Lies of the Week with Jeremy Hunt

Lies of the Week with Jeremy Hunt

Hello and welcome to ‘Lies of the Week with Jeremy Hunt. Every week we will look at what ever new ridiculous spin statement Jeremy is making. Now the cabinet office and the papers [4] are having ‘words’ about the ‘11,000 deaths’ misrepresentation, Jeremy has found new research to get wrong.

He said THIS [3] in a Radio 4 interview for the Today programme on Saturday, about the Junior doctor contracts dispute.

We have three times less medical cover at weekends and Sunday is the second busiest day of the week in A&E

There are so many things wrong with this one sentence it is actually impressive.

1) the 3x as many staff figure comes from THIS [2] – the HISLAC project on specialist cover in hospitals. They carried out a point prevalence survey of consultants and post CCT specialists – simply asking them this questionnaire- were you in hospital this Wednesday? And were you in this Sunday? 14,500 consultants responded. The raw data is not currently available. ** but the study found 3.6x as many specialists ‘attending’ acute inpatients on a Wednesday than a Sunday.

2) This study looked exclusively at consultants and those who have finished training- Jeremy brought this up in defence of the junior doctor contract. This is obviously completely unrelated, especially as junior doctors are usually on call in hospital at weekends in the stead of their consultants ie all the registrars.

3) The study included many many non-acute specialties – rehabilitation, clinical genetics, allergy, sexual health, sports medicine etc – specialties without usual admitting rights in most hospitals and very few, if any, weekend emergencies. This would heavily skew consultant presence numbers to appear understaffed at the weekend, again confusing routine and emergency work.

4) The study looked exclusively at patients who were ADMITTED. So it has nothing to do with how busy A&E might be on the weekend, except tangentially.

5) The A and E activity data is HERE.This data shows Monday is actually the busiest day of the week in A&E for attendances, and Tuesday is as busy as Sunday, although there isn’t much difference between any day of the week except Monday.

6) This is all hospitals, not those in the first study, so trying to link consultant cover at a group of specific hospitals to A&E activity everywhere is meaningless. As for hospital ‘admissions’ ; from the original BMJ Freemantle study, admissions actually drop on a Sunday, by about a third, and if you count only emergency admissions that drops by a third again.

In summary then, if we translate Jeremy’s spin into true representative figures; when asked why the government wanted to cut pay and remove hours safeguards for junior doctors, Jeremy hunt ACTUALLY answered;

‘In some hospitals, Consultants in urgent and non-urgent specialties looking after patients admitted to hospital are more likely to work Monday-Friday than be in on the weekend, when hospital admissions are lowest. In some other hospitals A&E is 2nd busiest on Sunday but actually It is busiest on Monday.’

And everyone looked at him like the inflammatory spin moron he is.

Join us next week for more- Lies Of the Week- with the Right Honourable Jeremy Hunt.

** another strike for poor ministerial conduct; discussing statistics that haven’t been yet released. Here is the code.

[1]http://www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/
[2] http://ow.ly/PQnru
[3] http://www.bbc.co.uk/programmes/b06hk68b from 01:10:00 onwards.
[4] http://www.bbc.co.uk/news/health-34598335

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But Who Cares For The Care Quality Commission?

Shit.

The Guardian
The Telegraph
The Daily Mail
All reporting on this State of Care publication, wherein the CQC has rated 61 trusts as ‘requires improvement’ for one domain: safe care, and 11 trusts as ‘inadequate’. This sounds super bad.
Here are some quotes:

Patient’s Association:

“It is worrying to see that there is still such variation in the quality of care being delivered.

This cannot continue. The safety of patients should be the primary concern of all healthcare professionals.”

Jeremy Hunt:

“There are some excellent examples of high quality care across the country but the level of variation is unacceptable.”

CQC:
“We are not saying 74% of trusts are unsafe. “
Oh. Hold on.

