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Health Chat

29th October King's Fund 5.30pm

Samantha Jones NHSE Director of New Models of Care and Vanguards.

Last few tickets... here.

Please re-read paragraph two 
News and Comment from Roy Lilley
Let me start by making something plain, absolutely black and white, no arguments:
Any unnecessary death, whilst in the care of the NHS, is unacceptable and must be the subject of rigorous examination to root out why, learn and put whatever is needed in place, to make sure it doesn't happen again.
Right, got that? Remember it, please.
Question; do 11,000 people die 'unnecessarily' within 30 days of admission to hospital at the weekend. The press got very lit-up  (more here) about a new BMJ report on the 'weekend effect'.
The BMJ brain-boxes have revisited work they did a few years ago. There is fresher data, polished up methods of crunching the numbers and more than a hint of bamboozling.
For starters; the BMJ has redefined the weekend as Friday, Saturday, Sunday and Monday. Are they really saying 57% of the week is dodgy? 
Before we unpack this report let's do a simple sum. Eleven thousand deaths mean 211 a week. Assuming there are about 155 Trusts at the sharp end of admissions; we are talking about 1.3 question-mark deaths a week, per Trust.
Before we go any further please reread paragraph two, above.
A simple mortality case note review could get to the bottom of why the person died; error, neglect, poor decisions, reduced staffing. We don't do that so we don't know and we will continue to be in the dark until we do.
Please reread my second paragraph, above.
The BMJ report actually says:
Our analysis of 2013-14 data suggests that around 11000 more people die each year within 30 days of admission to hospital on Friday, Saturday, Sunday, or Monday compared with other days of the week (Tuesday, Wednesday, Thursday). It is not possible to ascertain the extent to which these excess deaths may be preventable; to assume that they are avoidable would be rash and misleading.
The BMJ continues:
Appropriate support services in hospitals are usually reduced from late Friday through the weekend, leading to disruption on Monday morning. This could go some way towards explaining our finding of a "weekend effect" extending into Friday and Monday.
Note 'usually'. The brain-boxes have moved into an evidence free zone.  They might be right is all we can say.  Oh, and there is 'this could go some way towards explaining'.  Yes it 'could'. Funny how the big brain boxes can be so pedantic with the number crunching but so cavalier with their conclusions.
An uncharitable observer might say the deductions are being tailored to fit the objective.
The objective? Trying to win a row with the 1% of hospital consultants who opt out of weekend working but have been reduced to bystanders in the debate.  The report doesn't help. It does say, junior doctors might be unsupported (For 57% of the week?  Really?) and the analysis speculates:
"... that we need to determine exactly which services need to be improved at the weekend to tackle the increased risk of mortality..."
Please re-read paragraph 2 above.
Patients admitted at the weekend are more likely to be in the highest category of risk of death which might say more about primary and community care (where the Tinker-Man is embroiled in another row with the BMA), than it speaks to secondary care.
So, now what? Make hospitals, working on a Saturday, look like it's a Wednesday? Good idea but you'll need imaging, porters, administrators, social services, catering and the whole shebang. Let's do it. Make the assets sweat.
Cost? Forget the 'extra £8bn', that's just enough to keep the NHS doing what it's doing now. Seven-day-working cost estimates vary; some say 2% of total income.
Just how much should we spend on evidence based 7-day-working? We could ask NICE. They use a calculation called a QALY; the cost of a year of good health. The NICE price is about £30k.
The sum is simple:
11,000 deaths(?) times £30k = £330m pa.
Is that all we should spend.  Will that fix it?
Please reread paragraph 2 above.
In my view the BMJ's brain boxes have redefined 'dodgy dossier' and caused a brouhaha in the press, we can well do without... largely because people writing about it didn't read it and as far as I could see the BMJ did little to spell out what they are actually saying. 
The BMJ work takes us no further forward and does not explain 'the weekend effect'. Not even if you allow them to stretch the weekend to 57% of the week.
To me this looks political; manipulating public opinion, supporting the Tinker-Man who is struggling with some pretty flaky arguments and in a fruitless row with the BMA.
Is there something going on in hosptials? Obviously. What's the answer?
Please re-read paragraph two above. 

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