Interesting article about President Obama's healthcare proposals. It emanates from the Cato Institute.

Posted by James Bartholomew • Indexed in NHS

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Obama is moving on towards his reforms of American healthcare. The Cato Institute is mounting a carefully argued opposition to his reforms.

The existing US healthcare is, of course, bad in a number of respects. It is just less bad that British healthcare. One of the agreed faults of American healthcare is its ridiculous cost.

Here are a few ways in which the cost could, perhaps, be reduced:

1. All people could be allowed to buy the insurance they want instead of coverage dictated by their state. (See excerpt from Cato paper below.)

2. Break up the cartels that I suspect may exist in US healthcare such as accredition only by a very limited number of associations for doctors and nurses. This kind of cartel leads to many, expensive years of training which are an unnecessary expense if a practitioner is going to work exclusively, say, in in obstetrics. The customer pays for massive over-qualification. Competition in accreditation would bring down costs and allow innovative, lower-cost solutions.

3. Reduce the awards given by courts for medical malpractice. These big awards increase the cost of a doctor's insurance which, I gather, can be amazingly high. If the awards were lower, the doctor's insurance bill would be lower and the customer's bill would be lower. The laws on what constitute malpractice may well be worth revising, too.

I expect there are plenty more, major savings to be had. American healthcare could perhaps be half the price without sacrificing any quality at all.

Here is an excerpt from the Cato paper in which the policy proposals of Obama and also McCain were discussed. Here is the section on McCain's liberalising ideas:

Deregulation (mostly)

Whereas Senator Obama’s plan relies
heavily on new regulation, Senator McCain
generally calls for deregulation, particularly
in the area of insurance.
Most notably,McCain would allow people
to purchase health insurance across state lines,
a practice that is currently prohibited by state
laws. Since health insurance is largely regulated
at the state level, one of the major reasons
that costs differ so from state to state is
because of the varying regulations and mandates
that states have chosen to impose.

For example, New Jersey has imposed more than
40 mandated benefits, including in vitro fertilization,
contraceptives, chiropodists, and coverage
of children until they reach age 25.
The state has also adopted community rating
and guaranteed issue. In part as a result of this,
the cost of a standard health insurance policy
for a healthy 25-year-old man would average
$5,580 in the state. A similar policy in
Kentucky, which has far fewer mandates and
no community rating or guaranteed issue,
would cost the same man only $960 per
year. Unfortunately, consumers are more or
less held prisoner by their state’s regulatory
regime. It is illegal for that hypothetical New
Jersey resident to buy the cheaper health insurance
in Kentucky.

In contrast, if consumers were free to purchase
insurance in other states, they could in
effect “purchase” the regulations of that other
state. A consumer in New Jersey could avoid
the state’s regulatory costs and choose, say,
Kentucky, if that state’s regulations aligned
more closely with his or her preferences. Many
consumers would undoubtedly choose less
regulation. For example, young and healthy
individuals with low incomes may choose not
to buy coverage that forces them to subsidize
older, sicker (and generally wealthier) individuals.
For those risk-adverse individuals who
prefer greater regulatory protection, the cost
of those protections would be reflected in
higher premiums.

Senator McCain’s proposal would permit
this type of interstate competition. With millions
of American consumers balancing costs
and risks, states would be forced to evaluate
whether their regulations offered true value or
simply reflect the influence of special interests.
As McCain says, “nationwide insurance markets
that ensure broad and vigorous competition
will wring out excessive costs.”

McCain would also allow people to purchase
insurance through nontraditional groups. Today,
three types of organizations can offer group
insurance: employers,unions, and trade associations.
McCain would open this to other groups,
notably churches and professional organizations.

More problematically, he would also allow
small businesses to band together in “association
health plans” (AHPs) to gain benefits
from pooling their risks. That makes sense if
the AHPs can choose among competing state
regulations, but there are reasons to be concerned
over creating federally regulated
AHPs. Doing so would be a step toward
greater federalization of insurance regulation.
As costly and damaging as much insurance
regulation is today, it is at least somewhat
restrained by the fact that special
interests are forced to lobby in 50 state capitals.

Fundamental to McCain’s vision
of health care reform is
changing not just who pays for
health care, but how that health
care is paid for.Moving the locus of insurance regulation
to Washington would simply create a
“one-stop shopping” center for lobbyists.

On the supply side, McCain supports
“innovative delivery systems, such as clinics in
retail outlets and other ways that provide
greater market flexibility in permitting appropriate
roles for nurse practitioners, nurses, and
doctors.” His campaign speaks of healthcare
being offered through a variety of venues such
as “Minute Clinic, COSTCO, banks, investment
companies,hospital orhealthcompanies
such as Wellpoint, Humana or online services
such as Revolution Health, Google Health,
etc.,” with the government’s role limited to
establishing “some standards of transparency,
solvency, etc.”

He has also called for “different licensing
schemes for medical providers.” In particular,
McCain has suggested that some types of
care could be shifted to nurse practitioners
and other allied health personnel. “We need to
have flexibility in the delivery of care so physicians
can spend more time on the tasks they’re
suited for,” a McCain advisor explained.
Although most medical licensing and scope of
practice laws are a state, not a federal,
purview, there are some actions McCain could
take in this area, particularly in terms of federal
reimbursement policies.

Unfortunately, not all of Sen. McCain’s
proposals are free-market oriented.

Posted by James Bartholomew • Indexed in NHS

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Treatment of cancer in Britain frequently involves

- late diagnosis
- delayed investigation through scans and other tests
- tests using less than ideal equipment
- non-use of the latest drugs
- delayed treatment

The Daily Mail has pulled together a useful article describing some of the treatments and investigations which a cancer patient in Britain may not get.

Here is one section on PET scanners:

Positron Emission Tomography (PET) scans are immensely sophisticated, showing how body tissues are working. But they're expensive, so many surgeons have to rely on the results of a CT scan (computerised tomography) which is less detailed.

It means in some cases it is only when the surgeon begins operating that they realise a patient is not suitable for surgery, because there are tumours the CT scan hadn't spotted.

Dr Fox adds: 'The last thing a patient needs is an operation that's useless.'

An estimated 20 per cent of operations have to be aborted because of this.

Concerned patients can ask their specialist to refer them to a hospital with a PET scanner, says Dr Fox. However, they might not be granted their request.

I expect there are figures available on the number of PET scanners in Britain per million of population compared with the equivalent fitures for other countries. If anyone is willing to obtain and send me the figures, I will upload them.

