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12 May, 2008

Australia: A risk-averse public health bureaucracy puts its whims before patient welfare

Contrary to a claim made below, there is no clear research evidence about the best procedures for avoiding surgical site infections but that appears to be unknown to the bureaucrats. It is fire risk that moves them -- even though there have been no fires. They are prepared to take a daily risk in order to avoid a remote risk! It's just a bee in the bonnet of some bureaucrats and they are allowed to dictate patient care methods. Leaving surgical procedures to the surgeons concerned is too much to ask, apparently

PATIENTS are being put at risk because NSW Health had an inexplicably inconsistent approach to infection control procedures before operations, an orthopedic surgeon says. Dr Robert Molnar has for the past six months unsuccessfully sought an explanation from the Health Department as to why he is not permitted to use alcoholic surgical preparation solution on his patients at Westmead Hospital, yet he is able to at St George and Sutherland public hospitals.

The rules vary across hospitals: alcoholic solution can be used at Fairfield, Concord, Prince of Wales, Royal Women's and Royal Prince Alfred hospitals but is barred at Liverpool, Nepean, Gosford, Canterbury or Royal North Shore.

Dr Molnar believes a Westmead patient contracted an infection after surgery on a hip fracture last year because the hospital deemed the alcoholic preparation he wanted to use a fire risk. The patient has had 10 more operations, including one to remove the metal plates and screws in his hip, and now needs a hip replacement. Dr Molnar had used an aqueous antiseptic to prepare the skin. "You may as well spit on the wound. This guy's life is ruined; it's tragic and it's so predictable," he said, noting that alcoholic solution could be used at most private NSW hospitals.

After a series of letters between him, the Health Department and the office of the Health Minister, Reba Meagher, Dr Molnar was given exclusive permission last November to use the solution at Westmead but not in conjunction with electrically induced heat due to the risk of fire. That ruled out 95 per cent of his operations, he said. There has been no theatre fire in NSW due to alcoholic solution, a spokeswoman for the Health Department said.

In a letter in March to the parliamentary secretary for health, Noreen Hay, Dr Molnar wrote: "I believe the situation places patients in western Sydney at significant risk of morbidity." Dr Molnar told the Herald: "Most orthopedic surgeons wouldn't operate without it, just because of the risk of infection. They're ruining people's lives. It's bureaucratic madness."

A Sydney orthopedic surgeon, Doron Sher, said that if the surgeon was appropriately educated the risk of fire was minimal. "There is evidence in the literature showing that infection rates are lower using alcoholic Betadine," he said. "I use the alcoholic solution when I get the option because I believe that you get a lower infection rate."

Sydney West Area Health Service, which includes Westmead, put the restriction down to fire risk. Northern Sydney Area Health Service did not explain why it was not used. South Eastern Sydney Illawarra Area Health Service said it allowed alcoholic preparation at all its hospitals.

The Opposition Health spokeswoman, Jillian Skinner, said: "Infection is rife in our hospitals so I would expect Reba Meagher would endorse the use of products that are considered world's best practice."

Source




Australia: Pregnant women 'lie' to get beds in their city's better public hospitals

The "equal high quality for all" idea behind public hospitals is not mirrored in reality

DESPERATE pregnant women are using fake addresses so they can give birth at Melbourne's leading maternity hospitals. The Royal Women's and Mercy hospitals and Monash Medical Centre are sending women who are not from their areas and who do not anticipate complications elsewhere. The hospitals say they want to keep the beds for at-risk patients.

Hundreds of mothers from Melbourne's northwest suburbs have launched a protest against the Brumby Government, saying they are being shortchanged. Since October, mothers from Coolaroo, Craigieburn, Roxburgh Park and Meadow Heights have automatically been referred from the Royal Women's to the Northern Hospital in Epping if their pregnancy was expected to be straightforward. The state's other top level maternity wards - Mercy Hospital for Women and Monash Medical Centre - also direct women with uncomplicated pregnancies to local hospitals.

Women have lied to secure a bed at the highly regarded Women's. One pregnant woman, who asked not to be named, said she was scared to go to the Northern Hospital because she had suffered a miscarriage there. She had used a friend's address to get a booking at the Royal Women's.

Protest group Fair Go For Hume has bombarded Premier John Brumby with more than 460 complaints. Royal Women's Hospital spokeswoman Mandy Frostick said births at the hospital had jumped from 4600 in 2001 to 6500 last year. She said the hospital had to send women with low-risk pregnancies from the northern suburbs to the Northern Hospital. Mercy chief Stephen Cornelissen said it had a duty to care for mothers with "more complex" needs.

A Monash spokeswoman said they shared pregnancies between themselves, Casey and Dandenong, depending on circumstances. Northern Hospital maternity director Hammish Manning said they offered high-quality care. [The customers obviously don't think so]

Source





11 May, 2008

Australia: Seven year hospital wait

In one of the world's oldest (from 1944) "free" hospital systems



It took five years for this woman to get a seven-minute operation. The queues are growing and people are ... still waiting. Dorothy Bauer does not believe the State Government when it says Queensland's beleaguered health system has improved. Not when she waited five years for an eye operation that takes seven minutes. The Bundaberg 84-year-old still needs surgery on her other eye, joining another 36,000 Queenslanders on waiting lists for elective surgery. "Anything can happen. Nobody has any guarantees today with this health system," Mrs Bauer said.

It has been 1000 days since the State Government promised to fix the health system. Then-premier Peter Beattie made the pledge after scathing findings from the Davies inquiry helped expose the real waiting lists and systemic problems within Queensland Health, a development headlined by The Courier-Mail as The Truth At Last. However figures released yesterday show waiting lists for elective surgery have blown out by almost 15 per cent in those 1000 days. And the list of people waiting to see specialists has rocketed by 50 per cent to a record of almost 160,000. Only 900 hospital beds have been added in the same time.

Health Minister Stephen Robertson insists the system is working better than in September 2005. "We are reforming the system root and branch," he said. Premier Anna Bligh yesterday defended the system. "We have a larger, stronger workforce and are treating more Queenslanders than ever before," she said.

