Hospitals write foreign debt

25 January 2012 stand 20: 34 GMT by Jane Bradley studies producer, BBC London in total, £ 7. 6 m comes out of 33 NHS trusts in the region, since 2009

Hospitals have learned written off until 96% of what they not entitled to free NHS care are due from foreign patients, has London BBC London.

A freedom of information request showed that Newham wrote hospital trust all but 4% which it had been last year into account.

The hospital trust said that it was too heavy to costs be recovered, if foreign patients died or were failed asylum seekers.

In total, £ 7. 6 m was from 33 NHS trusts in the region since 2009 written off.

The trust is a total £ 26 m of the patients which owe £ 18. 4 m continues to actively search for.

Further wrote the main story Newham Hospital wrote from £ 345,000 from £ 358, 000Basildon and Thurrock wrote from £ 47,000 from £ 117, 000Hillingdon hospital from £ 335,000 £ 660, 000Luton and Dunstable wrote from £ 2,000 from £ 85, 000South London wrote from £ 29,000 from £ 481.000

All figures refer to 2010-11

All hospitals are required, for money owed for the treatment of these patients to restore.

The figures show that there are large differences between hospitals.

During the East London hospital trust wrote most of what it was last year due to ineligible foreign patients West Middlesex Hospital wrote only 3%.

East London hospital trust said: "there are some cases where it is not possible or is difficult, costs, such as when a patient dies failed asylum seekers or when they leave the UK."

NHS health care is free for everyone who needs treatment emergency, but bent patients, residing outside the European Union is to pay for services, with some exceptions.

"Health tourist" could someone, that specifically for free health care UK visited, or they can here already living and try to pay their invoice to avoid.

A senior doctor at a large hospital of London, who wanted to be identified, said that the problem of the outstanding debt was much higher than official figures show.

'Cannot afford to not'

"It's probably about three or four times, the figure," he said.

"These patients know someone in this country probably." "Very often they come only plane, to the first A & E Department, which deals with this kind of State and they know that they are treated, because they are very sick."

He added: "I think we can afford it?" "No, I think we can."

Among other things, Kings College have hospital from £ 343.000 last year.

A spokesman said: "we give patients enough time and opportunity, we prove that it entitled to free treatment."

"Under no circumstances treatment fees would be waived, if proof of status is not received."

Mercedes Abelando, 69, lives in South London but originally from Uruguay and not qualified for free NHS treatment, says that she was treated at the hospital while she was an illegal migrants.

Mercedes Abelando said that they could not afford to pay for treatment

She told BBC London, that they do not know that she would have to pay until after the treatment, she received an invoice for medical care.

"I went to the hospital and I told them that I not that kind of money and I could not pay," she said.

"The person who saw me at the hospital said to me: 'ok, that is good';" took the letter and I have not heard from them since.

"I was surprised, but I couldn't pay does not in any case."

Various hospital trusts, who had written off large amounts of their debts, said chasing the money often difficult when patients leave the country and sums were only written down when had exhausted all options to pursue.

There are no official figures, which some suspect to measure is a problem that is under the radar.

Some believe however, that "health tourists" there are not and are a sensational reports phenomenon.

"Read the main story

, which we cannot afford to an international health care, a free treatment for all"

Naomi Hartree, a volunteer on the project in London end quote Anne Milton Health Minister, a clinic in East London of the vulnerable populations helps such migrants and asylum seekers, health care/healthcare access, says that foreign patients are over-policed.

"We have documented many cases in which people of the hospital treatment shot have been because they are perceived to health tourists, and they are entitled to health care, people," she said.

Project London also argued that debt of foreign patients is chasing more expensive than to write it off.

Immigration powers introduced in November 2011 mean overseas patients who cannot enter debts which may be NHS £ 1,000 or more, or remain in the United Kingdom, until the debt is paid.

The Interior Ministry has said, it was still too early to see what impact it had.

In the meantime the Government access to health care studying patients NHS currently overseas.

It is expected, shall report to Minister in the next few months.

Health Minister Anne Milton said: "Hospitals meets appropriate measures to overseas recover any debt patients."

"NHS has endangered the obligation immediately everyone which life or long-term health is, but not to an international health care, we must free treatment for all,."

Source BBC

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Do hospitals do enough to help smokers quit?

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A man smokes next to a ''No Smoking'' sign in downtown Shanghai April 27, 2011.

Credit: Reuters/Carlos Barria

By Kerry Grens

NEW YORK | Thu Oct 13, 2011 1:19pm EDT

NEW YORK (Reuters Health) - Nearly every smoker hospitalized in the United States is given advice or counseling on how to quit, according to a new study of hospital records.

But that finding belies what researchers consider a failed attempt, initiated nine years ago, at getting hospitals to actually help people stop smoking. The next version of the program needs to do better, experts say.

"There was no requirement, other than a box to check off that any substantive counseling was given to help smokers to quit," Dr. Michael Fiore, director of the Center for Tobacco Research and Intervention at the University of Wisconsin, told Reuters Health. He was not involved in the current study but chairs a panel working to revise the hospital rules on smokers.

In 2002, the Centers for Medicare and Medicaid Services and The Joint Commission, which sets hospital standards, required that smokers discharged after having pneumonia, heart attack or heart failure be given quitting advice.

It was almost too simple a request, said Douglas Levy, lead author of the new study and a professor at Harvard Medical School and the Mongan Institute for Health Policy at Massachusetts General Hospital.

"There are anecdotal reports of hospitals putting a postcard in the patient's room saying, 'you should quit smoking' and checking off the box that they've provided smoking cessation advice or counseling," Levy told Reuters Health.

Levy and his colleagues collected information from the Centers for Medicare and Medicaid Services on how often hospitals provided quitting advice to patients.

Their study, published in the Archives of Internal Medicine, shows how readily hospitals adopted the new measure.

In 2002, just 67 percent of smokers hospitalized because of a heart attack received advice on quitting smoking.

By 2008, that number jumped to 99 percent of heart attack patients.

For heart failure patients, 42 percent admitted to the hospital in 2002 received smoking cessation information, compared to 97 percent of patients in 2008.

Similarly for pneumonia patients, 37 percent of them were advised to quit smoking in 2002, compared to 95 percent in 2008.

The numbers show that hospitals paid attention to the rules, but the rules were too easy to satisfy, Levy said.

The Joint Commission recognized that the requirements were not strict enough, and they put together an advisory panel in 2009 to revise the rules. One of the study's authors sits on the panel.

Fiore, the panel's chairman, said one of the changes coming out in 2012 is that hospitals will have to follow up with people 30 days after they are discharged to check whether the patients were able to quit smoking.

In this way, hospitals can better gauge how well their efforts are paying off.

Levy's results don't show whether the higher rates of quitting advice resulted in more people quitting smoking.

Take-home advice from hospitals doesn't always change outcomes. Another recent study showed that hospitals that set up children and their families with a plan for managing asthma did not reduce later hospital visits for the condition (see Reuters Health story of October 4, 2011).

