Bad Science, More Blame and a nasty U turn

Why has health secretary Jeremy Hunt been dangling his balls over the balcony of the British Medical Association? In his speech setting out a 25 year vision for the NHS, he claimed the BMA ‘was not remotely in touch with what its members actually believe’, that ‘your chance of dying on a Sunday in an NHS hospital is 16% higher than dying on a Wednesday’ and that ‘6,000 people lose their lives every year because we do not have a proper 7-day service in hospitals.’ The evidence for the 6000 lives lost is complex and imperfect. One study, from hospital admissions in England in 2009-10, was retrospective and observational, so only designed to spot an association not to prove cause and effect. The numbers were large – there were 14,217,640 admissions and 187,337 deaths in the 30 days after admission. Your overall chance of death was just 1.32%, so a 16% increase in risk sounds a lot but in absolute terms is still small.

Another study allegedly supporting the 6000 figure has yet to be published and scrutinised properly, so to make such bold political claims on the

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The Right Care

The eighth patient safety congress in Birmingham (July 6&7) turned out to be feistier than MD had predicted. In a show of hands, the vast majority of the audience – largely patient safety experts – declared it wrong that NICE had been told by Simon Stevens, CEO of NHS England, to halt its work on safe staffing levels in different NHS settings, including emergency departments. The work was a recommendation of the Francis report into failures at Stafford Hospital. Professor Mark Baker, director of the centre for clinical practice at NICE, told the conference “I think the reason they don’t want it is they don’t like the answer to the question. … The underlying problem is that the NHS has survived for most of its history by taking risks and not getting found out.”

NICE appeared to show commendable balls in announcing it will press ahead and publish its recommended nurse staffing levels for accident and emergency departments which are likely to propose minimum nurse to patient ratios. It would not be official NHS England policy but trusts may feel obliged to comply. NICE later announced a U turn – probably under pressure from the DH and

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Safe Staffing

Will patients be harmed by the government’s relentless demand for more efficiency savings in the NHS? Former health minister Norman Lamb believes that the proposed £22 billion savings by 2020 are ‘almost impossible’. And Morecombe Bay investigator Dr Bill Kirkup has warned of disastrous consequences if the NHS focuses on financial savings at the expense of patient safety. Meanwhile Mid Staffs investigator Sir Robert Francis is outraged that NHS England has halted the work on safe staffing levels by the National Institute of Health and Care Excellence. NHS England has instead decided to ‘take over the work’ despite lacking the independent authority and expertise of NICE, and not being able to cope with its current workload. As one senior NHS England manager told MD; ‘I get hundreds of e mails in my in box each day, many of which concern serious governance issues that have arisen out of the confusion of the Health and Social Care Act. I cannot possibly deal with them all – it’s a high risk strategy trying to pick out the urgent concerns.’

The topic was at least debated at the annual Patient Safety Congress (July 6/7) but pressure is being piled onto

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The Cost of Chaos

MD takes a very simple view on NHS reform. The perfect structure doesn’t exist in any organisation, least of all something as complex as the NHS, and it can be profoundly damaging to keep reorganising in the hope of finding it. The side effects of the unnecessary and ill-judged Health and Social Care Act have been so severe that even lawyers are blowing the whistle to the Eye. As one put it: ‘I get so angry when the government says it’s reduced NHS bureaucracy. It might have cut the number of managers, but the bureaucracy has mushroomed after Lansley’s act. For example, to run community services out of a GP practice used to be simple – a single lease arrangement and contract between the GPs and the Primary Care Trust. Now the PCT commissioning powers have transferred to the Clinical Commissioning Group. The PCT’s interest as tenant transfers to NHS Property Services Limited. NHS PS are now the direct landlord of the provider of the services and the commissioning contract is with the CCG. So now there are four parties to the arrangement to provide simple community services from the GP premises – the GPs, the

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Consent Concerns

On May 19, the Health Service Journal reported that the Care Quality Commission and NHS England have written to the General Medical Council stating that the current system for securing patient consent for treatment is open to abuse. Allegations are being investigated that some doctors have retrospectively altered consent forms to cover up mistakes, and although patients should routinely be given copies of their completed consent forms, many of them aren’t. The GMC will doubtless look into this as a matter of urgency (i.e. within the next decade). The issue is not just whether forms are filled correctly, copied to patients or retrospectively altered, but whether doctors have time to properly gain the consent of patients in an over-burdened NHS. Improper consent was central to the Bristol cardiac disaster, which the Eye exposed in 1992. The results for complex child heart surgery were demonstrably worse in Bristol than at other units at that time, but there was no defined minimal standards forcing them to stop. The surgeons were only found guilty of serious professional misconduct because they had deceived parents in the process of consent, by quoting national average success rates for operations, rather than their own, far

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