Queensland Health yesterday said $4.3 billion of $10 billion it had pledged to be spent by 2010 had been used. However it hasn't been enough to allow Mrs Bauer to have cataract surgery on both eyes. The former school teacher was forced to give up charity work because she couldn't read music to play the piano at fundraisers. Then late last year Queensland Health finally arranged for surgery for one of her eyes. The dramatic change allowed her to return to charity work and to care for her sister, who is 86. Mrs Bauer praised the doctors and nurses who treated her, but condemned politicians and health bureaucrats who "played God to people's lives".

Seven people who were profiled in the 2005 Courier-Mail series, The Truth at Last, say they owe their lives to getting off elective surgery waiting lists. All eventually had their health issues resolved, and some credited media attention for accelerating their cases.

Source




Australia: Surgery blowouts hit reform agenda

A blowout in the number of clerks and administrators would be more accurate



QUEENSLAND Health says it is being swamped with patients as it defends blowouts which have pushed surgery waiting lists to record levels. A Queensland Health bureaucrat said the state's public hospitals treated 825,725 people last year - up 6 per cent or three times population growth. However the key barometers - waiting lists - have ballooned by a greater margin. In the 1000 days since then premier Peter Beattie promised to fix the health system:

* The waiting list for elective surgery has increased by almost 15 per cent (31,478 to 36,030).

* The list of patients waiting to see a specialist is up by almost 50 per cent (108,568 to 159,223).

* In comparison to other states, Queensland spends less per capita on health and the number of hospital beds and medical staff per 1000 people is lower, according to the Productivity Commission. The Government says it is closing the gap.

* There has been an increase of only 900 hospital beds despite a 100,000 population gain.

* In the past 12 months, the number of patients waiting longer than the expected 30 days for the most urgent Category 1 surgery has blown out by 112 per cent.

* The number of patients waiting for Category 2 surgery, which has a 90-day benchmark, has increased by 16 per cent but the figure for the least-urgent Category 3 surgery (365 days) has decreased by 19 per cent.

Dr Stephen Duckett, Queensland Health's executive director for health reform and development, said the system was improving. "There is no doubt in my mind we are much better than we were three years ago," he said. "We're up 20 to 30 per cent in doctors and nurses, and have many, many more beds." Dr Duckett said public hospitals had treated a record number of patients in emergency departments last year. But concern continues in the community.

Deception Bay resident Sally Stanley remains upset after her brother died while waiting for a cardiac defibrillator. "The promises made didn't get kept," Ms Stanley said. "I think staff are doing the best they can with the resources they have. Politicians give them a bit, but it's not enough."

Australian Medical Association state president Ross Cartmill said the health system remained "chronically underfunded" by both state and federal governments. "I find it frustrating that the two levels of government are always arguing about which one hasn't paid its way," he said. "For health, we don't need a 2020 Summit, we just need to fund things properly." Dr Cartmill acknowledged the state was pumping an increasing percentage of funds into health, "but because we started so low, we still have not reached the level of other states."

Opposition health spokesman John-Paul Langbroek, a former Gold Coast dentist, blamed poor management and planning for inadequate beds and staff, while a bureaucratic culture continues to drive away doctors.

Source





10 May, 2008

McCain Health

It may be the best we can reasonably expect. Complete deregulation of health care would probably be on balance the best but that is a blue sky hope.

John McCain is proposing the most radical overhaul of American health-care policy in a decade and a half. Not since Bill and Hillary Clinton's failed reform attempt has a presidential candidate, or even a president, called for such sweeping changes to the way health care is delivered and health insurance is purchased.

The New York Times reported on Thursday that 71 percent of Americans now receive insurance through their place of employment, but employer-based health insurance is a historical accident, stemming from a combination of labor shortages and wage controls during World War II. It limits consumer choice by giving decisions over coverage to employers rather than employees, meaning workers who lose their jobs lose their insurance. And individuals who do not receive employer-provided insurance face a greater financial burden when they try to buy insurance on their own.

McCain would move us away from such a system. He would count at least some of a worker's employer-paid insurance as taxable income. At the same time, he would provide all Americans with a $2,500 refundable tax credit for individuals and a $5,000 credit for families, regardless of how people obtain their insurance. McCain's proposal exposes him to criticism that he would put people with pre-existing conditions at a disadvantage, because they have a hard time finding affordable individual coverage. But his campaign says he is considering risk-rating the tax credit he would offer, providing more money to those who need it most. And McCain would use federal funds to subsidize state high-risk pools already covering those who have trouble buying insurance in the open market.

In addition, McCain's campaign maintains that his proposal would make insurance more affordable for everyone, including those with pre-existing conditions. In particular, by making insurance more affordable to the young and healthy, McCain's plan will attract them into the market before they develop pre-existing conditions. And McCain rightly claims that deregulation will lead to the creation of new and innovative insurance products that can help solve these problems.

Most notably, McCain would allow people to purchase health insurance across state lines, a practice now prohibited. Health insurance is largely regulated at the state level, and the different regulations and mandates in each mean prices vary widely from state to state. For example, New Jersey imposes more than 40 mandated benefits, including in-vitro fertilization, contraceptives, chiropodists, coverage of children until they reach age 25, and other regulations. As a result, according to the Commonwealth Fund, the cost of a standard health insurance policy for a healthy 25-year old man in New Jersey comes to $5,580.

However, a similar policy in Kentucky, which has far fewer mandates, would cost him only $960 per year. Unfortunately, it is illegal for that hypothetical New Jersey resident to buy the cheaper Kentucky plan. McCain would change that.

McCain would also allow people to purchase insurance through non-traditional groups. Today, three types of organizations can offer group insurance: employers, unions and trade associations. McCain would open this to other groups, notably churches and professional organizations.

Finally, McCain wants to change not only who pays for health care, but how they pay for it. McCain challenges the concept of traditional "fee for service" medicine. "We should pay a single bill for high-quality health care," he says, "not an endless series of bills for pre-surgical tests and visits, hospitalization and surgery, and follow-up tests, drugs and office visits."

McCain also rightly calls for greater transparency for health care costs and prices. "Families, insurance companies, the government - whoever is paying the bill - must understand exactly what their care costs are and the outcome they received."

Steve Parente, professor of finance at the University of Minnesota, estimates that the McCain plan would cut the number of uninsured Americans by roughly half. But equally important, McCain's proposal would drive down the cost of health care for everyone. As Democrats often claim, the status quo isn't working, and that's because so many people are stuck without any good options. McCain's proposal would give people back the choices they need to get better care. And he would do it without having the government take over the health system.

