What I’m about to write is likely to make me very unpopular with some people. While I’d prefer to avoid that, the issues and the truth about them are too important not to write it. I have no axe to grind, no personal connection to the events or people (that I know of) – but I am passionate about the NHS and about truth.
A couple of weeks ago, I wrote a couple of articles about the Mid Staffs NHS (MSNHS) report by Robert Francis, and about David Cameron’s reaction to it. These articles focused on the political implications of the events and the report, and on setting the reported death figures in context, rather than on the veracity of the figures themselves and the story behind them. Although I touched on the fact that the wide range of the figures given – 400-1200 – showed how uncertain they were, like everyone else I assumed there must be some truth to them, because they were so widely reported and so seemingly uncontested.
Not only the more lurid newspapers like the Sun, but also the ‘respectable’ press and media have reported the 400-1200 figure as fact – and continue to do so, the relevance of which we’ll see toward the end this article. Only a couple of weeks ago, a politics round-up programme on BBC Radio 4 included these figures as simple fact in their comments on David Cameron’s Commons speech on the Francis Report – and none of their guests there to talk about the issue raised even a murmur of contradiction.
The idea that 400-1200 ‘excess’ deaths took place during a period from 2005-2009 has been repeated so often, with such a complete absence of dispute (unless you knew where to look), that in the public consciousness it has become, to all intents and purposes, a fact.
But it is an idea without any basis in fact.
If you’re a regular reader of this blog, you will know that I believe in research – in drawing together facts and making conclusions based on them. I am no stranger to research and to the effort and time that have to go into an article to be able to make credible statements. But the preparation for this article has taken that investment of time and attention to another level.
My research for my earlier articles on Mid Staffs had led to some even more fundamental questions in my mind that I had to investigate. If you’ve noticed that this blog has been quieter than normal for the past couple of weeks, it has been because almost every spare moment over that period has been spent in researching this post – reading transcripts of witness statements to the Francis Inquiry, investigating the comments and opinions of others on the MSNHS issue specifically or the issues around the use of statistics in general.
What was starting to become apparent to me about the whole Mid Staffs issue was so deeply at odds with the prevailing perception that I had to read more widely and deeply than ever before in order to make sure that I was perceiving correctly.
Because the issues are so complex, and the evidence I could use so abundant (I’ve read well over 1000 pages over the past couple of weeks and will leave out of this article far more than I can put in), that even my best efforts to distill them into conciseness will still leave a post that will take patience and attention for anyone to work through, I’m going to break from the normal ‘good form’ that would mean putting the reasoning and evidence first and saving the conclusion until last.
Instead I’m going to state the conclusion first, and then list the evidence and narrative around it, so that those who wish to and who have the patience to can read through it and satisfy themselves that the conclusion is justifed. So here is that conclusion, along with a very brief justification:
There were no ‘excess’ deaths at Mid Staffordshire NHS during the 2005-2009 period in which the news media and anti-MSNHS campaigners claim there were 400-1200 of them – or, in the words of the independent clinical expert who led the ‘Independent Case-Note Review’ (ICNR) into each individual, contentious death at the Trust:
maybe one
This information has been in the public domain since at least 2010 – but I doubt if you could find a single reference to it in the mainstream media. “One person might have died!” does not sell newspapers, or gain viewers, in the same way that “400-1200 unnecessary deaths!!!” does, I guess.
You’re quite possibly thinking to yourself, “What?! How can that possibly be correct?” Here’s how.
In 2009, Dr Mike Laker was asked to conduct an independent review into the detailed case notes of every contentious death at MSNHS during the period in question. To identify which cases needed reviewing, the Trust offered all patients who had been treated by the Trust, or their families, the opportunity to ask for a detailed case note review – and ‘detailed’ is the right word: each review would take 5-6 months to complete, so a large number of expert, independent clinicians were needed to complete the process within a reasonable timeframe.
60 such requests were received – which already puts a massive question mark against the figures of 400-1200 ‘excess deaths’. In the course of the review, Dr Laker eventually interviewed 120 families and edited the case notes of 40-50 cases. He was asked by Tom Kark, Counsel to the Francis Inquiry, how many ‘excess deaths’ had occurred among the cases he had reviewed. Mr Kark related Dr Laker’s answer in his ‘final submission‘ to the 2010 inquiry:
‘Perhaps one such death’ – so maybe not even one. People die in hospitals every day, of course – but as far as unnecessary, avoidable deaths caused by negligence or malpractice, the detailed, intensive reviews of all the deaths where relatives were dissatisfied enough to ask for one uncovered ‘perhaps one’.
Dr Laker is no ‘stooge’. His comments, which you can read about in the ‘final submission’ link just above, also included strong criticisms of the organisations overseeing the ICNR. He successfully had the overseeing body changed from the Trust itself to the responsible Primary Care Trust (PCT), to ensure independence, and also stopped the Trust from accessing the case review findings before they went to the families. His findings were not those of a man trying to court favour from, or minimise embarrassment for, the establishment – yet he still could only find ‘maybe one such death’.
In terms of demonstrating that the media portrayal of the story and the underlying reality bore no relation to each other, I could ‘rest my case’ here. But in order to understand why and how the false story that has so permeated the public consciousness came to do so, we need to look in more detail at other aspects of the background, the witness transcripts and the advice/opinions of other experts.
What this examination will reveal is a story of:
- overstretched and struggling hospital staff unable to provide the ‘basic care’ that any health professional would wish to, but managing just about to hold things together even though things weren’t pretty (and a ‘drinking from vases’ claim that appears to have been almost entirely fabricated)
- commercial conflicts of interest and over-stated claims
- statistics that could never say what they were made out to say, even if the data-input was perfect
- data input that was anything but perfect, creating an even more false picture
- bereaved relatives lashing out understandably but excessively
- most critically, collaborating political and media interests spinning a story in a wholly false way for their own ends
The (very truncated but still lengthy) details follow. You may prefer to skim the headings and choose the areas of immediate interest to you to read in detail, and then come back later for other sections as required. I leave that to your preference, but please make sure at least to read section 6, which examines the reasons why the misleading figures have been propagated and exploited – and by whom and why.
1. Even in an ideal world, HSMR is no ‘Ronseal’
The public furore over Mid Staffs began as a result of a set of statistics called ‘Hospital Standardised Mortality Ratios’, or HSMRs which – it appeared – showed a significantly higher ratio of deaths at MSNHS compared to the national average. At no point did the statistics or any report on them name a number of avoidable deaths, either in the 400-1200 range or any other figure. Robert Francis stated this unequivocally on the first day of hearings for his second report.
The reason for this is simple: even working perfectly, the HSMR system is neither designed nor intended to identify ‘unnecessary’ or ‘excess’ deaths, nor is it a measure of quality and safety in a particular hospital (the owners of the system did claim the latter, but backtracked on the witness stand). Chapter 5 of the 2013 Francis Report states the following (which again you will struggle to find in any media reports referring to Mid Staffs:
to this day, there is no generally accepted means of producing comparative figures, and unjustifiable conclusions continue to be drawn from the numbers of deaths at hospitals and about the number of avoidable deaths.
In the context of the careful, neutral wording used in official reports as well as the commercial sensitivities around the HSMR method and the vociferous and aggressive tendencies of the anti-Stafford campaigners, Francis might as well be putting up in neon lights: “HSMRs do not say what you’ve been told they say!”
Or take this exchange between Mr Kark and Roger Taylor, the Director of Research and Public Affairs for DFI, the company that supplies the HSMR data:
K: Can I just ask you this, we’ve heard a lot in this inquiry about how HSMRs might be used as no more than an indication of risk or a need for further attention in a particular area. Did the 2007 publication put the significance of HSMRs too high, calling it an effective way to measure and compare clinical performance safety and quality?
T: No, I — I don’t believe it did. I think it is an effective way to do exactly that. However, I will add to that comment the point that it’s really important to remember that in measuring clinical outcomes and clinical performance there are no perfect measures..
K: Does that mean to say that when the HSMR is above a certain level, and that is to say, if I can get my terminology correct, above certain control limits, it’s not just a tool to identify risk, but it is an effective measure of safety?
T: I’m saying an effective measure of safety is one that helps you identify the risk of something being wrong.
Kark asks Taylor about how the HSMRs can legitimately be used and Taylor fudges initially – but when he is asked directly whether HSMRs can provide an effective measure of safety, he backtracks and says it can only identify where there is a risk that something might be wrong.
Professor Brian Jarman, the creator of the HSMR system, made a statement in his evidence that demonstrates that quality of care and HSMRs are by no means automatically linked:
Now, you’re not going to measure the quality of care of pacemaker insertion by measuring the mortality because, you know, that’s – they are very low.
Similarly, the 2010 inquiry put out a ‘Joint Statement’ on the usefulness of HSMRs which included the following statement:
Along with other indicators, they can usefully help us to understand comparative information about in-hospital deaths. But they have limitations, and should not be used as a sole indicator of patient safety. To do so could potentially give a misleading interpretation of a hospital’s safety record. They should be used with other relevant indicators as a tool to support the improvement in the quality of care.
And the clincher comes (again) from Roger Taylor, as he is asked by Counsel about the link between HSMRs and the media claims about the numbers of ‘excess’ deaths:
Q. Where does Dr Foster stand on the portrayal of the figures about Mid Staffordshire as indicating or showing that there were 400 to 1,200 unnecessary deaths?
A. ..that is a misuse of these data.
Some 300 different indicators are used to assess hospital safety and quality. Even in perfect circumstances, with everything functioning as it should, HSMRs can only perform a small role in this assessment – effectively a signal to say ‘take a look, just in case something is wrong’. Using them to state anything beyond this is ‘misuse’.
1,2,3,4..
Another important indicator lies in the guidance provided by the company that owns the HSMR system to Trusts that find themselves with a high mortality ratio. This guidance takes the form of a list of recommended actions:
- Check to see whether incorrect data has been submitted, or whether an approach to coding which differs from other organisations’ approach has been adopted
- Consider whether something extraordinary has occurred which explains the result
- Consider whether their healthcare partners work in ways which are different from those in other areas
- Consider whether there are any potential issues with regard to the quality of care
The 2nd Francis Report criticised MSNHS for focusing first on whether the high HSMRs were caused by coding issues – but DFI’s own guidance to Trusts on what to do in the case of high HSMRs puts ‘check coding’ at number one in the list of actions. By contrast, checking whether there are actually any issues with care standards is down at number 4.
