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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

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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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Is Stafford losing its hospital because it humiliated Cameron in 97?

Post by skwalker1964 on Sun Mar 10, 2013 8:50 pm

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I’m still working my way through Monitor’s report on its reasons for putting Mid Staffs Foundation Trust (MSFT) into administration, and will write on that shortly.

But what’s already clear is that the decision to call in administrators, with the likely result of reducing Stafford hospital to not much more than an out-patients centre, is completely against the wishes of local people – and local clinicians, even though Monitor claims it has consulted with both.

This bodes ill for the wider NHS, as 14 other Trusts have been singled out for ‘special treatment’ on the spurious basis of a supposed similarity in ‘Hospital Standardised Mortality Ratios’ (HSMRs) – a statistical measure that is based on massively erratic and uncontrolled input of ‘mortality codes’, and is therefore useless as a measure of hospital quality.

But it bodes even iller in the short term for the people of Stafford, who face losing their local, and much-improved hospital and having to travel considerable distances for even emergency treatment. Even a local Tory MP is outraged by the decision.

As I said, I’ll write a fuller analysis of the decision shortly, but very briefly, just a few of the reasons why Stafford is supposedly unsustainable are:

  • It doesn’t serve enough people to be viable – even though Mid Staffs NHS serves 29% more people than the neighbouring North Staffs Trust

  • The Mid Staffs ‘brand’ is toxic – even though the Trust overwhelmingly has the support of local people

  • The Trust ‘had to be given significant financial support from the Department of Health last year in order to maintain provision of services for patients. These circumstances cannot go on indefinitely” – even though both the Dept of Health and Monitor agreed a financial plan with the Trust in January 2012 that was to last until 2015, which is not anything like ‘indefinitely’, and 2013 is far too early, according to the terms of that agreement, to put the Trust into administration.


As far as MSFT’s clinical and financial performance are concerned, the report by Ernst & Young, who were called in by Monitor, acknowledges that

The Trust has made significant progress in establishing its operational sustainability by implementing both strategic and tactical change over the past 18 to 24 months

and

MSFT has been working closely with Monitor to improve its performance in recent years, and has made significant improvements in the clinical care provided for patients. The Care Quality Commission (CQC), the quality regulator, has said it no
longer had outstanding concerns about the care delivered by MSFT.

So, both in clinical and financial terms, MSFT was on track – so why let Monitor loose and allow it to call in the administrators to implement plans that will rob the people of Stafford of their hospital?

Well, a local NHS worker reminded me of something I’d forgotten: in 1997, a young David Cameron stood as the Tory candidate for Stafford in the General Election – and lost humiliatingly. Stafford had been a relatively safe Tory seat, with a majority in the 1992 General Election of almost 11,000 – which Mr Cameron turned into a defeat to Labour candidate David Kidney by 4,314 votes.

I’m told that Mr Cameron turned up for the announcement of the polling result in confident mood – but by 3am was to be seen disconsolate in a corner, desolated by his humiliating defeat.

David Cameron has ridden through life and politics on a wave of privilege and connection. From a privileged childhood with family connections to royalty and aristocracy, to his only ever job outside politics (in PR for TV company Carlton), which he was given at a salary of £90,000 pounds by a friend of his mother’s at her request (no wonder he’s on the side of the strivers!), to his first position at Conservative Central Office, which came on the back of a mysterious phone-call from Buckingham Palace – Cameron has never been thwarted in anything he wanted.

Except by the people of Stafford in 1997.

Has Monitor been let off the leash because Cameron still smarts from his humiliation? Is the decision to strip a County Town of its much-needed and now strongly-performing hospital in spite of clinical and financial progress a form of ‘payback’ by a vengeful Prime Minister still as livid as a thwarted toddler that the townspeople dared to reject him and delay his ambitions?

