Barack Obama signs health care bill amid warnings of Pyrrhic victory

President Barack Obama will sign into law the historic reform of the American health care system that has eluded his predecessors for a century on Tuesday. The 219 to 212 vote in the House of Representatives, in which 34 Democrats sided with a united Republican opposition, was a significant victory for Mr Obama. But critics warned it would be a Pyrrhic one that could lead to electoral disaster for his party in November's midterm elections. Mr Obama's poll ratings have fallen steadily to just under 50 per cent over the 14 months in which he has pushed relentlessly for health care reform.

The legislation, due to be signed by Mr Obama in a South Lawn ceremony, will expand health insurance coverage to 32 million currently uninsured Americans at a cost of $938 billion (£622 billion) over 10 years.

It will mandate that almost every American carry health insurance-a provision that opponents are set to challenge in the courts. The legislation expands Medicaid, the state health programme for the poor, while those earning more than $200,000 (£133,000) will face higher taxes.

A package of changes to an earlier bill passed by the Senate was still to be considered by the body but Democrats were confident that they had the votes to secure easy passage and Republicans conceded that their only options were future repeal and fighting provisions in the courts.

Robert Gibbs, the White House press secretary, responded jubilantly to the Capitol Hill vote late on Sunday with an email that played on Mr Obama's hope-laden campaign slogan: "Yes we can became yes we did."

Mr Obama himself proclaimed: "We pushed back on the undue influence of special interests. We didn't give in to mistrust or to cynicism or to fear. Instead, we proved that we are still a people capable of doing big things. This isn't radical reform but it is major reform.

Nancy Pelosi, Speaker of the House and the architect of the successful plan to pass the bill, described it as a "great act of patriotism" that honoured the vows of our Founders for us to be a land of opportunity, all the way back to before we were a country, in the Declaration of Independence talking about life, liberty and the pursuit of happiness".

However, critics warned that voters would have their revenge. Senator John McCain denounced the “euphoria” and “inside-the-Beltway champagne toasting” and predicted that Democrats would be punished by voters in the mid-term congressional elections. “We are going to have a very spirited campaign coming up between now and November. And there will be a very heavy price to pay for it,” he said.

Republicans said the bill would burden the nation with unaffordable levels of debt at a time of economic crisis, leave individual states with expensive new obligations and give an inefficient and overweening government an unacceptably enlarged role in the health care system.

The deal in the House of Representatives was sealed on Sunday afternoon when a handful of anti-abortion Democrats led by Representative Bart Stupak of Michigan agreed to vote yes in return for a White House executive order stating that federal funds would not be used to pay for abortions.

There was a feverish atmosphere on Capitol Hill, where large numbers of conservative protesters gathered to chant "Kill the bill" and wave signs that said "Don't Tread on Me" and "Doctors Not Dictators". John Boehner, Republican leader in the House of Representatives, said: "The American people are angry. This body moves forward against their will. Shame on us."

Representative Paul Ryan of Wisconsin, a rising star in the Republican party, denounced the bill as "a fiscal Frankenstein" while his colleague Virginia Foxx described it as "one of the most offensive pieces of social engineering legislation in the history of the United States".

Rush Limbaugh, the Right-wing radio host, spoke for many American conservatives when he railed: "We're not a representative republic. The will of the people was spat upon."

The legislation will still leave 23 million uninsured in 2019, a third of those illegal immigrants. According to the non-partisan Congressional Budget Office, the cost of the bill will be offset by savings in Medicare, the state health system for the elderly, and by new taxes and fees, including a tax on some employer schemes and on wealthy Americans.

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A Point of No Return?

by Thomas Sowell

With the passage of the legislation allowing the federal government to take control of the medical care system of the United States, a major turning point has been reached in the dismantling of the values and institutions of America. Even the massive transfer of crucial decisions from millions of doctors and patients to Washington bureaucrats and advisory panels-- as momentous as that is-- does not measure the full impact of this largely unread and certainly unscrutinized legislation.

If the current legislation does not entail the transmission of all our individual medical records to Washington, it will take only an administrative regulation or, at most, an Executive Order of the President, to do that. With politicians now having not only access to our most confidential records, and having the power of granting or withholding medical care needed to sustain ourselves or our loved ones, how many people will be bold enough to criticize our public servants, who will in fact have become our public masters?

Despite whatever "firewalls" or "lockboxes" there may be to shield our medical records from prying political eyes, nothing is as inevitable as leaks in Washington. Does anyone still remember the hundreds of confidential FBI files that were "accidentally" delivered to the White House during Bill Clinton's administration? Even before that, J. Edgar Hoover's extensive confidential FBI files on numerous Washington power holders made him someone who could not be fired by any President of the United States, much less by any Attorney General, who was nominally his boss.

The corrupt manner in which this massive legislation was rammed through Congress, without any of the committee hearings or extended debates that most landmark legislation has had, has provided a roadmap for pushing through more such sweeping legislation in utter defiance of what the public wants.

Too many critics of the Obama administration have assumed that its arrogant disregard of the voting public will spell political suicide for Congressional Democrats and for the President himself. But that is far from certain. True, President Obama's approval numbers in the polls have fallen below 50 percent, and that of Congress is down around 10 percent. But nobody votes for Congress as a whole, and the President will not be on the ballot until 2012.

They say that, in politics, overnight is a lifetime. Just last month, it was said that the election of Scott Brown to the Senate from Massachusetts doomed the health care bill. Now some of the same people are saying that passing the health care bill will doom the administration and the Democrats' control of Congress. As an old song said, "It ain't necessarily so."

The voters will have had no experience with the actual, concrete effect of the government takeover of medical care at the time of either the 2010 Congressional elections or the 2012 Presidential elections. All they will have will be conflicting rhetoric-- and you can depend on the mainstream media to go along with the rhetoric of those who passed this medical care bill.

The ruthless and corrupt way this bill was forced through Congress on a party-line vote, and in defiance of public opinion, provides a road map for how other "historic" changes can be imposed by Obama, Pelosi and Reid.

What will it matter if Obama's current approval rating is below 50 percent among the current voting public, if he can ram through new legislation to create millions of new voters by granting citizenship to illegal immigrants? That can be enough to make him a two-term President, who can appoint enough Supreme Court justices to rubber-stamp further extensions of his power.

When all these newly minted citizens are rounded up on election night by ethnic organization activists and labor union supporters of the administration, that may be enough to salvage the Democrats' control of Congress as well.

The last opportunity that current American citizens may have to determine who will control Congress may well be the election in November of this year. Off-year elections don't usually bring out as many voters as Presidential election years. But the 2010 election may be the last chance to halt the dismantling of America. It can be the point of no return.

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THE DOCTORS OF THE HOUSE

House Democrats last night passed President Obama's federal takeover of the U.S. health-care system, and the ticker tape media parade is already underway. So this hour of liberal political victory is a good time to adapt the "Pottery Barn" rule that Colin Powell once invoked on Iraq: You break it, you own it.

This week's votes don't end our health-care debates. By making medical care a subsidiary of Washington, they guarantee such debates will never end. And by ramming the vote through Congress on a narrow partisan majority, and against so much popular opposition, Democrats have taken responsibility for what comes next—to insurance premiums, government spending, doctor shortages and the quality of care. They are now the rulers of American medicine.

Mr. Obama and the Democrats have sold this takeover by promising that multiple benefits will follow: huge new subsidies for the middle class; lower insurance premiums for consumers, especially those in the individual market; vast reductions in the federal budget deficit and in overall health-care spending; a more competitive U.S. economy as business health-care costs decline; no reductions in Medicare benefits; and above all, in Mr. Obama's words, that "if you like your health-care plan, you keep your health-care plan."

We think all of this except the subsidies will turn out to be illusory, as most of the American public seems intuitively to understand. As recently as Friday, Caterpillar Inc. announced that ObamaCare will increase its health-care costs by $100 million in the first year alone, due to a stray provision about the tax treatment of retiree benefits. This will not be the only such unhappy surprise.

While the subsidies don't start until 2014, many of the new taxes and insurance mandates will take effect within six months. The first result will be turmoil in the insurance industry, as small insurers in particular find it impossible to make money under the new rules. A wave of consolidation is likely, and so are higher premiums as insurers absorb the cost of new benefits and the mandate to take all comers.

Liberals will try to blame insurers once again, but the public shouldn't be fooled. WellPoint, Aetna and the rest are from now on going to be public utilities, essentially creatures of Congress and the Health and Human Services Department. When prices rise and quality and choice suffer, the fault will lie with ObamaCare.

While liberal Democrats are fulfilling their dream of a cradle-to-grave entitlement, their swing-district colleagues will pay the electoral price. Those on the fence fell in line out of party loyalty or in response to some bribe, and to show the party could govern. But even then Speaker Nancy Pelosi could only get 85% of her caucus and had to make promises that are sure to prove ephemeral.

Most prominently, she won over Michigan's Bart Stupak and other anti-abortion Democrats with an executive order from Mr. Obama that will supposedly prevent public funds from subsidizing abortions. The wording of the order seems to do nothing more than the language of the Senate bill that Mr. Stupak had previously said he couldn't support, and of course such an order can be revoked whenever it is politically convenient to do so.

We have never understood why pro-lifers consider abortion funding more morally significant than the rationing of care for cancer patients or at the end of life that will inevitably result from this bill. But in any case Democratic pro-lifers sold themselves for a song, as they usually do.

Then there are the self-styled "deficit hawks" like Jim Cooper of Tennessee. These alleged scourges of government debt faced the most important fiscal vote of their careers and chose to endorse a new multitrillion-dollar entitlement. They did so knowing that the White House has already promised to restore some $250 billion in reimbursement cuts for doctors that were included in yesterday's bill to make the deficit numbers look good. Watch for these Democrats to pivot immediately and again demand "tough choices" on spending—and especially tax increases—but this vote has squandered whatever credibility they had left.

