Does the British media hate the NHS?


11:05 am - November 29th 2010

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contribution by ‘AlienfromZOG

Yesterday saw the release of the Dr Foster 2010 Hospital Guide. This is an interesting piece of research, done by an independent agency which gives a lot of information as to how the NHS is functioning.

Here’s a representative sample of how it is being reported:
BBC: ‘Deaths concern for NHS Trusts
Sky News: ‘Alarm over high NHS hospital death rates
The Telegraph: ‘Death rates at 19 hospitals alarmingly high
The Guardian: ‘Exposed: the hospitals whose high death rates are failing the NHS

There is only one possible conclusion to draw from these headlines; there is a major problem with patient safety and you and those you care about are clearly not safe in an NHS hospital.

This conclusion is also entirely wrong.

I would recommend reading the report – for a start. Reading the various articles it seems quite likely that none of the reporters actually have.

Here’s a quick overview if you don’t have the time (taken directly from the report);

So, the top two main findings are that overall mortality is continuing to fall – and 7% is a significant drop. Furthermore the gap between the best performing and the worst performing hospitals in narrowing – suggesting that work to improve outcomes is working.

Funny how that hardly gets a mention.

Just a quick bit of explanation; HSMR (Hospital Standardises Mortality Rates) is quite a useful measure when comparing hospitals across the country. Crude mortality can be very misleading, as the kind of patients, age and co-morbidities can vary quite significantly.

HSMR corrects for this and creates a figure. The expected number of deaths is estimated. Having less than expected will give a number of less than 100 and greater than expected more than 100. Implicitly, such data across several hospitals will follow a normal distribution.

So a more accurate headline would be: Some hospitals have better outcomes than others – a statistical inevitability! It doesn’t have quite the same ring to it somehow does it?

That’s not to say that there isn’t some useful data in here, and it is a reasonable and important question to ask why some hospitals have relatively poorer outcomes and this can lead to improvements. However, the media reporting of this is extremely misleading.

And this matters because the constant denigration of the NHS is (whether wilful or otherwise) part of a process that undermines it. Ultimately, if people lose faith in the NHS, then the NHS will die.

Here’s some things about the NHS that you don’t tend to hear:
1. The NHS is the Most efficient healthcare system in the developed world
2. The NHS is rated as better than Germany, the USA, Australia and Canada in terms of quality care.
3. NHS heart surgery outcomes are 25% better than the European average
4. The NHS compares very favourably to other industrialised countries in terms of access to healthcare

There are many problems with the NHS as anyone who works in it could tell you. In general though, these problems are entirely different from what is reported in the media.


Dr Alienfromzog BSc(Hons) MBChB MRCS(Ed) DCH

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Reader comments


1. Chaise Guevara

Lying bastards they may be, but I don’t think that many British newspapers are anti-NHS. Indeed, they tend to assume that everyone should have the right to any drug they want and to experience world-class customer service, as shown with all that nonsense about Herceptin.

When papers write bullshit stories about the NHS, it’s either because the article provokes fear or outrage and thus helps to shift papers regardless of how one sees the NHS, or it’s because they’re actually saying the NHS should be better.

I agree and heartily endorse what you say. Your four point list should be posted in every hospital (and seared into the brains of every politician).

Standardised Mortality Rates are better than crude mortality for the reasons that you have given. There are several commercially available, two are Dr Foster’s HSMR and CHK’s RAMI (CQC also have their own mortality rate). These are commercial systems because hospitals pay for a real time version so that rather than waiting for the end of the year, the hospital will get a daily value compared to their previous score. (By definition the standardisation means that data has to be compared over all hospitals and so this is not possible with a real time system.) Hospitals pay for these systems to help identify why the mortality rates are high. As the article implies, crude mortality rates can be misleading: if you have a ward of people over 85 you would expect more to die than in a ward of 20 year olds with the same condition, standardisation corrects for things like age, co-morbidity and the health issues in the area (or it should). If a hospital has a real time system they can get past the crude mortality rate and see if there are any issues.

The problem with the commercial systems is that they are secret. You do not know what weighting they use to produce the final rate, for example, for age profiles, co-morbidity (how many health problems the patient has) or the general health issues of the area. Since the algorithm is secret hospitals lack confidence in it. after all, it is just a magic number produced once a year, and you have no idea whether it is because there is a high number of nursing homes locally or a low number of hospices; or whether it is because the surgeon in orthopaedics lacks crucial skills.

One significant point in the first Francis report was where the inquiry asked how Mid Staffs could have a HSMR of 127 and then a couple of years later have a HSMR of 85: what caused such a huge change? The expert witness said that there were three things. First, they improved coding (that is, they would list all of the health issues of the patient, and not just the condition they died from), second they stopped treating people with stroke or heart issues. These two changes should not have changed the HSMR, the system should have been robust enough not to be affected by these. The third reason was that the hospital had improved patient pathways (ie making it easier and quicker to be seen by the right person and get the right treatment). Only the third reason should have affected HSMR, and since the other two affected the value indicates that Dr Foster HSMR has flaws.

In response to the problems with Dr Foster HSMR the Department of Health is developing their own mortality rate: SHMI. This will be open, so hospitals will be able to see how the value is calculated and how to improve their value. Since it is open it means that if a hospital finds out how to game the system then the algorithm can be changed and we will know why it is changed and who has been gaming.

Personally, I am waiting for the SHMI values (due next April), I do not put much confidence in the HSMR for this year.

In my (long) experience, NHS propagandists are blind to its many failings and hate for the public to be reminded about them.

We don’t have a consistent national National Health Service if this can happen:

“Variations in the amputation rates in diabetes patients in England have been described as shocking by a charity.

