantage, even though - or perhaps because - more than one out five of the 44 million people on Medicare have joined up. Tying a $13.6 billion rollback to the must-pass doctor bill was the Democrats' way of kicking off the post-2008 party a little early. In an Obama Administration, Advantage is dead.

The gloomy outlook is another squandered opportunity of the Tom DeLay era. In 2003, the universal Medicare prescription drug benefit handed the GOP a moment of maximum political leverage for free-market reform. Instead, the majority settled for the largest entitlement expansion since the Great Society, while their long-range market experiments like Medicare Advantage were bound to come under assault once Democrats were back in power. Sure enough...

The Clinton Administration sabotaged Advantage's predecessor, Medicare+Choice, by starving it of money. The playbook is the same now, though their task is more urgent because Advantage's impressive growth is seeding a deeper private market. It might even be convincing people that competition and transparency can work in government health care - especially compared with decrepit fee-for-service Medicare. Since private insurers must vie for consumers on quality and price, the benefits are more generous, usually including preventative care.

Those are the same services that Barack Obama says are the best way to control soaring health-care costs. Ironically, Democrats think the best way to kill Advantage is by cutting the subsidies that make those benefits possible. Insurers receive about 12% more per patient than traditional Medicare. Never mind that these subsidies were designed by Congress so plans could spread into rural areas and are being phased out over time. Democrats usually favor taxpayer health subsidies, but it seems some are more equal than others.

And that's 12% "more" compared to an utterly arbitrary baseline. As a virtual monopoly, Medicare uses a complex formula to set reimbursement rates for thousands of services. In short, it controls prices. That's why doctors are supposed to eat a pay cut, even though everyone knows this would prompt more doctors to stop seeing Medicare patients. But price fixing is the way that an open-ended entitlement like Medicare - which gobbled up $432 billion in 2007 - tries to control spending.

Not that it's working. The Medicare Trustees, in their latest futile report, note that the program now has an unfunded liability of some $36 trillion over the next 75 years, give or take a few trillion. As a percentage of GDP, expenditures are projected to increase from 3.2% in 2007 to 10.8% by 2082. Sooner or later, this trend will collide with reality, and a better way to rationalize Medicare is to convert it into a premium-support program like Advantage.

Yet Mr. Obama wants to go in the other direction and create a Medicare-like "public option" for everyone of any age. Democrats will fund this program generously, crowding out private coverage and maintaining the slow-roll toward a complete government takeover. Call it Medicare Advantage in reverse.

The fight over doctor fees is merely an appetizer for such a system, where competing interest groups would clash for their share of the spending pie. Highly politicized Medicare-like price controls on providers and services would spread to every health decision. The result would be rationing and declines in quality of care.

The GOP is losing the Advantage fight because Democrats are pitting physicians against the insurance industry, which is about as popular as Big Oil. The Bush Administration has imposed a regulatory freeze that will give Congress three days to work out a new reprieve for doctors when it returns from recess today. But the fuse will still be burning - and Republicans will continue to lose if they don't get behind a reform alternative.

Source




Pop off, Popov

Australia: Answers wanted on suspect surgeon and lazy medical regulators

A patient whose surgery was allegedly botched by a doctor accused of a string of negligent operations has demanded to know why he was allowed to continue to practise. The woman said the operation by Ivan Lubenov Popov turned into her "worst nightmare".

The doctor has recently been referred by the Medical Board of Queensland to the Health Practitioners Tribunal over alleged professional negligence regarding surgery and medical procedures on seven women over 10 months. The obstetrician and gynaecologist, who worked at Caboolture Hospital and is believed to have moved to South Africa, is alleged to have lied to patients and misled staff about his procedures to cover up surgical mistakes and potentially illegal operations between July 2006 and May 2007.

One woman had an ovary removed by Dr Popov, who allegedly lied to her about the reason for the procedure. Another alleged victim, who asked not to be named because of possible legal action, demanded to know who was watching over Dr Popov when he was supposed to be watching over her. "I am devastated and disappointed with myself that I really didn't do anything earlier, but I was just too traumatised," the woman said. "It has taken me such a long time to recover. I still experience pain. "For a surgery that should have been a safe and pretty much problem- free surgery, it really did turn into my worst nightmare."

She said she felt betrayed and questioned Queensland's Health culpability. "I wonder why surgery was allowed to go ahead with me. Wasn't there someone that was senior to him, who would have checked my history?" she said. "Was it really just up to him - just one person? And that is scary if that is the case."

Queensland Health said in a statement that Dr Popov was referred to the Ethical Standards Unit in 2007. "Dr Popov resigned before Queensland Health's action was finalised," it said. Dr Popov left the hospital last July but did not resign until six weeks ago. "The Health Practitioners Tribunal will determine whether the significant adverse medical events which occurred were the result of inappropriate clinical practice or by circumstance beyond the doctor's control," the statement said.

Restrictions on Dr Popov were only imposed by the Medical Board of Queensland last month -- after he resigned and other investigations were completed. A tribunal date is yet to be set to hear Dr Popov's case.

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9 July, 2008

NHS dentistry chaos

Dentists are extracting patients' teeth rather than carrying out more complex repair work because NHS reforms have failed, an influential MPs' committee says today. The Government's overhaul of dentists' contracts, which promised to increase preventive treatments, has had the opposite effect, the Commons Health Select Committee says. The changes were designed to improve the quality of dental care and end a perceived "drill and fill" culture, in which dentists sought to slash waiting lists with quick fixes. Instead, the committee has suggested that a new payment system had made dentists even more prone to avoiding time-consuming repair work.

The number of tooth extractions, many of them unnecessary, experts say, has risen since the new contract was introduced, according to evidence presented to the committee. At the same time, the volume of more complex work such as crowns, bridges and dentures has fallen by more than half.

Dentists used to be paid a fee for each item of treatment they provided, but they now receive an annual income in return for carrying out an agreed amount of work, known as units of dental activity (UDAs).

The MPs' report, published today, said it was extraordinary that the Department of Health did not carry out pilot studies on the new payment system before introducing it across England.

Data published this month also high-lighted failings in the reforms, which were introduced in April 2006. Almost a million fewer people are now seeing an NHS dentist than before the changes, a report from the NHS Information Centre said. Less than half the population was found to have seen a dentist in the previous two years.

