The NHS underfunding is a choice. And people are dying. [video]

It’s really hard to capture and keep even the most interested and motivated persons attention long enough to explain how and why the NHS is being underfunded and the truly catastrophic impact of this.

This rather excellent video series does this perfectly. 

Share and RT, write to your MP. It’s your choice too; stand by and let the NHS die, or do something about it. 

The future of the NHS and junior doctors is bleak. Can we change it?

It’s clear, despite widespread junior doctor support for further reasonable industrial action against imposition, that the BMA has folded. Now in full “supporting transition” mode, the early imposed trainees already report chaotic rotas, trusts skipping pay protection clauses and lack of coherent safety reporting structures. Many doctors have left, or are considering leaving, the BMA.

Obviously into the midst of this Jeremy Hunt puts the boot in. Keen to build on the perceived political capital of pushing the BMA into withdrawal and supposedly ‘winning’ his High Court case against the contract, he goes onto announce plans to chain doctors to the NHS for four years after qualification, and to replace the ‘foreign’ doctors that prop up the NHS as it is, with ‘homegrown’ doctors.  His plan to expand medical student places by 1500 a year starting from 2018 isn’t unwelcome – it’s just dangerously unrealistic and overtly xenophobic. Doctors entering medical school today will enter the workplace, chained to the NHS, in 2021/22.

What will life be like then?

Hospital Activity
It’s fairly straightforward to extrapolate UK demand by 2022, and the Nuffield Trust have already done the work [ref]**. They report from 2014 predicted NHS demand, expressed in bed days, will roughly rise by 1.7%/year. That means by 2020/21, demand will have risen by 8.7% and by 2021/22, 11% compared to today.

Funding

By 2021, bar any dramatic announcements in the Autumn statement, the King’s Fund predict NHS funding in real-terms will rise by £4.5 billion, a rise of 4%. However, the current deficit this year is £1.8 billion, so this is actually just £2.7 billion to spend, a true rise of just 2.3%*.  Meanwhile, hospital demand will have risen by 2020/21 to 8.7%, which means each extra pound will need to work four times as hard just to stand still. Given waiting times in A&E and surgery have never been longer and the current deficit is the largest ever recorded, the system already appears to be stretched to crisis point.  Imagining it can now stretch to accommodate an efficiency of four times what it currently  can achieve is lunacy.

This prediction also relies on being able to discharge patients, reducing pressures on hospital, but social care has also had it’s funding slashed, back to just 0.9% of GDP by 2020, with an estimated shortfall there of £3-3.5 billion. It’s not going to get better.

Hospital bosses know this, and have already spoken out. NHS Providers CEO Chris Hopson and NHS Chief Executive Simon Stevens have both said current funding is unsustainable .

What will that look like on the ground? Well, resources will be diminished, pushing people out of hospital beds will become more commonplace, and with no staff budget more and more hospitals may have to close departments due to lack of staff to run services safely. Here is a list of sixteen hospital departments that have closed this year. Expect this to grow. This might mean working in hospitals without services on site, sending patients miles away and arranging urgent transfers to other hospitals, which is less safe, and very time-consuming, to already overstretched staff.

Training/workforce

As of 2015, there were 41,165 consultants and 36,919 GPs in the NHS,  plus 54,000 junior doctors, with 25% of them trained overseas, either EU or non-EU. For GPs and consultants, the NHS plans to increase this by 5000 a piece, or 14% by 2020. However, new workforce modelling predicts we may need as many as 12,000 more GPs to run a thread bones service, and 24,000 to run a safe and well staffed one.

I can’t find the numbers of junior staff required, but if we simply match demand in 2024, 14% compared to today, the ‘extra’ doctors would need to be 7560 more than today. It would taken ten years to catch up to demand, by 2034. That’s a huge deficit to walk into.

There’s of course a plan to expand the numbers of non-doctors to fill the shortfall;  non-medical endoscopists, surgical assistants, physicians assistants are all already active in the NHS. What this will mean for junior doctors is hard to gauge – it may help training, it may hinder, and a lot of work will need to be done to work out how workplace issues such as medicolegal responsibility and training will be impacted by the increasing use of non-medical staff doing work previously done by junior doctors.

And that’s of course assuming all the ‘foreign’ doctors are allowed to ‘stay’. Theresa May claims they can stay until at ‘least’ 2025, but why would they? If even 10% of the overseas trained doctors left the NHS in the next ten years, it would be utter cataclysm.

Morale

Needless to say, being chained to an organisation for four years, that requires you to stretch four times more work out of it’s resources compared to today, that’s missing thousands of staff, with hospitals in various states of closure, might dampen morale.

The imposition of the new contract for junior doctors of course will only make all of this worse. As budgets are tightened further cuts will need to be made to staff groups – the strikes this year will be far from the last to hit the NHS.

NHS

Ultimately all of this speculation relies heavily on the idea an NHS will still be the main provider of healthcare in the UK by 2024. Looking at the staffing, financial and patient demand projections, no credible plan emerges to preserve the NHS. Services will slowly degrade, and more and more private options will come available. Already a private Uber-style service is emerging into the current GP crisis. This could be the snowball that starts the avalanche, as more and more wealthier citizens are pushed towards private healthcare.

My point here is the battlefield ahead is perilous, for patients and staff, as we are guided by NHS bosses that are unheard and ministers either deliberately or incompetently steering us towards rocky shores. Whatever Jeremy Hunt’s plans, 1500 doctors a year will not make any impact whatsoever in 2024, far from being ‘self-sufficient’, and we will have huge crises in senior staff and resources that no amount of fresh-faced ‘homegrown’ graduates will solve. If our hardworking and invaluable overseas staff leave, the NHS will collapse instantly.

 

That’s the future of the NHS and junior doctors – bleak isn’t it?

So what are you going to do about it?

juniordoctorblog.com

 

*This assumes there will be no deficit for the next three years – an extremely tall assumption. More likely, there will be no extra money whatsoever.

**barring some huge paradigm shift in medicine, or an epidemic disaster. Brexit may count in this respect – the fall in the pound vs the Euro has made medicines more expensive, and the loss of research grants has made teaching hospitals poorer.

 

 

This is everything wrong with Jeremy Hunt’s tenure as Health Secretary

Yesterday in the Mail Hunt made at least two completely bogus claims;
1. He ‘won’ the judicial review into imposition and gained High Court backing for the junior contract

2. Post Brexit he is going to remove foreign doctors and replace them with ‘homegrown’ trainees 

There’s been enough of heated opinion lately- so let’s just serve cold hard facts.
1. The Justice 4 Health team took Hunt to court on three premises- that a) he does not have power to impose the contract b) that he acted without clarity and transparency and c) he acted irrationally. Despite a lot of press spin saying Hunt won, he actually just dodged the issue, by claiming that he never imposed and ‘no junior doctor’ thought that he was. As in last week’s blog here is the many instances that Hunt said he was. 