Fiore said he expects the new rules to be more effective at helping hospitals seize the opportunity to get smokers to quit.

Hospitals will also be required to document their efforts in more detail.

But Levy said some of his results left him concerned that certain hospitals may struggle under the stricter requirements.

The small numbers of patients who did not receive any advice on how to quit smoking were clustered at hospitals that serve a greater proportion of poor, minority or frail patients.

If these hospitals are not meeting the standards "when the bar is set low, it's going to be harder for them when the bar is set higher," Levy said.

He added that it will be important to make sure the most vulnerable hospitals don't fall behind.

SOURCE: bit.ly/rp6ipt, Archives of Internal Medicine, October 10, 2011.

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Study: Worst hospitals treat larger share of poor

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CHICAGO (AP) — The nation's worst hospitals treat twice the proportion of elderly black patients and poor patients than the best hospitals, and their patients are more likely to die of heart attacks and pneumonia, new research shows.

Now, these hospitals, mostly in the South, may be at higher risk of financial failure, too. That's because the nation's new health care law punishes bad care by withholding some money, says the lead author of the study published Wednesday in the journal Health Affairs.

"These hospitals are going to have a much harder time in the new funding environment," said Dr. Ashish Jha of the Harvard School of Public Health, who led the study. "I worry they're going to get worse over time and possibly even fail. I worry that we're going to see a bunch of that happening over the next three to five years."

Under the Affordable Care Act, hospitals that fail to improve will see their Medicare payments shrink by 1 percent starting October 2012. That could jeopardize some hospitals already on the brink of closure, Jha said.

That unintended consequence of the health overhaul could increase health disparities for minorities, Jha said.

"We have to make sure we pay attention to what the results of those policies are and be ready to change directions if they're causing harm in the marketplace," Jha said.

The study doesn't name the 178 hospitals the researchers rated as "worst" because of their low quality of care and high costs. A data use agreement with Medicare prevented the researchers from identifying the hospitals publicly.

The study, funded by the Commonwealth Fund, found 122 "best" hospitals with high quality and low costs. Those best hospitals were more likely to be in the Northeast, to be nonprofit and to have cardiac intensive care units compared to the worst hospitals.

Elderly blacks made up 15 percent of patients in the worst hospitals and about 7 percent in the best hospitals. There were similar differences for people on Medicaid, the state-federal health program for the poor. Worst-hospital patients with heart attacks or pneumonia were more likely to die than similar patients at the best hospitals.

Medicare chief Don Berwick called the study "valuable, but not completely new." He said the federal government is working to help all hospitals improve.

"We know they can improve," even if they treat sicker or disadvantaged patients, Berwick said. "There are examples of safety net hospitals that are some of the best in the country." He cited Denver Health, which has low death rates despite treating a large share of poor patients.

The health law's so-called "value-based purchasing" rewards hospitals for their rate of improvement, not just for attaining goals, Berwick said. So hospitals that start farther behind can get rewarded for making efforts to catch up. And the law provides money for hospital improvement programs.

"If I were talking to safety net hospitals, I would say, 'I know it's hard. Here's some help, and if you start (improving), you'll get rewarded for starting,'" Berwick said.

For the study, the researchers used data from six sources to determine which hospitals were worst and best. They divided the hospitals into four ranked groups for quality of care and divided them again into four ranked groups for cost.

Of 3,229 hospitals analyzed, 122 were in the top group for quality and also in the group that had the lowest costs. The researchers compared those hospitals to the 178 that were in the bottom group for quality and had the highest costs.

"What can we do to take the lessons from the high-performing institutions and help the low performers improve?" Jha asked. In markets outside of health care, business closures don't so directly affect people's survival, he said, but "here, there are tens of thousands of lives at stake."

With the health law's expansion of insurance in 2014, patients may have more choice in hospitals. But most patients don't use tools like Hospital Compare to find the best ones nearby, Jha said. Hospital Compare is a government website that rates how hospitals measure up to certain standards, such as giving heart attack patients aspirin.

"People go to hospitals because they've always gone there or their families have always gone there or their doctors have always referred them there," Jha said.

Nancy Foster of the American Hospital Association said the group is worried about whether the new funding formula will put safety net hospitals at financial risk, but believes all hospitals can improve.

"There's no hospital in the country right now that doesn't want to do the best for the patients it serves," Foster said. "That's where research comes in and sharing of good results on how to improve."

___

Online:

Hospital Compare: http://bit.ly/ac26AR

Health Affairs: http://www.healthaffairs.org

___

AP Medical Writer Carla K. Johnson can be reached at http://www.twitter.com/CarlaKJohnson

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Hospital's plea to give up leave

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6 October 2011 Last updated at 12:08 GMT Staff at the hospital are being encouraged to surrender holiday under the voluntary scheme

An east London hospital has urged staff to "sacrifice" some of their annual leave or do unpaid work to save money.

Whipps Cross told its 3,400 staff that the NHS trust was facing a £4.5m deficit and needed to take "extraordinary financial measures".

The offer was "purely voluntary" and would be a "one-off" measure that would not affect their terms and conditions, chief executive Cathy Geddes said.

Consultants are also being asked to do extra clinical sessions.

Whipps Cross University Hospital serves more than 350,000 people from Waltham Forest, Redbridge, Epping Forest.

It said it had a turnover of £233m in 2009-10 but was currently facing "unprecedented and demanding financial challenges in 2011-12 and beyond".

Staff 'responding positively'

In a letter to staff, seen by BBC London, the chief executive wrote: "To this end, and in the light of our month five financial results (£4.5m actual deficit), you will be aware that the trust has now launched extraordinary financial measures.

"As part of these measures we have asked staff if they are willing to volunteer to sacrifice annual leave and/or perform additional unpaid sessional duties.

"I would like to stress that any such sacrifice will be a one-off in 2011/12 and will not commit anyone on an ongoing basis or change anyone's terms and conditions of employment."

A statement from the hospital said it had also asked consultants to work an extra clinical session every month and members of the trust's executive team were all giving up two days of annual leave.

Ms Geddes said staff were "responding positively".

"We recognise that many people already go the extra mile and deliver over and above their job requirements," she added.

Whipps Cross is planning to merge with Barts and the London NHS Trust and Newham University Hospital NHS Trust. The business case will be put forward to NHS London soon.

The proposed merger will reduce back-office duplication while the savings made would be reinvested into patient care, the hospital said.

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Study: Worst hospitals treat larger share of poor

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CHICAGO (AP) — The nation's worst hospitals treat twice the proportion of elderly black patients and poor patients than the best hospitals, and their patients are more likely to die of heart attacks and pneumonia, new research shows.

Now, these hospitals, mostly in the South, may be at higher risk of financial failure, too. That's because the nation's new health care law punishes bad care by withholding some money, says the lead author of the study published Wednesday in the journal Health Affairs.

"These hospitals are going to have a much harder time in the new funding environment," said Dr. Ashish Jha of the Harvard School of Public Health, who led the study. "I worry they're going to get worse over time and possibly even fail. I worry that we're going to see a bunch of that happening over the next three to five years."

