Healthcare News

The UK Government has largely ignored lessons to be learnt from 60 years of NHS reorganisation leading to failures in the system, argues the author of a forthcoming book.

The NHS has subsequently evolved into a “sickness system” primarily designed to repair those who fall ill and doing little to promote or improve health, says the author.

Yet Professor David Hunter says the Government now needs to take major, well-informed action if it is to control health problems like obesity and reduce the massive burden on the health system.

Professor Hunter, a professor of health policy and management with Durham University, has observed and commented on fourteen reviews of the health service. In his book, ‘The Health Debate’, to be published by the Policy Press at the University of Bristol, he analyses the challenges faced by the NHS.

Professor Hunter argues that the majority of challenges the NHS grapples with today are, or resemble, those which preoccupied the health service in every previous reorganisation but lessons are often ignored. Policy makers ignore history at their peril and this failure to learn the lessons of the past can account for failure in the present and future, says the author.

Professor Hunter commented, “One of the curious ironies of the NHS, and many other health systems like it, is that it does not pay enough attention to health, focusing instead on ill-health and disease. The NHS diagnoses and treats rather than predicts and prevents.

“The Government needs to shift this balance as the increasing cost of lifestyle-related diseases, such as diabetes, obesity and some forms of cancer, will prove financially unsustainable making the NHS unaffordable.

“Changing people’s behaviour is difficult and merely giving people information and advice is known to be ineffective. It needs for the Government to take bold action to control rising obesity levels and other health problems. Yet, Government does not want to be accused of being the ‘nanny state’ and is reluctant to act on some of the determinants of ill-health.

“Bold action on the part of the Government should include taking tough action to control levels of fat, sugar and salt in foods, as well as trying to narrow the income gap between rich and poor.”

In his book, Professor Hunter also argues that the search for solutions to today’s health challenges has led to an unwise and unproven reliance on private sector management styles and international healthcare businesses. Policy-makers make unproven assumptions about the ability of new social enterprises to run complex services, according to the author.

He said: “The NHS faces some key ‘wicked issues’ to which there are no easy or ready solutions. These issues are very much focused on the way the health care is funded, prioritised and managed, and how it has evolved over the years.

“There is a fixation on the latest fads and fashion in management, combined with a ‘terror by target’ culture, which has resulted in low staff morale and a breakdown in relations between clinicians and managers. “

In addition to exploring the broad range of interrelated, recurring and largely unresolved, policy puzzles, David Hunter also makes comparisons between the UK NHS and other global systems, bringing examples together for the first time from mainland Europe, New Zealand and the United States.

http://www.dur.ac.uk/

Healthcare News

An announcement by government authorities in the UK that drugs which are too expensive should not be prescribed even if they prolong life, because the money could be better spent elsewhere, has caused an uproar.

The National Institute for Clinical Excellence (NICE), the government’s medicines watchdog, has rejected four new drugs for kidney cancer even though they have been shown to extend life by five to six months.

The decision comes after pressure from the drug industry to apply the so-called “rule of rescue” for costs to be set aside in cases where treatment is deemed necessary to save life.

NICE says the natural impulse to go to the aid of individuals in trouble such as when vast resources are used to save a sailor lost at sea, should not apply to the NHS.

NICE has decreed that if drugs are too expensive they should not be prescribed even if they prolong life and counters advice from its own citizen’s council, which recommended two years ago that it should adopt a “rule of rescue” as an essential mark of a humane society.

NICE says “the powerful human impulse to help an identifiable person whose life is in danger, no matter how much it costs”, could mean that spending too much on one patient may deny others when there are limited resources.

NICE’s 27 man citizen’s council says that individuals in “desperate and exceptional circumstances” should sometimes receive greater help than can be justified by a “purely utilitarian approach.”

The move has elicited criticism from many quarters including the British Medical Association (BMA), which says doctors had a duty to do their best for patients.

The BMA says they would be opposed to ignoring a rule of rescue when it introduces a degree of flexibility around extreme cases.

A NICE website report, Social Value Judgements, includes advice on the treatment of smokers, drinkers and the obese and rejects arguments that people whose illnesses are self-inflicted should get less or no treatment.

However it does say treatment may be withheld where behaviour reduces the chances of success, unless patients agree to change - therefore an alcoholic who refuses to quit drinking could be denied a liver transplant.

Such a philosophy could also suggest that treatment may also be refused to elderly patients if the benefits are deemed too low or the risks too high.

Critics say when billions are spent on research it is hard to understand why are people denied the benefits and many are calling for a debate on healthcare rationing but the British government appears to be reluctant to engage in a public debate about the issue.

They argue that state funds would be under less pressure if certain treatments which offer marginal or cosmetic benefit were removed from state funding, and more funds would be available for new “life-saving” drugs.

Healthcare News

The Australian Medical Association (AMA) has welcomed the announcement of a new national register of human papilloma virus (HPV) vaccinations but says it would be more cost effective to create a register for all vaccinations.