If even the owners of the system consider that there are 3 factors more likely to affect high HSMRs than actual poor care, can anyone seriously consider that the system is accurate, robust and reliable enough to provide an actual number of ‘excess deaths’ – even in perfect circumstances?
And yet the media continue to report the figures as fact. Since they can’t be unaware of all the above statements and factors (and many more that I’ve had to choose not include for the sake of some semblance of readability), then one has to ask ‘Why?’ – what is the real agenda?
A moving target
One of the key weaknesses with the HSMR system is that it is based around a ‘standard’ score of 100 – which is ‘rebased‘ every year. In simple terms, the statistics take an average score for all the hospitals in England and call that ‘100’. Hospitals scoring worse than average get a score above 100, while hospitals scoring better get below 100.
But what ‘100’ means moves every year. In the words of Professor Jarman:
we do for the simple — simple-minded English, if you like, adjust it so that the English value was every year.
(That Prof Jarman considers the English simple-minded and unable to handle a figure that isn’t simplified every year is interesting, given Roger Taylor’s testimony that DFI considers the public to be savvy enough to realise what you can’t do with its figures, even if the media are all screaming ‘Excess Deaths!‘)
This ‘rebasing’ means that a hospital can have exactly the same performance in a given year that it achieved in the previous one, and still show a worse HSMR because the overall average moved down. Similarly, if some hospitals are ‘gaming’ the system to improve their score (a possibility that the creator of the system, Professor Sir Brian Jarman acknowledged in his testimony to the 2nd inquiry), they will bring down the average so that ‘honest’ hospitals appear to be doing badly.
But even if nobody cheats, a hospital can be doing well, as well as it’s ever done, and still appear to be sliding down the performance table.
[EDIT: if you’re struggling to see why this rebasing to 100 is so misleading, please look here for some additional information that might help]
2. Rubbish in, rubbish out
We’ve just seen that, even if everything around the HSMR system is functioning perfectly, HSMR cannot be used to identify a number of ‘excess’ or avoidable deaths. But as a reading of the inquiry transcripts will quickly show, things were about as far from perfect as they could possibly be in terms of the data that was entered into the system – both nationally and, especially, in the case of Mid Staffs NHS.
One fundamental thing needed for any correct understanding of the issues surrounding MSNHS’ HSMR scores is the knowledge that, for most of the ‘problem’ period at the Trust, it had no coding manager.
The data on which HSMR scores are calculated are based on codes that have to be entered for each patient treated. These codes relate to the condition from which the patient is suffering, and an ‘expected’ death rate is allocated to each condition measured for HSMR purposes. If a hospital shows a higher rate of deaths for a particular condition than the expected rate, this pushes up the overall HSMR score for that hospital. If it shows a lower rate, that helps bring down the HSMR score.
Let’s take a simple example. ‘Fractured neck of femur’ (FNOF) is a fairly common result of falls in elderly people – and a serious one. Out of every 10 people, nationally, who go into hospital with this condition (which in layman’s terms might be called a ‘broken hip’), on average one will die as a result of complications arising from the initial condition. If a hospital loses more than 10 patients with FNOF for every 100 it treats, it will have a relatively high HSMR for that condition. Each condition has its own rate of expected deaths.
But there are serious problems with both the basic principles of the coding and with how it was done at MSNHS – and remember, Mid Staffs’ coding manager was on long-term sick leave for most of the period in question.
First or primary diagnosis
The rules of HSMR coding state that the first ‘non-vague’ diagnosis – sometimes referred to as the ‘primary diagnosis’ – for any patient when they enter hospital for an ‘episode of care’ must be used to determine the coding. But this is full of dangers in terms of measuring mortality rates.
If a patient enters hospital with, for example, a broken tibia (shin-bone), you would expect this to have a low death-rate – dying from a broken leg is pretty rare. The ‘first non-vague diagnosis’ is obviously going to be ‘broken tibia’. But if it is subsequently discovered that the bone broke because it was eaten through by an aggressive, spreading cancer, the expectation of death would clearly be completely different.
But, following the rules of HSMR coding, the code that is entered is the one for a fractured tibia – and the death will seem very unexpected and so will worsen the HSMR score.
Junior doctors
Junior doctors work long hours in an intense environment. They are often the first medics to assess and diagnose a patient, and they are unlikely – unless the importance is hammered home to them very hard – to consider it too important to put the right code down for a patient they are treating. Being junior, there is also a higher likelihood of them misdiagnosing or missing a condition when a patient is first examined.
MSNHS’ investigation of its coding, once it had a new coding manager in place, showed that there was a major problem with the coding entered by junior doctors.
POA
In his testimony to the 2nd inquiry, Prof. Jarman confirmed that his system did not ‘adjust for’ secondary diagnoses unless they were ‘present on admission’, or POA. In other words, if a condition – no matter how serious – isn’t either spotted by the doctor or otherwise known about when a patient is first treated, it’s ignored for the purposes calculating HSMRs. But Prof. Jarman made a key admission:
70 per cent of PMA (sic) — present on admission diagnoses are the same as the primary diagnosis.
In other words, in 30% of cases there is a discrepancy – 30% room for the figures to be skewed by a primary diagnosis of one thing when a serious condition might be present that would push the expected death rate much higher. So even if everything goes as planned, there is a known potential for variation in the system of as much as 30%.
C0-morbidities
‘Co-morbidities’ is the medical term for ‘other stuff that’s wrong with you’. So if you’re in for treatment on an ingrown toenail, for example, but you also suffer from congestive heart-failure and lung-disease, there’s a much higher chance you’ll die while you’re in hospital – and it wouldn’t mean the hospital did anything wrong. But the ‘episode of care’ is for treatment of an ingrown toenail – which would have a very low expected death rate.
The HSMR system does allow co-morbidities to be entered (based on the ‘Charlson Index‘)so that they are taken into account – but if these are wrongly entered or not entered at all, the figures will look as though you died from an ingrown toenail.
The investigations into coding at MSNHS showed that there were substantial problems with the coding of co-morbidities, probably because of the absence of the coding manager combined with problems of under-reporting of co-morbidities by consultants.
Z51.5 and the ‘parade ground’ effect
One the major problems with Mid Staffs’ HSMR scores that I found in my reading of the transcripts was in a change that was made to the coding system to include code Z51.5 – a code to indicate ‘palliative care’. A patient receiving palliative care is suffering from an incurable, terminal condition and is being treated to relieve pain, make him/her comfortable etc. At some point he or she is going to die from the condition – so the expected rate of death during any given ‘episode of care’ is going to be relatively high.
For the sake of brevity, I won’t go into every detail, but when the change to include Z51.5 was made, Mid Staffs’ coding did not change to include it. Since other Trusts were now using a code with a high expected death rate that would lower their HSMR score, and because this would affect the ‘rebasing’ and move the ‘100’ benchmark, this had the same effect as a rank of soldiers all stepping back at the same time except for one – he would appear to be standing out in front without having moved at all.
‘Zero stays’ and 30 days..
Another thing that came out during Prof. Jarman’s evidence was the effect of two particular peculiarities in the way that Mid Staffs was coding its patients. The first of these is the ‘zero days’ stay’ category (which actually includes stays of up to 1 day).
MSNHS was not including in its coding any patient who came for treatment and either didn’t stay in hospital at all or only stayed one day. Since the vast majority of patients who come into hospital and leave again in a day or less will be there for treatment of mild conditions (or mild manifestations of potentially serious conditions), the rate of deaths among such patients would be very low. This would have the effect of ‘concentrating’ the death rate at Mid Staffs (by reducing the total number of codes and taking out almost exclusively patients with good outcomes). Since all or almost all other Trusts were including these patients, their death rates would be ‘diluted’ by the ‘zero stay’ patients – again causing, or accentuating, the ‘parade ground’ effect and making MSNHS look worse without necessarily being worse.
Conversely, Mid Staffs was also negatively affected by the lack of ’30 day coding’ in HSMRs – codes allocated according to the outcome 30 days after discharge from hospital.
If a hospital discharges a patient early, who then dies outside the hospital, this is not reflected in the HSMR. But if a hospital keeps a patient longer to make sure he/she is fit for discharge, or is unable to discharge an elderly or infirm patient because of the lack of non-hospital care facilities, and the patient then dies, the hospital effectively suffers in its HSMR because it did the right thing.
The 30-day effect might not only occur because of irresponsible discharge of patients. If a hospital has a hospice nearby and can discharge terminally ill patients for palliative hospice care, the patients will die in the hospice and this will improve the hospital’s HSMR even though the patients still die.
Professor Jarman repeatedly claimed that the effect of correcting codings for co-morbidities and palliative care would be very small, but this claim appears highly questionable.
Firstly, the ‘parade ground’ rebasing effect when the Z51.5 palliative coding was launched in other hospitals caused Mid Staffs’ HSMR to rise by 13 points, from 114 to 127 – a serious change.
The group ‘Straight Statistics’, a “pressure group whose aim is to detect and expose the distortion and misuse of statistical information, and identify those responsible”, wrote an article examining the reliability of HSMRs and particularly the effects of errors/corrections in coding. The article included an examination of the relationship between ‘depth of coding’ (how many co-morbidities were recorded alongside the main diagnosis), which varies widely across Trusts, and HSMR.
Quoting a response from Prof. Jarman’s organisation ‘The Doctor Foster’s Unit’, the article says:
a hospital using only 2.5 codes per patient would show an HSMR about 15-20 points higher than one using 5.5 to 6 codes per patient
15-20 points is not ‘very small’. The number of codes per patient at Mid Staffs is not stated – but with no coding manager in place and proven issues with uncoded co-morbidities, it is certain that it was at the low end during the period of high HSMRs.
When the new coding manager joined MSNHS, she carried out a re-coding exercise (apparently 2, in fact, since the first one over-corrected). According to evidence given by acting Chair of the Trust David Stone in 2009 to the Health Scrutiny Committee, once the correct re-coding was done, Mid-Staffs’ HSMR score was:
88
Just in case there is any lingering doubt on the fact that coding can have a massive effect, we’ll leave the last word to Professor Jarman. Just 8 days ago, he sent the following message on Twitter:
PwC is PricewaterhouseCooper, a huge firm that carries out detailed audits and analyses – and it found a 25-30% difference in Mid Staffs’ high HSMR code due to incorrect coding.