Mrs. Pelosi did at least abandon, albeit under pressure, the "deem and pass" strategy that would have passed the legislation without a vote on the actual Senate language. We and many others criticized that ruse early last week, and the House decision to drop it exposes the likes of Norman Ornstein of the American Enterprise Institute and other analysts who are always willing to defend the indefensible when Democrats are doing it.

All of this means the Senate's Christmas Eve bill is ready for Mr. Obama's signature, though only because rank-and-file House Members also passed a bill of amendments that will now go back to the Senate under "reconciliation" rules that require only 50 votes. Those amendments almost certainly contravene the plain rules of reconciliation, and the goal for Senate Republicans should be to defeat this second "fix-it" bill. It's notable that Democrats didn't show yesterday for a meeting with the Senate parliamentarian to consider GOP challenges, no doubt because they fear some of them might be upheld.

Though it's hard to believe, the original Senate bill is marginally less harmful than the "fixed" version, not least because the middle-class insurance subsidies are less costly and it would avert the giant new payroll tax. That's the White House increase in the Medicare portion of the payroll tax to 3.8% that Democrats cooked up at the last minute and would apply to the investment income of taxpayers making more than $200,000.

If the reconciliation bill goes down, Big Labor and its Democratic clients would be forced to swallow a larger excise tax on high-cost insurance plans, and it would also forestall the private student-loan takeover that Democrats included as a sweetener. In other words, they'd be forced to eat the sausage they themselves made as they have abused Congressional procedure to push ObamaCare into law.

We also can't mark this day without noting that it couldn't have happened without the complicity of America's biggest health-care lobbies, including Big Pharma, the American Medical Association, the American Hospital Association, the Federation of American Hospitals, the Business Roundtable and such individual companies as Wal-Mart. They hope to get more customers, or to reduce their own costs, but in the end they have merely made themselves more vulnerable to the gilded clutches of the political class.

While the passage of ObamaCare marks a liberal triumph, its impact will play out over many years. We fought this bill so vigorously because we have studied government health care in other countries, and the results include much higher taxes, slower economic growth and worse medical care. As for the politics, the first verdict arrives in November

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Health care reform: We’re being fooled again

The medical system does need reforming — radical reforming. It’s more expensive than it ought to be, and powerful interests prosper at the expense of the rest of us. The status quo has little about it to be admired, and we shouldn’t tolerate it.

Thus, the American people should be fed up with Barack Obama, Nancy Pelosi, and Harry Reid for insulting our intelligence with their so-called heath-care reform. It is nothing of the sort. What they call progressive reform is little more than reinforcement of the exploitative system we suffer today.

Whether intentionally or not, Obama & Co. have misdiagnosed the problem with the current system and therefore have issued a toxic prescription as an alleged cure. They essentially say that the problem is too free a market in medical care and insurance; thus for them the solution is a less-free market, that is, more government direction of our health-care-related activities.

Yet if the diagnosis is wrong — which it is — the prescription will also be wrong.

Note that the attention of nearly all the “reformers” is on the insurance industry. What ostensibly started out as “health-care reform” quickly became health-insurance regulation. A common theme of all of the leading proposals is that insurance companies have too few restrictions on them. So under Obamacare, government will issue more commands: preexisting conditions must be covered; policy renewal must be guaranteed; premiums may not reflect the health status or sex of policyholders; the difference between premiums charged young and old must be within government specs; lifetime caps on benefits are prohibited, et cetera.

In return for these new federal rules, insurance companies are to have a guaranteed market through a mandate that will require every person to have insurance. So what looks like onerous new regulations on the insurance companies turns out to be a bargain they are happy to accept. Instead of having to innovatively and competitively attract young healthy people to buy their products, the companies will count on the government to compel them to do so. Playing the populist role, Obama & Co. bash the insurance companies, but in fact the “reform” compels everyone to do business with them.

What about this would the insurance companies dislike? Health insurance is not the most profitable business you can be in; the profit margin is 3-4 cents on the dollar. So a guaranteed clientele is an attractive prospect. The people who will be forced to buy policies are the healthy, who will pay premiums and make few claims. The only thing the companies don’t like is that that penalty for not complying with the mandate is too small. Many young people may choose to pay the penalty rather than buy the insurance because it will be cheaper. But that presents a problem: when the uninsured get sick and apply for coverage, they won’t be turned down because that would be against the law. So look for harsher penalties in the future to prevent this gaming of the system. The insurance companies win again.

What’s missed is that the “reformers” leave untouched every aspect of the uncompetitive medical and insurance cartels that exists entirely by virtue of government privilege. Most of this privilege is extended by state governments through monopolistic licensing, but Congress could repeal the prohibition on interstate insurance sales and the tax favoritism for employer-provided medical coverage. The ruling party has refused to consider those sensible moves.

The upshot is that this reform is a fraud. It leaves in place the government-created cartels and throws a few crumbs to people who are struggling — but mostly by bolstering the insurance monopoly.

Two myths must be shattered. First, the choice is not between this phony reform and the status quo. The “reform” merely puts makeup on the status quo. The free market is the real alternative.

Second, the free market couldn’t have created the medical mess because there has been no free market in medicine. For generations government has colluded with the medical profession and the insurance industry to force-feed us the system we have today.

The Who was wrong: We are being fooled again.

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Our future under Obamacare

The bill will cost more than advertised. It won't be long before Congress is shocked — shocked! — to discover that health-care reform is going to cost a lot more than expected. It's not just the budgetary gimmicks that Democrats have been employing to hide the bill's true cost. It's also that government programs — and government health-care programs in particular — almost always end up exceeding their cost estimates.

For example, when Medicare was instituted in 1965, it was estimated that the cost of Medicare Part A would be $9 billion by 1990. In actuality, it was seven times higher — $67 billion. Similarly, in 1987, Medicaid's special hospitals subsidy was projected to cost $100 million annually by 1992, just five years later; it actually cost $11 billion, more than 100 times as much. And in 1988, when Medicare's home-care benefit was established, the projected cost for 1993 was $4 billion, but the actual cost in 1993 was $10 billion.

Insurance premiums will keep rising. The president has tried to convince people that health-care reform will cut their insurance costs. They are in for a surprise. According to the Congressional Budget Office, insurance premiums will double in the next few years. The bill will do nothing to diminish that increase. In fact, for the millions of Americans who get their insurance through the individual market, rather than from an employer, this bill will raise premiums by 10–13 percent more than if we do nothing. Young and healthy people can expect their premiums to go up even more.

The quality of care will be worse. Doctors' reimbursements for providing care will be squeezed, making it harder to find a doctor. A new survey in the New England Journal of Medicine reports that 46 percent of doctors may give up their practice in the wake of this bill. While that is probably exaggerated, many doctors will likely decide to reduce their patient loads or retire. At the same time, increased demand will create additional problems.

In Massachusetts, after the passage of Romneycare, the wait to see a primary-care physician increased from 33 to 52 days. Research and development will also be cut back, meaning there will be fewer new drugs and other medical breakthroughs. And the government will increasingly intervene in medical decision making, micromanaging medical decisions and deciding what treatments are most effective or, frighteningly, most cost-effective.

The Left will keep pushing for more. Speaker Nancy Pelosi's inner censor was clearly on the fritz this week when she said, "Once we kick through this door, there'll be more legislation to follow." Faced with rising costs and higher premiums, not to mention millions still uninsured, Democrats will blame the "evil" insurance companies and demand further reform. They will argue that we tried "moderate" reform and failed. Pelosi could no longer keep a lid on what the hard Left has been restraining itself from saying all along: It sees this legislation as the perfect first step in the long march to universal single-payer health care.

Republicans won't really try to repeal it. Republicans will run this fall on a promise to repeal this deeply unpopular bill, and will likely reap the political advantages of that promise. But in reality there is little chance of their following through. Even if Republicans were to take both houses of Congress, they would still face a presidential veto and a Democratic filibuster.

But more important, once an entitlement is in place, it becomes virtually impossible to take away. The fact that Republicans have been criticizing Obamacare for cutting Medicare shows that they are not really willing to take the heat for cutting people's benefits once they have them — no matter how unaffordable those benefits are. Paul Ryan put forth a serious plan for entitlement reform — and attracted just six co-sponsors at last count. Enough said.

As Scrooge asked in A Christmas Carol, "Are these the shadows of the things that will be, or are they shadows of things that may be?

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A View from Britain

A British friend who has been following the health-care debate writes in:

In Britain the introduction of the NHS was passionately supported by both parties. Tory opposition to the legislation accepted the principle of medical care free at the point of consumption and concentrated instead on secondary questions. It could hardly have done otherwise since Churchill's wartime coalition government had developed its own plans for a single-payer system of universal health insurance—along with other statist social welfare measures.

At the time of its passage the cost-benefit structure of the new British system was radically opposite to that of Obamacare. Its benefits—mainly the extension of free medical care from the poor to the middle class—came at once; its costs were delayed for a decade and a half as almost all budgetary health allocations went to current spending and almost none to capital investment. Not until 1962 did a British government embark on a hospital building program; until then—and for many years afterwards—the national health service lived off the fixed capital invested by private Victorian philanthropy. (Even a few years ago you could tell this from the appearance of the buildings.) The advance of medical science today makes a repeat of this performance quite impossible. So the money to meet the increasing demand for medical services will have to come from somewhere other than the capital budget. Where?

Rationing is implicit in both Obamacare and the NHS. But the customers of both systems are very different. Most modern Americans get good health care. They have learned to expect it. They will complain if they don't get it. And they have their present care as a method of comparison to any new system. Brits in 1948 had just survived a terrible war. Rationing was part of their everyday lives. They were a deferential people to begin with in a much more hierarchical society. Brits of today would be much much harder to convince—if they had not got used to getting free but inadequate health care.