Setting out today's report, Kevin Barron, MP, the chairman of the committee, said that the failure of the reforms was compounded by the department's astonishing oversight in not conducting pilot tests. "While we readily accept that in some areas of the country, provision of NHS dentistry is good, overall provision is patchy," he said. "Fewer patients are visiting an NHS dentist than before the contracts were introduced in April 2006, we heard little evidence that preventive care has increased, and patients seem less likely to receive complex treatments they might require within the NHS."

The British Dental Association said: "This is a damning report which high-lights the failure of a farcical contract that has alienated the profession and caused uncertainty to patients." The new contract was introduced in 2006 with the aim of reversing the decline in NHS dentistry. It eliminated the need to register with a particular dentist, and introduced the "unit of dental activity". But the department's financial estimates were hopelessly adrift. It predicted that payments by patients in 2006-07 would be 159 million pounds higher than they actually were. The shortfall meant that primary care trusts, which are responsible for dental services, found themselves short of cash to pay for them.

In addition, targets for the UDAs were in many cases unachievable, dentists found. Nearly half of all dentists failed to meet their UDA targets in the first year, according to the British Dental Association. Some were forced to pay back money that they had already been paid.

Source




Australia: Overstretched doctors turning away 'chronic' patients

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

STATE capitals are feeling the brunt of the nation's doctor shortage, with GPs in these previously well-served areas shutting their doors to new patients due to overwhelming demand. In some cases, patients are having to travel 20-30km from their homes to find a doctor who can see them. Some GPs are using fees to dampen demand, charging as much as $100 for an in-surgery consultation after 6pm.

Although governments for years deemed the doctor shortage to be a largely rural phenomenon, an analysis of GP statistics shows doctor headcounts are falling hardest in metropolitan areas, which have so far been largely overlooked by medical recruitment incentive programs. Workforce data for Australia's 115 locally based divisions of general practice shows that in at least parts of all mainland state capitals, the number of GPs and the number of services they provide annually have both fallen between 1995-96 and 2005-06.

At the same time, there has in almost all cases been a huge jump in the proportion of GPs in each division aged over 55, raising the prospect that the doctor shortages in the affected areas will worsen when large numbers of GPs start to retire.

In the Central Sydney division, the GP headcount fell from 680 in 1995-96 to 590 nine years later, while the population grew. The number of services provided by GPs in those years also fell, from 2.7 million to 2.4 million. Similar patterns were seen in at least six other Sydney divisions, while headcounts in many rural NSW divisions rose. Headcount falls were also seen in the ACT, at least eight divisions in Melbourne, two in Brisbane, four in Adelaide and three in Perth.

The real impact on the workforce would be bigger, because the trend towards more women qualifying as doctors has led to a reduction in the overall numbers of hours worked, as women are more likely to work part-time.

Perth GP Tim Lipscombe closed his books to new patients seven months ago, as have about half the doctors in his nine-GP practice. "I wasn't able to service my own patients and I was being inundated by patients with relatively complex chronic diseases who were coming from other practices that had closed," Dr Lipscombe said. "There are a lot of doctors around here near retirement age, who I have heard on the grapevine will be retiring soon. I'm not sure what's going to happen - it's pretty scary."

A practice in Indooroopilly, Brisbane, said some patients came from as far away as Ipswich or after ringing "six other centres and are unable to get in". "I know a couple of practices whose standard consultation is about $65 - and certainly out of hours, anything after 6pm is a lot dearer, around $100," said the reception supervisor, who asked not to be named.

Federal Health Minister Nicola Roxon said the shortage of GPs was "a real issue right around Australia". "This is an issue we're determined to tackle," she said. "The increasing number of doctors coming on-line over the next few years should make a difference, but we need to do more."

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8 July, 2008

Private drug helps cancer man left to die by NHS

Aint socialized medicine wonderful?

A cancer patient sent home to die by the National Health Service has seen his health improve after he cashed in his pension and used funds raised by friends to pay privately for an expensive drug. Andrew Crabb, 49, a father of three from Abingdon, Oxfordshire, was told by doctors in October that there was no treatment available on the NHS for his advanced kidney cancer. His wife Diane, 57, was told that he had months to live.

The couple refused to accept the death sentence and have raised enough money to pay for the drug Sutent, at a cost of about 3,000 pounds a month. Oxford Radcliffe Hospitals NHS Trust has agreed to allow Crabb, a former bricklayer who has nine grandchildren, to pay for the medicine privately while continuing to receive NHS care. The hospital is one of at least six trusts in England and Wales which are ignoring government guidance that patients who pay for drugs privately must forfeit NHS treatment.

Alan Johnson, the health secretary, claimed that the arrangement, known as “top up” or “co-payment”, creates a two-tier health service. But he has been forced to order an inquiry into the ban after a revolt by the medical establishment, which is outraged that NHS cancer patients are being turned away after paying privately for drugs recommended by doctors. Nottingham University Hospitals NHS Trust, ABM University NHS Trust in Bridgend, the University Hospital Birmingham NHS Foundation Trust, Weston Area Health NHS Trust in Somerset and the Royal Marsden NHS Foundation Trust in London have also allowed some of their patients to pay for drugs privately.

If Crabb was forced to pay for all his care, including scans, consultants’ appointments, nursing care and blood tests, his bills could double. This weekend his wife, who works part-time as a sales assistant, revealed how she had refused to accept the NHS advice. “They said there was nothing they could do,” she recalled. “I just begged the doctor. I said, ‘You are not telling me that there is not a drug available for my husband?’ “I told her that my sister was diagnosed with cancer 10 years ago and she is still here. I was begging her to find a drug.”

Crabb has Sutent delivered to his house by a private firm, Healthcare at Home, while he continues to be treated by doctors at Churchill hospital, part of Oxford Radcliffe Hospitals NHS Trust. He is halfway through his second six-week course of the drug and doctors have observed an improvement in his condition.

Diane Crabb said: “Everything has continued within the NHS except the Sutent. There has been a vast improvement in my husband. He is walking into town, which he couldn’t do before. One day he walked for 4½ hours.”

