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Mid Stafford Hospital report

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Mid Stafford Hospital report

Post by blueturando on Thu Feb 07, 2013 4:07 pm

First topic message reminder :

The 1,700 page report has been released into the serious lack of care & compassion at Stafford Hospital that resulted on 1,200 premeture or unnecessary deaths between 2005 and 2008.

My questions is......Why has no one been sacked or prosecuted over these deaths?

My other query is......I would expected a big expose on cutting edge on this issue from the likes of Skywalker or Ivan as they usually do on such matters of importance, in particular the NHS. An expose out lining where the blame lies and what should be done to stop this happening again......... but the silence is deafening......Not a single mention, not even a faint whisper
My conclusion (which I knew already) is that the 'Left' has no concerns for the people/general public, only for political power. Subject are only worth discussion when there is an opportunity to slander the Tories, but as this was on Labours watch then the subjust and all those unfortunate people and grieving families must be ignored.

My hope is that the less militant posters on here will recognise the hypocrisy and total lack of 'giving a sh*t' from the left and realise that all Labour and their supporters desire is power and the people of this country will always come a distant 2nd to that need.

I await the lack of serious response to this charge

blueturando
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Mid Staffs: one 'excess' death, if that

Post by skwalker1964 on Tue Feb 26, 2013 4:01 pm

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Mid Staffs: was it what we’ve been told?

(Many links to sources in this article - for those please visit the original at [You must be registered and logged in to see this link.]

What I’m about to write is likely to make me very unpopular with some people. While I’d prefer to avoid that, the issues and the truth about them are too important not to write it.

A couple of weeks ago, I wrote a couple of articles about the Mid Staffs NHS (MSNHS) report by Robert Francis, and about David Cameron’s reaction to it. These articles focused on the political implications of the events and the report, and on setting the reported death figures in context, rather than on the veracity of the figures themselves and the story behind them. Although I touched on the fact that the wide range of the figures given - 400-1200 – showed how uncertain they were, like everyone else I assumed there must be some truth to them, because they were so widely reported and so seemingly uncontested.

Not only the more lurid newspapers like the Sun, but also the ‘respectable’ press and media have reported the 400-1200 figure as fact – and continue to do so, the relevance of which we’ll see toward the end this article. Only a couple of weeks ago, a politics round-up programme on BBC Radio 4 included these figures as simple fact in their comments on David Cameron’s Commons speech on the Francis Report – and none of their guests there to talk about the issue raised even a murmur of contradiction.

The idea that 400-1200 ‘excess’ deaths took place during a period from 2005-2009 has been repeated so often, with such a complete absence of dispute (unless you knew where to look), that in the public consciousness it has become, to all intents and purposes, a fact.

But it is an idea without any basis in fact.

If you’re a regular reader of this blog, you will know that I believe in research – in drawing together facts and making conclusions based on them. I am no stranger to research and to the effort and time that have to go into an article to be able to make credible statements. But the preparation for this article has taken that investment of time and attention to another level.

My research for my earlier articles on Mid Staffs had led to some even more fundamental questions in my mind that I had to investigate. If you’ve noticed that this blog has been quieter than normal for the past couple of weeks, it has been because almost every spare moment over that period has been spent in researching this post – reading transcripts of witness statements to the Francis Inquiry, investigating the comments and opinions of others on the MSNHS issue specifically or the issues around the use of statistics in general.

What was starting to become apparent to me about the whole Mid Staffs issue was so deeply at odds with the prevailing perception that I had to read more widely and deeply than ever before in order to make sure that I was perceiving correctly.

Because the issues are so complex, and the evidence I could use so abundant (I’ve read well over 1000 pages over the past couple of weeks and will leave out of this article far more than I can put in), that even my best efforts to distill them into conciseness will still leave a post that will take patience and attention for anyone to work through, I’m going to break from the normal ‘good form’ that would mean putting the reasoning and evidence first and saving the conclusion until last.

Instead I’m going to state the conclusion first, and then list the evidence and narrative around it, so that those who wish to and who have the patience to can read through it and satisfy themselves that the conclusion is justifed. So here is that conclusion, along with a very brief justification:

There were no ‘excess’ deaths at Mid Staffordshire NHS during the 2005-2009 period in which the news media and anti-MSNHS campaigners claim there were 400-1200 of them – or, in the words of the independent clinical expert who led the ‘Independent Case-Note Review’ (ICNR) into each individual, contentious death at the Trust:

maybe one

This information has been in the public domain since at least 2010 – but I doubt if you could find a single reference to it in the mainstream media. “One person might have died!” does not sell newspapers, or gain viewers, in the same way that “400-1200 unnecessary deaths!!!” does, I guess.

You’re quite possibly thinking to yourself, “What?! How can that possibly be correct?” Here’s how.

In 2009, Dr Mike Laker was asked to conduct an independent review into the detailed case notes of every contentious death at MSNHS during the period in question. To identify which cases needed reviewing, the Trust offered all patients who had been treated by the Trust, or their families, the opportunity to ask for a detailed case note review – and ‘detailed’ is the right word: each review would take 5-6 months to complete, so a large number of expert, independent clinicians were needed to complete the process within a reasonable timeframe.

60 such requests were received – which already puts a massive question mark against the figures of 400-1200 ‘excess deaths’. In the course of the review, Dr Laker eventually interviewed 120 families and edited the case notes of 40-50 cases. He was asked by Tom Kark, Counsel to the Francis Inquiry, how many ‘excess deaths’ had occurred among the cases he had reviewed. Mr Kark related Dr Laker’s answer in his ‘final submission‘ to the 2010 inquiry:

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‘Perhaps one such death’ – so maybe not even one. People die in hospitals every day, of course – but as far as unnecessary, avoidable deaths caused by negligence or malpractice, the detailed, intensive reviews of all the deaths where relatives were dissatisfied enough to ask for one uncovered ‘perhaps one’.

Dr Laker is no ‘stooge’. His comments, which you can read about in the ‘final submission’ link just above, also included strong criticisms of the organisations overseeing the ICNR. He successfully had the overseeing body changed from the Trust itself to the responsible Primary Care Trust (PCT), to ensure independence, and also stopped the Trust from accessing the case review findings before they went to the families. His findings were not those of a man trying to court favour from, or minimise embarrassment for, the establishment – yet he still could only find ‘maybe one such death’.

In terms of demonstrating that the media portrayal of the story and the underlying reality bore no relation to each other, I could ‘rest my case’ here. But in order to understand why and how the false story that has so permeated the public consciousness came to do so, we need to look in more detail at other aspects of the background, the witness transcripts and the advice/opinions of other experts.

What this examination will reveal is a story of:

- overstretched and struggling hospital staff unable to provide the ‘basic care’ that any health professional would wish to, but managing just about to hold things together even though things weren’t pretty (and a ‘drinking from vases’ claim that appears to have been almost entirely fabricated)

- commercial conflicts of interest and over-stated claims

- statistics that could never say what they were made out to say, even if the data-input was perfect

- data input that was anything but perfect, creating an even more false picture

- bereaved relatives lashing out understandably but excessively

- most critically, collaborating political and media interests spinning a story in a wholly false way for their own ends

The (very truncated but still lengthy) details follow. You may prefer to skim the headings and choose the areas of immediate interest to you to read in detail, and then come back later for other sections as required. I leave that to your preference, but please make sure at least to read section 6, which examines the reasons why the misleading figures have been propagated and exploited – and by whom and why.

1. Even in an ideal world, HSMR is no ‘Ronseal’

The public furore over Mid Staffs began as a result of a set of statistics called ‘Hospital Standardised Mortality Ratios’, or HSMRs which – it appeared – showed a significantly higher ratio of deaths at MSNHS compared to the national average. At no point did the statistics or any report on them name a number of avoidable deaths, either in the 400-1200 range or any other figure. Robert Francis stated this unequivocally on the first day of hearings for his second report.

The reason for this is simple: even working perfectly, the HSMR system is neither designed nor intended to identify ‘unnecessary’ or ‘excess’ deaths, nor is it a measure of quality and safety in a particular hospital (the owners of the system did claim the latter, but backtracked on the witness stand). Chapter 5 of the 2013 Francis Report states the following (which again you will struggle to find in any media reports referring to Mid Staffs:

to this day, there is no generally accepted means of producing comparative figures, and unjustifiable conclusions continue to be drawn from the numbers of deaths at hospitals and about the number of avoidable deaths.

In the context of the careful, neutral wording used in official reports as well as the commercial sensitivities around the HSMR method and the vociferous and aggressive tendencies of the anti-Stafford campaigners, Francis might as well be putting up in neon lights: “HSMRs do not say what you’ve been told they say!

Or take this exchange between Mr Kark and Roger Taylor, the Director of Research and Public Affairs for DFI, the company that supplies the HSMR data:

K: Can I just ask you this, we’ve heard a lot in this inquiry about how HSMRs might be used as no more than an indication of risk or a need for further attention in a particular area. Did the 2007 publication put the significance of HSMRs too high, calling it an effective way to measure and compare clinical performance safety and quality?

T: No, I — I don’t believe it did. I think it is an effective way to do exactly that. However, I will add to that comment the point that it’s really important to remember that in measuring clinical outcomes and clinical performance there are no perfect measures..

K: Does that mean to say that when the HSMR is above a certain level, and that is to say, if I can get my terminology correct, above certain control limits, it’s not just a tool to identify risk, but it is an effective measure of safety?

T: I’m saying an effective measure of safety is one that helps you identify the risk of something being wrong.

Kark asks Taylor about how the HSMRs can legitimately be used and Taylor fudges initially – but when he is asked directly whether HSMRs can provide an effective measure of safety, he backtracks and says it can only identify where there is a risk that something might be wrong.