“Department of Health data reveals the rate of major amputations in the South West, at three in 1,000, is almost twice the rate in the South East. The Diabetes UK charity says the majority could be prevented.”
http://www.bbc.co.uk/news/health-11832233

“The inquiry [into the Mid Staffordshire Hospitals Trust] follows a report which found appalling standards of care had led to 400 more deaths than should have been expected between 2005 and 2008.”
http://www.bbc.co.uk/news/uk-england-stoke-staffordshire-11711097

In a recent study of the care of the elderly in NHS hospitals, only just over third were judged to have had good treatment:
http://www.bbc.co.uk/news/health-11728163

If I’m in a position to select which hospital I’m going to for a major elective procedure, I certainly want to know which hospitals have relatively high mortality rates compared with other accessible hospitals. I also want to know how the quality of healthcare dispensed by the NHS in Britain compares with the quality of healthcare from healthcare systems in other west European countries.

Btw I’ve been a recent guest of the NHS. It doesn’t build much confidence in NHS administration when the surgeon hands me a consent form to sign with the wrong operation. He had to insert a manuscript correction on the form before I would sign. Then he took out a felt-tipped pen to mark the correct side.

4. George McLean

Sorry if this is badly-worded, but is it possible to compare private hospitals with NHS ones on the same criteria, eg HSMRs or heart surgey outcomes?

Of course the media don’t hate the NHS. They don’t hate the House of Commons either, but over the past couple of years they have focused on abuses of the expenses system rather than writing screeds about what honest, hardworking folk most MPs are.

Rotten apples and stuff going wrong is always going to be grist to the media mill. And rightly so. We don’t want or need Pravda-style reporting, thanks.

@4 No.

Dr Foster comment in their report that they don’t have access to the private sector data.

It could be interesting. Crude mortality in the private sector is undoubtedly lower than the NHS. However, the patient and procedure selection is very limited. A Standardised mortality rate might be quite revealing. (With the caveats so well explained in 2).

AFZ

@5: “Rotten apples and stuff going wrong is always going to be grist to the media mill.”

And that is just what we need to maintain a vibrant democracy.

Thomas Carlyle: “Burke said there were three Estates in Parliament; but in the reporters’ gallery yonder, there sat a fourth Estate more important than them all.”
http://www.famousquotesandauthors.com/authors/thomas_carlyle_quotes.html

8. the a&e charge nurse

Ahh, your item warmed my heart on a freezing day, AFZ.

I arrived at the painful conclusion that British journo’s are too fucking thick to understand many, perhaps even most health issues – Ben Goldacre gives them a right spanking here;
http://www.badscience.net/2009/03/venal-misleading-pathetic-dangerous-stupid-and-now-busted/

Goldacre concludes – “Journalists insist that we need professionals to mediate and explain science. From today’s story, their self belief seems truly laughable”.
The items you highlight are simply par for the course.

@Bob B #3

… in the South West, at three in 1,000, is almost twice the rate in the South East…

The issues you indicate are, of course, the effects of regional variations and will get worse as the system is fragmented under Lansley’s plans.

As for Mid Staffs, have you read the first Francis Report? And did you read my response above?

HSMR is an abstract figure. You cannot come up with a figure like “400 more deaths” from it. It is lazy (and ignorant) journalism. The current Francis inquiry is addressing this issue. For example, when high HSMR figures were reported the chair of the PCT toured the area with open public meetings for people to come and express their concerns: no one attended; then he toured the GPs talking to people in the waiting rooms and to GPs themselves, and found that no one was telling him the sorts of lurid reports that were coming out in the Press. If the local people were not reporting mass extermination of patients (which figures like 400, or in some cases 1200, extra deaths would suggest) there there is clearly something rum going on. Clearly the Press and local politicians had some agenda and the current Francis inquiry is throwing up some very interesting information about this. Until we know the truth, it would be best not to quote figures that have no fact behind them.

If I’m in a position to select which hospital I’m going to for a major elective procedure, I certainly want to know which hospitals have relatively high mortality rates compared with other accessible hospitals. I also want to know how the quality of healthcare dispensed by the NHS in Britain compares with the quality of healthcare from healthcare systems in other west European countries.

Go ahead. And before you do it, may I suggest that you first take a medical degree, or perhaps an MSc in public health? Or at least ask the local public health officers about things like the local health issues, how many hospices there are in the area and the proportion of people who die in nursing homes compared to the candidate hospitals? Mortality rates (and I emphasis HSMR is just one of them) should take these into account, but the variation between different mortality rates from different vendors for the same hospital shows that they all have flaws.

My advice to you (unless you do have a medical degree) is not to look at the figures yourself, you do not have the skills to make a meaningful conclusion. Instead, ask someone who does have the skills – ask your GP. Of course, under the last government’s Choose and Book scheme you could have done this: get advice and get a choice. The fact that you have “been a recent guest of the NHS” and did not choose the best hospital shows that you have little chance of choosing any better under Lansley’s plans.

How timely;

TELEGRAPH: Ed Miliband is leading Labour on a march into insignificance – Until it accepts and apologises for its mistakes, the party will never recapture its connection with the voters >> http://www.telegraph.co.uk/comment/columnists/matthewd_ancona/7823609/Ed-Miliband-is-leading-Labour-on-a-march-into-insignificance.html

Lets work up some background as to why some question Ed Miliband having blank pages in his policy document:

For over thirteen years Labour assured the country, with :-
More nurses? More doctors? More teachers?
= nope, more management and overheads with no identifiable increases in productivity.

More teaching assistants?
= perhaps, but if the gain was simply for more Teacher training, how does the public benefit from this?