As Crabb can no longer work, the couple have cashed in two pensions to help to pay for their living costs, while the drug is being funded by donations from friends and family. “One of my husband’s friends started the fundraising and it just escalated,” said Diane Crabb. “A friend of Andrew’s mum and dad gave 2,000 pounds. An old lady stopped Andrew’s mum in the street and gave 5 pounds. She said, ‘That’s all I can afford’.”

Karol Sikora, an oncologist at Hammersmith hospital in west London and medical director of CancerPartnersUK, a private cancer treatment company, said: “It is outrageous that this patient was sent home to die. His ability to top up his care by sacrificing his pension to buy the drug is a scandalous reflection of our times, but may save his life.”

Baroness Ilora Finlay, president of the Royal Society of Medicine, said doctors should tell patients about private drugs from which they could potentially benefit, even if the cost appeared prohibitive.

Last week Johnson promised to tackle the cancer drug “postcode lottery” by ordering the government’s rationing body, the National Institute for Health and Clinical Excellence (Nice) to speed up its assessments of whether new drugs should be funded by the NHS. He also reiterated that patients have a right to drugs once they have been approved for prescription on the NHS. Nice has yet to decide whether Sutent should be funded. However, some NHS trusts have already chosen to offer it to patients, which campaigners believe makes a mockery of government promises.

The Sunday Times has been campaigning on behalf of cancer patients who have had their NHS care withdrawn because they have chosen to pay for private drugs recommended by their doctor. A spokesman for Oxford Radcliffe Hospitals NHS Trust said: “We would have no reason to withhold treatment if a patient purchases other drugs from outside the NHS.”

Source





7 July, 2008

MORE MEDICAL MAYHEM IN AUSTRALIA

Three current articles about Australian public medicine below:

NSW paramedics being worked to death

An inquiry into the New South Wales Ambulance Service has heard many paramedics feel so stressed and overwhelmed by their workloads they are contemplating suicide. The Upper House inquiry has heard Three in Four ambulance officers feel over worked in the job, while a number of submissions have raised serious concerns about bullying.

Phil Roxbrough, Ambulance station manager in Moruya on the NSW south coast, told the hearing bosses needed to do more to address the problems associated with stress. "I hear stories from so many people who have come so close to attempting suicide or have gone through some really horrific experiences and someone needs to be a voice for these people, to care for these people," he said.

Source




Tasmanian public hospital bed shortages

Ongoing pressures at the Royal Hobart Hospital have surfaced again with staff and patients reporting issues across a number of departments yesterday. Australian Nursing Federation state secretary Neroli Elis said up to five ambulances were ramped outside the Emergency Department yesterday because of a drastic shortage of staff and beds. She said one patient in emergency had arrived at 8pm on Thursday and had not received a bed by 4.30pm yesterday. It follows an emergency meeting between staff and management last weekend after complaints that emergency patients were being left to wait on trolleys in corridors for up to 36 hours before beds were found.

Ms Ellis said the hospital was admitting elective surgery patients in order to meet its Commonwealth targets while emergency patients were left in crowded waiting rooms.

RHH spokeswoman Pene Snashall said the emergency department had not been abnormally busy. "I cannot find any evidence to substantiate their claims," Ms Snashall said. "The individual patient they refer to is not in (the emergency department) -- not on a trolley -- she is actually in the short-stay facility of ED under the care of neurosurgery specialists. "It is mischievous to suggest this person waiting in a waiting room or sitting in a chair for that amount of time."

Meanwhile a pregnant woman rang the Mercury yesterday to complain of overcrowding in the antenatal ward. "There are some very tired ladies here with heavy bellies and children running around and there are no seats for anyone," the woman said. "Staff have said we can look forward to a wait of one to two hours."

Last week, RHH chief executive Craig White admitted conditions in the hospital's maternity outpatient clinic were unsatisfactory but said there were limited options for improvement because of space constraints in the ageing hospital.

Source




Bulgarian doctor repeatedly botched surgery

While the regulators sleepwalked about it

A doctor accused of wrongly operating on patients and lying about the mistaken removal of a woman's ovary has just re-registered to practise. Dr Ivan Lubenov Popov is alleged to have lied to patients and misled staff about his procedures in an attempt to cover-up botched and potentially illegal medical procedures.

Documents filed to the Health Practitioners Tribunal registrar reveal a string of women have suffered complications and heartache since December 2006 because of the alleged negligent practices of the obstetrician and gynaecologist, who worked at the Caboolture Hospital. In one case he allegedly removed a woman's ovary that was meant to be preserved during a hysterectomy, and while admitting the surgical mistake to his superiors, continued to lie to the woman about the reason for its removal.

Four other women suffered complications following "inappropriate" surgery, which the Medical Board of Queensland claims should not have been performed at a provincial hospital given the women's medical history and potential for the operations to be complicated. In another case he is alleged to have consented to a medical procedure on a pregnant woman which he knew would result in a termination of her pregnancy, which she had earlier told him was unwanted.

But the Medical Board of Queensland said a termination was outside Queensland Health guidelines and Dr Popov deliberately tried to obfuscate the intent to perform the termination and misled his superiors and colleagues in the case.

The obstetrician is accused of negligence in a seventh instance, when he left a woman in labour with twins under the supervision of junior staff only, after ordering the top-up of an epidural. Dr Popov was able to continue his alleged cowboy operations on patients until he left his practice in July last year. It took another 11 months for the Medical Board of Queensland to place restrictions on his practice. It has now lodged action in the Health Practitioners Tribunal to have disciplinary action taken against him.

Dr Popov has re-registered to practise as a doctor from July 1 this year. But Queensland Health said he was no longer working for them and under Medical Board of Queensland guidelines, he has not been able to practise privately since the middle of last month. Queensland Health has also referred the matter to the Crime and Misconduct Commission and the Health Quality and Complaints Commission.

Spokesmen for both Queensland Health and the Medical Board of Queensland said they were unable to provide any more information on the doctor, who is understood to have moved to South Africa. Lawyers listed as a contact for Dr Popov in a Medical Board of Queensland document last month said yesterday they no longer represented him and were unable to assist with any further information. Neighbours at his last known address at Redcliffe said Dr Popov packed up and moved to South Africa last week. Dr Popov received his Diploma of Medicine from a University in Varna, Bulgaria, in 1990.