Source





9 May, 2008

The NHS is trying to extinguish an alternative to its own appalling childbirth service

Independent but highly qualified and very experienced midwives face extinction over the issue of professional indemnity insurance. If no help is offered by the NHS to contract in self-employed midwives under the clinical negligence scheme, they will be forced to stop practising by 2009

I am a mother of three who managed, after a protracted fight with the NHS, to have a wonderful, inspiring, uplifting birth with a private independent midwife at home. I am not a nutter. I made more than 100 phone calls in the two weeks between hospital appointments to find someone who would listen to my reluctance to go under the NHS knife, to find someone who would take me on to birth my twins normally. I knew that I could do it, but I didn't really want to fork out £2,000 for the privilege. My mother had birthed my twin brother and me normally, so why couldn't I be encouraged to do the same? After all the puffing and panting, I discovered a secret that too few mothers are let in on: birth can be great. Not an ordeal to be got through, but a powerful beginning to motherhood, a set-up for all the snot, sweat and tears to follow. Every woman in this country deserves what I had. Our mothers had it, so why shouldn't we?

Choice: that awful overused government word. The only phrase I hate more in matters of state is “informed choice”. It doesn't mean a thing. Pregnant women don't have any choice. That baby is going to come out one way or another whether they like it or not. Childbirth is a bloody, messy, unpredictable, painful experience that transforms women from selfish girls-about-town into all-important mother figures. Go ask any therapist. So why, in this modern age of feisty female CEOs, are women being dazzled by the flashing lights and deafened by the beeping monitors into believing that they have “choices” when they waddle in the hospital labour ward (if it is actually open for business)?

And why are so many of the good, experienced midwives who understand that women need kindness and encouragement above all in labour getting the hell out of hospitals? And why are these last guardians of normal birth, self-employed independent midwives, being hounded by the NHS in medieval witch hunts to put them out of business?

Has the maternity profession missed something here? Are they really so busy arguing over money, power and control that they fail to notice the labouring woman in the corner, not waving but drowning in her birth pool?

OK, let's put the weapons down for a moment. No woman is going to be challenged here for wanting to wail at the moon on her birth ball, electing for the clinical certainty of a Caesarean or wanting more drugs than Amy Winehouse on the night before a prison visit. Let's accept that all women are different and like to do things their own way, and wouldn't choose the same pair of shoes on the high street or Babygro at Mothercare. Let's focus instead on how all women are the same, have the same creature needs at this worry-filled time, and how those needs are not being met.

First, the Government is saying all the right things. Since 1993 and the first well-worded document Changing Childbirth, successive governments have made confident noises to reassure women that they are going to be looked after properly. The latest 2005 White Paper says even more of the right things, namely that all women will be looked after by “a midwife they know before and after the birth”. Ann Keen, a Department of Health Minister, says: “This will be in place by 2009.” So much for the theory.

Now for the brutal, bloody truth. This one-to-one care is to be achieved by 2009, says the Department of Health, by recruiting 1,000 midwives. But that's not enough, say the Royal Colleges of Midwives and Obstetricians in their report, Safer Childbirth. We need a further 5,000 midwives just to offer one-to-one care in established labour - that's just the pushing stage, let alone the pregnancy and post-birth period. So while the numbers don't add up, paying for these midwives is even more disastrous. According to Louise Silverton from the Royal College of Midwives, the extra 330 million pounds funding announced with a fanfare in January has not been ringfenced, so as the money has started to trickle through last month, reports are already coming back that it's being spent on other wards by the local hospitals.

And how did we get to this stage where dangerously few midwives are looking after far too many women, as many as five in labour at the same time? Christine Beasley, the Chief Nursing Officer, puts the shortage down to the rising birth rate: “The Office of National Statistics suggested that this was a blip at first, but it is now clear that the rising birth rate is an established trend,” she explains. “And the midwifery workforce is ageing. It was part of the baby-boomer population - and many midwives are now approaching retirement. We are recruiting younger people in a more competitive world.”

And at this moment of crisis, when the burnt-out hospital midwives are routinely handling around 170 births each a year in a revolving door of hospital anonymity, the Government chooses to turn on the very last resort left to women such as myself - the independent midwife. These midwives have often been driven out of the NHS because they can no longer practise what they see as safe, women-focused care in the context of a hospital. Many of them are among the most skilful practioners of normal birth in this country - my midwife, Mary Cronk, had assisted at hundreds of successful normal twin births over her 50-odd years on call and tours the country lecturing on normal breech birth. Their possible extinction over an insurance issue that could so easily be solved by contracting them into the NHS as they are in New Zealand, or by just dropping it as a mandatory practice, is a frightening possibility. If the issue is not solved by 2009, all that they symbolise as the “gold standard” of care in this country will be gone with them. As Louise Silverton says: “The NHS should be able to offer this to independent midwives. It shouldn't be a gold standard. It should be every woman's right.”

Make no mistake, this is not just a middle-class fuss. In speaking to dozens of women who have suffered in silence over their recent treatment in hospital, we are all in the same dirty boat. One 19-year-old mother was taken on free of charge by Virginia Howes, an independent midwife in Canterbury, when it became clear that she had been told nothing at all about pregnancy or birth. The girl saw the difference between her own quick labour in a pool at home (“I felt safe and looked after”) and her sister's birth in hospital five months later (“It felt manic and busy all the time, she didn't cope well with it”). While the 19-year-old went on to breast-feed her baby for six weeks, her sister was ejected the next day, with a bottle given for the baby. She never breast-fed and suffered depression.

Post-natal depression, sometimes triggered by a bad birth experience, is rife. Ruth Weston, 39, who lives on a council estate in Bradford, West Yorkshire, forked out 15 per cent of her annual income for an independent midwife for her fifth child, after the trauma of her fourth. “With my first child I got a lot of care on the NHS, and, ten years on, I'm paying for it, and that's wrong. My five births can chart the deterioration of the service.”

