It’s deeply ironic, really. In July, the truth about the media’s nonsensical distortions regarding NHS mortality finally entered the mainstream. The shamelessly misleading claims ahead of the publication of the Keogh report, and Keogh’s complete demolition of them as ‘reckless’ and ‘meaningless’, finally opened many people’s eyes to a tactic that has been used to the point of nausea by media and this government to undermine the public’s affection for, and confidence in, the NHS.
Those claims continue to be repeated, but fewer people are now fooled by them – and gradually the public is realising what has been known for some time: since the mortality claims about the wider NHS are nonsense, the claims about Stafford hospital, which were based on the same deeply-flawed statistics, are unfounded too.
But in the same month, just when the claims about Stafford are finally being exposed as invention, the government and it’s ‘TSA’ hit-men took a decision that will turn ‘avoidable deaths in Stafford’ from myth into reality.
In choosing to put the A&E department on a part-time basis permanently, the administrators have demonstrated their complete lack of commitment to the long-term maintenance of services for which the local people have been campaigning in vast numbers.
The decision to maintain a part-time A&E at Stafford is clearly intended merely to divert public wrath and media outcry. By closing critical care and other services to which any A&E department needs to be able to send patients after initial assessment and stabilisation, the TSAs have ensured that Stafford’s A&E will simply ‘wither on the vine’, shrivelling to the point where it will be closed by the Trusts that will be responsible for it once Mid Staffs Trust is wound up.
To use another metaphor, they have elected to ‘boil the frog slowly’ rather than kill it quickly, in the hope that by the time it’s boiled to death public attention will have moved on and few outside the local area will care enough to pay attention.
It’s a decision that will cost lives. The government and their friends in the media invented ‘avoidable deaths’ at Stafford to attack the NHS – but real avoidable deaths will be the result of the evisceration of services at Stafford. Here’s an example of why, which was provided by a doctor at Stafford hospital:
Even though the academics that have looked at this fairly recently are quite adamant about it, I suppose the men in suits think that it can’t be true because the hospital you travel to is super excellent (though this effect ought to be absent if the one you are closing is also very good). Think of this example.
2 men aged 23 have a fever and the worst headache they’ve ever had and can’t move their necks very well. Both have a worried wife and a 10 month old baby. Neither can see their GP for 3 days. One lives in a city with an A&E. The other lives 20 miles away in a town where the A&E was closed a year ago.The former thinks he’ll nip to A&E just in case, where he is rapidly diagnosed with meningococcal meningitis on account of the tell-tale rash the junior doctor would have been looking for in this type of case. Antibiotics are started but he becomes sicker and goes to critical care. He is stabilised and goes home a week later after a traumatic but ultimately successful experience of serious infection.
The other patient delays, not wanting to travel 20 miles with a baby in the back of the van only to be told it’s a virus, worried about the expense, parking, traffic etc but an hour or two later is taken anyway by his wife and her mother-in-law as he’s looking terrible and isn’t quite “with it”. She loses her way at some traffic lights but eventually gets there. She can’t seem to get attention quickly as a pub fight and it’s casualties have spilled over into the large A&E. He is in a semi-coma by the time he is seen. He is again rapidly taken to critical care but after a month in a coma and 2 leg amputations and kidney, then liver, then heart failure is deemed irretrievable and the ventilator is switched off. The widow and her extended family have travelled the 40 mile round trip twice a day for a month.
The government maintains that it’s better for patients to be treated at ‘super-hospitals’ further away than at adequate hospitals nearby, but in many cases it won’t matter how good the hospital is.
People won’t go until it’s too late because of the distance.
Trauma victims will die in the ambulance because of the longer journey.
Mothers and babies will die having driven past what used to be a well-equipped local maternity unit with consultants on call for when needed.
And the alternative hospitals are not ‘super-hospitals’ – they are overstretched facilities already facing serious problems of their own. The maternity unit at the University Hospital of North Staffordshire, which is expected to handle the births of Stafford babies, has already closed its doors on several occasions because it couldn’t handle local demand.
And the nonsense of all of it is that implementing these changes that will cost lives is going to cost up to £300 million, and at least £220m – far more than Stafford’s debt – and will still leave an annual deficit of £8.5 million per year.
