This Week's News 6-10 June 2011

Lack of junior doctors will affect service, hospitals warn

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Lack of junior doctors will affect service, hospitals warn

Irish Times


Hospitals expect to have real difficulty providing service next month if not enough junior doctors are registered in time, writes EITHNE DONNELLAN, Health Correspondent

A NUMBER of hospitals will not be able to maintain their current levels of service next month because of the shortage of junior doctors, the Health Service Executive (HSE) has been told.
A group representing medical manpower managers across the State’s hospitals issued the warning two weeks ago in a letter that has been seen by The Irish Times.
In it, the chairwoman of the group, Iris Cranley, says that when manpower managers met on May 18th “major concerns were expressed in relation to the lack of NCHD [non-consultant hospital doctor or junior doctor] staff” and the difficulties encountered in relation to registering new recruits with the Medical Council.
“Medical manpower managers are of the opinion that, unless there is some resolution to the current difficulties with registration, a number of hospitals will not be in a position to function at current levels, due to a lack of registered NCHDs in July 2011,” she wrote.
“We are all aware of the timeframe between doctors applying for registration and the approval of same as, quite rightly, there are a number of checks to be carried out on applicants.
“As July 11th looms, we would ask that you convey the real difficulties hospitals expect [to experience] in providing services should there be insufficient NCHDs registered,” she added. July 11th is when the doctors are rotated between posts as part of their training.
The letter was sent to Andrew Condon, the general manager of the office of the HSE’s national director of human resources.
In a response on June 1st, he said he appreciated “the very significant difficulties arising from delays in the processing of applications for registration with the Medical Council”.
All doctors need to be registered with the Medical Council before they can work in Ireland and Mr Condon confirmed that the HSE had arranged for four of its staff to be assigned to the Medical Council’s registration department to assist in the processing of applications.
Last week, one manpower manager suggested there were more than 440 doctors in India and Pakistan now who would be willing to come to Ireland to fill vacant junior doctor posts in hospitals if the Medical Council did not put so many obstacles in their way.

The Medical Council said, however, that it could not compromise the robustness of the registration process by fast-tracking processes that could affect the levels of protection afforded to the public.

Doctors from outside the European Union who want to be registered here need to produce documentary proof of their qualifications, and most also have to sit a written examination to evaluate their level of knowledge and an assessment of their clinical, communication and interpretation skills. This clinical exam must be taken in Ireland.
The entire process usually takes months, but the HSE is hoping it can be streamlined so that junior doctor posts falling vacant on July 11th can be filled. In a bid to fill an anticipated 200-400 vacant junior doctor posts in July, the HSE sent a delegation to India and Pakistan to recruit from there.
While the Medical Council has started a consultation process on requirements for exempting some doctors from having to take the written and clinical exams, it appears many of the Indian and Pakistani recruits are unlikely to be registered to work here by July 11th.
The shortage of junior doctors here has been blamed on the long working day, pay cuts, and lack of training opportunities and opportunities for career progression.
The HSE says, however, that the shortage is a worldwide problem.


NHS faces new crisis as Midwives leave to join the private sector

Express, UK


By Lucy Johnston

The Royal College of Midwives estimates the NHS is at least 4,500 staff short and safety is being compromised.
A Sunday Express inquiry found up to 2,392 baby deaths were linked to lack of proper care in maternity units.
The Independent Midwives UK group, which represents private practitioners providing home and hospital birth support, reported a huge increase in NHS staff applying to join their ranks.
“We know that thousands of qualified midwives have left and are choosing to walk away from the profession because they cannot bear to work in the fragmented system,” said leading independent midwife Annie Francis.
“We have newly qualified midwives who are thrown in at the deep end on these big labour wards. They last 12 to 18 months before they leave because they are so stressed.
“These big wards can be like baby factories and the stress levels are very high.”
Staff numbers are failing to keep pace with a 19 per cent rise in the birth rate. David Cameron has not yet honoured a pre-election pledge to create 3,000 new posts.
A report in The Lancet revealed Britain ranked 33rd in the developed world for stillborn babies with 11 delivered every day.
A recent study also showed 14 NHS trusts have shockingly high baby death rates which have soared to twice the national average.