Under the Affordable Care Act, hospitals that fail to improve will see their Medicare payments shrink by 1 percent starting October 2012. That could jeopardize some hospitals already on the brink of closure, Jha said.

That unintended consequence of the health overhaul could increase health disparities for minorities, Jha said.

"We have to make sure we pay attention to what the results of those policies are and be ready to change directions if they're causing harm in the marketplace," Jha said.

The study doesn't name the 178 hospitals the researchers rated as "worst" because of their low quality of care and high costs. A data use agreement with Medicare prevented the researchers from identifying the hospitals publicly.

The study, funded by the Commonwealth Fund, found 122 "best" hospitals with high quality and low costs. Those best hospitals were more likely to be in the Northeast, to be nonprofit and to have cardiac intensive care units compared to the worst hospitals.

Elderly blacks made up 15 percent of patients in the worst hospitals and about 7 percent in the best hospitals. There were similar differences for people on Medicaid, the state-federal health program for the poor. Worst-hospital patients with heart attacks or pneumonia were more likely to die than similar patients at the best hospitals.

Medicare chief Don Berwick called the study "valuable, but not completely new." He said the federal government is working to help all hospitals improve.

"We know they can improve," even if they treat sicker or disadvantaged patients, Berwick said. "There are examples of safety net hospitals that are some of the best in the country." He cited Denver Health, which has low death rates despite treating a large share of poor patients.

The health law's so-called "value-based purchasing" rewards hospitals for their rate of improvement, not just for attaining goals, Berwick said. So hospitals that start farther behind can get rewarded for making efforts to catch up. And the law provides money for hospital improvement programs.

"If I were talking to safety net hospitals, I would say, 'I know it's hard. Here's some help, and if you start (improving), you'll get rewarded for starting,'" Berwick said.

For the study, the researchers used data from six sources to determine which hospitals were worst and best. They divided the hospitals into four ranked groups for quality of care and divided them again into four ranked groups for cost.

Of 3,229 hospitals analyzed, 122 were in the top group for quality and also in the group that had the lowest costs. The researchers compared those hospitals to the 178 that were in the bottom group for quality and had the highest costs.

"What can we do to take the lessons from the high-performing institutions and help the low performers improve?" Jha asked. In markets outside of health care, business closures don't so directly affect people's survival, he said, but "here, there are tens of thousands of lives at stake."

With the health law's expansion of insurance in 2014, patients may have more choice in hospitals. But most patients don't use tools like Hospital Compare to find the best ones nearby, Jha said. Hospital Compare is a government website that rates how hospitals measure up to certain standards, such as giving heart attack patients aspirin.

"People go to hospitals because they've always gone there or their families have always gone there or their doctors have always referred them there," Jha said.

Nancy Foster of the American Hospital Association said the group is worried about whether the new funding formula will put safety net hospitals at financial risk, but believes all hospitals can improve.

"There's no hospital in the country right now that doesn't want to do the best for the patients it serves," Foster said. "That's where research comes in and sharing of good results on how to improve."

___

Online:

Hospital Compare: http://bit.ly/ac26AR

Health Affairs: http://www.healthaffairs.org

___

AP Medical Writer Carla K. Johnson can be reached at http://www.twitter.com/CarlaKJohnson

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Vending machines 'undermine' hospitals'

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23 September 2011 Last updated at 04:26 GMT By Dr Rachel Thompson World Cancer Research Fund Vending machines tend to dispense high-calorie food like chocolate Hospitals are, by definition, buildings that are dedicated to health.

But in this week's Scrubbing Up, Dr Rachel Thompson, deputy head of science at World Cancer Research Fund, says that good work is being undermined by the contents of hospital vending machines.

Whenever I visit hospitals, I am always struck by how the efforts of the dedicated healthcare professionals who work in them are being undermined by what is happening in the waiting areas.

All too often, these waiting areas have vending machines that are filled with high-calorie foods and drinks such as chocolate bars, crisps and sugary drinks.

But because these foods are a cause of obesity, they are part of the reason many of the people will have ended up in hospital in the first place.

There is strong scientific evidence that excess body fat is a risk factor for cancer, as well as other non-communicable diseases such as heart disease and diabetes.

And yet hospital vending machines are selling products that are a cause of obesity at the same time as the health professionals working there are trying to cope with its consequences.

That is why hospitals should put an end to vending machines that sell high calorie foods and drinks.

Little focus

It is true that on its own this would be unlikely to have a serious impact on obesity levels.

You would have to spend a lot of time in hospital waiting rooms for the contents of the vending machines to make much of a difference to your weight.

But rather, the fact that hospital vending machines are filled with these kinds of foods and drinks is a symptom of how little meaningful focus there is on the obesity crisis.

Across society, big changes are needed if we are to address obesity and the preventable cases of cancer and other diseases that result from it.

The changes that we need are supported by common sense.

If you prioritise the needs of motorised transport when you plan a town, it is to be expected that people won't walk or cycle enough.

If you allow the food and drinks industry to market unhealthy products to children, then don't be surprised when children pester their parents to buy those products.

But the fact that hospital vending machines are still stocked with high-calorie foods and drinks illustrates that we are not recognising the problem.

There is no great mystery about what needs to happen.

There is already a large evidence base for what works and doesn't work when it comes to policy changes. What we need to see is political will and a change to the mindset where we tolerate the things that promote obesity.

This would not only mean the end of the kind of culture where the sale of unhealthy foods and drinks in hospital waiting rooms is seen as acceptable.

It could also mean fewer people end up in those waiting rooms in the first place.

View the original article here

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Do hospitals' freebies undermine breast-feeding?

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HOLD FOR RELEASE AT 12:01 A.M., EDT MONDAY, SEPT. 26 WITH STORY BY LINDSEY TANNER - In this Sept. 14, 2011 photo, Jessica Ewald breast-feeds her 5-month-old son Bennett at her home in Oakbrook Terrace, Ill. Like many new moms, she got a hospital goody bag with supplies including free formula and formula coupons that she gave away as soon as she got home. Ewald, the daughter of a breast-feeding activist who fought to get those goody bags out of hospitals, says hospitals sending newborns home with formula can really undermine a woman's determination to breast-feed. (AP Photo/M. Spencer Green) HOLD FOR RELEASE AT 12:01 A.M., EDT MONDAY, SEPT. 26 WITH STORY BY LINDSEY TANNER - In this Sept. 14, 2011 photo, Jessica Ewald breast-feeds her 5-month-old son Bennett at her home in Oakbrook Terrace, Ill. Like many new moms, she got a hospital goody bag with supplies including free formula and formula coupons that she gave away as soon as she got home. Ewald, the daughter of a breast-feeding activist who fought to get those goody bags out of hospitals, says hospitals sending newborns home with formula can really undermine a woman's determination to breast-feed. (AP Photo/M. Spencer Green) HOLD FOR RELEASE AT 12:01 A.M., EDT MONDAY, SEPT. 26 - In this Sept. 14, 2011 photo, Nathan and Jessica Ewald hold their 5-month-old son, Bennett, at their home in Oakbrook Terrace. Like many new moms, she got a hospital goody bag with supplies including free formula and formula coupons that she gave away as soon as she got home. Ewald, the daughter of a breast-feeding activist who fought to get those goody bags out of hospitals, says hospitals sending newborns home with formula can really undermine a woman's determination to breast-feed. (AP Photo/M. Spencer Green) HOLD FOR RELEASE AT 12:01 A.M., EDT MONDAY, SEPT. 26 - In this Sept. 14, 2011 photo, Nathan and Jessica Ewald hold their 5-month-old son, Bennett, at their home in Oakbrook Terrace, Ill. Like many new moms, she got a hospital goody bag with supplies including free formula and formula coupons that she gave away as soon as she got home. Ewald, the daughter of a breast-feeding activist who fought to get those goody bags out of hospitals, says hospitals sending newborns home with formula can really undermine a woman's determination to breast-feed. (AP Photo/M. Spencer Green)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); CHICAGO (AP) — Jessica Ewald brought more than a new baby boy home when she gave birth earlier this year. Like many new moms, she got a hospital goody bag, with supplies including free infant formula and formula coupons.

