Although I question the validity of that “big round zero,” of course in a mixed private-public system, the enormously more expensive private side will have relatively more effective (and costly) medicine. Only the richest patients are funding it (and only the richest physicians, many of whom are among the most competent, are working in it).

Greenwood is just arguing from fantasy. Or does he have an example of a private medical system providing the same level of care to all a country’s citizens?

Historically, socialist institutions are like islands thrust up in an ocean of capitalism. And you have to ask yourself: How much is learned about continents from islands?

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It galvanised action on a problem well known (Killing patients at roughly the rate of North American hospitals) , but previously ignored .

Most of the reasons for growth of what were then called Hospital Acquired Infections (HAI) related to ;
1 Oversubscribing antibiotics
2 Lack of isolation facilities
3 Inadequate control of procedures (catheterisation etc.,)
4 Major growth in invasive surgery for longer periods.
5 An innate acceptance that age brings death and that is reflected (at least in the UK) by any post operative broncho-pneumonial conditon leading to death as “the old man’s friend”

Identification and the report’s resulting brou ha ha immediately led to a defensive clinical response;

1 Renaming and medicalising the condition as “nosocomal” helping to confuse and obfuscate reporting procedures and prevent comparisons over time and between locations – we now have learnt to call it Community RSA – it’s not even a hospital problem it’s everywhere. ***

2 Early discharge so that patients died at home, reducing the hospital death count as the collection , analysis and public ation of in fection rates became a point of public concern and Hospital Trust’s self flagellation – which was a preliminary to demanding more funds.

3 Whilst MRSA finds it’s happy home in the nasal mucosae and be distributed by that route. Clinical staff identified an area of practice – hospital cleaning which was without their area of responsibility – hence an orgy of concern about , floor swabbing, hand washing, laun dry procedures etc., I have maintained for many years that if there was a Royal College of Hospital Cleaners you would never have heard of dirty hospitals – underpaid, menial cleaners are an easy . transient and readily identified demon – xenophobia playing no small part as many were / are recent immigrants.

4. Profit incentivised suppliers soon found a ready market for alcohol wipes, swabs, copper door handles, UV light air filters and other technical wizardry as expenditure on these items was readily equated with effort and attention to the problem.

In the modern NHS Medical treatment is mistaken for health care and and their improvement is made to depend on allocating more resources to their management.

5. Due to the immutable Law of Unexpected Consequences, more intensive antibiotic therapy of MRSA suferers in hospital led to massive doses of agressive (and expensive) antibiotics , resulting in gastric flora being damaged and the adventitious and opportune invasion of other common and sub fatal organism, Klebbsiella, Clostridium which again weakened the host hastening death is a slightly more roundabout (and unpleasant fashion for both patient and family).

The use of expensive therapies bolstered of course the belief and all embracing management paradigm that expense is equivalent to effort and effort will be result in success.

Meanwhile in Holland with vanishingly low rates of HAI’s they screen patients before admission for communicable disease, they have isolation wards, they use small rooms with sliding doors (preventing contominated internal airflows), and simple effective procedures for dealing with wounds / catheters and other skin punctures with barriers, disposables and rigorous disposal.

Meanwhile in my local NW England surgery they have instituted a touch screen procedure for booking in at an appointment requiring at least seven screen touches. When I pointed out to the doctor that it was probably not possible to design and implement a better method of distributing communicable disease amongst patients she looked blank and said she hadn’t seen it in use.

The threat of MDRTB , multiple drug Resistant TB (especially for the UK with a huge growth in immigrants from areas where it is endemic (especially in prisons) – Estonia in the EU, parts of Africa, Russia / Ukraine ) was, when John Bourn reported in 2002 a mere speck on the horizon.

The prospects of this on a large scale are truly frightening in health and in cost, 2 outbreaks in London hispital have cost Millions to sterilise premises.

Hospital infection rates in England out of control – News – Brief Article – Statistical Data Included
British Medical Journal, Feb 26, 2000 by Zosia Kmietowicz
The NHS in England could save an estimated 150m [pounds sterling] ($240m) and many hundreds of lives by tightening hygiene rules in hospitals and investing in infection control, according to the spending watchdog the National Audit Office. The money could then be ploughed back into patient care.

At least 100 000 cases of hospital acquired infections occur each year in England, with an estimated 5000 deaths, all of which cost the NHS in the region of 1bn [pounds sterling] annually, states the report.