Reforms Needed to Stem Shortage of Birth Caregivers

Spiegel, Germany

By Lisa Erdmann
Midwives are a regular feature of childbirth in Germany, but it is getting a lot harder for expectant parents to find them. Stagnating birth rates and skyrocketing liability insurance premiums have led many midwives to look for other jobs. Some regions are already suffering for lack of available care.
Isabel Grafe presses softly on the belly of Christine, an expectant mother who is laying comfortably on a bed. "Feel there, this small part is the knee, but I am actually looking for the buttocks," Grafe says. Christine's due date is on Sunday and midwife Grafe is giving her a few last tips.
Grafe, 29, works in the Hamburg Birthing Center in the northern German port city. Ten self-employed nurse midwives are based here, with most working fulltime and as much as 60 hours per week. Birthing center manager Britta Höpermann says that a net average wage of €8 to €9 ($11.50-$13) per hour is normal for workers here, but that is barely enough to pay the rent in an expensive city like Hamburg.
Christine, from Henstedt-Ulzberg, a small town north of Hamburg, is determined to deliver her baby with a midwife by her side. "I associate hospitals with illness. And I'm not ill," she says. For each of her prenatal appointments, Christine has traveled from Henstedt-Ulzberg to Hamburg -- a distance of about 20 kilometers (12 miles) each way -- to see Grafe.
A birth is an emotional experience, one accompanied by immense joy and fear. Pain is a given, and support services for the woman giving birth are a must. In Germany, nurse midwives are a common part of the experience in the maternity wards at local hospitals. According to the latest available figures from the German Federal Statistical Office, close to 10,000 midwives aid in the births of 644,274 babies at hospitals each year.
In the future, however, German parents hoping to use the services of a midwife will be burdened by additional bureaucracy and planning when it comes to the birth of their child. Even today, it isn't uncommon for a person to be turned away when trying to secure a midwife in May for a December birth. It's likely to become even more difficult -- at least for women who hope to choose their own midwife. The number of self-employed midwives, who attend births in hospitals, birthing centers or even private homes, is declining.
Midwives Demand 30 Percent Pay Hike
For months, German nurse midwives and their supporters have been protesting for better pay for their services -- wages they say should better reflect the enormous responsibilities that come with the job. Protests have been held in Berlin, Kiel, Essen and Dresden. An online petition organized by the German Midwives Association has gathered hundreds of thousands of signatures, and now the protests are expected to grow. "The federal health minister promised improvements, but nothing has happened," says Edith Wolber of the Midwives Association. Wolber says her organization is going to take a firmer approach in its fight, because these days the job of helping women to give birth is hardly worth the effort -- at least not financially.
The midwives are demanding 30 percent greater pay for the services they provide that are covered by insurance providers with the national healthcare system. However, the pay rise faces an uphill battle since it would require that an exception be made in German legislation limiting the payments made by insurers for certain types of care.
So far, the German Health Ministry has dismissed the criticism. "We are doing much to accommodate these concerns," says ministry spokesman Roland Jopp. He adds the ministry is in the process of commissioning an auditor to look into the situation of Germany's midwives and produce a report by the end of the year. The ministry says it is also open to considering modifying the law.
Midwifery was never a career path that could lead to riches in Germany. Today, an 11-hour birth in a hospital will earn the attending midwife about €224 ($325). A follow-up appointment nets €26, regardless of how long the appointment takes.
Today, the average taxable income of a self-employed midwife is about €14,000 per year. However, insurance premiums can eat up more than one-quarter of that. Over the past five years, the financial situation of Germany's midwives has become increasingly dire: While liability insurance premiums for attending midwives have climbed steeply, the fees these professionals charge for their services have increased only incrementally. Four years ago, liability insurance fees for a midwife cost €1,218 ($1,755) per year. Now, a self-employed midwife who attends births can expect to pay €3,689 in liability insurance fees annually. Those who don't attend births, and provide only pre- and postnatal care, pay a fraction of this cost.
The numbers leave little surprise as to why ever more midwives are leaving their originally chosen profession. In the last year alone, 15 percent have left the career path, according to the German Midwives Association. Today only one-fourth of midwives attend births.
One Mistake Can Cost Millions