Posted by James Bartholomew • Indexed in NHS

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A man called Arthur (I didn't catch his surname) was on Radio 5 Live this morning saying that the equipment for treating prostate cancer in Britain is antique. He had had a recurrence of cancer a few years ago and realised that he would need radiotherapy.

He went did some investigation using the internet. He found that the NHS had none of the latest machines available at that time. The only ones in Britain were at the Harley Street Clinic and Cromwell Hospital (both private). Even these were not the very latest models. For these, you had to go to America. There they had a machine which was far more precise in killing the cancer with far less damage to the surrounding area.

I am not sure in what year he did his research. I have not done any research to check his story. So I do not pass this on as evidence of any strength. I only mention it as a lead for inquiry and verification.

Posted by James Bartholomew • Indexed in NHS

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A disturbing account of deaths at an NHS hospital in Gosport. It presents concerns not only about the hospital, but about operations of the coroner's office. My own personal experience of a coroner's office in London was not good. These officials seems to be a law unto themselves.

The story does not appear to put the General Medical Council in a good light, either.

Posted by James Bartholomew • Indexed in NHS

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Several ways have been revealed recently in which official NHS statistics have been manipulated.

The target: achieving a wait for patients in accident and emergency of no more than four hours.

Why claims of achieving this target are misleading:

1. The ambulance bringing the patient to the hospital is kept waiting outside. The hospital simply declines to accept the patient. This means that the starting time of the four hour wait is delayed and the hospital can claim it is meeting the target.

2. The hospital refuses to accept any emergency patients for a while. The patient has to be transported to a different hospital. This enables the first hospital rightly to claim that patients who get into the hospital are not kept waiting for more than four hours.

Why are the hospitals so keen to meet the target? Because the hospitals receive less money from the government if they fail to meet it.

Who or what suffers? Of course the patient suffers from being kept waiting for emergency treatment for more than four hours. In the second case, the patient may be carried to a hospital that is much further away, delaying treatment. Also people suffer who need an ambulance but cannot get one because ambulances are being kept waiting outside hospitals or taking journeys to hospitals far away. But this suffering is not a direct result of the target. It is a result of inadequate emergency provision in NHS hospitals. What suffers directly as a result of the target and the cheating on the target is the truth and public awareness of the truth. That, of course, suits the government well. The truth that is kept secret from the voters is the extent to which the massive increase in spending on medical services in Britain has been wasted. We simply do not know the extent because NHS statistics are lies.

The evidence: The information for these assertions comes from the article by Laura Donnelly in the Sunday Telegraph in which she quotes from letters sent between NHS senior executives obtained under the Freedom of Information Act. It also comes from comments she obtained from Katherine Murphy of the Patients' Association and Sam Oestricher, ambulance representative of the unison Unison.

Here is a part of the article:

In one of the letters, disclosed under the Freedom of Information Act, Sir Graham Meldrum, chairman of the ambulance trust, said patients were "being put at risk on a daily basis", with 7,600 delays last October - a position which has since deteriorated further.

Sir Graham Meldrum wrote: "The risks of delayed handover cannot be overstated.

"The constant and prolonged delays present risks to two patient groups: 1. the patient waiting in the corridor, with less than ideal clinical care, and forced to endure cramped/busy corridor environments, 2. the patients who dial 999 in an emergency and receive a delayed ambulance response, while ambulances are rendered unavailable whilst queuing at hospital departments."

The letter, sent last November, followed warnings from the ambulance service's head of operations that repeated closures of casualty units to 999 arrivals were putting patients in danger.

Over a six month period, hospitals in the West Midlands closed their A&E units to all ambulances on 472 occasions, forcing 999 crews to take seriously-ill patients on lengthy journeys in the search for hospital care, the documents say.

More than three quarters of the requests for such "diverts", in the six months ending April 2008, came from Heart of England Foundation trust, in Birmingham, the correspondence says.

Last September Rob Ashford, the ambulance trust director of operations, wrote to all hospital chief executives in the area, saying he could no longer "condone" the practice because of the "inherent dangers" it posed to patients.

Ambulance staff believe "diverts" are regularly used by hospital managers to ensure they do not miss Government targets to treat patients within four hours, by shifting pressures to other hospitals.

Mr Ashford proposed a total ban on the practice, in widespread use across the country, which allows hospitals to close their doors to all 999 patients when pressures can no longer be managed.

The local hospitals did not agree to the ban, although some restrictions on its use were agreed.

The full article as it appears online is here. But the printed article had extra sections.

Notably: "Sam Oestricher, ambulance representative for the trade union Unison, said ambulances were being treated "as mobile waiting rooms".

And again, "Katherine Murphy, from the Patients' Association said 'We are hearing increasing numbers of storied of seriously-ill patients lying in pain in ambulances, worried out of their mind. The A&E target is the one that comes with financial penalties attached, and it is the one hospitals care about.'"

And again, "Since family doctors stopped providing routine out-of-hours care five years ago, the number of emergency admissions to hospitals has risen by 30 per cent, while the number of beds has fallen by more than 20,000. More than 100,000 ambulance journeys were delayed at casualty units by more more than 30 minutes in the month of March alone - an increase of 18 per cent in 12 months."

One further quote from the printed article:

Most ambulance trusts measure delays by "turnaround time" - the time between the ambulance's arrival at A&E and its availability for the next call. It includes any time cleaning or restocking the vehicle, which should take no more than a few minutes.

Research by one ambulance trust found three quarters of delays occurred before the patient was handed over to staff, and that 84 per cent of those cases were connected to bed shortages.

It is a pity that the source for this information is not named. That would add further force to the evidence. However, if we trust the source and take it to be representative, then the vast majority of times when an ambulance has an overlong stay when delivering a patient to a hospital, it is because the hospital is overrun with patients and does not want to spoil its apparent (but not real) success in meeting the waiting time target.

Here are further details of the extent of ambulance delays.

Posted by James Bartholomew • Indexed in NHS

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The Cato Institute fears the consequences.

When I was in the USA recently, it seemed that Obama was talking mainly about trying to cap the cost of health insurance. But it still appeared to be very vague. There were meetings and consultations. Nothing definite appeared to have been decided.

Posted by James Bartholomew • Indexed in Education • NHS

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This account from the front line clearly explains two things:

1. How targets can damage the medical care of patients and
2. How you cannot trust government official statistics claiming to show improved patient care.

