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Australian government give research a boost
Key witnesses clash over evidence at Bristol Inquiry
L
ast week saw a clash between two senior UK doctors over the monitoring of surgical standards in the early 1990s. The difference of opinions emerged as Norman Halliday and Terrence English separately gave evidence to the ongoing Inquiry into paediatric cardiac surgery in Bristol, UK, during 1985–94. Halliday, former head of the medical policy division of the Department of Health, and English, former President of the Royal College of Surgeons, were being questioned on events in 1991–92 when, at the Department’s request, the College submitted a report recommending which units should continue to receive special government funding to provide paediatric cardiac surgery. The College duly submitted a report, which included Bristol as a unit that should continue to be approved. Following the submission, English received a letter from John Zorab, Medical Director of Frenchay
Hospital, Bristol, drawing attention to a report in the satirical magazine, Private Eye, which referred to the “dismal mortality statistics in the [Bristol] paediatric cardiac surgery unit since 1988”. Zorab wrote: “Whilst possibly having some inaccuracies, it quotes some statistics which have been confirmed elsewhere. One of the newer consultant cardiac anaesthetists feels that the mortality rate is too distressing to be tolerated and is job-hunting elsewhere.” English told the Inquiry that the letter prompted him to review the data from Bristol, which he found sufficiently wanting to recommend a last-minute adjustment to the College’s report to exclude Bristol. In the event, the Department ignored the College’s recommendations, and decided that the countrywide network of paediatric cardiac services should be “de-designated—ie, should lose its protected status. After these events, it seems that the trail goes cold as far as the concerns
raised in Private Eye and echoed by Zorab are concerned: at the Inquiry, Halliday stated that his impression had been that English simply had “reservations” about Bristol. Furthermore, he “did not remember any discussion with any clinician or official where the performance of Bristol was questioned”. Nor had he any recollection of his attention being drawn to the article in Private Eye. At the Inquiry, English said that Halliday was wrong to have said that he had not made his concerns plain. However, English conceded that, with hindsight, he ought to have made his concerns formal. Asked why he might not have taken this action at the time, English said: “I think I was very cross that the group had failed to accept the very considered advice of the professional working party that they had commissioned. That may have had something to do with it.” Sarah Ramsay
Australian government give research a boost
News in Brief
T
Marijuana sanction granted The right to use marijuana for medicinal purposes was bolstered on May 10 when Ontario Superior Court Justice Harry LaForme granted Jim Wakeford, who has AIDS, the right to smoke the drug. Wakeford is the second Canadian to be given a sanction to smoke marijuana, but the first to receive one from a Canadian higher court. Federal Health Minister Allan Rock says Ottawa will not appeal because Wakeford has been given the right to grow and smoke marijuana, not buy it.
he Australian government announced increased funding for scientific and medical research in its annual budget on May 11. This includes AUS$614 million to be invested over 6 years through the National Health and Medical Research Council of Australia, which doubles their funding. The govern ment has also started the “Lifetime Health Cover” programme to prop up the troubled private-health-insur ance industry (see Lancet 1999; 352: 1995). The programme will create premium penalties, which will increase with age, for those who delay taking out private health insurance. The intention is to encourage young people to join private health-insur ance funds. A rebate introduced earlier this year for those with health insurance has not been sufficient inducement to reverse the decline in the number of those who are privately insured. The government will also intro duce a plan to make transparent or remove the gap between medical
1776
fees and benefits provided by the funds. The government and the Australian Medical Association (AMA) had agreed that doctors could negotiate for private funds to be paid as a percent age of the AMA set fee. Doctors would then have to agree to accept this or estab lish a maximum gap fee in advance so that the patient was aware of what the out-ofpocket expense would be. This fee has become a deterrent to joining private health funds, and has meant that some who may be privately insured will still seek care through the public system to avoid paying the additional costs. Community rating will also be abolished, allowing funds to impose a range of fee structures that can take into account the health status of the person seeking to join. $7·5 million will also be allocated for a new “Office of the Gene Technology Regulator” to oversee a national system of regulation over therapeu tic goods, food, and agriculture.
Medicaid survey When Congress passed a major welfare reform law in 1996, it included provisions to allow those who would lose their cash benefits to keep their Medicaid health insurance. But this is not happening, according to a study released by Families USA, a consumer group, on May 13. The study says in 1997, 675 000 people were uninsured and would have had health insurance if the welfare bill had not become law. Many of these people were no longer eligible, but in some cases former welfare recipients, particularly children, who were still Medicare-eligible, had been wrongly taken off the programme.