As a student of liberation theology, she believes that the only way forward is for midwives and mothers to join forces, and she lobbies her MP and sends postcards to the local hospital to make her feelings known. “Abortion was legalised over a health issue. This is not a moral issue - a small number of women will go ahead and have their babies their way if independent midwives are lost. It's not acceptable, and it's not fair.” And that small number of women is already increasing as they opt out of the NHS altogether in favour of “freebirthing”. Veronica Robinson, editor of The Mother magazine, who lives in Cumbria, is writing a book on the subject, partly in answer to the number of inquiries that she fields from readers. “These women have educated themselves and are not irresponsible as people suggest,” says Veronica. “I think a lot more women will turn to unassisted birth.” Many of these radical freebirthers are often midwives themselves, she says.

However we fight the good fight, we must not sleepwalk into the nightmare of birth in America. In a country where one in three births is Caesarean and only 8 per cent of women are able to use midwives, 18-year-old girls are said to describe birth as like “having more plastic surgery”. Through the film The Business of Being Born, made with chat-show host Ricki Lake, however, that culture is now changing. The US campaign - The Big Push For Midwives - is being used for the Save the Independent Midwife Campaign here in the UK and the movie is being screened all around the country. “On the internet they have already said, ‘Ricki Lake gives birth naked... Ew, I want to vomit',” said Ricki Lake at the premiere. Popcorn, anyone?

Source





8 May, 2008

UK: Little old lady deemed a violent patient

The usual mindless British bureaucracy.

A retired schoolteacher who was found by social services to be a "medium to high risk" of causing violence has forced a council to review its assessments of the elderly. Ada Tremlett, 81, who is barely 5ft tall, needs two walking sticks to get around and was recovering from a broken wrist when she was deemed "potentially dangerous" by social services staff.

The warning was disclosed when the grandmother, whose late husband was a policeman, opened a file left for carers sent to her home. She complained and has forced a review of the way old people are assessed and also the re-training of social service staff.

"I was horrified," said the mother-of-two. "I am an 81-year-old woman with no history of violence, who has never been in trouble or anything. "I cannot believe that the council is putting my future care at risk." Mrs Tremlett, of Tiverton, Devon, complained to Devon county council and has won a complete apology.

The pensioner was referred to social services by her local hospital after she fell and broke her wrist. As part of the assessment, the health visitor filled out a two-minute, risk assessment form. The answers are given on a scale of one to 10. The score is then added up to determine if the patient is a low or high risk of violence.

Mrs Tremlett said: "I remember the questions were slightly odd. I thought it was a joke. You just have to look at me to see I am not a risk to anyone."

Source




Australia: Public hospital bathroom birth 'cover-up'

The notorious Royal North Shore Hospital again. At least the baby lived this time -- unlike last time

The grandmother of a baby girl born in a Sydney hospital toilet with the umbilical cord around her neck, has accused the hospital of a cover-up. Nick Patsidis yesterday said hospital staff were "too busy" to treat his wife Cathy Patsidis or administer an epidural when she went into labour on Monday morning and gave birth in the toilet of a nursing suite.

However, Royal North Shore Hospital (RNSH) has denied any wrongdoing in its treatment of Cathy Patsidis. It said two experienced midwives had helped deliver her healthy baby after a "precipitous labour".

Nick's mother Maria Patsidis today accused the hospital of lying. She said she was afraid her granddaughter would die in her arms. "Everything was a lie. Whatever they said - they're just trying to cover themselves up," she told Fairfax Radio Network. "It wasn't (a quick labour). The midwife who was standing on top of Cathy should have known what this was. She didn't call a doctor, she didn't call anybody. "This midwife is holding her legs together and my son opens her legs to let her baby come out. "What if Nick didn't do that - the baby had the (umbilical) cord around its neck. "I will never forget - what I saw was something you would see out of a horror movie."

Maria Patsidis said the family felt the need to speak out to prevent the same thing happening to other families. "We had to come out and talk about it because this is happening in our hospitals - this is 2008," she said.

Source





7 May, 2008

Amazing waste of medical time in Australian public hospitals

HOSPITAL doctors spend more time socialising with colleagues, filling out paperwork and being interrupted than they do treating patients. Australian researchers found doctors working on hospital wards spend just 15 per cent of their working days treating patients. They are also struggling with constant interruptions, according to the University of Sydney report, which found doctors devoted a third of their time on "professional communications" such as meetings and requests for information not related to medication.

Doctors trying to see patients on their wards are interrupted to attend to other tasks every 21 minutes on average, and up to 15 times an hour for those working in emergency departments. Author Prof Johanna Westbrook said the study debunked doctors' commonly held perceptions about the time consumed by specific tasks. "What we found was that doctors on wards are interrupted at considerably lower rates than those in emergency and intensive care units," she said. "On average doctors spent 15 per cent of their time with patients. The results also confirmed what interns have been saying for a long time that they are dissatisfied with their level of administrative work and documentation."

The team from the university's Health Informatics Research and Evaluation Unit observed 19 doctors at four wards at a 400-bed teaching hospital in Sydney. Publishing the results of the study in the Medical Journal of Australia, Prof Westbrook said doctors had complained that searching for X-rays and records took "all their time", however that actual time spent on such tasks was less than 1 per cent.

Prof Westbrook said this study looked at changes after the introduction of computerised medical record systems. "While such systems are promoted as reducing administrative tasks of clinicians, concerns were raised that many tasks . . . may have actually been quicker with the paper-based systems," she said.

Source




Wasted facility in an Australian public hospital

A $2 MILLION hyperbaric chamber at Royal Brisbane and Women's Hospital, which has never been used since it was built in 2002, will not see its first patient for at least another year. Health Minister Stephen Robertson had promised the machine, critical in the treatment of respiratory ailments, would be up and running by January. But a Queensland Health review of hyperbaric treatment at the hospital is expected to stretch into the next financial year, with the first treatment of a patient unlikely before late 2009, sources told The Sunday Mail.

A Queensland Health spokeswoman yesterday said the machine "is not a white elephant" and "it was never intended to be immediately commissioned", but was part of "long-term planning". Opposition health spokesman John-Paul Langbroek called it another government health "embarrassment".

The article above is by Darrell Giles and appeared in the Brisbane "Sunday Mail" on May 4, 2008.





6 May, 2008

Illegals leaving Britain because the NHS is so bad

Looks like the NHS is good for something after all!

ILLEGAL immigrants are sneaking OUT of Britain because they are sick of our weather and hospitals. Border officials yesterday revealed they are collaring a rising tide of failed asylum seekers who flee because life here is not cushy enough. Most escapees caught in the last few weeks are from hellholes like Iraq and Afghanistan – where temperatures rarely drop below 35°C. Many planned to head to balmy Italy after rumours of an amnesty for illegal immigrants. But they changed their minds when right-wing PM Silvio Berlusconi was re-elected and launched a clampdown.