According to Katrin Rüter de Escobar of the German Insurance Association, an umbrella organization of private insurers, the increased insurance premiums are the result of an enormous increase in damages that can be extracted in the event of a mishap. The problem isn't that midwives are making more mistakes, but rather that the liabilities have become much greater when one actually is made. "It's not about a broken vase, but a child -- and that costs money," Rüter de Escobar says of the increased premiums, which are often cited as a major problem for Germany's modern midwives. In 1998, the amount of damages paid out by Deutsche Ärzteversicherung, a standard insurer for German healthcare workers, was around €340,000. Within ten years time, however, the potential amount to be paid out for damages related to problems in birth caused by healthcare workers had risen to nearly €2.9 million.

Around 150 babies are born in the Hamburg Birthing Center every year. Midwives here can still afford to attend births because they have developed other means of making money: They offer yoga classes for pregnant women, nutrition courses and instruction on the proper way to carry a babies as well as gatherings for nursing mothers and babies. The center also recently added courses for future grandparents and young siblings of newborns.
The center doesn't accept insurance cards and participants must pay directly. "Our classrooms are at full capacity," says manager Höpermann, "Otherwise it would be too great of a business risk."
But models like the one in Hamburg are unlikely to succeed in small cities or rural areas, where demand is lower. Even in large cities, less well-off areas are suffering from a lack of available care, according to the Hamburg Midwives' Association. Hamburg's Wilhelmsburg district is one example: Residents of this area can't afford prenatal yoga or general birth preparation courses. Expectant parents like Christine from Henstedt-Ulzburg have no choice but to travel for such opportunities.
Midwife Grafe hooks up an electronic fetal monitor and listens to the baby's heartbeat. "When should we leave for the hospital? Once labor starts?" Christine asks. Sooner rather than later, according to the midwife. She also advises Christine to stay in close contact with the birthing center via telephone. She offers one last piece of advice: "No matter what, don't put your husband on the phone. He has no idea how you're doing anyway."


Faster is not always better

The Economist, UK

MALARIA and septicaemia (blood poisoning), responsible for 2m deaths worldwide every year, are among the biggest killers of African children. Clinics across Africa witness the same tragedy: a limp child, clammy and cold to the touch, with a fast, weak pulse, is carried in by a distraught parent. The body has sent blood to the vital organs in a last effort to cling to life. What happens next is critical. Up to 22% of children brought into African hospitals in this condition end up dead.
To stave off an immediate demise, the standard practice in most hospitals is rapidly to infuse a large dose of fluid, known as bolus. This is cheap and is supposed to keep the child alive long enough for medicine to start working. Yet a new study looking at 3,170 children in Kenya, Tanzania and Uganda was ended prematurely this year when bolus infusions were found actually to increase the risk of death. Children given fluids more slowly did better—though why is still a mystery. The research team says the findings are robust and “will save many lives in the future”.
Professor Kathryn Maitland of Imperial College in London, the lead investigator on the Fluid Expansion As Supportive Therapy study, known as FEAST, says that training medical staff to identify critically ill children, plus making sure that anti-malarial drugs, antibiotics, oxygen and glucose are available, is the best way to reduce the mortality rate.
Two lessons for emergency care of children in poor countries can be drawn. The first is to get the World Health Organisation and others to rethink their advocacy of fluid resuscitation to children with malaria, septicaemia, meningitis and similar diseases. The second is to organise emergency care better. The study’s counter-intuitive findings also strengthen calls for more clinical trials. “It shows we need to do more research in Africa for Africans,” says Peter Oluput-Oluput, a Ugandan doctor.


Soins : un temps d'accès satisfaisant pour les Français malgré de fortes disparités régionales

Le Parisien, France


L'accès aux soins de proximité, c'est-à-dire aux soins prodigués par les généralistes, les infirmiers, les masseurs-kinésithérapeutes et les chirurgiens-dentistes, apparaît comme globalement satisfaisant en France puisque 95% de la population résidait à moins de 15 minutes de ce type de services en 2007. Selon la dernière étude de l'Institut de recherche et documentation en économie de la santé (IRDES), diffusée mardi 7 juin, moins de 1% de la population générale vit à plus de 15 minutes de trajet d'un médecin généraliste.