Rubbish in, rubbish out..
3. Conflicts of interest and exaggerated claims
The HSMR system is run by Professor Jarman’s Doctor Foster Unit (DFU), which is part of the faculty of medicine at Imperial College. DFU receives the majority of its funding, confusingly, from Doctor Foster’s Intelligence, or DFI. DFI is a commercial, profit-making company (although 47%-owned by the Dept of Health). DFU calculates the HSMR scores for hospitals free of charge.
There is no suggestion, that I can make out from the transcripts, that DFI or DFU deliberately skewed any figures in the HSMR index for commercial gain. However, DFI does publish an annual ‘Good Hospital Guide‘ that includes a ‘league table’ of HSMR rankings. Based on these rankings, DFI attempts to sell to Trusts its ‘Real Time Monitoring’ (RTM) service for the sum of £35,000 per year. This service provides ‘alerts’ to customer Trusts about areas where HSMR is poor or starting to slip, so that the Trusts can take corrective action – and can optimise their position in the Good Hospital Guide. From Roger Taylor’s evidence to the 2nd inquiry:
Walsall hospital was named as the hospital with the highest death rate in the first hospital guide in 2001, which they were not very pleased about..Walsall subsequently became very enthusiastic and started using the RTM tool.
An email from a senior DFI director in 2011 stated:
we ran a consultation on the indicators used before they went into the hospital guide in 2010..We alerted hospital trusts to this by writing to them and letting them know and through the Health Service Journal. We will do the same this year. Providing access to them in the tools we sell is the obvious next step.
The fact that DFI stood to gain financially from the creation and publication of league tables based on HSMR must cast serious doubt on the use of HSMR as a tool for assessing quality of care – especially since the information is made public – even if DFI were not deliberately exploiting the opportunity. Despite the fact that Roger Taylor stated in his evidence that he did not think this represented a conflict of interests, an impartial observer must recognise that there was indeed potentially such a conflict.
The fact that Mid Staffs knew that their HSMR position was going to be made public in this way must also have contributed to their focus on coding, which was criticised by the Francis Report – especially when DFI’s own guidance on how to respond to poor HSMRs put ‘check coding’ as number 1 on the list of actions.
Overstated claims
As was revealed during the testimony given by Roger Taylor, DFI’s 2007 publication had massively overstated the usefulness and significance of its HSMR data, calling it:
an effective way to measure and compare clinical performance safety and quality. Deaths in hospital are important and unequivocal outcomes.
As we’ve already seen, HSMRs are nothing of the sort, and the information that they give on deaths is anything but ‘unequivocal’. Mr Taylor initially denied that this was claiming too much – but under further questioning he eventually said, when speaking about focus groups made up of members of the public, that they show a
general scepticism of the ability to accurately measure quality of care. In which regard they are being, I think, pretty smart, actually.
If the public are being ‘pretty smart, actually’ to be ‘generally sceptical’ of the system’s ‘ability to measure quality of care’, then I think that calling the HSMR measure ‘unequivocal’ as a measure of ‘clinical performance safety and quality’ is without question an exaggeration – and a pretty big one. Especially when Mr Taylor also acknowledged that the output of the system is only as good as the data that’s put into it – and when, as Prof. Jarman put it in his testimony,
it depends how the coder codes it.
Such an exaggerated claim can only have fanned the self-fuelling flames of misleading publicity about the ‘400-1200 unnecessary deaths’.
4. The top 3 factors in poor care at Mid Staffs: understaffing, understaffing and understaffing
There is no doubt that there was poor care in some parts of MSNHS. Various inspections that followed the initial public furore found that care in some departments was ‘appalling’. However, Robert Francis’ recommendation that individuals should not be pursued for events at Mid Staffs strongly suggests that the failings at the Trust were systemic rather than resulting from malice or neglect on the part of any one person or group of people, particularly front-line nurses and doctors.
This is supported by the statistics provided in Annex 1 (part of Volume 3) of the 2013 report which show that, over the 5 years covered by the report, the number of ‘serious untoward incidents‘ which were recorded at the Trust and ascribed to lack of staff was a massive 1,756 – an average of 351 ‘serious’ incidents per year attributable to short-staffing.
However, these ‘untoward incidents’ mostly represented failures of ‘basic care’ – cleaning, comfort and so on – rather than life-threatening incidents. Remember, the review of the 60 incidents (and interviews of 120 families) that were serious enough during this period for the families to accept the offer of a full case-note review resulted in ‘perhaps one’ avoidable death.
Patients were left in their own waste etc, which is a horrendous indignity that no one should have to suffer – but which is very, very rarely life-threatening. If staff numbers were too low, as the stats suggest, then nurses inevitably faced times when they were simply unable to do everything and had to prioritise.
I know from my many conversations with nurses from various hospitals that there can often be times when a patient’s ‘basic care’ needs have to wait – because all the available nurses were trying to help another patient breathe, or to keep him/her alive through a heart attack, or deal with sudden and serious haematemesis (vomiting blood) and so on.
At this point it’s worth addressing one of the most persistent myths of the ‘Mid Staffs phenomenon’: that ‘neglected’ patients were so thirsty, and so ignored, that they had to drink the water from flower vases.
Appalling if true – but flower vases were banned from the two MSNHS hospitals from the late 1990s, presumably for hygiene reasons. I’ve heard anecdotally that there may have been one incident in which a (probably confused) patient was allowed a vase as an exception, and did drink from it – but the idea that this was more than a one-off appears to be entirely unfounded. Instead it appears that the media spun out a one-off into a regular incident for the sake of lurid headlines.
Nurses feel terrible about those who have to put up with indignity or discomfort – and relatives of those patients frequently fail to understand that their loved ones are only suffering ‘neglect’ because nurses had to choose between that and allowing someone to die or suffer horrible fear and pain.
It’s awful and it should never happen – but it will, as long as wards are not fully staffed according to not only the number of patients but also the severity of their conditions and the level of their dependency. And under this government, it will happen more and more.
Which leads me on to my final sections – which I’ll try to keep brief because this post is already more than long enough.
5. The viciousness of grief, the cynicism of politicians and the collaboration of the media
Just last weekend, the Guardian’s online edition carried a call from a relative of someone who died at MSNHS for ‘heads to roll’. This same lady – to whom my heart goes out for her loss – was also heard, at a public meeting of anti-MSNHS campaigners, to call
Let’s shut the hospital, let’s sack all the staff!
Losing a close family member is a horrible experience – I lost my mother after a long and gruelling battle against ovarian cancer 9 years ago. But surely, someone who would rather have no hospital and see thousands of doctors, nurses and other health staff, most of whom she can never have met, made unemployed because of her grief and rage is not thinking straight.
One can understand and sympathise, certainly – and I do. But it must be a foolhardy decision indeed to allow someone who is in such a state of mind to influence policy and to invite him or her frequently to influence public opinion via media interviews and articles. When deciding the fate of health services that about a quarter of a million people rely on, ‘cool heads’ surely have to prevail and decisions made must rest on logic and fact, and not emotion and grief.
And a person or entity that would exploit the grief of such a vulnerable person would be reprehensible indeed.
Which leads me to my final section:
6. Politics, media and exploitation
In my opinion, it’s extremely telling that the ‘media mentor’ of the anti-MSNHS group was the Conservative MP for Stone in Staffordshire, Bill Cash. Mr Cash’s testimony to the inquiry makes perfectly plain that he understood absolutely none of the detail of what was happening at Mid Staffs and why. However, he evidently understood a political opportunity when he saw one, and he set up meetings for the group to promote its calls for a public inquiry.
Mr Cash was also associated with the first ‘leak’ of the supposed ‘unnecessary death’ toll of 400-1200 people to the Daily Mail. Mr Cash, it must be said, has denied being responsible for the leak, and there is nothing to prove that he was. The fact that the figures appeared alongside quotes from Mr Cash must at least raise the question – but the article also included quotes from the leader of the relatives’ group, so the provenance of the figures is uncertain.
It’s all political
At various points throughout his testimony, Prof Jarman refers to negative attitudes from the (Labour) government toward HSMRs – but then (from p.171 of the record) he reports a sudden change:
There has been an improvement, it seems, in [the Dept of Health’s attitude to the value of HSMRs.
In his view, this might be linked to the publication of the first Francis Report on Feb 2010. However, he is very specific about the point when the real change occurred:
But the statements in the White Paper of 12 July 2010 were very positive.
The white paper of 2010 in which the government published its outline plans that eventually led to the Health and Social Care Act 2012, under which they are decimating the NHS and at this very moment are trying to force through undebated, unvoted measures to force accelerated privatisation.
A Tory government takes power. Two months later it launches it’s ‘here’s one we made earlier’ blueprint for the destruction of the NHS – and ‘coincidentally’ it starts to take a ‘very positive’ attitude toward a tool that can make hospitals look as if they’re killing people even when they’re not.
A positive attitude in spite of the fact that Mr Francis’ first report contained the ‘Joint Statement’ that we’ve already seen about the weaknesses and limitations of HSMRs.
It doesn’t take a great deal of imagination to ‘put two and two together’ in a far clearer and more reliable way than the HSMR method.
What the papers say..
It’s also very significant that one of the most enthusiastic users of the spurious figures has been the Daily Telegraph – a ‘newspaper’ with a proven track record of NHS attacks for political purposes. The paper is on record as having co-ordinated articles on behalf of private health interests to help the passage of the invidious 2012 NHS Act and has even instructed sub-editors to leave anti-NHS material in an article to which it was irrelevant.
As recently as a few days ago, the Telegraph was still hammering the MSNHS issue – and just yesterday ran an article tarring the whole NHS with the Mid Staffs ‘brush’.
The desire for eye-catching headlines, improved circulation and journalistic laziness have all contributed to the spread of the myths about ‘excess deaths’ at Mid Staffs and the distortion of the public perception of what really went on there. But, without question, at its core lies yet another unholy alliance between the Tories and the right-wing media for the advancement of their multi-fronted, ideologically-driven assault on the NHS of which most of us are rightly proud.