"We gave it away the moment we came home because I said I'm not having that in our house," Ewald said.

Ewald, 32, of Oakbrook Terrace, Ill., is the daughter of a breast-feeding activist who fought to get those goody bags out of hospitals. Ewald was taught early on that "breast is best," and even though as a teen she rolled her eyes when her mom asked pregnant women about nursing, Ewald knew she'd choose breast over bottle when her own time came.

Borrowing a line from a blogger, Ewald says hospitals sending newborns home with formula "is like giving somebody divorce papers at their wedding." It can really undermine a woman's determination to breast-feed, she said.

The head of the federal Centers for Disease Control and Prevention shares her concern.

"Hospitals need to greatly improve practices to support mothers who want to breast-feed," Dr. Thomas Frieden said last month in releasing a CDC report card on breast-feeding. It showed that less than 5 percent of U.S. infants are born in "baby-friendly" hospitals that fully support breast-feeding, and that 1 in 4 infants receive formula within hours of birth.

Routinely offering new moms free formula is among practices the CDC would like to end. In some cases, hospitals agree to give out those freebies in exchange for getting free supplies for special-needs infants, Frieden said.

Exactly how many U.S. hospitals hand out formula is unclear. The American Hospital Association and the International Formula Council, a trade group for formula makers, do not keep statistics and formula companies contacted for this story declined to comment.

A nationwide study of more than 3,000 U.S. hospitals and maternity centers published last year in the Journal of Human Lactation found that 91 percent sent new moms home with free formula in 2006-07. A smaller 2010 study of 1,239 hospitals suggests that the practice has decreased, although most — 72 percent — still offered formula. That study is being released Monday in October's Pediatrics.

"I don't think hospitals are the right place to market anything and I don't think hospitals should be marketing a product that is nutritionally inferior to breast milk," said study author Anne Merewood, an associate pediatrics professor at Boston University medical school and editor of the Journal of Human Lactation.

"People do think if a doctor gives something it must be good for you," Merewood said.

Some women and activists, though, say the move to end formula freebies is part of a breast-feeding movement that has gone too far, overstating the benefits and guilt-tripping new moms who have difficulty nursing or just choose not to. And even some breast-feeding moms don't have a problem with the free formula.

"I think it's fine to offer freebies to any mom, especially those who are undecided or have already made up their mind not to breast-feed. We are always free to refuse," said the Rev. Camille Lebron Powell, an associate Presbyterian pastor in Little Rock, Ark.

Breast milk contains antibodies that strengthen babies' immune systems and help them fight infections. Research has shown that breast-fed babies have reduced chances of becoming obese or developing diabetes in childhood, and sudden infant death syndrome is less common in breast-fed infants.

The American Academy of Pediatrics and other medical groups recommend that infants receive only breast milk for their first six months. The new CDC report shows that only 15 percent of new mothers achieve that goal, and only 44 percent of new moms breast-feed at all for six months.

Lebron Powell doesn't dispute the benefits and chose to breast-feed her children, aged 9 months and 4 years old. But she says those who choose to use formula shouldn't be demonized.

"Breast-feeding is free. It's good for the baby and it's good for the mom. But it's hard and if you work and the employer doesn't support your pumping needs, you are in trouble," she said.

Hospitals have been offering formula freebies for decades, but they have a new incentive to abandon the practice.

The Joint Commission hospital accrediting group last year added "exclusive breast milk feeding" during newborns' hospital stays as a measure that hospitals can be evaluated on. While formula giveaways won't be evaluated, the commission mentions monitoring that practice when it educates hospitals on how to improve their performance, said Celeste Milton, an associate project director at the commission.

The goal is to discourage hospitals from giving infants formula when it's not medically necessary, said commission spokeswoman Elizabeth Zhani.

Central DuPage Hospital in Winfield, Ill., the suburban Chicago hospital where Ewald had her baby last March, boasts that 93 percent of its new mothers are breast-feeding when they're sent home. It also supplies lactation consultants to new moms — a service Ewald said she appreciated. But Ewald said she got a mixed message about breast-feeding, because nurses there wanted to give her baby formula to help him gain weight, and because of those free samples in her goody bag.

Hospital spokeswoman Amy Jo Steinbruecker said the gift bags contain "literature and samples of common items newborns may need, including a small sample of formula," and are meant to support healthy parenting and baby care.

But she said the hospital is examining the formula freebies as it seeks to be designated "baby-friendly."

The World Health Organization and the United Nations Children's Fund established that designation to encourage breast-feeding, with 10 criteria hospitals must meet. These include allowing new moms and infants to remain together throughout the hospital stay and not giving newborns any pacifiers or formula.

Jennifer Smoter, a spokeswoman for Abbott Nutrition, makers of Similac formula, declined to disclose how many hospitals Abbott provides with formula samples and would not comment on the practice. Representatives of Mead Johnson, makers of Enfamil formula, did not respond to several email and telephone requests for comment.

Haley Stevens, a scientific affairs specialist for the International Formula Council trade group, said not offering new moms formula samples "is really irresponsible."

New moms should have formula available, along with information on how to use it so they don't water it down or make other mistakes that could endanger their babies' health, Stevens said.

"We agree breast-feeding is the best, when you can do it," she said. "There's no question. But if one size doesn't fit all, it's good to have a backup."

___

Online:

CDC breast-feeding report: http://www.cdc.gov/breastfeeding/data/reportcard.htm

American Academy of Pediatrics: http://www.aap.org

___

AP Medical Writer Lindsey Tanner can be reached at www.twitter.com/LindseyTanner

Associated Press

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Do hospitals' freebies undermine breast-feeding?