Professor Brian Jarman, the creator of the HSMR system, made a statement in his evidence that demonstrates that quality of care and HSMRs are by no means automatically linked:

Now, you’re not going to measure the quality of care of pacemaker insertion by measuring the mortality because, you know, that’s – they are very low.

Similarly, the 2010 inquiry put out a ‘Joint Statement’ on the usefulness of HSMRs which included the following statement:

Along with other indicators, they can usefully help us to understand comparative information about in-hospital deaths. But they have limitations, and should not be used as a sole indicator of patient safety. To do so could potentially give a misleading interpretation of a hospital’s safety record. They should be used with other relevant indicators as a tool to support the improvement in the quality of care.

And the clincher comes (again) from Roger Taylor, as he is asked by Counsel about the link between HSMRs and the media claims about the numbers of ‘excess’ deaths:

Q. Where does Dr Foster stand on the portrayal of the figures about Mid Staffordshire as indicating or showing that there were 400 to 1,200 unnecessary deaths?

A. ..that is a misuse of these data.

Some 300 different indicators are used to assess hospital safety and quality. Even in perfect circumstances, with everything functioning as it should, HSMRs can only perform a small role in this assessment – effectively a signal to say ‘take a look, just in case something is wrong’. Using them to state anything beyond this is ‘misuse’.

1,2,3,4..

Another important indicator lies in the guidance provided by the company that owns the HSMR system to Trusts that find themselves with a high mortality ratio. This guidance takes the form of a list of recommended actions:

1) Check to see whether incorrect data has been submitted, or whether an approach to coding which differs from other organisations’ approach has been adopted

2) Consider whether something extraordinary has occurred which explains the result

3) Consider whether their healthcare partners work in ways which are different from those in other areas

4) Consider whether there are any potential issues with regard to the quality of care

The 2nd Francis Report criticised MSNHS for focusing first on whether the high HSMRs were caused by coding issues – but DFI’s own guidance to Trusts on what to do in the case of high HSMRs puts ‘check coding’ at number one in the list of actions. By contrast, checking whether there are actually any issues with care standards is down at number 4.

If even the owners of the system consider that there are 3 factors more likely to affect high HSMRs than actual poor care, can anyone seriously consider that the system is accurate, robust and reliable enough to provide an actual number of ‘excess deaths’ – even in perfect circumstances?

And yet the media continue to report the figures as fact. Since they can’t be unaware of all the above statements and factors (and many more that I’ve had to choose not include for the sake of some semblance of readability), then one has to ask ‘Why?’ – what is the real agenda?

A moving target

One of the key weaknesses with the HSMR system is that it is based around a ‘standard’ score of 100 – which is ‘rebased‘ every year. In simple terms, the statistics take an average score for all the hospitals in England and call that ’100′. Hospitals scoring worse than average get a score above 100, while hospitals scoring better get below 100.

But what ’100′ means moves every year. In the words of Professor Jarman:

we do for the simple — simple-minded English, if you like, adjust it so that the English value was every year.

(That Prof Jarman considers the English simple-minded and unable to handle a figure that isn’t simplified every year is interesting, given Roger Taylor’s testimony that DFI considers the public to be savvy enough to realise what you can’t do with its figures, even if the media are all screaming ‘Excess Deaths!‘)

This ‘rebasing’ means that a hospital can have exactly the same performance in a given year that it achieved in the previous one, and still show a worse HSMR because the overall average moved down. Similarly, if some hospitals are ‘gaming’ the system to improve their score (a possibility that the creator of the system, Professor Sir Brian Jarman acknowledged in his testimony to the 2nd inquiry), they will bring down the average so that ‘honest’ hospitals appear to be doing badly.

But even if nobody cheats, a hospital can be doing well, as well as it’s ever done, and still appear to be sliding down the performance table.

2. Rubbish in, rubbish out

We’ve just seen that, even if everything around the HSMR system is functioning perfectly, HSMR cannot be used to identify a number of ‘excess’ or avoidable deaths. But as a reading of the inquiry transcripts will quickly show, things were about as far from perfect as they could possibly be in terms of the data that was entered into the system – both nationally and, especially, in the case of Mid Staffs NHS.

One fundamental thing needed for any correct understanding of the issues surrounding MSNHS’ HSMR scores is the knowledge that, for most of the ‘problem’ period at the Trust, it had no coding manager.

The data on which HSMR scores are calculated are based on codes that have to be entered for each patient treated. These codes relate to the condition from which the patient is suffering, and an ‘expected’ death rate is allocated to each condition measured for HSMR purposes. If a hospital shows a higher rate of deaths for a particular condition than the expected rate, this pushes up the overall HSMR score for that hospital. If it shows a lower rate, that helps bring down the HSMR score.

Let’s take a simple example. ‘Fractured neck of femur’ (FNOF) is a fairly common result of falls in elderly people – and a serious one. Out of every 10 people, nationally, who go into hospital with this condition (which in layman’s terms might be called a ‘broken hip’), on average one will die as a result of complications arising from the initial condition. If a hospital loses more than 10 patients with FNOF for every 100 it treats, it will have a relatively high HSMR for that condition. Each condition has its own rate of expected deaths.

But there are serious problems with both the basic principles of the coding and with how it was done at MSNHS – and remember, Mid Staffs’ coding manager was on long-term sick leave for most of the period in question.

First or primary diagnosis

The rules of HSMR coding state that the first ‘non-vague’ diagnosis – sometimes referred to as the ‘primary diagnosis’ - for any patient when they enter hospital for an ‘episode of care’ must be used to determine the coding. But this is full of dangers in terms of measuring mortality rates.

If a patient enters hospital with, for example, a broken tibia (shin-bone), you would expect this to have a low death-rate – dying from a broken leg is pretty rare. The ‘first non-vague diagnosis’ is obviously going to be ‘broken tibia’. But if it is subsequently discovered that the bone broke because it was eaten through by an aggressive, spreading cancer, the expectation of death would clearly be completely different.

But, following the rules of HSMR coding, the code that is entered is the one for a fractured tibia – and the death will seem very unexpected and so will worsen the HSMR score.

Junior doctors

Junior doctors work long hours in an intense environment. They are often the first medics to assess and diagnose a patient, and they are unlikely – unless the importance is hammered home to them very hard – to consider it too important to put the right code down for a patient they are treating. Being junior, there is also a higher likelihood of them misdiagnosing or missing a condition when a patient is first examined.

MSNHS’ investigation of its coding, once it had a new coding manager in place, showed that there was a major problem with the coding entered by junior doctors.

POA

In his testimony to the 2nd inquiry, Prof. Jarman confirmed that his system did not ‘adjust for’ secondary diagnoses unless they were ‘present on admission’, or POA. In other words, if a condition – no matter how serious – isn’t either spotted by the doctor or otherwise known about when a patient is first treated, it’s ignored for the purposes calculating HSMRs. But Prof. Jarman made a key admission:

70 per cent of PMA (sic) — present on admission diagnoses are the same as the primary diagnosis.

In other words, in 30% of cases there is a discrepancy – 30% room for the figures to be skewed by a primary diagnosis of one thing when a serious condition might be present that would push the expected death rate much higher. So even if everything goes as planned, there is a known potential for variation in the system of as much as 30%.

Co-morbidities

‘Co-morbidities’ is the medical term for ‘other stuff that’s wrong with you’. So if you’re in for treatment on an ingrown toenail, for example, but you also suffer from congestive heart-failure and lung-disease, there’s a much higher chance you’ll die while you’re in hospital – and it wouldn’t mean the hospital did anything wrong. But the ‘episode of care’ is for treatment of an ingrown toenail – which would have a very low expected death rate.

The HSMR system does allow co-morbidities to be entered (based on the ‘Charlson Index‘)so that they are taken into account – but if these are wrongly entered or not entered at all, the figures will look as though you died from an ingrown toenail.

The investigations into coding at MSNHS showed that there were substantial problems with the coding of co-morbidities, probably because of the absence of the coding manager combined with problems of under-reporting of co-morbidities by consultants.

Z51.5 and the ‘parade ground’ effect

One the major problems with Mid Staffs’ HSMR scores that I found in my reading of the transcripts was in a change that was made to the coding system to include code Z51.5 – a code to indicate ‘palliative care’. A patient receiving palliative care is suffering from an incurable, terminal condition and is being treated to relieve pain, make him/her comfortable etc. At some point he or she is going to die from the condition – so the expected rate of death during any given ‘episode of care’ is going to be relatively high.

For the sake of brevity, I won’t go into every detail, but when the change to include Z51.5 was made, Mid Staffs’ coding did not change to include it. Since other Trusts were now using a code with a high expected death rate that would lower their HSMR score, and because this would affect the ‘rebasing’ and move the ’100′ benchmark, this had the same effect as a rank of soldiers all stepping back at the same time except for one – he would appear to be standing out in front without having moved at all.

‘Zero stays’ and 30 days..

Another thing that came out during Prof. Jarman’s evidence was the effect of two particular peculiarities in the way that Mid Staffs was coding its patients. The first of these is the ‘zero days’ stay’ category (which actually includes stays of up to 1 day).

MSNHS was not including in its coding any patient who came for treatment and either didn’t stay in hospital at all or only stayed one day. Since the vast majority of patients who come into hospital and leave again in a day or less will be there for treatment of mild conditions (or mild manifestations of potentially serious conditions), the rate of deaths among such patients would be very low. This would have the effect of ‘concentrating’ the death rate at Mid Staffs (by reducing the total number of codes and taking out almost exclusively patients with good outcomes). Since all or almost all other Trusts were including these patients, their death rates would be ‘diluted’ by the ‘zero stay’ patients – again causing, or accentuating, the ‘parade ground’ effect and making MSNHS look worse without necessarily being worse.

Conversely, Mid Staffs was also negatively affected by the lack of ’30 day coding’ in HSMRs – codes allocated according to the outcome 30 days after discharge from hospital.