And the ratio of winners to losers in both cases is very different. As the previous paragraph suggests, there were no real losers in the Britain of 1948. Only a tiny handful of very rich people had any experience of great medical care—and they were rich enough to pay higher taxes AND private insurance premiums. Everyone else got roughly the same medical care; but now the middle class got it for nothing as most of the poor had done before. Nobody lost—not for another fifteen years when the quality of medical care began to decline noticeably. And by then they were hooked. By contrast almost every insured Ameerican is a potential loser under Obamacare. And some of those considered to be winners—i.e., the currently non-insured—will feel like losers if they are forced to insure and then remain inconveniently healthy.

So, for all sorts of reasons, opponents of this bill should not feel deterred from hope of repeal by the British experience. At the very least they have a window of opportunity to reverse the legislation of about eight to ten years. It's doable if you think it's doable—not if not.

Finally the wise words of . . . John Maynard Keynes: "The unexpected always happens; the inevitable never."

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SOCIALIZED MEDICINE IN PRACTICE

Below are five reports from just ONE DAY in Britain

Terrifyingly inept foreign doctors are a symptom of a sickness in the NHS - not the cause

By Professor Karol Sikora

When a supposed cure has instead become a new kind of sickness, then surely something is badly wrong. Yet that is what has happened in the modern NHS. The target culture brought in to benefit patients is having fatal consequences. A system that originally aimed to improve performance and efficiency is now threatening patients' lives, distorting clinical priorities and encouraging the use of foreign doctors, who may be too inexperienced or unqualified for the jobs they have been given.

The tragic case of 94-year-old Ena Dickinson is a heart-rending example of what can go wrong in a health service that puts compliance with political requirements above the real needs of patients. Mrs Dickinson, a Lincolnshire grandmother, died in 2008, soon after she underwent a hip replacement operation which was carried out at Grantham Hospital by a German locum surgeon, Dr Werner Kolb. In an appalling series of errors, Dr Kolb cut through the wrong muscle, severed an artery and used the wrong cutting tool, with the result that Mrs Dickinson lost almost half her blood in an operation that should have been routine. One witness, another doctor from the hospital, said he was 'horrified by what I saw', while an expert surgical witness, Professor Angus Wallace, told the inquest on Tuesday that he 'could not believe the level of neglect in the operation'.

The episode raises troubling questions about the NHS's increasing reliance on foreign doctors, both from the European Union and from further overseas, a practice that has been driven partly by the Government's fixation with meeting targets and partly by an inadequate supply in the number of domestic trained doctors.

We do not, of course, live in an insular world and overseas doctors have long been an integral part of the NHS. Indeed, when I first worked in the NHS in the early Seventies, I saw that the service would not have been able to function without the support of doctors from Asia. And, whether we like it or not, Britain is part of the European Union, one of whose guiding principles is the free movement of labour throughout the member states. So, without drastic political changes to the very nature of our society, we would not be able to adopt a siege mentality when it comes to employment in the NHS.

Nevertheless, the disastrously botched operation that Mrs Dickinson suffered highlights a worrying trend, where too often foreign doctors have been imported to provide cover in the NHS, without any proper checks on their background, their ability to speak English, their experience or their competence.

According to reports about Dr Werner Kolb, he had actually performed few hip operations during his career and had spent most of his recent years giving lectures, hardly a record to inspire confidence in the operating theatre. Dr Kolb's negligence may be particularly graphic, because of the way he sawed through the wrong muscle, like some grotesquely inept carpenter.

Some might argue, therefore, that it is particularly dangerous to let foreign doctors carry out surgery without rigorous monitoring. But this would be a fallacy. Every branch of medicine, from general practice to pathology, has the potential to do mortal harm because of its intimate connection with the delicate structure of the human body. In my own field of cancer care, disasters can occur because of a misdiagnosis or the administration of the wrong dosage of drug.

The calamitous risks of incompetence by GP locums were illustrated in early 2008 by Dr Daniel Ubani, who flew in from Germany to Cambridgeshire to provide weekend cover for a local practice, only to end up killing one pensioner, David Gray, by accidentally giving him ten times the maximum dosage of diamorphine. The coroner then said Mr Gray's death had been caused by 'gross negligence', words that carry a chilling echo in the Dickinson case.

One of the key problems is that, under an EU directive of 2004, doctors who qualify in any EU country can move to work in any other EU state without even the most limited examination of their skills, aptitude or language. In contrast, foreign doctors (ie from outside the EU) must pass a skills and English language test - yes, even the Australians and Americans.

EU countries are also not forced to provide information on their doctors' professional histories - for example, whether they have been struck off for committing a criminal offence or killing a patient through negligence.

There are estimated to be around 20,000 EU doctors registered to work in the NHS, a quarter of them from the former Eastern Bloc countries.

Now the vast majority of them are certainly perfectly competent, but, even so, difficulties will inevitably arise over language and culture. Every nation, for instance, has its own medical hierarchies, differing relationships between doctors and nurses, or unique approaches to patient care.

Moreover, foreign doctors without a sound grasp of English will not understand what their patients are telling them, something that is a particular concern in GP services.

It is telling that EU doctors are twice as likely to face disciplinary hearings before the General Medical Council as their British counterparts, in which foreign doctors from outside the EU are three times as likely to be struck off the medical register - statistics that point to the laxity of checks.

We cannot blame foreign doctors for wanting to work in the NHS. Britain has one of the best-rewarded medical professions in the world, with GPs earning on average over £100,000-a-year and leading consultants far more. These are incredible riches for doctors from the old Soviet sphere of influence. In Poland, where my family has some of its roots, a doctor is likely to earn around £500 a month or £6,000-a-year, a sum that can be made with a few weekend or holiday stints in Britain. As a consequence, one in six of Poland's doctors now works abroad.

Nor is the NHS management entirely to blame for the catalogue of controversies that has arisen from the employment of foreign staff. NHS bosses are under tremendous pressure to meet waiting lists targets set by the Government, so they will take any action, bear almost any cost, to achieve this. So rather than postpone operations during periods when staff are on leave, they bring in foreign doctors to keep the conveyor belt moving.

In Ena Dickinson's case, it would not have mattered if her hip replacement operation had been delayed by a week or two, but no doubt the management of Grantham Hospital was appalled at the idea of slipping behind the Government's arbitrary 18-week deadline for such routine surgery. So, in a disastrous misjudgment, Dr Kolb was brought in so the needs of bureaucracy, if not the patient, could be met.

The problem has been compounded by the Government's failure to assess correctly the needs of the NHS for doctors, with the result that foreign doctors have been brought in to cover gaps in supply. It must be admitted that the demands on the NHS have grown enormously in recent years as a consequence of increasing numbers of elderly patients, a growth in the British population and advances in medical care. Twenty years ago, the idea of carrying out a hip replacement operation on a 94-year-old grandmother would have been unthinkable.

Moreover, the EU working time directive drastically reduced the number of hours that any doctor could be on duty, which meant that more staff had to be made available. But the need to increase the supply of doctors only emphasises the need to scrutinise their competence more vigorously. What we need, therefore, is an assessment of their skills by practical and verbal demonstration, accompanied by checks on their background and a basic language test. We're doing it for our own graduates, after all. That is what our NHS patients deserve. We cannot allow any more tragedies like that of Ena Dickinson.

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Killer Muslim doctor with repeated disregard for patients is suspended for just FOUR MONTHS by British regulators

A doctor with a 'disregard' for patient safety was suspended for just four months today for sending home a baby girl who died the next day from blood poisoning. Dr Salawati Abdul-Salam failed to spot little Aleesha Evans' deadly condition and sent her home saying she had a viral infection that needed only Calpol and Nurofen. She died the next day.

A year before the baby's death, another of Abdul-Salam's patients died after a wrong diagnosis, while a pensioner suffered a collapsed lung under the trainee's care. GMC panel chairman Professor Denis McDevitt said the doctor's actions demonstrated a 'total lack of attention to detail' and a 'serious degree of carelessness.'

Colin Perriam, 66, had died after Abdul-Salam analysed six-month old blood samples, then wrongly diagnosed a ruptured ulcer as constipation. Mr Perriam was discharged from Cardiff's University Hospital of Wales on December 15, 2004 with a prescription of laxatives.

Widow Pamela Perriam had told the hearing: 'She said that he was suffering from constipation. 'We were given some powders that you mix with water for mild constipation and we were not given any other instructions. 'We were not given anything else except to say that it was mild constipation and mild laxatives should deal with the problem.'

But the next day Mr Parriam could not get out of bed and when his stomach appeared swollen and blotchy the following evening, his wife called an ambulance. By the time it arrived her husband was unconscious. Mr Parriam underwent emergency surgery but never recovered and died the next day on February 5, 2005.

A month earlier, Abdul-Salam gave a 79-year-old woman an unnecessary chest drain after reading the wrong x-ray. She had to apologise after the elderly woman's lung collapsed.

On August 9, 2006, Aleesha Evans was rushed to the Royal Gwent Hospital in Newport, Wales, vomiting with a rash and a temperature of 37 degrees. But the trainee specialist registrar did not even examine the baby and discharged her two hours later after noting her condition was 'unremarkable.' The doctor had seen the patient by this stage and noted she appeared to be better than she had been and that she was playing. But her heart rate was still high and her temperature had risen to 39 degrees, the hearing was told. The baby was discharged at 11pm with a diagnosis of viral illness.