More police officers?
= Hasn’t meant more productivity but more overheads with PCSO’s costing as much as £150k.

Improved access to higher education? Guaranteed education or training for all school leavers?
= Unaffordable squandering of education budget with recruiting the socialist vote in mind.

Shorter waiting lists?
= any party can shift the burden of care to families. Or ensure immigrants get free healthcare if they find a way to vote Labour.

Improved education results?
= this is suggested even though 70% of new jobs created went to immigrants.

Better schools? Better hospitals?
= not nearly sufficiently improved as demonstrated by Labour ministers now complaining about the conditions of some schools. (look up hypocrite & dis-service ijn your dictionaries)
= financially burdening future generations (like Labour has done for everything else) with PFI does what for the balance sheet?

Stronger voice in Europe where we were for once taken seriously?
= more Labour MEP’s claiming expenses for simply agreeing to more regulation for no net gain and then troughing it up, serves the UK how?

Stronger voice with the US where we were for once taken seriously and did not have to indulge in the humiliating reference to ‘Special relationship’?
= wikileaks doesn’t support this.

Devolution?
= is this a positive for UK plc?

SureStart? Minimum wage?
= a UK employers glass floor is undone by others turning a blind eye to employment compliance (ie Baroness Scotland).

Shorter working hours?
= not aware anyone identified improved output for UK Plc?

Improved holidays?
= when Unionised workforces walk out at the drop of a biscuit, this is a failure.

Saving the economy from a depression?
= what? an end to boom and bust? the tin-pot chancellor Gordon Brown talked of saving the world from banking crisis despite being complicit by letting global banks make their own ‘rules’.

Increased wealth?
= perhaps for MP’s who ran amock without parliament being reformed despite Labours promises, seems mostly a win-win for no-one else. Yes, other party members exploited the John Lewis list, but Labour Government had the vast majority and renaged on yet another promise.

Now that we’ve covered the high points, there’s also:

Tony Blair and his :-
– 45 minutes warning
– WMD hysteria relayed from other (unsurprisingly) Middle East leaders and disgustingly converted into a British threat
– Iraq War dodgy dossier compiled with content copied from a students thesis
– PFI initiatives
– Legal Aid abused by those that shouldnt have access to it.
– repeated child abuse cases brought about by form-filling for statistical media presentations and less manpower on the job / this without redress from those involved in creating an unmanageable system.
– high Public Sector Borrowing for absolutely zero productivity improvements over the private sector as suggested.
– the confluence of scotland, lockerbie bomber al meghrahi, libyan visit, BP oil agreement with gadaffi,

Gordon Brown and chancellorship;
– and end to boom and bust
– selling gold cheaply
– putting nothing aside during the boom times
– signing up the UK to an insurmountable immigrant influx, their welfare and benefits plus overheads for their erstwhile families FOREVER!
– underfunding the MOD as they combat terrorism (or was it simply regime change for ME rewards)

In other news;

*
Tories must not expect Miliband to leap obligingly into every trap
12 Jun 2010
*
Ed Miliband says Labour needs to represent voters’ dreams
12 Jun 2010
*
Spending Review 2010: Let’s remind Ed Miliband where the deficit came from
12 Jun 2010
*
Ed Miliband shadow cabinet selection: reaction
12 Jun 2010
*
MPs? expenses: Sadiq Khan misused Commons? envelopes
12 Jun 2010
*
George Osborne: growth will come from the aspiration of the British people
12 Jun 2010

George – while Alien’s point is also right, it’s not even possible *in principle* to compare private hospitals to NHS hospitals, because all best-practice intensive and emergency care in the UK is done by the NHS. The reason why private health insurance is ridiculously cheap in the UK compared to elsewhere is because private healthcare in the UK means “a nice room and a bit of a queue-jump for your routine and not-very-expensive surgery, with the NHS picking up the costs if anything goes wrong”, rather than actual private healthcare.

“1. The NHS is the Most efficient healthcare system in the developed world”

Can we have a reference for this? Extraordinary claims require extraordinary evidence, and all that…

13. alienfromzog

@12 The reference for that is the same as for the second claim. It’s from a report by the Commonwealth Fund – a US based charity.

It’s not a particularly extraordinary claim, however. Firstly, it is a consistent finding over a long period of time from several studies. This was just the easiest to reference. Secondly, Across the developed world, virtually all healthcare systems are essentially insurance-based. How one pays the premium and who provides the healthcare is what varies between systems. In the abstract, it should not be surprising that a system that doesn’t depend on insurance and thus the inevitable level of administration that goes with that would be expected to be more efficient than one that does. In the real world, it is a bit more complicated and the NHS has a provider/commissioner division, however the administration is still a lot less than other systems. Furthermore, in general the NHS is much better at strategic planning.

AFZ

There’s a big difference between bad journalism and ‘hating’ the NHS. You don’t defeat hysteria by screaming louder and stamping your feet.

15. alienfromzog

@10,

Polleetickle, thank you for that, it was very entertaining.

“Everyone is entitled to their own opinion, but not their own facts.”

Sen. Daniel Patrick Moynihan

I won’t try to respond to your entire novel, but here are a few facts for you;

Number of nursing staff in the NHS in 1999: 261,340 (Whole-time equivalents)
Number of nursing staff in the NHS in 2009: 336,007

Number of doctors in the NHS in 1999: 86,837
Number of doctors in the NHS in 2009: 128,331

Number of managers in the NHS in 1999: 23,378
Number of managers in the NHS in 2009: 42,509

Correct me if I’m wrong but, 336,000 is more than 261,000. Similarly 128,000 is more than 87,000?