Chief immigration officer Les Williams said: “We have recently noticed people trying to leave the country. Some said they wanted to go to a warmer country as they are fed up with the English weather and their treatment on the NHS.”

A colleague told how he caught four Iraqis trying to sneak through Dover’s port. He said: “They were sick of the rain and cold and wanted to go somewhere with a bit more sun. They also complained they could not get appointments to see a doctor or a dentist. It’s all a bit rich really.”

Three Afghans were arrested just weeks ago when they were injured trying to sneak out on a Polish timber lorry. The trio were formally deported. The Sun revealed in December how pregnant Polish immigrants were heading home to give birth because prenatal care was better in Poland.

Source





5 May, 2008

Public hospital chaos

A chief doctor at a major hospital in the Australian State of Queensland reveals below how the frontline medical system is in chaos. But many don't care, he says, until they need emergency treatment

I work in a public hospital emergency department, so that means any time you are in my part of the world, you are potentially my patient - you, your family, your friends. Tomorrow could be the day that a bad thing happens to you and your life is changed forever. That heart attack you knew was coming sooner or later, the crash on the freeway, the toddler found face-down in the swimming pool. Tomorrow, you could be rushed to my hospital - and I'll be doing my best to help you. But, as your doctor, I have to warn you: things are not good.

I'm a Queenslander born and bred and have worked in public hospitals since 1982. I am a specialist in emergency medicine. My team and I save people's lives for a living. We are good at it, and enjoy it. We deliver first-class emergency care to Queenslanders and those visiting (yes, tourists, I'm your doctor, too). I've travelled enough to know our state has a fantastic emergency response service and I'm proud to be part of it. Queenslanders expect it and you deserve it. So what isn't good? Put simply, our emergency departments - the place every ambulance rushes to - are already clogged with people. You'll notice that from the time you arrive.

It may be some time before we can find a space for you. Only the sickest people get immediate attention: the ones who can't breathe, the ones who are unconscious. If that's you tomorrow, I'll see you as soon as you arrive and I'll use my skills and experience to stop you from dying, work out what's wrong with you, give you the immediate treatment you need and then move you on to another doctor who specialises in your kind of problem. You usually don't remember me, but I don't mind. If I smile when I see you in the hospital kiosk next week, it's because I like seeing a good result. For everyone else, I'm sorry about the wait.

We try to be thorough and that means taking time with every patient. When it is your turn you will get the same treatment. But although year-on-year more people are seen in emergency departments across the country, that's not the only reason we're clogged with patients. A bigger problem is that we can't get people out of the emergency department.

Hospitals (public and private) often have no available inpatient beds, no available intensive-care beds, or no available coronary-care beds. Often, very sick patients stay in my emergency department until a bed somewhere comes up. Sometimes that takes hours or even days. They stay in the beds we need for the people coming through the door. We don't have rubber walls. Somebody has to suffer. Patients on trolleys are in the corridors, and there they stay until a free bed is found. Sound dangerous? Sure is. I am making life and death decisions in an overcrowded noisy chaotic environment, and it is your life or death I am deciding about. No wonder we're both stressed.

As your doctor, I warn you that when you come to my emergency department tomorrow your experience may not match All Saints with a neat solution after 47 minutes plus ads. I will do the best I can to keep you alive and get you where you need to be. That's all I can do. Since you are going to be my patient tomorrow, I have requests for some of you:

TO THE 28-year-old salesman whose car hits a tree after the party tonight: You can't drive better with a few drinks under your belt. And don't take your mate's girlfriend for a spin; after tomorrow, she'll never look the same again.

TO THE 78-year-old male retired railway worker with chest pain: I know your GP is very familiar with the medicines you take, but I will need to know in a hurry and sometimes it's hard to get through to the GP. Please make a list of your usual drugs and keep it up to date.

TO THE 42-year-old businessman: Don't tell people you're going to kill yourself if you don't mean it, especially if you're drunk. It will take hours before I can talk sensibly to you and, yes, you do have to stay in my department all that time. And you have to have a blood test. Really.

TO THE 19-year-old student, nine weeks pregnant and bleeding: We know how upset and worried you are. We'll get you into a bed soon. But mostly, what happens will happen, whether we get you into a bed or not. But we'll still try.

TO THE 85-year-old retired coalminer and respiratory cripple: We have the technology to pull you back from the brink over and over, but it's like skipping a stone - each skip is shorter and lower than the last and eventually there's not a lot to be gained from skipping again. When a few more days or weeks aren't worth the needles, the tubes, the masks and the whole carry-on, let me know. Say you don't want to do it any more. I will look after you. But don't wait until tomorrow, because by then you'll be on the brink again and too starved of oxygen for me to listen to you. No matter what you say then, I will resuscitate you. You need to tell it to your loved ones now. Then tomorrow, when you tell me you don't want to be resuscitated, that you want comfort measures only, I can check with someone who knows you and I will do my best to follow that wish.

TO THE 35-year-old female shop manager with recurrent abdominal pain: Please see your GP again before coming to us. Yes, we deal with belly pain, but your GP is well on the way to discovering what is wrong with you. Please persist with him or her. If you come to see us we'll just have to start all over again.

TO THE 21-year-old male: Don't inject speed. If you act psychotic we will need to treat you, even if you don't want it. Please don't hit us, bite us or spit on us, we are only looking out for your best interests.

AND finally, to the 53-year-old Queensland Health senior manager: We are drowning down here in the emergency department. I am your doctor, too, and I am tired of waiting for the problem to be fixed. Quality emergency care is critical for all of us. It's in everyone's best interest to get my department cleared and functioning optimally. I want space, I want staff who can do this job well, and I want time to train them. The situation needs some action now. We are all at risk.

To other doctors: I am your doctor, too. Please help me when I ask you for help with a patient. I'm not doing it to spoil your day. I've got people building up behind them and there's nowhere else to go.

Politicians and powerbrokers: I am your doctor, too. I know you have private medical cover; I know you have a good GP and other specialists who look after you well. But tomorrow it may be you who collapses while walking the dog, it may be you collected by the BMW that lost it on the corner, it may be your child who is hurt on the school excursion. No one is going to check for a private health insurance card. They'll bring you to me and I'll be your doctor then. How prepared and capable do you want me be?