Where's my patient?" asked Ruby looking around A&E frantically. "I've lost her. She was here a minute ago." She stood by the cubicle where her patient had been and looked around. "Maybe she's discharged herself," I suggested. "She's just had a stroke and the left side of her body is paralysed, so I doubt it," Ruby replied. "I only turned my back for a few moments."

Now, it's not unheard of to lose things in a hospital: a handbag, even your sanity, but a patient? Surely an A&E cubicle would be a safe place to leave a bedridden patient? Apparently not, as Ruby and I discovered that evening.

"Oh, here she is," I said, looking on the inpatient system on the computer. "She's not in the cubicle, she's upstairs." "How did she get there? She can't even sit up, how could she make it up stairs?" replied Ruby, perplexed. "She's in a bed in the acute assessment unit. Someone's moved her," I replied. "What?" shouted Ruby. "She's not medically stable. She's not ready to go to a ward. There must have been a mistake."

After several frantic phone calls, it transpired that there had been no mistake. The decision to move the patient out of A&E had been taken not by a member of the medical team but by a manager, because the lady was about to breach the A&E waiting target of four hours. The decision as to when a patient is medically fit to be transferred was once purely clinical. Now, it's financial.

With the introduction of targets came financial penalties for hospitals that failed to meet them. Of course, targets were introduced with the best of intentions: to improve patient care. But they have metamorphosed into a stick with which clinicians are threatened by an increasingly powerful non-clinical management.

When I began my training 12 years ago, it would have been unthinkable for a manager to interfere with patient care, let alone act unilaterally. Now, it's commonplace. The shocking story of Mid Staffordshire NHS Trust is an indication of how far things have gone. A litany of failings was uncovered between 2005 and 2008, and managers were accused of putting targets and cost-cutting ahead of patient welfare, leading to as many as 1,200 needless deaths.

The article was by Max Pemberton, a doctor who writes regularly in The Daily Telegraph.

The full article (and the rest of it is worth reading) is here.http://www.telegraph.co.uk/health/healthadvice/maxpemberton/5061576/NHS-Have-targets-become-more-important-than-patients.html

Posted by James Bartholomew • Indexed in NHS

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From the Guardian, a remarkably frank account of the continuing failure of the NHS to treat cancer as well as the medical services in other advanced countries:

The government's national cancer plan, backed by a massive injection of cash for cancer services in England, has failed to boost survival rates substantially, a major study shows today.

The findings will dismay government ministers, who have secured a tripling of spending on cancer over the last decade with the ambition of bringing the UK from among the worst countries up to the standard of the best in Europe. But the authoritative study, from a team led by Professor Michel Coleman at the London School of Hygiene and Tropical Medicine, shows that survival rates have barely shifted since the cancer plan was launched in 2000.

"We are at best keeping track with improvements elsewhere rather than closing the gap," says an editorial in the journal which publishes today's study, Lancet Oncology. It adds that the government's aim of matching the survival rates of the best performing countries in Europe by 2010 is looking optimistic.

The study also shows that regional divides linger on, with people in some areas of England likely to survive longer than in others.

Cutting deaths and improving the length of time people survive with cancer, while ending health inequalities, is one of the major health goals of the present government, triggered by an outcry over data which showed Britain lagging at the bottom of the European league.

Full story here.

This account is utterly different from that which I heard on BBC Radio. That entirely accepted the propaganda offered by, I think, the so-called Cancer Tsar (perhaps he should be called the Cancer Commissar). It is a sign of the times that a civil servant should promote misleading propaganda in favour of his political masters. It is also a sign of the times that the BBC should accept this propaganda so readily. It is ironic that a Left-wing newspaper, which you might normally expect to be more sympathetic to the Labour Government, gives a more honest account than a civil servant or the BBC. Well done the Guardian but a sad time for the integrity of the civil service and the BBC.

It is worth adding that the different parts of the BBC perform differently. Radio 4, led by the Today programme, has a Left-wing, politically correct, pro big government mindset, as has been widely observed. However Radio 5 is far less predictable. Its great virtue is that its phone-ins make its producers and presenters more aware that there are other views around beyond the BBC view.

Posted by James Bartholomew • Indexed in Media, including BBC bias • NHS

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Here is one of the ways in which you would be better treated in an American (and doubtless also a Japanese, German, French or Swiss) hospital for heart disease than you would be in Britain. In America and, I suspect, the other countries mentioned, you might get a scan with a 64 slice CT scanner that will show quickly - and without ill effect on you - just how bad your arteries may be obstructed.

In Britain, you have a much lower chance of having access to this scanner.

The Daily Telegraph today carries a report that the 64-CT scanner has been shown as effective in revealing coronary disease as the traditional, much more invasive method. The chances of anyone surviving heart disease depends crucially on being assessed quickly and effectively and then getting an operation, if needed, quickly. But the process of assessing the disease is bound to be hindered in an medical system which does not have the use of 64-CT scanners.

I saw such a scanner at the Mercy Hospital in Miami about four years ago. It had been installed the day I arrived. That was the only hospital in America that I visited and it had the new scanner. There must have been many such machines even at that time. I looked up to find how many hospitals in Britain had it then. The answer appeared to be only one.

Now, according the Telegraph, still "only a handful" of these scanners are in British hospitals. I wonder how many that means? Is it five, perhaps? Clearly nothing like enough to scan more than a small fraction of those with heart disease.

I am afraid this is another example of the way in which the treatment you are likely to receive in Britain is years behind what you would expect in America and in other countries which have systems of medical care that use up-to-date equipment.

It is worrying that Americans still apparently think that the NHS may be a model worth following. It would be useful to see an estimate of how many people in Britain die prematurely of heart disease each year because of the inferior diagnosis and treatment here. We have such an estimate for cancer from Professor Sikora (10,000).

Incidentally, the 64-CT scanner has other important uses as well.

The Telegraph article is here.

Posted by James Bartholomew • Indexed in NHS

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One of the reasons that people are not more worried by the relatively low standard of the NHS is that they are are not aware of the treatments they are not getting.

There are drugs, scans, other diagnostic tests and therapies which are available in other advanced countries which the average British patient does not know he is not receiving. A very clear example of this was reported in the Telegraph last week in a small story. A survey was conducted Myeloma UK, a charity. It revealed that a quarter of specialists in myeloma, a bone marrow cancer, do not tell their patients about treatments that have not been approved by Nice, the government agency which decides whether or not drugs will be available on the NHS.

