Honesty about the NHS

Quality of care

As widely predicted the Tory press launches yet another attack on the NHS based on leaks from a report led by Sir Bruce Keogh into 14 trusts that had higher than average mortality rates over the last two years[1].  The report is to be delivered on Tuesday, but leaks abound and quotes from Ministers are already lined up.

The Tories attack our NHS for two reasons.  First to cover their main purpose which is to turn it into a market with much of the care delivered by private companies – they have just wasted around £3bn on a reorganisation to make this easier.  Second because they know Labour usually enjoys a large poll lead on issues around the NHS and they have to reduce this to boost their dwindling prospects for the 2015 election.  Cameron, Osbourne, Hunt and their cronies know if the Tories do not win the next election outright then the Tory party will come after them.

Our NHS is not perfect, but on everything worth measuring it was far better in 2010 than it was in 1997. But Labour left knowing more was needed and the growing focus on quality of care which dates back to 2008 and Lord Darzi shows this.  So if Labour tries to support the NHS or to bring balance into the debate it is accused of supporting or causing or condoning poor care or of covering things up – it is nauseatingly predictable.

On independent international comparisons the NHS is at the top for most factors except one where it is close to the bottom; patient experience.  Far too many patients experience poor personal (as distinct from clinical) care, especially those who are older.  Naturally those who see their loved ones being treated in an unacceptable way will be highly critical of the system; and poor care should never be condoned or excused.  But as has been pointed out, over and again, poor care does not directly link to “excess” deaths.  We know from proper case notes studies (that do not depend on dodgy statistics) that unnecessary deaths are at a level of around 6% – almost certainly lower than it has ever been and comparing well with other health systems.  Sadly there are no comparisons across hospitals of this measure – which is probably the one that matters most.

There will ALWAYS be 14 worst hospitals.  There will ALWAYS be some hospitals with mortality rates higher than others.  Sadly in an NHS dealing with millions of complex things every month things sometimes go wrong.  That does not justify claims that some hospitals are killing patients in the hundreds.  Nor are those hospitals with lower than average rates resurrecting people.

Ironically those hospitals known already to be in the firing line for closure under the new market regime, Stafford, South London, Peterborough all have below average mortality rates!  Stafford has amongst the lowest in the country as for some years it invested heavily in improved staffing – to the extent that it made itself financially bankrupt.  Good care costs.

What we know from proper research actually accords with common sense.  The key to good care is the level of staffing – doctors, consultants, nurses and even cleaners – consider it as total skill mix actually available on site.  This includes diagnostic and other support staff  as well as consultants actually in the hospital.  Mortality rates at weekends is not as good as during the week as (in general) there will be less skills deployed on site.  Care in smaller hospitals with less total overall skills will tend to be higher (although there are many exceptions).  Hospitals in areas where the level of funding is lower tend to have worse mortality rates.  And we have known all this for a very long time.  Just as we know that since the Tories took over our NHS there have been cuts in staffing levels.

We all know that if you want the best care everywhere 24/7 then the model for the NHS has to change which will take some years and it will cost more to deliver.  You do not get there by making cuts.

The best way to get good care is by having enough staff that are well trained, well led and motivated.  The previous three years of cuts and chaos through a wasteful and unnecessary reorganisation has made everything worse and reversed what was a well established trend of improvement.

Let’s learn from what the Keogh review actually tells us, lets do more studies of that kind using peer review not dodgy statistics, let’s implement the recommendations from the Francis review and let’s continue to improve our NHS based on its traditional values – not destroy it.

[1] If you used a different time period and different measures you would have got a different group of 14.  Some trusts that have higher current rates were not included.  Two of those included have lower than average rates on one measure.