Will patients notice when NHS reforms go live in April 2013?

The biggest reforms in NHS history go live in April 2013, but will patients notice? The strap-line of Andrew Lansley’s baby was ‘no decision about me, without me’ but patients have had little say in the make up or operation of the NHS Commissioning Board, the Health and Social Care Information Centre, Health Education, the NHS Trust Development Authority, Healthwatch England, Local Healthwatch, Health and Wellbeing Boards and Clinical Commissioning Groups. Every year, the Health Service Journal produces a list of the people with ‘ the greatest influence on  health policy and the NHS’, and MD shows it to patients. This year, none could identify any of the top ten (hint: all white men, and four of the top six are called David).

At least Lansley became recognizable, but the current NHS is led by men you’ve never heard of who are miles away. For all the talk of devolving power to GPs, there are none in the top 20 and only one Clinical Commissioning Group chief in the top 100. Anna Bradley, the chair of Healthwatch England, ‘the consumer champion who will make the system listen to the

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Will the BMA stand up for whistleblowers or shut them up?

IN JULY consultant paediatric surgeon Edwin Jesudason won a high court injunction with costs against Alder Hey Children’s Hospital (AHCH), which is seeking his “no fault” dismissal after certain surgical colleagues refused to work with him and surgeon Shiban Ahmed after they blew the whistle on malpractice and mistreatment of staff (Eye 1315). Next week, Jesudason hopes to make the injunction permanent. If successful, he may improve on the woeful statutory protections for whistleblowers by forcing trusts to follow their whistleblowing policies, or risk similar actions for breach of contract.

Jesudason, an award-winning surgeon who has never received a patient complaint or malpractice suit, has worked at AHCH since 1998 but since 2010 has been in the US on a Medical Research Council study. In 2009 he protested when Ahmed, who worked in AHCH and the University Hospital of North Staffordshire (UHNS), was suspended by UHNS after AHCH colleagues made the unsubstantiated claim that he was suicidal. The Eye has seen a 5.9.10 letter from surgeon Colin Baillie to AHCH which reads: “Shiban mentioned he had considered suicide. I have no doubt this was what was said because I

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Closure of Lewisham ICU – where’s the evidence?

Matthew Kershaw, the Trust Special Administrator for the now dissolved South London Healthcare Trust (SLT), is making recommendations under the ‘Unsustainable Providers Regime’ that will result in the closure of the Lewisham Intensive Care Unit (ICU). Some closures are inevitable, but is this one based on evidence or simply cost cutting?

Lewisham ICU expanded in December 2006 into a combined ICU and High Dependency Unit (HDU) in a State of the Art facility in the new Riverside building, providing up to 21 patients with their own bay. It has space for an additional 3 ICU and 3 HDU beds and could provide a significant proportion of the services currently provided within SLT.

The Borough of Lewisham contains some of the most deprived wards in England. Deprivation is known to make severe, complex illness more likely. Despite this, Lewisham ICU is one of the better performing ICUs in the country (www.ICNARC.org). The standardised mortality ratio (SMR) is used to measure performance and quality of care in ICUs in England, and results consistently show that a patient admitted to Lewisham ICU is significantly more likely to get better than

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Show Me the Data

On October 17^th, Tim Kelsey, the National Director for Patients and Information at the NHS Commissioning Board and founder of Dr Foster, said he ‘should be sacked’ if the NHS doesn’t undergo ‘a data revolution’ under his leadership. Both Kelsey and David Cameron are fond of citing the publication of outcome data for adult heart surgeons in England as proof of a more transparent, accountable NHS. Alas, as the Telegraph spotted, the scheme has stalled due to a lack of funding.

The publication of comparative clinical outcomes was one of the key recommendations of the Bristol heart inquiry and in 2004, heart surgeon Sir Bruce Keogh – now clinical director of the NHS – managed to persuade his 240 colleagues to publish the results of adult heart surgery. Dramatic improvements in survival rates followed. As Kelsey puts it: ‘In some procedures, more than a third of patients are living when they might previously have died and adult heart surgery in England is measurably, demonstrably and statistically better than anywhere else in Europe.’ Or at least it was until they stopped publishing the data.

Mortality ratios don’t give the full picture of how a

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Below are some strong arguments against and for publishing the adjusted mortalities of child heart surgery units, with certain caveats. Personally, I’m in favour of publishing. Mortality rations are not perfect, but I think they can help spot problems. They pointed out the problems of child heart surgery in Bristol and Oxford, and the high death rates in Mid Staffordshire. The problem was that the medical and political establishments sought to discredit the data, rather than investigate swiftly to see if there was a problem and so prevent patients suffering avoidable harm.

Mortality ratios for child heart surgery have been published in New York since 1997 and the world hasn’t come to an end. So it can be done. The latest report was published in October 2011 (see http://www.health.ny.gov/statistics/diseases/cardiovascular/index.htm, and scroll down to ‘Pediatric Congenital Cardiac Surgery in New York State’ near the bottom).

What seems to have caused most offence is my statement that I would choose a unit with a below average mortality ratio for my child. There are clearly other complex factors involved but if my local unit had a high mortality ratio, I would want a good explanation as to why before I proceeded.

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