But she was suffering from meningococcal septicaemia - blood poisoning - and died the following day. Abdul-Salam was placed under supervision at the Princess of Wales Hospital in Bridgend after Aleesha's death. She was only allowed to perform three hours of clinical work a day and had to sign every patient off with a supervisor. But within three weeks Abdul-Salam had broken the terms of her training and more than a third of her patients had been discharged without her superior's consent.

One of these patients was a 10-year-old girl with a broken wrist who attended A&E on 22 September 2008. The child required treatment under anaesthetic but Abdul-Salam discharged her to the outpatient fracture clinic.

Prof McDevitt told Abdul-Salam: 'The panel has concluded that you have not yet fully appreciated the magnitude of your deficient performance and misconduct. 'You demonstrated poor judgment when under pressure. Your lack of careful clinical method resulted in the inadequate assessment and management of patients and you failed to appreciate fully the discordance between the patients' clinical condition and the results of investigations. 'The panel considers there remains of risk of you repeating errors and exercising poor judgment, particularly if you were to return to work in a more pressures environment than you are currently exposed to.'

Prof McDevitt said the panel had considered imposing conditions on Abdul-Salam's practice but concluded her actions involving baby Aleesha Evans were too serious: 'Taking all the factors into account, the panel concluded that your registration should be suspended for a period of four months. 'Your misconduct was sufficiently serious to undermine public confidence in the profession. It is also important that you, and the medical profession, are left in no doubt that such behaviour, which clearly had consequences for patient safety, is unacceptable.'

The doctor had been working as a locum at the Kent and Sussex Hospital in Tunbridge Wells, Kent for the last five months, but she will now be unable to keep her job.

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British doctors who wouldn't listen allow little girl to die

An eight-year-old girl with an acute fear of dentists who starved to death after her milk teeth were taken out under anaesthetic died because of a “lack of communication” between health agencies, an investigation has concluded.

Sophie Waller refused to open her mouth even to eat after the operation. She had developed her phobia at the age of four when her tongue was scratched during a routine check-up. When she refused treatment after cracking a tooth on a boiled sweet her parents became so concerned they took her to their GP who referred her to the Royal Cornwall Hospital in Truro.

Surgeons decided to remove eight remaining milk teeth under anaesthetic to avoid problems in future. But she was left so traumatised by it she refused to open her mouth to eat or drink.

A report by the Local Safeguarding Children Board has now found there was a “lack of clarity” from the agencies responsible for Sophie’s care after her discharge from hospital. She was sent home despite her condition and her parents did not know who to turn to when her health deteriorated.

By the time of her death in December 2005 Sophie, from St Dennis in Cornwall, was severely malnourished and weighed just 22kg. Her parents had been feeding her a diet of yoghurt and mashed fruit and tried to get help from their GP and the hospital but were instead referred to a child psychologist.

She was found dead in bed by her mother four weeks after her discharge and the cause of death was given as kidney failure as a result of starvation and dehydration. An inquest in February 2009 found there was no blame attached to her parents who had tried to get help for their daughter.

The serious case review found of a lack of communication between all the health agencies involved in her care. The report says: “No clear written plan was made on discharge and there was lack of clarity about responsibility for medical review following discharge.

“The clinical psychologist made telephone contact with the child’s parents in the week after discharge but did not see her again. “There was a lack of clarity over the open door arrangement which was intended to allow the child’s parents to bring her back in the week following discharge. When they phoned for advice on the seventh day, they were referred back to the psychologist for support.”

Her mother Janet Waller, a nursery school teacher who has two other children, said the report highlighted how their pleas should have been heard. She said: “All we’ve wanted all along is for people to listen to us. People ask me how many children I have, I say three, but technically I haven’t any more. I’ve got to live with this for the rest of my life.”

At Sophie’s inquest in February last year the Cornwall coroner, Dr Emma Carlyon, said that the Royal Cornwall Hospital was guilty of a number of failings which led to Sophie’s death. She said: “The severity of her malnutrition and dehydration was not recognised. This prevented her from receiving the medical support that could have prevented her death.”

Dr Ellen Wilkinson, Medical Director of Royal Cornwall Hospital Trust, said: “We would like to apologise to the family of Sophie Waller. Everyone involved in her care was saddened by her tragic death. This was a very unusual case. “There were shortcomings in the communication between the health organisation and Sophie’s parents.”

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'Blood-spattered walls and mouldy equipment': How a quarter of British government hospitals fail to meet basic hygiene tests

A quarter of NHS hospital trusts are failing to meet basic hygiene standards, with some treating patients on blood-spattered wards or with dirty equipment, a damning report has found. A third of ambulance trusts have also missed the targets set, according to the Care Quality Commission. The watchdog's report follows the introduction of tough new hygiene standards after a series of scandals at hospitals in Maidstone, Basildon and Stafford.

It also came as a survey of NHS employees found many are too overstretched to do their jobs properly because of staff shortages.

On hygiene, the CQC found 42 out of the 167 NHS trusts inspected were in 'breach' of registration requirements by failing to meet standards, with some hospitals being warned over blood-spattered wards and dirty equipment. In Basildon, where at least 70 patients died as a result of poor hygiene last year, investigators found a commode soiled under the seat and 'procedure trays, used by staff to carry equipment when they take blood samples or give injections, had blood spattered on them'.

At children's hospital Alder Hey, in Liverpool, the inspection revealed dirty toys, hair stuck to medical equipment and 'nappy changing mats stored on the floor next to a toilet'. Water 'ran brown' from taps in patient areas.

A total of 36 trusts did not provide areas to decontaminate instruments, three trusts failed to flush unused water regularly to control legionella outbreaks, and a dozen failed to keep clinical areas clean. The situation was so bad at four ambulance trusts that they were given written warnings about the state of their vehicles and stations.

Nigel Ellis, the CQC's head of inspection, said: 'We have on rare occasions found evidence of a direct risk to patients and have intervened using our enforcement powers to ensure swift improvements were made. 'In over half of trusts we have made some suggestions or requirements for improvements to ensure their practices are the best they can be.'

A spokesman for the Department of Health said: 'There's no doubt that the trusts rose to the challenge --we've seen swift and tangible improvements in their performance, and on follow-up meetings all met the required standards.'

Meanwhile, half of NHS workers claim that staff shortages are stopping them doing their jobs properly. Of the 160,000 workers questioned by the CQC, 46 per cent said they were unable to do a proper job.

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One in ten doctors in Britain is foreign and untested

Almost one in ten doctors on the medical register comes from the EU and has not had to take any language or competence tests before working in Britain. The shocking figure exposes the lax controls over European locums taking up hospital posts in the NHS and providing out-of-hours GP cover. Unlike doctors from elsewhere in the world - who are forced to prove language skills and medical knowledge before being registered - such testing is forbidden for doctors qualified in Europe and Switzerland.

Campaigners want a complete overhaul of the system after the death of a grandmother following appalling blunders by a German surgeon flown in by the NHS. Ena Dickinson, 94, lost nearly half the blood in her body during what was meant to be a routine hip operation at Grantham Hospital in Lincolnshire. Werner Kolb, who had been working in the NHS for three weeks, severed an artery and became so flustered he started speaking German in the operating theatre.

An expert witness described it as the worst case of negligence he had come across - yet Dr Kolb, pictured today for the first time, was left free to work in the UK for a further eight months before being suspended by the General Medical Council.

Dr Kolb, who had been mainly lecturing for four years before the tragedy, refused to attend the inquest and denied his conduct had anything to do with Mrs Dickinson's death eight weeks later from pneumonia. Last night a colleague at Bethesda Hospital in Stuttgart insisted: 'I find it hard to reconcile the words said against him in Britain with the precise surgeon I know.'

But Mrs Dickinson's daughter Kathy Ingram, 57, said: 'The system is disgraceful and clearly isn't working. NHS trusts have to assume that locum doctors' qualifications from Europe are reliable without doing their own checks. 'You trust your doctor because he's in authority but if he hasn't been verified and isn't monitored, you never know what standard of treatment you'll get. The law has to be changed so that there is closer monitoring.'

Figures show there are more than 230,000 doctors on the GMC register of which 21,451 - almost 10 per cent - gained their qualifications in other EU countries. The ban on checks comes from a European directive ordering member states to allow workers free movement. This means the GMC is forced to accept qualifications at 'face value', according to its chief executive Niall Dickson.

The GMC has protested about the rights of doctors to work freely across Europe being put ahead of a patient's right to safe treatment. In a presentation to the EU's Green Paper on the European Workforce for Health, it said: 'Legislation must be amended to allow healthcare regulators across Europe to establish that a doctor has the level of language proficiency necessary to practise safely. 'We are also prevented from adopting a general requirement to prove competence and cannot specify the standard of acceptable competence. 'The current situation is profoundly at odds with the pursuit of safe and high quality health care.'

Dr Vivienne Nathanson, head of science and ethics at the British Medical Association, said: 'Whilst it is essential doctors are able to communicate with their patients and the regulatory authorities are able to assess fitness to practise, it is also important we don't make it impossible for those that do have the appropriate skills to work in the UK.'

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Obama hones final health care pitch

Fighting to overcome the impression of high spending and backroom deals, President Obama has honed his health care message to highlight his bill's benefits to consumers — from better Medicare prescription-drug coverage for seniors to guaranteeing insurance regardless of pre-existing conditions.

Supporters say the White House's public relations offensive has breathed new life into Democrats' last-ditch effort to pass the legislation by next week. "So much of his activity in the last few weeks has been around health care," said Karen Davenport, director of health policy at the liberal Center for American Progress. "And I think the power of the presidency drives the stories and makes a huge difference."

After months of drift, with the House and Senate arguing over competing bills, Mr. Obama has taken control of the debate, combining the two bills into a grand compromise, adding Republican ideas and dubbing it bipartisan. On Monday, both he and Democratic leaders said they were very optimistic it would become law.

