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Health Care

Bit of a problem for the health scare de jour people

He checked 8,000 death certificates from the Sheffield area against detailed medical notes and case histories but found inaccuracies in about 2,000 of them.

Often doctors had listed the immediate trigger for a patient’s death, rather than the root cause.

Examples included patients with terminal cancer who were classed as dying from pneumonia as that was the condition which caused their final deterioration.

In about 40 per cent of those – or a tenth of the overall total – the cause of death given on the certificate was a different category of disease.

If we don\’t actually know what people are dying of then we can\’t really use our inadequate knowledge to prove that x, y or z (say, for example, booze, food etc) are killing people.

For example a patient who was bed-bound with severe dementia which led to pneumonia was classed as dying as a result of respiratory illness rather than a neurological condition.

Everyone\’s going to project their own personal prejudices onto this and mine is that, at a guess, we\’re under recording such \”neurological\” deaths and over recording some others.

I\’m looking forward to the narrative on Hinchingbrooke

I mean, someone on the left is going to comeup with a story about why this is a very bad thing indeed.

Hinchingbrooke Hospital in Cambridgeshire, previously described by ministers as “a clinical and financial basket case”, released its latest performance data yesterday. In just six months, waiting times had been turned around – from the worst in the region to the best. Patient care had improved; satisfaction ratings were higher than ever. Money was no longer being wasted. Staff morale was up. Even the unpopular car parking fees had been scrapped.

I expect to see a number of ideas floated.

Doesn\’t matter that it\’s got better because that\’s just a post code lottery now? It was all lies it wasn\’t that bad to start with? The budget has been increased (never mind whether it has or not) showing that it\’s all about resources? It\’s all Goldman Sachs money being poured in to make this first one go well?

Most of these attempts will sink without trace but there will emerge some contortion from somewhere about why this doesn\’t actually show what it does show. That private provision within a state financing system can and does (sometimes!) do better than state provision.

It\’s going to be interesting to see how they manage to fit reality into their world view.

 

Ebola in Uganda

Ebola is one of the most feared infectious diseases in the world and there is no specific treatment or vaccine. But despite being extremely virulent the disease is containable because it kills its victims faster than it can spread to new ones.

Not entirely and wholly true.

Yes, it does kill people quickly and thus a pandemic is most, most, unlikely. But it doesn\’t infect and then immediately people are dead. There is time for further infections to occur.

What seems to have been the limiting factor in earlier outbreaks was that they were in very rural areas. We really don\’t know what will happen if it ever turns up in a crowded urban area.

Officials from Uganda’s health ministry only confirmed that the disease was Ebola at the weekend, by which point it had reached the capital.

But we might be about to find out.

Comparing health care systems

Of course it\’s not just people not being patched up and sent on their way efficiently. It\’s an entire culture of bureaucracy. I\’ve no doubt bits of the NHS are world-class. But the shop-window walk-in & A&E is grotesquely inefficient, and that\’s all I\’ve seen first hand. And I can compare it against the similar systems in France, Germany, Canada and Norway, all of whom manage to achieve Triage without demanding everyone who isn\’t dying always waits 4 hours.

Isn\’t this a known effect?

Researchers in Canada have found that for every million doses of the H1N1 pandemic vaccine that were administered in 2009/10 there were two extra cases of Guillain-Barré syndrome which can be fatal in extreme cases.

Somewhere lurking at the back of my mind is the idea that this is a known possible side effect of many vaccines?

Economies of scale in the health service

The researchers said one possible solution is to reorganise stroke services into fewer larger hospitals which are more able to offer high quality care seven days a week.

Services in London were altered in this way in February 2010 and early results show that it has been successful, although mortality data is not yet available.

Suspected stroke patients in the capital are now taken by ambulance past their nearest hospital to a dedicated stroke unit which operates scanners seven days a week and has specialists on duty round the clock.

The idea of local care for local people doesn\’t seem to survive close examination…..

The Liverpool Pathway and euthanasia

It might be better if we called the Liverpool Pathway what it actually is: euthanasia.

The combination of morphine and dehydration is known to be lethal, and four-hourly reassessment is pointless if the patient is in a drug-induced coma. No one should be deprived of consciousness except for the gravest reason, and drug regimes should follow the accepted norms as laid down in national formularies.

Agreed, there is a delicate line between the opiate doses needed to alleviate the pain of certain diseases and the opiate doses which kill.