So the patients of these consultants simply are unaware that they might have been given a more effective treatment in, say, France or Switzerland. The ignorance of the public about how the NHS is treating them less well than other systems is perpetuated.

The Daily Telegraph article is here.

Posted by James Bartholomew • Indexed in NHS

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Yet another international study has shown how bad is the record of the NHS in treating cancer. This, in turn, can probably be treated as a proxy for the performance of the NHS in all diseases. Further evidence that by mistakenly opting for the NHS model - the most statist in the advanced world - Britain has suffered tens of thousands of unnecessary, premature deaths.

The point from this latest report which will really gall those for whom the NHS is a religion rather than a means to give the best possible healthcare to the greatest possible number is that the United States, of all countries, comes out either as the best or one of the best. This point was not, of course, highlighted in either the BBC or Guardian reports. How can it be that the USA, which is treated by these two organisations as if it were near criminal in its treatment of the ill, have got a far better overall record than supposedly loving, kind Britain?

I certainly do not hold up the USA as a model healthcare system. It is deeply flawed. But it is still much better at saving the lives of the greatest possible number than our, far more deeply flawed system. It depends what you want: a flawed system that saves more lives or a disastrous system that people feel is virtuous. This is a secular version of creationism. Many people in Britain love the NHS. They don't care about evidence. They don't care how many die. Believing in the NHS makes them feel good about themselves. I find it appalling that people are so self-indulgent and so uncaring about the reality.

Of course the government has claimed that the British performance has improved since the years which the study reflects. This is true. But so has the performance of the rest of the world. There is plenty of reason to think (use the search facility and find entries with the word 'Sikora') that Britain still has performance decidedly below the average in Europe, let alone that of the best in Europe or of the United States.

Here is an excerpt from the BBC report:

The study showed the US had the highest five-year survival rates for breast cancer at 83.9% and prostate cancer at 91.9%.

Japan came out best for male colon and rectal cancers, at 63% and 58.2% respectively, while France fared best for women with those cancers at 60.1% and 63.9%

.

The full BBC report is here.

Posted by James Bartholomew • Indexed in NHS

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The NHS is behaving like a spurned and angry lover. It tells a woman who is dying of cancer that if she has drugs that it refuses to pay for but which she herself will pay for, then she is unwelcome. She can no longer have free NHS care. Never mind that, like the rest of us, she has paid her taxes for a lifetime. It is as if she was unfaithful to the NHS and her lack of love and devotion should be punished by total rejection.

What a perversion this is of the welfare state. How horrified would be Attlee and Beveridge and others who had the dream of excellent healthcare provision for all.

The psychology of the NHS decision to abandon those who are so insulting as to pay for some better drugs is a fascinating subject. I guess the reason the NHS feels so bitter towards those who pay for better drugs is the implication that the drugs supplied by the NHS are not good enough. This, of course, is true. But the NHS cannot bear the truth to be pointed out or to accept it. So it wishes to punish those who assert it. This is the psychology, perhaps, not of the jealous lover but the spoilt, vain, self-centred child who cares nothing for the actual well-being of others.

The actions of the NHS are immoral and I hope they will prove to be illegal, too.

Here is the beginning of the story in today's Sunday Times:

A woman dying of cancer was denied free National Health Service treatment in her final months because she had paid privately for a drug to try to prolong her life.

Linda O’Boyle was told that as she had paid for private treatment she was banned from free NHS care.

She is believed to have been the first patient to die after fighting for the right to top up NHS treatment with a privately purchased cancer medicine that the health service refused to provide.

News of her death at the age of 64 has emerged as six other patients launch a legal action to trigger a test case that they hope would force the NHS to allow them to top up their care with private drugs.

The full story is here.

Posted by James Bartholomew • Indexed in NHS

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More than 8,400 beds were cut in the year ending March 2007, the largest fall in 14 years. One in six beds has been closed over the decade. There are now 167,019 beds in NHS wards, compared with 198,848 in 1997.

There is an argument for reducing the number of beds. Part of it is that doctors now believe that the long times in hospital that used to take place - after childbirth for example - were unnecessary and even undesirable for the patient. However it is hard to doubt that the massive drop in bed numbers that has taken place since the creation of the NHS goes beyond what would be suggested by improved medical treatment and revised theory on how long one should stay in bed.

Hospitals ought not to be working near to capacity. They ought to have spare capacity so that new arrivals can be admitted quickly and can be treated promptly. For many years, the NHS has been working too close to capacity. What is dismaying is that despite all the extra money spent by the Labour government since 1997 that this is still the case. The system is not working. The NHS does not just lack money. It is a bad system that causes suffering and unnecessary deaths despite the sometimes heroic devotion of those in the front line.

The full article on Labour's bed closures is here.

Posted by James Bartholomew • Indexed in NHS

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Further evidence comes that the NHS, despite the vast injection of funds, is failing to deliver medical care that is of the average standard in the rest of Europe.

Professor Mike Richards, the national cancer director, has said that in 2004, Britain spent £76 per head on cancer drugs compared with £143 in Germany and £121 in France. Even after adding in private spending on cancer drugs in Britain, our figure still fell well short of the others at £90 a head.

This spending on cancer drugs - particularly new and therefore expensive cancer drugs - is a forward indication of what the survival rates will be (so I am told by Professor Sikora, the leading cancer specialist). So we may be confident that when the figures finally emerge for cancer survival rates for the past few years, Britain will again be among the worst performers. Or, to put it quite clearly, thousands of people will continue to die of cancer in this country because we have the NHS instead of one of the other systems in the advanced world.

The story from the Daily Mail is here.

The situation with prostate cancer is more complex. But there is reason to suspect, at the very least, that the USA has dramatically lowered its deaths from prostate cancer because of active screening. A friend of mine in the USA is screened as a matter of routine for prostate cancer and colon cancer. Prostate cancer is apparently the second biggest killer of men in Britain. The screening test for it is far from ideal. The British medical profession tends to be sceptical of it to the point of hardly using it at all unless the patient pushes hard for it. I suspect that this is one of many instances where the medical opinion of the British has been influenced by the rationing mentality of the NHS. It is true that the American may over-test and over-prescribe but British medicine certainly has the opposite, more serious defect. In any case, in America, where they screen for prostate cancer, the death rates have come down more dramatically than in Britain. Or, to put it clearly again, many men die of prostate cancer each year in Britain because we have the NHS. The news story is here.