To all of you who are my patients: I am doing the best I can under the circumstances. I can't save everyone. I can't be right every time. I won't be able to get to you as quickly as I would like, and nowhere near as quickly as you would like. And please be understanding. It's hard enough keeping you alive without being abused while I'm doing it.

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4 May, 2008

The train-wreck up north

Post below lifted from Doug Ross

"Access to a waiting list is not access to health care" --Chief Justice Beverly McLachlin, Supreme Court of Canada (Chaoulli v. Quebec)

Last year, the Canadian government issued a series of reports to address the outcry over long wait times for critical tests, procedures and surgeries. Over a two year period:

  Wait times for knee replacements dropped from 440 to 307 days.
  Wait times for hip replacements dropped from 351 to 257 days.
  Wait times for cataract surgeries dropped from 311 to 183 days.
  Wait times for MRIs dropped from 120 to 105 days.
  Wait times for CT scans dropped from 81 to 62 days.
  Wait times for bypass surgeries dropped from 49 to 48 days.

These "improvements" are unheard of in the United States. Waiting 48 days for a bypass or 105 days for an MRI could very well be a death sentence.

The public has fought for 50-plus years to build a publicly funded Medicare system that they're now telling us isn't quite working for them. -- Health Care in Canada Round Table 2005

A Commonwealth Fund 2005 International Health Policy Survey (slide 16) showed that 41% of patients in the UK and 33% of patients in Canada waited more than 4 months for non-emergency surgery,. Only 8% American patients waited more than 4 months for surgery.

Meanwhile, in Hamilton, Ontario, hospitals are receiving an infusion of cash to cut wait times for diagnostic procedures and certain surgeries, which have become intolerable.

And these are precisely the type of government-controlled health-care systems proposed by the Democratic candidates. Not only are they destined for failure, they will cost thousands of lives. And with the UK and Canada as examples, everyone can see the train-wreck coming.





3 May, 2008

McCain's Progress

The Grand Guignol between Hillary Clinton and Barack Obama has to end eventually, and then the public discomfort over health care will resurface as a genuine policy dispute between the Democratic and Republican nominees. For a man whose heterodoxies have no doubt triggered GOP heartburn, John McCain delivered another speech yesterday on health care that offered a sophisticated set of policies that could lead to some of the most constructive changes to the system in decades.

It is good news for his candidacy if Mr. McCain is making space now for political creativity and policy risks. Last week he laid down an economic plan, even venturing to Democratic redoubts like Youngstown, Ohio, and New Orleans's Ninth Ward. Now he has returned to his health-care reform, based on market principles and increased consumer choice, which he first outlined during the primaries.

The Senator is also starting to enfold these ideas in a larger narrative that will be indispensable in the philosophical fight that is so clearly ordained for the general election between private and government health care. Mr. McCain undertook yesterday to recast this looming argument in a new mold. He contended that the health insurance and delivery system is in fact failing many Americans - but that it was failing because of market distortions mostly created by the government itself. Fixing these irrationalities would both make insurance more affordable and increase overall coverage in the bargain. Nor would it require the vast new entitlement programs Democrats are eyeing.

His major proposal would change the tax treatment of insurance. To review: Today's tax code permits businesses to deduct the cost of providing insurance to their employees, but it doesn't do the same for individuals. This creates third-party payment problems; workers aren't aware of the full, true costs of many treatment decisions, part of the reason the U.S. has double-digit health-care inflation. And it makes insurance less affordable for everyone outside the employer-based system, who must pay with after-tax dollars besides. Mr. McCain would correct this imbalance with a refundable tax credit, restoring the parity of health dollars.

As the Senator argued, coverage shouldn't be "limited by where you work" and said that "Americans need new choices beyond those offered in employment-based coverage." Focusing on equity is a canny political argument. For those who don't get insurance through their employers, the current system is patently unfair. As the private market for health insurance became revitalized, everyone else would be more liberated from their bosses' system. A significant portion of the uninsured population at any given point is people who left or lost employment; but portable individual policies would follow them from job to job.

That's a broader political and economic argument than the exclusive liberal concentration on the uninsured. Mr. McCain is saying that the health-care system isn't working as it should, or delivering the quality it should, for the large majority of Americans. "The real reform," he noted, "is to restore control over our health-care system to the patients themselves," introducing more competition on price into the system.

It's true that individual subsidies might be required for some people with severe chronic illnesses who might have a harder time finding private insurance in this kind of world. So Mr. McCain sharpened his proposal for high-risk pools to cover "uninsurables," building on current insurance experiments in about two dozen states. Such provisions are crucial to a functioning market but also blunt a political liability that Democrats were eager to exploit in the fall's debates, suggesting that Mr. McCain is preparing to frontally assault liberal health-care assumptions.

If Mr. McCain's plan is short of ideal, the innovative portions outweigh its false lunges. It also energizes the intellectual progress conservatives have made in recent years in their health-care thinking. Not least, it marks significant progress for Mr. McCain, who often hasn't seemed as engaged with domestic policy as he ought to be. Fortunately, it looks as though the curtain is rising for a necessary debate about the role of government in health care.

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Drug companies win appeal against arrogant and secretive British drug regulator

NICE did not want to reveal details of the "model" it uses. Not surprising given the erratic results obtainable from such models

Tens of thousands of Alzheimer’s sufferers and their families had their hopes raised yesterday as two drug companies won a landmark victory in the Court of Appeal. The court ruled that the powerful body that controls the prescription of new drugs must give up its most precious secrets — how it measures the benefits that novel treatments bring.

The ruling is the first case that NICE, the National Institute for Health and Clinical Excellence, has lost in court. It means that in future it will have to be completely transparent in the way it reaches its decisions, revealing the inner workings of the computer models it uses to measure value for money.

Drugs are approved if they cost the NHS less than about 30,000 pounds per quality-adjusted life year. That means for every 30,000 spent prescribing them, the benefit enjoyed by patients must add up to the equivalent of a single patient living an extra year of good-quality life.