It would hardly be out of character for a man of whom even the right wing press who had worked with him when he was at Carlton said

a poisonous, slippery individual (Ian King, former business editor of The Sun)

and

I wouldn’t trust him with my daughter’s pocket money (Jeff Randall, Daily Telegraph)

Consider the facts for yourself. But I think it’s beyond question that Cameron will hold no affection for the one place that hasn’t given him the power and position he considers his due. Even failure to win a majority in 2010 didn’t prevent him taking up residence at Number 10.

It’s speculative at this point, of course – but the particularly brutal and baseless nature of the opportunistic assault on Stafford hospital would sit perfectly with the possibility.

Stafford made him wait 4 years for a seat in Parliament. It’s hard to see him letting that ‘slide’ unpunished.
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Re: Mid Stafford Hospital report

Post by boatlady on Sun Mar 10, 2013 9:27 pm

I'd like to say I'm shocked - but this just seems so believable.
At the very least i expect he's having a bit of a smirk.
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Re: Mid Stafford Hospital report

Post by skwalker1964 on Wed Mar 13, 2013 10:08 pm

More to follow on Mid Staffs. For now, I can confirm that my analysis of the reasons for the high HSMRs were - and this is straight from the horse's mouth, so to speak - correct. Pity the press' version was so far off!
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Re: Mid Stafford Hospital report

Post by oftenwrong on Wed Mar 13, 2013 10:56 pm

"No new concerns in Stafford"

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Re: Mid Stafford Hospital report

Post by skwalker1964 on Wed Mar 13, 2013 11:35 pm

Not just 'no new', but 'no':

What #CQC says about Stafford - yet govt still wants it closed
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With surprisingly (or not!) little fanfare, the Care Quality Commission (CQC) report on Stafford hospital was published a few days ago. Given the continued brickbats hurled at the hospital and just about anyone associated with it by politicians and “patients’ groups” like ‘Cure the NHS’, the verdict of the report might surprise you.

The CQC’s report leads with a graphic that shows how the hospital is performing against expectations:

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According to the website, a green tick means:

All standards were being met when we last checked. (If this service has not had a CQC inspection since it registered with us, our check may be based on our assessment of declarations and evidence supplied by the service itself.)

The bracketed part of the description definitely does not apply to Stafford, as the hospital was inspected on the 1st, 4th and 5th of February.

Disturbingly, but definitely unsurprisingly, the report also states (as the image shows) that the inspection was carried out because of

concerns that standards weren’t being met.

But it’s not the possibility that standards are not being met that is disturbing – it is the fact that these concerns were raised at all.

You see, the hospital was inspected less than 9 months ago, in June 2012. The result?

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Stafford Hospital was meeting all the essential standards of quality and safety‘.

For another inspection to be arranged so soon because of ‘concerns’ raised about standards in a hospital that had been ‘green-ticked’ in all areas can only mean one thing.

That someone – or more likely a group of someones – is agitating against Stafford Hospital without good reason. Or to put it another way, the raising of these ‘concerns’ betrays another agenda being followed, and a mischievous (or more likely malevolent) one.

The timing of the ‘concerns’ that triggered the inspection, while Monitor’s report on Mid Staffs’ viability was in its final phase of preparation, seems unlikely to be mere coincidence.

The fact that the CQC report could find no fault with the hospital, but that Monitor has still decided that the Trust is financially and clinically unviable, tells its own story of the real reasons and motives for the attack on Stafford hospital, and through it on the people of Stafford themselves.

What do patients say about this ‘financially and clinically un-viable hospital? The CQC report tells us:

the patients we spoke with were positive about the care they had received in the hospital. One patient told us, “I was in a lot of pain but they have sorted it. Eleven patients all told us, “I cannot fault the care”. One patient told us that they needed frequent stays in Stafford and other hospitals and said, “I have been on a number of wards, I have always been well cared for and am always treated well. I have had a better experience in this hospital than others I have been in”. Parents that we spoke with on the children’s ward told us that their child had received, “Brilliant care” and, “Excellent care”..
We saw positive and friendly interaction between staff and patients in the hospital. Staff were seen to be friendly, polite and respectful. Patients told us, “Nothing is too much for them”, “I’m sure if I was worried about anything it would be sorted” and, “They are very good but I would still tell them if I was not happy”.