In a single week there was yet one more story about how the NHS has failed to perform as intended. Figures from the NHS Information Centre, apparently, show that nearly half the population has not seen an NHS dentist in the past two years. Story here.

It is possible that regular publicity about the bad record of Britain in treating cancer compared to other advanced countries will, eventually, prompt the government to spend more money on cancer drugs. That could be regarded as a 'good thing'. However, given the huge amount of money wasted in the NHS on excess back-up staff, poor use of staff and under-used equipment, it only means that money will be taken away from other service to patients that are less easily measured - care for the elderly for example. So even if the government moved to spend more on cancer drugs, it could well mean no net improvement in the amount of unnecessary suffering British people accept because we have the NHS rather than the medical care of other advanced countries.

Posted by James Bartholomew • Indexed in NHS

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Most of the media has cooperated with the idea that the enormous amount of extra money put into the NHS has made it good enough. This, of course, is not at all true. It is accepted by most people that at least the waiting lists and waiting times in emergency are now fine. Even these things are not true.

Here is a doctor who works in accident and emergency writing about the manipulation of waiting times:

But what about the 98 per cent success rate for meeting the four-hour target?

From the patient's point of view it sounds marvellous - it means you have a 98 per cent chance of being seen and sorted from arrival in A&E.

Right? Wrong. You haven't had a Department of Health maths lesson.

Say you come in to hospital complaining of abdominal pain. You wait three hours to see a doctor -they organise a scan and blood tests and transfer you to a ward next to A&E.

The results come back two hours later and you can be discharged. In the real world, three plus two is five - that's five hours you've been waiting.

But in fact, because you were transferred to the A&E ward before four hours, officially you weren't actually in A&E all that time.

Confused? Me too - and I spend my working life in A&E!

It is even worse if you are a patient referred by your GP for emergency treatment. You bypass A&E and go straight to a ward.

As there are no targets for patients who bypass A&E, you may wait four hours before even being seen by a doctor, but this is not even recorded in the official figures as you went to an emergency ward and not the accident and emergency department.

If you are starting to understand the logic, a job in NHS management awaits you.

As well as the rules being "bent", the fact is the figures are often "fiddled".

This is done in numerous ways, from simply changing the discharge time - it is amazing how many patients are discharged at three hours 59 minutes - to delaying when ambulances are allowed to hand over patients to the hospital.

The most cynical way the figures are massaged is when patients are "moved" on the computer when in reality they are not physically moved at all, but perhaps go from a trolley to a bed, have a curtain drawn round them and the light turned off.

You don't have to be a brain surgeon to know this shouldn't happen, but it does, because A&E staff are concerned that if they have too many breaches, then they will face the Spanish Inquisition from management the next day.

But the saddest thing for me as a doctor, and you as a patient, is that I often have to see people not according to the urgency of their need but simply to satisfy a government target.

I remember having to treat a bloke who had called an ambulance for an ingrowing toenail and wanted to sort it out there and then as he was "off to Ibiza that evening".

Because his four-hour target was nearly up, he was seen before a patient in severe pain with a dislocated shoulder.

So Government claims that everything is lovely-jubbly are inaccurate.

In my experience, the real picture is that between 5 and 10 per cent of patients end up waiting longer than the four-hour target.

At peak times that can rise to 15 per cent - that's a million patients nationwide. And it will probably only get worse.

There has been a year-on-year rise in A&E attendances; many factors have contributed to this - an expanding population (in number and waist size), more alcohol and drug-related attendance, lower-quality GP out-of-hours services, and an increasingly elderly and frail population.

However, there has not been a corresponding increase in resources.

In A&E there are not enough nurses treating patients and there is a lack of senior A&E doctors to make treatment decisions.

When we do decide to admit a patient, there are not enough beds on acute wards, so patients have to wait unnecessarily in A&E.

Why is it that France and Germany have double the number of acute hospital beds that we do in the UK?

The doctor is Dr Nick Edwards. The full article in the Daily Mail is here. He has also written a book, IN STITCHES: The Highs And Lows Of Life As An A&E doctor.

Posted by James Bartholomew • Indexed in NHS

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Gordon Brown announced yesterday that the National Health Service would become preventative as well as curative. Actually, this is precisely what Labour promised in 1943 in its pamphlet which originally proposed "A National Service for Health".

Item 2 of the section describing the "The Medical Service that we need" (and which the National Service for Health would provide) began:

(2) Preventive as well as curative. It must be equipped for preventing avoidable damage to the intricate working of body and mind, and for promoting the full flowering of every man's and woman's physical and mental strength; it must be positive as well as negative, helping those who are fit to keep fit, and those who nearly fit to become fully fit.

I expect that some extra testing will indeed take place as a result of Mr Brown's initiative. But this is spinning while Rome burns. The NHS is providing an inadequate curative service, as previous postings in the NHS category have described. There is something grotesque, in the circumstances, about creating new services which will, inevitably, take money away from other areas of the NHS which might have a more important role in the health and well-being of people. Physiotherapy will be even more stringently rationed. Cancer drugs will be more rationed. Care for the elderly will be even worse and so on and on.

Posted by James Bartholomew • Indexed in NHS

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A few days ago, I met a consultant who told me patient care has become worse in the past five years. She mentioned a number of things that were worrying and/or were making the business of treating patients more difficult.

1. The NHS management has imposed an expectation that, in her speciality, there should be two follow-up meetings with patients for every one meeting with a new patient. This target varies from one speciality to another. Her target is, as far as she is concerned, wholly arbitrary and damaging to good patient care. She believes that good care requires, on average, a higher proportion of follow-ups. But if the hospital fails to keep to the proportion prescribed, then it will lose some funding. So an attempt must be made to keep to it or to fake it.
If they were to keep to it, then patients who needed to be seen more than twice after the initial visit would suffer. She suggested that therefore, in order to maintain good patient care despite the target, they fake it - at least some of the time. They call an old patient a new patient. Presumably they pretend that the patient has a new ailment whereas, in fact, it is the continuation of the old one.
How depressing it is that senior doctors have to spend their time getting around silly rules rather than devoting themselves to their job of looking after patients.

2. She told me that doctors gain the status of consultants far more quickly than before. Previously they spent four years training generally and then another seven years in their speciality. They also worked all hours, thereby seeing a great deal of illnesses and their treatment. Now, however, they can be called 'consultants' after only five or six years and they have had significantly less experience in those years than they would have done previously because of the new rules limiting their working hours. A consultant today is often not the highly experienced top doctor that he or she would have necessarily been in the past.

