at the local private hospital. It has never had a single case of C diff or MRSA. B
-
that makes no sense. I work as an anaesthetist in the private and public systems and can assure you that the doctors, nurses and patients will to a high degree be carriers of MRSA. If no-one is dying from MRSA in the private hospital it's probably because their patients are so much less sick in general. For example last night in my tertiary inner city hospital I had multiple stabbings, patients on emergency cardiac bypass, patients with amputated legs, various 90+ year-olds dying of general decrepitude...while in my last shift at the private I had a 30yo with a little ankle fracture from skiing and a girl with an ovarian cyst both for semi-elective procedures. Believe me, I'd privatise everything except law and war but MRSA isn't the clinching argument.
Off topic.
The Charlemagne column in this week's Economist has an interesting idea of the current economic slowdown being the best test/advertisement for the different 'social models' in the EU.
"Burn it down, and rebuild from scratch - it's the only sure way"
I've always wondered if we'd be better off building hospitals from Portakabins.
10 year life. Then burn the things.
Beds would be replaced by 10 years. Equipment would be near obsolescence in 10 years. A modular pre-fab hospital with operating theatre modules, ward modules, etc could be factory pre-built and undergo a rapid technological evolution (build the module to a standard exterior space frame pattern, the interior subject to any improvements arrived at along the way. With good design, a damaged module could be replaced with little effect on the rest of the module conglomerate.
In a similar vein, socialist marxists should be designed for a 10-year life.
Then burn the lot of them.
@The Underdog.
I saw an extension to the Royal Berkshire Hospital being built out of portacabins/prefab units last year. It looks very nice. 
Milliband is worse than Brown if he got in the job because he, even more than Brown, has no experience of the world or reality of life as known by 99.99% of the population.
That is Browns main problem, and it will be Millibands too.
The points on CDif and MRSA is not the private/public devide, which is real anyway, but the RISE in these infections under this Government.
Why is this so hard for some to bear? Maybe because all that money wasted and spin missed for their chosen party?
rechoboam
"If no-one is dying from MRSA in the private hospital it's probably because their patients are so much less sick in general
Believe me, I'd privatise everything except law and war but MRSA isn't the clinching argument."
Fair point. Private hospitals clearly don't deal with the really tough stuff.
But as I understand it, European general hospitals have far less c diff/mrsa than the NHS. So there's clearly something going on.
Any info on that?
Dave B-
interesting Economist link.
I gave up my sub to the Economist 3 years ago because I could get all the lefty PRog Con input I needed from the BBC.
But under Micklethwaite (of the excellent Right Nation fame) I gather it's slowly returning to the clear-headed markets-based analysis it used to do so well. Maybe it's time to take another look.
And I've just retrieved the Sapir paper they discuss - looks worth a read and a blog.
The Underdoug-
10 year life Portakabins - excellent idea.
In fact, of course, it's been done before- back in 1943/4 the US army built loads of temporary military hospitals here to deal with the anticipated casualties from the invasion of Europe.
One of these temporary villages became our local NHS hospital, with many of the buildings are still in use today... er... 65 years later.
As for Mili, Littlejohn has an excllent piece today, under the headline "The Slop Bucket Kid for PM? The boy's a fool!"
see- http://www.dailymail.co.uk/news/...-boys-
fool.html
Off Topic.
Mr Brown's record as chancellor takes a pasting in the Mail today.
ANDREW ALEXANDER: We are paying the price for Gordon's errors
So there's clearly something going on.
Better staffing + increased isolational facilities + not running bed capacity at 100% = reduced infection rates.
You can wash your hands as much as you like (soap and water being the primary defence against transmission of C.Diff), but things will - quite literally - go to shit if you are being forced to play musical beds with vulnerable (esp elderly) patients. That is the real scandal of Kent n' Snuffit.
It's not surprising that MRSA and C.Diff get kicked around as political footballs, but I'd be very, very surprised if your local private hospital has "no MRSA" - anymore than your local high street!