The media and politicians are hammering away ceaselessly at Mid Staffs, exploiting – and grossly distorting – past troubles to get away with destroying yet another NHS hospital.

But the CQC’s report makes absolutely clear – for anyone not wilfully blind to it – that Stafford is a good hospital. Perhaps even a great one. And certainly one that the people of Stafford will be massively worse off without.

Show support to Stafford hospital and the people of Stafford – and for the NHS - here, and write to your MP to demand that they take concerted action to save the hospital from the unwarranted attack on it.
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Another 'Mid Staffs'-like scandal - with a scandalous ending?

Post by skwalker1964 on Thu Mar 14, 2013 1:12 am

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I need to tell you about a situation that I've come across which could fill you with horror. If you've been appalled by the Mid Staffs scandal, then you'll want to know about this. I'm almost certain that this story is not by any of the mainstream media.

This article concerns a nurse with responsibility for a large, busy ward in which she tended many severely ill patients, with many terrible outcomes. Death rates under her care were at a level that no one should accept in a modern hospital.

I'm so sure of the facts I'm about to tell you that I'm even prepared to name the nurse: Kate Arriens. That so many British patients died under this Dutch nurse will surely appall.

Arriens failed to maintain sterile procedure in her 'care' of her patients. Infections were rife, and some even lost limbs because of them. Some were left so desperate for water that they even drank from their toilet. Others died in fear and agony, with only the rudiments of care provided to them and without even being able to talk to a priest or minister. Arriens often left her patients completely, often only returning an hour or more later, and didn't offer pain relief to most of the suffering patients in her charge.

In the relatively short period she was in charge of her single-sex ward, an astonishing number of patients died, yet no one blew the whistle. Even though the chain of command and responsibility was absolutely clear, the people in charge of her hospital took no action against her, and completely failed to improve conditions.

Who is responsible for this astonishing cover-up? You're probably outraged and wondering what happened to the woman responsible for this terrible episode.

If so, you'll be even more outraged to know that, not only was she not punished, but she was rewarded for her performance.

With a medal.

The "Most Excellent Order of the British Empire", to be precise.

Kate Arriens - better known by her married name of Kate ter Horst - was a Dutch woman who lived in Arnhem in 1944. Her house became the 'hospital' for hundreds of British paratroopers wounded in the attempt to take Arnhem Bridge - the 'bridge too far'.

Ter Horst's house was surrounded by German forces and she was forced to bind wounds with strips torn from sheets, and after the water pipes were ruptured, she would often leave her patients to find water at great risk to herself and, in extremis, even gave them water from the toilet to ease their thirst.

With no anaesthetic, blood supply or antibiotics, often all she could do was read to her patients from the bible and hold her hand until they died. In spite of the dirt, stink, screams, deaths and unimaginable suffering, Kate ter Horst was remembered by those who survived as

the Angel of Arnhem.

You see, context is everything.

Something might seem, out of context, to be the most appalling neglect - even callous irresponsibility or outright cruelty. But in their properly-understood context, the very same facts can portray courage, nobility - even heroism.

What might, in ideal circumstances, seem like the most intolerable misdeeds can in fact be an almost-superhuman effort of compassion, diligence and self-sacrifice - if the context is one of lack of sufficient resources, support and personnel to have even the remotest chance of offering ideal care.

The events at Mid Staffs NHS have been portrayed as typifying callousness, neglect, laziness - the very opposite of the compassion we expect from our doctors, nurses and healthcare assistants.

But strip away the misleading headlines and misunderstood (or deliberately twisted) statistics and replace them with a correct understanding of what happened at Mid Staffs - or even a dispassionate, objective reading of Robert Francis QC's official report, which emphatically does not say 'hundreds died' - and the 'poor care' at Mid Staffs takes on a completely different significance.