In this context, it’s perfectly plain why David Cameron found it expedient to ‘eat humble pie’ and apologise on behalf of the country for the “horrific pain and even death” suffered by “many” (again propagating the myth). The recommendations of Robert Francis’ report include the closure of hospitals found to have similar problems to MSNHS; by accepting the report with crocodile tears and in sackcloth and ashes, Cameron has positioned himself to be able to exploit those recommendations as another excuse to close hospitals – alongside ‘rationalisation’, creating ‘centres of excellence’ and the financial problems of neighbouring Trusts (as the people relying on the successful Lewisham Trust have already found to their cost).
And, of course, to tarnish the image of the NHS in the eyes of a public that still considers the NHS the crowning achievement of our country.
The moral is clear:
Don’t believe everything you read in the papers – especially when it involves Tories and the NHS.
Interesting. I wondered about this myself, but didn’t really have the time (or know where to star) to look into this. A lot of claims like “400 – 1200” extra deaths are often based on some kind of comparison with an average and ignores that we would naturally expect a distribution and that it can vary quite widely. We should at least have some idea of how many standard deviations it is away from the mean.
This isn’t to suggest that some horrible things didn’t take place at Mid-Staffs, but it doesn’t surprise me that the claim of hundreds of extra deaths is questionable.
Excellent article and many thanks for doing all the hard work. Are you getting much response?
Thank you, a very good detailed critique of the real data behind the story. This is why blog exist – to counter the MSM.
As always, though I do have to find something wrong. I am your enemy being a Libertarian and all! 🙂 But it’s only a minor typo fix. Your last sentence should read: “Don’t believe everything you read in the papers – especially when it involves politicians and the sacred cows.”
I always had the feeling that something wasn’t right about MSNHS. This amount of extra deaths couldn’t have come from poor care, however unacceptable poor care is. But doing the research to get to the bottom of this was daunting. Thanks for your hard work. The media and lazy journalism has a lot to answer for. The campaigns run recently against the disabled and benefit claimants are proof of this. Whenever they talk about a subject I happen to know something about, I am appalled by the lies/distortions they tell. This makes me very wary of believing anything they might say on any subject!
The royal college of physicians in their article this week, while much shorter in content than all the above, states quite clearly they believe the efficacy of the stats in relation to mid staffs, that the culture iPod the NHS needs to change and that we could have other mid staffs tragedies anywhere in the UK. I give their professional views more credence than yours. Are you an employee of unison by any chance. Clearly you are a labour supporter.
I am a Labour supporter, but not a member or employee of Unison. Any NHS changes need to be driven by people absolutely committed to it – not by those who hunger for its demise. RCP are not statisticians – and even if they’d been correct, the stats never supported the headlines, as the inquiry showed clearly.
No your enquiry tried to prove the stats never supported the headlines, other more qualified and able persons and organisations ( not politically biased ) accept the reality. Until one accepts an organisation needs curing it will not happen. Even the majority of staff at mid staffs and many other hospital trusts wouldn’t like their relatives to be a patient in them. Treble the budget during the labour administration and productivity goes down every year while malpractice and the culture of self-serving increases as a matter of routine.
Your own political bias shows clearly in the last part of your comment.
Most expert statisticians seem to have serious doubts about validity of 2005-9 Mid Staffs HSMRs, as I linked in my article.
What’s being done now is no ‘cure’ – unless being bled dry by leeches still counts as medicine.
No system is perfect – but the NHS is the world’s best, or was until the Tories got their hands on it. Needs restoring and supporting, not a ‘cure’ of the type you seem to support.
The First Francis Report said: “Taking account of the range of opinion offered to the Inquiry, including a report from two independent experts, it has been concluded that it would be unsafe to infer from the figures that there was any particular number or range of numbers of avoidable or unnecessary deaths at the Trust.”
This issue is not about poor care (that was well reported) it was about the figure of 400 – 1,200 “unnecessary” deaths. Francis said it is unsafe to infer any number of deaths from HSMR. The media are wrong to use these figures.
As it happens two of the trusts near me have high HSMR. They also serve very elderly populations, with risk averse care homes and less than ideal hospice coverage. One of them I know very well. It has been rigorously inspected but the trust, by LINk, by a local independent patient group and by CQC and no poor care has been reported. Neither of these trusts HSMR now, they both use SHMI and one of them uses (another commercial product) RAMI. Above all, both trusts point to raw mortality. A step change in levels of quality of care will show a step change in raw mortality (you are comparing with the same population, so if there is a change in mortality, it shows some significant change occurred).
The whole point of a measure like HSMR should be to improve care. And that should be foremost. However, there is something odd about Dr Foster. First, why do you want a figure that compares your hospital with another. What point is that? It does not improve care. HSMR allows Dr Foster to produce a league table, something they are very proud of, as a commercial company. A much more useful measure would be standardisation within the trust, so you can compare one month’s figures with another. As Steve mentioned, Dr Foster produces a commercial product. I mentioned that I know two local trusts with high HSMR, one of these bought that Dr Foster product hoping that it would help to identify the “poor care” that was causing the high HSMR. It didn’t. So they then asked Dr Foster if they could explain how the algorithm worked so that the trust could determine themselves what care was causing the high HSMR and fix it. Dr Foster refused, claiming commercial confidentiality. As I said: the foremost reason to do anything is to improve care, but Dr Foster refused to help improve care. The trust then stopped paying for that product because it could not help improve care.
Thanks – I’ve used the Francis 1 quote in the ‘debate’ article just posted! The comment about Trusts with high HSMRs passing inspections with flying colours is extremely relevant and is something I already touched on in the debate post.
I share your concerns about commercial interest – it has to be a conflict of interest, however much DFI might say otherwise.
Try this statistic then: the main driver of the reduction I waiting times while labour were in power was the contracting out of procedures to the private sector. And how does my mentioning the drop in productivity and the self serving culture show my political bias? I don’t have any political bias they’re all much the same.
You denigrated the increased investment as a bad thing, which is clear enough. Do you have any actual evidence for your assertion about the reason for the drop in waiting times?
Thank you for raising such an interesting point that needs to be shared with the people of Stafford.
Andrew – your comment about most mid staffs workers is a very sweeping statement based on what? I can’t believe it’s based on fact. It’s comments like these that make the whole situation worse not better!
Thank you – couldn’t agree more!
Try this:
http://www.dailymail.co.uk/news/article-2273054/Thousands-NHS-staff-admit-wouldnt-want-families-treated-hospitals-care-poor.html
Which poll was this? Who carried it out? I can’t see the stats behind the headlines so would be grateful for clarification. Thanks.
Steve, the Mail has its own agenda so its ‘facts’ have to be treated with caution. For some reason they love to defend A&E services, but anything else is fair game.
Whatever the source of their figures, they speak of 25% of nurses. Try these for size from the Francis inquiry: 75% (yes, seventy-five percent!) of staff feel there are not enough staff overall in the NHS to provide a good standard of care, and 55% said they work on wards that are too understaffed to provide the standard of care they want to.
There is really only one problem in the NHS affecting standards of care, and it’s understaffing. The Tories have reduced nursing posts by over 7,000 now, and that’s probably dwarfed by the number of unfilled positions (more than 250 at just one hospital that I sent an FOI request to).
Training for HCAs could be better, too – but again, it’s not possible under a government that is starving the NHS of funds (however they try to weasel out of saying so).
Completely agree. I just wondered if Andrew Magee was able to quote from the poll itself. I find it extraordinary that anyone could quote an unsourced poll from that paper in response to such detailed analysis.
Sadly, it’s about typical of responses from the ‘bash the NHS’ side.
Do you know why? Severe understaffing, and cost-restrictions that minimise training of HCAs. The Mail’s article talks about 25% of staff. The Francis inquiry heard that 75% – that’s seventy-five percent! – of staff feel there is not enough staff to provide a good standard of care, and 55% said they work on wards where there is not enough staff to provide the standard of care they want.
It shows your talk of over-investment in the NHS to be so much bollocks, frankly.
You forget that this scandal took place during a time of massive year on year increases in he NHS budget. It had nothing to do with cuts and all to do with a self-serving culture which is systemic in any public sector organisation.
Of course it did. MS was working toward becoming, and then became, a Foundation Trust, and had to cut costs for that. You need to get your facts straight.
And that was under which national administration at the time then?
Labour, which is already acknowledged in the article – so your point is?
Andy Burnham has acknowledged Labour’s errors in introducing ‘market’ conditions and financial pressures – to the Tories this is not an error but an imperative. So there’s no question which is the party to vote for if you value the NHS.
There are 6 GP’s in the family practice I use. Before the generous new contracts awarded a few years ago they all worked a 5 day week. Immediately after they all reduced their working week to 3 and a half days. Understaffed? Rubbish.
Oh for God’s sake. Everyone knows that the GP contract awarded under the Blair government is a disgrace, but this is nothing to do with hospitals. You need to become less anecdotal and more analytic. If you want anecdotes, my daughter in law is a nurse and I know exactly how understaffed hospitals are and it’s hospital we’re talking about here not GP practices.
Oh for Gods sake I’m talking about the culture of self-service in the public sector. My son is an airline pilot but I know damn all about British airways or how to fly an aeroplane.
No, you’re not. You’re talking about a completely different type of healthcare, and it’s irrelevant. What next – dentists?!
Well said. Mr Magee, I make it a practice to approve all comments on this blog, but if you keep spouting unsupported nonsense I might have to make an exception.
What, precisely, do GPs have to do with staffing in hospitals? If GPs reduced their hours, you can be sure they were paying other Drs to maintain the service. That’s their prerogative, since GP surgeries are run as independent businesses these days. Hospitals should not be.
Mid Staffs is about more than numbers (disputed or otherwise). It’s about breakdown of corporate and clinical governance in various organisations.
But back to numbers. The Kennedy report (2001) of the Bristol Heart Inquiry said:
“Bristol was awash with data. There was enough information from the late 1980s onwards to cause questions about mortality rates to be raised both in Bristol and elsewhere had the mindset to do so existed. Little, if any, of this information was available to the parents or to the public. Such information as was given to parents was often partial, confusing and unclear. For the future, there must be openness about clinical performance. Patients should be able to gain access to information about the relative performance of a hospital, or a particular service or consultant unit.”
