Monthly Archives: May 2013

D.C. approves proton beam cancer centers

,The Washington Post Friday, May 31reports on a new cancer therapy:

“D.C. health officials on Friday approved plans for two of the region’s largest hospital systems to offer a controversial cancer treatment , allowing MedStar Georgetown University Hospital and Sibley Memorial Hospital to establish proton beam therapy programs.

In making the decision, health officials chose to approve a slimmed-down version of Sibley’s proposal and the original MedStar proposal, a D.C. Health Department spokeswoman said.

The decision has been closely followed by health experts because critics say it reflects a nationwide medical arms race, as hospitals scramble for dominance by investing millions of dollars in technology that has not been proven to be better than cheaper alternatives for some cancers.

In addition, the University of Maryland’s proton centre in Baltimore is expected to start treating patients in two years; a proton centre at Hampton University in Virginia’s Tidewater area, about 180 miles to the south, opened in 2010…..”

I wonder when if ever this treatment will be available to Regional Health Services in the UK? If we accepted overt rationing it should be possible to aspire to excellence..


Maryland pressing for expanded powers over hospitals

Lena H. Sun and Sarah Kliff in the Washington Post report, and highlight the states need to control health spending.

“In a world of constantly rising health-care costs, Maryland has long stood alone. Through a novel system that gave regulators unusual leverage to set prices, the state delivered care at a price that grew slower than elsewhere in the country — even at some of the nation’s most renowned hospitals.

But after saving an estimated $45 billion for consumers over four decades, the system is in danger of running aground. Hospital expenses have risen so relentlessly in recent years that the original price controls now appear unsustainable.

Americans cut back on spending after their income failed to grow, a sign economic growth may be slowing.

In its place, Maryland officials are pressing for an expansion of the state’s authority over its hospitals. The new system would not only set prices for the procedures they perform but also cap the growth in their overall spending.

Aided suicide ‘will increasingly be choice of dementia patients’

Rosemary Bennett Social Affairs Correspondent of The Times 31st May 2013 reports:

“A retired doctor who helped an 83-year-old man with dementia to die at the Dignitas clinic in Switzerland has predicted that many more people who suffer from the illness will choose to end their life in the same way.

Michael Irwin, 82, said that, with the number of people succumbing to dementia growing rapidly, and dramatic improvements in early diagnosis but no cure in sight, more would opt for assisted suicide. He would do the same if he were in that situation, he said.

The British man who died at the Zurich clinic last month contacted Dr Irwin in January to help him to find a psychiatrist who would verify that he was of sound mind. The man’s wife made the travel arrangements and accompanied her husband to the clinic.

The patient, who has not been named, is thought to be the first Briton to end his life at Dignitas because of dementia alone.”…..

As a liberal I believe patients and the public should have as much autonomy over their own lives as possible. I am uncertain that I would be courageous enough or have the desire but if I did I would not want the choice prohibited by the law, and my relatives put at risk of breaking it. As a Doctor, I really don’t know where I would stand until a specific patient with a specific complaint presented before me, but I would be reluctant not to help… if I could.


Europe to tackle Spain in health insurance row. It’s not just the UK in financial trouble.

BBC news reports 30th May 2013:#

“The European Commission is launching legal action against Spain over the refusal of some hospitals to recognise the European Health Insurance Card.

The EHIC entitles EU citizens to free healthcare in public hospitals.

But some Spanish hospitals rejected the card and told tourists to reclaim the cost of treatment via their travel insurance, the Commission says.

BBC Europe Correspondent Matthew Price spoke to British holidaymaker Ray Burton, who says one hospital wanted his credit card……”

Slightly related to this story, I was on holiday in Scotland and staying at the same B&B was an American family. The lady broke her arm and attended the local casualty. She was amazed at the speed, quality and free service she got, and even offered to pay and had insurance for her plaster cast, sling and anaesthetic. Because there is no incentive for NHS staff to obtain payment from those ineligible for the free NHS, they don’t usually bother. Why not introduce staff or departmental incentives in Hospitals?


Oxfordshire bed-blocking statistics ‘worst’ in England

BBC News 28th May 2013 reports:

“Oxfordshire was the worst place in England for bed-blocking last month, according to figures from the Department of Health. A snapshot of delayed transfers from hospitals to community care workers showed that 163 patients were stuck on wards after they were fit to leave. Patients spent 5,609 unnecessary days in hospital in the county in September. A senior GP looking at the problem said it was a struggle to recruit care workers…”

Freddie Whitaker in the Oxford Mail on 2nd April 2013 reports: New system aims to tackle bed-blocking

“HOSPITAL patients needing further care will be sent home to wait for social services assessments rather than going to care homes.

The new system, called “discharge to assess” is aimed at helping to ease the so-called “bed- blocking” crisis after it was revealed Oxford University Hospital’s Trust missed 10 out of the past 11 monthly targets for reducing the number of delayed transfers of care.

At the moment some patients who are clinically well enough to be discharged are kept in hospital beds while social care arrangements are put in place. This may mean a wait for a place in a nursing home or alterations to their existing accommodation.”…

When we consider the demographics of old age around the country, is it appropriate to try to keep the GDP health spend stable.

Would it be fair for elderly people to pay an age related health care tax supplement?