Toutefois, l'étude met en relief des inégalités entre les différentes régions de l'Hexagone, notamment dans les zones rurales et montagneuses à faible densité de population. A titre d'exemple, les personnes résidant en Corse (11%), en Champagne-Ardenne (2%) et en Auvergne (1,5%) habitent à plus de 15 minutes d'un médecin généraliste.
En moyenne, les Français ont accès aux spécialités et disciplines médicales et chirurgicales en moins de 20 minutes par la route. 95% de la population générale peut trouver un service de chirurgie orthopédique, une maternité, ou des services de cardiologie et de pneumologie en moins de 45 minutes par la route.
Néanmoins, les personnes résidant dans les zones les plus isolées sont également confrontées à des temps d'accès plus longs pour bénéficier des soins de spécialistes libéraux. Dans certaines régions, comme la Corse, le Limousin, la Bourgogne ou l'Auvergne, un cinquième de la population vit à plus de 30 minutes en voiture du spécialiste le plus proche.
Autre constat, l'enquête présentée ce jour fait état d'une évolution des distances d'accès aux soins depuis les années 1990. Cette évolution apparaît une fois de plus contrastée en fonction des différentes spécialités médicales. Ainsi, la distance moyenne a été réduite de moitié pour les urologues, alors qu'elle a très peu diminué pour les dermatologues, les pneumologues, les gastro-entérologues et les cardiologues, et qu'elle a augmenté pour les pédiatres, les psychiatres et les médecins généralistes.
Cet état des lieux est conduit au 1er janvier 2007, "date à laquelle le nombre de médecins a atteint un niveau historiquement haut en France", selon les auteurs de l'étude.


Decanos alertan de que muchos alumnos de Medicina no trabajarán como médicos

El Mundo, Spain


Responsables de la Conferencia Nacional de Decanos de Medicina han alertado hoy de que dentro de diez años, cuando finalicen su formación los actuales estudiantes, "habrá decenas de miles de médicos en España muy bien formados, que trabajarán en un supermercado o de taxistas, pero no de médicos, porque se ha planificado mal".

Dicha "ausencia" de planificación se concreta en "la falta de equilibrio" entre el aumento del número de plazas ofertadas en las facultades y "las plazas profesionales que hay cubiertas, las jubilaciones que se prevén y las plazas MIR. No habrá sitio para todos", según ha indicado el secretario de la Conferencia Nacional de Decanos de Medicina, Emilio Sanz.
Sanz, quien es decano de la facultad de La Laguna, y Joaquín García-Estañ, presidente de la Conferencia y decano de la facultad de Murcia, han concedido una entrevista a Efe con motivo de la celebración hoy y mañana en Bilbao de la Conferencia Nacional de Decanos de Medicina, que analiza la situación actual de los estudios y la profesión.
Emilio Sanz se ha referido al futuro de los estudiantes y ha destacado que ya este año los sistemas de salud de las diferentes comunidades autónomas no podrán absorber a un 20 o 25 % de los especialistas que ya se han formado, por lo que estas personas "acabarán en la medicina privada subcontratada o en el paro, pero después de once años de formación".
Joaquín García-Estañ, por su parte, ha hablado sobre el elevado número de jóvenes, cercano a 20.000, que aspiran a iniciar la carrera de Medicina todos los años y ha advertido que ni las facultades ni los hospitales, donde se aprende la especialización, tienen capacidad para formarlos.
"El problema no es tanto la facultad -ha precisado- como las plazas MIR (Médico Interno Residente), que no se pueden incrementar porque los hospitales están al cien por cien de su capacidad formativa. Realmente los 'numeros clausus' están en las plazas de formación médica especializada", ha dicho.
Ha explicado que en la actualidad se ofertan 7.000 plazas para estudiantes de Medicina en España, una cifra que ha considerado "suficiente para la capacidad tanto de la universidad como de los hospitales".
Tras recordar que para ejercer la medicina en España hay que cursar una especialización, ha indicado que cada año se convocan unas 6.200 plazas MIR y se presentan 11.000 licenciados en Medicina, con lo que anualmente se quedan fuera unas 4.000 o 5.000 personas.
"Flaco favor les haríamos si admitimos a los 20.000 aspirantes, como propugnan algunas consejerías de Sanidad", ha subrayado.
Se ha referido también a la "tradicional" ausencia de planificación en el sistema sanitario español y ha apuntado que comenzó en la década de los noventa cuando había un déficit de unos mil médicos al año, del que "nadie se dio cuenta hasta 2006".
En ese año y por el "efecto llamada" de la necesidad de profesionales, llegaron muchos inmigrantes médicos a España -más de 40.000 extracomunitarios y más de 3.400 europeos-, lo que en su opinión, "crea una distorsión, porque da la sensación de que no hay suficientes médicos españoles, y es verdad, pero por la tradicional falta de planificación del sistema sanitario español".
En la Conferencia que se celebra en la capital vizcaína también se ha tratado sobre la reiterada petición de los decanos españoles de que se establezca un sistema de prescripción nacional para todos los estudiantes de Medicina, y que no se ha concretado "por las reticencias de las comunidades autónomas,que lo ven como una pérdida de competencias, cuando no es asi".
"Pedimos un sistema que asigne las plazas de una manera técnica y de una sola vez y no en diecisiete procesos como ocurre ahora, lo que obliga a los estudiantes a estar pendientes de los movimientos de listas para saber dónde pueden matricularse. No es solo un problema académico, también social, porque el curso pasado fue un caos total".