In 2012 SWWHAG went to the media with some big numbers about serious misdiagnosis in Bristol:
http://tinyurl.com/7cex6ps
We made it clear that this was a hypothesis and we invited the NHS to test it, in public. It declined to do that and accused us of a “crude extrapolation”. In fact the figures were checked by a statistician who confirmed that the hypothesis was reasonable on the basis of information made available to the public.
Mid Staffs and other scandals simply prove that Kennedy was largely ignored by the Department of Health and NHS. There is still no collection and publication figures to agreed national standards as you have acknowledged in your blog.
“But as a reading of the inquiry transcripts will quickly show, things were about as far from perfect as they could possibly be in terms of the data that was entered into the system – both nationally and, especially, in the case of Mid Staffs NHS.”
Developing conspiracy theories of an “unholy alliance” between the media and the Tories over the 400-1,200 figures does not change the root cause of the problem Kennedy identified years ago. Also your implication that an “anti-MSNHS group” (do you mean Cure the NHS?) was used as a political opportunity by an MP seems simply an attempt to score political points and appears disrespectful to the group.
You refer to the “eyes of a public that still considers the NHS the crowning achievement of our country.” You might be right. However where’s your independent, peer reviewed data to support that assertion? What’s sauce for the goose……….?
I’d agree with some of your points. Regarding the NHS, I don’t recall where I saw it, but it was a survey that asked (among other things) what people were most proud of about the UK. ‘NHS’ was the biggest response by a distance.
Collusion among the media, Tories and private health interests are far more than a theory. Tory MPs and peers with private health investments are on the public record.
A report to its members by the chief of an association of private health providers included a statement that he had been working with the Telegraph to co-ordinate a series of articles designed to promote public support for the then-NHS bill (now Act) because it would be favourable to the private health industry. See http://socialinvestigations.blogspot.co.uk/2012/07/unedited-document-from-nhs-private.html
Labelling something a ‘conspiracy theory’ might make people think it’s speculative. This is anything but.
It was an Ipsos-Mori that looked at what it meant to be British. 72% said that the National Health Service symbolised everything that made them feel most proud about being British.
Brilliant – thanks! I’ll probably be able to find the poll, but if you have a link that would save me some time! 🙂
Still looking for it. I can’t see the specific poll. This one is interesting.
http://www.slideshare.net/IpsosMORI/ipsos-mori-end-of-year-review-2012
Fantastic article.
No doubt this is being used to facilitate the smooth transition from ‘public’ to ‘private’ ownership.
Exactly the same blueprint is being used to turn state schools into academies, by declaring a target school as an OFSTED fail ready to ‘save’ it by turning it into an Academy.
The MSM is and always has been complicit in this.
Do we remember why we went into the last Iraq war – WMD’s that the MSM told us they had. Turns out that it was a fairy story (as Dr David Kelly tried to point out, no doubt causing him to be ‘suicided’ in the woods shortly after).
It is clear by now, that the ties and overlaps of interest between politicians (all parties, they’re all as bad as each other) and the press, Sky, BBC are indisputable. The current emerging ‘peado’ scandal is just more proof of this conspiracy to fool us, lie to us and to spout propaganda.
Follow the money, who stands to profit from NHS privatisation? It isn’t us, the tax payers.
Stafford are the best hospital that my severely disabled son has been treated at .. He has very complexed needs and at times they have struggled to stabilise him ..(just as any other hospital would struggle ) But on the whole they have done their best for him .. There are a few staff on the ward that are not good nurse material but on the whole they all do a very difficult job .. If stafford hospital closes my Sons life will be in danger .. He has “open access” to the ward when needed .. If he has to be rushed elsewhere In An emergency he could die .. (Like many others .. )It is essential this hospital stays open … And it is essential A&E reopens 24/7 .. The knack of a good survival rate is to been seen fast .. (This doesn’t not mean a trip to another town for treatment .. For some it would be too late ..) always new the media was to blame for some of this ..!
Would you mind if I used some of your comments in a follow-up article shortly?
” there are a few on the ward who are not good nurse material “. Do the maths here and gross this up across the whole of the NHS. What have you done about these nurses? Complained? Of course not. And this acceptance of less than acceptable standards is part of the problem. I’m pleased for your son and the care he receives I just hope those nurses you have concerns about don’t get their hands on him but that’s OK isn’t it because if they don’t they’ll be ” caring ” for another mother’s son but that’s not your problem is it?
You appear to be a fairly odious man, Andrew. Nothing in Mr/Ms D’s comment indicates he/she doesn’t care what happens to others. Of *course* there is variation in the capability of nurses, just as in any other workplace. Replacing the less able is not easy – and would be a very slow process.
I’m done with you, so please don’t bother commenting further or I’ll just ‘junk’ all your comments. If you stop now, I’ll let the ones you’ve made so far stand.
I’ve been researching the NHS since they almost killed my wife 18 months ago due to negligence. It was only due to my persistence and research that she survived. She was let down by 4 doctors and a nurse practitioner. Recently and for a totally different medical condition she was admitted to the Manchester royal infirmary. The catalogue of errors and cock ups were extraordinary. I’ve managed private hospitals both here and in the UK. I have supplied the NHS. With high value capital medical equipment, as well as German and French hospitals. Our NHS. Compared unfavourably. So in recent months I’ve been researching our ” envy of the world ” NHS as well as the public sector in general. Shortly my findings will be made available on 2 web sites, one curethepublicsector.com and the other in a similar vein on the NHS. I’m an experienced researcher having an MBA and have written reports for parliamentary committees into trade and industry. I h
I’m glad about your wife, but I don’t trust your conclusions because I distrust your motivation.
Sorry about the cut-off at the end of my post, pressed the wrong button on my ipad. Back to the issues here. I don’t trust your motivation either, but please have a look at the attached link:
http://www.dailymail.co.uk/news/article-2273054/Thousands-NHS-staff-admit-wouldnt-want-families-treated-hospitals-care-poor.html
You won’t accept any of the content and I understood from an earlier comment of yours that you may censor my posts: typical response from defenders of the indefensible. I’ll save you the trouble and leave your blog it’s a left wing pro union anti-change reactionary blog anyway. A final personal point – I have a permanent limp due to NHS cock ups. Nothing to do with understaffing or pressure. Nothing more than poor quality health care from A and E doctors. Had they done their jobs properly I would have made a full recovery. Anyhow your campaign to protect the NHS’s image is doomed: too many shocking incidents over too long a period of time and too many prepared to stand up and be counted at long last. Patient power is on the move and has momentum. It’ll take a long time but the journey has begun
I’ve approved all your posts so far unedited, mate, so again you’re showing yourself up.
If Daily Mail articles are your best evidence, your point of view really does have no foundation. I’ve already answered that article and your comments on it, so why repeat them? Nurses would worry about their relatives being on wards because they know they’re massively overstretched and understaffed – which is being deliberately inflicted and escalated by this government.
The ‘people power’ you describe sounds more like a mob of dupes – and like most mobs, once they’ve finished they find things worse than before because they’ve trashed everything good.
Your own motivation appears to be mostly self-pity. Of course errors happen and of course there’s poor care – and they’d happen just the same in a privately-run hospital, because people are imperfect.
Invest, improve – and do it all in a *measured* way. Not the unseemly, helter-skelter rush to ill-advised and greed-driven privatisation that this government is set on – and which only the ill-informed or bitter could ever think of supporting.
So those deeply hurt relatives of the mid staffs trust behind the Cure the NHS are a” mob of dupes “? That’s one of the most egregious comments I’ve ever heard in the wide ranging debates anywhere about the NHS.
That’s your conclusion and not what I actually said. But the slash and burn mentality you’ve been describing will leave us worse off than we already are – that’s reminiscent of a mob.
MR magee. did it ever occur to you thet patients dont want choice, what they want and need is competance so all the propaganda is being focussed ine the wrong direction with a purpose. Excellent article
Well said, Christine. There is such a degree of personal animus here as to make it not worth while continuing to argue. My right arm was permanently damaged by an A&E cock up in South London years ago, but it doesn’t lessen my support and respect for the NHS. No big organisation is or can be perfect, but that is no excuse for trying to get rid of it. Of course it needs permanent reform but not this absurd attempt to treat patients as commodities in a false market. I am signing out of this discussion.
Well said – thanks for your participation. I’ve already told Andrew if he continues I’ll just delete all I’ve let stand so far, as his straw-men and personal attacks based on things people haven’t said are just too much.
OK sky walker my final comment. Slinging personal insults at me is the last resort of those losing an argument. I wish the lady and her son well but fear for those under the care of the less able. You exhibit the classic public sector mentality in saying that replacing less able staff is not easy and a long process: it is easy and needn’t take long provided the culture is one where the needs of the service users take priority over those providing the service. A culture that accepts second best can never be considered acceptable. The truth is often in the detail, take the following example. The nurse from stepping hill hospital admitted stealing 9 different types of drugs from the hospital. Yesterday the RCN after a hearing suspended her from nursing for 3 months. And we just know she will gain employment. Would you like this nurse caring after your loved ones?
I made an observation based on what you said to the woman(?) in your comment, which insulted her for something she hadn’t actually said. In terms of winning the argument, I’ll leave that to others to judge but I have no concerns about the outcome.
The nurse might be a great nurse with an addiction problem, or other mitigating factors that the RCN would be right to take into consideration if they were there. Your black and white approach to everything means you’d be the last person I’d want in charge of a ward or hospital that I was either working in or being treated in (I don’t work in healthcare, btw).
It takes years to train a nurse – and that’s assuming you can find enough candidates who combine the desire to do that very difficult job with the willingness to do it for not very much money. If you think you can just resolve the issue in a year or two, you’re wrong.
Just back from a most informative evening with dear friends, many of whom are NHS medics. I showed them your blog. Great fun. The most cutting remark came from a sister of many years standing in relation to our drug stealing nurse, ” it took many years to train Harold Shipman too “.
Since the drug-stealing nurse wasn’t part of the blog, and was only raised by you, you’re talking bollocks as usual, andrew.
If she had an addiction problem how could she be relied upon in her job? Oh I forgot of course the employees take priority.
If she resolved her problem, you think she should never work again? No doubt then you’d label her a ‘scrounger’..
No she should be able to work but not with responsibility for vulnerable people who depend on get.