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CHICAGO (AP) - Jessica Ewald brought more than a new baby boy home when she gave birth earlier this year. "Like many new moms, she got a hospital goody bag, with supplies including free infant formula and formula coupons.""We gave it away the moment we came home because I said I'm not having that in our house," Ewald said.Ewald, 32, of Oakbrook Terrace, Ill., is the daughter of a breast-feeding activist who fought to get those goody bags out of hospitals. Ewald was taught early on that "breast is best", and even though as a teen she rolled her eyes when her mom asked pregnant women about nursing, Ewald knew she'd choose breast over bottle when her own time cam.Borrowing a line from a blogger, Ewald says hospitals sending newborns home with formula "is like giving somebody divorce papers at their wedding." It can really undermine a woman's determination to breast feed, she said."The head of the federal Centers for Disease Control and Prevention shares her concern.""Hospitals need to greatly improve practices to support mothers who want to breast feed," Dr. Thomas Frieden said last month in releasing a CDC report card on breast-feeding. It showed that less than 5 percent of U.S. infants are born in "baby-friendly" hospitals that fully support breast-feeding, and that 1 in 4 infants receive formula within hours of birth.Routinely offering new moms free formula is among practices the CDC would like to end. In some cases, hospitals agree to give out those freebies in exchange for getting free supplies for special-needs infants, Frieden said.Exactly how many U.S. hospitals out hand formula is unclear. The American Hospital Association and the International Formula Council, a trade group for formula makers, do not keep statistics and formula companies contacted for this story declined to how.A nationwide study of more than 3,000 U.S. hospitals and maternity centers published last year in the Journal of Human Lactation found that 91 percent feel new moms home with free formula in 2006-07. A smaller 2010 study of 1,239 hospitals suggests that the practice has decreased, although most — 72 percent - still offered formula. "That study is being released Monday in October's Pediatrics."""I don 't think hospitals are the right place to market anything and I don' t think hospitals should be marketing a product that is nutritionally inferior to breast milk,"said study author Anne Merewood, an associate pediatrics professor at Boston University medical school and editor of the Journal of Human Lactation.""People do think if a doctor gives something it must be good for you," Merewood said.Some women and activists, though, say the move to end formula freebies is part of a breast-feeding movement that has gone too far, overstating the benefits and guilt-tripping new moms who have difficulty nursing or just choose not to. "And even some breast-feeding moms don't have a problem with the free formula."I think it's fine to offer freebies to any mom, especially those who are undecided or have already made up their mind not to breast feed. "We are always free to decline," said the Rev. Camille Lebron Powell, an associate Presbyterian pastor in Little Rock, Ark.Breast milk contains antibodies that strengthen babies' immune systems and help them fight infections. Research has shown that breast fed babies have reduced chances of becoming obese or developing diabetes in childhood, and sudden infant death syndrome is less common in breast-fed infants.The American Academy of Pediatrics and other medical groups recommend that infants receive only breast milk for their first six months. The new CDC report shows that only 15 percent of new mothers achieve that goal, and only 44 percent of new moms breast-feed at all for six months.LeBron Powell doesn't dispute the benefits and thing to breast feed her children, aged 9 months and 4 years old. "But she says those who choose to use formula shouldn't can't be demonized."Breast-feeding is free. It's good for the baby and it's good for the mom. "But it's hard and if you work and the use doesn't support your pumping needs, you are in disorder," she said.Hospitals have been offering formula freebies for decades, but they have a new incentive to abandon the practice.The Joint Commission hospital accrediting group last year added "exclusive breast milk feeding" during newborns' hospital stays as a measure that hospitals can be evaluated there. While formula giveaways won't be evaluated, the commission mentions monitoring that practice when it educates hospitals on how to improve their performance, said Celeste Milton, an associate project director at the commission.The goal is to discourage hospitals from giving infants formula when it's not medically necessary, said commission spokeswoman Elizabeth Zhani.Central DuPage Hospital in Winfield, Ill., the suburban Chicago hospital where Ewald had her baby last March, boasts that 93 percent of its new mothers are breast-feeding when they're sent home. It also supplies lactation consultants to new moms - a service Ewald said she appreciated. But Ewald said she got a mixed message about breast-feeding, because nurses there wanted to give her baby formula to help him gain weight, and because of those free samples in her goody bag.Hospital spokeswoman Amy Jo Steinbruecker said the gift bags contain "literature and samples of common items newborns may need, including a small sample of formula," and are meant to support healthy parenting and baby care.But she said the hospital is examining the formula freebies as it seeks to be designated "baby-friendly."The World Health Organization and the United Nations Children's Fund established that designation to encourage breast-feeding, with 10 hospitals must meet criteria. These include allowing new moms and infants to remain together throughout the hospital stay and not giving any pacifiers newborns or formula.Jennifer Smoter, a spokeswoman for Abbott Nutrition, makers of Similac formula, declined to disclose how many hospitals provides Abbott with formula samples and would not how on the practice. Representatives of Mead Johnson, makers of Enfamil formula, did not respond to several email and telephone requests for comment.Haley Stevens, a scientific affairs specialist for the International Formula Council trade group, said not offering new moms formula samples "is really irresponsible.""New moms should have formula available, along with information on how to use it so they don't water it down or make other mistakes that could endanger their babies' health, Stevens said.""We agree breast-feeding is the best, when you can do it," she said. "There's no question." "But if one size doesn't fit all, it's good to have a backup."___Online: CDC breast-feeding report: http://www.cdc.gov/breastfeeding/data/reportcard.htmAmerican Academy of Pediatrics: http://www.aap.org___AP Medical Writer Lindsey Tanner can be reached at www.twitter.com/LindseyTannerAssociated Press

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Free formula samples at hospitals raise concern

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By Genevra Pittman

NEW YORK | Mon Sep 26, 2011 1:19am EDT

NEW YORK (Reuters Health) - Company-sponsored infant formula samples are still the norm at many hospitals, although fewer are giving out the freebies now than in 2007, according to a new report.

Experts worry that giving new moms the free samples could undermine official recommendations that they stick to breastfeeding until their baby is at least six months old.

"If a hospital gives it out... the patient thinks it's the best thing for the baby," said Anne Merewood from Boston Medical Center, who worked on the new study. "The bottom line is that the hospitals are marketing for the formula industry."

The free samples typically come in diaper bags that maternity wards give out to moms when they leave the hospital. Sometimes those bags are funded by the hospital. But as research has shown, more often than not they're provided by formula companies.

"The companies have an incentive to give as much away early on, because it kind of gets hospitals and mothers hooked on that," said Chessa Lutter, regional advisor on food and nutrition for the Pan American Health Organization, part of the World Health Organization.

In 2007, Merewood and her colleagues surveyed hospitals in every state and found that more than 90 percent of them gave company-sponsored formula to mothers.

To see if anything had changed, last year the researchers went back to all hospitals in the 10 states that were most likely to give out free formula and the 10 that were least likely to do so.

Of the more than 1,200 hospitals in those 20 states, 72 percent said they gave out company-sponsored samples to some or all mothers, compared to the 86 percent in 2007.

Merewood said that trend may be due to grassroots movements working to promote breastfeeding. The states least likely to hand out the freebies include California, Massachusetts and Minnesota.