Mr. Obama took his health care pitch on the road Monday for the third time in one week, traveling to Ohio to again make his case that Congress should ignore the political implications of supporting his bill and vote for it because it's the right thing to do. "The American people want to know if it's still possible for Washington to look out for these interests, for their future," Mr. Obama told a crowd in Strongsville. "So what they're looking for is some courage. They're waiting for us to act. They're waiting for us to lead. They don't want us putting our finger out to the wind. They don't want us reading polls."

Democrats don't yet have the 216 votes required to pass the bills, but House Speaker Nancy Pelosi reaffirmed Monday that they will collect them, dismissing the concerns of some House Democrats about federal funding of abortion, Medicaid funding, Medicare reimbursement rates and the exclusion of protections for illegal immigrants. She called them unfounded. "When we bring a bill to the floor, we will have the votes," she said at a press conference while surrounded by more than a dozen babies and representatives of children's groups that support the health care reform plan.

The yearlong push for health care has seen a series of starts and missteps, culminating with Republican Sen. Scott Brown's surprise victory in a special election to fill the seat of the late Sen. Edward M. Kennedy, Massachusetts Democrat. That victory denied Democrats their filibuster-proof majority in the Senate, and gave backers in both chambers pause.

More here






Talking Points vs. Realty

by Thomas Sowell

In a swindle that would make Bernie Madoff look like an amateur, Barack Obama has gotten a substantial segment of the population to believe that he can add millions of people to the government-insured rolls without increasing the already record-breaking federal deficit.

Those who think in terms of talking points, instead of realities, can point to the fact that the Congressional Budget Office has concurred with budget numbers that the Obama administration has presented. Anyone who is so old-fashioned as to stop and think, instead of being swept along by rhetoric, can understand that a budget-- any budget-- is not a record of hard facts but a projection of future financial plans. A budget tells us what will happen if everything works out according to plan.

The Congressional Budget Office can only deal with the numbers that Congress supplies. Those numbers may well be consistent with each other, even if they are wholly inconsistent with anything that is likely to happen in the real world.

The Obama health care plan can be financed without increasing the federal deficit-- if the administration takes hundreds of billions of dollars from Medicare. But Medicare itself does not have enough money to pay its own way over time.

However money is juggled in the short run, the government's financial liabilities are increased by adding this huge new entitlement of government-provided insurance. The fact that these new financial liabilities can be kept out of the official federal deficit projection, by claiming that they will be paid for with money taken from Medicare, changes nothing in the real world.

I can say that I can afford to buy a Rolls Royce, without going into debt, by using my inheritance from a rich uncle. But, in the real world, the question would arise immediately whether I in fact have a rich uncle, not to mention whether this hypothetical rich uncle would be likely to leave me enough money to buy a Rolls Royce.

In politics, however, you can say all sorts of things that have no relationship with reality. If you have a mainstream media that sees no evil, hears no evil and speaks no evil-- when it comes to Barack Obama-- you can say that you will pay for a vast expansion of government-provided insurance by taking money from the Medicare budget and using other gimmicks.

Whether this administration, or any future administration, will in fact take enough money from Medicare to pay for this new massive entitlement is a question that only the future can answer, regardless of what today's budget projection says. On paper, you can treat Medicare like the hypothetical rich uncle who is going to leave me enough money to buy a Rolls Royce. But only on paper. In real life, you can't get blood from a turnip, and you can't keep on getting money from a Medicare program that is itself running out of money.

An even more transparent gimmick is collecting money for the new Obama health care program for the first ten years but delaying the payments of its benefits for four years. By collecting money for 10 years and spending it for only 6 years, you can make the program look self-supporting, but only on paper and only in the short run. This is a game you can play just once, during the first decade. After that, you are going to be collecting money for 10 years and paying out money for 10 years. That is when you discover that your uncle doesn't have enough money to support himself, much less leave you an inheritance to pay for a Rolls Royce.

But a postponed revelation is not part of the official federal deficit today. And that provides a talking point, in order to soothe people who take talking points seriously.

Fraud has been at the heart of this medical care takeover plan from day one. The succession of wholly arbitrary deadlines for rushing this massive legislation through, before anyone has time to read it all, serves no other purpose than to keep its specifics from being scrutinized-- or even recognized-- before it becomes a fait accompli and "the law of the land." Would you buy a used car under these conditions, even if it was a Rolls Royce?

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The Slaughter Rule: Yet Another Reason Obamacare Would Be Unconstitutional

As written, the current health care bill before Congress already is guaranteed to face serious constitutional challenges on enumerated powers, 5th Amendment, racial discrimination, and unequal state treatment. Now the White House seems determined to add a whole new reason courts will throw out Obamacare on sight. Director of the Stanford Constitutional Law Center at Stanford Law School and former-federal judge Michael McConnell explains:

To become law—hence eligible for amendment via reconciliation—the Senate health-care bill must actually be signed into law. The Constitution speaks directly to how that is done. According to Article I, Section 7, in order for a “Bill” to “become a Law,” it “shall have passed the House of Representatives and the Senate” and be “presented to the President of the United States” for signature or veto. Unless a bill actually has “passed” both Houses, it cannot be presented to the president and cannot become a law.

To be sure, each House of Congress has power to “determine the Rules of its Proceedings.” Each house can thus determine how much debate to permit, whether to allow amendments from the floor, and even to require supermajority votes for some types of proceeding. But House and Senate rules cannot dispense with the bare-bones requirements of the Constitution. Under Article I, Section 7, passage of one bill cannot be deemed to be enactment of another.

The Slaughter solution attempts to allow the House to pass the Senate bill, plus a bill amending it, with a single vote. The senators would then vote only on the amendatory bill. But this means that no single bill will have passed both houses in the same form. As the Supreme Court wrote in Clinton v. City of New York (1998), a bill containing the “exact text” must be approved by one house; the other house must approve “precisely the same text.”

These constitutional rules set forth in Article I are not mere exercises in formalism. They ensure the democratic accountability of our representatives. Under Section 7, no bill can become law unless it is put up for public vote by both houses of Congress, and under Section 5 “the Yeas and Nays of the Members of either House on any question . . . shall be entered on the Journal.” These requirements enable the people to evaluate whether their representatives are promoting their interests and the public good. Democratic leaders have not announced whether they will pursue the Slaughter solution. But the very purpose of it is to enable members of the House to vote for something without appearing to do so. The Constitution was drafted to prevent that.

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Obama's Health Care 'Victim' Exposed

At his health care pep rally today, President Obama was introduced by Connie Anderson, sister of Natoma Canfield. The president said it was a touching letter written to him from Canfield that brought him to Ohio. (I'm sure the decision had nothing to do with rustbelt America being the source of Democrats' vote deficit at this point...)

In her letter, Canfield described her battle with cancer how she was forced to give up her health insurance after it became too costly--a sad story, to be sure. But, as Gateway Pundit reports, not likely an entirely true story:

Natoma Canfield is 50 years old. She was diagnosed with cancer 16 years ago. She quit her job or was laid off 12 years ago. She has reportedly held odd jobs cleaning homes the last few years. Natoma was paying $5,000 a year for her insurance but dropped it after it went up to $8,000. She wrote president Obama in December to tell him about it. She was worried she might lose her home. Some people might say she’s lucky to still have a home after losing her job 12 years ago.

Barack Obama came to Ohio today to prop Natoma up on stage with him. But, Natoma Canfield couldn’t make it. She is back in the hospital. (Our prayers for a quick recovery) She is getting cared for despite the fact that she has no insurance. She’s not out on the street. She’s not a statistic like Rep Alan Grayson would have you believe. Natoma is getting the care she needs.

And if Canfield were in favor of real reform, she should encourage President Obama to change the tax code to help insurers properly pool risks instead of additional taxation and government subsidies.

In addition, if the president really wanted to help people like Ms. Canfield, he would encourage the individual ownership rights over health care plans so the American people can maintain control over their health insurance, not employers or the government.

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The Health Care Plan You are Going to Get

The itsy-bitsy spider climbed up the water spout and apparently bit the Speaker of the House. Ms. Pelosi had a delusional moment the other day, but she was clear on one thing. She never intended to listen to any Republican suggestions regarding the health care bill.

Close observation of the Bipartisan Health Care Summit provided clarity within the first half hour that there was not much bipartisan here. After listening to President Obama, Harry Reid, and Nancy Pelosi, it was obvious that there was no way that they were going to overhaul their 2,400 page (or is it 2,600) health care bill.

I recently enlisted expert advice on the issue. My source was Dr. Bill Cassidy, who doubles as the Congressman from the sixth district of Louisiana and is part of the growing breed of medical professionals that refuse to leave the administration of our country to interests hostile to a cost-effective, patient-oriented, health care system. Dr. Cassidy was elected to Congress in 2008 after spending 20 years serving the uninsured in Louisiana’s public hospital system and teaching at LSU’s outstanding medical school. His specialty is gastroenterology and like many other elected physicians, he still sees patients when he’s back in his district. He is one of the very few people in Congress who truly has first-hand knowledge of those that the omnibus health care bill supposedly seeks to help.

Dr. Cassidy reminded me of an interesting exchange that confirmed President Obama’s utter ignorance of how markets function. Republicans pointed out that the Congressional Budget Office (CBO) analysis stated that premiums would rise under the existing proposals. The President initially insisted that this was not true, but then backtracked, arguing that premiums would go up because the new policies would have additional benefits. What the President doesn’t understand is that for each additional mandate – every one of which increases premiums – more and more consumers would no longer be able to afford the policy. Dr. Cassidy pointed out that the price of health care insurance is not inelastic.

