Health information on Gaza

This summary on health in Gaza is from the excellent people at Medact. Please write to your local paper, MPs, MEPs, embassies etc. This war must stop now.

Recent information directly related to health in Gaza

January 4^th 2009

According to the Ministry of Health in Gaza as reported by the UN Office for the Coordination of Humanitarian Affairs (OCHA) on January 4^th evening, 491 people have been killed and approximately 2,400 persons have been injured during the military operations of the last 9 days. At least 20% of the fatalities and 40% of the injuries are women and children. As of January 3^rd Magen David Adom reported 46 injuries (5 moderate, 4 severe) and 4 fatalities over the past week on the Israeli side.

Gaza has 700-1000 chronic medical patients who had been receiving ongoing treatment in Israel and East Jerusalem each month. There are presently no referrals through the Erez checkpoint (or any other since the land invasion).

(Reasons for being unable to transfer people have been the subject of complex debate but in the present land offensive no-one can move anyway).

There is presently (evening Jan 4^th) almost total blackout in the governorates of Gaza, North Gaza, Middle Area, Khan Yunis. Prior to this hospitals had already been operating on backup generators for their electricity during blackouts. At Shifa hospital there are 70 patients in intensive care and 30 in neonatal care who would be affected catastrophically if the generators fail.

Even before the recent escalation industrial fuel was needed for Gaza Power Plant and ten transformers needed replacing to restore electricity to 250,000 people in central and northern Gaza. This effects water, sanitation, and hospitals including intensive care and operating rooms.

An ambulance from AlAwda hospital was shelled on the morning of January 4^th seriously injuring 4 medical staff.

On 21 December OCHA reported that approximately 20% of Gaza’s ambulances are grounded due to the dearth of spare parts.

Nutrition: the food the UN World Food Programme was trying to distribute prior to the land invasion should have been distributed in the October –December cycle.

Water and sanitation: on January 2^nd airstrikes in the Al Mughraga area damaged a main drinking water pipe cutting the water supply of 30,000 people in Nuseirat Camp. There is growing concern that current military operations could damage the sand walls of the Beit Lahiya sewage lagoon causing a sewage overflow putting 15,000 people and agricultural areas at risk.

Warning leaflets dropped to warn people to evacuate are reported as causing confusion and panic among the civilian population (OCHA Gaza Humanitarian Situation Report 3 January 2009). Gaza has a population of 1.5 million people in an area 25 miles long and 3-7 miles wide.

Branson on MRSA - letter to the NT

Following comments on the Nursing Times website, this is a letter to the NT:

Dear Editor,

Peter Carter’s comments about Richard Branson’s lack of insight into HCAI control are very welcome. Branson has continuously slated dedicated NHS staff over the past few months, and has even suggested that the NHS should have the same level of safety as the air industry, despite being a very different beast. Of course, Mr Branson ignores the damage that the air industry does, while direct deaths from accidents are rare, the impact of air travel on the climate is large and growing.

Strangely though, Mr Carter’s list of interventions that reduce HCAIs do not seem to include bringing cleaners back into the NHS. The need to reverse the years of outsourcing of cleaning services has never been higher – contractual control of cleaning can never be as effective as direct control. This outsourcing has been one of the most damaging NHS policies of the past 25 years.

The NHS can and must do better to reduce the level of infections but Richard Branson should not only listen to infection control experts before making such suggestions like blanket compulsory screening, but he should set his own house in order too.

Stuart Jeffery
Health Spokesperson for The Green Party

Long term care: who should pay?

The Torygraph reports today that adults could be forced to take out private insurance to pay for 'nursing home' costs in the future. Of course, the paper is missing the distinction between nursing care and residential care that we have in this country (currently the nursing aspect is broadly covered by the NHS and the 'non-health' aspect is paid for either by individuals or social services), but that is not really the problem.

Clearly there are a very difficult questions to be answered on how long term care is funded but also how it can be delivered.

Should people pay for it themselves (currently they pay out of their savings / house sale until they are down to £22.k savings)? The government is considering forcing people to take out private insurance to pay for this. The suggestion in the article is that critics are claiming the NHS already has enough money and long term care should be paid for out of this, is simply barking mad. These 'critics' have obviously failed to have any insight into health care - do they really want NHS services to be cut? Perhaps they want to pay healthcare staff less?

So is private insurance the right way to go?

Firstly private profit from health care: the short answer is NO! But the private sector can do it better the privateers / capitalists will be screaming... as history has taught us time and again they can't. Just look at the US if you want to find out why private insurance should have nothing to do with healthcare (15% of GDP, tens of millions without access to health care etc.).

Secondly, if you want a form of insurance to cover long term care then taxation is easily the best option. Progressive taxation is fair and just, ensures that 'premiums' are used for care - not profit, and ensures that care provision can be controlled to a democratically agreed standard (i.e. fair and equitable).

Strangley the Shadow Health Minister doesn't like Labour's idea. Strange because it is a real Tory type policy. He doesn't suggest an alternative so I guess his comments are just political sour grapes. The Lib Dem health guy, Norman Lamb, seems to be suggesting that the current system is OK but not enough money is being spent. I'm not sure he is suggesting more taxes to cover this or more money from individuals...

I think a much more demanding question is who is going to provide this care when the population bubble centred around the current 41 year olds hits 80 ish. The proportion of people in caring roles will soar and it likely to be in crisis.

This is the start of the article in the Telegraph:

"Taxpayers would have to pay hundreds of pounds in premiums every year while working, and would receive payouts if they later have to move into a nursing home.

