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27th January 2016
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Former Secretary of State for Health and now Chair of the Confed
Stephen Dorrell
Last few tickets 

Doing something good 
News and Comment from Roy Lilley
The row over weekend admissions and death rates is sooooo annoying.  If there is a good time to get run over by a bus, I want to know when it is.  I can study the time-tables and make the necessary arrangements.
 
There is something unedifying about the academic community huffing and puffing over the minutia of data when we all know, intuitively, it is saying something.  A hospital on a Sunday is different to a hospital on a Tuesday.  Does it matter... I'm not talking midnight podiatry clinics.  You know what I mean.   
 
I say there's nothing wrong with poking around, seeing if we can make the NHS safer.  I know it's underpinned by the money 'thing'.  It is important, of course but if I was the Secretary of State I'd have a go at safety, quality and most important, variability of outcomes. 
 
I want to know when it is the best time to have a stroke, or get treated for cancer and when to avoid.  It really isn't a temerity, is it?  If I go on holiday I want to know the best time to catch the sunset, the best place to put the sun lounger, the best time to get into the restaurant
 
I want to know the best time to get on a train to avoid the crowds. The best time to go shopping to avoid the queues.  Why not the time to avoid ending up on Florence Ward?  We all want the best, don't we?
 
I know the data doesn't spell it out but here, in Scandinavia and Germany, it points to the same direction.  More deaths do seem to occur following certain admission criteria.  Causation?  No.  Common-sense, maybe.  A pointer, a warning, a smoke alarm, a cautionary.  Worth checking?  Of course.  
 
Airports, flying; the captain of a plane has the same full range of air and ground crew, traffic control and support services on Sunday as a Tuesday.  Can the same be said of a junior doctor?  Are they supported in the same way?  Be honest.
 
Is it more sensible to ignore than it is to ask?  We all want to do the right thing. 

I have news.  There is some more stuff to worry about. 
 
I have come across something very interesting.  Someone who gave me a light-bulb moment.  Forget planning to fall off your bike mid-week.  Start thinking mid-day.
 
Forget days, think time-of-day.
 
A delightful man, Seamus McGirr the Greater Manchester Academic Health Science Network's Director of Clinical Development and Nursing;  "...analysed 3.5 million ED attendances, 866,000 non-elective admissions and initially 18 hospitals, to show that inpatient length of stay and hence bed availability is highly sensitive to the ward arrival-hour of patients... across all specialties."  Slides here.
 
In other words the time of day you pitch up on the ward seems to count.  Big time.  The knock-on effect, on discharge and all the rest... you don't need me to spell out.
 
McGirr tells us:
 
".. patients admitted in the afternoon and evening (ward arrival time) can have up to a three-day longer hospital stay than patients admitted in the morning.  Moreover, admission hour appears to be a stronger predictor of length of stay (LoS) than admission day.  Elderly patients exhibit the greatest variation in LoS by admission hour."
  
He goes on to say:
 
"Observation suggests that the increased LoS seen [in the data], is, in part, attributable to the comparative down-scaling of clinical resource in the afternoon and evening period and the significantly reduced probability of 'senior doctor driven care planning' for afternoon and evening admissions."
 
I realise I have unleashed the hounds of hell and data demons and even I can see why there might be benign explanations about some of the variation. And, I'm braced for the angry emails telling me 'where I work everyone is everywhere all the time...' 
 
I'd rather you contacted Seamus, if you ask him nicely he might analyse your data!  But, d'ya know what; we can't keep on ignoring this kind of work.  There is something going on.  Day of the week, time of the day.  It is starting to matter.  If the NHS were a store and they were talking customer flows... I can promise you; they'd be all over it.
 
Here's the deal; data-wallahs, fuming GPs, upset consultants or irate junior doctors do not write to me.  It is not personal. 
 
I just think; if we all agreed making our hospitals seamless... as safe as the safest day and the safest hour in that day...every day... everywhere... every time... it would be a good thing.

And, if, together, we tried to extract some sense from data and not snuff it out... talk to each other about it instead of shouting at each other over it...  we might be doing something good.
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Stephen Dorrell
Former Secretary of
State for Health
Chair of the Confed.
'the reforms were the biggest mistake of the Parliament'
Last few tickets.
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Gooroo
Writes exclusively for us
 'An end to Annual planning'
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This is what I'm hearing;
if you know different,
tell me here
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>> I'm hearing - there's another review on the way.  This time it's 'digital'.  Big names rolled in to tell us what we already know.  At what cost?  Dunno.  (Exclusive here from the HSJ that may be £walled)
>>  I'm hearing - a huge umber of Trusts will have to breach the agency spending cost cap.  Monitor is going to be busy say ing 'yes'.  If they say 'no' and there is a quality failure you wouldn't want to be the person who refused.
>>  I'm hearing - the LMC conference is discussing the end of the GP independent contractor status; if they're talking about it, well...
>>  I'm hearing - up to 3,000 pharmacies could close; that means 10k job losses.
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