Dr. Cassidy cited Senator Max Baucus as a prime example of the problem with the proposals. Other than the fact that Senator Baucus had to be tone deaf when he stated that the two sides were not really that far apart – a stunning statement unto itself – he shockingly misstated the reality of Health Savings Accounts (HSAs). Dr. Cassidy knew that a Kaiser Family Foundation study showed that because the HSA program provides an affordable health insurance alternative, 27% of new HSA participants were previously uninsured. Just think what might happen if HSAs were widely known and encouraged by the government.

But what seems to upset Dr. Cassidy the most is that the legislation does not address the largest problem with the health care system. He believes the system needs to be changed from a volume-based to a value-based system. The system has come to this gradually over the last 45 years as government has become more in involved in health care decisions. Doctors today need to treat huge numbers of patients to generate enough revenue to cover their costs. They often don’t have the ability to properly focus on their patients’ needs and may prematurely kick their patient to a specialist or order costly tests. The value-based system that Dr. Cassidy envisions would create greater synergy between doctor and patient, reduce malpractice costs, and provide higher quality service. Unfortunately, Obamacare will force doctors to see even more patients – thereby reducing individual attention even further – because it cuts physician reimbursements to the bone.

The largest single challenge centers on how to pay for the plan. The Democrats propose that everyone be required to carry insurance. They blithely assume that everyone will happily buy expensive insurance to subsidize those who have pre-existing conditions. Welcome to Dreamland; there’s no way that healthy young Americans will incur these huge costs, even with the threat of harsh (but obviously unenforceable) penalties.

Republicans have offered a far more palatable solution. Instead of arm-twisting middle-class Americans, Republicans propose to focus subsidizes on the limited market of individuals with medical challenges, and allow everyone else to buy competitively-priced products.

Dr. Cassidy is one of less than 20 health professionals in Congress able to offer realistic solutions based on their first-hand experience within the health system, but unfortunately, their sensible solutions have fallen on deaf ears. Perhaps the spider that Ms. Pelosi was speaking about had a venomous bite that has driven her to push these disastrous policies. God willing, her colleagues will listen to Dr. Cassidy and the American people.

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Big rise in complaints about NHS nursing care

But complaints are usually responded to by bureaucratic coverups and there are no apparent changes

For 12 months, while her son Kane underwent treatment for cancer, Rita Cronin sat by her youngest child's bedside. She fed him, gave him drinks, washed him and ensured he had a bedpan. And if Rita was unable to be there, husband Peter, daughter Emma or other son Matthew would take over the nursing duties.

'We'd learnt, quickly, that if we didn't carry out his basic care then we couldn't rely on the nurses to do so,' says Rita, 50, a civil servant from Balham, South-West London. 'It wasn't just Kane who was affected. We saw buzzers being left out of reach and patients missing meals, as no one had the time to feed them. 'The attitude was that patients had to wait. That nurses had other, more important, things to do. The more you asked for things, the more irritated they seemed to become. The night nurses were the worst - they were always "too busy" even to bring a bedpan. But the day ones were often unhelpful, too.'

St George's hospital, in Tooting, where Kane was a patient, 'is an award-winning hospital, yet we may as well have been in a third-world country for the nursing care my son got,' says Rita.

Strong words, but Rita is, tragically, qualified to say them. For three days after being admitted to the hospital for a hip replacement, her 22-year-old son was dead from dehydration. Kane had suffered brain cancer - while treatment was successful, the chemotherapy and radiotherapy had weakened his bones, causing him to the need the surgery. The cancer had affected his pituitary gland, which regulates the body's mechanisms, such as hydration. So, Kane was on desmopressin, medication to control the flow of fluid in his body. We later discovered that the day Kane was admitted in to hospital was the last time he took desmopressin,' says Rita.

Following his hip operation, a routine test showed Kane's sodium levels were high; his fluid levels were out of balance. A ward nurse was told this by the hospital lab, but she went off duty without sorting out treatment. He began begging for water. When his requests were turned down he became - understandably - aggressive. Inexplicably, instead of reading his notes which would have indicated the problem, nurses called security staff who restrained him.

An increasingly desperate Kane then rang the police and begged for help to get a drink. The police turned up, but were sent away by nurses who reassured them Kane was confused.

By the time Rita went to see him before work the next day, it was clear her son was very ill. 'The night nurse was standing outside the room handing over to the day nurse and I said I thought Kane was really ill,' she says. 'It was clear she thought I was being neurotic and said he was fine.'

It wasn't until the ward doctor appeared on his rounds, nearly 15 minutes later, that suddenly everything changed. He took one look at Kane and quickly called for help.'

The post mortem revealed Kane had died from dehydration. Rita has other ideas, and so, it seems, does the coroner who adjourned the inquest, calling the police in to investigate.

'Kane died because of sheer incompetence of the nurses who failed to do their job,' says Rita. 'I found out later that the nurses were offered counselling. They should have been in another job.'

Over the past few years there have been far too many similar accounts. Despite all the money poured into the NHS, and the proliferation of training, job titles and initiatives, it seems patient experience is not improving. Poor nursing care was a key factor in the 400 deaths at Mid Staffordshire NHS Foundation Trust, according to the recent official investigation. Staff numbers were allowed to fall 'dangerously low', causing nurses to neglect the most basic care. While many staff did their best, others showed a disturbing lack of compassion to patients, said Robert Francis QC, heading the inquiry.

Basic nursing care and lack of hygiene have also been blamed for 70 deaths at Basildon University Hospital, where the Care Quality Commission, the health service regulator, found, among other basic failings, blood-splattered equipment and patients lying on stained and soiled mattresses.

And statistics would suggest they are not one-offs. Complaints about nurses have risen by 18.9per cent in the past year, according to the Nursing and Midwifery Council (NMC) , the profession's regulatory body. Although the organisation points out that this figure represents just 0.2 per cent of their total membership, the fact is complaints investigated by them have risen by 30 per cent since 2005.

Experts think the problem is actually far more endemic than even these figures suggest, as many people don't know about the NMC - and instead complain through the hospital system. 'Even then, many incidents are not investigated properly,' says Vanessa Bourne, of the Patients' Association. 'Answers to complaints generally fall into one of two categories; either the letter will say: "You haven't been able to name the nurses responsible so we can't investigate". Or, "you have named the nurses responsible, but they deny any wrong-doing, so we can't take the investigation further".

'The NHS managers and nursing bodies like to say this poor treatment is from a minority of nurses, but it is more about a fundamental lack of decent nursing leadership and a refusal to admit that mistakes are being made. 'When the Staffordshire scandal broke last year, we were inundated with a deluge of heartbreaking cases where people had received careless, sloppy or even rude and cruel treatment at hospitals up and down the country, and where no investigation had ever been carried out. 'The Department of Health bring out endless guidelines and initiatives on patient satisfaction and safety, but our complaint rate doesn't drop.'

Nurses themselves are also concerned about levels of care. A recent survey for the Nursing Times found that only a third of nurses were confident the poor standards at Mid Staffordshire weren't being repeated to some degree in their own hospitals.

Last week, the government published the first comprehensive report on the profession in 40 years. The Commission into the future of nursing and midwifery made some recommendations on how nursing could be improved for the 'new challenges ahead'.

While it was initiated before the recent scandals broke, there's no doubt those events were key to its proposals. 'Events like Mid Staffs do tend to focus the mind,' says Heather Lawrence, a former nurse, now chief executive of Chelsea and Westminster Hospital and a member of the commission. 'And I would agree that in some areas of the country - not all - patient trust has been eroded. As a result there has now been an acceptance within the NHS that the way some wards have been managed has not always been in the patients' best interests.'

In order to help restore patient trust, the Commission wants all nurses to pledge their "commitment to society and service users... to give high-quality care to all and tackle unacceptable variations in standards". 'The Commission is clear that high-quality, safe and compassionate care must rise to the top of the agenda for a 21st-century worldclass NHS,' said health minister and commission chair Ann Keen.

It begs the question: if high-quality, safe and compassionate care is not a priority for some nurses, why are they nursing at all? 'We welcome the pledge, but it is a sad indictment that there is a need for one in the first place,' says Vanessa Bourne. 'Patients should expect compassion.'

'The bottom line is that in Mid Staffs - - and we believe in many other hospitals, still - - there was a culture of nurses saying "its not my job". But if everyone says that, then the job - whether it's feeding a patient, or getting them a bed pan simply doesn't get done. 'Nursing is about rolling up your sleeves and caring and too many nurses seem to forget that. 'Our response would be that if you don't want to do the nitty-gritty of spoon-feeding an elderly patient or changing soiled sheets, then don't go into nursing.

'Employers also have to accept that not everyone who comes into nursing will be cut out for the job. I was told by a university nursing tutor that some trainees on her course who were clearly not suited to nursing and not interested in caring, but it was impossible to remove them because of funding complications.

So what is the solution? The official response is that we need better leadership - giving ward sisters more authority. 'One of the things we found was that on many wards there was no one figure who had the authority to properly lead the ward,' says Heather Lawrence. 'In the Mid Staffs inquiry it was discovered that one nursing sister was in charge for three wards - an impossible task.'

Nurses acknowledge leadership is part of the problem; and the solution. The Nursing Standard magazine (the nurse's own trade magazine) is campaigning to boost the authority and status of ward sisters. 'All these NHS scandals have a common theme,' says editor Graham Scott. 'There was not a clear, identifiable person in charge of the ward. 'We have ward sisters, specialist nurses and nurse specialists, nurse consultants and modern-day matrons. No wonder people get confused about who is in charge.'

But will such a simple solution make the wards a better and safer place for patients? According to Graham Scott, it will. 'Research shows that on a ward where there is an identifiable - and, most importantly, accountable - person in charge, patients have a much better experience,' he says.