If a hospital discharges a patient early, who then dies outside the hospital, this is not reflected in the HSMR. But if a hospital keeps a patient longer to make sure he/she is fit for discharge, or is unable to discharge an elderly or infirm patient because of the lack of non-hospital care facilities, and the patient then dies, the hospital effectively suffers in its HSMR because it did the right thing.

The 30-day effect might not only occur because of irresponsible discharge of patients. If a hospital has a hospice nearby and can discharge terminally ill patients for palliative hospice care, the patients will die in the hospice and this will improve the hospital’s HSMR even though the patients still die.

Professor Jarman repeatedly claimed that the effect of correcting codings for co-morbidities and palliative care would be very small, but this claim appears highly questionable.

Firstly, the ‘parade ground’ rebasing effect when the Z51.5 palliative coding was launched in other hospitals caused Mid Staffs’ HSMR to rise by 13 points, from 114 to 127 – a serious change.

The group ‘Straight Statistics’, a “pressure group whose aim is to detect and expose the distortion and misuse of statistical information, and identify those responsible”, wrote an article examining the reliability of HSMRs and particularly the effects of errors/corrections in coding. The article included an examination of the relationship between ‘depth of coding’ (how many co-morbidities were recorded alongside the main diagnosis), which varies widely across Trusts, and HSMR.

Quoting a response from Prof. Jarman’s organisation ‘The Doctor Foster’s Unit’, the article says:

a hospital using only 2.5 codes per patient would show an HSMR about 15-20 points higher than one using 5.5 to 6 codes per patient

15-20 points is not ‘very small’. The number of codes per patient at Mid Staffs is not stated – but with no coding manager in place and proven issues with uncoded co-morbidities, it is certain that it was at the low end during the period of high HSMRs.

When the new coding manager joined MSNHS, she carried out a re-coding exercise (apparently 2, in fact, since the first one over-corrected). According to evidence given by acting Chair of the Trust David Stone in 2009 to the Health Scrutiny Committee, once the correct re-coding was done, Mid-Staffs’ HSMR score was:

88

Just in case there is any lingering doubt on the fact that coding can have a massive effect, we’ll leave the last word to Professor Jarman. Just 8 days ago, he sent the following message on Twitter:

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Prof Jarman’s telling tweet.

PwC is PricewaterhouseCooper, a huge firm that carries out detailed audits and analyses – and it found a 25-30% difference in Mid Staffs’ high HSMR code due to incorrect coding.

Rubbish in, rubbish out..

3. Conflicts of interest and exaggerated claims

The HSMR system is run by Professor Jarman’s Doctor Foster Unit (DFU), which is part of the faculty of medicine at Imperial College. DFU receives the majority of its funding, confusingly, from Doctor Foster’s Intelligence, or DFI. DFI is a commercial, profit-making company (although 47%-owned by the Dept of Health). DFU calculates the HSMR scores for hospitals free of charge.

There is no suggestion, that I can make out from the transcripts, that DFI or DFU deliberately skewed any figures in the HSMR index for commercial gain. However, DFI does publish an annual ‘Good Hospital Guide‘ that includes a ‘league table’ of HSMR rankings. Based on these rankings, DFI attempts to sell to Trusts its ‘Real Time Monitoring’ (RTM) service for the sum of £35,000 per year. This service provides ‘alerts’ to customer Trusts about areas where HSMR is poor or starting to slip, so that the Trusts can take corrective action – and can optimise their position in the Good Hospital Guide. From Roger Taylor’s evidence to the 2nd inquiry:

Walsall hospital was named as the hospital with the highest death rate in the first hospital guide in 2001, which they were not very pleased about..Walsall subsequently became very enthusiastic and started using the RTM tool.

An email from a senior DFI director in 2011 stated:

we ran a consultation on the indicators used before they went into the hospital guide in 2010..We alerted hospital trusts to this by writing to them and letting them know and through the Health Service Journal. We will do the same this year. Providing access to them in the tools we sell is the obvious next step.

The fact that DFI stood to gain financially from the creation and publication of league tables based on HSMR must cast serious doubt on the use of HSMR as a tool for assessing quality of care – especially since the information is made public – even if DFI were not deliberately exploiting the opportunity. Despite the fact that Roger Taylor stated in his evidence that he did not think this represented a conflict of interests, an impartial observer must recognise that there was indeed potentially such a conflict.

The fact that Mid Staffs knew that their HSMR position was going to be made public in this way must also have contributed to their focus on coding, which was criticised by the Francis Report – especially when DFI’s own guidance on how to respond to poor HSMRs put ‘check coding’ as number 1 on the list of actions.

Overstated claims

As was revealed during the testimony given by Roger Taylor, DFI’s 2007 publication had massively overstated the usefulness and significance of its HSMR data, calling it:

an effective way to measure and compare clinical performance safety and quality. Deaths in hospital are important and unequivocal outcomes.

As we’ve already seen, HSMRs are nothing of the sort, and the information that they give on deaths is anything but ‘unequivocal’. Mr Taylor initially denied that this was claiming too much – but under further questioning he eventually said, when speaking about focus groups made up of members of the public, that they show a

general scepticism of the ability to accurately measure quality of care. In which regard they are being, I think, pretty smart, actually.

If the public are being ‘pretty smart, actually’ to be ‘generally sceptical’ of the system’s ‘ability to measure quality of care’, then I think that calling the HSMR measure ‘unequivocal’ as a measure of ‘clinical performance safety and quality’ is without question an exaggeration – and a pretty big one. Especially when Mr Taylor also acknowledged that the output of the system is only as good as the data that’s put into it – and when, as Prof. Jarman put it in his testimony,

it depends how the coder codes it.

Such an exaggerated claim can only have fanned the self-fuelling flames of misleading publicity about the ’400-1200 unnecessary deaths’.

4. The top 3 factors in poor care at Mid Staffs: understaffing, understaffing and understaffing

There is no doubt that there was poor care in some parts of MSNHS. Various inspections that followed the initial public furore found that care in some departments was ‘appalling’. However, Robert Francis’ recommendation that individuals should not be pursued for events at Mid Staffs strongly suggests that the failings at the Trust were systemic rather than resulting from malice or neglect on the part of any one person or group of people, particularly front-line nurses and doctors.

This is supported by the statistics provided in Annex 1 (part of Volume 3) of the 2013 report which show that, over the 5 years covered by the report, the number of ‘serious untoward incidents‘ which were recorded at the Trust and ascribed to lack of staff was a massive 1,756 – an average of 351 ‘serious’ incidents per year attributable to short-staffing.

However, these ‘untoward incidents’ mostly represented failures of ‘basic care’ – cleaning, comfort and so on – rather than life-threatening incidents. Remember, the review of the 60 incidents (and interviews of 120 families) that were serious enough during this period for the families to accept the offer of a full case-note review resulted in ‘perhaps one’ avoidable death.

Patients were left in their own waste etc, which is a horrendous indignity that no one should have to suffer – but which is very, very rarely life-threatening. If staff numbers were too low, as the stats suggest, then nurses inevitably faced times when they were simply unable to do everything and had to prioritise.

I know from my many conversations with nurses from various hospitals that there can often be times when a patient’s ‘basic care’ needs have to wait – because all the available nurses were trying to help another patient breathe, or to keep him/her alive through a heart attack, or deal with sudden and serious haematemesis (vomiting blood).

At this point it’s worth addressing one of the most persistent myths of the ‘Mid Staffs phenomenon’: that ‘neglected’ patients were so thirsty, and so ignored, that they had to drink the water from flower vases.

Appalling if true – but flower vases were banned from the two MSNHS hospitals from the late 1990s, presumably for hygiene reasons. I’ve heard anecdotally that there may have been one incident in which a (probably confused) patient was allowed a vase as an exception, and did drink from it – but the idea that this was more than a one-off appears to be entirely unfounded. Instead it appears that the media spun out a one-off into a regular incident for the sake of lurid headlines.

Nurses feel terrible about those who have to put up with indignity or discomfort – and relatives of those patients frequently fail to understand that their loved ones are only suffering ‘neglect’ because nurses had to choose between that and allowing someone to die or suffer horrible fear and pain.

It’s awful and it should never happen – but it will, as long as wards are not fully staffed according to not only the number of patients but also the severity of their conditions and the level of their dependency. And under this government, it will happen more and more.

Which leads me on to my final sections – which I’ll try to keep brief because this post is already more than long enough.

5. The viciousness of grief, the cynicism of politicians and the collaboration of the media

Just last weekend, the Guardian’s online edition carried a call from a relative of someone who died at MSNHS for ‘heads to roll’. This same lady – to whom my heart goes out for her loss – was also heard, at a public meeting of anti-MSNHS campaigners, to call

Let’s shut the hospital, let’s sack all the staff!

Losing a close family member is a horrible experience – I lost my mother after a long and gruelling battle against ovarian cancer 9 years ago. But surely, someone who would rather have no hospital and see thousands of doctors, nurses and other health staff, most of whom she can never have met, made unemployed because of her grief and rage is not thinking straight.

One can understand and sympathise, certainly – and I do. But it must be a foolhardy decision indeed to allow someone who is in such a state of mind to influence policy and to invite him or her frequently to influence public opinion via media interviews and articles. When deciding the fate of health services that about a quarter of a million people rely on, ‘cool heads’ surely have to prevail and decisions made must rest on logic and fact, and not emotion and grief.

And a person or entity that would exploit the grief of such a vulnerable person would be reprehensible indeed.

Which leads me to my final section:

6. Politics, media and exploitation

In my opinion, it’s extremely telling that the ‘media mentor’ of the anti-MSNHS group was the Conservative MP for Stone in Staffordshire, Bill Cash. Mr Cash’s testimony to the inquiry makes perfectly plain that he understood absolutely none of the detail of what was happening at Mid Staffs and why. However, he evidently understood a political opportunity when he saw one, and he set up meetings for the group to promote its calls for a public inquiry.