No blog today since along with thousands of other blogs, BOM has been locked by Blogger/Google. They say their spambot thinks BOM may be a spam site and they need to investigate.
Supposedly they will unlock it by Sunday morning... we'll see.
Do the house rules on this blog allow me to say he is an ill conceived cunt borne of Marxism? Sorry if they don't.
Just read in the Times that Millipede had a fling with Ruth Kelly.Doesn't bear thinking about.
Wat - following on from your logic, are we to assume that antibiotic resistant organisms simply refuse to replicate outside of NHS facilities ?
Nursing homes, which as you know, are often run as private concerns are rife with MRSA [well, that's what can happen when the private sector starts slumming it, I suppose].
But you're probably right, if NHS staff only saw middle class punters on an elective basis [with the proviso that they could be shipped elsewhere if the shit really hit the fan], then I suspect that rates of MRSA would tail off fairly rapidly.
Fleming warned about penicillin resistance in the 1940's.
Since then, the NHS has ALWAYS lagged behind the Swiss, Germans & French when it came to funding, and still does to this day [admittedly the gap has closed in recent years - but the big 3 all still cost more].
The bigger picture when it comes to the NHS is one of chronic underfunding [for a period of about 50 years], reducing bed capacity [400,000 in 1948, to around 150,000 beds today] while NHS staff still attempt to treat just about EVERYTHING that comes in through the door [as exemplified by rechoboam's comments].
If you want the nice sort of hospitals that tend to crop up on the BUPA ads then you need to sacrifice universal and comprehensive coverage for a health system that would cost more, yet would begin to exclude a significant proportion of the population, or provide only basic services.
Remember the cost of bureaucracy does not come cheap when it comes to multiple private providers and insurance schemes.......look at the picture in States, and their record of hospital acquired infections is no better than ours [in fact it may be even worse].
http://www.stophospitalinfection....org/
learn.html
Ho hum, another NHS and Labour apologist that doesn't have the wit to realise that the point is in the MASSIVE RISE under this Government in deaths from infections, as opposed to there being none in private hospitals.
And also brainbox, please explain how this seems to be an NHS phenomena in a worldwide context?
You'll be telling us next how we shouldn't concentrate on the tens of thousands of deaths because the NHS does after-all, save ten of thousands of lives too in the course of earning what we pay them to do, or is that just too predictable?
Can't stand NuLab, actually, Houdini - look at Hewitt coining it in now she has her feet under the table at Boots & Cinven.
In fact, NuLab are rather more fond of market solutions [PFIs, Polyclinics, ISTCs, out-sourced management consultancy, etc] than front line NHS staff like me - don't forget many consider, Milburn, Alastair Campbell & Co to be little more than Thatchers children.
If you bothered to follow the link it would alert you to the fact that antibiotic resistance and hospital acquired infections are causing even bigger problems in a country that spends more on health than anywhere else in the world [17% of GDP] - look at the OECD stats if you don't believe me.
Lets look at the market a bit closer, perhaps you are delighted with the 30% hike in gas prices while the fat cats are laughing all the way to the bank ?
What about rail services, hardly an unqualified success are they ?
And perhaps you applaud the banks for hitting customers with £800 in charges for being overdrawn by 8p ?
http://www.metro.co.uk/news/arti...0&
in_page_id=34
If you have any relatives with schizophrenia or dementia take them along to BUPA and see what sort of "packages" are on offer.
I've heard it said that one the reasons the UK has such low rates of HIV infection [relatively] is because this particular problem so preoccupied the minds of our policy makers - perhaps an unintended consequence of this focus was that there has been a failure to address the growing problem of other types of infections, especially HAIs.
The problem, of course is acutely exacerbated, by bed reductions, combined with insane levels of hospital occupancy [well above the safe upper limit of 85% at any given time].