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6 July, 2008

Kennedy leads renewed effort on universal healthcare

Presses for bipartisan support before new president takes office

Senator Edward M. Kennedy's office has begun convening a series of meetings involving a wide array of healthcare specialists to begin laying the groundwork for a new attempt to provide universal healthcare, according to participants. The discussions signal that Kennedy, who instructed aides to begin holding the meetings while he is in Massachusetts undergoing treatment for brain cancer, intends to work vigorously to build bipartisan support for a major healthcare initiative when he returns to Washington in the fall.

Those involved in the discussions said Kennedy believes it is extremely important to move as quickly as possible on overhauling the healthcare system after the next president takes office in January in order to capitalize on the momentum behind a new administration. Kennedy was an early endorser of Senator Barack Obama, the presumptive Democratic presidential nominee who is also a member of the Committee on Health, Education, Labor and Pensions, which Kennedy chairs.

Obama's Senate staff has attended the roundtable discussions. If Obama is elected, Kennedy's effort to identify points of agreement among senators could smooth the way for the new administration to press ahead on universal healthcare, which Obama has promised to implement within four years.

The last time a national healthcare plan was attempted, under President Clinton in 1993, the presidential panel charged with devising a proposal was widely criticized for not consulting enough with Congress, and protracted disagreements erupted, delaying its progress for months and ultimately resulting in its demise. Kennedy's effort appears to be designed to identify areas of common ground between Democrats and Republicans, business and labor, providers and insurers, and others before the new president takes office.

"The senator is trying to learn from health reform attempts in the past and to build a fair amount of consensus among his Senate colleagues, House colleagues, and the Obama campaign . . . and find a strategy that could carry with some momentum into the new administration," said Dr. Jay Himmelstein, a health policy specialist at University of Massachusetts Medical School and a former Kennedy staff member who has been involved in the talks.

The initiative also suggests that Kennedy, who has made healthcare his signature issue in his 45-year Senate career and who is fighting an aggressive brain tumor, is considering his legacy as a new administration arrives in Washington - a moment many see as the best chance for widespread changes in the healthcare system in 15 years....

Kennedy played a critical role in helping Massachusetts create a healthcare overhaul proposal in 2006 by aiding the state in obtaining the federal money needed to subsidize it. It appears he is now looking to Massachusetts to help shape the debate in Washington. Earlier this year, Kennedy recruited John McDonough, executive director of Health Care For All in Boston and a major player in the Massachusetts healthcare overhaul debate, to lead the new health initiative.

Aides to Kennedy have also assembled a network of Massachusetts advisers, including healthcare lawyers, economists, nonprofit leaders, doctors, and health insurers who may be asked to work on specific aspects of a national plan. At a recent meeting in Boston, the group discussed how different elements of the Massachusetts approach might work on a national level.....

Intraparty disputes were one reason Clinton's 1993 proposal foundered. Back then, Daniel Patrick Moynihan, the Democratic chairman of the Senate Finance Committee, dismissed the financing of Clinton's plan as "fantasy" just before the president presented it to Congress.....

Even though health costs have soared along with the number of uninsured over the past 15 years, the defeat of the Clinton health overhaul plan was so politically devastating to the administration and to efforts to enact universal health insurance law that nothing approaching such a large-scale effort has been tried since. One purpose of the roundtable discussions, participants said, is to educate Senate staff on broad issues that have not been seriously debated in years.

Source




Bad British teeth

The new NHS constitution outlined this week in the Darzi report promises an NHS accessible to all, free at the point of use, and provided on the basis of need, not ability to pay. No aspect of the service falls short of this ideal by a bigger margin than dentistry. The Health Select Committee, with a majority of Labour members, did not set out to spoil the NHS's 60th birthday. But its report certainly puts those promises into perspective.

For decades, most adults of working age have paid a substantial part of their dental costs - just the same kind of co-payment which, we are told, would undermine the whole ethos of the NHS if it were to be allowed in paying for cancer drugs. Yet in spite of this, NHS dentistry has a terrible reputation. Americans are said to recognise British people at 100 yards by the poor quality of their teeth. The old "fee per item of service" contract rewarded NHS dentists for the amount of drilling and filling they did.

The new contract was supposed to put all this right. But its implementation was left to a succession of junior ministers who never carried enough clout to make it work. The British Dental Association pulled out of the negotiations, but the Department of Health did not take the hint. It remained convinced it was right and brought in the new contract regardless. This simplified the scale of charges, but in such a crude way that it further distorted dental practice. No pilots were carried out to see if it worked. It would be all right on the night, critics were told. It was not.

The department and the Chief Dental Officer remain convinced that these are, well, teething pains. Meanwhile, private dentistry has overtaken NHS dentistry in the number of patients treated, and millions who cannot afford to go private let their teeth deteriorate. Can NHS dentistry be rescued? It seems unlikely. But the attempt made by this Government has made a bad situation worse, at greater cost. Next time it should try listening to the dentists.

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5 July, 2008

NHS bosses grumpy about new EU rights

The Government interrupted its week-long celebration of the NHS yesterday to issue a sharp warning to anyone tempted to desert it. Rather than welcoming a new EU Directive that codifies the rights of patients to travel abroad for treatment, the Department of Health gruffly announced that "health tourism" would not be funded by the NHS. This assertion missed the point so spectacularly that one wonders if anybody was awake in Richmond Terrace, the DoH's headquarters. The new directive - the result of several years of negotiation in which the Government has been fully involved - does not confer any new rights on EU citizens to become health tourists. Nor does it impose any new costs on health systems.

It simply says what is already EU law, though now codified in a far more comprehensive fashion. People have the right to travel and to have treatment abroad. If they do so, they will be reimbursed by the exact amount that their treatment would have cost in their home country. Nobody stands to gain or lose. Suppose a British patient decides he wants his hip implant done in Spain. If the local cost exceeds the NHS price (5,587 pounds for a straightforward cemented implant) he will have to pay the difference. If the cost is less, then the operation will have cost the NHS less than if he had stayed in Britain for it, and he will have reduced the queue by one. What's to worry about?