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Latin America & Caribbean


Severe shortage of specialist nurses, says NAJ

Jamaica Observer

THE Nurses Association of Jamaica (NAJ) is reporting a severe shortage of specialist nurses and clerical staff to provide adequate services in Jamaica's health sector, even as the Government embarks on a drive to scale down sections of the public sector workforce.
President of the NAJ Anthonette Patterson painted a frightening picture of Jamaica having only one retired specialist nurse in some medical disciplines.
Patterson explained further that for every discipline in medicine there should be a specialist nurse, but this is far from the case since there is a severe shortage of these personnel in the country.
Patsy Edwards-Henry, recording secretary of the NAJ, told reporters and editors during a meeting at the Observer head office in Kingston Tuesday that the only specialist nurse in orthopaedics is retired.
She explained further that there are only two trained nurses in oncology in Jamaica and one is already retired.
"In nephrology we just started a school, in ENT (Ear, Nose and Throat) we had one and she is retired, and in ophthalmology there is only one," said Edwards-Henry.
Patterson said that by failing to ensure that there are enough expert personnel to provide these specialist services, the Government was displaying scant regard for Jamaicans.
"You will have a registered general trained nurse providing all the services... right now on an orthopaedic ward there is no specialist trained orthopaedic nurse," she said.
"The one specialist orthopaedic nurse that we had used to work in Mandeville Regional Hospital and she retired," she explained.
She added further that the sole oncology nurse is now in training in Trinidad.
"The one ophthalmology nurse we have works at the KPH and she works between the clinic, in the office and she sometimes provides teaching at an institution, so we are grossly short," Patterson said.
At Mona Rehab, she said there are no specialist nurses in rehabilitative care.
"So the Government cannot, at any time, even harbour the thought of reducing the nursing staff," she argued.
The NAJ president also said there is a significant shortage of clerical support staff, resulting in doctors and nurses having to take on a lot of this responsibility.
"At Victoria Jubilee and KPH (Kingston Public Hospital) right now we don't have clerical staff, so when we finish our nursing work we have to go to clerical or we have to ask the doctor to write up this card for me," explained Patterson.
She said the clerical staff at Victoria Jubilee and KPH -- two of the largest hospitals in the island -- have been scaled down drastically overtime.
"So you don't have clerks on the wards to assist the patients when they are going home and to give them their appointments and so that has to be done by nurses and doctors," she explained further.
According to Patterson, the clerical department is closed on weekends, forcing patients to wait until the next weekday to have important documents stamped.
"If you get a sick leave on a Saturday you have to wait to come back on a Monday to get it stamped," she said.
As such, the NAJ president further reiterated that the nursing workforce and its support cannot be reduced at all.

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