Mr Cash was also associated with the first ‘leak’ of the supposed ‘unnecessary death’ toll of 400-1200 people to the Daily Mail. Mr Cash, it must be said, has denied being responsible for the leak, and there is nothing to prove that he was. The fact that the figures appeared alongside quotes from Mr Cash must at least raise the question – but the article also included quotes from the leader of the relatives’ group, so the provenance of the figures is uncertain.

It’s all political

At various points throughout his testimony, Prof Jarman refers to negative attitudes from the (Labour) government toward HSMRs – but then (from p.171 of the record) he reports a sudden change:

There has been an improvement, it seems, in [the Dept of Health’s attitude to the value of HSMRs.

In his view, this might be linked to the publication of the first Francis Report on Feb 2010. However, he is very specific about the point when the real change occurred:

But the statements in the White Paper of 12 July 2010 were very positive.

The white paper of 2010 in which the government published its outline plans that eventually led to the Health and Social Care Act 2012, under which they are decimating the NHS and at this very moment are trying to force through undebated, unvoted measures to force accelerated privatisation.

A Tory government takes power. Two months later it launches it’s ‘here’s one we made earlier’ blueprint for the destruction of the NHS – and ‘coincidentally’ it starts to take a ‘very positive’ attitude toward a tool that can make hospitals look as if they’re killing people even when they’re not.

A positive attitude in spite of the fact that Mr Francis’ first report contained the ‘Joint Statement’ that we’ve already seen about the weaknesses and limitations of HSMRs.

It doesn’t take a great deal of imagination to ‘put two and two together’ in a far clearer and more reliable way than the HSMR method.

What the papers say..

It’s also very significant that one of the most enthusiastic users of the spurious figures has been the Daily Telegraph – a ‘newspaper’ with a proven track record of NHS attacks for political purposes. The paper is on record as having co-ordinated articles on behalf of private health interests to help the passage of the invidious 2012 NHS Act and has even instructed sub-editors to leave anti-NHS material in an article to which it was irrelevant.

As recently as a few days ago, the Telegraph was still hammering the MSNHS issue – and just yesterday ran an article tarring the whole NHS with the Mid Staffs ‘brush’.

The desire for eye-catching headlines, improved circulation and journalistic laziness have all contributed to the spread of the myths about ‘excess deaths’ at Mid Staffs and the distortion of the public perception of what really went on there. But, without question, at its core lies yet another unholy alliance between the Tories and the right-wing media for the advancement of their multi-fronted, ideologically-driven assault on the NHS of which most of us are rightly proud.

In this context, it’s perfectly plain why David Cameron found it expedient to ‘eat humble pie’ and apologise on behalf of the country for the “horrific pain and even death” suffered by “many” (again propagating the myth). The recommendations of Robert Francis’ report include the closure of hospitals found to have similar problems to MSNHS; by accepting the report with crocodile tears and in sackcloth and ashes, Cameron has positioned himself to be able to exploit those recommendations as another excuse to close hospitals – alongside ‘rationalisation’, creating ‘centres of excellence’ and the financial problems of neighbouring Trusts (as the people relying on the successful Lewisham Trust have already found to their cost).

And, of course, to tarnish the image of the NHS in the eyes of a public that still considers the NHS the crowning achievement of our country.

The moral is clear:

Don’t believe everything you read in the papers – especially when it involves Tories and the NHS.

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Mid Staffs death-rate debate with journalist Shaun Lintern

Post by skwalker1964 on Thu Feb 28, 2013 11:37 pm

Original at [You must be registered and logged in to see this link.] hope you find it as interesting to read as I did to participate in!

Following a discussion on Twitter earlier today with Midlands journalist Shaun Lintern and various others today, it was agreed (because of the limitations of the 140-character format) that Shaun would post his comments on my blog and I'd respond.

He's done so this evening, but rather than answer within the limitations of a response to a comment, I think it's better to do so as a separate post, so I can place my answers alongside his points for clarity.

Shaun's points will be inset as quotes:

I usually like this blog and have worked with Stephen in the past however I feel it is incumbent upon me to correct what is essentially a misleading article that could be used by those wishing to deny the appalling care at Mid Staffs for their own ends.

Thank you for the initial kind comment, but as you'd imagine I disagree with many of your objections.

I have been involved with the Mid Staffs scandal for over five years, interviewed countless families and victims and sat through most of the 139 days of evidence to the Francis inquiry and so I consider I can speak with some authority on the issue.Stephen has made a number of assumptions, made I assume in good faith, which are incorrect and should be altered.One simple fact before I go into more detail is that we know hundreds of people suffered poor care at Mid Staffs. Robert Francis first inquiry had evidence from over 966 patients. Volume II of his first report is full of harrowing stories – so let’s all agree that this trust failed hundreds of patients and some did not survive their treatment. To suggest there were none and maybe only one excess death is a terrible insult to the many families I have personally spoken to and shed tears with over the last five years.

I'm personally disappointed with this opening point. My original article was very explicit in saying that there was poor care, and in some cases 'appalling'. Nothing I wrote suggested in even the vaguest way that there was no suffering. I assume there's no ill intent as we've got on well in the past, but the effect of this part of your points is to set up a 'straw man' and argue against something I have never said.

The second disappointing thing is the lax way you're treating 'excess', when I was very careful to use the terms according to their exact meanings as discussed by Francis' counsel and witnesses.

People die in hospitals all the time, and sometimes they die through neglect, malpractice or error. Some people will certainly have died in Mid Staffs through these causes, because they are inevitable in any large institution treating tens of thousands of people.

But that's not what 'excess' addresses. 'Excess', with regard to the HSMRs, means 'above the national average' or 'above a score of 100', which means the same thing. As we'll see shortly, the 'excess' deaths at Mid Staffs were down to errors in allocating codes and errors in inputting them.

Once these errors were corrected, Mid Staffs had a below-average death rate. This means that the poor care which undoubtedly existed was not causing a higher death rate - it doesn't mean (and I have not said) that nobody died.

Most poor care doesn't kill people. It may cause discomfort, even pain. It may well cause indignity and embarrassment. But people generally don't die from, for example, being left in their own waste for an afternoon.

Where the 'excess/avoidable' line does blur is in the statement from Dr Laker, as quoted by Counsel Mr Kark, that there was 'perhaps one such [excess] death'. It seems clear from the context that Dr Laker was thinking in terms of 'avoidable' and that he only found one case out of the 40-50 he had reviewed that might have been avoidable - but he (or Mr Kark) used 'excess'.

Since I was quoting, I wasn't free to change the wording and I make no apology for that. Again because it was a quote, I left it as was in the title - but in this case it also served a purpose. The limitations of title length on a blog (and even more so for the purposes of publicising it on Twitter) meant I needed a 'shorthand' to convey both the idea of statistical excess and that of 'only one avoidable' which Dr Laker clearly meant.

Here are a few quotes from Robert Francis QC who knows the facts better than anyone and cannot be considered anything but independent.“The evidence gathered by this Inquiry means there can no longer be any excuses for denying the scale of failure. If anything, it is greater than has been revealed to date. The deficiencies at the trust were systemic, deep-rooted and too fundamental to brush off as isolated incidents.“This is a story of appalling and unnecessary suffering of hundreds of people. They were failed by a system which ignored the warning signs and put corporate self-interest and cost control ahead of patients and their safety.”

Again, you're arguing against what I haven't said. My article is very clear that there was poor care. What I don't agree with is that the poor care led to a higher death rate, since that is not borne out by the evidence. People died, and some may have died because of poor care (or they might have died anyway if their care had been perfect), but the Trust's mortality performance against the national average was not worse because of it.

That doesn't make for such a gripping headline, but it's nonetheless true.

Let’s consider the mortality rate figures. Stephen is right in a sense that they have been misquoted by mainstream media, that does not mean it is wrong to say hundreds of deaths. Here are the facts.
It is often reported there were between 400 and 1,200 excess deaths at the Mid Staffordshire Trust between 2005 and 2008. This estimate is regularly attributed to the Healthcare Commission and its report on the trust published in March 2009.
In fact the figure never appeared in the HCC’s final report but was contained in a draft and was removed by the HCC chairman Sir Ian Kennedy following concerns raised by former Monitor executive chair Bill Moyes and then health secretary Alan Johnson. Sir Ian denied he was put under pressure to remove the numbers.
The figures were leaked to the press ahead of the report and have been repeatedly quoted ever since. In his first inquiry into the Mid Staffordshire scandal Robert Francis QC found the actual number of excess deaths between 2005 and 2008 was 492 and between 1996 and 2008 it was 1,197.

I took this up earlier with the Guardian's Randeep Ramesh on Twitter. Francis 1 did not find that there were 492 excess deaths from 2005-2008. That's a very sloppy (albeit understandable) interpretation of what it does say.

(Edit - here's a very apposite quote from Francis 1 that Richardblogger provided as a comment on the original post:

“Taking account of the range of opinion offered to the Inquiry, including a report from two independent experts, it has been concluded that it would be unsafe to infer from the figures that there was any particular number or range of numbers of avoidable or unnecessary deaths at the Trust.”
)

Francis 1 said that the statistical 'observed' death figure, minus the figure for 'expected' deaths left a figure of 492. This does not mean 492 avoidable deaths - it means a statistical excess of 492, which is not the same thing at all.

In such cases, it can be that the 'excess' was real - if every single piece of data entered is correct, and is entered correctly.

But because every condition has its own expected death rate, then if the 'first diagnosis' is wrong in some cases, or co-morbidities were not entered correctly, or the Z51.5 'palliative' code wasn't used when it should have been, then the 'expected' figure would be wrong - and therefore the 'excess' would be wrong too. If all 3 errors existed in the data, then the 'expected' figure could be massively wrong.