The finger of blame is also being pointed at healthcare assistants, who do the basic caring jobs, such as washing, feeding and changing bedpans. 'Some NHS Trusts do train nursing assistants properly,' explains Graham Scott. Others don't. Cleaning, washing and feeding a patient are actually quite complex tasks.'

The Commission recommended these staff need some form of regulation to ensure high-quality care. 'We have to be careful about blaming the healthcare assistants,' says Bourne. 'After all, they are supposed to be supervised by the nurses.'

But will any of this make a real --difference? It seems there will be no legal recommendations to abide by the regulations. 'We do tend to raise our eyebrows at these recommendations,' notes Bourne. 'There is a big noise about them, and then everything goes back to how it was. We still get horror stories like poor Kane's. We are told things will change and they don't.'

Indeed St George's has told Rita Cronin they've made changes to ensure what happened to her son can never happen again. 'But what exactly are these changes?' she asks. 'My son suffered a needless death. How I do know that the same thing isn't happening to someone else?'

A spokesman for the hospital said: "We are extremely sorry about the death of Kane Gorny. 'From the investigation it was clear that there had been failures in communication between clinical staff. Disciplinary action did result from our findings and a number of important changes have been introduced to help prevent such a tragic incident from happening again.'

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Why the Health Bill Makes No Sense

So it's come down to this -- desperate Democratic leaders strong-arming members on the worst bill ever before they go home to explain to constituents why they decided to commit political suicide. We've said just about all we've had to say on this issue -- actually dating back to 1993-94, when we wrote nearly 100 editorials in opposition to HillaryCare. Since January of last year, we've weighed in 150 more times against the latest version of socialized medicine. But to review, here are just 15 reasons why a government takeover of the finest medical system in the world makes no sense at all:

1. The people don't want it! This, we would think, should have some bearing on decision-making. Yet the Democrats forge ahead without consent of the governed. In the latest Rasmussen poll, 53% opposed the Democrats' reform while 42% were in favor. More than four in 10 "strongly" opposed; just two in 10 "strongly" favored. This jibes with other surveys, including our own IBD/TIPP Poll, taken since last year.

2. Doctors don't want it! A survey we took last summer of 1,376 practicing physicians found that 45% would consider leaving their practices or taking early retirements if the Democrats' reform became law. In December, the results were validated by a Medicus poll in which 25% of doctors said they'd retire early if a public option is implemented and another 21% would stop practicing even though they were far from their retirement years. Even if the bill doesn't have a "public option," nearly 30% said they'd quit the profession under the plans being considered.

3. Half the Congress doesn't want it! Not a single Republican backed the health care bill that cleared the Senate on Christmas Eve 60-39. House passage was by a slim 220 to 215, and the lone Republican "aye" has since switched to "no." Columnist Michael Barone says other changes would put the House vote today at 216-215 in favor, and he has doubts Democrats can even muster 216.

House Speaker Nancy Pelosi made her job of securing yes votes even more difficult last week when she told a meeting of county officials that "we have to pass the bill so you can find out what is in it." Members of Congress aren't waiting: They've already exempted themselves from whatever they inflict on us.

4. People are happy with the health care they've got! Polls show that 84% of Americans have health insurance and that few are displeased with what they've got. Last month, the St. Petersburg Times looked at eight polls and reported that satisfaction rates averaged 87%.

5. It doesn't even cover the people they set out to cover! Supporters of government-run health care say there are as many as 47 million Americans — 9 million to 10 million of them illegal aliens — without medical insurance. The Democrats' plans, however, will put only 31 million of the uninsured under coverage.

6. Costs will go up, not down! Democrats say their plans will cost less than $1 trillion over the first decade. But analyst Michael Cannon at the Cato Institute puts the cost at $2.5 trillion over the first 10 years. Even if we go with the government's lower estimates, the cost is already on the rise. A new estimate by the Congressional Budget Office puts the cost of the Senate bill at $875 billion over 10 years, $4 billion more than its original projection. Imagine how fast costs would soar if one of the bills became public policy.

7. Real cost controls are nowhere to be found! The Democrats are offering no meaningful tort reform that will help push down the high malpractice insurance premiums that are a burden to doctors and their patients. Nor are they considering any other cost-saving provisions, such as allowing the sale of individual health plans across state lines or easing health insurance mandates.

8. Insurance premiums will rise, not fall! One goal of nationalizing health care is to lower costs, to bend the spending curve downward. Yet, as Democratic Sen. Dick Durbin acknowledged Wednesday, that won't be the case.

"Anyone who would stand before you and say, 'Well, if you pass health care reform, next year's health care premiums are going down,' I don't think is telling the truth," he said from the Senate floor. "I think it is likely they would go up."

An analysis completed by the CBO at the request of Sen. Evan Bayh confirms Durbin's suspicions. Insurance coverage in the individual market will "be about 10% to 13% higher in 2016 than the average premium for nongroup coverage in that same year under current law," it concluded.

9. Medicare is already bankrupting us! The Medicare trust fund, which has unfunded obligations of $37.8 trillion, will be insolvent in 2017. How can lawmakers justify another entitlement that will cost trillions when they can't pay for existing liabilities?

10. There aren't enough doctors now! Last month, 26% of physicians responding to a Web poll on Sermo.com, which calls itself "the largest online physician community," said they had been forced to close, or were considering closing, their solo practices. Providing coverage for an additional 31 million Americans when the number of doctors is shrinking won't improve our health care.

11. The doctor-patient relationship will be wrecked! The latest IBD/TIPP Poll, taken just last week, found that Americans, by a wide 48%-26% margin, believe the doctor-patient relationship will decline if the Democrats' plan is passed.

12. Medical care will also deteriorate! IBD/TIPP has also found that 51% of Americans believe care would get worse under government control. Only 10.5% said they felt it would improve. In our doctor poll, 72% disagreed with administration claims that the government could cover 47 million more people with better-quality care at lower cost.

13. Rationing of care is inevitable! Health care is not an unlimited resource and must be rationed, either by the individual, providers or government. In Britain and Canada, where the government does the rationing, medical treatment waiting lists are sometimes deadly and quite often excessively long.

For instance, late cancer diagnoses in an overcrowded public health care system cause up to 10,000 needless deaths a year in Britain. The reasons cited for the late diagnoses include doctor delay, delay in primary care, system delay and delay in secondary care.

14. Private health insurers will be destroyed! Added mandates and price controls will force many insurers to simply get out of the health plan business because it will no longer be profitable.

15. It's probably unconstitutional! One way to help bring down the number of uninsured is to demand that those without coverage buy health plans. But the government has never passed a law requiring Americans to buy any good or service. Constitutional scholars say any such mandate would likely draw a legal challenge.

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Top Democrat Implies Obama Not ‘Telling the Truth’ about Health Care Premiums

Senate Majority Whip Dick Durbin (D-Ill.) on Wednesday contradicted President Barack Obama on whether the health care reform bill will lead to a decrease in health care premiums. Durbin claimed that rates would go up, while the president said the rates would go down. “Anyone who would stand before you and say well, if you pass health care reform, next year's health care premiums are going down, I don't think is telling the truth. I think it is likely they would go up, but what we are trying to do is slow the rate of increase,” Durbin said, speaking on the Senate floor.

Compare Durbin’s remarks to what President Barack Obama said during a speech at Arcadia University in Glenside, Pa., on Monday: “Our cost-cutting measures mirror most of the proposals in the current Senate bill, which reduces most people’s premiums and brings down our deficit by up to $1 trillion over the next decade because we’re spending our health care dollars more wisely,” the president said. “Those aren’t my numbers. Those aren’t my numbers --they are the savings determined by the Congressional Budget Office, which is the nonpartisan, independent referee of Congress for what things cost,” Obama added.

But as CNSNews.com reported, the Congressional Budget Office’s analysis of the final Senate health care bill indicates that it would impose a mandatory $15,000 annual fee on middle-class families that earn greater than 400 percent annually of the federal poverty level. That means $88,200 for a family of four.

Among the five basic facts that the CBO analysis cites about the bill is that “Your family insurance plan – if your employer drops your coverage and you are forced to buy it on your own – will cost about $15,000 per year when the legislation is in full force in 2016.”

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Dems seek agreement, quick vote on health care

Under White House pressure to act swiftly, House and Senate Democratic leaders reached for agreement Friday on President Barack Obama's health care bill, sweetened suddenly by fresh billions for student aid and a sense that breakthroughs are at hand. "It won't be long," before lawmakers vote, predicted Speaker Nancy Pelosi. She said neither liberals' disappointment over the lack of a government health care option nor a traditional mistrust of the Senate would prevent passage in the House.

At the White House, officials worked to maximize Obama's influence over lawmakers who control the fate of legislation that has spawned a yearlong struggle. They announced he would make a campaign-style appearance in Ohio next week to pitch his health care proposals, as well as delay his departure for an Asian trip later in the month.

With Democrats deciding to incorporate changes in student aid into the bill, Republicans suddenly had a new reason to oppose legislation they have long sought to scuttle. "Well of course it's a very bad idea," said Senate Republican leader Mitch McConnell of Kentucky. "We now have the government running banks, insurance companies, car companies, and they do want to take over the student loan business." He said it was symptomatic of Democrats' determination to have the government expand its tentacles into absolutely everything."

At its core, the health care bill is designed to provide health care to tens of millions who lack it and ban insurance companies from denying medical coverage on the basis of pre-existing medical conditions. Obama also wants the measure to begin to slow the rate of growth in medical costs nationwide. Most people would have to get insurance by law, and families earning up to $88,000 would receive subsidies.

Whatever the outcome, there was no doubt the issue would reverberate into this fall's elections, with control of Congress at stake. The health care bill appeared on the cusp of passage in early January, but was derailed when Senate Republicans won a Senate seat in Massachusetts, and with it, the strength needed to sustain a filibuster and block a final vote.

