Thursday, October 11, 2007

Another snapshot of the state of nationalized health care.

It has been awhile since I’ve presented a snapshot of health care under socialized medicine. What this column presents is relatively simple. I pull up recent news stories on the National Health Service and see what has been reported in the last week or two, sometimes only the last couple of days depending on the number stories.

String enough of these stories together and you have a good idea of what happens with socialized medicine on a fairly regular basis. One story by itself is not adequate to gage anything. The key to understanding is to look at the trends long-term.

The first story was posted just two hours ago (from when I write this). It’s open line is “Significant failings in the management of several Kent hospitals resulted in the death of 90 NHS patients in Britain’s worst outbreak of a hospital superbug, the government’s health watchdog said on Thursday.”

What they found was that “lax management at all levels... fueled the outbreak of the bacterial infection, Clostridium difficile.” This is considered so serious that that the report has been handed to the police who “have the option of bringing charges of murder, manslaughter or breach of health and safety regulations.”

“The study claims dirty wards, inadequate staffing and pressure to reach government targets were contributing factors in two outbreaks of C. difficile in 2005 and 2006.”

It gets worse! They found “evidence of ingrained blood stains on floors, bedpans that had supposedly been cleaned but still contained faeces and open skips containing bags of old dressing and bodily fluids.” Lovely. (This one is particularly disturbing as these are all hospitals in the area where I am currently staying. I think if a car hits me crossing the main road I might be better off recuperating the street than being taken to in for treatment.)

As a result of these lax standards they concluded that “90 deaths ‘definitely or probably’ occurred as a result of of infection. Sixty of these deaths were found to be a result of the failure to introduce adequate counter-measures.”

The BBC reports that as a result of the report “Kent Air Ambulance has suspended all flights to Maidstone Hospital” and will be taking patients elsewhere. But the NHS Trust that runs Maidstone slammed that decision saying that their “infection rates” “are better than average nationally.” If true that is frightening.

Another report has more precise numbers. It says that over 1,000 patients were infected in the NHS hospitals and that “345 patients died while being infected with C diff, the infection being a definite contributing factor to their deaths in 124 cases, probably a factor in 55 and possibly a contributing factor in 62.”

Obviously this story is dominating the media especially in the United Kingdom. There are more accounts than worth reporting. Most emphasize the breaches of acceptable medical care -- such as nurses not washing their hands and patients left to lie in their own diarrhea.

The Telegraph has a report on a relatively obscure NHS agency called the NHS Litigation Authority. They are the agency that pays out the claims for harm caused by negligence by NHS staff toward patients. Obviously they will be very busy in light of the previous story. The report notes that last year they paid out compensation of around $1.22 billion to patients who were harmed by the care they received. The report focused on the almost total secrecy under which the agency operates. They don’t have their name on their door, don’t give copies of their annual report to the press, or even send out press releases about it. They try to avoid press interviews. They do say that they have one open meeting a year but the press never attends, however they admit that they don’t actually inform the press as to when those meetings are held.

This is London reports that the NHS “rationing body” has made a decision to deny medication to “hundreds of thousands of women”. They are restricting drugs for osteoporosis and ordering doctors to “prescribe only the cheapest drug, even though it does not work in many cases.”

Women in Wales and England with osteoporosis are being told by the National Institute for Health and Clinical Excellence that they will only be allowed to use alendronate, which costs about $2 per week. The alternative, more effective medicines cost about $8 per week. Those will only be available if special permission is granted. It is reported that there “is also evidence that some taking other drugs are being swapped to the cheapest without their doctor’s knowledge.”

The Daily Mail reports on the NHS budget which is scheduled to rise to $220 billion by 2010. Even with the extra $40 billion the budget is “less than advisers told the Treasury were needed to maintain standards in the NHS.” Since the problems with the “superbug” are in the media the government announced that they will spend $280 million just to try to end the infections patients contract while in hospital. In just the first quarter of 2007 there “were 15,592 cases of C. Diff in patients over 65” which is an increase of 2 percent from last year. Funding increases greater than what were given were supposedly needed and it is not feared that “more wards [will] have to close and more drugs [will] have to be rationed.” The Financial Times reports that the NHS now consumes one fifth of the entire national budget for the British government.