Consider these three key facts:

  • The Francis report was clear that the immediate cause of poor care was drastic understaffing.


  • Far from there being 'hundreds of needless deaths' at Stafford Hospital, the real Hospital Standardised Mortality Ratio statistics demonstrated one clear fact: the death rate was below the national average.


  • The vast majority of patients at Mid Staffs during the crucial period reported good care and remained supportive of the Hospital and its staff.


The government and the media have painted a picture of a hospital where staff didn't care and where patients were wantonly ignored in their mess and suffering.

But in view of the severe understaffing and the lower than average death rate, a radically-different picture emerges - one of hard-pressed, over-stretched, harried staff who couldn't possibly deliver good basic care to everyone all the time, but who still managed to make sure that the severe shortages did not cause more people to die than would have died anyway.

This conclusion will win me no friends in some quarters - but the truth is too important to worry about that.

No doubt there were a few poor nurses, carers or doctors at Stafford. Any large organisation, and any profession, has some people who under-perform, no matter how much effort is made to prevent it.

But the majority of staff at Stafford Hospital performed near-heroic feats to keep everything from falling apart, and succeeded not only in preventing deaths but in delivering good care to the majority of patients.

Don't be deceived by the lazy headlines and attention-grabbing soundbites that leave out the context for the sake of ulterior motives.

Without context, we're almost certain to get the wrong end of the stick - and if we're wilfully deprived of the context, we should be questioning the motives of those doing the depriving, rather than falling for the ruse and standing by while the wrong people are attacked.
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Re: Mid Stafford Hospital report

Post by boatlady on Thu Mar 14, 2013 9:46 am

Steve
This seems to me to be a masterful piece and puts the current moral panic about the NHS in a very clear context.
I hope you can get this a very much wider circulation
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Re: Mid Stafford Hospital report

Post by oftenwrong on Thu Mar 14, 2013 12:04 pm

Fifteen years on from the revelation that our diet of News was controlled by spin-doctors, can the general public still not distinguish between fact and party propaganda?
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Re: Mid Stafford Hospital report

Post by tlttf on Thu Mar 14, 2013 4:48 pm

Nice touch ref: the dutch nurse Steve, what does that have to do with modern reality though. The reality is at Staffs if somebody pointed out failings they were sacked and the failings continued, because of the governments obsessions with stats it was easier to remove the whistle blower than rectify the problems. Isn't this why the latest job contracts being offered (advertised this week) include the requirement for staff to point out failings without fear of losing their jobs?

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Re: Mid Stafford Hospital report

Post by skwalker1964 on Thu Mar 14, 2013 5:26 pm

boatlady wrote:Steve
This seems to me to be a masterful piece and puts the current moral panic about the NHS in a very clear context.
I hope you can get this a very much wider circulation

Thank you! I'm doing my best. Smile
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Re: Mid Stafford Hospital report

Post by skwalker1964 on Thu Mar 14, 2013 5:30 pm

tlttf wrote:Nice touch ref: the dutch nurse Steve, what does that have to do with modern reality though. The reality is at Staffs if somebody pointed out failings they were sacked and the failings continued, because of the governments obsessions with stats it was easier to remove the whistle blower than rectify the problems. Isn't this why the latest job contracts being offered (advertised this week) include the requirement for staff to point out failings without fear of losing their jobs?

Where are you getting that from, t? The people who were sacked at Mid Staffs were those who almost had the hospitals back on an even keel but fell to the baying of a few MPs and members of campaign groups. If you can source the comment, I'm most interested to read it.

The new contract regulations won't do any harm - but the whole 'whistleblower' thing has become just another misused tool in the hands of those who emphatically do not have the best interests of the NHS at heart, nor those of its patients and staff.