The government claims that its changes to the NHS are about improving it. It claims that the fragmentation and the enforced marketisation are about patient choice and value for money. It claims that its motives are improvement and ‘putting the patient at the centre’. It claims that the NHS is ‘failing’ and that NHS workers are ‘coasting’.
It claims that putting Stafford into administration, which has resulted in the Trust’s dissolution and the downgrading of its services, are in the best interests of the people of Stafford.
What do you think?
Reblogged this on Vox Political and commented:
As the article asks: What do you think?
I think it’s time we had a revolution.
a revolution indeed against the corporate govt. http://paul8ar.wordpress.com/2013/05/28/the-rise-of-the-shadow-state-the-truth-about-outsourcing/#comments
TIME FOR A REVOLUTION IN THIS COUNTRY … but it will never happen and heres why …
a revolt requires 3 things…1 a majority of the population angry with the system (OK we’re all angry about something – but the whole system ?) … 2. that self same population must care enough about people who are strangers to them to do something about it (for the past 30 years this attitude has been strangled out of the British by successive governments policies (look after number 1, I’m alright Jack, it only affects “scroungers”)…. and finally 3. a population that is armed and prepared to use it (if China invaded us tomorrow and promised to leave us the X factor, football and Lizzy in Buck House, then most people would do fuck all about it) … but by all means enjoy the fantasy, the last 2 people to enter and leave Westminster with their honour intact were Cromwell (when he dissolved parliament causing the Civil war) and Guy Fawkes .
I cry
Reblogged this on paul8ar.
Is anyone engaged in responding to the administrators report?
It lacks evidence , is tendentious and if the logic is followed will close half the hospitals in the country.
Judicial review allows this level of analysis through (see Lewisham judgement) but local authorities charged with public overview and scrutiny should not.
Yes. I haven’t personally been able to get into the details yet, but the Support Stafford Hospital group, and I’m sure others, are working through it with a fine-toothed comb – as well as through the Lewisham judgment to see what is useful in that.
“If the logic is followed will close half the hospitals in the country”. Merging of Trusts has already done away with or significantly downgraded small hospitals.
This “round” is about using some sort of financial definition/mechanism to close/downgrade medium sized ones. The problem is that many of these small and medium sized hospitals are in rural or semi-rural areas where access is already a problem.
Take both “rounds” of closures/downgrading and you do, indeed, have about 50% of our hospitals.
I don’t think Nye Bevan would think much of it, as he saw the purpose of having an NHS as serving (as a priority, since they are sicker and can’t shout very loudly) the poor, for whom access was an important component of the provision.
I don’t think you understand the way in which the NHS is funded, and how NHS Trusts receive their money.
The simple fact is that the hospital doesn’t receive enough throughput of patients in order to generate enough income to cover its costs, hence why it makes a loss every year.
There are already many places in the UK where people are 20 minutes away from a hospital. Stafford Hospital was built at a time when the NHS was rich, and we’re simply not in those times anymore.
To expect the taxpayer to subsidise a large hospital in a small town is simply not an option.
I understand very well how hospitals are funded – and better than most why Stafford has a shortfall.
Hospitals can’t really make a loss. The treatment they give costs what it costs – if they don’t receive enough reimbursement from the government, that’s a problem with the tariffs.
ALL hospitals are government-subsidised – and people in small towns are no less needing, or deserving, of care than those anywhere else.
We subsidise bus routes for small towns and rural areas, and companies are expected to factor in when they take on a contract that they won’t make the same money there. It’s all part of the mix.
Why should healthcare, something much more important, be any different?
Also Stafford Hospital’s shortfall has 3 other causes.
1) The overall funding formula works against rural and semi-rural areas (if the per capita allowance for South Staffs was the same as Stoke, you could afford to have 2 Stafford Hospitals open and still have money left over – or a minor adjustment would wipe out the defecit); OR to put it another way, far from Mid Staffs being subsidised, the local population of taxpayers is already subsidising the hospitals in Stoke and Wolverhampton via the capitation payments for the relevant CCGs.
2) The PBR tariffs are biased in favour of elective or easy to cost items. Tariffs for acute general medicine (“off legs”, “confused”, “chest pain” etc) do not support the cost of providing adequate care in any hospital. The large institutions simply subsidise their general activity for their often small general catchments from the more generous PBR tariffs they get for complex orthopaedics, liver transplants, clever heart operations etc. If all you do is general, unsorted, initially undiagnosed care for a substantial population you have a financial problem.