The evidence given to Francis 2 strongly indicates that all 3 errors were very present in the data. Along with the fact that the new coding manager's coding-correction exercise resulted in the revised HSMRs being below the national average, this makes it certain beyond reasonable doubt that the 'expected' death figure was massively wrong - and therefore the 'excess' likewise.

HSMRs are a statistical estimate, with all the associated problems that come with statistics, they do not relate to real people and it is true to say we will never know the true number of individual deaths at Mid Staffs as a result of poor care. You can’t say with certainty there were 1,200 deaths, neither can you say there weren’t.

There were certainly many more than 1,200 deaths - but there is no evidence at all, from the statistics, that more people died than would be expected to die anyway. Again, this is not to say that there wasn't poor care, or even appalling care in a few places. But the statistical appearance of 'excess' deaths doesn't stand up to an analysis of the data issues.

But the numbers for Mid Staffs were 27% per cent above the national average at their highest and coupled with the real families who have come forward it is quite clear the use of the word hundreds is perfectly accurate and could even under play the true numbers. Robert Francis himself has accepted the argument that hundreds of people were affected.

As observed by even Professor Jarman, PricewaterhouseCooper's analysis of the statistics and the data concluded that the figures were 25-30% wrong directly because of coding issues. This alone would bring down Mid Staff's HSMRs down to, or below, the national average.

The fact that the Trust's second, far more cautious recoding exercise brought the Trust's scores down further still means the level of distortion caused by data/coding issues may well have been even greater - but if you want to just go with PwC's figure, it still changes the picture completely.

Clearly in a news story the media cannot explain the statistical methods behind HSMRs without losing the interest of the reader or listener – I’m afraid Stephen has done exactly what he has accused the media of in the title of this blog and its conclusion.

I'll repeat what I said near the beginning of this response - this is because of lax use of the terms in your understanding of my article, when I was being very exact in how I applied them (except where I was quoting someone else).

Coding of deaths was of course a factor, but Robert Francis has examined this and he concluded it did not adequately explain the numbers of deaths and complaints coming out of the trust.

I don't believe that's true at all. In his 1st report, he left in the 'excess' figure of 492 - but it has to be understood in the exact statistical sense.

By report no.2, he had decided to leave out any mention of a figure. This strongly suggests he'd realised that the excess figure didn't stand up. Instead, he concentrates entirely on 'poor care' and 'suffering' - all of which are bad enough, but can be put down entirely (or very nearly) to understaffing (which is a regular refrain in Francis 2).

The issue of coding has been widely put forward by those wishing to downplay events at Mid Staffs and Robert Francis has repeatedly, and clearly, said it does not explain away what happened. It is a smokescreen behind which deniers of Mid Staffs and problems in the NHS hide.

For the reasons already outlined, this is a completely incorrect assertion.

HSMRs as Robert Francis, Sir Bruce Keogh and almost every other senior NHS figure have accepted are useful warning signs.

And I would agree: they are useful warning signs. But they can easily be a false alarm because of their dependence on the accuracy and correctness of the input - which nobody at DFI or DFU was checking. Neither body was providing any kind of adequate training to those entering the data or allocating the codes to improve the quality of the data either.

Wherever a trust has been found to have a high HSMR other significant patient care problems are often identified. Trusts with low HSMRs generally don’t. HSMRs, whilst not perfect, do serve as smoke signal for deeper issues.

'Wherever' is an over-assertion. During Brian Jarman's & Roger Taylor's testimonies, the issue was discussed of Trusts with poor scores who were then assessed as 'good' or 'excellent' by on-site assessments. Similarly, Trusts had been identified to have excellent HSMRs and then found to have poor care.

On the issue of rebasing HSMRs the point is that all hospitals will seek to have less patients die and continued improvements will try to be made. A trust that doesn’t improve its mortality from one year to the next, while the rest of the UK does, should surely be a concern to be highlighted and the rebasing would serve as one method to do this.

It's perfectly possible that a Trust is doing very well in regard to mortality and is honestly and correctly entering its data, but appears to be standing still or getting worse because of improved performance or dishonest coding at other Trusts. Prof Jarman touched on this when he mentioned that in other countries they don't rebase, but allocate reducing/increasing scores to reflect changes in performance, rather than resetting what '100' means every year for the 'simple-minded English'.

The Laker review.
Dr Mike Laker, who led the Independent Case Note Review, was NOT asked to look at every contentious death at Mid Staffs. This review was made available to those families who REQUESTED it. In total 219 families requested a case note review, which was handed to the local PCT to complete. Many did not because the review was initially handled by the trust and in fact Dr Laker ended up in a dispute with the trust due to its handling. He did not work on the whole review.

It was still recognised as an independent review and Dr Laker fought hard to change the oversight to make it more so. Since nobody in the inquiry seems to doubt his integrity or competence, and Mr Kark certainly would have found it worth mentioning in his final submission if Dr Laker had considered the ICNR to be inadequate or its conclusions unreliable, the conclusion has to be that the cases that were reviewed were those that needed to be.

In the absence of evidence that 'many did not' ask for the review for the reasons you stated, it has to be supposition. If anyone was free to ask for the review and chose not to, it has to be concluded that most, if not all, of the cases that needed review made it into the reviewed set.

If there were 219 requested reviews and Dr Laker found (perhaps) one 'excess' (avoidable) death when he personally edited 40-50, the most that you could reasonably extrapolate from that would be 8-10 avoidable deaths over a 3 or 4 year period.

The review was flawed in that it was under resourced and poorly run. It also relied on the medical notes of patients – many notes were lost; many were inaccurate; not completed at all; and in some cases referred to the wrong patient. To draw any conclusions about the wider scale of poor care at Mid Staffs from this review is extremely risky and open to significant error.

Is Dr Laker under disciplinary action from the GMC for his conduct of the review process? If not, then your 'poorly-run' comment is questionable and possibly libellous. I'm sure it's anything but uncommon for notes to be mislaid etc, but it's the nearest to objective evidence that was available - the accusations of grief-stricken relatives cannot be considered reliable evidence, however understandable their grief.

What is still absolutely clear out of all this is that the 400-1200 figure that the media ran with has no basis in reality. It was drawn from faulty statistics (as evidenced by the massive range it covers) and even the worst-case interpretation of the case notes and even anecdotal evidence would not get anywhere near those figures.

General points

Stephen makes some good points in this blog and it is not all completely wrong.

I'm delighted you think so! Smile

But the simple fact is hundreds of people did die at Mid Staffs. The true number will never be known but we know at least 219 requested a case note review (not all those affected did), 966 witnesses gave evidence to Robert Francis’ first report.

Of course they did - as they did in every hospital during the period in question. But for all the poor care at the hospital, once the input data were corrected, the poor care didn't lead to a higher mortality. And that's the issue my article was addressing - the press spun misleading and ultimately incorrect stats into "poor care killed hundreds of people", and the claim is simply unfounded.

Former Chief Executive Antony Sumara estimates he personally met with more than 200 families.In short Stephen has got lost in the details of the HSMR which I accept are being wrongly quoted as 400-1200 deaths but can correctly be quoted as hundreds. They are a useful descriptor of the scale of the problems at Mid Staffs.

For the reasons already stated, I disagree utterly - the figures have provided a useful club for certain vested interests to exploit and bash the NHS with, but they are not based in reality. And, just to be sure you're understanding me - I'm not saying this means there was not poor care (which according to Francis appears to be solidly rooted in understaffing and in management that led to understaffing).

As a final point – anyone who doubts that Mid Staffs was the worst disaster in the NHS should do two things….
One – stop reading blogs and articles written by people who were not there and do not know all the details.
Two – read the summaries of the first Francis report and the recent public inquiry report. You will be unable to deny the scale of this catastrophe. Better yet read the actual reports including volume II of the first report.
If you still think there were no excess deaths at Mid Staffs then I am afraid you are beyond help.

It was certainly a disaster - just not of the type or scale that it's been made out to be. It's an object lesson of what will happen if hospitals are put under constant pressure to reduce cost and then respond to that by cutting staff numbers to untenable levels. But it's not a story of poor care killing many more people than would have died anyway - as the properly-corrected HSMRs show.

That doesn't make for great headlines, though - and it's less politically useful for a government that is looking for ways to erode public affection for the NHS. That's why the HSMRs were misleadingly used instead.
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Re: Mid Stafford Hospital report

Post by tlttf on Fri Mar 01, 2013 10:17 am

As usual Steve excellent post and as usual you argue your corner better than most. Extremely honest of you to put forward the alternative point of view and it seems that everybody is in agreement that the mid stafford trust had serious concerns over the period quoted and the majority of it was caused by aiming for targets rather than care. The main concern (from my point of view) is why somebody isn't having to answer the concerns under police caution?

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Re: Mid Stafford Hospital report

Post by skwalker1964 on Fri Mar 01, 2013 11:57 pm

tlttf wrote:As usual Steve excellent post and as usual you argue your corner better than most. Extremely honest of you to put forward the alternative point of view and it seems that everybody is in agreement that the mid stafford trust had serious concerns over the period quoted and the majority of it was caused by aiming for targets rather than care. The main concern (from my point of view) is why somebody isn't having to answer the concerns under police caution?

Actually, once you get into the nitty gritty of what underlay the problems, (clinical) targets had nothing to do with them. The problems were caused by financial pressures caused by:

1) The need to cut costs to satisfy Monitor and achieve Foundation Trust status.
2) The need to cut further to maintain FT status
3) Staff cuts to achieve 1) and more staff cuts to achieve 2)

Since the current government is imposing financial targets and restrictions on the NHS that make what was done to Mid Staffs look like an idyll, it was inevitable that they'd try to spin different lessons from the Francis report - but really they don't stand up to scrutiny.
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Re: Mid Stafford Hospital report

Post by boatlady on Sat Mar 02, 2013 11:54 am

The main concern (from my point of view) is why somebody isn't having to answer the concerns under police caution?