The case pushed Hunt to clarify in law that he isn’t imposing the contract, simply passing the buck to local hospitals. The judge also found he could’ve acted with less ambiguity but found it hard to demonstrate the high legal threshold for irrationality.

So far from ‘winning the case’, Hunt was forced back from claiming falsely he was imposing leaving local negotiations with hospitals now a real possibility.

Secondly, Hunt’s plan to replace foreign doctors with ‘homegrown’ talent is as laughable as it is xenophobic.
We are already in the midst of a workforce crisis- applications to medical school dropped 13.5% in the last 5 years, and increasing numbers of junior doctors are leaving training and the country. On top of this, the existing doctor workforce increasingly cover the work of two or more doctors- 7 in 10 doctors work in departments where at least one doctor is missing, 2/5 of consultant posts are unfilled, and 96% of doctors work in wards with nurse shortages. 
To add insult to injury, health education England, the body that funds training of so-called ‘homegrown’ talent, has had its budget slashed by £1 billion next year– all on Hunt’s watch.

Now around 25% of the doctor workforce are non-UK, and 10-15% of all NHS staff. 

We are well below the European average in hospital beds per person and doctors per person in the NHS as we are- yet Jeremy Hunt plans to push away up to a quarter of the workforce, cut the training budget to train less doctors who are already doing two or more doctors work, and make no plans to actually address the drop in ‘homegrown’ talent already, a direct repercussion of Hunt’s own morale plummeting war against the profession. 
Those are the facts. Unfortunately if you read the Mail comments you will see why Hunt would ignore them; there’s a segment of the populace that laps up this anti-immigrant posturing, even if it’s completely insane as an actual plan. 

This is everything wrong with Hunts tenure as Health Secretary- politics before policy before patients. The NHS will only continue to suffer if it goes unchallenged. 
Juniordoctorblog.com

Down the Rabbit Hole; Incompetence or Corruption?

If you read just this sentence, then read this; this Tory Government has ‘cooked the books’ on NHS finances, cut the budget far below what is safe or feasible, and let patient’s suffer to pursue a political ideology.

Want more information? juniordoctorblog goes down the rabbit hole. Watch your step – it’s a proper mess in here.


Let’s start at a beginning.

Here is a graph.

Here is the NHS budget (navy line). Here is the number of hospital ‘episodes’ (purple line). Here is the % of A&E attenders waiting over 4 hours (orange line), and here is the pan-NHS deficit (charted bars). A&E and hospital activity has risen predictably and steadily, while the NHS budget has fallen progressively behind, at a rate of ~0.9%/year, meanwhile hospitals started in 2010 with a £1.5 billion surplus, and will finish 2016 with a probable £2.3 billion deficit.

Bottom line: we are already doing more and more with less and less, and we are in trouble.

NHS 2010-16

Let’s walk on. Mind your step, Andrew Lansley has been in here.

How did we get to this point?

Well here is the Public Accounts Committee meeting into NHS workforce planning – the four heads of the NHS sat down in front of a parade of MPs and revealed they didn’t really have a clue what was happening, with ‘7-day NHS’ plans or with the ‘junior doctor contract’.

The bosses of the health service were told they were ‘flying blind’ on some of the biggest issues in the NHS at the moment.

During the proceedings the panel were rather anxious to find out how the NHS has fallen into such massive debt. It would seem that in trying to meet ‘efficiency’ targets, or ‘cuts’ as we would say, “they discovered that it was too ambitious and, as a consequence, they had to find temporary staff […] to help to meet safety parameters”. This was very expensive.

The problem with healthcare is when you try to ‘cut costs’ you often actually create larger costs. Look at social care – by cutting social care provisions e.g. carers and social workers, you save a little bit of money, but the patient waiting in hospital for a social placement is then stuck in a hospital bed with hospital care for longer – this costs a great deal of money.

The best way to explain it I have come across is this. Imagine you own a van, and every year you drive it a little bit further, and carry a little bit more. Now imagine you decide to make it more ‘efficient’ to save money. You make the van lighter by removing the car rack. A lighter van drives longer distances for the same money. To save a bit more money you stop taking the van to the garage. A year goes by, driving further, carrying more. Next the gearbox breaks, you could’ve prevented that if you’d gone to the garage every year. That costs more money, but rather than pay to replace it you decide to make more ‘efficiencies’. You sell off the wing mirrors and the bonnet one year, then sell the passenger seat, and the electrics the next. Before long you are driving further than ever before, on the same budget, but your van has no doors or windows. It’s not safe. You still won’t invest any more money, still want to drive it further. Next you sell the wheels and the engine. The budget is balanced, but the van is dead. A neighbour then says “Do you want to rent my van? It’s more expensive, and it’s not as good as your van was, but it’s all you’ve got.” Your neighbour is Richard Branson.

But I digress.

Let’s keep going. Here is a report to the public accounts committee on NHS finances, released this week.

Here’s a few highlights;

“The financial performance of NHS trusts and NHS foundation trusts has deteriorated sharply and this trend is not sustainable”

“There is not yet a convincing plan in place for closing the £22 billion efficiency gap and avoiding a ‘black hole’ in NHS finances.”

But we knew all that already. So who is to blame?

Let’s dig a little deeper. Watch your head.

Here’s some written evidence from an anonymous whistleblowing financial director of a NHS hospital – they were frightened to give their name publicly for fear they would lose their job.

They are concerned that “patient safety and quality of care may be compromised by trusts’ short term actions to reduce headcount” but even worse that financial directors are making ‘questionable adjustments’ to their accounts which are ‘merely window-dressing’ to their accounts to please ‘no 10 influence’. Through several dodgy practices, including a ‘Capital-To-Revenue’ Transfer scheme- which essentially means the Department of Health pays money to hospitals, which record revenue, and then pay it straight back to the Dept of Health, which record ‘capital’. When trusts find they cannot pay costs, like the wages of their staff, the government steps in, but only with large strings attached, that the hospital must make further cuts.

Bottom line: NHS trusts may have been ‘cooking the books’ in order to appear as if they are not making massive cuts and crumbling under the massive pressure of No.10 and treasury underfunding.

It’s hard to decide whether this is incompetence on the behalf of the department of health, or deliberate underfunding from David Cameron, to move to privatisation, which, without a democratic mandate, is corrupt.

In the meantime we cannot afford to staff our hospitals properly, we cannot afford to cope with the demand in A&E and into this crisis the government impose a completely unmodelled contract on junior doctors, and decide to pursue ‘7-day’ services and the ‘safest healthcare system in the world’. It’s as if the Titanic is sinking and the captain wants everyone to rearrange the deck chairs.