3. Another effect of the new working hours is that the new consultants more frequently than before have a shift mentality. When their time is up, they go home regardless of the state of their patients. This is a change from the time when a consultant very frequently felt his or her prime responsibility was to the patient and that this would quite often mean he or she would stay around until a procedure involving the patient was complete.

4. She told me that there is a drive for doctors to account for everything thing they do. She said that in one hospital, I think it might have been Great Ormonde's in London, they were trying out a system whereby doctors would account for each thing they did for patients on a personal digital assistant (PDA. I remarked that I had recently seen another consultant in a different hospital swiftly moving from task to task - ordering an X-ray for one patient, asking for another patient to go to his office, consulting with another doctor about a third patient, examining the second patient, looking at X-rays for a fourth patient, having a word with the relatives of that patient all in quick succession. If he had had to itemise such things, he would not have had time to do them. She heartily agreed. In trying to monitor such things, the administrators were going to damage the productivity of doctors and thus damage patient care.

5. She also remarked what a vast army of people there must be doing all the monitoring of targets. Somebody from her hospital would have to collate all the figures showing whether or not she was meeting the unnecessary and damaging target of two follow-up consultations for every one initial consultation. Then the information would have to be sent to the central administrators who would have to check and analyse the figures. I presume someone would have to decide if the funding should be cut. Letters and warnings would be issued and replied to. Someone must also have been paid who thought up the idea. Someone must have thought up how it should be implemented. Stationery would have been designed, printed and distributed to hospitals. And so on and on. One bad 'bright' idea. Hundreds more people employed by the NHS to produce no improvement in treatment. In fact their employment damages patient treatment since their wages and costs such as office space, heating, lighting, pension rights and so on have to be taken out of the NHS budget and taken away from patient care.

I had spoken to this consultant when researching The Welfare State We're In. She told me that she thought things in the NHS were bad then but they are worse now. She also remarked that having damaged the NHS, the regulators and administrators have also moved in on the private sector, requiring more and causing more damage even to the private sector.

6. There is a requirement now that hospital consultants can only do certain treatments if the hospital concerned has beds that are suitable for that particular speciality. Presumably this is in case there is a mishap and the patient needs a hospital bed. But the result is that hospitals where a consultant used to do minor treatments immediately and on the spot are not allowed to do this any more. In the past, the consultant could decide whether or not it was wise to do such treatments. Now he or she is not allowed to decide. The patient has to make a new appointment at a different hospital, quite possibly seeing a different consultant who has to learn about the case afresh. Patient time and care is damaged. More consultant time is wasted.

She painted a very depressing picture of how the NHS is being administered and how even the private sector is being interfered with and damaged by government.

Posted by James Bartholomew • Indexed in NHS • Waste in public services

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When I calculated, for The Welfare State We're In, how many people a year die prematurely because Britain has the National Health Service rather than an averagely good system for an advanced country, I did not include deaths from Deep Vein Thrombosis (DVT). There is now plenty of reason to think that if these deaths were added, the toll of unnecessary deaths Britain endures would be even higher.

Today most papers have a report of the high death rate from DVT. However what is lacking, as far as I know, is any comparison with how other countries perform. If anyone knows of an international comparison, I would be grateful to hear of it. It is hard to believe they do worse.

I have personal experience of how much of the British medical establishment has got into the habit of not giving the risk of DVT proper attention (as with hospital acquired infections). A close relative broke her hip and afterwards, I came to learn, being elderly and not very mobile, she was at considerable risk of developing DVT. But she was not monitored. I, as the main person responsible for her, was not told of the risk. And although she was visited by a district nurse and developed symptoms, no effort was made to check whether she had the problem. It was only when I rang the consultant who did the operation to ask about her inflated leg that a check was ordered. She did indeed have DVT and might well have died as a result if I - not the district nurse - had not seen that there was a problem that should be checked out.

I suspect it is true that the failure of the National Health Service in general and, in truth, large parts of the private medical service in Britain, too, to take DVT seriously has caused tens of thousands of unnecessary deaths.

Here is some of the coverage of the story in the Daily Mail:

Nearly 11,000 patients have died during the past seven months because of a failure by NHS hospitals to prevent them developing blood clots, a report claims.

Guidelines introduced in April mean every patient at risk should be assessed for treatment to cut the toll of deep vein thrombosis, or DVT.

But only one in three trusts is taking action, according to the damning report from the All Party Parliamentary Thrombosis Group.

It estimates that the failure to implement the guidance has cost 10,700 lives from DVT in the past seven months - nearly three times the number of deaths from the MRSA superbug and C Difficile infections.

The death toll in a year is greater than that from breast cancer, Aids and traffic accidents combined.

DVT is caused by blood clots forming in the deep veins of the legs. If they travel to the lungs it may trigger a pulmonary embolism that can cause them to collapse, and heart failure.

The blood clots often form as a result of immobility during and after surgery. If part or all of the clot breaks off and lodges in the lung, 30 per cent of those affected will die without treatment.

A substantial number of patients are struck by a surgical DVT - whose medical name is Venous Thromboembolism, or VTE - after they have been discharged from hospital.

The report says it is a "public health emergency" yet preventive drugs given at the time of surgery cost just £1 a day, while compression stockings can help others.

Altogether, 99 per cent of 140 NHS Trusts surveyed in the report are fully aware of the guidelines, but only 32 per cent are taking steps to assess patients at risk.

These include patients in hospital for longer than four days with reduced mobility, severe heart failure, respiratory failure, acute infection, inflammatory illness or cancer.

John Smith, chairman of the parliamentary thrombosis group, said: "The stark realisation is that while nearly all hospitals are now aware of what best practice looks like, and the steps they should be taking on a daily basis to protect their patients, over two-thirds of NHS Trusts admit to not having in place a mandatory risk assessment for every hospital patient on admission.

"DVT causes more than 25,000 deaths each year. It is worrying

that some NHS Trusts are still failing to adhere to these guidelines, which could reduce deaths by over 40 per cent."

Campaigners say DVT causes 10 per cent of all hospital deaths.

Dr Beverley Hunt, medical director of Lifeblood: The Thrombosis Charity, said: "The total costs of managing DVT within the NHS are estimated to be £640million and it's deeply concerning that the simple step of risk-assessing patients is not being taken.

"Any unwell adult entering a hospital bed has a 17 per cent risk of DVT but this risk rises considerably if they are over 40, are having surgery or have a predisposing condition such as cancer."