But dosing them up and dehydrating them is over on the other side of that line, no?

the pathway, which is implemented in up to 29 per cent of hospital deaths.

Note that this is not about do not resusitate: we have a deliberate and specific course of action which is intended will lead to the death of the patient.

It\’s very difficult indeed to call this anything other than euthanasia.

And, you know, killing people is wrong.

Polly on competition in the NHS

Cancer networks are the template, as they caused survival rates to soar by joint working: one hospital does the best diagnostics, another the best surgery and a third the best chemo and radiology, collaborating not competing.

That is the heart of a market economy. The division and specialisation of labour. And the only way of getting to the collaboration part that we know of is a market.

As for the competition: it\’s the diagnostics departments of hospitals two and three, the surgery departments of one and three and the chemo and radiology departments of one and two which are the competition.

Why do people find this so difficult to understand? This \”collaboration\” that the left are cheering on is a market economy. It\’s the whole damn point of having one.

Homeopaths: no, we don\’t have to kill them

Just to infect them with malaria.

Today\’s stupidity leads us to this page.

Homeopathy was used in the past to treat and prevent malaria but largely fell into disuse with the emerging dominance of the pharmaceutical industry. Today, people are taking a second look and finding that homeopathy is still useful in the fight against malaria. It is also safe, inexpensive, and free of parasite resistance.

No, we don\’t have to kill them as they would kill others. Just infect them with malaria and watch them using their homeopathy to treat it.

The marketisation of the NHS

What bastards, eh?

A row has broken out over a debt-ridden NHS hospital being handed over to a private company that will keep a large chunk of the millions of pounds in savings it will seek to make.

Bosses at Circle, which is running the Hinchingbrooke Health Care Trust in Cambridgeshire, have insisted they will improve standards despite claims that they will need to make what have been described as \”eye-watering\” cuts.

The Health Service Journal (HSJ) has published a report saying the hospital will need to make surpluses of at least £70m over the next decade if it is to clear its debts and meet Circle\’s contracted share.

A letter deposited in the House of Commons library by Earl Howe, a junior health minister, and uncovered by the HSJ, details for the first time the terms of the deal to hand running of the hospital to Circle.

A statement from the HSJ said: \”The first £2m of any year\’s surplus goes to Circle; the company then takes a quarter of surpluses between £2m and £6m and a third of surpluses between £6m and £10m.

Cue wailing about cuts.

However, that\’s not actually what is going to happen. The services they must provide are detailed elsewhere. They can\’t, for example, collect a cheque for doing hip replacements and then not do any hip replacements.

What they have to do is increase the efficiency with which the money they get is spent. That is, provide the services they are contracted to provide at a lower cost, thus creating that surplus through greater efficiency. Only if they manage to do that do they then get a slice of those efficiency savings.

Which brings us to the meaning of \”cuts\” in this instance. There will be no fewer services: only less money spent on providing those services. So what we\’ve actually got is people whining about inputs again instead of what we all want to be concerned about, the efficiency with which inputs get turned into outputs.

Very, very, British lefty. Insisting that it is the amount of money spent which is important instead of the outcome of having spent it.

Shock horror on diabetes!

Diabetes threatens to \’bankrupt\’ NHS within a generation

Treatment will use £16.9bn of budget as the number of diabetics rises from 3.8m patients to 6.25m by 2035

I don\’t really see what the problem is. We pay for the NHS to treat any diseases or illnesses that we might develop. More of us get diabetes? Well, that\’s what the NHS is for.

However, the important part of this is here:

Their research, funded by the drugs company Sanofi, also examined the costs of diabetes to the UK as a whole.

What does Sanofi make? Diabetes drugs.

Diabetes UK have just sold themselves out lock stock and barrel.

Gross fucking ignorance

Christina McAnea, the head of health at Unison, the largest health union, which will present its evidence on regional pay on Monday at its health conference, said: \”The Department of Health\’s evidence on regional pay is built on sand. For a government that says it wants to cut paperwork, introducing regional pay would be a massively expensive, bureaucratic nightmare, designed to cause huge disruption and conflict.

\”Regional pay would cause skills shortages in so-called low-cost areas, with nurses, midwives and specialised staff being hard to recruit and retain, hitting the care of patients.

The actual evidence is that national pay rates make recruitment in high cost areas more difficult and that this then leads to people dying.

You twat.

This is of course pure rent seeking. If there are not national negotiations on what the national pay should be then what point national unions who aren\’t negotiating national pay?