NICE was adjudged to have acted unfairly in making an appraisal of the Alzheimer drug Aricept, which works by increasing levels of a brain chemical linked to memory and decision making. NICE had ruled that Aricept should not be prescribed on the NHS to patients with mild Alzheimer’s disease because the model failed to show that it provided good value. But it refused to allow Eisai and Pfizer, who market the drug, full access to the model. The Court of Appeal yesterday ruled that refusal unlawful. The judgment said that the two companies were disadvantaged in appealing against the guidance by NICE’s refusal to let them have a “fully executable” version of the economic model.

Had the companies had the full version, they could have tested it using a variety of assumptions and been in a better position to challenge the guidance. NICE must now make such a version available. Lord Justice Richards, giving the ruling of the appeal judges, said NICE had supplied a spreadsheet of the economic model and had refused a request from Eisai for full details. He allowed the appeal by Eisai/Pfizer, which will receive the full details and make new representations to NICE, which will then make a fresh appraisal of the drugs.

The ruling could influence many other appraisals made by NICE. For example, last year it issued guidance over drugs for osteoporosis that similarly relied on an economic model. When the National Osteoporosis Society appealed against the guidance, it complained that it had never had access to the economic model, despite several requests. “It always seemed to us that this public policy should have been subject to proper scrutiny,” said Nick Rijke, of the NOS. “It is a pity it took a court case to establish that.”

Economic models of this sort can be very sensitive to the precise details that are entered into them. The drug companies will want change the starting points and the assumptions built into the models to see if that produces a different answer. Potentially, it opens up a large and controversial area of public policy to greater scrutiny. NICE has been criticised widely for its propensity to reject new drugs. Companies disappointed by its rulings will in future be able to judge whether, for example, treating different groups of patients with a particular medicine might result in it being found more cost-effective, the Association of the British Pharmaceutical Industry said yesterday. “This judgment provides further momentum behind the drive to make NICE processes more transparent,” said Richard Barker, director-general of the association.

NICE could appeal to the House of Lords and seek a reversal of the ruling. Andrew Dillon, its chief executive, said: “We will be considering very carefully the findings and the implications for the time it takes us to provide advice to patients and the NHS on the use of new treatments. The ruling will increase the complexity of our drug appraisals in some cases and they may take longer as a result.” The ruling will not make Aricept available to new patients. It will simply enable Eisai and Pfizer to search for any flaws in NICE’s reasoning.

The drug acts against a key process of the disease. In Alzheimer’s, the damage is caused by the loss of brain cells that produce a transmitter, acetylcholine, that carries signals from cell to cell. When it has finished transmitting its messages, it is broken up by an enzyme, acetylcholinesterase. Aricept inhibits the action of this enzyme, thereby slowing progression of the disease.

Nick Burgin, managing director of Eisai, said: “We believe that this decision represents a victory for common sense. As soon as we have reviewed their cost-effectiveness calculations we will submit any new findings to NICE. We hope that this action will ultimately restore access to anti-dementia medicines for those patients at the mild stages of Alzheimer’s disease.”

John Young, managing director of Pfizer, said: “Contrary to NICE’s position that they follow a fully fair and transparent process, the Court of Appeal found that this is not the case.”

Neil Hunt, chief executive of the Alzheimer’s Society, said: “Today’s decision is a damming indictment of the fundamentally flawed process used by NICE to deny people with Alzheimer’s disease access to drug treatments.”

Source





2 May, 2008

Law lords rule NHS policy on overseas doctors is unlawful

Thousands of doctors trained outside Europe yesterday won a House of Lords ruling that the Government could not block them from applying for training posts in Britain. By a four to one majority, the law lords ruled that guidance originally issued by Patricia Hewitt when she was Health Secretary, aimed at limiting the employment rights of overseas doctors, was illegal. She had issued instructions saying that doctors from outside Europe should be appointed to training posts only if there were no suitable candidates from Britain or the EU to fill them. By "dashing the legitimate expectations" of doctors who had been encouraged to come to Britain, the law lords said, Ms Hewitt had acted unfairly.

The ruling ends a long legal battle. Her guidance was challenged by the British Association of Physicians of Indian Origin (Bapio), which lost in the lower court but won on appeal. The department brought a further appeal to the Lords, which it has now lost, bringing final victory to Bapio. The ruling will mean 4,000 to 5,000 overseas-trained doctors already in Britain are guaranteed equal chances of winning training posts.

A Department of Health spokesper-son said: "We are disappointed that the Lords have ruled that our guidance as it stood was unlawful. However, this is a complex judgment which needs careful consideration. "We are coming to the end of a consultation on this difficult issue. That consultation is due to end on May 6. We need to study the House of Lords findings carefully, alongside the responses to the consultation, to see what the best course of action will be."

Although the department lost, the ruling does not mean an ever-open door. The Home Office has changed the rules for immigration to prevent people coming to Britain under the Highly Skilled Migrants Programme (HSMP) from applying for medical training posts. Bapio's victory does mean that applications for training posts in the next few years will remain tight, with roughly 700 to 1,000 British-trained doctors likely to be unable to get a training post in 2009, 2010 and beyond.

For this year, the ruling would have had no effect even if the department had won. Competition for training posts in 2008 is likely to be even tougher than in 2007, with about three applicants for every place. In 2007 more than 1,300 applicants from British medical schools failed to get posts. This year the department estimates that between 1,000 and 1,500 will be disappointed. They will still be able to get jobs in the NHS, but training posts are much more desirable because they lead eventually to qualification for consultant posts.

The issue now is what the department will do to solve the problem. Medical school places have been steadily increasing, leaving the prospect of many expensively trained British graduates being denied the opportunities they hoped for. One alternative is to increase the number of training places, but that would be pointless if there were not a corresponding increase in consultant jobs. It would be moving the point of unemployment to later in a doctor's career. Another alternative would be to cut the number of medical school places, reversing the policy of self-sufficiency embraced by the Government. But this would take up to ten years, represent a volte-face and would return Britain to its traditional position of dependence on foreign doctors.

In the Lords ruling, Lord Rodger of Earlsferry said that it must have been clear to the Government that, due to a change which it had itself initiated soon after taking office, from about 2005 there would be an increased supply of home-grown medical graduates. To try to put it right, Ms Hewitt "dashed the legitimate expectations which it had fostered and on which the foreign doctors had acted. The advice was accordingly unlawful. "Obviously, the Government could have achieved its objective if it had amended the immigration rules. For various reasons, it chose not to do so. "But, if it had chosen to try to amend the rules, it would have been required to pay the political price of subjecting the proposed change, and its highly damaging effects on the international medical graduates with HSMP status in this country, to the scrutiny of Parliament."