In March 2005, a report from the Health Select Committee warned the NHS was systematically and dangerously underestimating the threat from bloodclotting.

It found preventive drugs were cheaply and easily available but not widely administered.

The full article is here.http://www.dailymail.co.uk/pages/live/articles/news/news.html?in_article_id=495064&in_page_id=1770

Posted by James Bartholomew • Indexed in NHS

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I have been unable to upload any entries for a number of weeks and the site has been down for a few days, so I want to catch up on a few items that I have not been able to write about in the past month or more.

The Sunday Telegraph had an article on October 21st about people going abroad for dentistry. I myself have been one of these people, getting dental work done in Malta by British-trained dentists at a fraction of the price in London. But this is still a small business and we should not lose sight of the bigger issue: the decline and fall of NHS dentistry. It is one of the services of the NHS that is simply falling off the back of the lorry, as this passage in the article makes clear:

In April 2006, when new NHS dental contracts were drawn up, they severely limited the number of treatments dentists could claim from the NHS. The supposed aim was to make the service less complicated. Instead, the result was that dentists flocked into the private sector.

While it is true that the number of dentists has increased from 15,000 in 1999 to more than 24,000 now, almost none works exclusively for the state.

Thus, in the past year, 1.4 million people have been left without access to a NHS dentist and, according to a survey by HSA, the medical payment plan provider, about 40 per cent of those questioned believed it was ''only a matter of time" before NHS dentistry disappeared altogether.

Needless to say, the private sector is booming. Virtually non-existent 20 years ago, it is now worth £2.4 billion. In 1990, for example, only five per cent of a dentist's income came from private patients. Today it is nearer 60 per cent.

Posted by James Bartholomew • Indexed in NHS

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It is said by some in Britain that although the NHS has its failings, it is still great when it comes to emergencies. I am sceptical about this claim. For one thing, if a hospital lacks up-to-date scanners (as many hospitals in the NHS do)then it may not be able to do the best possible scan for the particular emergency concerned.

I believe, as I have written before, that the only reason that private medicine in Britain includes very little in the way of emergency care is that the scale of private care is not yet big enough in the UK to make the big investment worthwhile for a private company. Companies might also fear political opposition.

There is, incidentally, one emergency care private clinic in London for relatively minor conditions. It is, understandably, in London near the road which leads to Heathrow airport and the West.

Meanwhile, I am interested to get this from a correspondent in Australia,

Hello James, Thought you might be interested in the huge increase in the use of private emergency rooms here in Australia:

"Record numbers of patients are paying up to $300 to beat public
hospital emergency queues by seeking treatment at Perth's only private
emergency department, which charges them according to how sick they
are."

"In the past year, 25,000 people have attended its 24-hour emergency
department, about half the number of patients seen by each of the
emergency departments at (the Public) Royal Perth and Sir Charles
Gairdner hospitals."

http://www.thewest.com.au/default.aspx?MenuID=158&ContentID=35113

Posted by James Bartholomew • Indexed in NHS

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The UK National Screening Committee, which advises ministers, recommended screening for aortic aneurysms in January 2006. In May this year, it agreed detailed plans on how it would work. But the government still has not made a decision.

The Vascular Society of Great Britain and Ireland, which represents surgeons who work in the specialism, said the delays had already cost thousands of lives.

Jonothan Earnshaw, the society's honorary secretary and a leading surgeon, said: "The Government needs to get on with this. There are at least 3,000 men dying an early death every year who could be saved if screening was introduced."

The full article is here.

In the book, I calculated how many people die each year because Britain has the NHS instead of an average system of European healthcare. Perhaps another 3,000 deaths a year should be added to the calculation. But I am not sure because I have not had the opportunity to discover to what extent other countries - and not just European ones - screen for aortic aneurysms. Any comments with information on this would be most welcome.

Posted by James Bartholomew • Indexed in NHS

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This is a grim account of one way in which treatment in the NHS is, effectively, being delayed. None of this, I assume, will appear in the calculation of 'waiting lists'. So this is also another way in which the waiting list calculation is being manipulated. To put it more bluntly, it is anothe way in which the waiting list figures are lies.

Family doctors say that new "referral management" systems, set up to allow primary care trusts (PCTs) to overrule decisions taken in the surgery, are being used to delay and cancel hospital care, and to divert patients referred to a hospital consultant to cheaper clinics in the community.

Other schemes run by PCTs have offered GPs payments if they reduce the number of patients sent to hospital.

Of 750 doctors polled across Britain, 75 per cent said they had referred patients to hospital only to have their decision overruled, with 40 per cent saying that it happened regularly. Dr Laurence Buckman, the chairman of the British Medical Association's GP committee, himself a London family doctor, said such schemes were a short-sighted attempt to save money by delaying hospital care.

"If I think my patient needs to see an orthopaedic surgeon, the chances are they do," he said. "These kinds of schemes just set up an extra layer, which delays the patient getting to see the right person."

Dr Buckman said he believed the schemes were "simply about saving money" by delaying hospital bills. "Most PCTs are on the verge of bankruptcy and if they can find a way to defer payment until the next quarter, or next financial year, they will," he added.

Norman Lamb, the Liberal Democrat health spokesman, said that GPs in his North Norfolk constituency had complained to him after referrals for teenagers requiring psychiatric help were delayed, while local PCTs had introduced "minimum waits" for surgery in order to push hospital bills into the next financial year.

He warned: "Patients will be confused. They will trust their GP to make the right judgment and when their referral comes back, they can only assume it was for financial reasons."

Katherine Murphy, from the Patients' Association, said her group was hearing a growing number of complaints from orthopaedic patients who believed their health had worsened after they were diverted for treatment by a physiotherapist when their GP had intended them to see a surgeon. She described the policy as "a prime example of deficits putting lives at risk".

Paul Rybinski, a GP in Croydon, Surrey, said doctors were under increasing pressure to reduce hospital referrals to save NHS funds. His own practice has a referral cuts target of 5 per cent.

Dr Rybinksi said he feared "referral centres" would make decisions based on very partial knowledge of the patient. "When I make a referral it is based on a complex decision relating to the individual in front of me. It is very difficult for a panel at a PCT to second-guess what I was thinking, and the factors I was taking into account, based on a reading of a basic referral letter."

The poll, by Pearl Medical, which provides mobile communications to GPs, also found that doctors strongly opposed Government plans to create networks of "polyclinics", replacing individual GP surgeries with huge group practices, serving populations of 50,000.