Yet the 10 states most likely to give out samples, including Oklahoma, New Jersey and Texas still distribute them at 93 percent of their hospitals, the researchers reported Monday in Pediatrics.

"Most of them are still giving it out," Merewood told Reuters Health. "It's not too rosy a picture."

The free samples are an ethical issue for hospitals because mothers might think that their doctors endorse the formula, and that they should use it instead of, or in addition to breastfeeding, Merewood said.

She and Lutter said that just about all formula companies sponsor samples, because they're at a competitive disadvantage when moms shop for formula on their own if they don't.

Lutter, who wasn't involved in the new study, said there's no law in the U.S. saying formula companies can't use hospitals to give out samples of their products -- but the WHO has come out strongly against that practice in all countries.

Not accepting free formula, she said, "is essential for assuring that the knee-jerk reaction for hospital (staff) as well as moms is not to go to the formula when there's any question or any concerns" about breastfeeding.

Breastfeeding has a number of health benefits for kids, Lutter pointed out. That includes prevention against infection, and possibly an IQ boost. After six months of exclusive breastfeeding, the WHO recommends at least partial breastfeeding up to two years or longer.

While formula might be helpful when new mothers can't breastfeed for one reason or another, free samples usually do little good, Merewood said.

"Nurses like to give things to people, especially when they're not very wealthy," she told Reuters Health. "It's not really a gift, because it's not good for their health."

Abbott Nutrition, which makes formula, would not comment on the study.

The International Formula Council, which represents formula manufacturers and marketers, told Reuters Health that formula samples serve a valuable purpose.

"The IFC believes mothers should be trusted to make good choices for their babies according to their individual family circumstances," it said in an email to Reuters Health.

"Hospital discharge packs provide key educational materials, which may include an infant formula sample -- directing moms to the right type of formula and to proper use and storage instructions, if needed."

But Lutter and Merewood agreed that there's little room for debate about the right move for hospitals when it comes to company freebies.

"Hospitals should not accept any donations of a formula," Lutter said.

SOURCE: bit.ly/jsoh2P Pediatrics, online September 26, 2011.

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Vending machines 'undermine' hospitals'

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23 September 2011 Last updated at 04:26 GMT By Dr Rachel Thompson World Cancer Research Fund Vending machines tend to dispense high-calorie food like chocolate Hospitals are, by definition, buildings that are dedicated to health.

But in this week's Scrubbing Up, Dr Rachel Thompson, deputy head of science at World Cancer Research Fund, says that good work is being undermined by the contents of hospital vending machines.

Whenever I visit hospitals, I am always struck by how the efforts of the dedicated healthcare professionals who work in them are being undermined by what is happening in the waiting areas.

All too often, these waiting areas have vending machines that are filled with high-calorie foods and drinks such as chocolate bars, crisps and sugary drinks.

But because these foods are a cause of obesity, they are part of the reason many of the people will have ended up in hospital in the first place.

There is strong scientific evidence that excess body fat is a risk factor for cancer, as well as other non-communicable diseases such as heart disease and diabetes.

And yet hospital vending machines are selling products that are a cause of obesity at the same time as the health professionals working there are trying to cope with its consequences.

That is why hospitals should put an end to vending machines that sell high calorie foods and drinks.

Little focus

It is true that on its own this would be unlikely to have a serious impact on obesity levels.

You would have to spend a lot of time in hospital waiting rooms for the contents of the vending machines to make much of a difference to your weight.

But rather, the fact that hospital vending machines are filled with these kinds of foods and drinks is a symptom of how little meaningful focus there is on the obesity crisis.

Across society, big changes are needed if we are to address obesity and the preventable cases of cancer and other diseases that result from it.

The changes that we need are supported by common sense.

If you prioritise the needs of motorised transport when you plan a town, it is to be expected that people won't walk or cycle enough.

If you allow the food and drinks industry to market unhealthy products to children, then don't be surprised when children pester their parents to buy those products.

But the fact that hospital vending machines are still stocked with high-calorie foods and drinks illustrates that we are not recognising the problem.

There is no great mystery about what needs to happen.

There is already a large evidence base for what works and doesn't work when it comes to policy changes. What we need to see is political will and a change to the mindset where we tolerate the things that promote obesity.

This would not only mean the end of the kind of culture where the sale of unhealthy foods and drinks in hospital waiting rooms is seen as acceptable.

It could also mean fewer people end up in those waiting rooms in the first place.

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Nurses at dozens of Calif. hospitals strike

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Kaiser Permanente employees walkout to protest proposed benefit cuts and a lack of progress on contract talks outside the Kaiser Permanente hospital Wednesday, Sept. 21, 2011, in Los Angeles. About 2,500 employees: nurses, social workers and therapists walked the picket Wednesday as part of a larger three-day strike across California to protest Kaiser attempt to reduce their retirement benefits and health care coverage. (AP Photo/Damian Dovarganes) Kaiser Permanente employees walkout to protest proposed benefit cuts and a lack of progress on contract talks outside the Kaiser Permanente hospital Wednesday, Sept. 21, 2011, in Los Angeles. About 2,500 employees: nurses, social workers and therapists walked the picket Wednesday as part of a larger three-day strike across California to protest Kaiser attempt to reduce their retirement benefits and health care coverage. (AP Photo/Damian Dovarganes) Kaiser Permanente employees walkout to protest proposed benefit cuts and a lack of progress on contract talks outside the Kaiser Permanente hospital Wednesday, Sept. 21, 2011, in Los Angeles. About 2,500 employees: nurses, social workers and therapists walked the picket Wednesday as part of a larger three-day strike across California to protest Kaiser attempt to reduce their retirement benefits and health care coverage. (AP Photo/Damian Dovarganes)eval("var currentItemd57851005a80479aaeeb90a12c70b9ff = 1;");eval("var nextd57851005a80479aaeeb90a12c70b9ff = 0;");eval("var previousd57851005a80479aaeeb90a12c70b9ff = 0;"); SAN FRANCISCO (AP) — Nurses in red union shirts carried signs and chanted slogans outside dozens of Northern and Central California hospitals into the night Thursday as part of a one-day strike over benefit cuts and other concessions sought by hospital management.

The California Nurses Association, the union organizing the strike, expected nearly 23,000 nurses to participate although hospital officials reported that many nurses had crossed the picket line.

Union officials could not provide an estimate of how many nurses took part in the strike, but Charles Idelson, a spokesman for the California Nurses Association, described it as "overwhelming participation."

Striking nurses were planning to return to work at 7 a.m. Friday, but Idelson said he expected lockouts at some of the hospitals.

The strike affected 33 not-for-profit hospitals run by Kaiser Permanente and Sutter Health, and the independent Children's Hospital Oakland, said Idelson.

Hospital officials said they had made preparations to minimize any possible patient disruptions. Replacement nurses were on hand at some of the eight Sutter Health hospitals affected by the walk-out, the hospital said.

"Surgeries are continuing, babies are continuing to be born," hospital spokeswoman Karen Garner said.

