11th May 2016

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Health Chat
Lord Carter in conversation with Roy Lilley
King's Fund 18th May
Drinks, networking details here.
News and Comment from Roy Lilley
It's a simple question; how safe is a hospital at the weekend?
It's not rocket science. Try the car-park test.  Look at any hospital staff car-park at the weekend... then have another look on Tuesday.  A hospital on a Sunday has a very different look.  

Something tells us the weekend has arrived; does it matter?

The weekend when, if you are lucky enough, life changes gear, the weatherman is always wrong, the right company arrives on your doorstep and the rust of the week is cleared away.  For others; one day is much the same as the rest. 

Do we expect the HR department, the finance family and everyone else to be around seven days a week?  No. 
Do we expect to be admitted to hospital on a Friday and sit tight all weekend, 'till the consultant turns up, or the imaging people are open for business, or someone somewhere can take some bloods and do this test or that?  No.
Do we expect the big brains of the NHS to be locked in combat over which is the best day to be admitted?  When is a good day for a dying? No.
It seems obvious to me that there is 'something' going on over weekend admissions but like everyone else; I don't know what!
Think about typical medical admissions.

There are two ways for yer granny to be admitted over the weekend.  The first is blue-light, through the front door of A&E.  The scenario is familiar;  she has no one to make her enough cups of tea and gets dehydrated, has a UTI, gets giddy, falls over, found in a heap by a neighbour.
Neighbour dials three nine's and ambulance carts her off.
Second granny; maybe had a bit of a dicky week?  Son turns up on Sunday, with a bunch of petrol station flowers, doesn't like the look of her and calls the OOH service.  Locum GP turns up, decides she can't be left.  Number-one son has to get back to his kith and kin.  Not a lot of options but to admit her. 
Two common scenarios with a dozen or two derivatives.  The paramedics a might have given granny a once over and bag of Baxter's.  The Locum might have access to an outreach team?  A Vanguard service might be across it all.
Without any of the good stuff... what happens next is anyone's guess.  In some hospitals, that are 'weekend blind' granny is given the works.  In others she might be parked.
Getting her home again is a whole different story.  In some hospitals health and social care are intertwined, in other places they are tied up in knots.
Add to the concoction somebody, somewhere, miscodes the whole process and a bunion becomes brain surgery and a UTI becomes an MI.
Depending on how you do the numbers, if granny dies within 30 days of a weekend admission, it could be counted as a 'weekend death'.  In another set of numbers, only the granny that was admitted through A&E would be counted.  In another data set the GP admission would count.
Mystified?  No, it makes me cross.  It's Guantanamo Bay data management; if you torture numbers enough, they will tell you anything.
We are counting on you to count and if we can't count on the way you count, there is no point in counting.
Are hospitals safe on a weekend, or is it their weak point?  It's a simple question to which there would appear to be a row but no one can get all the ducks in a row.
I seem to recall Germany and Sweden struggle with the 'weekend effect'.  To make everything worse the 'problem' has become imbroglio with politics.  The junior doctor's fiasco has cast a deep shadow over what should be a source of concern and pride.  How can we make our services safer?  What is wrong with that? 
Academia is locked in a civil war.  I'm past caring.  Somebody is right, somebody is wrong.  Everyone could be wrong, everyone might be right.  I've lost interest in the whole, point scoring, my numbers are bigger than yours, thing.
Look at it this way; if our hospitals are generally safe, what's wrong with striving to make them safer still?  Not just on a Wednesday but a Saturday, too.  What is wrong with the simple ambition to make our NHS the first, truly 7-day, seamless, safest service in the world?
Ok, I know, right now, we don't have enough doctors, nurses and everyone else, to scrape through five days.  Is that a reason not work towards the time when we do?  Why shouldn't we sort out our game plan and strategy to make it happen?
What's wrong with ambition?
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if you know different,
tell me here
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