Where shall we go from here?

So, in 2009 David Cameron takes over the country. George Osbourne and Andrew Lansley take huge amounts of money out of the health service, while demand rises and rises. Later Jeremy Hunt, with aggressive No.10 and Treasury influence, continues to do the same, only now there is no slack to give, and the system starts to implode. This is a political ideology driving shambolic managers with few options to either ‘cook the books’ or get fired, and in the meantime the NHS is in the midst of the biggest crisis in it’s history. As it looks, it could be the last one- this time next year there won’t be an NHS if things carry on like this.

It doesn’t sound good for the Department of Health and Mr Hunt. Apparently some scallywags are taking them to court.

Anyway, I’m off. Make your own way out.

juniordoctorblog.com

 

 

 

The government aren’t listening. Time to make them.

The junior doctor contract dispute has taken its toll; eight gruelling months, three major protests, four days of strike action, and 54,000 angry, articulate, dedicated individuals.

We have staged sit ins, delivered giant books, set up fake betting shops, supported two hugely successful choirs and one Christmas number one, created fashion lines, and even collaborated with a Time Lord or two. We have become our own investigative journalists: uncovering dubious research practice, revealing departmental incompetence and lies, and documenting tragic cases of the government’s spin causing real patient harm. We have become our own researchers: revealing flawed data, misrepresentation of statistics and huge holes in the government’s ‘evidence’ arguments. 
We are not giving up anytime soon.
Why are we doing this? David Cameron and company would have you believe we are grabbing for a payrise, grabbing for free weekends and better perks. Many of you know by now this is simply untrue.
What we are terrified of is an imposed contract, unmodelled, uncosted, and unbelievably unsafe. The NHS is on its knees- the knock-on effect to recruitment and retention alone, not just for junior doctors but all NHS staff, could collapse the entire service.
So what next? How can we make a government listen to our concerns.
This. We, a group of patients, doctors and NHS staff, are proud to announce the initiation of a second independent judicial review into the junior doctors contract.
We are not the BMA- they have challenged the government as an employment dispute, on equality grounds.
We are challenging them over patient safety- patients who are concerned an already underfunded NHS cannot cope with the government’s insistence on ‘7-day’ services without additional funds or additional doctors. We have huge gaps in cover already- 60% increase in rota gaps for doctors, 50% increase in agency nurses in a single year. 9/10 junior doctors have said they will resign if the new contract goes ahead. Even if 1/10 actually leave- for locum work, abroad, pharmaceuticals, or even simply stop being doctors- the system will crumble. Then the nurses, the pharmacists, the AHPs, the consultants, the GPs will undergo the same.

We have instructed renowned Human Rights and judicial review specialist law firm, Bindmans LLP, to investigate the legality of the decisions of the Secretary for Health. We will ask for a wide-ranging review into the impact on staffing, costing and the evidence for need and benefit of imposition. We will force the government to finally listen, and come up with the so-far missing evidence to back up months of wild claims and false promises.
At the very least we will see the necessity, and take the time to consider the biggest gamble in the history of the NHS. At best, we may finally prove that the DoH and government have been peddling smoke and mirrors, and find the real reasons for the underfunding, the enforced contracts, the increased privatisation. Most importantly, we may avert catastrophic patient harm.
What can you do to help?

We are not an organisation- we are simply individuals who care deeply about the future of the NHS. We are crowdfunding our case here, at CrowdJustice. Follow us on Twitter and Facebook as #JustHealth. We are off to a great start, but need at least £100,000 or more to fund such a complex and important legal action. We will possibly need more to keep going, and it will be only your support that will make this possible.
For years I have ranted on about trying to save our NHS. Many of you agree, but ask “what can I do about it?”
This. You can do this.
We can save our NHS. We must.
Juniordoctorblog.com

Exhausted? Of course I am.

imageJeremy Hunt’s strategy now is to exhaust the junior doctors.” Guardian 1/2/16

I am, like many of my colleagues, indeed, exhausted.

I’m exhausted of going to work to find huge gaps in the rota where doctors used to be, where nurses used to be, where physiotherapists and OTs used to be. I’m tired of never seeing a contract, never being able to plan to see my family. I’m exhausted by the deaf ears of faceless administrators.

I’m tired of endless top-down reorganisation, target-chasing and publicity managing. I miss looking after patients. I miss training to be a better doctor.

I’m exhausted by the media. I was on BBC radio during the last strike, and a rather hostile presenter asked me “Why are you on strike? Why aren’t your doing your job”. I gave a PC, measured answered. But what I wanted to say was this ; “I’m striking today to protect the long-term health of patients. That’s my job. But what about you and your fellow ‘journalists’? Are you doing ‘your job’? When a Secretary of State and Prime Minister can say anything and it is reported verbatim; unscrutinised,unchallenged and uninvestigated? When they can lie about stroke care, perinatal care, weekend hospital care, consultant cover, NHS funding, NHS safety and privatisation and not a single journalist will take the time to report the utter lack of credibility on any health issue in any way? I’m doing my job to the best of my ability- are you doing yours?”

Sigh.

I’m exhausted by the politics and the endless endless lies and spin. I’m tired of having to counter the same propaganda ad nauseum. A ‘seven-day NHS’ sounds great- but what is it? Is it urgent emergency care? We already have that. Is it routine care? We don’t need and can’t afford that- not when the NHS has never been poorer. Can we make it better? Of course- but we need investment, policy based on evidence not sentiments. Should I go to hospital at the weekend? Emphatically, categorically and unreservedly YES.

I’m sick of noxious columnists pumping out toxic nonsense; d’Ancona, Baxter, Lawson, Vine…the cogs of the Tory spin machine are many, and they are all dirty.

Most of all I’m exhausted by fighting for an NHS on the brink of destruction- and the public remains wholly unmoved. When you go to the doctor and she tells you something is seriously wrong- how do you respond? Do you then go to the Daily Mail to fact check it? Do you ask for a balanced opinion from a government think tank, deeply invested in privitization? I’ll declare my vested interest right here; I’m a junior doctor and I think the NHS is the best healthcare system for my patients- in equity, in outcomes, in value for money. Now the junior doctors are striking, the GPs are resigning, the consultants are halfway between both. The student nurses are striking, the staff nurses are planning, and pharmacies are closing. Meanwhile NHS services are already being sold- to Virgin, Circle, TDL. Domestic and domiciliary have been private for years already. PFI hospitals are £80 billion in debt for £10 billion of services – does that sound efficient to you?

The end of the NHS is here- not in five or ten years, but here, now, collapsing from August. Do you really believe this government is ‘the party of the NHS?’