Not exactly a surprise Mr. Buffett

In a letter to Berkshire Hathaway shareholders, the 81-year-old billionaire revealed that he has stage one prostate cancer but his condition \”is not remotely life-threatening or even debilitating in any meaningful way\”.

I\’m not quite sure whether it is many, most or nearly all 81 year old men who have prostate cancer.

For most, many, nearly all, it\’s an irrelevance as it grows so slowly that something else kills them first. There are fast growing types too, but they\’re rare.

Dr. Google more accurate than doctors

One in four women have bought the wrong medication after misdiagnosing themselves on the internet and one in ten has suffered unpleasant side effects as a result, research suggests.

That sounds bad but:

Iatrogenesis is a major phenomenon, and a severe risk to patients. A study carried out in 1981 more than one-third of illnesses of patients in a university hospital were iatrogenic, nearly one in ten was considered major, and, in 2% of the patients, the iatrogenic disorder ended in death.

The short definition of iatrogenesis is \”doctors fucking up\”.

Yes, agreed, this is not a rigorous statistical comparison. However, it is the correct one.

It isn\’t \”are women and google misdiagnosing?\” but \”how much worse than doctors are women and google diagnosing?\”, a question to which I don\’t see a clear answer as yet.

If indeed they are worse…..

Just a bit of NHS trivia

When I was born, almost 50 years ago, in the bitter winter of 1963, the National Health Service was just 15 years old. It must still have been hard for people to believe that – for the first time in the history of these islands – they could fall ill without risking financial ruin, that nobody need die for want of funds.

That\’s also the first year that the NHS actually built a hospital. Before that it was simply using what others had built from private funds.

And as to not dying for lack of funds: what the hell does anyone think NICE does? Decides who will die for lack of funds of course.

It\’s a different method of taking the decision, sure, but it\’s the same decision being taken.

So this is good news

A new treatment for prostate cancer can rid the disease from nine in ten men without debilitating side effects, a study has found, leading to new hope for tens of thousands of men.

Glad they start to get it sorted out as I enter the age group where I might be interested in their having sorted it out……

In which we introduce the Academy of Medical Royal Colleges to Arithmetic

This thing about obesity, this reason that everything should be taxed and regulated:

According to the latest research, 48% of men and 43% of women in the UK will be obese by 2030, a trend that will significantly increase the prevalence of strokes, heart disease and cancer, and lead to higher costs for the NHS.

Bzzzt! No! Wrong!

In order to find out whether something costs the NHS money or not you have to add up what it does cost the NHS and then compare it with what the absence of that something or other would cost the NHS.

And for both obesity and smoking we get our answer here.

Fat boozing smokers die younger, before they spend a decade in that clammy embrace with Alzheimer\’s.

Now, what you can say is that obesity (smoking, boozing, shagging around, whatever) costs those who do it some part of their lives. On average it certainly does.

But then they are their lives to waste as they wish, aren\’t they?

Thus the way in which the lies are endlessly told, that it costs the rest of us money and thus the rest of us (or our puritans self-appointed on our behalf) have a right, nay a duty, to prevent this choice being made.

This is going to be fun

Thousands of elderly people are dying unnecessarily early because ‘despicable’ age discrimination in the NHS is denying them treatment for cancer, a charity has warned.

Yes, obviously. For the system is set up to do this.

Indeed, I\’ve seen Polly commending the NHS for taking such a robust attitude to expense control. Why spend fortunes on the last few months of the elderly when we could be eradicating child inequality?

According to research published in the journal Cancer Epidemiology, there would be 14,000 fewer deaths from cancer in those aged over 75 per year if if mortality rates from cancer matched those in America.

It\’s generally accepted that that\’s one of the reasons that makes the US system so expensive and the NHS so cheap. Because the NHS does a fairly brutal triage on who it will bother to treat aggressively and who it will offer simple palliative care to based upon the crude measure of age.

Now, whether it should be this way or not is one matter (one I\’m really not sure about myself). But the amusement might come from reactions to this report. I can see the usual suspects clamouring that this just proves how the Tories are bastards while ignoring their own previous stance that this shows how wonderful the NHS is because it doesn\’t waste resources.

No, really, it doesn\’t

Small quantities of processed meat such as bacon, sausages or salami can increase the likelihood of dying by a fifth,

The likelihood of dying is one in one. Unity, 100%.

OK, I\’ll give you the Virgin Mary, the Prophet Elijah and even Lazarus Long if you wish. Still indistinguishable from one, the chance of dying.