AMA president Dr. Rosanna Capolingua says the $23.5 million in Federal funding earmarked for the project could be used to develop and implement a ‘whole-of-life’ immunisation register.

Dr. Capolingua has called on the Rudd Government to create a single national immunisation register.

There is currently only a childhood vaccination register and the AMA says a national register for all vaccinations would prevent unnecessary immunisation or vaccinations and would also ensure that the country is well protected.

Dr. Capolingua says the National Human Papilloma Virus Register is an important part of the fight against cervical cancer, which will help remind girls and women when they need vaccine updates, and collect data on the program’s effectiveness.

Dr. Capolingua says the efficient and cost-effective use of funds to establish a complete national whole-of-life register of all immunisations for all Australians should also be considered.

Dr. Capolingua says a properly administered register would provide a real benefit to patients as their doctor would be able to check a patient’s immunisation status.

In the past the states, territories and medical groups have overwhelmingly supported a whole-of-life immunisation register and the AMA says the government needs to take action on a register that would maintain complete records.

The AMA says the issue is one of considerable importance to the health of all Australians and to the government’s overall prevention agenda.

Healthcare News

Today has seen the launch of new national codes of ethics and professional conduct for nurses and midwives.

The codes are the result of a collaboration between the Australian Nursing and Midwifery Council (ANMC), the Australian College of Midwives (ACM), the Australian Nursing Federation (ANF) and the Royal College of Nursing, Australia (RCNA).

They were reportedly developed after extensive consultation with the public and with input from nurses and midwives across the country in order to provide national, uniform codes of behaviour and codes of practice.

According to Adjunct Associate Professor Moira Laverty, the Deputy Chair of the ANMC, the Rudd Government’s ongoing reviews of the health system had highlighted the importance of healthcare regulation.

Professor Laverty says the intention of the codes is to protect healthcare consumers by providing a solid regulatory framework for nurses and midwives which ensures they are competent to practice.

Professor Laverty says the codes of ethics and professional conduct is important to nurses and midwives and who are accountable to the community for providing quality care through safe and effective professional work practices and the wide-ranging public consultation on the codes demonstrates that the nursing profession takes its responsibility to consumers seriously.

The Federal Government says the new national codes of ethics are an important step towards a national nurses register as they set minimum national standards for the work done by nurses and midwives and also provide the public with a basis to evaluate their work.

The Government apparently hopes to have a national nurses register operating by the end of 2010 that will ensure that nurses can move around the country and are able to practice in each state and territory.

Healthcare News

Puget Sound-area cancer survivors have access to a new strength-and-fitness program designed specifically for them thanks to a partnership between the YMCA of Greater Seattle and Fred Hutchinson Cancer Research Center.

The 10-week program, Exercise and Thrive, is available free to adults who have completed cancer treatment, regardless of where they were treated.

Exercise and Thrive will help cancer survivors strengthen muscles, increase flexibility and improve endurance while receiving health-and-wellness coaching and support from professional YMCA staff. Studies have shown exercise can improve cancer survivors’ quality of life, lessen treatment side effects and help recovery.

The program is supported in part by the Lance Armstrong Foundation, which has developed a multi-year partnership with 10 YMCAs nationally, including the YMCA of Greater Seattle, to create wellness programs for cancer survivors. The partnership is a key component of the YMCA’s Activate America initiative, which is designed to address the country’s growing obesity-related health crisis.

Some participants of Exercise and Thrive are patients of the Fred Hutchinson Cancer Research Center Survivorship Program, which provides clinical care, patient education and research opportunities to patients who have survived cancer and are not in active cancer treatment or are in long-term therapy. The Survivorship Program also receives support from the Lance Armstrong Foundation.

Exercise and Thrive classes will be held at three YMCA locations in the Seattle area: Downtown Seattle YMCA, Meredith Mathews East Madison YMCA (in Seattle’s Central District) and Northshore YMCA (in Bothell). All participants receive a free 10-week YMCA family membership. Participants must be 21 years of age or older and have medical clearance from their doctor to participate.

http://www.fhcrc.org

Healthcare News

Queensland health are in a spot of bother yet again over the employment of a foreign born doctor.

This time the debacle involves an Egyptian-trained doctor who was appointed to Mackay Base hospital in 2004 even though his performance at hospitals in both Townsville and country Victoria had been a cause for concern.

According to the Health Quality and Complaints Commission (HQCC) there were concerns about Dr. Abdalla Khalifalla’s competence before he joined the Mackay Base hospital in 2004, but the information was not passed on.

The report found there were significant deficiencies in the management of Dr. Khalafallah’s clinical competence at Mackay Base Hospital and he was allowed to perform major surgery beyond his credentialed scope of practice.

The HQCC report says though the Royal Australasian College of Surgeons had been notified about concerns regarding Dr Khalafallah’s competence in the years before he was employed for work in Mackay, it failed to alert relevant health authorities.

Commissioner Michael Ward says his poor performance had continued after his appointment, resulting in an unacceptable level of patient care.