Now let's imagine the reverse scenario. An EU national, attracted by the paeans lavished this week on the NHS, decides he would like to come here for the same operation. Unlikely, but bear with me. If the NHS cost is higher than the cost in his country of origin, he will have to fund the difference. If it is less, the NHS will be reimbursed its normal tariff cost. The NHS will have to find room for another patient, but it will have been fully reimbursed for treating him. EU officials expect just one in 300 European patients to take advantage of the rules. The great majority will live on the mainland with attractive hospitals just over the border.

With a Channel to cross, the odds are that an even lower proportion of British patients will choose to travel. Anybody hoping to take advantage of a few weeks in a German spa - generously provided by the German healthcare system - will be disappointed. The NHS does not do spas. So it is not obliged to pay for anyone travelling to one. In any case, there is an opt-out clause. Should the numbers of British patients wanting to travel abroad become so large that they threaten the future of a service or a hospital here, they can be required to obtain a "prior authorisation" that would not in those circumstances be granted.

The new directive, it should be made clear, is distinct from the case law established by Yvonne Watts, who won the right to be reimbursed for having a hip operation in France when waiting lists in Britain were long. The judges at the European Court ruled that she was entitled to reimbursement if she had suffered undue delay in treatment. Under the Watts ruling, full costs would be reimbursable, not just the NHS tariff cost. But now that maximum English waiting times for elective operations are down to six months, it is unlikely that anyone would qualify under the Watts criterion - and they would have to go to court to prove undue delay.

The directive seems unlikely to create a flood of patients in either direction. In any case, there is a safeguard. The department's anxiety appears misplaced.

Source




NYTs Practice Of Medicine

In another one of those long, in this case 4278 words, articles by the New York Times, "Weighing the Costs of a Look Inside the Heart," it again demonstrates its failure to conduct or convey elemental journalistic research. And, again, an agenda appears at work. The result is that certain key facts and distinctions are omitted, which surely could have found space within this long article, that would have conveyed more and important information.

The agenda is rationing of health care. Rationing is inherent in the various schemes for "universal" or "single-payer" or "government-run" or "nationalized" health care. There's no doubt that some degree of rationing already occurs for those relatively few who truly can't afford insurance or co-pays but earn a bit too much to benefit from government programs. But, by shifting their earnings and taxes to the benefit of those few, the schemes would subject everyone else to rationing.

I'm a decades-long participant in HMOs, and even advocate them in areas like mine where their panels are so large and inclusive of the quality providers that there's nothing material to be gained by not being in one. However, most prefer more freedom of choice, as in PPOs, though their premiums are higher, and polls consistently show overwhelming majorities not favoring government-run health care. The fear is tangible and sometimes real that in case of an extreme circumstance or particular set of facts they will be denied covered care.

It's true, as the NYTs article says, that we collectively overuse medical care, and that costs. The problem is that, first, most of that is a personal decision and, second, the only way to drastically cut that cost would be wholesale imposed rationing that would often discriminate against many cases where the extra measure would save lives or make them more salutary. Third, many of the treatments proposed for rationing show demonstrated benefits but are, while not 100% proven - whatever that means, if even possible, discriminated against due to their cost. In that case, it's ironic that those who advocate greater preventive medicine, also advocate against preventive medicine.

The gist of the NYTs article is that overuse of heart CT scans is expensive, deliver large doses of radiation, may be spurred by self-interest profits by some doctor owners of CT machines, and the test and diagnoses not certain. As generalizations, that may be so. But, the NYTs fails to mention there are large-scale, reputable studies of those cases where it is proper and beneficial.

For example, the American Heart Association and American College of Cardiology Foundation in 2007 examined all the literature and studies to reach a "Clinical Expert Consensus Document on Coronary Artery Calcium Scoring By Computed Tomography in Global Cardiovascular Risk Assessment and in Evaluation of Patients With Chest Pain." Patients who either score low or high (high already evident for additional treatment) on risk predictors are not indicated for the test. Patients who are scored intermediate risks are indicated for the test, as "such patients may be reclassified to a higher risk status based on high CAC score, and subsequent patient management may be modified". Many other peer journal articles affirm this finding. This test, calcium scoring, is - as the NYTs mentions only briefly in passing - "a less extensive form of scanning," but is grouped in with the NYTs negativity toward coronary CT scanning in general.

The NYTs article ends with a quote from an opponent of CT scanning, "We're spending a lot of money on technology of unclear benefit and risk." The NYTs want us to forfeit individual or independent expert judgments to centralized government-run entities whose track-record on cost-benefit analysis is proven repeatedly faulty and causing higher risks. No thank you to a British National Health Service.

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4 July, 2008

EU good for something after all?

Every NHS patient is to be given the right to go abroad for free treatment. They will be able to escape queues and the fear of superbug infections and head anywhere within Europe under a blueprint for 'health tourism'. In almost all cases, they will be able to send the bill to the NHS - prompting fears that its finances could be thrown into chaos. Previously, patients who chose to pay for better treatment in France, Germany, or other EU countries had to mount legal action to make the NHS reimburse them.

But an EU directive on cross-border healthcare, to be published on Wednesday, will let patients shop around freely in all 27 member states. The move is designed to ease congestion in countries with long waiting lists and give patients greater freedom. They would have the right to seek any treatment offered by the NHS - such as cancer care or hip replacements - anywhere which would provide it more quickly.

Patients would have to pay upfront where they were treated, but as long as the cost was lower than in the NHS, they could reclaim it in full. However, patients are likely to have to pay for their travel and accommodation, if they stay outside hospital.

The attractions of EU treatment for Britons are clear. NHS waiting times have fallen dramatically as Labour has poured billions into the system, but they are still longer than in many other countries. The UK also has a higher incidence of hospital superbugs and poorer survival rates for many conditions, including some cancers. For the same reasons, experts say, there is unlikely to be an influx of foreigners to the NHS. Procedures are more expensive and queues longer here, although world-renowned facilities such as the Royal Marsden cancer hospital are potential draws.

The plan could threaten the stability of NHS finances, however, as the health service will lose revenue to hospitals overseas. Budgets could be thrown into chaos by patients jumping queues and then billing the NHS. There is also serious concern about Britons living abroad charging the NHS for all their medical care. Currently, many rely on private medical insurance to cover local treatment.

