21st July 2015

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Health Chat

Minister for Life Sciences - George Freeman - in conversation with Roy Lilley

King's Fund - 16th September - 5.30pm

Tickets and details here.

Something in that
News and Comment from Roy Lilley
Because he was a long-time Harvard faculty member, fifty years and was a public official, diplomat, author, economist, writer, novelist and public intellectual... everyone thinks he is an American.


He's not.


France made him a Commandeur de la Legion d'honneur. But, he's not French. His parents were Scots... he wasn't Scottish. He had a degree in agricultural economics... but not a farmer. In India he set up one of the first computer science departments... but he's not Indian.


He was married for 68 years and had a child who died of leukaemia. He was born in Canada... J K Galbraith. He believed in the 'investment in men'; publicly funded education programmes aimed at empowering ordinary citizens.


In his book Economics, Peace and Laughter (1971), p. 50 he says:


"Faced with the choice between changing one's mind and proving that there is no need to do so, almost everyone gets busy on the proof."


He coined the phrase; 'conventional wisdom'. He did not consider it a compliment:


"With what most closely accords with self-interest.... or promises best to avoid awkward effort.... we... find highly acceptable what contributes most, to self-esteem..."


"... we cling, as to a raft, to those ideas which represent our understanding..."


Conventional wisdom... it has become a 'conventional wisdom' that if you are admitted into hospital on a Sunday you are more likely to die.   Sixteen percent, apparently?


Do variations in hospital mortality patterns, after weekend admissions, reflect reduced quality of care? Apparently not, too tricky to say.


It seems there is no source to support the claims that 6,000 deaths a year could be avoided by putting the majority of hospital doctors on 7-day contracts.


Sunday hospital admissions are a bigger risk? Er no.


There might be some evidence to come from the outturn of 2013/14 Hospital Episode Statistics due to be published 'soon', (Say the DH) but it is wrong for Ministers to site statistics that are not yet published. The UK Statistics Authority has been asked to rule.


We are in Galbraith territory...   


'We cling to ideas that represent our understanding.'


Walk into a hospital on a Sunday. Does it look and feel like it is a Tuesday? No.  Therefore it can't be as safe... we cling to ideas that represent our understanding.


Look at the staff carpark. Is it choc-a-bloc Monday morning full, on a Sunday?  No. Canteens bustling, shops with queues? This place must be safer when it's full... we cling to ideas that represent our understanding. 


We all have stories of relatives and friends admitted to hospital on a Friday, left twiddling until the head honcho turns up on Monday and the test-cycle cranks-up. I have a friend in hospital, right now, testament to this fact.  Ideas framed by understanding based on personal experience.  It can't be as safe.


Does this mean a criticism of overstretched doctors working at weekends? No; it has been whipped into a froth of misunderstanding on Twitter and elsewhere, presented as a calumny on all 24-7 doctors, but it is not.


Do we want hospitals to run hot, 7-days a week? Of course; there is a huge investment in kit and caboodle and the assets should sweat.


A cataract operation, on a Sunday afternoon, home in time for Songs of Praise? Why not and when there is enough money thrown at waiting lists, it happens.  Right now there isn't enough money for CCGs to commission five day services, never mind seven.


The Tinker-Man, frustrated by the British Machiavellian Army, has got himself into a row where right and conventional wisdom, is on his side but the evidence isn't. In a punch-up that feels right, there is no proof.  The Docs claim to be up for it but cunningly, want to know the how.


There might be a lot at stake.  If you have ever had a private operation, a cynic will say, you'll know the answer. Private practice flourishes in the evenings and weekends. Is this why many consultants exercise their right to opt-out?


Can we answer five questions:

  • Do we know how many consultants have used their right to opt-out of weekend working who could, effectively, be deployed 7 days a week? What are the numbers? How big a deal is this?
  • Counting who died up to 30 days after admission to hospital on a Sunday is not good science. Where are the causal links?  There are attenuations such as age, nature of the illness and so-on. Plus, mortality is measured over 30 days; anything could happen in the 29 days after, including discharge. We need better data to support the conventional wisdom.
  • What is the cost of full, on-site, consultant cover 24-7.  Conventional wisdom says it isn't affordable.  Let's find out.
  • Has anyone got a cost benefit analysis of 7-day working, based on Qualys.  The data says there may not be a problem, conventional wisdom says there is?
  • Are social services funded and tooled-up for weekend discharge?  Conventional wisdom says they are not.

Galbraith also said;


"In any great organisation it is far, far safer to be wrong with the majority than to be right alone."


There's something in that.


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