Waiting times;
Median waiting time for inpatient treatment March 1997: 13.2 weeks
Median waiting time for inpatient treatment March 2009: 4.0 weeks

[Source, the King’s Fund]

Productivity is a difficult concept in healthcare and there is little agreement on how you actually measure it. One calculation estimates that productivity is stable. However, I’m not sure that referring simply to productivity is actually helpful. For example, one of the wards I work on has reduced the number of qualified nurses on the morning shift from 4 to 3 in the last 3 months (No cuts to frontline services). On the basis of that crude productivity must be higher – the same number of patients are cared for but the quality of care is clearly affected. Mornings are very busy – we have a wardround and then patients going to and returning from theatre as well as the daily care, washing and drugs are all the other things the nurses do. Acute surgical patients can be very unstable. So I’m not necessarily interested in productivity figures.

AFZ

@13, Ok, thanks for clarifying.

But do you really find this stuff a convincing argument against NHS reform? The 2010 Commonwealth Fund report doesn’t seem to be finished yet, but I read the 2009 report, and I have to say that I still have absolutely no idea where the “Country Rankings” numbers in the PDF you linked came from.

“Effective Care”? “Safe Care”? “Coordinated Care”? How on Earth have these things been measured objectively? How do you turn “Efficiency” into a single number between 1.0 and 7.0?

Come on, you’re a doctor. The great advances in medicine were achieved through solid research, not this flim-flam. Flim-flam which just happens to show that America is the worst at everything while Britain is the best. How convenient that this should be exactly the conclusion that the highly political Commonwealth Fund wants to see for their “Alliance for Health Reform”. It’s lucky that your medical predecessors insisted on real evidence, otherwise we’d still be treating bubonic plague with leeches.

17. alienfromzog

@16

I like the idea of treating Yersinia pestis with leaches….

There is an entire report behind those figures but the website is annoying and I couldn’t find the link to the full report when writing last night. Sorry about that, I’ll see if I can find some of the data.

I are not arguing against NHS reform per se. My point of this article was my on-going frustration with the inaccurate media narrative about the NHS. Again, I couldn’t find the link last night but there was a brilliant poll (last year I think) which asked people about there perceptions of the NHS and their experience. There was a huge gap between the two with over 90% of people reporting good or excellent care if they had recently accessed healthcare, whereas a majority of people felt the NHS was poor – based on their perception rather than experience.

One bit of data for your consideration is that the USA’s healthcare spending is about 4-5 times that of the UK and yet life-expectancy is higher in the UK. I didn’t go into that in the article because it is a lot more complex than that but if I was an American I would certainly be asking why that is the case.

The NHS White Paper will certainly make things worse – for one thing it inevitably multiplies some of the administration functions of the hospital trusts by 3-4 times.

If you asking what changes I would make, then that is an interesting question. And it is not a simple one. There are several things I would look at but that’s a more complex issue – my point in this article was simply that the reporting was very misleading.

AFZ

18. the a&e charge nurse

[16] I thought the point of this article was about the standard of health reporting?

If we are sympathetic to health churnos than maybe we should bear in mind this analogy;
http://en.wikipedia.org/wiki/Blind_men_and_an_elephant

I take Shatterface’s point [14] but the apparent lack of ability to understand research (perhaps because churnos cannot be arsed to read half of it) and tendency to pessimistic analysis/reporting does start to grate after a while.

so, alienfromzog, extrapoltes some equally entertaining tho positive healthcare employment figures. OK, fairly selective, but I was enthralled until the concluding footshot:

Productivity is a difficult concept in healthcare and there is little agreement on how you actually measure it. One calculation estimates that productivity is stable. However, I’m not sure that referring simply to productivity is actually helpful. For example, one of the wards I work on has reduced the number of qualified nurses on the morning shift from 4 to 3 in the last 3 months (No cuts to frontline services). On the basis of that crude productivity must be higher – the same number of patients are cared for but the quality of care is clearly affected. Mornings are very busy – we have a wardround and then patients going to and returning from theatre as well as the daily care, washing and drugs are all the other things the nurses do. Acute surgical patients can be very unstable. So I’m not necessarily interested in productivity figures.

AFZ

So, why was so much time, manpower, money and PR invested by Labour in statisticians? Not spin, surely?

20. the a&e charge nurse

[19] “So, why was so much time, manpower, money and PR invested by Labour in statisticians” – dunno, but I doubt if the health churnos could shed much light on it either – what’s YOUR hypothesis?

@ 13: You can’t use the Commonwealth study of 7 health care systems as evidence of best in the OECD.(which is a useful euphemism for developed world).

Also worth noting that the NHS is worst (as in, howlingly awful) at “patient centred care” from the same report.

Perhaps the WHO rankings would be more appropriate?

http://www.photius.com/rankings/healthranks.html

They’re a decade old, there are large problems with them but the NHS is 18th: not quite such a comforting story. Especially as more than 50% of those rankings comes from things like taxpayer financing, equality of access etc, all things the NHS does very well on. The other bits must be terrible to drag it that far down the ranking.

“They’re a decade old”

Really?

“there are large problems with them”

Like what?

“They’re a decade old”

Come on Tim, this is the sort of sloppiness that you’d skewer, are you really using figures comparing the NHS 10 years ago in a discussion on the NHS now?

They’re a decade old because the WHO doesn’t compile them any more. All we’ve now got is those from hte C Fund: which is hardly a neutral source.

The problems with the WHO ones?

http://www.cato.org/pubs/bp/bp101.pdf

It’s the assumptyions which are made about what to measure and what weighting to give them.