Many patients die in hospital, [and the number is growing because natural death at home seems to have become a thing of the past] and a percentage of these patients will indeed be colonised with MRSA [as are many NHS staff if you care to swab their noses] but this fact is often completely unrelated to the actual cause of death.
Here is the link to the C-diff outbreak at Tunbridge Wells - please note [on p4] the Healthcare Commissions report concluded that MANY [of the 90 people] may well have died of other causes if they had not acquired c-diff [because they were old, with an acute medical problem and multiple underlying problems, like diabetes, etc].
The report also found that some would have died of c-diff infection even if they had had the best care.
http://
www.healthcarecommission....rt_Oct_2007.pdf
By the way, please continue to ignore the historical context of chronic underfunding in the NHS - it makes it so much easier for you to score points.
As ever - well said, A+E C/N.
And as for that witch Hewitt, uhh, facilitating things for Cinven... words are not enough.
Just a question Wat, do you often link to David Irving? There aren't many right wingers I DON'T like but I felt a little unclean after clicking on the link below the photo you provided...
....ronic underfunding in the NHS - it makes it so much easier for you to score points.
the a&e charge nurse | 08.02.08 - bla bla bla...
Waffle and piffle to avoid the point put forward. Quite a trite little exercise in how to shift the debate away once you'd been found waffling. Chronic underfunding for fifty years? Sounds like an excuse for the past ten years of massive rises in deaths in the NHS.
As I said, waffle and piffle.
BTW: As has been seen throughout the past decade, and you demonstrate here, you don't have to be a lover of Labour policies to be a Labour acolyte and supporter.
So is it your contention, Houdini, that the the rate of hospital acquired infections are not rising outside of the NHS ?
Or that that the NHS is somehow responsible countries with similar rates of infection like the USA.
As for my political affiliation I thought I had made that clear as well.
Hey, ho.
I’m supposed to be on holiday but, with a wifi window, just checked into BOM. Dear oh dear Wat, have you stopped your medication? The Millipede’s power punt is too funny for words, and well worth a piss-take, but then the sudden tirade on the NHS, headlined by a quote from the well-known, health fascist hyena, HJ, beggars belief.
I can’t improve on the remarks by the ever sensible a/e charge nurse. I await with relish the howls of anguish from Mrs HJ and the HJ-ettes when the ever principled HJ disconnects his house from the gas and electricity supplies until “the market” and the private sector to come up with a more competitively priced product.
Of course no one was prosecuted after the Maidstone/Tunbridge botty bug debacle. It’s going on all over the country. Shooting the soldiers never solved anything. They were just implementing government policy. Read the a/e charge nurse again. This is about hot-bedding, about unsustainable turnover, about the culture of unrealistic targets.
Of course private hospitals say they do not have MRSA and C.Diff. – unless and until there is a death in a private hospital directly attributable to C.Diff they will keep saying that. But they are lying. They DO have MRSA. WH Smith’s has MRSA. You may well have it. Doesn’t matter if all you are doing is running a private clinic to freeze warts and inject thread veins.
Running a cherry-picking service for fit wealthy middle class business men to have minor procedures is easy. Tell you what. Let’s balance things up a little shall we? Let’s interdigitate an 87 year old dement with intractable diarrhoea in between each business man. See how they like being popped onto a mattress which still has shit underneath it because there were not staff to clean it. Lets make the private hospitals devote 50% of their assets to managing mental illness, dementia and multi-system illness in the elderly. Oh, and lets force them to have 98% bed occupancy rates. Let’s remove 75% of their trained nurses and replace them with well-meaning, ever smiling teenagers from Poland and Polynesia. Let’s pass a law saying that no senior doctor is personally responsible for the care of an individual private patient, that no such patient is to be seen by the same doctor more than once per admission, and that any doctor seeing a private patient must not have been qualified for more than 18 months.
When you have made theses changes, what do you think will happen?
John
Another childish unprovoked ad hominem attack from the oh-so pompous and self-important Crippen.