Just beacuse we have suffered a great loss, it does not necessarily follow that someone is 'to blame' - just because we have identified that someone is 'to blame' does not necessarily mean that that someone is guilty of a crime.

No-one was arrested because no-one broke the law.
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Re: Mid Stafford Hospital report

Post by tlttf on Sun Mar 03, 2013 5:28 am

If nobody broke the law, perhaps it's time for the law to be changed, if somebody has been identified and is to blame they're definitely guilty of something surely?

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Re: Mid Stafford Hospital report

Post by boatlady on Sun Mar 03, 2013 9:52 am

If you're building a wall that needs 500 bricks and 2 tons of mortar, and your boss gives you only 450 bricks and 1.75 tons of mortar, who is to blame if the wall is not so high as planned, and has a crime bern committed?
You've still got a wall, it's still good enough for some purposes, it's the best wall it can be, given the resource constraints.
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Re: Mid Stafford Hospital report

Post by tlttf on Sun Mar 03, 2013 5:15 pm

Being partly built is pointless boatlady. If the wall needed 500 bricks then they should be there, otherwise somebody has underestimated the requirements and would lose their job. As an anecdote I can't see the comparison myself.

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Re: Mid Stafford Hospital report

Post by oftenwrong on Sun Mar 03, 2013 6:14 pm

Mid Staffs: Twenty MPs call for NHS chief Sir David Nicholson to resign

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Re: Mid Stafford Hospital report

Post by boatlady on Sun Mar 03, 2013 7:41 pm

Losing your job is not the same as answering police questions - maybe someone has been incompetent, maybe someone has underestimated the resources to do the job, maybe someone has been a bad manager - none of these is a crime - that may be
why somebody isn't having to answer the concerns under police caution?
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Re: Mid Stafford Hospital report

Post by skwalker1964 on Sun Mar 03, 2013 11:53 pm

tlttf wrote:If nobody broke the law, perhaps it's time for the law to be changed, if somebody has been identified and is to blame they're definitely guilty of something surely?

Leaving someone sitting in their own waste is not a crime if you're up the other end of the ward trying to stop someone dying of a heart-attack or stem an attack of haematemesis (vomiting blood). Sometimes it's just not possible to do everything with the resources available.

Sadly, a relative arriving on the ward at that moment is (understandably) unlikely to have the objectivity and perspective to realise this, and will not only 'kick off' but also go away and bad-mouth everyone 'to blame'.

Knowing all this at a very small remove means I take the extent of the care 'failures' at Stafford with a pinch of salt. Undoubtedly there were failures - but greatly exaggerated by media, politicians and relatives' activist groups.
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Re: Mid Stafford Hospital report

Post by skwalker1964 on Sun Mar 03, 2013 11:59 pm

oftenwrong wrote:Mid Staffs: Twenty MPs call for NHS chief Sir David Nicholson to resign

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Nicholson was only distantly involved with Mid Staffs - as interim CEO of the regional Strategic Health Authority for a period.

The Tories' desire to remove him has nothing to do with Mid Staffs and everything to do with the fact that (according to Labour MPs known to me and intimately involved with health) he is extremely smart and capable - and that he is a former Communist party member who has outwitted the Tories and blocked their moves on the NHS on a number of occasions.

That the Telegraph is cheerleading this is no surprise, since they are on record as collaborating with the Tory party and private health interests to support their wishes for the NHS:

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Re: Mid Stafford Hospital report

Post by tlttf on Mon Mar 04, 2013 10:01 am

Steve, attached a lis of the best and worst of NHS hospitals. You might already have it, if not hope it helps in your research as I know you feel strongly about the NHS.

Guide rates best and worst hospitals


Published on Monday 4 March 2013 09:36

The Daily Telegraph has today revealed the findings of the latest Dr Foster Hospital Guide. The guide, published annually, closely scrutinises a range of healthcare data to measure hospital performance and detect trends that could save lives.

As well as listing the hospital trusts in England that score above and below average on a range of different mortality measures, this year’s guide also found that:

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Hope it's of use to you.

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Re: Mid Stafford Hospital report

Post by tlttf on Tue Mar 05, 2013 12:07 pm

The sheer arrogance of Nicholson:-
NHS chief David Nicholson brushes aside patient deaths
David Nicholson (centre) answers questions in Westminster this morning

Shocking levels of care seen at Stafford hospital still exist in pockets "dotted" across the NHS, health secretary Jeremy Hunt has said.

Tuesday, 5 March 2013 11:26 AM

By Alex Stevenson

This was the moment they had been waiting for. The families and friends of the patients who died unnecessarily in the NHS – especially the 1,200 patients who lost their lives while supposedly under the care of the Mid-Staffordshire NHS Trust between 2005 and 2009 – have spent years frustrated and angry at the seemingly endless abilities of the NHS' most senior official, Sir David Nicholson, to evade responsibility. They have found it impossible to understand how Nicholson – who was the chief executive of the West Midlands Strategic Health Authority at the time of those deaths – could possibly not accept the most basic principle of accountability and resign for what happened on his watch. Today he faced MPs on the Commons' health select committee. It was a big day for all concerned.

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Re: Mid Stafford Hospital report

Post by skwalker1964 on Tue Mar 05, 2013 12:34 pm

tlttf wrote:Being partly built is pointless boatlady. If the wall needed 500 bricks then they should be there, otherwise somebody has underestimated the requirements and would lose their job. As an anecdote I can't see the comparison myself.

The point is that the Tories know full well that their under-resourcing of the NHS will lead to a deterioration of care. Yet they are shameless about using exactly such failures to further their agenda to cut/close/sell off even more:

Nicholson: Tory 'knives out' have nothing to do with Mid Staffs and everything to do with wanting to close hospitals

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The knives are out for NHS Chief Executive Sir David Nicholson. In spite of the conclusion of the Francis Report on events at Stafford hospital and public backing from both Prime Minister David Cameron and Shadow Health Secretary Andy Burnham, a growing group of Tory MPs is calling for his resignation, including unnamed ‘cabinet ministers’, and has tabled an early day motion demanding that he ‘face the consequences’ and step down.

The right-wing media chorus has joined in vociferously. The Daily Mail is currently referring to him, with ‘The Sun’-like ad nauseam repetition, as “the man with no shame”, while the Telegraph chips in with claims that a ‘neutered Francis report’ was doctored to protect Nicholson.

At the same time, campaign group ‘Cure the NHS’, in line with a recent article by founder Julie Bailey, is calling for ‘heads to roll. When former Tory health minister Stephen Dorrell dared to express the opinion that Mr Nicholson is a “distinguished public servant”, Ms Bailey criticised the MP, saying that he

should not have made the comments prior to Sir David’s evidence session before the [health select] committee on March 5..

I would also like to call into question Stephen Dorrell’s position in defending Sir David Nicholson when he is chair of the select committee. It calls into question his impartiality when he is speaking to defend him before he has even heard evidence from him.

And of course, every article and statement refers to the “as many as 1,200 patients who died needlessly” at Stafford – even though, as I showed in a heavily-researched article last week, no such thing happened and the Francis Report says nothing of the sort.

Ms Bailey’s comments completely ignore the fact that Mr Nicholson has testified many times to the select committee in his role as NHS Chief Executive and there Stephen Dorrell has ample evidence on which to form his opinion of Nicholson’s stature and service.

But they are sadly typical of the kind of comments that come out of some ‘patients’ groups’ if anyone dares to question whether the facts support their claims. When I wrote my analysis of the Francis Inquiry testimony last week, the reaction on Twitter from some people involved with ‘Cure the NHS’ included many comments along the lines that I was ‘disrespecting [their] loved ones’ by showing that the evidence did not support the many headlines, and that since I had not lost a relative at Mid Staffs I had no right to an opinion. I was even associated with paedophiles and rapists for daring to consider that the facts of the case are important and should affect how we view the events at Mid Staffs.

Bereaved relatives have some excuse for being unreasonable and for ignoring inconvenient facts – grief can easily prevent people from seeing straight or cause people to lash out at the wrong person or people.

Politicians and news editors, on the other hand, have no excuse. The headlines and the ‘Early Day Motion’ calling for Mr Nicholson’s resignation and tarring the man with such cheap jibes as ‘the man with no shame’ involve MPs and journalists ignoring clear facts, which are clear for them to see if they bother to look, in a way which is inexcusable:

The excess deaths that weren’t

First, and most critically, there were no ‘excess’ deaths at Mid Staffs in the 2005-2009 period, in spite of claims by media, politicians and campaign groups. There was poor care in a few areas because of severe understaffing, but Mid Staffs’ mortality rates were actually considerably below the national average once the ‘HSMR’ coding was corrected for glaring errors.

Short-staffing led to basic care failures in few areas of Stafford hospital – but poor basic care very, very rarely kills anyone. The independent physician who oversaw the ‘independent case note review’ (ICNR) was asked by the Francis inquiry how many ‘excess’ (by which he meant ‘avoidable’) deaths he had found during the review. His answer? “Perhaps one”.

Mid Staffs CEO?

David Nicholson was indeed interim Chief Executive of Staffordshire Strategic Health Authority (SHA) – for all of about 8 months, from August 2005 to April 2006. At the same time, he was also CEO of 2 neighbouring SHAs ‘Birmingham and Black Country’ and ‘West Midlands South’.

Mr Nicholson was therefore doing 3 jobs at once and could not reasonably be expected to get to grips with what was happening at a ward level in a particular hospital during an 8-month tenure.

No realistic way to know

Nicholson’s tenure as CEO of Mid Staffs ended in April 2006, well before any of the supposed ‘facts’ concerning mortality rates were in the spotlight – and also well before the sad death of Julie Bailey’s mother.