Bebe Loff, Stephen Cordner
THE LANCET • Vol 353 • May 22, 1999
L
ast week saw a clash between two senior UK doctors over the monitoring of surgical standards in the early 1990s. The difference of opinions emerged as Norman Halliday and Terrence English separately gave evidence to the ongoing Inquiry into paediatric cardiac surgery in Bristol, UK, during 1985–94. Halliday, former head of the medical policy division of the Department of Health, and English, former President of the Royal College of Surgeons, were being questioned on events in 1991–92 when, at the Department’s request, the College submitted a report recommending which units should continue to receive special government funding to provide paediatric cardiac surgery. The College duly submitted a report, which included Bristol as a unit that should continue to be approved. Following the submission, English received a letter from John Zorab, Medical Director of Frenchay
Hospital, Bristol, drawing attention to a report in the satirical magazine, Private Eye, which referred to the “dismal mortality statistics in the [Bristol] paediatric cardiac surgery unit since 1988”. Zorab wrote: “Whilst possibly having some inaccuracies, it quotes some statistics which have been confirmed elsewhere. One of the newer consultant cardiac anaesthetists feels that the mortality rate is too distressing to be tolerated and is job-hunting elsewhere.” English told the Inquiry that the letter prompted him to review the data from Bristol, which he found sufficiently wanting to recommend a last-minute adjustment to the College’s report to exclude Bristol. In the event, the Department ignored the College’s recommendations, and decided that the countrywide network of paediatric cardiac services should be “de-designated—ie, should lose its protected status. After these events, it seems that the trail goes cold as far as the concerns
raised in Private Eye and echoed by Zorab are concerned: at the Inquiry, Halliday stated that his impression had been that English simply had “reservations” about Bristol. Furthermore, he “did not remember any discussion with any clinician or official where the performance of Bristol was questioned”. Nor had he any recollection of his attention being drawn to the article in Private Eye. At the Inquiry, English said that Halliday was wrong to have said that he had not made his concerns plain. However, English conceded that, with hindsight, he ought to have made his concerns formal. Asked why he might not have taken this action at the time, English said: “I think I was very cross that the group had failed to accept the very considered advice of the professional working party that they had commissioned. That may have had something to do with it.” Sarah Ramsay
Australian government give research a boost
News in Brief
T
Marijuana sanction granted The right to use marijuana for medicinal purposes was bolstered on May 10 when Ontario Superior Court Justice Harry LaForme granted Jim Wakeford, who has AIDS, the right to smoke the drug. Wakeford is the second Canadian to be given a sanction to smoke marijuana, but the first to receive one from a Canadian higher court. Federal Health Minister Allan Rock says Ottawa will not appeal because Wakeford has been given the right to grow and smoke marijuana, not buy it.
he Australian government announced increased funding for scientific and medical research in its annual budget on May 11. This includes AUS$614 million to be invested over 6 years through the National Health and Medical Research Council of Australia, which doubles their funding. The govern ment has also started the “Lifetime Health Cover” programme to prop up the troubled private-health-insur ance industry (see Lancet 1999; 352: 1995). The programme will create premium penalties, which will increase with age, for those who delay taking out private health insurance. The intention is to encourage young people to join private health-insur ance funds. A rebate introduced earlier this year for those with health insurance has not been sufficient inducement to reverse the decline in the number of those who are privately insured. The government will also intro duce a plan to make transparent or remove the gap between medical
1776
fees and benefits provided by the funds. The government and the Australian Medical Association (AMA) had agreed that doctors could negotiate for private funds to be paid as a percent age of the AMA set fee. Doctors would then have to agree to accept this or estab lish a maximum gap fee in advance so that the patient was aware of what the out-ofpocket expense would be. This fee has become a deterrent to joining private health funds, and has meant that some who may be privately insured will still seek care through the public system to avoid paying the additional costs. Community rating will also be abolished, allowing funds to impose a range of fee structures that can take into account the health status of the person seeking to join. $7·5 million will also be allocated for a new “Office of the Gene Technology Regulator” to oversee a national system of regulation over therapeu tic goods, food, and agriculture.
Medicaid survey When Congress passed a major welfare reform law in 1996, it included provisions to allow those who would lose their cash benefits to keep their Medicaid health insurance. But this is not happening, according to a study released by Families USA, a consumer group, on May 13. The study says in 1997, 675 000 people were uninsured and would have had health insurance if the welfare bill had not become law. Many of these people were no longer eligible, but in some cases former welfare recipients, particularly children, who were still Medicare-eligible, had been wrongly taken off the programme.
Bebe Loff, Stephen Cordner
THE LANCET • Vol 353 • May 22, 1999