I'm not intimately familiar with the Gary Walker case, but the facts are hotly disputed - and his 'modernleader' self-appellation on Twitter makes me very cautious about his motives and statements, to put it mildly.
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Re: Mid Stafford Hospital report

Post by oftenwrong on Thu Mar 14, 2013 5:56 pm

Jeremy *unt is more than happy to hear bad news about "conditions in NHS hospitals", so removing the gag from whistle-blowers can only be to the long-term advantage of Tory scheming.
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Re: Mid Stafford Hospital report

Post by astradt1 on Thu Mar 14, 2013 6:08 pm

I can't wait for all the whistle blowers who cite lack of funding as a major problem........

I wonder what J Hunt will do then.........'Free' Hospitals......Like 'Free' Schools anyone?
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Media/Jarman: 20k needless NHS deaths. Why it's nonsense.

Post by skwalker1964 on Sun Mar 17, 2013 9:25 pm

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In the immediate aftermath of the release of the Francis Report into events at Mid Staffordshire NHS Foundation Trust, I identified that David Cameron’s crocodile-tears and apparent humility were just a feint that would quickly turn into an attack on the NHS nationally (yet another front in their all-out war on it), using Mid Staffs as a template for attacking other hospitals – and Labour.

This morning’s headlines – covered by the BBC (website and news channel) and the right-wing press – about Professor Sir Brian Jarman’s claim that 20,000 NHS deaths could have been prevented come on the back of a 2-week long assault by Health Secretary Jeremy Hunt on Labour’s supposed failings leading to Mid Staffs.

The claims are utter nonsense – but they are being used by the press and the government as

A sledgehammer to smash the NHS – and Labour

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HSMRs – the wrong sledgehammer, in the wrong hands, to crack the wrong nut

I’ve already shown, at considerable length, that the headlines you will have seen in the media about 400-1200 ‘needless deaths’ at Stafford are utterly unfounded. Prof Jarman’s latest claim takes all the same errors and distortions that the media and government have shamelessly stated as fact – and then compounds them into even greater distortion and error.

Why it’s all nonsense

Prof Jarman’s errs on so many fronts that it’s almost unbelievable that a clearly intelligent man can make such fundamental mistakes. That a statistician can so plainly ignore obvious statistical truths suggests a deep-rooted personal agenda – one which is shamelessly being exploited by the Tory-friendly media to foster the government’s aim of destroying the NHS as a national, social institution.

Those errors are both logical and factual.

The ’100′ error and the danger of the average

As I explained in my post on the real story of Mid Staffs, Prof Jarman’s HSMR (hospital standardised mortality ratio) system rates English hospitals according to where they sit according to the average death rate for the nation. A hospital hitting exactly the average rate would receive a ‘score’ of 100. A hospital doing better than average would have an HSMR below 100, and one doing worse would be over 100.

So far, so clear – I hope. But here’s the key fact: every year, the system is ‘rebased‘ – the averages are re-measured and ’100′ is re-calibrated to the new average.

This leads to 3 key problems:

1) Because of how averages work, unless by some miracle every single hospital in the country got exactly the same score, you will always have some hospitals above 100 and some below. This does not mean the ‘extra’ deaths in those hospitals were avoidable – it just means that somebody has to be above the line because it’s an average.

2) Because the ’100-line’ moves every year, a hospital can maintain exactly the same standard in one year as it achieved in the previous year – and yet can score below 100 one year and above 100 the next. The performance of the hospital did not get worse. The line just moved. It’s not only wrong but ridiculous to extrapolate ‘extra’ or ‘avoidable’ deaths from a position above or below a line that moves every year.

3) Leading on from number 2 – and it’s impossible to overstate this – there is no ‘standard’ rate of deaths from a particular illness. No expert clinicians are sitting down together and saying ‘Yes, we agree that out of every 100 patients with an intracranial bleed, this many are going to die’. No. All that happens is that the average for the previous year becomes the re-calibrated ‘expected death’ figure for the following year. This means that HSMRs are measuring the success/failure in achieving/beating/failing to bear a target that moves every year – and has no basis in clinical expertise. It’s just a number.