A visit by the Chief Executive of the Royal College of Nursing (RCN) found the standard of care provided by the parts of the hospital he visited to be excellent – so what poor care did exist at the hospital was not immediately apparent unless a visitor went to the ‘right’ areas at the ‘right’ time – and the problems that did exist were not being reported at that time.

Mr Nicholson was therefore not realistically in a position to know about any care problems during his 8 months as CEO, let alone to fix them.

Ultimate responsibility?

Those who want Nicholson to resign may also claim that, as NHS Chief Executive, he carries ultimate responsibility for what goes on in any NHS hospital. While this might appear true on the face of things, the real story is far from straightforward.

Mr Nicholson became NHS CEO in September 2006. In July of the same year, the three SHAs mentioned above merged to become the West Midlands SHA (WMSHA) and became the body with overall responsibility for the area that included Mid Staffs.

The NHS website describes an SHA:

Strategic health authorities (SHAs) were created by the government in 2002 to manage the local NHS on behalf of the Secretary of State for Health. There were originally 28 SHAs, reduced to 10 on July 1 2006.

SHAs are responsible for:

developing plans for improving health services in their local area
making sure local health services are of a high quality and are performing well
increasing the capacity of local health services so they can provide more services
making sure national priorities (for example, programmes for improving cancer services) are integrated into local health service plans
SHAs manage the NHS locally and provide an important link between the Department of Health and the NHS.

SHAs form a layer of management with responsibility for local services – with almost 170 hospitals under them in England. It would be extremely difficult for an NHS Chief Executive to become aware of what was going on at a Trust level unless the responsible SHA flagged it to him.

However, when the high HSMRs at Mid Staffs were reported, the WMSHA employed Birmingham University to evaluate the HSMR methods and results. Quite rightly, the SHA suspected that the primary causes of the inflated mortality statistics were weaknesses with the system itself and with the data going into it. No ‘warning flags’ of increased numbers of unnecessary deaths would have been raised to Mr Nicholson – and quite rightly so, since there was no increased death rate in reality.

Once the Trust became a Foundation Trust in February 2008, the distance between it and the CEO of the NHS grew even wider. Here’s how the NHS website describes a Foundation Trust:

NHS foundation trusts, first introduced in April 2004, differ from other existing NHS trusts. They are independent legal entities and have unique governance arrangements..They are set free from central government control and are no-longer performance managed by health authorities. As self-standing, self-governing organisations, NHS foundation trusts are free to determine their own future.

To expect David Nicholson to resign because of what happened at Mid Staffs would be entirely unreasonable even if there had been hundreds of avoidable deaths at the Trust – and there were not.

For politicians and media maintain calls for his resignation requires holding onto an interpretation of the events that are simply does not stand up to fact-based scrutiny.

So why, then?

If David Nicholson is not to blame for what happened at Mid Staffs, and what happened is not what the media has misleadlingly portrayed – why want rid of him? I believe the answer doesn’t take a great deal of finding – and it has nothing to do with Mid Staffs except that Mid Staffs provides an opportunity.

Who will rid us of this troublesome CEO?

An MP I know personally, and who is intimately involved with health, told me that David Nicholson stands head and shoulders above his colleagues in terms of intellect and capability. David Cameron’s public support of Nicholson is, I believe, a temporary posture for appearances’ sake, but the Shadow Health Secretary thinks highly of him, as does the Conservative chair of the Health Select Committee Stephen Dorrell. But Mr Nicholson has ‘form’ when it comes to being a thorn in the side of the government when it comes to its plans for the NHS,

The Tory front bench is therefore far less well-inclined to him. Nicholson famously described Andrew Lansley’s NHS reforms – which the government were pushing through in spite of a promise of ‘no top-down reform’ – as being so big you can see them from space.

Similarly – and this is the key point – Nicholson has a track record of speaking out against the government’s closure of NHS facilities and warning of the risks they pose to patients. Here’s how the RCN website put it:

David Nicholson speaks out on the government’s health reforms
The Observer reports that the head of the NHS laid bare his fears that the government’s reforms of the health service could end in “misery and failure”. Sir David Nicholson, chief executive of the NHS, said high-profile, politically driven changes almost always end in disaster. He warned against “carpet bombing” the NHS with competition. His comments were made to GPs at a conference held by the Royal College of General Practitioners.

But the most important factor in the Tories’ desire to oust Nicholson lies in how he believes that the government and the NHS should respond to ‘failing’ Trusts.

The Francis report recommends that failing hospitals should be closed. The Tories’ desire to close NHS hospitals is so strong that Health Secretary Jeremy Hunt infamously chose to downgrade both the A&E unit at Lewisham and to turn the whole university hospital into a centre for joint replacements because of financial problems at a neighbouring Trust.

The government has already ‘identified’ a further 14 hospitals that it says have similar problems to those we’ve been led to believe existed at Stafford – over 8% of the total in England. The Tories view Mid Staffs and the Francis report as a prize opportunity to downgrade and even close NHS hospitals before they can be kicked out at the next general election.

Alongside forced privatisation and the massive sell-off of NHS land at knock-down prices, the ‘closure’ option of the Francis recommendations represents a chance to accelerate the dismantling of the NHS that the Tories are simply not going to let pass. The unseemly rush to put Mid Staffs into administration while public sympathy is low demonstrates this clearly.

But David Nicholson? His solution to hospitals ‘failing’ like Mid Staffs would be to re-nationalise them – to bring the ‘autonomous’ Foundation Trusts back fully into the NHS and into public ownership.

And the ‘nub’

In the context of obvious Tory hopes to bring an end to the NHS as we know it before the next General Election in 2015, it’s clear that David Cameron is simply ‘keeping up appearances’ by publicly supporting David Nicholson.

The fact that David Nicholson has the respect of MPs on both sides of the house who are involved with health and in the best position to judge, and that (as my MP friend put it) there’s nobody who’d be in the frame to replace Mr Nicholson who is anywhere near as savvy and competent, cannot be allowed to interfere with the ‘greater’ Tory vision.

I therefore believe that it’s only a matter of time – days or even hours – before David Cameron asks David Nicholson for his resignation and we see a statement from Cameron along the lines of:

It is with great regret that I have been ‘forced’ to accept the resignation of Sir David Nicholson as Chief Executive of the NHS. Sir David’s service to this country, and to the NHS that we all love, has been exemplary, but in the wake of the Mid Staffordshire scandal and the deaths that occurred there, his position had become untenable. I thank Sir David for his service and wish him well for the future.

Don’t believe a word of it when it comes. The Tories only ‘love’ the NHS like a cat loves a mouse – and they’ll remove David Nicholson because he’s an impediment to their ‘scorched earth/fire sale’ ambitions before the next election. He may be the most competent option, but they’re more interested in compliance than competence.

As seems consistently to be the case with Mid Staffs, what you’ll hear won’t be the truth but rather a version of it that suits a very dark, hidden agenda – and shame on the Tories and their press supporters for exploiting the grief of a few bereaved families to achieve their goals.
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Re: Mid Stafford Hospital report

Post by skwalker1964 on Tue Mar 05, 2013 12:42 pm

tlttf wrote:The sheer arrogance of Nicholson:-
NHS chief David Nicholson brushes aside patient deaths
David Nicholson (centre) answers questions in Westminster this morning

Shocking levels of care seen at Stafford hospital still exist in pockets "dotted" across the NHS, health secretary Jeremy Hunt has said.

Tuesday, 5 March 2013 11:26 AM

By Alex Stevenson

This was the moment they had been waiting for. The families and friends of the patients who died unnecessarily in the NHS – especially the 1,200 patients who lost their lives while supposedly under the care of the Mid-Staffordshire NHS Trust between 2005 and 2009 – have spent years frustrated and angry at the seemingly endless abilities of the NHS' most senior official, Sir David Nicholson, to evade responsibility. They have found it impossible to understand how Nicholson – who was the chief executive of the West Midlands Strategic Health Authority at the time of those deaths – could possibly not accept the most basic principle of accountability and resign for what happened on his watch. Today he faced MPs on the Commons' health select committee. It was a big day for all concerned.

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Wrong on so many levels I almost don't know where to start. I'll just list key facts that the article ignores:

1) There were no '1,200 patients who lost their lives' - not, at any rate, who wouldn't have died in any other hospital. In fact, there were significantly fewer who died than who would have elsewhere - since Mid Staffs' corrected mortality rate was 12 points below the national average.

2) Nicholson was CEO of Staffordshire SHA for 8 months out of a period of 5 years or so, and at the same time was juggling two other jobs. His period as CEO pre-dated knowledge about poor care - and the poor care did not lead to an increased death rate anyway..

3) The Francis report was emphatic in attributing poor care to short-staffing. In Mid Staffs' case, this was caused by the financial stringency involved in becoming, and then remaining, a Foundation Trust. Jeremy Hunt speaks of 'shocking levels of care' while requiring every NHS Trust to become a Foundation Trust by April 2014 - and imposing cuts and funding 'claw-backs' that make the underfunding and understaffing at Stafford look like a utopia.

Alex Stevenson is guilty of cheap and lazy journalism - and Hunt of the most malevolent, malignant hypocrisy.
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Re: Mid Stafford Hospital report

Post by tlttf on Tue Mar 05, 2013 1:44 pm

Great answer Steve, If a man goes for a job that takes ultimate responsibility for the departments under him, if those departments are failing who is ultimately to blame. To pay him the money, give him the status yet not expect him to be responsible should go against the grain of any working man/woman.

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Re: Mid Stafford Hospital report

Post by skwalker1964 on Tue Mar 05, 2013 1:50 pm

tlttf wrote:Great answer Steve, If a man goes for a job that takes ultimate responsibility for the departments under him, if those departments are failing who is ultimately to blame. To pay him the money, give him the status yet not expect him to be responsible should go against the grain of any working man/woman.