Keith Pollard, director of Treatment Abroad, a company which helps patients get care overseas, said last night: 'This is the first step to creating a truly European market in healthcare. 'It could revolutionise the way we experience healthcare in this country and throughout Europe. It's very good news for the fast-developing medical tourism industry. The directive will take the concept of patient choice to a new level.'

The Tories predicted that many patients would take up the offer to travel abroad. The party's health spokesman in Brussels, former health minister John Bowis, said: 'We will see people voting with their feet on the Government's handling of the NHS. 'People have been travelling abroad for treatments for years and the procedure needs to be formalised.'

Under the draft proposals, member states will be able to impose the same conditions on cross-border care as they do for domestic treatment - for instance, a requirement to consult a GP or a hospital specialist. The NHS would be obliged to fund all overseas outpatient treatment - such as scans and minor operations - even where patients do not seek authorisation beforehand.

But Health Secretary Alan Johnson is fighting for the right to make patients obtain NHS permission in advance for major operations, which mean a stay in hospital. The health department said: 'We are absolutely committed to ensuring that the NHS retains the ability to decide what care it will fund.' The EU, however, is understood to be insisting that funding for major procedures can be refused only if the NHS can show that services here will suffer as a result. And Britain does not have a veto to stop the plan becoming EU law if a majority of countries back it.

Doctors' leaders said the move would be a spur for the NHS to improve standards - but warned that the well-off and well-educated would be more likely to travel. Dr Terry John, chairman of the BMA's international committee, said: 'Patient mobility must not be just for the wealthy and educated. 'Standards of care for people who choose to stay in their home country, or are unable to travel abroad, must be maintained.' Some doctors are also warning that there could be problems in providing follow-up care, particularly for patients returning from countries where surgical techniques and procedures are different.

Source




Another comment on the latest NHS reforms -- as drafted by Lord Darzi

The management structure of the NHS has always reminded me of a huge pile of spaghetti. The shape is generally conical, like almost every management structure, but so convoluted are the workings between apex and base that trying to track where the money goes or how the ideas move is like tracing the strands of spaghetti as they wind in-out, up-down and around. Some strands are long, some small, some thickly coated with sauce, some almost bare, and no one can possibly work out how the strands interweave without taking the whole thing apart. It is a complete mess and mangle.

Today we learned of Lord Darzi's new plan for the NHS. Not surprisingly much of it is just window dressing wrapped in management speak: "personal care plans", "dashboard", "quality accounts". We know the result of this nonsense already - more form-filling for doctors and nurses, more managers required to audit the forms, more number crunching from Whitehall and an annual statement from the government that things have improved since this time last year. There is no wide-ranging proposal to address the biggest problem with the NHS - government interference in a professional service for political purposes.

We recently saw the most blatant example of this type of interference that i can remember, the Deep Clean. No less than 57million pounds of additional money was promised to pay for all hospitals to be cleaned thoroughly in an attempt to counter the spread of MRSA and c. difficile infections. True though it is that 57m is a drop in the NHS ocean, it is still 57m quid thrown at a gimmick designed purely to show that the government was doing something. Not surprisingly the Treasury did not fund the whole 57m as it had originally promised and the total spent on the project was more than 65m, only about 60% of which was spent on cleaning, the balance being sucked into the bottomless pit of administration. Little effect on infection rates appears to have resulted but a big dent was made in existing hospital budgets. It was, like all such knee-jerk gimmicks, counterproductive. Even if infection rates had been cut substantially it was a one-off exercise and did not look to the main causes of the problem.

Of far greater benefit would have been the introduction of simple old-fashioned accountability. The person in charge of a hospital ward should be accountable for its cleanliness. Ask any nurse with 30 years' experience and he or she will tell you that when they started work the wards were spotless. Matron was responsible. She could lose her whole career if the state of her ward caused illness or death and she made sure that those under her command cleaned everything thoroughly every day. Now who is responsible? The chief nurse no longer has control because he or she is given priorities based on government diktat by the ward manager, complying with the latest priority from Whitehall takes priority over other spending. The ward manager no longer has control because he or she is simply doing what has been passed down the chain; the same for the department manager, the hospital chief executive and the area trust. By the time we reach that level everything is so remote from the dirty ward that it doesn't matter how many more people can pass the buck up the chain. No one is directly responsible so one possible incentive to cleanliness is missing.

There is, of course, a simple solution; move cleanliness of wards to the top of the list of priorities and then apportion the remaining budget between the many other competing claims for funding. That is how things are done in private hospitals and the levels of infection are negligible. But to approach it in that way is impossible because the government has set targets for waiting times and failure to meet those targets will cost votes. Because the government might suffer, so heavy sanctions can be applied to a hospital or trust which misses the targets. Again political interference gets in the way of doing things properly.

Every private sector business which provides goods or services to the public looks to delivery first and tailors its operation to suit the needs of the customer. A company which manufactures hospital beds must make beds which hospitals want to buy, namely beds which have the features required by clinicians for the benefit of the patients. The customer is asked what is needed and the manufacturer must make it in order to stay in business. If the bed maker operated like the NHS the managing director would decide on the design and require that everyone should have access to just that one design. It is a recipe for commercial disaster but within the NHS it would be claimed to be a great improvement because there is no "post-code lottery" over which patients get the best beds.

Lord Darzi goes a small way to addressing this problem in his proposal for a pilot scheme by which people with long-term health problems are given control over their own "personal care budget" (another ghastly slogan, but the benefit is in the substance not the slogan). We wait to see just how much control the patient will have but it is a welcome first step towards making the service respond to the needs of the customer rather than the political interests of the governing party.

Much more will be needed before the NHS turns from a pile of spaghetti into an efficient organisation ... from little acorns etc.

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3 July, 2008

Callous and crooked city-run NYC hospital

Vote Obama and you too can get treated like this

Shocking surveillance camera footage shows a [black] woman collapsing and dying on a hospital emergency room floor and then lying for an hour while staff walk past. The video has been released to the media as evidence by lawyers suing the hospital for neglect and the alleged abuse of mental health patients. The lawsuit will also allege that staff have falsified medical charts to cover up their inaction because during a period that Green is seen thrashing on the floor, her medical chart claims she was "awake, up and about, went to the bathroom", New York's Daily News reports.