3) Because of the general furore against Stafford Hospital/the Mid Staffs Trust, the Trust has had to spend huge amounts not only on better staffing (desirable) but also on risk management, PR, regulatory visits (far more than any other Trust) AND some GPs/patients around the peripheral catchment have chosen to refer/travel further thus reducing the income – and end-income is much more important because costs are more marginal. The TSA report makes much of the fall-off in activity but you could see it as a triumph – given the total opprobrium that Stafford Hospital has suffered, it is amazing that it has held onto any patients at all, let alone most of them.
The bottom line is this. Mid Staffs Trust, like all hospital organisations, has a “natural catchment” of a land area nearer to it’s facilities than any other. This is 325 sq miles and it contains 300,000 people. This is a clinically and financially viable population by any definition, especially in a rural/semi-rural area. The correct approach long term is therefore to rehabilitate the Trust rather than throw it to the Wolves on a rather artefactual basis.
If this principle were applied in the whole of the NHS, access/equity and outcomes would be optimum AND the evidence would suggest it would be cheaper. The ordinary people of Stafford (and indeed the UK) know this.
You really, really ought to turn that into a guest post!
Could you please ask yourself this question, Where did we get £375 billion to rescue the banking system and how Quantitative Easing (printing money) is alright for the private financial sector but not for the public sector.
In case you do not know what I mean this little Link will explain it all:
http://www.youtube.com/watch?feature=player_embedded&v=4bXpOUYrr1c
What is happening in this country is politicians are asset stripping our nation and transferring wealth and power upwards, it has nothing to do with sound economics or efficient use of resources.
We need to spend more on the Health service not less, that way we can progress like a civilised country rather than the dog eat dog system of neo-liberalism that we suffer today.
I love this stuff. The power of the internet and social media to inform.
I live in Stafford. I’ve never got to North Staffs Hospital in less than 30 minutes, likewise 40 minutes for NXH Wolverhampton (Walsall 35 mins, Telford 40 mins, Shrewsbury 55 mins). That’s by car with best traffic conditions. How far is too far? Clearly there are remote places but the number of people affected must be part of the equation and it’s a lot in this case.
Distance matters most when you don’t know what the matter is – that is why acute local services are reassuring to the public. Academic studies suggest that acute unsorted undiagnosed general patients have a mortality increase of 1% per extra 10Km – i.e. a statistical reality that underlies what the public feel.
Clearly these services can be delivered to a high standard in Stafford (with Cannock) with a limited amount of tariff change (a good use of the surplus the DoH has given the Treasury in the last 2 years I would submit). To do that would prevent all the disruption and heartache – a small price to pay, surely (I won’t rehearse the arguments about what else HMG spends it’s money on).
The unaffordability argument is simply an artefact of the way the NHS is organised (ie primarily on financial rather than need grounds). Also see below…..
Steve, This why the report we drafted here in Gloucestershire is so important, Cheltenham A&E has been closed to night service and all emergencies transferred over night to Gloucester. This means an already overburdened A&E will suffer from the log jam of patients and as mentioned trauma patients will die in ambulances before they even reach Gloucester.
Our challenge to the system is on going and we are pressurising local MPs to ask the questions we need answers to.
The CCGs do not have to automatically comply with tendering out services either as this link proves:
http://www.gponline.com/bulletin/gp_commissioning_bulletin/article/1193141/gp-commissioners-vote-against-putting-services-tender/?DCMP=EMC-ED-GPCommissioningbulletin-
If we all put pressure on them we can stop this insanity in it’s tracks.
Absolutely! I’ll help however I can.
Stafford is NOT a small town. Rugeley, Stone et al are small towns. We will be having a large influx of troops to our barracks within the next 2 years ….. are they supposed to leave their families behind because they won’t be able to access a local maternity and paediatric unit? The potential for no future Staffordians to be born in their home town, the COUNTY town, is unthinkable.
Great, great point. Complete lack of forward thinking.