Did you vote for this? Did you look at the Tory manifesto and read the pledge ‘Seven Day NHS’ and think- “That’s got my vote, now bulldoze the thing and where’s that private health insurance brochure?”

We haven’t explained ourselves properly and for that I wholeheartedly apologise. The junior contract is simply a means to make lucrative weekend work cheaper, and reduce the pay bill and pension bill on hospitals for private takeover. There really is no other reason to do what the government are doing. They don’t care about the safety of patients- they’ve cut hospital budgets in relative terms the deepest in NHS history, we have less doctors and spend less % GDP on healthcare than most of Europe, and they tried to suppress reports on safe staffing levels for nurses. They don’t even care about ‘balancing the books’- the NHS will be £2 billion in debt this year. The national debt in 2007 was £500 billion, now it’s £1.6 trillion. In 2007, the deficit was £41 billion – now it’s £90 billion. I hear your cries of ‘the financial crash’. Exactly- and here is the cost- years of private debt generated by illegal banking practices absorbed into the public purse. Banking and corporate tax evasion remain unchecked. The NHS and every other public service for sale. It’s a crime too huge to see.

I’m exhausted. Yes. And alone, perhaps, defeated. But I’m not alone. 250,000 doctors in this country, 400,000 nurses, 150,000 allied health professionals. 19 million families. 66 million people.

Dear other normal human beings, join us, and help save our NHS, if we can.

Second Junior Doctor’s Protest, Saturday 6th February, 12.00 Waterloo Place, London

Second Junior Doctor’s Strike, Wednesday 10th February, picket lines at every local hospital.

juniordoctorblog.com

How to Sell The NHS: Appendix 1 – Dealing with Troublemakers

284

Dear Dept Of Health,
I am very pleased to hear you have been following my step by step programme; “How to Sell off the NHS; A Users Guide“.
Obviously you seem to have hit a bit of a bump with the junior doctors- but always happy to troubleshoot a good privatization! Here’s a quick road map to where you’ve gone wrong and what to do to get back on track!

Mistake #1 – You didn’t smear everybody beforehand. A good smear campaign is like suntan lotion- if you don’t get it everywhere then it doesn’t work! Excellent work on attacking GPs and Consultants- but you forgot those pesky junior docs! Nice catch up efforts [1]– but surely you can come up with something better than Facebook holiday snaps?

Mistake #2 – Doctors aren’t miners. [2] Nurses aren’t miners. No one in this situation is a miner. You don’t have to dress up as Thatcher every Halloween. You’ve forgotten the first rule of dismantlement- keep it quiet.

Mistake #3-  Stop being surprised doctors don’t want to screw over other doctors. Nice try with ‘pay protection’ [3]– but you realise this just highlights exactly how much the next generation are getting cut by? Doctors tend to be doctors forever and it’s hard to avoid your junior colleague’s eye for 40 years. You’ll get a squint.

Mistake #4 – You p***d off the anaesthetists. You probably don’t know this but every doctor, at some point in their training, had to phone the anaesthetist and grovel for help. Usually when they were right up s**t creek, minus paddle. No doctor would think hacking them off is a good idea. You could’ve hated on histopathologists until the cows came home by the way. Missed a trick there.

So what to do? Well here’s an idiots guide to breaking the strike and getting those dirty no good training docs into some great cheap labour for the privatization wagon.

1) Keep on spinning – it doesn’t matter what’s true or not. Keep using selective phrases from research about weekend mortality, [4,5] and then mention junior contracts straight after. Hopefully people won’t notice they’re not linked at all. [6] Like when the newspapers put a giant picture of someone they hate on the front page next to a completely unrelated story with an offensive headline like ‘SEX OFFENDER’. Smear them for being militants [7], or trotskyists [8], or extravagant jet setters [9] or even women [10]. Eurgh. Bloody pacifist militant socialist aristocratic 50% of the population.

2) Take the opportunity to completely bury any other problems- cut the NHS bursary [11,12] (oh? You didn’t manage that), carpet the NHS reinstatement bill [13], and quietly suppress safe staffing level reports and whistle-blowing junior docs. [14,15] Keep TTIP super quiet [16]- holy Boris bikes you don’t want the public nose in that!

3) If you get challenged on statistics you’ve used don’t worry- get this phrase made up on some rubber stamps “there is clear clinical evidence of [insert whatever you are wrong about here] – and we make no apology for doing something about it”[17,18,19,20] Stamp it on every response from angry academics who actually wrote the research you have misrepresented. Don’t worry about investigative journalism- pretty rare to find any these days.

4) If you aren’t winning here – just hire a few £million worth of extra spin doctors [21]. Way more value for money than real doctors.

5). Pretend like you’re not actually responsible for this -take every opportunity to ‘slam’ your own organisation. [22,23] Make a slam book. If this isn’t demoralising enough why not leak some ‘well-placed’ sources as veiled threats on the news to get your point across. [24]

6) And whatever you do- don’t sit down with the doctors in a public place. [25] They spend their lives accruing knowledge and applying it in life saving situations – in a head to head debate you will definitely get shown up as a disingenuous moron. But flush out those handy think tanks [26] you pay so much for and get them out there as ‘balanced’ opinion holders. No one will notice their huge conflict of interest as privatisation lobbyists taking cash from big tobacco on the side. [27]

7) Money. Don’t mention it unless preceded by the phrase ‘extra’ [28] or simply total up expected underfunding as five yearly totals so they sound huge. Ignore the fact this is complete nonsense. [29,30] Pretend hospitals are like houses or supermarkets- people understand those. If you cut a hospital budget- that sounds bad, but if you tell a hospital to ‘live within their means’ [31]– well, that’s just good old fashioned common sense.

And don’t worry if you lose your job. Some very friendly chaps at a grateful private health company will greatly appreciate all that you’ve done for them while fondling the public purse. They really appreciate it. REALLY. [32]

And the best news of all? Even if you p**s off every doctor and nurse in the country they will still give you the same world class service they give every patient if you need them, any hour of any day. Phew. Idiots.