Still, it's not just me he has his tantrums against. There was an interesting piece in the Independent that is worth reading if anyone doubts that this is par for the course with Crippen if anyone says anything he disagrees with:
http://www.independent.co.uk/opi...ned-
876681.html
" The most innocent of suggestions – that doctors should not be above criticism, for example – is seen as a foul, ungrateful slur on a noble profession."
Crippen and the nurses here should come out any say why they disagree with the simple assertion that choice and making medics directly answerable to the people they supposedly serve (and they only way to do this is through purchasing power) is the best way to improve matters. Yes, central targets and government control are bad and misguided, but we should remember why the government (misguidedly) decided on these as the solution. It's because, as many politicians have found out before, just providing more money to the producers of medical doesn't result in improvements - it results in complacent self-interested producers (and I challenge anybody to name a more self-interested body than the BMA).
The solution is neither of these things - it is to put purchasing power in the hands of patients and their representatives and to liberalise supply of medical services. Note that I didn't mention private sector suppliers to the NHS - Hayek pointed out very clearly the perils of such an approach (much as mentioned by "the nurses" here) - or even the private sector in general. Milton Friedman, of course, famously attacked medical provision in the US - private though it is - because the structure there also favours producers over consumers.
I am not in favour of any particular proscribed solution - just one that allows any type of provider that thinks they can offer a better service to be given the opportunity and for them to be judged by their users and potential users.
At present, many continental European countries and Japan come much closer to such a situation and they are demonstrably superior in most respects (and they have much lower rates of hospital acquired infections).
rechoboam
"Just a question Wat, do you often link to David Irving? There aren't many right wingers I DON'T like but I felt a little unclean after clicking on the link below the photo you provided...">/i>
OMG- somehow I didn't see that. I just Googled around for a pic and read the accompanying article (which as you will have seen, came originally from the Mail).
Actually, A Reader has sent me another fascinating link on Miliband senior that I'm reading and will blog.
Surely the conditions you describe already exist in the care home market, HJ ?
Presently 442,000 adults use such services.
http://www.csci.org.uk/about_us/
..._care_fact.aspx
Some care homes are OK but many remain substandard [despite the kings ransom individuals, or the state have to pay for them each month].
Choice may be helpful in some circumstances but I don't think it is a huge factor when it comes to driving up health standards - and choice can be counterproductive, especially on the margins of controversial treatments [see the recent debate about the pros/cons of providing very expensive cancer drugs to those with advanced disease].
Even if a service is poor, providing it's slightly better than a local competitor it will still attract business.
Depending on a host of variables most services eventually seem to find a usual or typical level - look at the banks.
I've heard a similar arguments [vis-a-vis choice] put forward for schools - but leaving aside the debate about todays vs yesteryears approach to education, the ratio between good, average and crap schools has not changed very much, at least in my life time [accepting a certain amount of ebb & flow here and there].
There is something superficially attractive about punter power but there is no doubt that one of the unintended consequences of any initiative is that spare capacity will immediately be consumed by increased demand.
Take A&E, nowadays we see 30% more patients [nationally] than we did 5 years ago - I can tell you now that the thousand who storm the Bastille each day are not there because of an increase in either accidents or emergences.
One key factor fueling the publics obsession with health is lack of knowledge, I'm afraid.
Hi Doc
First, you really shouldn't be reading blogs on hols - you're meant to be destressing. Think what would happen if the Prime Minister followed your example and spent his hols fretting about business.
Second, I'm sure you and others are quite right about MRSA being everywhere, including Tyler Towers.
But as I read it, nobody is denying the infection/death record in NHS hospitals is much worse than elsewhere in the developed world. And it's got much worse under Labour.
I can quite believe occupancy rates are too high - which makes you wonder why the commissars have gone on closing hospitals. As you will know, over the decade to 2007-08, approximately 30,000 hospital beds were lost in England, a decline of about 15%.
As HJ says, consumer choice and real competition surely offer the only realistic road to improvement.
a&e charge nurse-
"Choice may be helpful in some circumstances but I don't think it is a huge factor when it comes to driving up health standards."