Her training – over years and at considerable cost – is in nursing. I don’t know the details of the case, but there might be all kinds of mitigating factors, and return from the 3-month suspension might be conditional on various steps. Or maybe it’s a bad decision. But there is more than one possibility.
BTW you did refer to those aggrieved people lobbying for change ad a ” mob of dupes “.
No, I didn’t. I referred to your comment about ‘people power’ gathering unstoppable momentum.
Same thing, you did.and you call me odious!
No it isn’t. The ‘Cure the NHS’ group are a small part of ‘people power’ as you called it. Issue of ‘dupes’ is far wider and largely driven by the Mail, whom you apparently like to quote, the Telegraph etc. Telegraph in particular is on record colluding with anti-NHS interests, as you’ll see if you look around this blog a little.
Great article Stephen, and well done for highlighting the misuse of these figures. I like your handling of Andrew Magee BTW – he just doesn’t get it at all, purely for ideological reasons I suspect.
🙂
Another scandal brewing:
http://skwalker1964.wordpress.com/2013/02/26/the-real-mid-staffs-story-one-excess-death-if-that/comment-page-1/#comment-7104
Oops wrong link, try this:
http://www.theboltonnews.co.uk/news/10253954.Probe_into_hospital_death_rates_has_been_launched/
Once again, seems it’s a coding issue – rubbish in, rubbish out.
Do some research on google on this trust. Missing funds of almost £4 million, coding error likely to be deliberate and I emphasise the word likely here but the error brought significant benefits to the trust.
It wouldn’t surprise me. The whole mortality rate and treatment tariffs issues are full of the potential for perverse incentives. It’s human nature to pursue gain, so in any national organisation there will be examples of misconduct – but that would apply anywhere.
Tariffs designed to underpay for treatment in order to force down spending are a serious problem with the way the NHS operates – but that’s a DoH issue, not an NHS one.
Human nature to pursue gain. Interesting.
Fascinating piece, thank you. You might be interested to know that on today’s BBC website http://www.bbc.co.uk/news/health-21613932 it repeats the assertion that…”appalling” care led to the deaths of more than 400 patients…so the myth continues. Incidentally, I was a patient at this hospital in 2005 and had excellent care.
Thanks for the pointer, mate – I’ve tweeted the author with a request to correct it!
I usually like this blog and have worked with Stephen in the past however I feel it is incumbent upon me to correct what is essentially a misleading article that could be used by those wishing to deny the appalling care at Mid Staffs for their own ends.
I have been involved with the Mid Staffs scandal for over five years, interviewed countless families and victims and sat through most of the 139 days of evidence to the Francis inquiry and so I consider I can speak with some authority on the issue.
Stephen has made a number of assumptions, made I assume in good faith, which are incorrect and should be altered.
One simple fact before I go into more detail is that we know hundreds of people suffered poor care at Mid Staffs. Robert Francis first inquiry had evidence from over 966 patients. Volume II of his first report is full of harrowing stories – so let’s all agree that this trust failed hundreds of patients and some did not survive their treatment. To suggest there were none and maybe only one excess death is a terrible insult to the many families I have personally spoken to and shed tears with over the last five years.
Here are a few quotes from Robert Francis QC who knows the facts better than anyone and cannot be considered anything but independent.
“The evidence gathered by this Inquiry means there can no longer be any excuses for denying the scale of failure. If anything, it is greater than has been revealed to date. The deficiencies at the trust were systemic, deep-rooted and too fundamental to brush off as isolated incidents.
“This is a story of appalling and unnecessary suffering of hundreds of people. They were failed by a system which ignored the warning signs and put corporate self-interest and cost control ahead of patients and their safety.”
Let’s consider the mortality rate figures. Stephen is right in a sense that they have been misquoted by mainstream media, that does not mean it is wrong to say hundreds of deaths. Here are the facts.
It is often reported there were between 400 and 1,200 excess deaths at the Mid Staffordshire Trust between 2005 and 2008. This estimate is regularly attributed to the Healthcare Commission and its report on the trust published in March 2009.
In fact the figure never appeared in the HCC’s final report but was contained in a draft and was removed by the HCC chairman Sir Ian Kennedy following concerns raised by former Monitor executive chair Bill Moyes and then health secretary Alan Johnson. Sir Ian denied he was put under pressure to remove the numbers.
The figures were leaked to the press ahead of the report and have been repeatedly quoted ever since. In his first inquiry into the Mid Staffordshire scandal Robert Francis QC found the actual number of excess deaths between 2005 and 2008 was 492 and between 1996 and 2008 it was 1,197.
HSMRs are a statistical estimate, with all the associated problems that come with statistics, they do not relate to real people and it is true to say we will never know the true number of individual deaths at Mid Staffs as a result of poor care. You can’t say with certainty there were 1,200 deaths, neither can you say there weren’t.
But the numbers for Mid Staffs were 27% per cent above the national average at their highest and coupled with the real families who have come forward it is quite clear the use of the word hundreds is perfectly accurate and could even under play the true numbers. Robert Francis himself has accepted the argument that hundreds of people were affected.
Clearly in a news story the media cannot explain the statistical methods behind HSMRs without losing the interest of the reader or listener – I’m afraid Stephen has done exactly what he has accused the media of in the title of this blog and its conclusion.
Coding of deaths was of course a factor, but Robert Francis has examined this and he concluded it did not adequately explain the numbers of deaths and complaints coming out of the trust. The issue of coding has been widely put forward by those wishing to downplay events at Mid Staffs and Robert Francis has repeatedly, and clearly, said it does not explain away what happened. It is a smokescreen behind which deniers of Mid Staffs and problems in the NHS hide.
HSMRs as Robert Francis, Sir Bruce Keogh and almost every other senior NHS figure have accepted are useful warning signs. Wherever a trust has been found to have a high HSMR other significant patient care problems are often identified. Trusts with low HSMRs generally don’t. HSMRs, whilst not perfect, do serve as smoke signal for deeper issues.
On the issue of rebasing HSMRs the point is that all hospitals will seek to have less patients die and continued improvements will try to be made. A trust that doesn’t improve its mortality from one year to the next, while the rest of the UK does, should surely be a concern to be highlighted and the rebasing would serve as one method to do this.
The Laker review.
Dr Mike Laker, who led the Independent Case Note Review, was NOT asked to look at every contentious death at Mid Staffs. This review was made available to those families who REQUESTED it. In total 219 families requested a case note review, which was handed to the local PCT to complete. Many did not because the review was initially handled by the trust and in fact Dr Laker ended up in a dispute with the trust due to its handling. He did not work on the whole review.
The review was flawed in that it was under resourced and poorly run. It also relied on the medical notes of patients – many notes were lost; many were inaccurate; not completed at all; and in some cases referred to the wrong patient. To draw any conclusions about the wider scale of poor care at Mid Staffs from this review is extremely risky and open to significant error.
General points
Stephen makes some good points in this blog and it is not all completely wrong. But the simple fact is hundreds of people did die at Mid Staffs. The true number will never be known but we know at least 219 requested a case note review (not all those affected did), 966 witnesses gave evidence to Robert Francis’ first report. Former Chief Executive Antony Sumara estimates he personally met with more than 200 families.
In short Stephen has got lost in the details of the HSMR which I accept are being wrongly quoted as 400-1200 deaths but can correctly be quoted as hundreds. They are a useful descriptor of the scale of the problems at Mid Staffs.
As a final point – anyone who doubts that Mid Staffs was the worst disaster in the NHS should do two things….
One – stop reading blogs and articles written by people who were not there and do not know all the details.
Two – read the summaries of the first Francis report and the recent public inquiry report. You will be unable to deny the scale of this catastrophe. Better yet read the actual reports including volume II of the first report.
If you still think there were no excess deaths at Mid Staffs then I am afraid you are beyond help.
You have been involved as a journalist you mean, not, as you are in my opinion trying to imply you were officially involved in any inquiry.you worked with “curethenhs” and interviewed families etc, who I am guessing you were steered onto by that organisation? how many staff did you interview?
as to your final points exactly how many days were you at MSH, during 2005-2008.or as i suspect you didn’t get involved until after the 1st inquiry.(google just proved me right on that score) I think you will find that other hospitals have a lot worse problems than Stafford., and now that the present government appears to want to get rid of the NHS more and more will come to light, as is already happening, Politicians at their best? why were they not found out and media reported before now?
. I have been admitted to MSH several times since the late 80’s, on various wards and only once did I not receive the care I would expect, and this was due to the amount of geriatric patients that need a lot of attention and due to insufficient staff, others were unfortunately left out.
Again in my opinion people who have had unfortunate experiences and death of relatives at MSH,they were ill and can it be proved conclusively that they could have been saved?quite possible some of those would have been, but in reality are the figures really worse than any other hospital but did know how to “use” the coding to their own advantage? will we ever know? I doubt it MSH is just a scapegoat on behalf of closing down the NHS apparently
For my response to Shaun’s points, see http://skwalker1964.wordpress.com/2013/02/28/mid-staffs-death-rate-debate-with-hsjs-shaun-lintern-2/
The coding problems are crucial, I once got data sets for all the spinal decompress ions in a region so my group could look at differences across the region. We thought spinal decompressions were a pretty basic intervention but the HES data sets showed 61 named consultants carrying our spinal decomps. One was an endocrinologist, another a psychiatrist. Worryingly of the 21 surgeons in the region qualified to do these only 11 were in the data sets. This is just last year.
The issue is the right people were doing spinal decomps, no-one was getting a bad service!!
But you couldn’t get that from the data.
That’s the point of this article
More than likely people were dying and being badly treated …. It is unforgivably awful and truly tragic on any human level
But to CHANGE THIS we MUST get the data sets right so we can realistically tackle the issue
One only needs to look at Mid Staffs SMR over the last few years, now coding is being done properly, to see the effects of this change. It is also interesting to see what Dr Foster counts and does not count – you are for instance allowed to die of sepsis.
Nicholson needed to save £10 million and Yeates did as he was told. Unfortunately sacking Nurses and replacing them with HCA whilst leaving Emergency services dangerously undermanned in a rush to become a Foundation Trust was a recipe for poor care. What is truly very sad is that is that a hospital that many people spent a long time campaigning to be built not so many years ago is in danger of being closed down. Ironically the Trust might come under the control of New Cross – the place where much of the management at the start of this debacle originally heralded.