Better education of staff on the spread of infection, improved surveillance of patients who have had major surgery, and the involvement of senior clinicians and management in the control of infection could reduce this burden by 15%, Sir John Bourn, head of the National Audit Office, told parliament.

At any one time 9% of patients in hospital are being treated for an infection they acquired there. Yet one in five trusts do not have an infection control programme, 40% are dissatisfied with their isolation facilities, and 60% have no defined budget.

Despite guidance from the Department of Health that chief executives should take overall responsibility for ensuring effective infection control, there is little evidence of their involvement. More than half were not aware of the resources spent on hospital acquired infection or the number of cases, says the report.

BMJ. 2002 February 2; 324(7332): 258.

Winter virus closes Scottish hospitals
Bryan Christie

Top A monitoring programme is to be accelerated at Scottish hospitals to check if they are meeting new national standards on infection control. It follows the deaths of three patients at Glasgow’s Victoria Infirmary from salmonella poisoning and an outbreak of a gastric virus at several other hospitals.
The viral infection, which causes severe vomiting and fever, has affected many parts of Britain, but Scotland has been worst hit. Almost 300 patients and staff at the Victoria Infirmary contracted the virus, and the hospital was forced to close to new admissions for a week. Nine other Scottish hospitals had to impose temporary ward closures.

The virus involved, a Norwalk-like virus (formerly known as the small round structured virus), can spread through the air and is difficult to control. However, its serious impact in Scotland, coming immediately after the deaths from salmonella, has led to concerns about hospital cleanliness and hygiene standards. The health trade union Unison said that the health service now employs one cleaner for every 360 patients compared with one for every 60 patients in 1985.

Scotland’s health minister, Malcolm Chisholm, announced that the Clinical Standards Board for Scotland is to accelerate its programme of external checks of hospitals to see how their performance compares with national standards on infection control.

“There is no shortage of work going on within the NHS to tackle this problem—and no shortage of independent scrutiny of NHS performance. I intend to ensure that we maintain momentum in that work over the coming weeks and months,” said Mr Chisholm.

Hospital acquired infection is a huge problem. A report from the House of Commons public accounts committee in 2000 found that 9% of hospital patients acquire an infection while in hospital. It concluded that 5000 people die a year in England and Wales as a direct result of hospital acquired infection, and it may be a substantial contributory factor in a further 15 000 deaths. The annual death toll in Scotland is estimated at around 450.

However, 15-30% of cases of hospital acquired infection are preventable, and Professor Hugh Pennington, one of Britain’s leading infection specialists, said that Britain needed to learn lessons from countries such as the United States and Australia, where tackling such infections had been given greater priority. He said that British hospitals needed more infection control staff.

“We are nearly always reacting to events rather than having any substantial programme of preventative measures. There is a bit of a culture change needed here to get the status of hospital infection control at least as important in managers’ minds as waiting lists,” he said.

Dr. David Gratzer, a practising physician licensed in Canada and the United States writes “Canadian doctors, once quiet on the issue of private health care, elected Brian Day as president of their national association. Dr. Day is a leading critic of Canadian medicare; he opened a private surgery hospital and then challenged the government to shut it down. “This is a country,” Dr. Day said by way of explanation, “in which dogs can get a hip replacement in under a week and in which humans can wait two to three years.”

Market reforms are catching on in Britain, too. For six decades, its socialist Labour Party scoffed at the very idea of private medicine, dismissing it as “Americanization.” Today Labour favours privatization, promising to triple the number of private-sector surgical procedures provided within two years. The Labour government aspires to give patients a choice of four providers for surgeries, at least one of them private, and recently considered contracting out some primary-care services — perhaps even to American companies.

Other European countries follow this same path. In Sweden, after the latest privatizations, the government will contract out some 80% of Stockholm’s primary care and 40% of total health services, including Stockholm’s largest hospital. Beginning before the election of the new conservative chancellor, Germany enhanced insurance competition and turned state enterprises over to the private sector (including the majority of public hospitals). Even in Slovakia, a former Marxist country, privatizations are actively debated.

Under the weight of demographic shifts and strained by the limits of command-and-control economics, government-run health systems have turned out to be less than utopian. The stories are the same: dirty hospitals, poor standards and difficulty accessing modern drugs and tests.

Admittedly, the recent market reforms are gradual and controversial. But facts are facts, the reforms are real and they represent a major trend in health care.”

Finally, I work in the Los Angles County Department of Health Services and I have seen first hand the results of no profit motive at work at Martin Luther King Hospital, which is about to lose it’s license to operate because it is not up to standards.