A strike involving 23,000 nurses would be large, particularly in recent years when the strength of organized labor has declined, said John-Paul Ferguson, assistant professor of organizational labor at Stanford University.

"It's rare for us to have these days in the United States that many people on a coordinated strike," Ferguson said.

The eight hospitals employ about 4,500 nurses who are members of the union, according to Garner. At least at two of the hospitals, a majority of unionized nurses who were scheduled to work reported for duty, Garner said.

"Many of our nurses recognize that our hospitals provide competitive wages, competitive benefits and a rewarding working environment, and they've chosen to report to work to care for our patients," she said.

Children's Hospital Oakland was also expected to bring in replacement nurses. The hospital had rescheduled elective surgeries as well, according to Erin Goldsmith, a hospital spokeswoman.

Kaiser officials said many nurses had crossed the picket line and their hospitals were "fully staffed."

The focus of the strike was Sutter Health, where union officials say nurses in contract negotiations are being asked to accept thousands of dollars in higher costs for their health care.

Sutter's proposed concessions would also reduce the ability of certain nurses to advocate for patients, cut pay for newly hired nurses, and slash vacations and holiday pay, according to the union.

At Alta Bates Summit Medical Center in Oakland — a Sutter Health-affiliated hospital — nurses held signs that read, "Community Care, Not Corporate Profits," and "Some Cuts Don't Heal."

"We're not just here for money," said Vicki Theocharis, a nurse in the hospital's oncology unit. "We want to take care of the patients, and it almost feels like we're being penalized for doing it."

Millicent Borland, 65, a nurse on the union bargaining team at Summit Medical Center, said the cuts management has proposed would set a dangerous precedent in the health care industry.

"It would set a precedent that all other management will think about and pass it down to other workers," she said.

Garner has said the hospital has an obligation to keep health care costs down for patients.

Union members at Children's Hospital, who have been without a contract for more than a year, have objected to a proposed increase in the cost of a health care plan the hospital offers.

At Kaiser Permanente, 17,000 nurses were expected to walk-off the job to show solidarity with the National Union of Healthcare Workers. The union is in contract talks with Kaiser and facing demands for cuts in health and retirement benefits, Idelson said.

Thursday's action was among the largest nurses' strikes in recent years, according to the Bureau of Labor Statistics. In two strikes in March and May, up to 2,500 health care workers, including 2,100 nurses, held one-day walkouts at Kaiser Permanente's flagship Los Angeles Medical Center as part of a contract dispute.

The last largest nurses' strike, according to the BLS, was in June 2010, when a dispute over nurse-patient ratios led to a one-day walkout of 12,000 nurses working at 14 Minneapolis-area hospitals.

Kaiser Permanente has said it is bargaining in good faith.

The strike is scheduled for one day, but Sutter Health and Children's Hospital officials said nurses will not be able to immediately return to work because the hospitals' contracts with replacement agencies require a minimum number of days of service.

At Sutter Health, that ranges from three to five days, Garner said. At Children's Hospital, it is five days, according to Goldsmith.

___

Associated Press writer Terence Chea in Oakland and Jennifer Farrar of the Associated Press News Research Center contributed to this report.

Associated Press

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Why closing hospitals is good for your health

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12 September 2011 Last updated at 12:56 GMT By Nick Triggle Health correspondent, BBC News Stroke services have been revamped in London Decisions about closing - or moving - hospital services are always controversial. But there is mounting evidence that such changes can actually improve care and save lives.

Every hour someone in London has a stroke - but in many ways they are the lucky ones.

It is now widely acknowledged that the city is probably the best place in the world to have one.

And it is all because some services were shut down.

The capital's stroke care was overhauled in early 2010. Instead of being spread across 30 hospitals as they used to be, services are now centralised on eight "super sites".

It has meant patients get fast, 24-hour access to the best care and is expected to save 400 lives a year.

If a stroke is suspected, a patient is immediately taken to one of the eight centres. There they are assessed by a stroke specialist and given a brain scan within 30 minutes of arrival.

This allows medics to ensure the patients receive the right treatment in time.

For example, 15% of stroke patients need clot-busting drugs to restore blood flow to the brain within hours of the stroke. In London, virtually all of them get it.

Continue reading the main story

The problem is you get everyone on board and agreed to the idea, but then when it is their local unit under threat a local campaign gets underway and it makes it more difficult than it should be”

End Quote Mike Farrar NHS Confederation Indeed, six of the eight units have been given the highest grade possible by inspectors. Across the rest of the country just one in 13 units have been given that rating.

Tom Greenwood, head of London operations for the Stroke Association, says: "I think there is evidence to suggest that the system in London is world-leading.

"Patients tell us they are amazed by how seamless and integrated it is - it really has made services better."

Risk for patients

But it is not just stroke care that can benefit from such a redesign.

The King's Fund has argued a whole host of specialities would benefit from being delivered from fewer sites.

In a report published earlier this year, the think-tank highlighted A&E, maternity, neonatal and heart services in particular.

Researchers said without such measures, patients could be put at risk.

The argument has been put forward by other bodies too.

A wave of new hospital developments have happened in the past decade

The Royal College of Surgeons has said emergency departments should not be providing services to population of less than 300,000 to ensure expertise is not spread too thinly.

At the moment the north east has an emergency department for every 150,000 people. The north west and London fair little better.

Similar arguments have been put forward for maternity care by the Royal College of Obstetricians and Gynaecologists and child heart surgery during an official NHS review by local health bosses.

But these steps come at a price - the closure of individual hospital departments or, sometimes, entire centres.

'Attachments'

For example, the review of child heart surgery said between four and five units needed to stop doing surgery to ensure doctors carried out enough operations to keep their skills up.

This suggestion has ignited local campaigns to save the threatened units, with one even winning the right to challenge the proposals through the courts.

It is this sort of backlash which makes overhauling hospitals such a difficult step.

Despite the strong case that can be often put forward, the public feel attached to their local hospital.

And, as a result, politicians have shied away from publicly backing the case for change - even though centralisation of services often saves money by making the health service more efficient.

Hospitals have been the visible face of the NHS ever since it was created. This was cemented in the 1960s which saw the network of district general hospitals expanded to every corner of the country.

And it has been further reinforced by the use of PFI since the 1990s which has used private money to build or refurbish over 100 hospitals.

But Mike Farrar, chief executive of the NHS Confederation which represents health managers, says this attachment to hospitals can often get in the way.

He had experience of two major reconfigurations when he was head of the North West Regional Health Authority - one involving the closure of an A&E unit and the other the overhaul of maternity care in the Greater Manchester.

"The problem is you get everyone on board and agreed to the idea, but then when it is their local unit under threat a local campaign gets underway and it makes it more difficult than it should be.

"It means we spend years going though the arguments for change and sometimes can't do the very thing that will benefit patients."

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Why closing hospitals is good for your health

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12 September 2011 Last updated at 12:56 GMT By Nick Triggle Health correspondent, BBC News Stroke services have been revamped in London Decisions about closing - or moving - hospital services are always controversial. But there is mounting evidence that such changes can actually improve care and save lives.