19. Polleetickle

The ONS figures about “productivity” that the Tories like to quote are attached with some important caveats. It is interesting that the Tories in their manifesto quoted that NHS “productivity” fell by 4% over the ten year period 1997-2007 (I’ll come to that in a moment) and yet they say that the private sector productivity over the same period increased by 20%. I looked up the figures on ONS and eventually found that there are no figures whatsoever for private sector healthcare, instead the Tories used “private sector services” which, umm, does not include healthcare. How misleading is that?

So onto the ONS figures, this is what they say:

“Over the period 1997-2007, healthcare output has grown the fastest, by 52.5 per cent, with an annual average growth of 4.3 per cent”

In other words, over the period, the NHS did more each and every year. That is good, right? This is what they measured (I’ll come back to this in a moment).

“The healthcare output figures are quality-adjusted for the period 2001 to 2007 (using a forecast for 2007). The overall adjustment incorporates adjustments for patient experience, reflecting how patients are treated, clinical outcomes in general practice, and
health effects, measuring impact in terms of life expectancy, health gains, survival rates and waiting times (ONS, 2008b).”

Productivity change is calculated from comparing the outputs change with the inputs change, so what are the inputs?

“Healthcare inputs increased by 59.3 per cent, an annual average of 4.8 per cent” (compare this to outputs)

Comparing outputs and inputs gives the productivity:

“Healthcare productivity fell by 4.3 per cent, an annual average fall of 0.4 per cent”

OK so let us dismiss the entirely misleading Tory quotes that private sector call centres have increased productivity over a decade compared to the productivity of clinicians treating patients which has decreased that period. (Can someone tell the Tories the difference between an apple and an orange?)

A recent paper by the University of York (CHE Research Paper 57) does a more comprehensive study of NHS productivity. It says:

“Between 1998/9 and 2003/4 there was strong input growth, particularly after 2000/1, averaging 5.5% a year. Recruitment increased, in part to satisfy the European Working Time Directive, and staff received new pay awards. There was greater investment in equipment and buildings. Over the same period output growth lagged behind input growth. This is unsurprising. The EWTD placed limits on working hours, entailing reductions in the number of patients per doctor, and investments are not realised immediately. Even so, year-on-year increases in the number of patients
treated meant that output growth averaged more than 3.8% per year up to 2003/4. The net effect, though, was slightly negative productivity growth between 1998/9 and 2003/4.”

So basically there was a drop in productivity over this period basically because the government tried (though some would say not successfully) to allow clinicians (particularly doctors) to work fewer hours to something closer to what the rest of us work. Significantly the inputs rose because of the “greater investment in equipment and buildings”, in other words, after 18 years of under-investment by the Tories, Labour had to do something about the leaking roofs. That means spending more money, which raises inputs and lowers “productivity”. It is easy to argue that that investment should have been made during the Tory years, so this is delayed from the years of Tory mis-management.

The York paper goes on:

“This has since changed. NHS output has continued to rise, but at the faster rate of 5.7% a year. Not only are more patients being treated, but the quality of the care they receive has been improving.” [Here they give examples of the quality measures they use.]

“The index of input growth suggests a slowdown in input growth since 2004/5, which has been increasing at a rate of 4.8% a year, compared to 5.5% previously. This slowdown is due to a levelling off in staff recruitment and reduced reliance on agency staff. Since 2004/5 growth in inputs has been matched or slightly exceeded by growth in outputs, so recent NHS productivity growth has been slightly positive.”

When comparing their results with ONS they say:

“Our estimates differ from those of the Office for National Statistics, which estimates that productivity fell by 0.3% in 2007 and by 0.7% 2008. The main reasons for the differences are that:
– The ONS measure of output is not comprehensive, capturing around 80% of activity. In particular much community care activity is omitted, where growth has been above average. This biases the ONS productivity measure downwards.
– The ONS measure of labour inputs does not account for the contribution of non-NHS (eg agency) staff. There have been recent reductions in the use of non-NHS staff. Omitting their reducing contribution biases the ONS productivity measure downwards.
– The ONS estimates of productivity for 2008 are based on projections based on the first
quarter’s data. The accuracy of these projections will not be established until the actual data are available.”

So, the York paper is more accurate and more comprehensive that ONS, and shows that productivity was positive from 2004/05 onwards. You didn’t hear the Tories saying that at the last election, did you? And I have not even mentioned about the adjustment for private/public sector complementarity, which improve NHS outputs further.

Why am I saying this? Well the Tories like to roll out their misleading graph every now and again. It is wrong, and the York study shows that the NHS does not suffer from the falls in productivity that the Tories claim it has. If you have an open mind then I encourage you to read the York paper and then when Lansley or Cameron says that the NHS has falling productivity I invite you to sing this to them.

Crude mortality in the private sector is undoubtedly lower than the NHS. However, the patient and procedure selection is very limited.

And the private sector does tend to dump its patients on the NHS at the first hint of the shit hitting the fan, so transfer data and outcomes would need to go into any private sector HMSR calculation to get a reliable picture.

Unity,

And the private sector does tend to dump its patients on the NHS at the first hint of the shit hitting the fan, so transfer data and outcomes would need to go into any private sector HMSR calculation to get a reliable picture.

To be fair, that is because private hospitals generally do not have the specialised capacity to handle serious cases the NHS does, being set up to conduct specific sorts of operation (generally relatively-low-risk, short stay), not the full range of treatment (note NHS hospitals also transfer patients when things are serious for the same reasons). This does however mean that HMSR comparisons are pretty pointless – you can really only do them for the medical sector as a whole unless you have two competing (not complementary) systems.

