Hospital mortality- fact or political smokescreen?

stock-footage-sick-diabetic-women-in-hospital-room

For those of you who read this blog in the USA, where our National Health Service (free at the point of entry, paid for by taxation) is frequently vilified as inefficient and a yardstick for poor patient care, the news today will no doubt support the stereotype you have been given.

Inspectors sent into hospitals with higher-than-expected death rates found evidence of poor practice such as too few staff, inadequate infection control, patients left unmonitored on trolleys for long periods and badly maintained operating theatres, Jeremy Hunt has said.

The health secretary cited the problems uncovered by an inspection team led by the NHS medical director, Prof Sir Bruce Keogh, into mortality rates at 14 hospitals in England, as he confirmed that 11 of them were being put into “special measures” to push through urgent improvements to patient care.

The Guardian

The NHS lives on in the affections of the British People like some kind of slightly eccentric aunt who is always there when we need her, but is someone we would rather not invite for Christmas dinner. Or at least this used to be the case- until these stories started to dominate the headlines.

We are starting to see a polarisation of attitudes- on the one hand, we have a government whose main party (the Conservatives) are instinctively against public sector spending, and see an opportunity for opening up the hugely lucrative health sector to the white heat of the market forces, whilst on the other hand, others see this whole episode as a smash and grab raid. This was one of the comments made below the Guardian article above which sums things up rather well;

Reduce staffing levels by cutting funding.
Watch as lives are lost due to this.
Blame the NHS at large for the failings.
Cut more funding as punishment.
Repeat until Privatisation.
Profit.

Except, anyone with half a brain who takes time to look at the basis for these claims will understand that the reality is far from simple. The NHS is a highly complex system, full of endless variation- departments that work well hampered by poor professional relationships with key partners, good management but funding shortages, adequate resources but staffing shortages, areas of total excellence in hospitals that are ordinary etc etc.

The other thing that we have to note are the statistics that the claims of an NHS crisis are being based on.

Check out this summary of the problems of the Hospital Standard Mortality Ratios (HSMRs).

Or this account of what the data means from the Guardian.

There is no doubt that the NHS provides health care to each and every member of this country that is the envy of most of the world. What is more, it does this too everyone, regardless of their spending power, or (as in the US) the quality of their health insurance package (which may well be the same thing.) To any of us who have worked in and around the NHS it is also more than clear that the system is not perfect- no system ever is. It needs constant improvement and review.

But what might kill it in the end is if it becomes a political football used to wage an ideological war.

One further thought about hospital mortality. There will always be variation in hospital mortality rates- but what is the primary cause of this? Is it poor hospitals? Staff who do not care? Bad management? And even if these things play a part in the whole, what is the largest causal factor?

Remember the Black report back in 1979?

Or the Marmott Review as recently as 2008?

The Guardian summarises it all like this;

• People living in more deprived areas are more likely to die in hospital
• Greater deprivation is often found in areas where there is more inequality – i.e. where there’s a large gap between the life expectancies of the richest and poorest
• The impact of poverty on life expectancies appears greater for man than women.

It may be tempting for the media to focus on headline numbers in today’s report but they are unlikely to find any. The NHS medical director has signalled:

However tempting it may be, it is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths.

What’s clear is that several factors contribute to mortality rates and without being able to hold these constant, it is impossible to say how many deaths resulted from weaknesses in the 14 hospitals identified.

I am no conspiracy theorist- but I do think that the Conservatives are seeking to make political capital out of these figures- and to give a message that suits a portrayal of a crisis that is simply not there.

And I also believe that the NHS, in all its cluttered glory, is worth fighting to save, to improve, to celebrate as something that we Brits should be proud of.

One thought on “Hospital mortality- fact or political smokescreen?

  1. The Conservatives have waited years for the right political/ economic climate to wage war on all parts of the welfare state – Benefits, Education, and NHS are all casulties of this ideological battle. We live in hard and dangerous times for many people but when all is said and done ……. I would still invite her round for Christmas.

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