Every hour someone in London has a stroke - but in many ways they are the lucky ones.

It is now widely acknowledged that the city is probably the best place in the world to have one.

And it is all because some services were shut down.

The capital's stroke care was overhauled in early 2010. Instead of being spread across 30 hospitals as they used to be, services are now centralised on eight "super sites".

It has meant patients get fast, 24-hour access to the best care and is expected to save 400 lives a year.

If a stroke is suspected, a patient is immediately taken to one of the eight centres. There they are assessed by a stroke specialist and given a brain scan within 30 minutes of arrival.

This allows medics to ensure the patients receive the right treatment in time.

For example, 15% of stroke patients need clot-busting drugs to restore blood flow to the brain within hours of the stroke. In London, virtually all of them get it.

Continue reading the main story

The problem is you get everyone on board and agreed to the idea, but then when it is their local unit under threat a local campaign gets underway and it makes it more difficult than it should be”

End Quote Mike Farrar NHS Confederation Indeed, six of the eight units have been given the highest grade possible by inspectors. Across the rest of the country just one in 13 units have been given that rating.

Tom Greenwood, head of London operations for the Stroke Association, says: "I think there is evidence to suggest that the system in London is world-leading.

"Patients tell us they are amazed by how seamless and integrated it is - it really has made services better."

Risk for patients

But it is not just stroke care that can benefit from such a redesign.

The King's Fund has argued a whole host of specialities would benefit from being delivered from fewer sites.

In a report published earlier this year, the think-tank highlighted A&E, maternity, neonatal and heart services in particular.

Researchers said without such measures, patients could be put at risk.

The argument has been put forward by other bodies too.

A wave of new hospital developments have happened in the past decade

The Royal College of Surgeons has said emergency departments should not be providing services to population of less than 300,000 to ensure expertise is not spread too thinly.

At the moment the north east has an emergency department for every 150,000 people. The north west and London fair little better.

Similar arguments have been put forward for maternity care by the Royal College of Obstetricians and Gynaecologists and child heart surgery during an official NHS review by local health bosses.

But these steps come at a price - the closure of individual hospital departments or, sometimes, entire centres.

'Attachments'

For example, the review of child heart surgery said between four and five units needed to stop doing surgery to ensure doctors carried out enough operations to keep their skills up.

This suggestion has ignited local campaigns to save the threatened units, with one even winning the right to challenge the proposals through the courts.

It is this sort of backlash which makes overhauling hospitals such a difficult step.

Despite the strong case that can be often put forward, the public feel attached to their local hospital.

And, as a result, politicians have shied away from publicly backing the case for change - even though centralisation of services often saves money by making the health service more efficient.

Hospitals have been the visible face of the NHS ever since it was created. This was cemented in the 1960s which saw the network of district general hospitals expanded to every corner of the country.

And it has been further reinforced by the use of PFI since the 1990s which has used private money to build or refurbish over 100 hospitals.

But Mike Farrar, chief executive of the NHS Confederation which represents health managers, says this attachment to hospitals can often get in the way.

He had experience of two major reconfigurations when he was head of the North West Regional Health Authority - one involving the closure of an A&E unit and the other the overhaul of maternity care in the Greater Manchester.

"The problem is you get everyone on board and agreed to the idea, but then when it is their local unit under threat a local campaign gets underway and it makes it more difficult than it should be.

"It means we spend years going though the arguments for change and sometimes can't do the very thing that will benefit patients."

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Why close hospitals is good for your health

12. September 2011 booth 12: 56 GMT by Nick Triggle health correspondent of the BBC News stroke was Services revised in London over decisions close - or move - hospital services are always controversial. But there is häufenden evidence that actually support better these changes and can save lives.

Every hour someone in London has a stroke - but are the lucky in many ways.

It is now widely recognised that is probably the best place in the world, a city to have.

And it's all because some services were shut down.

The capital of stroke care has been overhauled in the spring of 2010. Instead is spread over 30 hospitals, how they are used, services are now centralized in eight "super sites".

It's meant, patients quickly, you will receive 24-hour access to the best care and 400 lives per year to save.

If a stroke is suspected, a patient is immediately placed in one of the eight centres. There they are measured by a stroke specialist and a brain scan within 30 minutes of arrival.

This allows physician to make sure that patients receive the right treatment in time.

For example, require 15% of stroke patients clot-busting drugs blood flow to the brain within hours of the stroke to restore. In London, almost all of them get it.

Read the most important story

the problem is, all of you on board and agreed to the idea, but then their local unit is threatened local campaigns is underway and it makes it harder than it should be "

end quote Mike Farrar NHS Confederation in fact six of the eight units have received the highest degree possible by inspectors." In the rest of the country, only one in 13 units were the review, da.

Tom Greenwood, head of London operations for the Stroke Association, says: "I think there is evidence that the system in London is leading."

"Patients tell us, they are amazed at how seamless and integrated it is - it really has services better."

Risk for patients

But it is not only stroke care that can benefit from such a redesign.

King's Fund has argued that a number of specialties will benefit would come from fewer pages.

In a report published earlier this year marked the think tank of A & E, maternity, neonatal and heart services in particular.

Without such measures, said researchers at risk patients.

The argument has also from other places were provided.

A wave of new hospital, developments have taken place in the last ten years

The Royal College of surgeons said that emergency departments should be not services, to ensure that the expertise is not too thinly scattered less than 300,000 inhabitants.

Currently, the North-East has an emergency room for all 150,000 people. The North west and London fair little better.

Similar arguments have care of the Royal College of Obstetricians and gynecologists and child heart surgery for motherhood while an official NHS review put forward by local health chiefs.

But these steps at a price - the closure of the individual hospital departments or sometimes whole centres.

'Equipment'

For example, said the review of child heart surgery between four and five units had to stop operation ensure, doctors, the enough operations carried out, to keep their skills.

This proposal has local campaigns to save the endangered units, with one even entitled, ignited the proposals by the courts.

It is this kind of backlash that makes such a difficult step to overhauling hospitals.

Despite the strong case, which often cannot be relied upon, feel connected to their local hospital the public.

And as a result, politicians have publicly eschewed change - back up, even if the centralisation of services often saves money by to make healthcare more efficient.

Hospitals were the visible face of NHS, since it was created. This was cemented in the 1960s, that extends the network of General district hospitals seen to every corner of the country.

And it has to build the private money through the use of PFI in the 1990s has been reinforced or renovated has used over 100 hospitals.

But Mike Farrar, Chief Executive of the NHS Confederation is health managers, says, that in hospitals, which can often come in the way.

He had experience of two large transformation as he head of the North West regional health authority - one with the closure of an A & E unit and the other is the overhaul of maternity care in the Greater Manchester.

"The problem is, all of you on board and agreed to the idea, but then their local unit is threatened local campaigns is underway and it makes it harder than it should."

"It means that we for years, if the arguments for change and sometimes not exactly what benefit the patients."

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