The Times publishes details of an NHS survey today,
” Mid-Staffordshire NHS trust, which was on Thursday threatened with being put into administration by regulators, also continues to perform poorly, according to the survey. Only 59 per cent of staff said they would recommend treatment to family and friends.”
It’s cash-strapped, under-staffed, under pressure and unjustly hated because of misleading headlines – that it gets as high as 59% is a massive testament to the NHS and what it stands for.
A quick browse of the Times website shows it to be one of the worst of the NHS-bashers, with a clear agenda, particularly with regard to Mid Staffs and the fallacious figures – so its figures and its interpretation of them are extremely doubtful.
The Times are merely reporting statistics produced by an internal survey conducted by the NHS itself. Using your logic in respect of the Times being an NHS basher does this mean that the NHS is also an NHS basher too?
Don’t be ridiculous. My comment wasn’t based on that one article but a scan of all the Times’ recent articles.
I work at mid staffs. Mid Staffs has come along way since the scandal. Unfortunately Patients and relatives alike seem intent in bringing the hospital to its knees. Unfortunately A small majority of patients who walk through the doors think the worse of the trust so go out of there way to make our jobs as difficult as they can for us. They think they can make a quick buck of the back of the hospitals misfortune. Staff moral is at an all time low. We work our ass’s off day in and day out. Many of our patients/relatives do thank us and telling us how extremely happy they are with the level of care. Unfortunately this doesn’t sell newspapers does it? When A&E closed it doors at 10pm the response from local residents was ‘Where do we go’? and ‘Can the other hospitals cope’? If this hospital does close, I see this to be the start of the End for the NHS. 🙁
Couldn’t agree more with your last comment, and sympathise wholeheartedly with the rest! Hopefully my articles have gone some little way to help and to change public perception. Don’t lose heart!
I give up. You’re the type who’d swear black was white rather than admit you’re wrong. You said, “…..it’s figures and it’s interpretation of them are extremely doubtful “. This in response to the internal NHS piece they covered and which your reply addressed.
How did you manège a scan of their web site? Access is very limited without a subscription.
Simple – use their ‘search’ function to look for articles on Mid Staffs and see what the headlines say.
Very quiet on here today.
Been travelling. Plenty of people reading, few comments on other posts.
So you draw your conclusion about the Times’s being an NHS basher on the basis of headlines rather than the full content and assessment of the entire article: sounds like jumping to conclusions on a less than rigorous investigation to substantiate your statement.
It’s impractical to read every single article, but with headlines like ‘The NHS is run for staff, not for patients’ and ‘The new hippocratic oath: cover your back’, a scan is more than enough to ascertain The Times’ editorial position. Hardly surprising, since its executive editor is an ex-Tory politician and free-market think-tank head.
Interesting article came here via the Guardian. Thanks for shinning a light into MSM dirty practice, there is as always with these matters more to these stories than meets the eye. Can I offer an additional view on another cause of these poor care problems.
I have recently retired as a Pharmacist, who worked mainly in the NHS, but also did some time in the private health care sector and for Saudi Aramco’s health care set up.
When I first qualified I worked in a hospital in Glasgow and stayed in the nurses home for a while. This is where mainly the student nurses stayed, but also some doctors and staff nurses. I think the NHS has suffered badly with the transfer of nurse training to the university sector. In the past training was mainly ward based, backed up with classroom theory. Most wards had a small group of trainees at various stages of their course. However these nurses were employed by the hospital and worked in the wards and were the backbone of the wards, they did most of the dirty work and cleaning and most of what they did was practical training they learned as they went. When they qualified and were employed by the hospital they were able to hit the ground running and were working from day 1, and new students came in to replace them.
When I left my final post university training had taken over and the student nurses only did placements in various wards. However because they were not employed by the trust the were able to do very little and most of what they did was standing and looking while a staff nurse tried to explain what was going on. When they finally qualified they had little practical experience and took some time to get up to speed. There was often this attitude I am a graduate I do not do that job and certainly never cleaning.
In my last hospital there was often one staff nurse in charge of two surgical wards at night, 60 patients , most of the last 30 years or so has seen the expansion of other staff posts at the expense of ward nursing posts, this has included consultant nurses and an expanded nursing management structure. Eventually the elastic snaps.
Always remember that most hospital general management are like eunuchs in a harem they can see it going on all around them but they cannot do a f***** thing themselves.
I’ve heard similar from many experienced nurses – the balance in the training is off, and a return to a predominantly ward-based training would help matters.
I understand why the RCN pushed for degree-based nursing to raise the status of the profession – but the law of unintended consequences kicked in.
Sallysadface
What does sell newspapers is 41% of your medical colleagues stating in a survey they wouldn’t recommend using mid staffs to their families or friends. The survey – conducted by the NHS itself – was widely reported yesterday, apart from the Guardian if course which completely ignored it.
And the reasons for this were already addressed – nurses overwhelmingly (75%) believe that their hospitals are too understaffed to provide the level of care nurses want to provide. So your (Daily Mail) article jumps to all the wrong conclusions – which isn’t exactly an exception for that rag.
Hi Andrew,
I see that your expertise is in sales for a company that “is the UK’s leading manufacturer and provider of cosmetic laser solutions and aesthetic equipment to the medical, cosmetic and beauty industries”. This company sells a multitude of products including the “Radiofrequency Cellulite Reduction Systems”. Such a background clearly provides you with the breadth of knowledge to provide such big insights into working in the NHS and NHS reform. I guess your ‘medical’ aesthetic related paraphernalia are very popular with new privately run healthcare consortia which are piecemeal taking over the NHS. Unfortunately though I’d be prepared to wager that most of these machines have nothing to do with medicine; with no evidence base, and are essentially a waste of money.
They probably make rather a lot of money for the private consortia using them though. We are currently seeing General Practices up and down the country littering their surgeries with gadgets such as those you sell to enable them to make ‘a little on the side’.
Just out of interest, what proportion of Lynton Aesthetic & Medical Equipment employees would use their products or recommend them to friends and family, and do you?
It’s quite amazing how contributors to this blog, the ones who have the same agenda as skywalker anyway, get their facts wrong and make generalisations based on poor research/digging and delving. I think I’ve tracked down the company you believe I work for but like you shan’t publish their name. I have no connection with this firm. I can’t comment on their aesthetic products but I am familiar with the use of lasers in surgery and believe me lasers have a lot to do with medicine ( more accurately surgery, there is a difference you know ), have a substantial evidence base ( otherwise no surgeon in their right mind would dare use one ) and are not a waste of money. Just do a bit more googling and you’ll find lasers are widely used in the NHS for the resection of tumours to name just one procedure. Tell that to the surgeons who use them and the patients who have benefitted.
One final point and this is a bit of advice: it took me 5 seconds to identify the firm you erroneously think I work for, as you quoted their web site blurb word for word. You then denigrate their products – if I did work for them I’d probably have my lawyers come after you. Be careful who and what you criticise on the internet. Heh ho it’s Saturday evening time to go and enjoy an evening out with friends.
Have just re read you piece oldstaffy. You do mention the company by name. I missed that. So just to nail this one for good – I have no connection WHATSOEVER with them.
A long piece of flawed analysis, to serve someone’s vested interest.
Nothing in here about staff behaviour and the way the patients are treated
Lies, damned lies, and statistics
Nicholson should go and be subject to criminal proceedings
You clearly haven’t read the article, since poor care gets a clear acknowledgement.
RIGHT!!!!! As I’m a woman it is only fair I have the last word. 😉 Why not try your hand at working on one of our wards for a week, then you can give me a VALID opinion. RANT RANT RANT about how and why’s but probably never been on a ward long enough to see the real truth behind the stories. Skywalker I commend you for raising the point about the drinking water from a vase incident. It actually never happened. No patient is aloud flowers or vases for that matter on the ward. WHO SAID IT????? My rant is now over. 😉 goodnight. 🙂
Just for a laugh have just had a look at the vision statement for mid staffs. ” To create a culture of caring ” is first on the list. If the management have to make caring the number one priority, and it is the number one, should I as a potential patient be worried by this statement of the bleeding obvious? Damn right I should. If the staff need reminding why they are there then they shouldn’t be there in the first place. Having analysed a few vision statements in my time I’ve had a go at a rewrite: ” to create a working environment where only those who don’t need telling what caring is will be employed, all the rest of you can go and work flipping burgers” .
If it *hadn’t* contained something about caring, you’d have criticised it for missing the bleeding obvious.
Its very hard to get to the bottom of these statistics. One set of figures suggested roughly 1200 excess deaths over a period of 12 years (roughly 100 a year) and about 500 excess deaths over the last 4 years of that period (roughly about 125 a year). The writer went on to say that at its worst there were 27% more deaths than would be expected based upon the national average. Well if the 125 excess deaths were that 27%, that would imply that if N Staffordshire lay on the national average, it would have had 463 deaths per year to explain, but instead it had 588 to explain, i.e. 125 more (588 – 463) than the putative average across the nation for a trust carrying out the range of procedures done at N Staffordshire.
Maybe I have oversimplified this but not by too much I expect.. So now let us imagine two parallel universes, one (call it Universe A as in Awful) being N Staffordshire as it is (588 deaths a year to explain) and the other (call it Universe B as in Better) a perfected version of N Staffordshire (463 deaths a year to explain). Let us send a few journalists and politicians into each of these two universes but without telling them which universe they were in. They would be given access to 100 affected families selected at random from each universe. When they interview the families they’d have a field day, identifying terrible suffering, unnecessary mistakes, and a relatively casual attitude to death that is inevitable among those exposed to hundreds of deaths a year. Make no mistake about it, the tales told by the families would be harrowing.
Let us imagine that they then emerge from their parallel universes and that they had to be interviewed by Professor Frances so he might assess which of the universes had the most harrowing tales to be told. I would be willing to bet that he would find it impossible to distinguish the difference in degree between the tales from Universes A and B. I’d go further. I would suggest that if he had been told that the rapporteurs from Universe A had visited B and vice versa, he might have been tempted to infer that Universe B (Better) was in fact worse.
Yes, I am guessing, but imagine hearing the shocking tales by the hundred families. They’d all be shocking wouldn’t they? So how would a listener distinguish the Awful from the Better? I do not believe that it would be possible to make such a distinction.