The video shows 49-year-old Esmin Green keeling forward in a psychiatric emergency room in Kings County Hospital in Brooklyn, New York, where she was admitted to treat agitation and psychosis on June 19. Green is shown clutching at her stomach, thrashing on the floor before lying face-first on the tiled floor with her upper body lodged in the corner space between two sets of chairs.

Two other patients move around the room, security guards walk past and one even stares at Green for about 20 seconds but the woman is left prone until one of the patients gets help after about an hour has elapsed.

The two security guards shown in the video and four other hospital workers have been fired over the incident. The hospital had a lawsuit filed against it last year alleging horrific neglect and abuse of mental patients. There were claims patients who could not fight for themselves were left without care in unsanitary conditions, which prompted an investigation by New York City officials.

In reponse to the damning video and the other claims, the hospital says it is increasing staffing and bringing in new protocols, including that patients in the emergency room have to be checked every 15 minutes.

Source




Australia: Ambulance computer system fails yet again

We were orginally told it just needed oiling (or some such). For those who follow government computer systems, the initial description of it as "innovative" was all that was needed to predict the outcome

THE statewide rollout of the Emergency Services computer system has been put on hold after it went offline for a fourth time. Again ambulance and fire officers were forced to write incoming jobs on a whiteboard.

Yesterday morning's crash was the worst to date. All but two ambulance and fire communication centres were left without their computers for more than two hours, from before 3am until after 5am. Three previous system failures were put down to human error and the Department of Emergency Services said "early advice" was that human error was again to blame.

However Emergency Services Minister Neil Roberts said the system's rollout to the remaining Central and South-eastern regions would be "put on hold" pending advice from the system's American supplier, who had been asked to analyse yesterday's outage. "I am advised that triple zero telephone and emergency services radio communications were not affected by this incident. Communication centre staff dispatched ambulance and fire crews using a manual back-up system," Mr Roberts said.

Fire officers have been highly critical of the new system, which they say has only been "half implemented" by the department making it ineffective. "The system is meant to locate the closest vehicle to an incident and dispatch that vehicle. But they're yet to install the automatic vehicle locaters in our trucks so it can do this," an officer said.

He said vehicles from two or three stations away were being sent to jobs instead and even driving past these manned stations on the way. "The most ridiculous example we had was when the computer tried to dispatch a vehicle from Capalaba station to a job on the Sunshine Coast," the officer said.

Fire communications centre staff have also raised concerns about screen freezes in the new system which can take valuable seconds off a job. "You're trying to talk to a coms centre operator and they're like, `Oh, wait a minute, the screen's frozen'. It happens every time," the officer said.

Mr Roberts said the "state of the art" computer-aided dispatch system was in use in communication centres across the world, including Australia and all of New Zealand's emergency services. "DES remains confident that its full implementation will result in improved response to calls for service from the community," he said.

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2 July, 2008

NHS bosses still dreaming



After 60 years, the NHS has signalled the end of cheap-and-cheerful, any-colour-so-long-as-it's-black healthcare. That's about 30 years after manufacturing, retailing, telecommunications and the rest of the service sector embraced the idea that the customer is king, and what he (or she) wants is quality service. But let's not quibble. Lord Darzi's review sets quality of care first, and everything else a distant second. Almost all the detailed changes he proposes are designed to raise standards. Doctors and hospitals will be measured by the quality of care they deliver, and rewarded accordingly. Patients will be asked their opinion, and other more specific outcome measures - such as how many patients die - will be used to determine just how good their care has really been.

In general practice, the Minimum Practice Income Guarantee (MPIG) will go. Income will instead depend more on the Quality and Outcomes Framework, which measures what GPs do, rather than what their historic income has been.

Hospitals that deliver a classy service will be paid more than the rest, under the tariff that determines the cost of every procedure. Everybody will publish annual Quality Accounts, equivalent to their yearly financial accounts.

Primary Care Trusts will be forced to pay for treatments passed cost-effective by the National Institute for health and Clinical Excellence, and Strategic Health Authorities given a legal duty to encourage innovation. Patients will get enhanced rights of choice over where they are treated, harnessing market power to raise standards. The theme is clear. "This whole report is about quality," Lord Darzi said. David Nicholson, chief executive of the NHS, said: "Quality is to become the organising principle of the NHS".

But can the service deliver? Historically, it has always valued shifting large numbers of patients through their episodes of care as a greater good than ensuring they were as well-treated as medical knowledge makes possible. Central targets enshrined this principle, to the fury of clinicians.

Lord Darzi now claims to have listened to the clinicians, and shaped his report from what he heard. "This is not a document pulled together by a small group of people in the Department of Health" insisted Mr Nicholson, as if we might possibly have suspected it.

At issue is whether the levers are strong enough to bring about change. The document assumes that quality improvement will have no victims. But better quality can only come about by chasing out bad: that means eliminating poor GPs, closing failing hospital services, or even entire hospitals. Otherwise there won't be the money to reward the good. These changes are painful. Lord Darzi envisages them being driven locally, but his chosen instrument, the primary care trusts, are weak reeds. Hitherto most of them have been easily managed by ingenious GPs and popular local hospitals. Most patients don't even know what PCTs are: and if PCTs try to do anything tough, they are easily characterised as "NHS bosses" cutting services.

There are also some spectacular gaps in the promises the documents make. The NHS Constitution - a "declaratory document" said Lord Darzi, for which read the usual well-meant pieties - makes only one new promise, that of universal patient choice. But when pressed, the Health Secretary, Alan Johnson, seemed unsure how that would apply to popular GPs whose lists are full, and Lord Darzi disabused anybody of the idea that it means you could choose a particular surgeon - for instance, him.

In his team of colorectal surgeons at St Mary's Paddington, all were equally good, he insisted. But if choice doesn't mean the right to choose a particular GP or a particular consultant, what does it mean? And if you can't really choose, how can bad practitioners be driven out to make way for better ones? Competition is a bloody business, as a million corner-shops run out of business by the supermarkets can attest.

Lord Darzi's report lacks any acknowledgement of this. It simply envisages an NHS aspiring ever upwards to unimagined levels of quality and care, leaving nobody behind: no victims, no bankruptcies, no tears. Life isn't like that.