27. the a&e charge nurse

Penny Campbell became unwell the day after she had surgery for haemorrhoids.
The procedure was carried out at a private hospital.
Two days post-op Mrs Cambell contacted her surgeon, Susan Clark, who said “the illness is unlikely to be linked to the operation and tells her to ring her GP”.
No emergency clinic appointment was offered neither did the surgeon examine the patient.
A few days later Mrs Campbell died after visiting a number of out-of-hours NHS GPs over the bank holiday weekend.
http://uk.reuters.com/article/idUKL2542736220070525

An enquiry was convened by the NHS but not, as far as I know, by the private hospital who operated on Mrs Campbell – how are we to compare the two services?
http://www.bmj.com/content/334/7604/1130.2.extract

“Some hospitals have better outcomes than others – a statistical inevitability!”

That’s only true to a point. Yes we expect some variability, but that doesn’t mean there isn’t an underlying performance level. Otherwise you might as well say Newcastle are as good as Chelsea, seeing as they drew with them the other day.

A big indicator that the NHS remains a postcode lottery, the fact that Airedale is small trust of the year for a fourth time. If random variations were truly what gave the impression of varying service quality then it would be highly unlikely that we’d see the same trust winning the award more than once, let alone four times in five years (in fact, with 16 small trusts there’s only a 1 in 10,000 chance of that happening by chance).

So yes, there are improvements (as we should expect with a £100bn annual budget) but we shouldn’t let that kid us into thinking the NHS is even remotely close to providing high quality care consistently across the country. I may not like the idea of socialised medicine, but the NHS is here to stay so I might as well support making it work.

[19] Those stats are impressive, but what I’m talking about – like a great deal of life, even of what the Tories claimed in the past – ongoing reality demonstrates so very different a picture of a deteriorated healthcare system – albeit hosted in newer buildings – suggesting matters are not at all good across the spectrum, as demonstrated by the finer details of lifes experiences.

All the more frustrating when surgeries are ‘booked out’ on a Friday afternoon so that highly rewarded medical practitioners can get to the 19th hole before sundown! [no cliche]

Consider also; what are the private sector numbers in the ‘comparable’ OECD countries compared to the UK?

Having also been engaged with a number of PFI projects throughout the UK after the past fifteen years, I am not blind to the investments made in the NHS. I am neither I a card-carrying Tory. I voted Labour until 2010 when experiences of; Labour ministers lauding-it over others with more expertise and, frankly, far greater humanity. Access to ongoing PFI projects being declined where introductory ‘warmers’ weren’t forthcoming. When exploiting the public purse became a greater priority for some rather than industrial evolution and giving UK Plc an edge. When relatives were turned away multiple times from hospitals that couldn’t guarantee equipment availability even though they had marvellous public records. When myself was humiliated by healthcare staff after tearing ligaments around the base of my spine. When

RE: [16]: Here’s some things about the NHS that you don’t tend to hear:
1. The NHS is the Most efficient healthcare system in the developed world
2. The NHS is rated as better than Germany, the USA, Australia and Canada in terms of quality care.
3. NHS heart surgery outcomes are 25% better than the European average
4. The NHS compares very favourably to other industrialised countries in terms of access to healthcare1/

# when the NHS claim to have remedied waiting lists and healthcare charters, they fail to provide the numbers of patients passed over to the private health sector.

UNITY – subscribing to Private Health does not indicate tax avoidance. Thereby, emergency departments are ‘open’ (selectively these days) to receive all comers – even non-doms and foreigners.

# I presume no one is suggesting the NHS is mopping up large volumes of private healthcare botch jobs. After all, it works both ways as demonstrated.

# so, which way is it? costs? staffing? qualifications? output vs input? All improved? A number of third-parties have tried to meaningfully assess the NHS, but the experience is mostly poor – with one exception I have to say after a crash that the Reading Hospital was amazing! I even wrote to thank them for my recovery.

# If this is still the place to

Damn right it looks like I’m a Labour basher. Because in my view that’s exactly what they deserve.

(sorry, rushing out)

‘We don’t want or need Pravda-style reporting, thanks.’

Of course, when Pravda reported social conditions in Stalin’s ideological enemies, it wasn’t exactly depicting them as a sunny bed of roses. The distinctive thing about Pravda-style journalism is not the conclusion is positive or negative, but the way in which the conclusion is entirely predetermined, completely independent of any underlying facts.

Not that the UK newspapers typically hit the comedy heights of North Korea, or climate change deniers. But still, it would be pretty hard to produce a parody of that reporting style that would be rejected as unbelievable and over-the-top:

Doctors inflict 70 years of suffering on premature baby.

X Factor flops as 40 million don’t switch on.

Sun failing to provide illumination between dusk and dawn

@17 Thankyou again for your response.

I had great difficulty tracking down the raw data used to generate the figures, although I did find the 2009 report. I am suspicious of their provenance. “Soft” data is very easy to manipulate for political ends.

However, you are certainly right that things like overall healthcare spending per capita and mortality rates *are* hard data, and a comparison *is* useful. And the popular perception of the NHS is almost certainly inaccurate.

32. the a&e charge nurse

[28] “the NHS is here to stay” – I disagree, I suspect the survival of the NHS is very unlikely as anything more than a corporate brand?
http://www.redpepper.org.uk/Dismantling-the-NHS

On the theme of crap reporting here is another item demonstrating how some health churnos really do not seem to the know the difference between their arse and their elbow?
http://drgrumble.blogspot.com/2010/11/more-bbc-garbage.html

@9: “Go ahead. And before you do it, may I suggest that you first take a medical degree, or perhaps an MSc in public health?”

C’mon. GPs are professionally obligated to advise on what choice is in their patient’s best interest, isn’t he/she, and he/she therefore needs comparative data on healthcare outcomes? If that data is in the public domain, I’m able to also seek the advice of informed friends – as I do. And, sometimes, the advice diverges.