What’s the issue here- how are suddenly 3/4 of hospitals apparently ‘damned’. This doesn’t add up.
Have you ever read a CQC report? They make interesting reading.
Here’s the ‘safe care’ domain for Mersey Care Trust which achieved a ‘requires improvement’ for safe care. Points that meant that this hospital is classed as ‘failing’ by the Telegraph;
  •  it has reflective doors on an elderly care ward
  •  there are things to hang things off in the garden, which could be a hanging risk
  •  some audits aren’t finished off (these are mostly done by unpaid staff as additional projects btw)
  •  mental health is busy and some of the rooms need upgrading
And that’s it. Seriously.
Here is another ‘requires improvement’ safety report from Cambridgeshire and Peterborough, with the following ‘problems’.
  • ligature points (hanging risk)
  • three rooms in one department need upgrades
  • one team has vacancies
  • there is no out of hours learning disability service
  • occasionally one ward is short staffed
That’s it. That is the whole report on ‘safety’.
I could go on.
I’m not saying that the CQC isn’t serving a vital function- far from it. There are trusts here that fully deserve their ‘requires improvement’ moniker. Some have genuine problems with ‘never events’ and incident reporting. But this is getting lost in the noise.
I’ve compiled an analysis of 64 reports myself (i gave up at 64). I’ve rated every safety report on a different scale, using a professional eye. If there were less than six points for improvement on the entire safe care section I’ve classified it as ‘working’. If there are more than six but no actual patient harm, and all fixable within six months I’ve classified as ‘improving’. And everything else I’ve classified as failing.
Here are the stats:
  • % actually failing- 9.4%
  • % improving – 20.3%
  • % working – 70.3%
Here is the full spreadsheet: CQC.  (feel free to finish it off)
The commonest theme that emerged was a need for staff, in pretty much every trust. 71% of the total.
You can quibble with my methods- and please do. I’d be the first to admit they are awful. But the point still stands- if you look at the actual reports the CQC has published for ‘requiring improvement’ hospitals, there is little evidence to label them as ‘failing’.

When the CQC is your left hand, you should be  watching what the right hand, Monitor, is up to. They published this, this week, also in the Telegraph. In the name of  efficiency to save money, Monitor suggest we move some surgery from senior into more junior or even nursing hands. I am all for proper training by experience, but hospitals that did this would soon have the CQC come in and label them ‘inadequate’ as well. This two-pronged attack is genius really. The trusts are held at length, and then slapped about by both agencies- so eventually we can get to this. “The public isn’t as afraid of NHS privatisation as politicians think”. 15/10/15
This is the piece in the Telegraph that right alongside their headline ‘Hospitals are Failing’- it even has the same list of hospitals embedded into the online article. A puerile, poorly researched opinion, extolling the benefits of ending the state pay system, despite the fact that every other system mentioned in this article costs more money, by a factor of 30-100% of what the NHS costs, has poorer outcomes and are less equitable.
This, colleagues, contemporaries and fellow human beings is what the end game looks like.
The campaign against the junior doctor contract is now in full swing, but let us not forget what we are truly fighting: a corrupt government that has an ideological agenda to move public NHS services into private hands. The junior doctor contract is just a single step in a very long game, but one that is nearly up. We may still be able to do something about it.
Join the protest tomorrow, 2pm from Waterloo Place to Parliament Square, London.
Protect our patients. Protect our NHS.
Juniordoctorblog.com

The Hunt Effect

swiss_cheese

There is a popular model of mistake-making in medicine known as the ‘Swiss Cheese’. We know patients that come to an adverse outcome pass through many opportunities to correct or avoid an error- this cumulatively leads, through all the holes in all the layers of the cheese, to death or major harm. This reflects the complex interplay of many factors; between patient and staff, between staff, between systems and people and even between systems.

Health professionals recognise this: we can all think of instances where a single missed outpatient appointment, omitting a single tablet or even just being in the wrong place at the wrong time led to catastrophic consequences- the importance of that pivotal moment only apparent in retrospect.

