Another Obamacare Lesson in Failure from Britain’s National Health Service

Posted on April 21, 2011


It seems that every other week the British press has a story of yet another deficiency in the National Health Service which may prove to be a great deal like Obamacare.  The latest headline from the Guardian:

Third of NHS children’s units fail to comply with EU working time directive

Doctors forced to work over 48 hours, trainees left in charge and consultants doing overnight hospital stays to plug gap.

NHS paediatric nurse

An NHS paediatric nurse monitors a baby undergoing phototherapy for jaundice at a London hospital. Photograph: Alamy

When 15 year-old Sian Jones complained of stomach pains following a successful operation to remove her appendix at Heartlands ho

spital in Birmingham in 2007, her family said they were told by the over-stretched medical staff that she was “a drama queen”. Four days later, she died of multiple organ failure as a result of an infection in the lining of the stomach and intestines.

An inquiry last year into the care at Heartlands and a second Birmingham children’s hospital, Good Hope,following Sian’s unexpected death and that of two other children, was critical of emergency care and concluded categorically that staff shortages had been a serious problem. There were not enough consultants or children’s nurses. The NHS trust has since moved to address all the problems, including appointing two more consultants and 15 children’s nurses and has integrated care across the two sites.

But much of the time, the pressure that children’s hospital services are under goes unnoticed, according to the president of the Royal College of Paediatrics and Child Health (RCPCH), Prof Terence Stephenson. The college is flagging up a serious shortage of consultants and the need to amalgamate some of the many smaller children’s units around the country in order to deliver safe care. At a time of budget cuts and when attention is on radical reform of the NHS, it may be still be hard to get attention – although a political storm blows up every time anybody suggests closing a hospital department.

“We have a very politicised health service compared to many European countries. When there is any discussion about changing hospital services, the MPs get very anxious,” Stephenson told the Guardian. “We’re not telling government or individual hospitals what to do. We’re trying to flag up that there is a big problem. The way we have done that is collect the data rather than shroud-wave.”

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The college’s data shows that a third of the 220 children’s units in the UK are not compliant with the EU working time directive. Doctors are forced to work longer than 48 hours, trainees – albeit senior trainees working to become consultants – are left in charge, locums are having to be employed and consultants end up having to stay overnight unexpectedly in the hospital because there is no one else.

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Under-investment in children’s services is partly to blame. The number of children arriving in accident and emergency has gone up by 12% since 2009 – now almost 4 million children a year, a quarter of all visits – possibly because GPs no longer routinely do their own out-of-hours cover. And a surprisingly low proportion – 37% – of GPs has done any training at all in paediatrics. In many other countries children are not taken to a GP but to a paediatrician.However, more children are being admitted – up by 13% over the past five years. Stephenson says this could be because trainees, with less confidence and experience, are more likely to admit a child and keep her in than a consultant.The college blueprint says the number of consultants needs to rise by 50%, and for those dealing with emergencies it needs to rise from 1,331 to 1,647. But there are also shortages of community paediatricians and consultants in 19 paediatrics sub-specialities, such as children’s cancer care and kidney disease. That would lead to a total rise from 3,084 to 4,625. [read the remainder of the article here]

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