We are dealing with many hundreds of deaths a year and then we are trying to decide whether there were a hundred or so more than would have been expected. And as the author of this blog has pointed out so clearly, the methodology in the statistics is hugely suspect. He gave a number of only too plausible reasons why this might be. I think I have suggested how, once people are convinced they are in the Awful universe, they will interpret everything that happens in that universe as being awful, whereas it may in fact be Better than they think. Reporters and politicians should beware. They were probably out of their depths, as, i suspect, would most of the medics have been.
This is a long and complex analysis and I commend you for the time and effort that you have invested. It is being widely quoted which is good because it raises a number of important issues about risk estimation methods, data distortion (accidental or deliberate), and how personal and politcal agendas distort the picture further. My question is “How does your article help to move us towards a safer, better, quicker, and more affordable NHS?”
Hopefully, it starts the difficult process of clearing the fog around what happened so that the real cause of the poor care can start to be seen. The government would love to make it about targets so that people don’t identify that the real lesson of Mid Staffs is that if you cut staff, poor care and suffering are likely to follow.
The government is desperate for that not to be the public perception, because it is busy imposing cuts that make the short-staffing at Stafford look like nothing.
Thank you. I’m not sure much fog has been cleared though for several reasons. One being that few commentator appear to understand what “risk” means and how the “estimated excess mortality” figure is calculated. To do a case note review of the actual deaths is meaningless in a multi-step distributed-risk time-dependent non-linear causal network: aka the “system”. There is no statistical test yet invented that can unpick probabilistic causal-event paths leading to specific binary outcomes (i.e. deaths).
True. But getting the facts out there and opening the debate is a beginning. Not many have dared to challenge the prevailing version of events, but it’s essential.
Can anybody explain why hospital understaffing is such a big problem when the previous government supposedly poured billions of pounds into the NHS ? Where did all that money go ? If it mainly went to doctors, why was that ? Also, I was shocked during my only recent experience of a local hospital (as a visitor 7 years ago) to find that many if not most of the nurses appeared to be foreigners — how and why did this come about ?
Has anybody used the same research skills to investigate and explain the finances of the NHS ? I’ve never understood how politicians (of all stripes) can refer to the financial problems/performance of hospitals, trusts etc. as if they were businesses, when none of them generate any revenue, own any assets or borrow in their own names — all of them presumably operate using funds allocated from some central budget, which can be increased or reduced by government at will (unless I completely misunderstand the situation).
Mid Staffs had a funding (and therefore staffing) problem that had nothing to do with the general level of NHS funding. In trying to become a Foundation Trust, it had to achieve financial targets and streamlining – and then to continue to meet financial targets once it had become one. This led to a ‘microclimate’ of financial pressures.
One of the most telling comments during the Francis II testimony was about Monitor, the NHS regulatory body:
Monitor misses nothing – as long as it’s financial. A focus on finance – combined with a system that connected financial payments to performance in areas that really are not central to patient care – led to serious understaffing, and so to poor care.
The government continues to cut the NHS ever further to prepare it for piecemeal privatisation. The govt is therefore desperate for the real less of Mid Staffs not to become the public perception: shortstaffing will inevitably lead to care failures.
The NHS is NOT short of money, its short of leadership.
A lot of money was thrown at the nursing staff in one way or another.
The worst case was the provision of the so called ‘Nurse Consultant’, when no patient or taxpayer had requested it. It was a blatant way to stuff more money into nurses pockets. Without taking the required qualifications. The unions have not a great job for them but a disastrous one for the patients & taxpayers. The only people diagnosing should be doctors, who have a 5 yr degree, from a British Medical school. If you value your life make sure it is ..
This analysis above shows great disrespect for those people who suffered, died and the remaining relatives
John is correct. The DoH data shows that over the 10 year period leading up to the alert being sounded by Dr Foster – there was a 100% increase in NHS funding and only a 25% increase in head count (mainly doctors and nurses). Most NHS costs are salary so this means they are all getting paid more for doing essentially the same job. So whay are they all so miserable? See http://www.saasoft.com/blog for the data charts.
Agenda for Change corrected a long-standing situation of underpayment for nurses.
Labour was also investing to correct underfunding and funding cuts by the preceding Tory government, building hospitals etc to replace worn out ones.
But – as the article you referenced itself points out – the major increases in the NHS cost over the period was in the very generous awards to GPs and consultants, who increased their income substantially over the period. That’s all well and good, but has little effect on issues of ‘basic care’ – GPs and consultants are generally not going to be found cleaning sore backsides and soiled bedsheets, or administering routine injections etc.
Your comments miss the main point I made in response to John, which was that Mid Staffs existed in an underfunding ‘microclimate’ caused by the constraints involved in achieving and then maintaining FT status. This was detached from the overall funding picture of the NHS, but provides an object lesson in what is happening and will continue to happen as the Tories inflict similar spending constraints on the wider NHS.
This is an idiotic comment. ‘Nurse consultant’ posts were in fact primarily a cost-cutting measure – creating a layer of nurses taking on greater clinical responsibilities so you didn’t have to pay for as many doctors.
It proves the very opposite of what you’re trying to say.
You’ve also managed to miss the point that Mid Staffs existed in a microclimate of cuts, underfunding and understaffing because of the desire of its board to achieve, and then maintain, Foundation Trust status – which then put it under the particular financial regime for FTs required by Monitor. Conditions there were therefore divorced from the wider NHS situation.
The fact that the government now requires ALL NHS Trusts to become FTs by April 2014 should be a source of great concern to anyone who cares about the NHS.
As for ‘stuffing money into nurses (sic) pockets’, Agenda for Change merely went some way to correcting a long-standing situation of underpayment to nurses by the preceding Tory govt. Nurses are not overpaid.
Congratulations on an excellent article showing the folly of trying to enforce competition in public services on the basis of statistical indicators. I notice that none of your critics have addressed any of your statistical arguments.
Indeed! And thank you.
That’s not true, because I have (at 2.44 am on 3rd March) but no-one seems to have noticed.
Peter, not sure what you’re referring to when you say ‘I have’ etc. Your first comment made some good points but didn’t seem to require a reply. If you think I’ve missed something, let me know what.
To SK Walker
I have tagged my reply to myself because your message at 8.21 this morning has no “Reply” tag. My comment was to Dennis Leech who said none of your critics seem to have addressed your statistical arguments. I did address them.
What I estimated, on the basis of your exposition and some other figures which appeared in this thread, was the total number of deaths from which the list of unnecessary deaths was originally produced. I’d be interested to see if my estimate meets the approval of anyone who examines it.
And of course I’d be interested to hear if people think that distinguishing the unnecessary deaths from the “necessary deaths” – sorry that’s a horrible expression – is possible for the layman and therefore whether the huge campaign in Staffordshire is something that could have developed anywhere if families started to sense that there was anything unusually wrong compared to the norm across the NHS.
Thankyou Skywalker for shedding some light on something which was a mystery to me in connection with the mid Staffs outcry. I could not believe that it would be possible for that number of people to die unnecessarily over a period of time without some-one noticing. I accept that there was probably poor care – basic care however that does not normally lead to death. I accept this because I work as a staff nurse on a very busy 24 bedded acute medical ward where our staffing is often down to 2 staff nurses ad 2 health care assistant. That gives you a ratio of 12 patients to each staff nurse. There is no nationally recognised official nurse to patient ratio but it is normally accepted that 6 is about the limit in order to be able to provide good patient-centred care. We frequently work with responsibility for twice those numbers and it is virtually impossible to provide the sort of care that everyone should be able to expect. I have to prioritise on a daily basis and I very rarely go home feeling that I have done a good job. I never leave work on time, my breaks are unpaid (except for a 10 minute tea break) and as I don’t get time to take more than a sandwich on the run break, I am giving the Trust my time every day for nothing.
The reason I carry on working is that I consider myself to be a good nurse, and I try to make a difference to some-one’s life every day. However, I can’t begin to tell you how angry it makes me to see the demonisation of the NHS and nurses in particular as if we are the main reason why the NHS doesn’t always perform as well as it should. There are few jobs where people would put up with the conditions that we have to work in under a constant barrage of criticism. The danger as I see it is that people will be put off going into nursing – I know many colleagues who have left to go into other jobs where they don’t go home at night worrying about the dear old chap in bed 1 who may not be there when you go in for your next shift.
My heartfelt sympathy goes out to anyone who was or still is working at mid Staffs hospital because I think I understand what you have been struggling with. I also sympathise with all those people who feel that their relative didn’t get the care they deserved whilst at the hospital but I can’t help[ but feel that the constant negative press coverage does nothing but hurt us all eventually.
I have no political bias – I am in a union because I have to be working as I do in such a litigious society where there must always be someone to blame. I just feel that we all need to wake up and smell the roses before we end up with a healthcare system like that in America where those who can’t pay get virtually no treatment at all.
Brilliant comment. Would you mind if I used some in a follow-up article at some point soon?
Macpolly, you are so right. I also worry like your good self. I found myself phoning the ward at 3.20 in the morning last week to make sure I had brought up some patients belongings from A&E. Something so trivial yet it worried the hell out of me, I couldn’t sleep thinking that he won’t have anything in the morning and his bag may get lost. Lol. I had actually took it up with him, DOH! but when your busy, your heads trying to think of a billion things to do. I’m a HCSW and I really do respect what you nurses have to do on a day to day basis. I’ve been kicked, punched, verbally abused and bitten, yet nothing is done about it, just recorded and that’s it! I sometimes wonder why on earth I do this job, but the simple fact is I love it. I love interacting with the patients, caring for them no matter how vunrable they are. Sitting with a dying patient and comforting them through there final hours and most of all saving someone’s life. These are the most rewarding things about my job. 🙂
More great comments. I’m starting to put together an article showing the NHS nobody sees in the news headlines – could I use some of your examples?
Feel free. 🙂 It’s about time we heard it first hand from staff, not from surveys and third parties. 🙁
Just uploaded the article – hope it meets with your approval!
Feel free to use anything that you like – just feels nice to interact with some like minded people and Sallysadface – keep up the good work – we need more people like you. Best wishes
Just uploaded the post – hope you like it!
This is an excellent article! Thankyou for taking the time to produce this and wish that the newspapers and news would pick up on it.