Source




Australian public hospitals slower to see patients

Public hospital emergency departments are seeing a smaller proportion of patients within the recommended time than they did eight years ago - and the federal Government has admitted that "much work lies ahead" to fix the system. More than 6.7 million people sought treatment at Australia's emergency departments in 2006-07 - the equivalent of one-third of the population - and 30 per cent of these patients were not seen within the minimum recommended times laid down by the Australasian College of Emergency Medicine.

The figures, contained in the latest annual State of Our Public Hospitals report released by the federal Government, have prompted a chorus of protests from health organisations who say it shows the system has been starved of funds, even though overall spending on hospitals hasnearly doubled over the past decade.

Releasing the report yesterday, federal Health Minister Nicola Roxon said it illustrated "11 years of Liberal neglect". She said all states and territories except NSW were seeing a smaller proportion of emergency patients punctually in 2006-07 than they were eight years previously, in 1998-99. Over the same time frame, the number of people presenting to emergency departments rose by 34 per cent, up from five million in 1998-99.

The report showed there were 4.7 million admissions to public hospitals in 2006-07. Ms Roxon said the latest report showed admissions were growing by about 3 per cent a year - more than double the rate of population growth - and hospitals were "under severe strain". "While it will take time to turn around a decade of neglect, the Rudd Government is determined to deliver dramatic improvements in healthcare," she said.

The proportion of elective surgery patients seen within recommended times in 2006-07 ranged from 68.6 per cent in the Northern Territory, and 67.6 per cent in Tasmania, to 85.9 per cent in NSW. Longest waits are for knee replacement (162-day median wait), a type of nasal surgery called septoplasty (113 days) and hip replacement (106 days).

Between 1998-99 and 2005-06, the amount of commonwealth money provided for state hospitals rose from $6.1 billion to $9.2 billion. But over the same period, that money as a proportion of the total spending on state-run hospitals fell from 48.1 per cent to 42.7 per cent.

Yesterday's report also showed continuing increases in some states in the proportion of same-day procedures, and decreases in average lengths of stay. Both are techniques hospitals can use to cope with an ever-growing stream of patients needing treatment.

Australian Medical Association president Rosanna Capolingua said the report was "a wake-up call to the governments of Australia" and that doctors and regular patients "have known for a long time that our public hospitals are at breaking point".

Prue Power, executive director of the Australian Healthcare and Hospitals Association, called on the Government to increase its share of total hospital funding from its current level of 42 per cent. The annual indexation also needed to be raised from the "inadequate" current rate of 1.7per cent.

Source





1 July, 2008

Britain makes unsustainable health promises

They are too busy paying hordes of clerks and "administrators" to afford the best drugs for their patients

A pledge to give patients any approved medication on the basis of clinical need rather than cost risks creating an almost limitless drugs bill, the Government has been warned. Plans for a new NHS constitution, to be unveiled by the Prime Minister today, will enshrine a universal right to treatment if clinically appropriate in an attempt to end the “postcode lottery” of access to new drugs. Experts gave warning that the pledge, one of a series of new measures in the landmark draft document, carried huge costs that could not be covered by current NHS budgets.

Publication of the new constitution comes at the start of a week of celebrations to mark the 60th anniversary of the NHS. It will set out a “right to expect local decisions on funding of other drugs and treatment to be made rationally following a proper consideration of the evidence”.

While the drive to reduce inequalities of access to drugs will be welcomed, health economists question how the Government will be able to devise a policy that delivers on such a pledge without punitive costs. Roy Lilley, a former director of an NHS trust and independent health policy analyst, said: “We have to ask ourselves the question: will drugs get more complex? Yes. Will they get more expensive? Yes. “To say that we will buy them whatever, however much they cost, you might as well give the pharmaceutical industry a blank cheque. “It’s a huge worry. There are some fantastic drugs. I’m not saying we shouldn’t have them. But there has to be a rationale behind the use of resources. You can’t say because it’s here we’re going to buy it. That’s crazy.”

The National Institute for Health and Clinical Excellence (NICE), the watchdog that determines value for money on the NHS, can currently take up to 2½ years to decide whether to approve a drug. Ministers want this cut to a maximum of six months.

Alan Johnson, the Health Secretary, said yesterday that patients would have a universal right to approved treatments “if clinically appropriate” and might resort to legal action if they were still disappointed. The moves are expected to generate at least £100 million worth of extra prescriptions a year, funded centrally by the Department of Health.

While patients’ groups and health economists welcomed the Government’s aims to provide quicker treatment, they said that the increasing cost — and sometimes modest benefits — of new drugs could not be taken out of the equation. John Appleby, chief economist of the King’s Fund health think-tank, said: “There are cases where patients have died after being denied drugs for cancer. But these medicines often cost more than ten times NICE’s threshold for achieving one extra year of life. “In a system of finite resources you have to draw a line somewhere in terms of a drug’s effectiveness — it may add extra minutes, days, months of quality years to someone’s life but how much is enough? Perhaps the Government has decided that it can avoid bad headlines by promising greater access to drugs but it will have to look into this carefully or be braced for a surge in patient demand, with the associated costs.”

The Royal Pharmaceutical Society of Great Britain agreed that “better, more comprehensive access to new treatments will not be without cost”. Alan Maynard, Professor of Health Economics at the University of York, added: “Often new drugs that haven’t been approved by NICE simply aren’t cost-effective. We have to confront this issue head on, by speeding up the NICE appraisal process but also by putting pressure on pharmaceutical companies to lower their prices.”

One of the biggest “postcode lottery” disputes has been over drugs for “wet” age-related macular degeneration, which affects more than 250,000 Britons. Barbara McLaughlin, of the Royal National Institute for the Blind, said that NICE had been considering the drugs since February 2006 and that the slowness of the processes had threatened the sight of thousands of people.

Andrew Lansley, the Shadow Health Secretary, said that comparisons of access to emerging treatments between Britain and other countries was “frankly scandalous”. “We have some of the best cancer research in the world in this country but we have among the slowest uptake of new cancer drugs. So it is not just about a postcode lottery inside the UK.”

The Department of Health said the NHS constitution would be the first of its kind in the world and would state “what patients, public and staff are entitled to expect from the NHS”. It will be presented to Parliament this afternoon as part of the year-long review of NHS services completed by Lord Darzi of Denham, the surgeon brought in as a health minister by Gordon Brown.

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