The Waterbury Republican-American editorialized on health care and mentioned the case of Jane Tomlinson, a victim of breast cancer, who worked tirelessly to raise fund for the NHS. They say she “raised $3.5 million for the NHS” and was an “unflagging supporter.” They also reported:
Mrs. Tomlinson, 43, died last month because the NHS refused to pay $13,700 for anti-cancer drugs that would have extended her life. The reason? Her address made her ineligible for the benefit. This quirk in the socialistic system is described in the British press as "the gap between the rhetoric of a comprehensive and universal 'national' (healthcare) service" and reality. She valiantly fought the NHS for months, but by the time the bureaucrats relented, her condition had deteriorated past the point where the drugs could hold her tumors at bay. Her widower, Mike Tomlinson, told the British news media his wife was "fundamentally let down by an unjust system." For her troubles, she got a posthumous apology.
Another story in the Telegraph told more of the story. Tomlinson knew that the system was geared so that patients who got lots of publicity, and made the politicians look bad, could get priority treatment. And she knew she was considered a celebrity. But she thought that was wrong and didn’t want to use her status to force a political decision in her favor. She had requested the use of the anti-cancer Lapatinib. But the NHS refused the treatment to her.

She could, however, get treatment at another NHS hospital is she was willing to travel 150 miles round-trip each time. But that was a grueling experience for her and that was only after waiting too many months. She asked her husband to only release the details of her case after her death, which took place last month. Mr. Tomlinson “detailed how she battled to get access to Lapatinib, which costs £6,700 per patient, per year. Mr Tomlinson said her medical team in Leeds decided that the drug was her best option. However, Leeds Teaching Hospitals NHS Trust had taken the decision not to participate in a GlaxoSmithKline-sponsored access study of the treatment.” Remember that under socialized medicine the last decision maker is not you or your physician but a bureaucrat.

Mrs. Tomlinson had to make further applications with different NHS Trust’s before she found one that would accept her. But that took time. “The delay,” said her husband, “ in not having treatment from January to April severely affected Jane’s health. It is unproven, but felt by the family, that this shortened her life. All individuals should have a right to access to the same drugs. Jane has been fundamentally let down by an unjust system.” In response the local NHS Trust said they were “disappoint not to offer Jane the treatment she and her consultants wanted.”

Tomlinson, who was actually a radiographer for the NHS, was to received a Commander of the British Empire award from Queen Elizabeth for her service to the NHS in November. Instead her 10-year-old son will receive the award on her behalf.

This report says that the Healthcare Commission audit of the NHS complaint system “found NHS trusts are failing patients who make complaints and not learning from their mistakes.” In total 32 NHS Trusts were being inspected “due to concerns that they were not meeting standards.” The Commission says the Trusts seem more interested in process complains rather than finding a resolution for the patient concerned.

And the British Dental Association is very unhappy that the NHS continues to short-change patients on dental care. They note that since 1990 the NHS budget has gone up by 75% while the budget for dentistry has gone up 9%. Peter Ward, chief executive of the BDA says: “Investment in NHS dentistry remains inadequate as the government itself acknowledges that around two million people who want to access NHS dental care are unable to do so.”

This next report strikes me as a bit odd. The NHS says that in Worcestershire alone there is $8 million wasted due to “unwanted repeat prescriptions”. For the West Midlands region the total is $70 million. The report says the patients no longer need the medications and many have stopped using them.

The NHS has launched a campaign for the patients to remind them to order only what they need and to review their needs for prescriptions. The will put up posters and billboards and distribute leaflets all aimed at patients. The entire campaign seems to be geared toward the idea that the patient is at fault.

But these are prescription medicines that patients can’t get without the NHS first authorizing it. It seems to be that the NHS is giving lots of patients medications they no longer need while other reports are showing the NHS denying patients the medications that do need. Since the patient can only get the medication if the NHS prescribes them shouldn’t the emphasis be on the prescription process not on the patients?

And even if patients were the ones responsible for this misallocation of funds why run a general advertising campaign that will cost millions? Wouldn’t the NHS actually know to whom prescriptions were given? And wouldn’t it be cheaper to just contact those people directly rather than running ad campaigns that are mainly seen my people not using prescriptions?

Those are just a few of the media reports on the NHS over the last few days, most over a three day period. Starting to see a pattern yet? Isn't the political allocation of medical care precisely what America needs? The ideal is apparently a health service run by the same people who give you the Department of Motor Vehicles -- no lines, speedy and friendly service. Yep! Just what America needs.

Photo: I'm cheating with the first photo. These are some people who were killed by the care they received from the NHS. I cheat because it is from a story from last year. That article reports that 2,159 people died as a result of "serious lapses in care" which were avoidable mistakes. You can read that story here. Click on the photo to enlarge it and read what happened to these people. The second photo is Jane Tomlinson with her son.

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