In the weeks since, the White House and Democrats have embarked on a two-part rescue strategy. It calls for the House to pass legislation that cleared the Senate in December, despite numerous objections, and for both houses to follow immediately with a second bill that makes changes to the first. The second, fix-it bill would be drafted under rules that strip Senate Republicans of the ability to require Democrats produce a 60-vote majority.

Obama outlined numerous requested changes several weeks ago, many of them designed to satisfy the concerns of House Democrats. They would increase subsidies for lower income families who cannot afford insurance; give additional money to states that provide higher-than-average benefits under Medicaid, and gradually close a coverage gap in the Medicare prescription drug program used by millions of seniors.

Congressional officials said all three issued would be addressed in the fix-it bill, although other administration requests remained in doubt. The president wants creation of a commission with authority to force savings in Medicare and Medicaid, for example, and is seeking the deletion of items sought by individual senators. Those were among the issues still in dispute after days of secretive talks involving the White House and House and Senate leaders.

The decision to add far-reaching student aid changes to the bill had its roots in obscure parliamentary rules governing the Senate's debate of the legislation. But House Democrats and the White House quickly seized on it as a way to advance a top administration priority that lacks the 60 votes needed to clear the Senate otherwise. The measure would require the government to originate student loans, closing out a role for banks and other private lenders who charge a fee. Obama proposed taking the savings and plowing it into higher Pell Grants that go to needy college students. Officials said that under current estimates, the change would free as much as $66 billion over a decade, although Pelosi indicated she wanted it spread beyond Pell Grants to other education programs.

At a news conference, the speaker confessed to being disappointed that the legislation would not include a government-run health care option, but said other parts of the legislation would hold insurance companies accountable. The tussle over a public option roiled Democrats for months, but has subsided in recent weeks. "We've crossed that bridge," said Rep. Bill Pascrell, D-N.J. "Those people who were saying 'public option' are muted right now. That's done. It's not going to happen. They've hit the mute button."

At a closed-door meeting of the rank-and-file, House Democratic leaders sought to allay concerns that Senate Democrats might simply refuse to pass the fix-it bill after the House swallows the measure it doesn't like. Rep. G.K. Butterfield, D-N.C., said party leaders told the House caucus they have "a firm commitment" from the Senate to do its part.

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Dereliction of Duty

How many flavors of crazy is it for President Obama and Democrat leaders to continue the forced march toward a vote on a health care bill despised by the majority of Americans? The New York Times lays out what's happening: "Leaving a meeting of the House Democratic Caucus, lawmakers said they had received few details about what would be in the [health care] legislation, on which they may be asked to vote in the next week or two".

Got that? This is legislation that would remake fully 1/6 of the US economy, and the House members who are being pushed to vote on it aren't even sure about what's in its final version. How, under any circumstances, can voting in favor of this -- given the rush, the uncertainty about the bill's contents, not to mention its effects (and including the widespread, fierce opposition to it) -- be anything other than a dereliction of duty?

Pat Caddell and Doug Schoen warn that passing the legislation will be a political disaster for the Democrats. Frankly, the point is so obvious that it's frightening that it needs to be made.

But the bigger problem now, for Democrats, is that their interests and President Obama's diverge. Many Blue Dogs can save themselves (and their party) if they take a principled stand against ObamaCare. But the President needs this victory -- in a sense, just to stay in the game. Without it, he's revealed as politically impotent. With it, he can at least comfort himself with his "historic" expansion of the welfare state.

Overall, though, the President's in trouble either way this goes. Even if he wins, he's paid a heavy price. First, he's lost the trust of the American people by his willingness to say anythign to get the bill passed; second, he's shown himself willing to ignore the expressed wishes of those he governs; and third, he's revealed himself as arrogant enough to believe that opponents are too stupid to understand what's in the bill -- but once ObamaCare is foisted upon them by the "platonic guardians" in The White House and on Capitol Hill, the ignorant rubes will love it.

A President can come back from political defeat. Recovering after losing the trust of the people is much more difficult.

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Health-Care Hell

by Jonah Goldberg

The time for talk is over. So proclaimed the most talkative president in modern memory. I can't remember when Barack Obama said that. Maybe it was during the first "final showdown" on health care. Or maybe it was the third. The fifth? It's so hard to tell when pretty much every week since the dawn of the Mesozoic Era, Obama or Nancy Pelosi or Harry Reid has proclaimed that it is now Go Time for health-care reform. So you'll forgive me if I'm somewhat skeptical about the possibility that the health-care reform debate is about to come to an end.

The president recently said, "Everything there is to say about health care has been said, and just about everybody has said it." But wait. If everything, pro and con, has been said about the subject, by everybody, that means someone isn't telling the truth, right? I mean, if you've said X and not-X, that means you've probably said something that isn't true.

That, at least, is the impression I got this week listening to Obama make his closing arguments for health care at rallies in Pennsylvania and Missouri. It's telling that the president -- long in favor of a single-payer system -- is selling his health-care plan on the grounds that it will increase "choice" and "competition," reduce "government control" and "give you, the American people, more control over your own health insurance."

You know your sales pitch for a government takeover of health care hasn't worked when you have to crib rhetoric from free-market Republicans. And that's after you've already tried to pin your plan's unpopularity on the ignorance of the American people.

Obama's talking points track reality about as well as the screenplay for "Avatar." Indeed, the same week he was hawking competition, choice and less government, Obama backed a new Health Insurance Rate Authority that would do even more to cement big health insurance companies into their new role as government-run utilities.

This latest gambit is of a piece with the White House's demonization of the health-insurance industry. I have no love for that industry myself, but let's get some perspective. As of August, the health-insurance industry ranked 86th in terms of profit margins -- behind anemic industries such as book publishing (38th) specialty eateries (71st) and home furnishing stores (84th), according to data compiled by Mark Perry of the American Enterprise Institute.

Insurance companies account for less than 5 percent of American health-care spending -- less than hospitals (31 percent), doctors (21 percent) and medicine (10 percent). But because health-insurance companies are unpopular, Democrats are beating up on them, even though if Democrats are serious about containing costs, the cuts will have to come from those other slices of the pie.

But enough with the substance. The health-care debate ceased being about substance a long, long time ago. Fair or not, the Democrats' plan is unpopular, period. There is simply nothing Obama can say that will change that fact before Democrats vote for it. That hasn't stopped him from talking out of every side of his mouth. But outside the Obama bunker, no serious pollster, pundit or pol in Washington disputes this basic point: Obama cannot take the stink off this thing.

And that's why the Democrats are contorting themselves like a yoga swami in a hatbox trying to figure out how to pass it. (Note: If it were simply popular among Democrats, it would have passed months ago.) The latest idea involves the "Slaughter Solution" -- named after House Rules Committee Chairwoman Louise Slaughter -- which would allow the House to fix-and-pass the Senate version of the bill without ever voting on the senate version, or something like that.

But here's the thing: There is no "over" to this debate. Obama, Pelosi & Co. have demonstrated time and again that no deadline is final if it means losing. Meanwhile, if ObamaCare passes, Republicans will run on a promise to repeal it, and that means we'll be debating health-care reform at least through 2010. Then, depending on how the election goes, the repeal debate will become part of the legislative process. That will in all likelihood carry the debate into the 2012 presidential election. In other words, there will be time for talk as far as the eye can see.

Now, part of me thinks this is too cruel a future to contemplate. I can't remember whether it was pederasts or mattress-tag removers, but I'm pretty sure someone in Dante's Inferno is condemned to spend eternity listening to a C-SPAN panel on community rating, preexisting conditions and rate pools. But it's a better prospect than losing. That's one point that has bipartisan support.

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Baby twins put in NHS hospitals 50 miles apart

Because of very limited facilities for premature births

The parents of two-month-old twins have criticised the NHS for placing their poorly daughters in separate hospitals, 50 miles apart. Stephanie Dawson, 25, and her partner Martin Collins, 38, have to take a 121-mile trip to visit Ruby and Krystal Dawson-Collins, which they said leaves them with just 10 minutes with each daughter.

The twins were born at just 26 weeks in Maidstone Hospital, Kent, weighing 1lb 9oz and 2lb 4oz respectively. They were suffering from Twin to Twin Transfusion Syndrome, where one twin gets more blood in the womb than the other. Following their birth by Caesarean section on January 18 they were transferred to a specialist neonatal unit at St Peter's Hospital in Chertsey, Surrey. After a few days Krystal was deemed well enough to be transferred to Pembury Hospital in Tunbridge Wells, Kent, and split up from her sister.

Her parents, who do not have a car, said they were struggling to visit each baby while still caring for their two other children Mitchel, 10, and Kym. They said that even with the help of friends and family the distance means they can only see their frail daughters twice a week as they cannot leave their Maidstone home until they have collected Mitchel from school. Mr Collins said: "We only get about 10 minutes with each of them, a quick update and a stroke of their heads, before we have to get going.

"It is so awkward getting up through Pembury then into Surrey. "I would have thought it was better for them to be together and it would be easier for us if they were in one place, even if that was in Surrey. "It's like no one realises we are miles away and don't have a car. It is a real struggle, but for the sake of our family, we cannot lose it."

A spokesman for the Maidstone and Tunbridge Wells NHS Trust said the girls needed very specialist care only provided in a handful of hospitals in the South East. He said: "We recognise this is a tough time for Stephanie and Martin and are helping them in any way we can."

Dr Paul Crawshaw, clinical director for paediatrics at the Ashford and St Peter's NHS Trust, Surrey, said the separation was a short-term situation. He said: "We always regret the separation of twins and are well aware of the difficulties it is causing the family. "We hope to get them reunited in the very near future."

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