I don’t have private healthcare insurance but several of my friends do. I now think they were wise to take up the option when it was affordable. Frankly, it’s not much comfort to know the NHS delivers healthcare that is free at the point of delivery when the quality of that healthcare is uneven or even hazardous:

“The Royal College of GPs (RCGP) is calling for appointments for standard patients to be increased from 10 to 15 minutes so doctors can spend more time with the growing number of people with long-term conditions such as diabetes, cancer and obesity.”
http://www.guardian.co.uk/society/2010/mar/23/gps-consultations-ill-patients

The predictable outcome of the 10 minute appointment regime is that GPs mostly just hand out pills.

“Britons are increasingly turning to prescription drugs to cure every ailment, a new study found. The average number of prescriptions dispensed per person rose from eight a year to more than 16 over the past two decades, according to the paper, titled A Pill for Every Ill.”
http://www.independent.co.uk/life-style/health-and-families/health-news/britain-turning-to-prescription-drugs-1930212.html

“At least 100 patients are dying or suffering serious harm each year after healthcare workers give them the wrong medication. The number of alerts relating to errors or ‘near-misses’ in the supply or prescription of medicines has more than doubled in two years, the National Patient Safety Agency said.

“More than 86,000 incidents regarding medication were reported in 2007, compared with 64,678 in 2006 and 36,335 in 2005. The figures, for England and Wales, show that in 96 per cent of cases the incidents caused ‘no or low harm’, but at least 100 were known to have resulted in serious harm or death.”
http://www.timesonline.co.uk/tol/life_and_style/health/article6820090.ece

“Accidents, errors and mishaps in hospital affect as many as one in 10 in-patients, claim researchers. The report in the journal Quality and Safety in Health Care said up to half of these were preventable.

“Checks on 1,000 cases in just one hospital found examples of fatal surgical errors, infections and drug complications.”
http://news.bbc.co.uk/1/hi/health/7116711.stm

From my own recent experience, NHS administration verges on the shambolic.

“At least 100 patients are dying or suffering serious harm each year after healthcare workers give them the wrong medication.

Excellent news: people in the UK only have a 1 in 600,000 chance of dying or suffering serious harm from getting the wrong medication. Investment in reducing that statistical noise any further would be a colossal waste of money.

Well, yes John.

But iatrogenic death is usually considered to be the third leading cause: after heart attacks and cancer.

Not that this is specific to the NHS of course. But a still alarmingly large number of us do die from medical treatment itself (despite the obvious point that a vastly larger number are kept alive by other medical treatments, long enough to have the one that kills us).

36. the a&e charge nurse

[35] “Not that this is specific to the NHS” – and that is the bottom line.

When Bob B trots out endless factoids most are virtually context free.

Take his point about the bdged consent form – is he seriously suggesting that other systems,especially those encumbered with far greater bureaucracy (especially the states) do not encounter administrative or similar medical errors.

One study identified four main categories of errors significantly associated with one or both of these highest levels of harm: (1) prescription drug errors, (2) coordination of care errors (specifically errors involving communication), (3) errors in clinical activities (generally timing of these activities), and (4) errors related to cognition.
http://www.ncbi.nlm.nih.gov/books/NBK43641/

I doubt if the NHS is any worse in each of these categories than most other developed health systems but I do not think we can rely on the churnos, or Bob B for that matter, to shed much light on these questions?

Tim – sorry, my last post wasn’t as clear as it should have been. The intent was to pick up on Bob for using stupid statistics that don’t prove what he thinks they prove.

*If* iatrogenic deaths in the UK were running at 100 a year, that would be an occasion for great rejoicing, rather than petulant blogging. But they aren’t – they’re a hell of a lot higher. As A&CN says, I doubt they’re significantly higher than elsewhere-developed.

More about the NHS in the news today:

“A report from the Organisation for Economic Co-operation and Development concluded that improving efficiency could do more to raise life expectancy than simply spending extra money.

“It found the NHS paid higher salaries but employed fewer doctors and that inefficiencies contributed to a lowering of life expectancy in the UK by two and a half years for women and three and a half years for men.

“Cutting waste is therefore more important for wealthy countries in the current economic climate than spending more, it said.”
http://www.telegraph.co.uk/health/healthnews/8169516/NHS-waste-taking-three-years-off-Britons-lives-research-suggests.html

Another exciting “factoid” from the ONS about earnings in healthcare:

“The full-time occupations with the highest earnings in 2009 were ‘Health professionals’, (median pay of full-time employees of £1,031 a week), followed by ‘Corporate managers’ (£745) and ‘Science and technology professionals’ (£698). The lowest paid of all full-time employees were those in ‘Sales occupations’, at £278 a week.”
http://www.statistics.gov.uk/cci/nugget.asp?id=285

Just a part of my recent experience of waste and administrative shambles in the NHS:

My GP initiated an online procedure enabling me to make an appointment to see a consultant at my local hospital. Duly equipped with my special personal password, I phoned “Choose and Book” (based in Milton Keynes) to make an appointment for 19 May. Two days before, on 17 May, I phoned the hospital to confirm the appointment and to find whereabouts in the (large) hospital I needed to go. All was OK.

On the morning of 19 May, I receive a letter by 1st class mail cancelling the appoinment that very afternoon – fortunately I was at home when the letter arrived. A manuscript note on the letter, rescheduled the appointment for 23 June. Rather irritated by this since I wanted a resolution, I phoned around the hospital and PCT to seek an explanation for the cancellation. The only information I could extract was that all scheduled appoinments for that consultant that day had been cancelled.

