Friday, 29 January 2016

The truth about NHS emergency care at weekends?

Much has been made by the Prime Minister and the Health Secretary, Jeremy Hunt, about a seven day NHS and doctors working at weekends.  They cite in their case against the action of the Junior doctors in their opposition to the new contracts that more patients die at weekends.  This they say is a scandal and imply it is because there is less care over the weekend in the NHS. 

But is this claim really true.  A new study published today in the Emergency Medicine Journal reveals that it is at best an oversimplification. 

Looking at what happens in one hospital in Belfast, the study shows that patients admitted as medical emergencies at the weekend are significantly older and more dependent than those admitted to hospital on other days of the week.

The authors suggest that while staffing levels may have a part to play, the profile of the intake may help explain the seemingly higher death toll of patients admitted as medical emergencies at weekends.

They base their findings on an analysis of 536 patients admitted to the acute medical unit of a large teaching hospital in Belfast during November 2012.

They compared the profile of patients admitted as medical emergencies between 1700 hours on Friday and 0900 hours on Monday with those admitted on other days of the week.

Because there are proportionally more night shifts worked during weekends than on week days, the researchers also compared the profile of patients arriving in the unit during both the day and night at weekends and on week days.

Their analysis showed that there were no major differences in the severity of illness between patients admitted on weekdays and weekends, as evidenced by key clinical indicators and test results.

But patients admitted at the weekend as medical emergencies were significantly older—on average, more than 3.5 years—than those admitted at other times of the week.

They were also more physically incapacitated than patients admitted during the week, as measured by a validated disability scale (Rankin scale), attracting an average score of 3 compared with 2 for weekday admissions.

Patients admitted during the day at weekends were also more functionally dependent than those admitted during the day on other days of the week.

The researchers stress that this study reflects the experience of only one acute hospital, so may not be indicative of patterns elsewhere.

But the researchers point out: “These findings illustrate major differences in the age and functional dependence of patients admitted to hospital at weekends. This difference in profile may fully or partially explain the increased mortality that has been publicised.”

They also question the belief that greater numbers of senior doctors at the weekend would make any difference to the survival of patients.

“Additionally, the lack of difference in physiological and laboratory markers of illness acuity presented here questions the plausibility of the inference that increased senior medical presence at the weekend would improve outcomes,” they write.

They conclude that if arguments are to be made about the number and seniority of staff required at the weekend, these need to be based on solid evidence and take account of other factors that may potentially influence death rates.

Tuesday, 26 January 2016

It Wasn't Always Late Summer

I have taken a short break from the blog, but will be posting again this week. Meanwhile why not take the opportunity to preview my novel.

Wednesday, 6 January 2016

Junior doctors stand tall

News that the talks between the government and the junior doctors has stumbled is no surprise. Junior doctors are right to be sceptical about the motives of the Health Secretary.

In November, in a ballot of junior doctors, 98 per cent voted for industrial action in response to the Government’s attempt to introduce an unsafe and unfair contract. Despite this overwhelming mandate, the BMA sought conciliation talks through Acas – talks that were initially rejected by Jeremy Hunt – which led to action being temporarily suspended to allow further negotiations. Despite weeks of negotiations, talks have failed to reach agreement.

The BMA has made it clear that it wants to reach agreement on a contract that is good for patients, junior doctors and the NHS. This is why, despite overwhelming support for industrial action, the BMA instead sought conciliation talks with the Government. Those talks were initially rejected and delayed by Jeremy Hunt.

As the BMA say, after weeks of negotiations, it is clear that the Government is still not taking junior doctors’ concerns seriously. Furthermore, the Government has repeatedly dragged its feet throughout the process, initially rejecting talks and failing to make significant movement during negotiations.

The damage inflicted on the NHS over five years of the coalition government and now this Tory government will be costly and difficult to repair. The Tories promised there would be no 'top down reorganisation of the NHS' yet they introduced a complex reorganisation of commissioning, ignoring the warnings of Doctors organisations such as the British Medical Association that such a reorganisation at this time would inflict damage on a cash-strapped health service.

They promised to ring-fence NHS funding but have taken funds out of the NHS through the back door with £20 bn of 'efficiency savings' amounting to a cut in funding to the front line service of 4% per year for the last five years. That is a massive cut and it is no wonder that the fabric of the NHS is crumbling.

Doctor and Nurse organisation have warned that the NHS is at breaking point. Social justice is being eroded. The social care system is crumbling with an added burden on the NHS as it picks up the pieces of failing social care. Top down imposed 'Efficiency Savings' are creating a bed shortage and NHS rationing is creating post-code lotteries in health care.

A report by the RNIB last year showed that cataract surgery is being rationed by hospital trusts in England with considerable variation to access to this vital surgery in different regions. This has created a post-code lottery for access to essential treatment. But that is a tip of a large iceberg with rationing of hearing aids, hip replacements and essential access to drugs.

What explanation does the Secretary of State have for this state of affairs? Does the Secretary of State find this situation acceptable and if not what does the government propose to do about it? They fail to understand the nature of the problems and they fail to see why junior doctors are at the end of their tether trying to prop up a broken system. They are fighting for patient care and safety not just salaries. This is why they command the support of the majority of voters.

We need a joined up Health and Social Care system. Social care is fragmenting through cuts to local authorities. Care homes are closing and families are struggling to look after their loved ones. This is what the coalition achieved in just four years with Tory austerity. They say they have increased NHS funding. We know on the ground that in real terms this is not so.  Increased spending on the NHS as a percentage of GDP  is at the lowest level since it was founded - and the NHS is left stumbling from one winter crisis to another. Nobody is fooled. We all know that a smaller percentage of a smaller cake is a cut - and that is what the government has done. It has sliced it to the bone.

Increasing numbers of NHS trusts are now in deficit and struggling to meet demand. The government boasts of the new funding it is putting it, but this is merely sticking plaster for the cuts they have imposed for the last five years.  They said they would protect NHS funding. They have brought it to its knees. 

The Prime Minister seems to be fooled by his own deceit when he says funding has increased. It hasn't - and that is the bottom of it.  The NHS is struggling because it has been starved of funds - its oxygen has been choked off. It has been throttled in an ideological drive to push more into the hands of private equity provision. With private health care increasing, much needed funds are being diverted to outsourcing provision. 

We need to restore a national health care system where availability to treatment is not dependent on where people live. This isn't rocket science. It simply requires political vision and will. What it does not require is a dogmatically driven attack on the core principle of the health service.

Today, junior doctors stand tall whilst the Secretary of State and the Prime Minister should hang their heads in shame.