Juniordoctorblog.com

 

[1] http://www.donotlink.com/htxh
[2] http://www.theguardian.com/society/2015/nov/19/nhs-bosses-pressure-hunt-arbitration-junior-doctors
[3] http://www.nhsemployers.org/your-workforce/need-to-know/junior-doctors-contract/faq
[4] http://www.bbc.co.uk/news/health-34598335
[5] http://www.huffingtonpost.co.uk/2016/01/13/junior-doctors-jeremy-hunt-professor-nhs-stroke-deaths_n_8973206.html
[6] https://juniordoctorblog.com/2016/01/11/the-hateful-eight-an-exploration-of-the-evidence-presented-for-jeremy-hunts-weekend-effect/
[7] http://www.donotlink.com/hady
[8] http://www.donotlink.com/i20t
[9] http://www.donotlink.com/hu3o
[10] http://www.donotlink.com/hwtn
[11] http://www.bbc.co.uk/news/business-34919523
[12] http://www.bbc.co.uk/news/uk-35263402
[13] http://www.theguardian.com/society/2016/jan/26/caroline-lucas-green-party-labour-repeal-tory-nhs-reforms
[14] http://www.telegraph.co.uk/news/nhs/12110806/AandE-units-may-be-short-staffed-half-the-time-secret-guidance-says.html
[15] http://www.54000doctors.org/thecase/2-what-is-whistle-blowing-protection.html
[16] http://www.theguardian.com/business/2016/jan/26/anger-government-blocks-ttip-legal-documents-nhs-health-service
[17] http://www.theguardian.com/politics/2015/oct/15/doctors-cabinet-office-investigate-jeremy-hunt
[18] http://www.independent.co.uk/life-style/health-and-families/health-news/plan-to-put-price-tag-on-nhs-medicines-is-a-headline-grabbing-gimmick-says-journal-10444508.html
[19] http://www.mirror.co.uk/news/uk-news/jk-rowling-supports-junior-doctors-6650327
[20] http://www.mirror.co.uk/news/uk-news/furious-junior-doctors-deliver-giant-7221155
[21] http://www.independent.co.uk/news/uk/politics/labour-accuses-government-of-hiding-rising-special-advisers-bill-a6775561.html
[22] http://www.donotlink.com/i212
[23] http://www.belfasttelegraph.co.uk/news/uk/jeremy-hunt-slams-nhs-over-utterly-unacceptable-failure-to-probe-deaths-34276082.html
[24] http://www.bbc.co.uk/news/uk-politics-35298370
[25] http://medlines.org/2015/11/24/jeremy-hunt-snubs-nhs-junior-doctors-strike-debate/
[26] http://www.donotlink.com/i217
[27] http://www.tobaccotactics.org/index.php/Adam_Smith_Institute
[28] http://www.itv.com/news/update/2015-04-11/jeremy-hunt-we-can-fund-extra-money-for-nhs/
[29] http://blogs.channel4.com/factcheck/factcheck-george-osborne-generous-nhs/22104
[30] https://juniordoctorblog.com/2016/01/05/its-the-spin-that-wins/
[31] https://www.facebook.com/JeremyHuntMP/posts/992474864129700
[32] http://www.theguardian.com/politics/2015/oct/20/andrew-lansley-advise-firms-healthcare-reforms

The Hateful Eight: An Exploration of the evidence presented for Jeremy Hunt’s ‘Weekend Effect’ – UPDATED 13/1/15 with Stroke data

“We now have seven independent studies showing mortality is higher for patients admitted at weekends.”
JEREMY HUNT, ALL THE TIME.

You can view these seven (or rather eight) ‘studies’ here:

On the basis of this evidence Jeremy Hunt and the Department of Health have put forward the argument for sweeping changes to the NHS to create ‘Seven-Day’ services.

Juniordoctorblog deconstructs the Hateful Eight.


DISCLAIMER: this is written for a lay person. Further details on all the papers available on request.

1. Increased mortality associated with weekend hospital admission: a case for expanded 7 day services?  by Freemantle and Sir Bruce Keogh, published in the BMJ in 2015.

This is the most recent and most quoted paper, and where the soundbites “11,000 excess deaths” and “16% increased probability of death” come from. The study was performed by a group of researchers which included Sir Bruce Keogh, and was commissioned on his request, which makes the claim “independent” rather dubious. The study was an update of a 2012 paper (see below) and therefore 2 of the Hateful Eight are actually the same paper for different years.

This study pulled numbers from Hospital Episode Statistics, which records patient information from the discharge summaries written by junior doctors when you are discharged from hospital. If you have ever been to hospital you would know this is not always 100% accurate. The study identified the day of admission for every patient admitted to hospital in 2013/4, and then counted how many patients had died at 30 days after admission.

Overall just over 1.5 in 100 patients died in the study. They found patient deaths were LOWEST on Sunday, and HIGHEST on Wednesday, but for those ADMITTED on a Sunday or a Saturday they found a small increase in the risk of death at 30 days, an absolute increased risk of 0.07%* for admissions between Friday and Monday, compared to those admitted on a Wednesday.
The study also found 1/3 of patients died after being discharged from hospital, and the majority died after 7-8 days in hospital. For the first time the study tried to work out how sick patients were and found a higher proportion of the very sickest patients were entering the hospital on Saturday and Sunday compared to the weekdays. The authors conclude ‘to assume these excess deaths are avoidable would be rash and misleading’. At no point did this study measure staffing levels, rota cover or hospital resources, and the figure “11,000 excess deaths” is a statistical guess based on the numbers the study cranked out – they are NOT real identifiable cases.

BOTTOM LINE: Patients admitted at weekends are sicker, and they have a very tiny increased risk of death compared to the weekday admissions. “To assume this is avoidable is rash and misleading.”

2. Weekend hospitalisation and additional risk of death: an analysis of inpatient data by Freemantle/Sir Bruce Keogh published in 2012

This was the original paper as described above, by the same group from the same data using broadly the same methods. The only thing to add for this paper is it actually found patients in hospital on a Sunday were 8% less likely to die than those on a Wednesday.

BOTTOM LINE: 2 papers from the ‘Eight’ are written by Bruce Keogh of NHS England and are actually the same paper repeated.

3. The Global Comparators Project: international comparison of 30 day in-hospital mortality by day of the week by Ruiz, published in BMJ Quality and Safety 2015

The authors for this paper work for the Dr Foster Unit, sponsored by Dr Foster Intelligence: a former Department of Health co-owned patient safety monitoring company. They looked at the same data as the above from the Hospital Episode Statistics warehouse, and compared this to other countries: USA, Australia, the Netherlands and several more. This study looked at emergencies and routine surgery only for 2.8 million patients, 1.3 million of which came from the UK. For surgery, the UK had the lowest risk of death at 30 days. Emergency admissions were sicker than planned admissions. The results were similar for all countries studied, suggesting that this is an international phenomenon. UK planned surgery patients who had procedures on a Sunday, before adjustment**, were 0.7% more likely to die than those on a Monday. For emergency admissions the risk was 0.4% higher on a Sunday compared with a Monday. The effect was seen in nearly every country. Again this study performed no measurement of staffing levels on each day and the authors conclude themselves “we are not able to determine the reason for these findings.”
BOTTOM LINE: The ‘weekend effect’ is seen across the world in varying health systems.

Now is a good time to pause and discuss mortality. Imagine if you will two hospitals. Hospital A has a 90% mortality rate at 30 days – 90 in 100 people die within 30 days of admission, while at Hospital B the rate is only 2%, or only 2 in 100. Which would you rather be treated at? On the face of it, the answer would be Hospital B, because the obvious logic is: all illness should be curable, therefore I go to hospital to get better, therefore I choose the hospital where I have the greatest likelihood of getting better, ie not dying. Which makes sense: except if I told you Hospital A is a hospice, for end-of-life terminal cancer patients, and Hospital B is a community minor treatment unit for children, for scrapes and bruises and runny noses. Now this changes your perception of the figures: Hospital A has a surprisingly low mortality rate, considering everyone admitted is there to die peacefully, and Hospital B has a worringly high rate – considering no one should be dying at all. Now what if I told you Hospital C had a 1% chance of death for a procedure, and Hospital D had a 1.1% chance? Would you be bothered which hospital you went to? I wouldn’t. But if I told you that Hospital D had a 10% higher probability of death than Hospital C, you might change your mind. This illustrates the problem with superficially accepting statistics and why it’s so important to properly scrutinise the figures. Anyway, back to the papers.

4. East Midlands Clinical Senate (2014), 7 Day Services Project: Acute Collaborative Report

This is not a scientific report at all, but a consulting report from ATOS. The same ATOS that the Department for Work and Pensions recently dropped for the ‘poor quality of their work’. The report is from a group of executives from the East Midlands. It’s really dull, and not scientific at all – all of the numbers come from the other ‘studies’ here in regards to weekend and weekday working. Of 10 clinical standards for ‘seven-day’ services it found all were already being met 50-60% of the time. The biggest fail areas were ‘mental health’ and ‘transfer, discharge to social care’. Both budgets of which have been cut in the last ten years. However, here are some favourite quotes

“It is likely unsustainable and unnecessary for all trusts to provide all services 7 days a week”.

“There may be a need to drive funding for the whole system to deliver 7 day services”.

Here is a good time to remind readers the last eight years have been the worst funded decade for the NHS in its history (including the recently announced ‘extra’ £3 billion). Again no measure of staffing levels and no mention of junior doctors.

BOTTOM LINE: 7 day a week routine services require proper funding and are not necessary or sustainable in all areas. A good proportion of 7-day emergency services are already available.

5. NHS Services, 7 days a week report by NHS England/Sir Bruce Keogh

This is a policy document from NHS England and, again, Sir Bruce Keogh’s office. Also, again, not a scientific ‘study’ at all. Interestingly the focus is nearly entirely on emergency services – no mention of ‘routine’ care at all. The review notes that doctors and nurses are present on the acute medical unit 100% of the time weekday or weekend, the importance of diagnostic services being available 24/7, and lots of case studies- all of which achieved better cover without changing work conditions for staff. Interestingly in the annex it notes that many more weekend admissions are end-of-life patients compared to the weekdays- suggesting an increased need for community hospice and palliative care services.

BOTTOM LINE: Bruce Keogh and friends re-hash other research in this list- but importantly define the need for seven-day services as emergency care improvements, not routine services.

6. Academy of Medical Royal Colleges Report: 7 day consultant present care published in 2012

Again, not a unique scientific study but a review of many other studies. Produced by the Academy of Medical Royal Colleges to look into the necessity and feasibility of increasing consultant presence on the wards for emergency unscheduled patients. Again, not routine services and again, nothing about junior doctors or staffing levels.

BOTTOM LINE: Consultant presence is important for emergency admissions, not routine services.

 7. Weekend mortality for emergency admissions: a large multicentre study, BMJ Quality and Safety by Aylin published in 2010

Here is an ACTUAL scientific study, another from the Dr Foster Unit at Imperial College London (which was 50% part owned by the Dept of Health at the time of writing). This is the fourth study in this list that uses the Hospital Episode Statistics warehouse: again discharge letter information. This paper focused only on emergencies. They reached the same conclusion as the papers above, with an absolute increased risk of death at the weekend vs the weekday to be 0.12%*. They didn’t take into account how sick patients were, or their method of admission, and again no explicit measure of staffing levels were made.

BOTTOM LINE: A fourth study from the same data, showing a very small increased risk of death in weekend vs weekday emergency admissions, and no accounting for how sick patients were or staffing levels.

8. Time for training Report by Professor Sir John Temple from the Department of Health published in 2010.

Unfortunately this the original report has disappeared but in summary this was another policy document from the Dept of Health looking at the issue of training doctors under the European Working Time Directive. It’s main conclusions was that shift work is anti-social and has had an impact on training, and that consultants should be more involved in 24/7 work to support trainees.

BOTTOM LINE: Another non-study, suggesting a larger consultant presence day-to-day would help training. Nothing to do with the ‘weekend effect’.

I’d be remiss for not mentioning the latest papers in the ‘weekend effect’ argument, which haven’t quite made it onto the gov.uk website yet but are already in the briefs and interviews of Mr Hunt and the spin machine.

9. Association between day of delivery and obstetric outcomes: observational study by Palmer, published in BMJ 2015

A fifth paper looking at Hospital Episode Statistics, and the third from the Dr Foster Unit. It is remarkable actually that no single paper has tried to analyse ‘the weekend effect’ in any other way than use the same source. This group tried to identify a weekend effect on seven different measurements associated with giving birth. Overall the stillbirth rate was 0.7%, or 7 in 1000. It actually finds that the stillbirth rate is significantly lower on Monday and Tuesday, which had

‘no association with staffing’.

BOTTOM LINE: No  link between mortality and staffing, and no obvious ‘weekend effect’ (Thursday had the highest rate of perinatal mortality.)

10. Mortality of emergency general surgical patients and associations with hospital structures and processes by Ozdemir published in the British Journal of Anaesthesia in 2016

This study unsurprisingly also used the Hospital Episode Statistics database, looking at all emergency admissions undergoing surgical procedures or admitted with pancreatitis over five years. The study then cross-referenced these numbers with data about the hospitals it was collected from – e.g. staffing levels, number of beds etc. The methodology in this paper was actually quite good, and they show a very strong association with the number of doctors, nurses and beds and the association with better surgical outcomes- of course this does generally reflect the amount of money a hospital has, and how well-resourced it is overall. The weekend data shows the same bump in mortality at the weekend as all the other studies that looked at the HES data, but didn’t measure weekend vs weekday staffing levels, as many media stories wrongly reported.

BOTTOM LINE: Increasing resources improves outcomes from emergency surgery, regardless of the day of the week.

UPDATE: Following the strike announcement Jeremy Hunt began quoting ‘you are 20% more likely to die from a stroke at the weekend’. Given how stupendously dangerous delaying presentation to hospital is for a stroke I’ve updated this post to add in the following; (Full credit to Prof David Curtis and Ben White for drawing this to public attention.)

11. Mortality following Stroke, the Weekend Effect and Related Factors: Record Linkage Study published on PloSOne in June 2015 by Roberts.

This was a study that took the Welsh equivalent Hospital Episode Statistics and looked specifically at patients who were admitted to hospital for a stroke between 2004-2012 and counted how many died at 7 days, 30 days and 1 year. They found less patients were admitted on a weekend for strokes (88) and patients admitted during the week (111), and a small increase in mortality of 1.8% at 7 days between weekend and weekday admissions. There are three really important things to say about this:

  • 1) The study notes – stroke mortality fell by 3.1% every year for the 8 years of the study. This reflects the radical improvement in stroke care that has occurred over the last twenty years with the introduction of ’emergency’ stroke pathways and hyperacute stroke units. Here is a nice graph. This study doesn’t really factor in this massive improvement in overall care, and isn’t relevant to today. Also – this improvement was done without changing working conditions for staff.Stroke trends
  • 2) Stroke occurs on any day with equal frequency except mondays– where it is slightly higher. Stroke can range from transient weakness or loss of vision which resolves after 24 hours, to permanent loss of power to limbs and face and even death. The authors note that the effect ‘may be influenced by a higher stroke severity threshold for admission on weekends’. If you look at day of stroke, regardless of admission, there is NO WEEKEND EFFECT, as seen here in a study from Japan.
  • 3) Stroke is defined as ‘maximal at onset’ – it represents sudden and complete blood loss to an area of the brain. There is only one main treatment, which is to give clot-busting medication. However- this is very dangerous and the list of situations where the risk of the treatment outweighs the benefit is very long. Having worked on-call in a stroke unit and ICU previously I have only seen one patient who met the criteria. Only 15% of strokes were treated this way in 2014. 60% of patients came to hospital too late for treatment. Stroke is now treated as an emergency – the ambulance calls a stroke-centre hospital before the patient arrives, and a specalist team sees the patient as soon as they come in to the door. The limiting factor now is when the patient dials 999.
  • 4) Lastly, a recent study found the presence of a consultant or doctor had no effect on a patients survival after stroke, whatever day of the week they were admitted. However, the presence of adequate nurses had a huge impact: increasing nursing numbers from 1.5 nurses/10 beds to 3 nurses/10 beds reduced mortality by 4%. This reflects the fact that stroke patients are very vulnerable in the immediate period after the event, and it’s good nursing care, not junior doctors, that directly influence this. However – Jeremy Hunt has so far suppressed the NICE recommended safe staffing levels for nurses- and the NHS student bursary to incentivise nursing training has been cut.

BOTTOM LINE: This study took place 12 years ago, in Wales, during a time of rapid improvement in stroke care overall. It shows a reduced number of strokes admitted on the weekend – and likely increased severity of those admissions resulting in a small 1.8% bump in mortality overall. Jeremy Hunt’s scaremongering has previously led patients to delay coming to hospital – in this particular case this could lead to devastating loss of function and even life. Time is the single biggest factor in survival in stroke, and has nothing to do with  weekend doctor staffing or junior contracts.

Now time to look at things differently. You hear a lot about the studies showing a ‘weekend effect’. But did you know there are many studies that show no effect? The fact that you don’t is an example of something called publication bias – the government only wishes you to think the ‘body’ of evidence all points one way. It doesn’t.

Here are some studies that show NO WEEKEND EFFECT.

Weekend mortality in paediatric patients in Scotland – published by the Royal College of Paediatrics, Turner 2015. [1]
Byun 2012 (small study compared to the others) [2]
Kazley 2010 (US study) [3]
Kevin 2010  (Canada) [4]
Myers 2009 (USA) [5]

Overall: 

  • Of the ‘Hateful Eight’ studies only four represent actual research
  • Two are the same paper and co-authored by Sir Bruce Keogh,
  • The other two are from Dr Foster, formerly owned by the Dept of Health.
  • All of the studies come from a single source of data.
  • None of them show any link to staffing levels, and none of them show any link to junior doctors working patterns.
  • Much research exists disputing the weekend effect
  • Research shows that increasing resources improves outcomes. Which is obvious.

And here is the pièce de résistance. When there is a finite amount of money the logical management of resource is to put money where it will do the most good. The National Institute for Health and Care Excellence, NICE, have a recommended money spent vs benefit formula for approving treatments. The cut off is currently about £20,000 to buy a year of quality life. This is how all new medications are decided if they are value for money or not.

Meacock in 2015 sat down and worked out the cost of a ‘seven day NHS’ and then tried to work out if NICE would approve if it were a medicine. Needless to say the money spent (estimated for emergency services to be £1-1.4 billion) is 2x-3x as much as the ‘recommended’ cut off.

BOTTOM LINE: This isn’t even good value for money.

Finally – some context. Every year in the UK 25,000 people will die of a blood clot to the lungs, 60,000 people will die of a heart attack, 30,000 people will die from chronic lung diseases, mostly smoking related. Improving research and treatment pathways for any of those conditions would save more lives than this endless politically driven ‘seven day’ debacle. I dread to think how much money has already been spent on the ‘seven-day’ services problem – but if it is real, it is a tiny relative problem and a problem no country anywhere has been able to solve.


All doctors would want to have the entire gamut of services on hand every day of the week – but the first lesson of practicing medicine is learning to prioritise. So far, the ‘studies’, simply don’t add anything useful to the debate – we need to know where and how to spend our money, whether that’s in the community, in social care, in improving hospice care, or in expanding emergency departments or increasing perioperative care. The list goes on. It’s not clear there is a truly avoidable ‘weekend effect’, but more importantly it’s not clear if it’s worth the vast amounts of money, damaging publicity, time and general consternation being spent on it.

This is a classic situation of political meddling in the NHS creating harm. We have a government and media who prefer soundbites to sound decision-making and spin doctors to actual doctors. THIS is the true threat to the safety of patients.

juniordoctorblog.com

 

Have-A-Go-Health Secretaries: Juniordoctorblog runs the NHS

In an extremely welcome move, Jeremy Hunt has resigned, and in an open free-for-all, juniordoctorblog put down all-comers and sat on the Iron Throne of the Health Service to become the new health secretary.

Iron-Throne

So what to do?

Well, rather than squander this opportunity on a parade of hospital touring photo ops, I think I might fix the health service.

I know, i know : I have to stick to the manifesto, to deliver a 7-day health service, blah blah blah.

And my budget is £115 billion [1]  plus supposedly £10 billion up to 2020.

So….

  1. My first act is to immediately cease all trust payments to PFI companies – pending further legal action, review of spending and renegotiation, and cancel or restructure all pipeline PF2 deals. This will immediately be legally challenged, which will cost millions. However, in the interim, individual trusts will each save up to £2 million A WEEK [3]. Winter is sorted. After 6 months of negotiation I will nationalise the PFI debt, from the projected £80 billion for £10 billion pounds of services. If I can restructure this debt to payments even a 1/3 less than this I have just saved the NHS £25 billion- money that would continue to come back over the next twenty years. No money spent so far. Budget now £115 billion, plus £35 billion up to 2020. I have just funded the NHS for the next five years.
  2. Meanwhile I will end the internal market. All non-NHS contractors will be brought in house over the next five years, paid at value or less, and the administration for tendering contracts and fighting legal challenges will be scaled back and eventually cut. I will recruit experts in this field, to help dismantle and replace this system. The NHS just saved a conservative £5 billion [4] a year from 2020 onwards – safely funded from 2020-2030. Budget now £115 billion, plus £35 billion up to 2020, then a further £5 billion year-on-year, plus inflation. Ending the internal market also brings back high revenue work such as elective knee and hip operations. I would support the NHS reinstatement Bill [5] and push it through parliament.
  3. I haven’t spent any money yet.
  4. We now have 15 years, of a properly funded health service. Time to invest the surplus.
  5. Firstly: I would triple the public health budget, from £2.9 billion to £7.9 billion, create the Department of Preventative Health, and fund and recruit it to the hilt. It’s independent remit – to improve the general health of the country, via local authorities and nationally. I run a loose ship- so it will have a fairly free reign, but it must demonstrate evidence-based improvement before widespread roll out of any intervention. With 15 years and a decent budget, I expect good things. Funding recreational facilities, in-school sports and exercise facilities, public gyms and outdoor spaces, subsidising fresh fruit and vegetables, and even trialling taxes on ill-health foods would all be tried. If it didn’t work, it goes in the bin. Cost: an extra £5 billion and 10 years investment. Potential savings are huge- if you estimate disease costs caused by avoidable risk factors and aimed to reduce these by just 10%- you could save from smoking £200 million a year, from obesity £200 million a year, from hypertension £200 million a year, and £1 billion a year from diabetes. Total savings; £1.6 billion/year, but a long way down the line. Eventually pays for itself.
  6. Next I would push to integrate the NHS and social care budgets, and then make it my remit as health secretary to double the adult social care budget from £13.9 billion [7] to £23.9 billion with NHS money. I would establish in-house community care – carers would be employed by the NHS and rotate between at home care work and nursing homes. Home carers would be NHS-trained and qualified. Alongside this I would provide on-call medical cover- carers would be training to an HCA level to look out for early illness and those who are sickest would have access to a visiting GP. Again, all programmes would be piloted scientifically to demonstrate benefit. Care of the elderly MDTs would be specifically funded, based in the community, to review and prevent illness in the over 75’s- as long as the evidence [7] continues to show cost-effective benefit. Limits of treatment discussion would be a standard quality indicator for the programme.
  7. So far- I have spent an additional £15 billion of £35 billion by 2020.
  8. I would spend a further £10 billion over fiver years on long-term recruitment and incentivisation for permanent nursing staff, based on recommendations from Royal College of Nursing. I would spend a further £5 billion on the same recruitment and retention for doctors, to increase doctors/head to at least the OECD average 3.2/1000 and £2.5 billion on supporting professionals- radiographers, pharmacists, physiotherapists, occupational therapists. Yes, all clinical staff would see pay rises.
  9. So- fixed staff morale and numbers, fixed public health and social care, saved billions in prevented falls and disease- and still an extra £2.5 billion leftover. At this point a seven-day routine care model might naturally materialise with proper staff and resources- it would need proper trialling for uptake however, and if it didn’t work, it would be scrapped.
  10. Now to get bold. I would scrap both monitor and the CQC- saving millions. In 2017 I would launch a £2 billion initiative, to place and recruit medical MDT teams trained and tasked solely with the responsibility for quality improvement into every hospital and trust. Any intervention has to show patient benefit and be cost-effective. The team is independent from the hospital and responsible for collating all DATIX reports and never events and organising and implementing the root cause analysis and the changes. They would organise hospital Mortality and morbidity meetings, support QIP projects with funds and support services and have a duty to report and improve unsafe practice.They are answerable directly to the Department of Health, and have power over every aspect of hospital management and budget as needed to protect patient safety.
  11. All patient data is placed into an anonymised, opt-out, national database of outcomes, freely accessible for health research to any of my departments. With such large numbers, new data and initiatives can be evidenced properly before formal studies begin.
  12. Whew. Now it’s 2020 and the NHS looks pretty healthy to me. Not a penny of extra money overall has been taken from the treasury. If I’m still in office I would now expect individual hospitals to be reporting, via their internal quality monitors, what they need. I would put aside a further £2 billion fund to trial any major improvement. This would be rolled out everywhere if it was successful.
  13. At this point I will begin the drive to increase funding for the health service to equivalent OECD levels, by at least 1-2% more GDP spending. I would demonstrate the economic benefits of having a properly funded and preventative health system, hopefully increasing the budget by a further £20-30 billion.
  14. And then, after 15 years as the greatest health secretary since Bevan, I would change the law so to limit the powers of the Health Secretary, appoint several heads of the NHS outside of political influence and mandated to spend based on evidence and cost/effectiveness alone, and transparent public spending of money. The law would also mandate that budgets for trialled initiatives are ring-fenced outside of political interference for a defined time period- this is to stop wasting money by cutting funding before projects have a chance to show benefit.

I would be open to any evidence-based argument to implement any policy that showed patient benefit and was cost-effective. As I said, I run a loose, evidence-based ship. And then I would retire, having set up the NHS to remain one of our greatest national achievements for the century to come.

Oh? He’s not actually resigned?
Can we do this anyway?
No?
Oh. Never mind.
Juniordoctorblog.com
[1] http://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspx
[2] http://www.kingsfund.org.uk/blog/2015/04/manifesto-pledges-more-money-nhs-problem-solved
[3] http://www.telegraph.co.uk/news/nhs/11748960/The-PFI-hospitals-costing-NHS-2bn-every-year.html
[4] http://chpi.org.uk/wp-content/uploads/2014/02/At-what-cost-paying-the-price-for-the-market-in-the-English-NHS-by-Calum-Paton.pdf
[5] http://www.nhsbill2015.org
[6] http://www.local.gov.uk/documents/10180/11607/Briefing+on+public+health+funding+settlement+September+2014/d751f317-8843-450c-9e4a-82c676b656fe
[7] http://www.adass.org.uk/uploadedFiles/adass_content/policy_networks/resources/Key_documents/ADASS%20Budget%20Survey%202015%20Report%20FINAL.pdf
[8] http://www.thelancet.com/journals/lancet/article/PII0140-6736(93)92884-V/abstract?cc=y=