Lord Bingham of Cornhill said that to speak of the guidance being "issued" was to "suggest a degree of official formality which was notably lacking". It was published on the NHS employers' website, but no official record had been produced during the legal proceedings. Instead, the Lords had been referred to a Home Office e-mail. "It is for others to judge whether this is a satisfactory way of publishing important governmental decisions with a direct effect on people's lives," Lord Bingham said. Lords Carswell and Mance also dismissed the Government's appeal.

In a dissenting judgment, Lord Scott of Foscote said that the Health Secretary was entitled to adjust the policy on employment of junior doctors in postgraduate training positions to give priority to British or EU nationals. Terry John, chairman of the BMA's International Committee, said: "It's right that we have a debate about the numbers of doctors coming to the UK in future, but it's wrong to scapegoat those already here."

Source




Australia: Hospital sits unused as man dies from lightning strike

The TV comedy "Yes Minister" comes to life -- tragically



A man struck by lightning in far north Queensland has died after he was unable to be treated in a hospital - which sits unmanned despite being built almost six months ago. The man, Joey Tamwoy, believed to be in his mid 30s, was on a crayfish expedition with a friend in waters off Darnley Island in the Torres Strait when he was struck by lightning about 3pm on Tuesday. Mr Tamwoy, a well known local man who worked as a garbage collector for the Torres Strait Island Regional Council, was alive when the small tinnie he was aboard returned to shore. However he died a short time later. It could not be confirmed whether he died before or after he was admitted to the island's existing medical centre.

Medical staff operate out of the condemned building, which locals say is rat infested and occasionally without running water, despite the completion last year of a $5.3 million hospital, just 200m away. But the new hospital is a virtual ghost facility despite being operational since December last year. A temporary generator was installed before Christmas that can power the entire hospital, except the morgue and doctor's quarters. Despite that, Queensland Health has refused to commission the hospital until full scale power is provided to the remaining areas.

A Torres Strait Islander, speaking on the condition he remain anonymous, said he and others on the island believed Mr Tomwoy's life could have been saved had the new hospital been staffed. ``They have stuffed us around for so long,'' he said. ``They finished it last year and it's just been sitting there doing nothing. ``Maybe it could have saved him. He had a pulse when he came to shore. ``Lots of people survive a lightning strike.''

The man said Mr Tamwoy, while ``no angel'', was a ``decent bloke'' who was much admired on volcanic Darnley Island, a tiny indigenous community of about 350 people, most of whom are in shock at his death. ``He didn't have to go out like that,'' he said. ``He was a good guy. ``No one can believe it. We're all just very sad and shocked.''

The island has been without a registered nurse since late March when the island's only nurse left amid concerns at the decrepit old medical centre. Beth Mohle, the assistant secretary with the Queensland Nurses Union, said the nurse was keen to return to the island when the new hospital opens. ``Our member has always been keen to get back to work on Darnley as soon as is practical but unfortunately the nurse's old facility is condemned and the new facility hasn't even been commissioned yet,'' she said.

Health Minister Stephen Robertson told state parliament yesterday the ``power supply issues (at the facility) should be resolved this week''. Ms Mohle said the hospital was probably closer to opening sometime in late May, a claim backed by Queensland Health's northern area general manager Roxanne Ramsey.

Ergon Energy declined to comment on when the hospital would be fully operational. Electrical infrastructure has already been delivered to the island but a native title and cultural heritage assessment of the area needs to be undertaken before construction work commences. ``It's a top priority project and we'll finalise it as soon as all other party's needs are satisfied,'' Mr Bowes said.

Mr Tamwoy's body was yesterday flown to Thursday Island for an autopsy. The scandal is yet another for Queensland Health in the Torres Strait. In May this year a nurse was raped while sleeping in her quarters on Mabauig Island. The alleged attack occurred despite forewarnings about safety from the nurse herself, 27, and others, in remote Queensland communities.

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1 May, 2008

NHS medical procedures halted by unfit equipment

The NHS is too negligent to supervise the supply of surgical instruments. When the cat's away the mice will play and there is basically NO cat in the NHS. They are all too busy with cups of tea

Operations are being cancelled because of dirty or broken instruments sent back by private companies employed to clean them, the Royal College of Surgeons (RCS) said yesterday. Hospitals used to sterilise their operating instruments on site but are being encouraged by the Department of Health to put the job out to private companies. A survey of surgeons found that equipment was often unfit for use, damaged, or late - meaning that operations were cancelled at the last minute, often when patients were already anaesthetised.

Two thirds of surgeons questioned by the RCS were unhappy with the availability and condition of instruments sent away for sterilisation. The survey showed that 70 per cent of paediatric surgeons using outside firms were unhappy about it. The same was true for 82 per cent of neurosurgeons, 79 per cent of ear, nose and throat surgeons and 60 per cent of plastic and reconstructive surgeons. Decontamination of instruments is essential to prevent the spread of infection.

Thirty-two per cent of plastic surgeons were not happy with the level of sterility, as were 30 per cent of ear, nose and throat surgeons, 28 per cent of neurosurgeons and 28 per cent of paediatric surgeons. When it came to equipment being maintained in good condition, 70 per cent of paediatric surgeons were not happy with the service along with 85 per cent of neurosurgeons and 84 per cent of plastic surgeons. Surgeons using in-house decontamination services were not satisfied with some aspects of this equipment care.

The RCS said that although private firms largely succeeded in sterilising kit, too much came back late or went missing. Sensitive, expensive tools were being broken, a statement said. "Without the equipment to do the job, surgeons are forced to cancel or abandon operations - sometimes when patients are anaesthetised and prepared."

Prof Richard Ramsden, who collected the evidence, said: "Operations are delayed because vital tools are not available. Surgeons working with on-site instrument cleaning facilities are getting a better service, enough to warrant an urgent reassessment of what's best for the NHS." Bernard Ribeiro, the RCS president, said: "This is yet another example where something that looks good on paper in Whitehall gets rolled out without adequate professional consultation and piloting." A Department of Health spokesman said that more than £200 million had been invested in improving decontamination services since 2001.

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