"The radical plan is being considered by ministers as a way to tackle the system of long-term support for the elderly in England, which is widely considered to be unfair, underfunded and too complex.

"Currently thousands of middle-class pensioners are forced to sell their homes to pay for nursing home accommodation - which can cost £700 a week - while a postcode lottery of eligibility gives people in some parts of the country far more free help than elsewhere."

Failure to consult

Local NHS bodies are not fulfilling their legal duty to consult the public according to a new study by the NHS Support Federation.

Darzi-inspired health centres are being introduced nationwide, but a survey of Primary Care Trusts found that plans have gone ahead without meeting legal obligations to inform the public and include their views.

Given the scale of the failures the report recommends that the Department of Health should drop its 31 December deadline for contracts to be signed (outside London), allowing more time to ensure that the public has been given full information about the plans and a genuine opportunity to influence them.

PCTs have also been given specific advice from Department of Health lawyers on how to consult, but the report compares this with what PCTs actually did and found that many fell short of these recommendations. Examples from the study are being sent to the DH with a request for them to investigate.

Part of the report contained a study of 40 PCTs that were consulting and found that:

- 2/3 of PCTs do not ask local people whether they agree with the overall plan for a GP-led health centre
- 42% make no reference to the fact that a new health centre could be run by a commercial or voluntary sector provider. Legal advice issued by the DH clearly states that consultation should cover “the approach to selecting the preferred bidder and the proposed contractual mechanism”
- 16% provided less than 12 weeks for responses - the minimum set out in the cabinet code on consultation
- only 16% of PCTs asked about the importance of the distance of travel to the new health centre

“The public must be given a genuine influence over their local NHS. There is real danger that the public will become cynical about consultation and not take part. The public can help to develop better services and their support is crucial for the future of the NHS and its funding.

“Major change is occurring to primary care without public knowledge or consent. We are very concerned that the introduction of commercial interests to run health centres will be damaging, but this and other important aspects has been missing from public consultations.”

- said Paul Evans NHS Support Federation director

full report - http://www.nhscampaign.org/news/82/80/NHS-fails-to-consult-the-public-on-Darzi-health-centres.html

The NHS Support Federation is an independent organisation that works to protect and promote a comprehensive NHS, with equitable access and active public involvement. Our supporters and affiliated organisations are drawn equally from the health profession and the general public.

EU working time directive

I have no idea what the Lib Dems were up to with the opt out vote on EU working time directive.

The Tories voted to keep it, i.e. they are happy for people to work ridiculous hours, much of it unpaid - I'd expect nothing less from them.

Labour MEPs rebelled against Gordon Brown who also wanted to keep it and voted to end the opt out.

Obviously Green MEPs voted to end the opt out!

But I don't understand what the Lib Dems were playing at by voting to keep the opt out. The comment in the Guardian was a euro skeptic, 'who do they think they are telling us what to do?'. Personally I think the EU has every right to protect the people of Europe against bad employers and practices. Claiming that the opt out is essential in a downturn is equally bizzare. Why should we employ someone to work for 50 paid hours each week plus 10 unpaid hours when we could employ two people?

The implications of the end to the opt out are probably the greatest in the NHS. It will give managers a bit of headache when trying to cover rotas, but the solution is to grown more clinicians, not work them into the ground. Of course that takes money and time, but so be it.

I also think it is important that the unions take note about what LDs did.

Safe as airlines

Lots in the press about the NHS killing people through errors. This is from the Torygraph and this from the BBC after the head of the Healthcare Commission has said that the NHS in England and Wales is failing to ensure patient care is "as safe as it reasonably could be". Cue lots of tabloid headlines and industry rebuttals.

Richard Branson complained that the NHS doesn't have air industry safety standards a few months back. Well that is hardly suprising given that it isn't the air industry.

The National Patient Safety Agency have claimed that the actual number of deaths due to errors last year was around 3500. Whatever the number we all want healthcare to be as safe as possible, however with the vast number of humans working in it, it will never be as safe as the air industry.

For me, governance is key. Multiple providers all running as independent companies don't lend themselves to slick processes where patients cross company borders (as is almost always the case in health care). Commissioners have a much harder time governing the safety through contracts rather than through direct management. Patients fall between contractual gaps. Ending the market is not a panacea but it would help.

To vaccinate or not to vaccinate

The recent measels outbreaks in Manchester and London, which include the death of one child, have prompted calls for compulsory vaccination and the BMA has a very useful piece on this.

The benefits of vaccination to the individual are well established and should those benefits just sit with the individual, I suspect calls for compulsion would fall on deaf ears. The issue gets heated for four main reasons:

1. The benefit of immunisation is even greater for society than for the individual - herd immunity is a major goal of immunisation programmes.
2. Scare stories have abounded about side effects, most notably with MMR. While it is possible for most medical interventions to have side effects, vaccines are considered very safe and the autism and crohns links have been discredited.
3. Personal choice on how children are raised and treated. Nobody likes to be told what to do, and compulsion of this sort is felt to be an infringement of human rights.
4. Profit driving vaccination programmes, both profit for BigPharma and for GPs who get paid for high vaccination rates.

Personally I think that the human rights issue is the key. We must not make vaccination compulsory, but we must promote it as much as possible. Vaccination should, once again, become part of the routine of bringing up children - that is not to say that it should not be questioned. Parents should be able to make decisions on their child's health, but the information that they base their decisions on must be clear and unbiased. Promotion is the key to herd immunity.