I agree with your analysis. When we hear on the “reputable” BBC news that there may have been 1200 avoidable deaths at this hospital, it shows that nobody who is processing the misinformation from the govt has any idea of how statistics are used in epidemiology. One dissatisfied daughter of a patient has stirred things up out of all proportion. I am so pleased that people in Lewisham have saved their A & E – nobody considers that the simple fact of travelling 10, 20 or 30 miles to the next A & E is fraught with all the dangers of travelling quickly – too quickly – on the roads, in either an ambulance or the family car driven by a stressed, anxious driver. Having a siren doesn’t make you immune to crashes. You need an A & E near you and also good walk-in clinics that can treat some people and triage others to A & E – like the ones being developed in Liverpool. All towns near a motorway like the M6, however big or small the town, need an A&E just for road crash victims.
Keep on telling the truth skwalker
anna briggs
Thurso
You may be interested to know that a complaint against the BBC’s irresponsible use of these very dodgy (to say the least) figures over a considerable period has now reached the highest level (investigation by the BBC Trust of the actions of the BBC itself).
There have been many complaints mostly all ignored, they even won a damn award for reporting inocorrect information.
Blimey! Mind, I won’t hold my breath given the people at the top.
Thank you – I’ll do my best!
I’ll make the guillotine then we can start at the top with Cameron and work our way down till we have chopped of all the heads of the aristocratic government. A Revolution is definitely needed to rid us of what is the biggest bunch of liars we have ever had in Government.
On Wednesday is the first public consultation, why the TSA are even bothering to go through with it I don’t know because they certainly did not listen during the first meetings or since,..doubt if they even read the letters and e mails giving our opinions. I hope they will look in every face of every child and every young woman on Wednesday and commit them to memory because if one dies en route to Stoke, Birmingham Sheffield we will ensure they are sued.
You may have provided figures already, but do you know what the total cost of various enquiries, reports, TSA involvement has been so far? As TSAs hadn’t got the necessary knowledge of NHS they also got others involved which won’t have been provided for free.
Not the total, but it’s quite a number of millions, from what I recall. No doubt someone here will refine the figure!
Approx figures in public domain:
Francis Inquiry – £13.5m
CPT report for Monitor – £2m
TSA (so far) – £2.5m
also estimates (see elsewhere in this blogsite):
Mgt Consultants in Mid Staffs: £2m total
Cost of extra regulatory visits (to Trust): £2m in total
Shortfall in PBR payments for work done on account of poor management, anomalies, poor coding etc since 2004: £50m
and so it goes on ….
Is this a bit of a farce? (Don’t answer that!)
Knew someone would have it! lol
for gods sake,im just an old man,so i cant do much[disabled] so please get all this out into the mainstream media any way you can to stop whats going on. im frightened for my grandchildren,and everybody else who doesnt realise the bomb shell that this evil government is unleashing on them.
The MSM don’t want to know, that is the problem, and includes the BBC. We simply need an alternative to MSM news like the US has.
http://www.youtube.com/user/TheYoungTurks
Steve (and others) do an excellent Job but in general a large swathe of the public want their news read to them. So a British version of The Young Turks would be a good start, or some budding documentary film makers are needed to put all this into a youtube “spamable” film.
Thanks to you, Steve, and others prepared to speak out, we know what Hunt’s game is with NHS hospitals like Stafford. Blacken its name until an outraged public almost begs him to hand it over to a private sector company hyped up to appear super efficient and cost effective. The tired old formula is always the same: NHS = poor care; Private sector = excellence. Its no wonder then that the story you can read via the link below has been kept out of the mainstream media. Can you see our wonderfully impartial BBC featuring this? And if Stafford is sold off will this happen to that hospital in a couple of years?
http://www.thecomet.net/news/lister_surgicentre_signed_over_to_nhs_amid_patient_safety_concerns_1_2309631
The BBC did have a page, not that you’d know if you were not looking for one:
http://www.bbc.co.uk/news/uk-england-beds-bucks-herts-23546240
Its more from an apologist POV though. But none of the TV news carried the story, same as none are talking about this:
http://www.theguardian.com/politics/2013/aug/02/universal-credit-staff-flagship-reform?CMP=twt_gu
Sue, I submitted a complaint about the constant repetition of the 1200 deaths at Mid Staffs and heard nothing. I complained again when the headline about it being the first Foundation Trust to be dissolved was given top ranking on the online news and high ranking on the Today programme, whilst Lewisham’s extraordinary win at the High Court was sidelined to local news online. The online article for Mid Staffs had a tag line about the scandal of excess deaths. I complained about accuracy in that and bias in the placing of the reports. The reply I received blandly reassured me that they were happy that they had now settled on a wording that properly reflected the facts. And as for the bias they said they regularly shifted items between the main and local news sections and there was no bias. I was quite rude in my response to all that, including saying that it was not possible to report ‘possibly one such death’, ie arguably less than singular, as death(s) plural and that it was possibly a basic qualification for a journalist to be able to differentiate between those facts. As far as I can tell Lister Surgicare also only got reported in local news, under the Bucks and Beds section.
