NHS authorised ambulance teams to give restricted drugs

An ambulance service jeopardised patient and staff safety to try to improve its performance, a health watchdog said. Staffordshire Ambulance Service NHS Trust also issued staff with drugs that they were not legally allowed to have, the Healthcare Commission found. The trust took risks with patient and staff safety while making “innovative” attempts to improve its service. The service has since merged with West Midlands Ambulance.

In a 96-page report, the commission emphasised that the Staffordshire service was a “good performer” in terms of response times for emergency calls. But the eight-month inquiry found that the achievements of the service were undermined by a “culture and approach” that did not prioritise safety. Investigators found that ambulance staff and volunteer community first responders were supplied with controlled drugs, such as the sedatives diazepam and midazolam, that they were not entitled to possess. It was also discovered that medicines in the trust’s stations regularly went missing or were unaccounted for and that community first responders were allowed to drive at speed using blue lights and sirens without the necessary advanced driver training.

Commenting on the report, Anna Walker, the Healthcare Commission chief executive, said that managers at Staffordshire Ambulance Service NHS Trust were motivated by the best intentions. But she added: “Some of the practices in the trust put the safety of patients, volunteers and staff at risk. “Patients, staff and the public could have been seriously hurt as a result of the compromised safety culture. The trust sought to be innovative, and that is to be applauded, but it did not have effective systems in place to handle this innovation safely. “This undermined many of the good achievements made on behalf of patients.”

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Phone calls don't make you healthier! How surprising!

Making socialized medicine work well is beyond the wit of man. Many have tried but nothing succeeds

An ambitious three-year experiment to see whether the Medicare system could prevent expensive hospital visits for people with chronic conditions like congestive heart failure and diabetes has suggested that such an approach may cost more than it saves. The test borrowed a practice long available through private health plans. Nurses periodically place phone calls to patients to check whether they are taking their drugs and seeing the right doctors. The idea is that keeping people healthier can help patients avoid costly complications. After paying eight outside companies about $360 million since mid-2005 to try to improve such patients’ health, Medicare is still trying to figure out whether the companies were able to keep people healthier. But the preliminary data indicate that the government is unlikely to save money.

The experiment, meanwhile, is proving something else: how difficult it can be, politically and practically, to make fundamental changes in the sprawling $400 billion federal Medicare program, which now covers some 44 million Americans. With health costs soaring, few would dispute that the government needs to find better ways to spend its Medicare dollars. But because the system relies heavily on private industry and is subject to Congressional oversight, few changes come easily, and even experimental programs can take on lives of their own.

Several of the companies, including two that specialize in disease management, Healthways and Health Dialog, are pressing Medicare to continue the project in some fashion beyond the end of this year, saying the government mishandled the experiment. The senators from the home states of those two companies, including John Kerry, Democrat of Massachusetts, and Lamar Alexander, Republican of Tennessee, have taken up their cause, demanding that Medicare rethink ending the experiment. “Stopping this program,” the senators wrote in a letter to Medicare last month, “creates serious health risks for the Medicare beneficiaries already enrolled and heavily reliant” on the services provided by the experiment.

Medicare, for its part, says the experiment so far has not reduced medical bills enough to offset the fees the companies are charging the government — as much as $2,000 a year for each patient. A final accounting of the experiment is likely to come no sooner than next year. About 160,000 people have taken part in the test, known as the Medicare Health Support program, and some 70,000 are still receiving calls from nurses employed by the companies.

Experts say that Medicare and the companies alike were too optimistic about how easy it would be to prevent costly complications and hospital visits by patients who are very sick. “Everybody shares some blame,” said Dr. David B. Nash, a health policy professor at Thomas Jefferson University in Philadelphia, who at the outset was enthusiastic about the program’s prospects for transforming Medicare.

On the experiment’s front lines are nurses like Jill Coker, who works for Healthways and makes 25 to 30 telephone calls a day, trying to ensure that each patient receives a call every few weeks. Through dozens of such nurses, Healthways, based in Nashville, is overseeing the care of 16,000 people in Maryland and Washington. Ms. Coker said she spent most of her time on rudimentary issues, like explaining to patients what prescription drugs they are on and helping them devise ways to make sure they remember to take their medicine. She may also arrange a conference call with a patient’s doctor if there are some worrisome new symptoms, or she may direct someone to a specialist to get better care. “There have been numerous diabetics who didn’t even know what an endocrinologist was,” she said.

Medicare has not finished studying how well patients do under the program and whether patients are satisfied with the help. Three of the original companies — Cigna, McKesson and LifeMasters — eventually dropped out. The program has failed to meet the government’s original financial target: an overall savings to Medicare of 5 percent after factoring in the companies’ fees and the patients’ medical bills. Initially, the companies were supposed to return their payments if they did not hit that target. Late last year, Medicare relaxed its standard, requiring only that the experiment not end up costing the government money. The agency says that it will consider keeping any promising pieces of the program. But it says it cannot legally extend the experiment beyond December if it is not budget neutral.

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