The belief that hospitals are closed or dangerous on the weekend has reportedly been leading patients to avoid or delay seeking treatment for fear of dying, and likely causing widespread harm. This has been dubbed the ‘Hunt Effect’. For now the patients remain rightly confidential- but efforts are underway to collect their stories. The seemingly small perception that weekends are not well staffed in the NHS is leading to catastrophic harm: loss of vision and paralysis are two tragic examples quoted so far. [1] Efforts are under way to collect more information, if you have a case add it here.
I’m glad this ‘Hunt Effect’ is gaining traction in the mainstream press- it is a very real attitude we are encountering on a daily basis. However, this isn’t just a phenomenon unique to the failed marmalade salesman [2] , Mr Hunt, and we shouldn’t forget it.
The ‘Hunt Effect’ is the first time people have tried to objectively document harm arising from the irresponsibility of media outlets and politicians in discussing and reporting on health. The Daily Mail and other tabloid newspapers routinely inflate stories like this with headlines such as ‘[nearly anything] gives you Cancer’ [Daily Mail- 3] , ‘GPs who miss cancer  should be named and shamed (another Hunt Effect)’ [4,5], and more recently: ‘Consultants STILL won’t work weekends‘ [6]. I’ve proposed trying to work out the harm these stories create before*.
When it gets into party politics it gets much worse than the newspapers. It becomes endless. Political statements get beaten into every interview and speech by MPs and party members and ‘Independent’ talking heads for hire (e.g. Taxpayers Alliance) over and over again. It  creates a lasting grubby aura of an idea, like a toothpaste stain that just can’t wash out.
The ‘Hunt Effect’ is the latest in a long history of dangerous misconceptions – unintended consequences perhaps, but quantifiable harm nonetheless. We are not quite in Wakefield/MMR territory yet, but it’s on its way. This is a great illustration of what happens when a Health Secretary likes to play loose with the facts.
Just to reiterate;
1) there is no evidence that there is decreased care and attributable risk to being admitted on the weekend
2) even if one imagines there is- on the most contrived scale that I must stress is in no way evidenced to be attributable- the extra risk of death that Jeremy hunt has banged on about is 0.07%. (11,000/14,500,000).
3) the hospital is fully staffed for all emergencies 24/7. That’s what emergency means.
4) Junior doctors (any qualified doctor below GP or Consultant level) work all weekends evenings and nights as standard
5) So do 99.97% of all consultants [7]
But if you want to create the illusion a change is necessary, you need to create the illusion there is danger. However if you try to influence a patient’s health beliefs you will also influence their behaviour, and harm occurs as a consequence. ‘The Hunt Effect’ should be subtitled ‘What Happens When the Health Secretary is an Inflammatory Moron’.
The reason that ‘The Hunt Effect’ has gained such legs is because it has been said unchallenged in so many news outlets. It has permeated the cultural ether of what is ‘known’.
There are two reasons why doctors aren’t challenging this effectively.
1) We are being overly polite- we are treating this like dealing with an angry relative, calm and professionally, when we should universally be openly damning of what is an idiotic interpretation of the data. For those of you who haven’t got a handle on it yet: here and here.
2) Deep down we all believe that there IS a worse service on the weekends. The BMA has said this for years- but it’s got nothing to do with doctors or nurses being unavailable. If we had the whole hospital at our finger tips, radiology, biochemistry, porters, phlebotomy, we could give our patients the best care possible. But we can’t do that without funding, and we can’t do that with burnt out staff. And when money is tight we should be efficient with our priorities- keep elective work to the weekdays, concentrate resources while we figure out how to manage the sickest patients first, with the rising demand and decreasing money we already have.
So from now on, when you hear this ‘weekends’ are dangerous’ lie- call it out and challenge what it is. This is propaganda to dismantle the NHS and it is already hurting real people. Hunt has already broken patients confidentiality, now he is actually harming them as well. Any doctor that did the same would be in prison right now.
Protect our patients, protect our NHS, from the failed marmalade salesman, the Right Honourable Jeremy Hunt.
Juniordoctorblog.com
[1] http://www.theguardian.com/society/2015/oct/07/the-hunt-file-doctors-dossier-of-patients-put-at-risk-by-health-secretary
[2] https://en.wikipedia.org/wiki/Jeremy_Hunt
[3] http://www.anorak.co.uk/288298/scare-stories/the-daily-mails-list-of-things-that-give-you-cancer-from-a-to-z.html/
[4] https://juniordoctorblog.com/2014/06/29/named-and-shamed-gps-who-miss-cancer-diagnoses/
[5] http://www.donotlink.com/mCA
[6] http://www.donotlink.com/g76k
[7] https://magic.piktochart.com/output/7136876-consultant-opt-out-figures
* (from original post [4] June 2014) If you are interested, here is how I propose we investigate irresponsible health journalism;  All health stories in major newspapers (Especially the Daily Mail) from the past ten years regarding health topics are identified, scrutinised for their accuracy against the scientific data available, and then calculated how inaccurate they are qualitatively on a scale of 1 to 5, 1 being minor inaccuracies (e.g. misspelling a name) to 5 being major inaccuracies causing potential harm (e.g. reporting an unsubstantiated conclusion and recommending a change in the behaviour of the individual that could result in disease e.g. Avoiding vaccinations). The impact of the story is then calculated by the potential harm, the readership, and the prevalence of the outcome. An excess death figure is calculated based on this. E.g. reporting vaccinations cause autism, calculating the drop in vaccination as per the readership and then the prevalence of new cases of measles for example and excess death. I appreciate this would  be nearly impossible, but this is an exercise in imaginary science. Then, based on this, we could Name and Shame the greatest offenders and the relative risk of reading each paper on the individuals health. By law, this would have to printed on the front of each newspaper under a Health Warning label.