Dr Khalafallah had his contract terminated in August 2007 after the Medical Board of Queensland de registered him but this only came about following concerns about him were raised in Federal Parliament.

The HQCC report says there was an inadequate exchange of information between the Royal Australasian College of Surgeons, the Medical Board of Queensland, and Queensland Health about Dr. Khalifalla’s past and ongoing competence.

The two-year investigation by the HQCC has led to calls for an Australia-wide reporting system for tracking the performance of registered health professionals.

Healthcare News

Consumers should never have to second-guess information on product labels, and through a recent settlement between the U.S. Environmental Protection Agency (EPA) and Lonza Inc., the nation’s largest manufacturer of hospital disinfectants, consumers will now assuredly be getting what they pay for.

In March 2007, EPA charged Lonza with making false claims about the effectiveness of its products against microbial pests. As a result, Lonza has agreed to develop and implement an unprecedented nationwide quality assurance program to ensure that the quality and efficacy of the disinfectant products that are sold to hospitals around the country are up to par.

“When a person uses a disinfectant, she should be able to wholeheartedly trust that that disinfectant is doing what the label claims,” said Alan J. Steinberg, Regional Administrator. “Lonza misled the public, but EPA is turning this situation into a positive by overseeing this quality assurance program and sending a message to others that these deceptive actions will not be tolerated.”

Before any pesticide is sold in the U.S., it must go through EPA’s rigorous registration process, dictated by the Federal Insecticide, Fungicide and Rodenticide Act (FIFRA). During this process, companies must provide health studies and environmental information about the product to ensure that its proper use does not cause any negative human or environmental effects. It is incumbent upon the manufacturer to ensure that its product lives up to its claims. If EPA decides to register the product, it grants the manufacturer an EPA registration number, which is listed on the product. EPA also works closely with the manufacturer on the label language, to make sure it is clear and as specific as possible about how the product may be used.

However, some of the hospital disinfectant products that Lonza sold under false pretenses were Formula 158 Lemon Disinfectant, Fresh and Clean and REV. Formula 158 Lemon Disinfectant and Fresh and Clean did not kill Pseudomonas Aeruginosa, and REV did not kill either the Pseudomonas Aeruginosa or Staphylococcus aureus, as claimed on the labels. Both pathogens can cause infections that can be serious, but are often treatable with antibiotics.

Lonza has now agreed to begin implementation of a Supplemental Environmental Project (SEP) which is the first of its kind nationwide. The SEP’s intent is to secure significant environmental and public health protection and improvements. In agreeing to develop and implement this project, Lonza will evaluate whether or not the companies that formulate its products are doing so safely and legally, and will inspect the plants, interview key personnel, and review required documentation. Only those companies that are found to be in sync with the criteria of regulatory, quality assurance and manufacturing compliance will be permitted to continue to formulate Lonza’s products. Lonza has until December 2009 to develop and fully implement this project.

For more information about pesticides, their health effects, and how they should be used and disposed of, call the National Pesticide Information Center at 1-800-858-PES, or visit: http://www.epa.gov/region02/pesticides.

http://www.epa.gov

Healthcare News

A possible cancer cluster at a private hospital at Benowa on the Gold Coast is causing some concern.

According to the chief executive of Pindara Private Hospital, Richard Lizzio, some staff are concerned about the number of cancer cases among staff at the hospital over a 10-year period - thought to be 25 among a current staff of around 700.

Mr Lizzio says a detailed investigation by the independent environmental consulting firm Noel Arnold and Associates has been instigated and epidemiologists Dr. John Parks, Dr. Bruce Hocking and Professor Ian Gordon from Melbourne University will also conduct a statistical analysis.

Mr Lizzio says there has been no more than two occurrences of the same type of cancer, the largest group is breast cancer with eight people, but there were also cases of bowel and pancreatic cancer, leukaemia and melanoma.

The majority of the cases involve current staff members and in the last four years four people have died from four different forms of cancer, and all were women.

Mr Lizzio says most of the predominantly female staff were aged over 40 and around 2,000 people would have been employed at the hospital over the last ten years.

He says early results of the hospital’s water, radiation levels and electromagnetic levels had shown the levels were within accepted standards.

Gay Hawksworth for the Queensland Nurses Union says they are pleased the hospital was taking the concerns seriously.

Healthcare News

The House width=396 align=left vspace=5 border=0>This article is republished with kind permission from our friends at The Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery of in-depth coverage of health policy developments, debates and discussions. The Kaiser Daily Health Policy Report is published for Kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. Copyright 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

Healthcare News

A Los Angeles Superior Court judge width=396 align=left vspace=5 border=0>This article is republished with kind permission from our friends at The Kaiser Family Foundation. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery of in-depth coverage of health policy developments, debates and discussions. The Kaiser Daily Health Policy Report is published for Kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation. Copyright 2008 Advisory Board Company and Kaiser Family Foundation. All rights reserved.