Cancer waiting time target missed in Wales despite pledge

By James Williams BBC News Wales 29th May 2013:

“Waiting time targets for urgent cancer cases in Wales are still being missed, despite a pledge they would be met by March. The Welsh government target is for 95% of patients to see a specialist in 62 days, but the latest figure is 84%. Abertawe Bro Morgannwg University Health Board had 69.9% of patients start treatment in time while Aneurin Bevan achieved 98%. The Welsh government said most patients are seen within the target…..”

Most patients means over 50% – is that good enough? The problem with cancer is that it is so diverse, and whilst target groups which have had lots of money like breast cancer do well, rarer cancers like thyroid or kidney have much more variable courses – they are not in specific target groups. If we rationed out high volume cheap services (paracetamol) we would have more money to ensure all cancers were treated quickly. It is pertinent that Wales does not have choice. I doubt if the trusts which fail to meet the targets are offering their patients alternatives, as in England.

The politicians need to answer this question. “Are there any services which are so cheap that they feel all patients, whatever their circumstances, should pay for?” If there are, then at what level of finance? My opening suggestion is equivalent to two pints of beer and a packet of 20 cigarettes, which would of course increase with inflation!

‘Virtual wards’ urged as answer to strain on NHS

Report urges patients to opt for  ‘virtual ward’, saying they can be back at home within hours after  treatment Denis  Campbell, health correspondent reports in The Guardian 30th May 2013

“The NHS  is being urged to relieve the pressure on hard-pressed hospitals by treating  thousands of patients in “virtual wards” – at home, with regular visits from  health staff replacing long stays on wards.

The service could create 5,800 “virtual beds” in people’s homes to help  hospitals cope with bed shortages and overcrowded A&E units deal with  patients arriving as emergencies, a new report says.

A few hospitals have begun treating certain types of patients this way in an  effort to provide a patient-friendly response to growing demand at a time when  NHS budgets are tight. In some places up to 35 patients a week, whom doctors  agree do not need to be kept in hospital, are being cared for this way…..”

Things must be getting really desperate when advice of this nature is given without trial. What record of skills and training in telephone triage do the hospital and community staff have for this change. I happen to think its a good idea but implementation seems risky ++

Every revolution evaporates and leaves behind only the slime of a new bureaucracy. Franz Kafka. The great Wall of China: Aphorisms 1917-19, 1941.


Royal Glamorgan hospital could lose specialist services

BBC Wales news reports 22nd May 2013:

The Royal Glamorgan hospital in Llantrisant could stop treating the most serious accident and emergency cases as part of a major NHS shake-up in south Wales.

Health officials say the “best fit” is to locate specialist services in Cardiff, Swansea, Merthyr, Bridgend and in a new hospital near Cwmbran.

But a consultation will include options involving the Royal Glamorgan.

NHS leaders believe services are currently spread too thinly.

They have warned some specialist hospital services are “on the edge” and could “collapse” unless big changes are made to the way they are delivered.

NHS 111 non-emergency helpline for Wales set to progress

BBC news Wales reports 29th May 2013:

“Plans to launch a new NHS non-emergency helpline service in Wales look set to go ahead despite problems in England.

The 111 line would replace NHS Direct as a “gateway” to all kinds of different services.

The Welsh government hopes it will ease pressure on accident and emergency departments said to be “at the point of meltdown”.

Medical staff have mixed views as to whether the 111 line will ease or add to pressures on A&E services.

The line is intended to allow access to services such as out-of-hours GPs, district nurses, and eventually social care too, so that people will be less likely to end up taking themselves off to hospital.

“To expect this to reduce pressure on emergency departments is delusional”

Dr Aruni Sen Wrexham Maelor Hospital

The 111 service was fully launched in England in April but has been beset by problems, with reports of patients struggling to get through.”…

History ….is a nightmare from which I am trying to awake. James Joyce.  Ulysses.

History repeats itself — the first time as tragi-comedy, the second time as bedroom farce. Private Eye Magasine. 1978

Will Healthwatch give patients a better deal?

Dick Vinegar in The Guardian 29th May reports:

The community watchdog will have to work hard to realise the patient-centric  dreams of Andrew Lansley and Jeremy Hunt

“Trying to provide a channel for patients to engage with their local  healthcare providers is not new.

Indeed, it has been going on for decades. In 1974, Community Health Councils  (CHC) were set up.

In 2003, they were abruptly replaced in England (but not Wales) by Patient  and Public Involvement Forums (PPIF), reporting to the Department  of Health. In 2005, these were replaced by Local Involvement Networks  (LINks), which were funded by local government, and were aggressively local,  with no central controller. Now, there is yet another change, the fourth in  eight years, towards Healthwatch, the community watchdog  which really is going to realise the patient-centric dreams of Andrew Lansley,  Jeremy Hunt, and me.

I am not sure. All the previous iterations worked only in places where the  local CHC or LINk were uncharacteristically well-run, knowledgeable, and, above  all, stroppy. The rest failed, and the patient’s voice was ignored, ending up in  Mid Staffs-type disasters. At a recent Westminster Health Forum about  Healthwatch, Sir Steven Bubb, who runs the Association  of CEOs of Voluntary Organisations (ACEVO), admitted that when he sat on a  CHC, he was patronised by doctors. That is the big problem. Will doctors and  hospital CEOs ever take patient groups seriously?…..

Patient centric means trying to win votes, but does patient centric mean individuals or community? Is there a need for utilitarianism – Which means rationing out?