A fortnight later, I get a letter in the post from Choose and Book offering to book another appoinment. I phone them about their letter – they won’t speak unless I quote my special password. I thank them for their offer and tell them I already have another appointment – for 23 June. They have no record of this.

I’m now worried in case I don’t have the appointment for 23 June that I think I have so I start phoning around the hospital to check on whether I do really have an appoinment for 23 June. Eventually, by chance I locate someone who confirms that appointment so I ask that they inform Choose and Book to avoid further confusion.

I attend for the appointment on 23 June – the downstream outcome of which was an operation in October.

The following day, on 24 June, I get a letter in the post from Choose and Book offering to book an appointment for me. I phoned them to break the news (after disclosing my special password) that I had an appoinment the previous day. But did I attend? I assured them that I had. They said I would not be receiving anymore letters from them.

As I said before, NHS propagandists are blind to it many systemic failings. They just don’t want to know so the failings continue.

39. alienfromzog

“As I said before, NHS propagandists are blind to it many systemic failings. They just don’t want to know so the failings continue.”

This is another of those really annoying myths.

I am not remotely blind to the systemic problems of the NHS. I could right very long articles listing them. Some would be very straightforward to fix (these are the most annoying ones) – some more problematic because healthcare is a complex business.

However, the point is that the media reporting of the NHS is not remotely balanced. You’re personal experience described above is not as atypical as it should be. However that doesn’t get away from the fact that the NHS provides comprehensive, quality healthcare for around £1800/person. That is astounding. I will have a look at those references but permit me a degree of scepticism for a newspaper report, until I’ve had time to look at the actual data.

The problem is this. The NHS works, really really well. Does it have problems? Yes, lots. For the most part they are the same problems that every healthcare system in the world has. Healthcare is a bottomless pit however you try to fund it. There are some specific problems that come from a government run system. A fair analysis would compare these problems to the ones that come from a private system and then we could have a serious debate. That is not what happens. Ever. What happens is that critics exaggerate, misrepresent or down-right lie about the NHS’s problems to make out that it is constantly failing.

The truth is much more that the anti-NHS propagandists are blind to its qualities

40. alienfromzog

@38, Bob,

I’ve just scanned through the OECD report, that Telegraph article was based on. I’m sorry that I haven’t got time to read it properly.

It can be found here: http://tinyurl.com/335etp4 (As always, one has to hunt around quite a lot to find reports that newspapers are referring to.) It is quite complex and detailed and covers a lot of data.However the conclusions you draw and not justified by the report.

To quote directly;
“Ireland, New Zealand and the United Kingdom are less efficient though performance scores should be interpreted with particular care in the case of New Zealand and the United Kingdom because recent reforms and increases in spending might require time to fully translate into better health outcomes.”

The report uses a range of outcomes to determine healthcare efficacy and then compares that to spending to determine efficiency. This is one approach although it has its problems.

One of the outcomes it uses is life expectancy. The main problem with that is that health prevention measures that have the greatest effect on this take a long time to filter through. It the past decade there has been a lot of money directed to these kind of measures but the effect of which will not be seen for another ten years. Not to mention that life expectancy is a very complex thing with many lifestyle, environmental and genetic factors having a bigger impact than healthcare per se.

Some of the other measures they use are quite interesting – asthma admission rates is one at which the UK’s performance was not as good as I would have expected. They also use Measles vaccinations rates as a measure of outcome. This of course is low in the UK for a specific reason.

The newspaper article tries to make bitesize some very complex data which is of course laudable, however, once again, it is clear that the journalist has not actually read the report.

Plenty of evidence – including my own recent experience – is testimony to embedded inefficiencies in the NHS and the uneven quality of care the monolith provides – such as the comparatively high diabetes amputation rates in the South West region or the findings of that recent study into care of the elderly:

In a recent study of the care of the elderly in NHS hospitals, only just over third were judged to have had good treatment:
http://www.bbc.co.uk/news/health-11728163

But denials prevail and so the failings continue.

What does seem to be undoubtedly true is that the pay of healthcare professionals in Britain is good.

BRITISH doctors now earn more than their counterparts on the Continent, according to a new study. It has revealed that hospital consultants’ salaries increased by more than 30% between 2000 and 2004. British consultants and GPs are now better off than medical specialists in France, Germany and Denmark.
http://www.timesonline.co.uk/tol/news/uk/health/article758105.ece

Oh. And with 1.3 million employees, the NHS is the largest employer is west Europe.

[41] “such as the comparatively high diabetes amputation rates in the South West region’ – compared to what?


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  1. Liberal Conspiracy

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    RT @libcon: Does the British media hate the NHS? http://bit.ly/hIBCgn

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    RT @libcon: Does the British media hate the NHS? http://bit.ly/hIBCgn

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    RT @libcon: Does the British media hate the NHS? http://bit.ly/hIBCgn [The answer is yes, the Media does hate the NHS]

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  7. Smitha mundasad

    Something Ive bn wondering: Does the British media hate the NHS? | Liberal Conspiracy http://t.co/uCm9TLY via @libcon

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    Does the British media hate the #NHS? http://bit.ly/hIBCgn / Or just headlines designed to sell papers? Refreshing, positive spin..(@libcon)

  9. Nick H.

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    RT @libcon: Does the British media hate the NHS? http://bit.ly/hIBCgn

  13. Wesley Rykalski

    RT @sdv_duras: RT @libcon: Does the British media hate the NHS? http://bit.ly/hIBCgn [The answer is yes, the Media does hate the NHS]

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    How the Tory press smear the NHS in an attempt to justify the current top down "reform" http://tinyurl.com/387evg4

  15. Wendy Maddox

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