Yes, that would apply IF the job description of the NHS Chief Exec was to do that. But the NHS is so fragmented, with so many layers and 'silos', that it really isn't. Should be, but it isn't.

That situation is not purely a Tory-created one - but the Tories are taking all the lessons that should be learned from Mid Staffs, ignoring them, and then multiplying all the contributory factors instead of winnowing them out.
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Re: Mid Stafford Hospital report

Post by skwalker1964 on Tue Mar 05, 2013 1:57 pm

It's also important to remember that Nicholson has regularly opposed government measures. If a CEO voices opposition to a move and is forced to implement it anyway, the blame passes up the chain to those who made him do it.

That said, Nicholson wasn't in charge of Stafford in any sense at the time when the Foundation Trust system was implemented, nor when Stafford decided to pursue FT status.
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Re: Mid Stafford Hospital report

Post by astradt1 on Tue Mar 05, 2013 9:07 pm

If a man goes for a job that takes ultimate responsibility for the departments under him, if those departments are failing who is ultimately to blame. To pay him the money, give him the status yet not expect him to be responsible should go against the grain of any working man/woman.

For NHS CEO read Banking CEO.........
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Re: Mid Stafford Hospital report

Post by oftenwrong on Tue Mar 05, 2013 10:22 pm

Most people assume that a paid servant will carry out the instructions of his Employer.
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Re: Mid Stafford Hospital report

Post by tlttf on Wed Mar 06, 2013 4:53 pm

There seems to be an awful lot of people stating that the trust failed badly and was reported to the then health secretary Alan Johnson who appeared to be more worried about the effect on himself and his department than on the report?


Who should we blame for the Mid-Staffs scandal?
Chris Skidmore 6 March 2013 16:27
Stafford Hospital

As the row over who knew what and when in the Mid-Staffordshire tragedy grows, it’s worth taking a close look at the data involved. When you consider the Mid-Staffs scandal across the timeline of the previous government, the findings present extremely uncomfortable evidence for which the Labour party must be held to account.

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Re: Mid Stafford Hospital report

Post by oftenwrong on Wed Mar 06, 2013 5:45 pm

Which provides the explanation for Cameron's cowardly decision to separate the Government's Health Minister from direct responsibility for the NHS.

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Re: Mid Stafford Hospital report

Post by boatlady on Wed Mar 06, 2013 7:26 pm

See, I'm happy to blame Hitler et al for the conscious and rather nasty decision to exterminate certain classes of people - that's just bad - I do struggle with the notion of blaming people for not knowing something, or making a genuine mistake.

In the wake of any scandal of this sort, isn't it more important to work out what went wrong and make arrangements to guard against those things going wrong in the future?
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Re: Mid Stafford Hospital report

Post by oftenwrong on Wed Mar 06, 2013 10:02 pm

",,,,important to work out what went wrong and make arrangements to guard against those things going wrong in the future?"

In abstract, the answer is obvious, but Parliamentary history suggests that an incoming administration has as its priority reversing the actions of the previous Government. Whatever those might have been.
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Re: Mid Stafford Hospital report

Post by boatlady on Wed Mar 06, 2013 10:07 pm

problem with the current system of Parliamentary democracy - or should I say demagoguy (I think that may be nearly the spelling)
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Re: Mid Stafford Hospital report

Post by oftenwrong on Wed Mar 06, 2013 10:19 pm

Who cares? "e" is only worth one point in Scrabble anyway.
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Re: Mid Stafford Hospital report

Post by skwalker1964 on Wed Mar 06, 2013 10:59 pm

tlttf wrote:There seems to be an awful lot of people stating that the trust failed badly and was reported to the then health secretary Alan Johnson who appeared to be more worried about the effect on himself and his department than on the report?


Who should we blame for the Mid-Staffs scandal?
Chris Skidmore 6 March 2013 16:27
Stafford Hospital

As the row over who knew what and when in the Mid-Staffordshire tragedy grows, it’s worth taking a close look at the data involved. When you consider the Mid-Staffs scandal across the timeline of the previous government, the findings present extremely uncomfortable evidence for which the Labour party must be held to account.

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It all depends what the nature of the scandal was and on the reporting structures of the NHS. Skidmore's article sticks to the completely unfounded 'hundreds of deaths' line. He's also woefully inaccurate on the terminology used to describe the statistics - not once in the entire inquiry, as far as I can recall (and I have an excellent memory) did anyone call the difference between expected and actual deaths 'unexplained deaths'. The term consistently used is 'excess deaths', and it's a strictly statistical term.

Since the deaths did not happen, because Mid Staffs' real HSMR was below the national average, the rest of his points are, well, pointless, not to put to fine a 'point' on it.
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Re: Mid Stafford Hospital report

Post by skwalker1964 on Wed Mar 06, 2013 11:00 pm

oftenwrong wrote:Who cares? "e" is only worth one point in Scrabble anyway.

'er' would be two, though... Smile
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Re: Mid Stafford Hospital report

Post by boatlady on Thu Mar 07, 2013 8:38 am

I used to always come top for spelling - imagine my humiliation
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Re: Mid Stafford Hospital report

Post by oftenwrong on Thu Mar 07, 2013 12:02 pm

I've been trying to think of ANYONE currently sitting in Parliament who might remotely carry the description "firebrand" or demagogue. (noun 1. a person, especially an orator or political leader, who gains power and popularity by arousing the emotions, passions, and prejudices of the people).

After points-scoring over opponents, their principal interest, beyond their expenses claim, would appear to be frotting the female contingent at Conference.
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Re: Mid Stafford Hospital report

Post by boatlady on Thu Mar 07, 2013 12:25 pm

The demagogues all work for the Sun and the Daily Mail
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Re: Mid Stafford Hospital report

Post by oftenwrong on Thu Mar 07, 2013 5:18 pm

Newspapers print what their readers want to read.
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Re: Mid Stafford Hospital report

Post by tlttf on Fri Mar 08, 2013 8:26 am

Simple facts follow!

How many people died "unnecessarily" at Mid Staffs?
7 March, 2013 - 17:48 -- Emily Craig
Mid Staffordshire NHS sign
Certain politicians and sections of the media have continued to call for the resignation of the NHS Chief Executive, arguing that he ignored the warning signs that meant up to 1200 people died in Mid Staffordshire hospitals "unnecessarily". But where is this number from?

Earlier in the week Sir David Nicholson, the Chief Executive of the NHS, appeared before MPs to defend his handling of the Mid Staffs scandal. Sir David was in charge of the West Midlands Strategic Health Authority for part of the time when there were an unusual number of deaths at two local hospitals, Stafford Hospital and Cannock Chase.

The Francis Report, which was published earlier this year, documented the shocking failures of care at these hospitals, as well as recommending how the NHS might improve its treatment of patients.

Unnecessary deaths?

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Re: Mid Stafford Hospital report

Post by boatlady on Fri Mar 08, 2013 8:58 am

Thanks for that link - not clear what you think it demonstrates.
The conclusion seems to be:-

"...it is in my view misleading and a potential misuse of the figures to extrapolate from them a conclusion that any particular number, or range of numbers of deaths were caused or contributed to by inadequate care."

and

"it would be unsafe to infer from the figures that there was any particular number or range of numbers of avoidable or unnecessary deaths at the Trust."


whcih I thought was what Steve was saying all along.
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Re: Mid Stafford Hospital report

Post by skwalker1964 on Fri Mar 08, 2013 10:23 am

Indeed!
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Re: Mid Stafford Hospital report

Post by tlttf on Fri Mar 08, 2013 1:54 pm

boatlady, I don't think you'll find I've disagreed with Steve over this thread, simply trying to find more info, if that helps confirm his version then thats fine by me. The facts are still the same, if you followed the link, there was an higher than average death rate at the Staffs hospital, there was undoubted lack of care toward patients to the point of malpractice and yet only one doctor has been sacked, the remaining staff have either been allowed to retire (nice) or are still employed. No matter what way your politics lean this was/is unacceptable especially when the government at the time was throwing money at the NHS as if it was there own. That's the point!

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Re: Mid Stafford Hospital report

Post by skwalker1964 on Fri Mar 08, 2013 4:19 pm

tlttf wrote:boatlady, I don't think you'll find I've disagreed with Steve over this thread, simply trying to find more info, if that helps confirm his version then thats fine by me. The facts are still the same, if you followed the link, there was an higher than average death rate at the Staffs hospital, there was undoubted lack of care toward patients to the point of malpractice and yet only one doctor has been sacked, the remaining staff have either been allowed to retire (nice) or are still employed. No matter what way your politics lean this was/is unacceptable especially when the government at the time was throwing money at the NHS as if it was there own. That's the point!

That's the main thing - there wasn't a higher than average death rate at Stafford. There was an apparent one, but it was caused by flawed/missing input.

There was poor care - in a couple of areas - but not such that it resulted in more deaths than would be expected for the conditions treated. In fact, there were fewer, since Mid Staffs had a lower than average death rate once the stats were corrected.

That should stand as testimony to the heroic efforts of the majority of staff there in preventing understaffing from resulting in death and serious harm to patients - but the 'noise' and 'smoke' raised by campaigners and media are making that fact indistinguishable to all but the most careful observers.
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Re: Mid Stafford Hospital report

Post by boatlady on Fri Mar 08, 2013 7:09 pm

Always the same for those working in the public sector - don't really understand why anyone does it myself, unless it's from a selfless desire to be of service to one's fellow human.
Certainly at the 'coal face' the rewards are few and the exposure to opprobrium is extreme - why would anyone do it?
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Re: Mid Stafford Hospital report

Post by oftenwrong on Fri Mar 08, 2013 7:21 pm

Whoever those selfless public servants might be, they should not expect to keep their jobs if UKIP has a part in the next Government.
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Re: Mid Stafford Hospital report

Post by boatlady on Fri Mar 08, 2013 7:31 pm

I think most of the ones I worked with have already lost out
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