You did well, Deborah, to hold them to account. Its amazing how much extra energy needs to be spent though to challenge the obvious and blatant lies that seem to be acceptable even to journalists charged with keeping us informed. And, as in your experience, the standard response is denial (‘there was no bias’). Government spokespeople are full of this and I wonder why the BBC etc bother inviting them on when all we get is defensiveness and obsessive adherence to the party hymn sheet. What happened to debate? The (desired?) effect for most people is to give up. It takes a lot of passion and determination to keep fighting and insisting on the truth and I thank you for doing that.
It’s hard not to get rude in the end, isn’t it? Eventually, you just reach the end of your tether – and not just with the BBC.
Very hard to keep the emotion out of your complaints, yes. You keep hoping that honest debate and the exchange of views will result in the truth being told. Perhaps that’s a naive position in what appears to be a nasty, grasping world. I still want to hang on to it, though. I want to live in a world where all views are valued and truth is more important than selfish profit and personal gain.
In case you missed it above I will repeat here:
“You may be interested to know that a complaint against the BBC’s irresponsible use of these very dodgy (to say the least) figures over a considerable period has now reached the highest level (investigation by the BBC Trust of the actions of the BBC itself)”
IE somebody has been at them for months (there are at least 4 levels) – all big organisations have “appropriate” complaints systems but that doesn’t mean they are easy to navigate.
Reblogged this on paurina and commented:
the continuing destruction of the NHS – at the expense of unnecessary deaths (not those mythical ones you’ve heard about, no, these are real future deaths)
Thanks for the video link rotzeichen….the TSA’s have shown how completely out of touch they are, and indeed are trying to make out that by appearing to save the A & E that Stafford is Ok and then all this alledged theoretical work to get utilisation up to 85% at Cannock means it is safe. Now these proposals are theoretical and only tested theoretically so imagine the consequences of implementing them. I know exactly how risky it is to transfer a sick patient by ambulance, it is difficult…restricyed space, you cannot hear very well..it makes lots of things partic difficult..also you are out on a limb if something goes wrong… in case of ICU transfer you have anaesthe tist + nurse or anaesthetic support and the paramedics….good skill set but limited resources despite transfer kits etc…..doing things outside hospital, back up is where? Now take that as a sick patient just with paramedics and none of the extra kit and skllls and drugs doc carries. OK amb bypass local and go to specialist centres now…I know and this has been happening for years for some specialities but decide to take all pts with abdo pain and bypass local hospital because TSA have shunted services elsewhere then there becomes a problem….what is the cost of a life? To the bean counters not much and also to the government who are hell bent on privatising the land and all its utlities and services to make them and their buddies richer. They believe that private healthcare = excellence in standards, Regards the NHS they believe that super hospitals are the only places where experience is…this is incorrect and many ICU’s in DGH as will the hospitals have projects in place and develop and try new techniques, been there and know that this happens… And dont even get me started on the erroneous death figures and HMSR’s ….
You are so right about the hazards of transferring very poorly patients by ambulance, Helen. Hunt and his followers have no conception of the practicalities. Its all about balance sheets. I did my share of these transfers as an A&E nurse and even with an anaesthetist present it was one of the most stressful parts of the job, especially when it was a child. Even more scary if the paramedics are alone having to travel miles to the nearest specialist unit.There are only two of them. One has to drive leaving only one to monitor and attend the patient and make all the decisions about the limited treatment they can give.
As Steve says the avoidable death myth is going to be turned into an awful reality. It will be interesting to see what statistical trickery will be used to cover this one up.
My next article is going to touch on this – should be today.
Great! Look forward to it.
I look fwd to it as well…..
Steve, thank you so much for your continued good work.
Just to add to the comment about the complaint to BBC going all the way to the top….our complaint got to the Director General himself, though you’d never know it due to the total lack of response!