You're quite right to point out the dire situation with carehomes for the elderly, where theoretically there is already choice and competition.
I need to take a proper look at that, but my personal experience immediately points to two issues:
a)although there are many competing private sector care homes (some of which are excellent BTW), local authorities are big buyers of their services. My Simple Shopper antennae tell me that almost certainly hinders the way the market works.
b)the market is dominated by small local "Mom and Pop" operations. They can be great, but for poorly informed consumers it's difficult to make the right choices. Much easier if we had some more "brands" move in, brands consumers would learn to trust, or not - after all that's the real world way consumers make choices over most of the complicated stuff (see Helen Evans' recent excellent paper for the IEA - http://www.iea.org.uk/record.jsp...=release&
ID=142 )
But I admit really don't know enough about carehomes at present - I'll investigate and blog.
I'd be interested to see the results of your investigations about care homes, Wat. As for small "mom and pop" operations, I know of at least two care homes near to me which are owned (via "kitchen table" companies) by NHS GPs as profitable sideline businesses.
It's axiomatic on these kind of blogs that the botched privatisation of railways, utilities etc is not "really" the market in operation, and "that's not what we mean" etc etc ad nauseaum. But no market in healthcare is EVER likely to be as fluid as some commentators pretend. I'm all for patient power, but if people are unable to grasp ugly-but-basic facts about gut/skin flora, antibiotic resistance and co-morbidity, then where does that leave notions of informed choice? Indeed, even the mighty Wat makes rather facile (sorry Wat) comparisons between "private" (elective surgery in the generally fit and well) and "public" (acute medicine - i.e. everything that comes thru' the door).
In the meantime, public healthcare will go the way of the railways - rather than consumer utopia. It's no accident that the smug suits at Cinven are so excited by ISTCs, rather than looking after dementing grannies. As for acute abdo pain in the post-NHS "market", I'd suggest that the most trustworthy brand for most of us ordinary joes will remain the big teaching hospitals (which will be besieged, like that scene from Threads).
Unfortunately, Lost nurse, the big teaching hospitals are already being undermined by backdoor privatisation projects underwritten by PCTs with financial incentives for subcontractors (which are usually healthcare companies, acting alone or taking GPs on board with financial incentives). The NHS is generally accepted as a failed system, being one of the worst performing health services in Europe, but it will be a brave government to dismantle it and replace it with an efficient service independent of Government control.
lost-nurse,
Rail privatisation was, indeed, deeply flawed, but it has nevertheless been a relative success. The railways are safer, punctuality is better, capacity and usage is much higher and investment has improved hugely. Don't you remember BR?
Similarly water. There are deep flaws in the water market and regulation, but the facts are that historical under-investment has been corrected and water quality is better than ever. According to Ofwat, the worst water company, by far, in terms of efficiency, prices and water quality is Scottish Water - the only water company that is still publicly owned. Water companies have financial incentives to invest and to become more efficient that didn't exist before.
When it comes to medicine and the likes of Cinven, you may well be right. But why are Cinven is a position to rip us off? Because they are supplying a public sector monopsony buyer that doesn't get the best deal. If they are as bad as you say (and perhaps they are), do you think they would have such a strong position were their performance subject to scrutiny from many customers and buying organisations incentivised to get the best value?
You look at this situation from exactly the opposite starting point to me. I ask why it is considered reasonable for my tax money to be compulsorily taken from me and for me to be given no say in the way it is spent, even though I think it is spent badly? That is the situation that we have with the NHS. You would be outraged if it happened with food, for example. You personally may do a very good job, but shouldn't I have the right to take my money elsewhere if I think someone can do a better job or provide better value? If I don't, what is your incentive to change the way you do things? Note that my problem is not so much with public funding but with public provision. Just as you (and I) don't like private monopolies, I don't like public monopolies either. Neither has the right incentives, in my opinion.
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