The full article in The Sunday Telegraph is here.

Posted by James Bartholomew • Indexed in NHS

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After writing The Welfare State We're In, I now notice instances of welfare provision as they appear in novels which previously I would have missed. Recently I listened again to an audio-book of Mapp and Lucia, the comic novel by E.F.Benson. For the first time, I noticed that the focus of the early rivalry between the two women was the competition between their two charitable events for the benefit of the local hospital.

Lucia won this battle hands-down. Everyone went to her fete. No one went to Mapp's event. But underneath the comedy lies the way in which it was simply normal for people of their class to put on events to raise money for local hospitals.

These hospitals might be charitable or run by the local authority. In either case, the people of the town or locality felt that they were connected to it. They, personally, might need it one day. They had a stake. They could also gain status by helping it financially and probably in other ways, too.

The town in which Mapp and Lucia is set is called Tilling. But I think I am right in saying it is based on the very pretty Sussex coastal town of Rye.

I wonder how hospital provision in Rye has changed since Mapp and Lucia was written (circa 1930?)? Did it have a hospital then? Does it have a hospital now?

Whatever may be the case, it is certainly true that hundreds of local hospitals have been closed down since the NHS was created. There are some good reasons for this and some bad. It is noticeable that the Labour Party, when it promoted the idea of the NHS in 1942 argued that local provision of hospitals was important. After the NHS was created, both parties were persuaded that big hospitals offered economies of scale and could develop the capacity to deal with all eventualities. They could also develop particular strengths. But since then, the political parties have re-discovered the idea that local healthcare has it merits in maxi-GP practices or mini-hospitals.

Of course local hospitals have their merits. That is why pre-NHS healthcare created them. In some ways the value of them has actually increased. If there is an emergency in one part of London and a patient needs to be rushed to hospital, it now takes longer to get there because of the density of traffic. The same applies all around the country. I presume that, in some cases, patients lives can be at risk because of the distance between an emergency patient and a hospital.

A local hospital can promote loyalty and commitment on the part of both staff and patients. Patients in hospital are also easier to visit if they are local and this, in turn, means they are more likely to be visited and, I believe, those who are visited are more likely to get well soon.

The closure of quite so many local hospitals has surely been one of the range of bad effects of the creation of the NHS.

Posted by James Bartholomew • Indexed in Charity • NHS

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A commenter on the posting below has argued that American healthcare is inferior to British healthcare. Here is a link to an article I wrote on this subject a few years ago:

http://www.thewelfarestatewerein.com/archives/2005/02/which_is_better.php

which I followed up with this posting a little later

http://www.thewelfarestatewerein.com/archives/2005/02/perhaps_i_was_t.php

Posted by James Bartholomew • Indexed in NHS

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Here is a new and important report providing evidence that despite the increased spending on the National Health Service, it still provides substandard care.

A report by the spending watchdog concluded that Britain has one of the worst records in Europe for ensuring dementia sufferers receive the best drugs available.

It likened the situation to 1950s cancer care when GPs did not tell patients of their diagnosis because they did not want to distress them and because they believed nothing could be done to help them.

In 2004, the UK was in the bottom third of European countries in terms of the proportion of patients receiving antidementia drugs.

Only 18 per cent of British dementia patients received drugs to alleviate their condition - compared with 50 per cent in France and 46 per cent in Ireland. Only Poland, Bulgaria, the Netherlands, the Czech Republic and Slovakia fared worse.

Care for the elderly has been one of the services that has been allowed to fall behind international standards while the NHS has concentrated its attention on the more politically sensitive issue of waiting lists. There is not enough money for everything in the NHS because the huge amount of waste and inefficiency (please see the book for more on this) uses up a large part of the budget.

The story is from the Daily Mail, citing a report from the National Audit Office. It has a league table which is particularly telling. I assume it comes from the National Audit Office report.

Posted by James Bartholomew • Indexed in NHS

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From the Guardian:

One in eight NHS hospital patients still has to wait more than a year for treatment, the government acknowledged yesterday in its first attempt to tell the full truth about health service queues in England.

A Department of Health analysis of 208,000 people admitted to hospital in March showed 48% were wheeled into the operating theatre within 18 weeks of a GP sending them for hospital diagnosis. But 30% waited more than 30 weeks and 12.4% more than a year.

In a key manifesto pledge at the 2005 general election, the government promised that by December next year all patients would be treated within 18 weeks.

Posted by James Bartholomew • Indexed in NHS

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One of the ways in which the government has sought to hide the dreadully low effectiveness of the extra money it has put into the NHS has been by cutting back on services which are not in the public eye.

Great effort has been put into cutting waiting lists. Plenty of money has been put into hiring staff, especially managers but also doctors and nurses. But the money has not reached many other service which are less in the public eye but extremely important. One of the major ones is care for the elderly.

This is from yesterday's Sunday Telegraph:

Hundreds of thousands of elderly people have had their "social care" cut in the past decade.

Seven in 10 councils in England have been forced to "ration" services since Labour came to power, according to the Local Government -Association.

Most town halls now provide services - including meals-on-wheels, trips to day centres and home visits from social workers - only to pensioners with "substantial" or "critical" needs.

and later,

Although council spending on care for the aged has risen 65 per cent since 1997, central government grants have increased only 14 per cent. In a foreword to the document, Lord Bruce-Lockhart, chairman of the LGA, says: "[To receive care] people have to wait until their life is threatened, they have serious physical or mental illness, or they are unable to carry out the majority of domestic routines."

Full article here.

Posted by James Bartholomew • Indexed in NHS

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One of the allegations in The Welfare State We're In is that the published figures for deaths resulting from MRSA in Britain are seriously understated.

This suggestion was supported this weekend by Dr Mark Enright, a microbiologist at Imperial College, London. He was quoted in the Sunday Telegraph saying,

"I would expect that the death figures substantially under-report the true situation. In a lot of cases, MRSA doesn't make it on to the death certificate when it should. Instead you see organ failure, pneumonia, or sepsis.

"Often it is hard to say exactly how much of a contribution MRSA caused to the death, but there is a tendency not to include it."

And further on,

He said that neither the number of deaths officially linked to MRSA nor the rate of bloodstream infections provided a full picture.

"I would say bloodstream infections account for 10 per cent of the infections in total," he said. "If people tested every infection, the rate would be far, far higher."

The Sunday Telegraph also offered a particular example of someone who was not classified as dying from MRSA yet who was evidently suffering from it very seriously: