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Archive - Month: March 2010

March 22, 2010

Dr Phil’s Private Eye Column, Issue 1258, March 17, 2010
Filed under: Private Eye — Tags: , , — Dr. Phil @ 10:02 am

 Labour’s dead babies

‘The death of a child is an unbearable sorrow that no parent should have to endure’ said Gordon Brown a year ago. And yet Labour’s record in providing safe services to critically ill babies is lamentable. Whatever cause the current inquiry finds for the deaths of four babies following heart surgery in Oxford, it’s patently clear that the unit simply isn’t fit for purpose. With just one dedicated paediatric cardiac surgeon (now departed) and one surgeon mixing adult and paediatric work, it beggars belief that – after the Bristol scandal – Labour could have allowed such a small unit to carry on performing such complex surgery.

This is not a new argument. Since exposing the Bristol scandal just 18 years ago, MD has argued ad nauseum that highly specialised healthcare must be concentrated in fewer units that are safely staffed and equipped. Hardly rocket science. The Kennedy Inquiry reached the same conclusion in 2001 and triggered an expert review, chaired by cardiac surgeon James Munro, which recommended that the number of child heart surgery centres be reduced to six. Labour ignored the recommendations. NHS Medical Director and cardiac surgeon Bruce Keogh realised that another disaster was imminent, and instigated a second service review last year, saying that ‘Failure to reconfigure child heart surgery will be a stain on the soul of the specialty and will compromise the treatment of the most vulnerable members of the next generation.’ (Eye 20.1.10).

This review will shortly recommend that each unit must have a minimum of four surgeons and perform at least 400 procedures a year. Oxford did less than a hundred, but at least surgeon Caner Salih realised he worked in an unsafe environment and reported the run of deaths himself before leaving for another job. Labour should have decommissioned the Oxford unit back in 2003, along with several others with only two surgeons. But that would have been politically awkward. As MD predicted in January 2004,  ‘All the units will continue to provide a miraculously safe service with inadequate staffing until one cracks under the pressure… The seeds have already been sown for another Bristol, and the blame lies firmly with this cowardly government.’

Eye reader Joanne Ferguson is equally unimpressed with Labour’s failure to adequately fund neonatal care. The NHS Neonatal Taskforce was set up in February 2008, prompted by a National Audit Office report criticizing the organisation of neonatal services and staff shortages. Last November, the taskforce launched a Toolkit for High Quality Neonatal Services, describing it as ‘the best opportunity in 30 years to raise special care baby services up to the standard that babies and their families deserve.’ Alas, there is a shortfall of over 2,700 nurses and 300 supporting therapists that are needed to give premature babies one on one care. Labour has done very little to reverse this shortfall in paediatric intensive care, and labour wards are also perilously understaffed with 500 potentially preventable deaths a year still occurring in childbirth (see Eye November 2009).

Mrs Ferguson has set up a website1 linking expert recommendations that Labour hasn’t funded with harrowing stories of unsafe care. Brown may claim he wants no parents to endure what he has, but plenty still are thanks to a lack of courage from his government. And if he bumps into Mrs Ferguson on the stump, he’ll get some tough questions. Such as why, if £105 billion goes into the NHS, is she reporting the story of a premature baby lying all day in shit?



March 4, 2010

Dr Phil’s Private Eye Column, Issue 1257, March 3, 2010
Filed under: Private Eye — Tags: , — Dr. Phil @ 8:56 am

Medicine Balls: A Tale of Two Scandals

What goes around, comes around. The Bristol heart scandal of 1984-1995 occurred under the Tories’ watch but it was the incoming Labour government that ordered a Public Inquiry and used the results to impose sweeping, centrist health reforms. Now the Mid Staffs scandal – which in many ways is worse than Bristol – has occurred under Labour’s watch and it’s the Tories lobbying hard for a Public Inquiry, the results of which – if they get in – will doubtless be used to force their own ideology on the NHS.

The Bristol heart surgeons at least cared deeply about their work and were trying their best, even when their results for complex heart surgery were demonstrably poor. The Francis Inquiry into Mid Staffs, held behind closed doors but published last week, is more troubling: “It was striking how many accounts related to basic nursing care as opposed to clinical errors leading to injury or death”.

The Kennedy Inquiry found that from 1991 to 1995, between 30 and 35 more children under one died after open heart surgery in Bristol compared to a typical NHS child heart surgery centre at that time. 198 recommendations were made to prevent avoidable deaths happening on such a scale again.  The largest ever increase in NHS funding was coupled with the largest and most complex regime of targets and scrutiny. But in March 2009, the Healthcare Commission uncovered ‘appalling standards of care’ at Mid Staffs, and estimated that from 2005 to 2008, between 400 and 1,200 excess deaths occurred compared to comparable NHS trusts. And in these years, the Commission itself had judged the hospital to be performing well and Monitor awarded it Foundation status for its managerial excellence.

Labour’s centralised monitoring of quality and safety just doesn’t protect patients.  It’s expensive, retrospective data collection is slow, insensitive, inaccurate and misleading. Hospitals can game their mortality rates by fiddling with the coding system and unsurprisingly, the crude results and rating scores aren’t believed by NHS staff, politicians or the public. Health secretary Andy Burnham caused insult of Hewitt proportions, describing Mid Staffs as ‘ultimately a local failure’ and claiming the NHS has had its ‘best year ever’. Five separate panic reviews have been ordered that are unlikely to see the light of day this side of an election, if ever.

The take home message at Bristol came from Steve Bolsin, the anaesthetist who first raised concerns and paid for them with his NHS career. ‘If you want to avoid another Bristol, never lose sight of the patient.’ This is strikingly similar to the conclusion of Robert Francis QC in the Mid Staffs report: “If there is one lesson to be learnt, I suggest it is that people must always come before numbers. It is the individual experiences that lie behind statistics and benchmarks and action plans that really matter, and that is what must never be forgotten when policies are being made and implemented”.

The difference now is that we have the technology for patients and relatives  to provide valid and timely feedback on their care that will spot problems in the NHS years ahead of any quango. What’s needed is a cultural change that invites constructive scrutiny and has zero tolerance of avoidable harm to patients. Most NHS staff would love to work in such an environment, free from the tosh of political control and focusing entirely on the needs of the patients in front of them. That ‘new’ Labour could contrive a culture where £105 billion goes into the NHS and it’s still no safer then bungee jumping, with widespread staff shortages, over-crowded emergency departments, disillusionment and patient harm, suggests that much of our increased funding hasn’t gone where it’s needed. Oh, and we’re desperately short of inspirational managers who’ll stick two fingers up to Whitehall (when necessary) and focus on helping their staff to serve their patients.

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