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August 11, 2015

Private Eye 1398
Filed under: Private Eye — Dr. Phil @ 11:23 am

Bad Science, More Blame and a nasty U turn

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

Another study allegedly supporting the 6000 figure has yet to be published and scrutinised properly, so to make such bold political claims on the back of an unpublished source is very bad science. Hunt has cleverly manipulated the debate to look as if the barrier to ‘a proper 7 day service’ is consultants who have opted out of weekend working. This prompted a barrage of social media posts of NHS staff of all grades working at weekends, including many consultants (#IminworkJeremy) and a petition for a vote of no confidence in Hunt that has gained well over 200,000 signatures.

Hunt may have been warming up for a pop at the Tory leadership but he’s also saddled with some election pledges that simply aren’t deliverable in the context of a further £22 billion of efficiency savings. Promising everyone over 75 a same day appointment with a GP when 30% of GP training schemes have vacancies and older GPs with full pension pots are lining up for early retirement is hard enough. An NHS where every day offers the full range of elective and emergency care is impossible without considerable investment and safe staffing levels.

A sensible approach would have been to focus the 7 day service on urgent and emergency care, which all NHS staff would support. Attempts to extend routine general practice to 7 days were tried by Labour and found to be expensive and unpopular (few people choose to spend their Sundays at a GP surgery). And you can’t have a 7 day NHS with a 5 day social care service, itself facing even more draconian cuts than the NHS. Hospital patients are largely elderly, and many very frail, and they can’t be discharged without proper social care support.

Most worrying is the government’s – and NHS England’s – lack of transparency on safe staffing levels. NICE – the National Institute of Health and Care Excellence – is an internationally trusted source of evidence that has finished vital work on safe nurse staffing levels in accident and emergency departments, along with four reviews of safe staffing in other settings such as mental health and community nursing. The NHS needs to see and act on this evidence now to prevent similar understaffing tragedies to Mid Staffs.
Having been told by NHS England CEO Simon Stevens to halt the work so it could be taken over by a new organisation, NICE promised to go ahead and publish it for the good of the NHS (and other health services that rely on NICE evidence) before doing a dramatic U turn. How much it was pressured to shut up by the Department of Health and NHS England remains to be seen. But it was ironic that NICE should announce its capitulation in the week that the Department of Health published its response to the ‘Freedom to Speak Up’ review, claiming that the NHS would no longer tolerate cover ups. To then cover up the safe staffing evidence when it is the vital to prevent future scandals and patient harm is an act of breath-taking hypocrisy.

Even more worrying for NHS staff is that if an organisation as powerful and supposedly independent as NICE feels unable to speak up and publish vital safety information that is clearly in patients’ interests, what hope is there for individual whistle-blowers? Research by the Health Service Journal found that 84 per cent of acute trusts failed to meet the existing nurse staffing targets for both day and night in April 2015. If the NHS cannot afford the safe staffing levels that the best available evidence says it needs, the public should be asked if it wants to pay more for the NHS, not have the evidence hidden from view because it is politically damaging. Never mind the truth. Just blame the BMA.

MD’s book, Staying Alive – How to Get the Best From the NHS – is available here