In his testimony to the Francis inquiry, Prof Jarman claimed that he had to present the figures this way because the English are ‘simple-minded‘ – but in doing so he has committed a fundamental error of logic worthy of a simpleton.

These fundamental logical errors mean that even if everything else was perfect, HSMR scores over 100 cannot be used to calculate avoidable deaths.

But everything is not all perfect with HSMRs

Prof Jarman’s claims are based on his repeating his assumptions about Mid Staffs to arrive at an even larger death figure for the 14 hospitals that are under investigation for having similar HSMR scores to that hospital. But if the assumptions don’t stand up for Mid Staffs, then they are meaningless for the larger set of hospitals. And they are meaningless.

I won’t repeat everything I wrote in my earlier post, as this one would become unreadably long. I’ll summarise a few key points, and if you want to check the details, please refer to the full post.

But I also have additional information.

Earlier this week, I had the opportunity to meet with Sandra Haynes Kirkbright – the coding manager that was brought in by Mid Staffs to address the problems they knew they had with their coding. She had read my first post on the Mid Staffs HSMRs and told me

I thought, ‘Someone gets it!’ I thought ‘How did he get inside my head?!”

She therefore let me know that she wanted to meet me and give me more information crucial to a proper understanding of what happened at Mid Staffs – and why the claims of press and politicians are so deeply misleading.

The information I got from Ms Kirkbright (who had begged to be allowed to testify to the Francis inquiry in person but been forbidden by the Trust’s lawyers) sheds even more light on the Mid Staffs HSMRs – and that light shows them (and the headlines and assumptions that have been based on them) to be even more full of holes than I already knew.

I’m going to write a separate post on the full discussions with Ms Kirkbright, as they ranged more widely than Mid Staffs. However, while the claims in the media about 20,000 needless deaths are absolutely risible, they are also potentially catastrophic for the NHS if they are widely believed.

Because of the urgency of getting good information out into circulation to counteract the invidious nonsense, for this post I’m going to pick out some of the key points about Mid Staffs and its HSMRs that have not, as far as I’m aware, been covered at all by the mainstream media.

First the earlier post, summarised:

Only one ‘excess’ death at Mid Staffs

HSMRs are a statistical device. If you want to be sure whether deaths were avoidable or not, you need to look in detail at the case notes for each patient. The doctor in charge of the Independent Case Note Review (INCR) was asked by the inquiry how many ‘excess’ deaths he had discovered among all of the cases for which families asked for a review. His answer was telling – but has been almost completely ignored:

Perhaps one such death.

Rubbish in, rubbish out

Prof Jarman’s HSMR scores are based on comparing ‘expected’ deaths with ‘observed’ deaths. Each condition has its own typical death rate, so if more people die than would be expected for any recorded condition, an HSMR of over 100 will result.

But the conditions generating Mid Staffs’ HSMRs often did not reflect reality. For example:

  • HSMRs are based on the first diagnosed condition, even if a much more serious condition is subsequently diagnosed.

  • HSMRs can be adjusted by taking into account ‘co-morbidities – conditions that existed alongside the main diagnosis. But Mid Staffs coding manager was absent on long-term sick leave, and co-morbidities were not entered. Co-morbidities increase the ‘expected’ death rate – so leaving them out will make the ‘expected’ figure too small and lead to an ‘excess’ in the observed figures.

  • Doctors were not aware of the significance and consequences of poorly-recorded or missing diagnoses and co-morbidities.

  • Under pressure because of short-staffing, many gave only minimal effort to coding and recorded onlyone diagnosis – often an inappropriate one.

  • Mid Staffs was not recording ‘zero-length stays’ (people who came in, got treated and went home the same day or the next day). Since those people would, by definition, not have died in the hospital, including them would lower the overall death rates and bring down HSMRs. Mid Staffs’ HSMRs were therefore inflated by not including them.

  • ‘Palliative care’ is treatment given to patients that are going to die no matter what. A code, ‘Z51.5‘, was introduced for palliative care so that people dying from incurable diseases would not worsen the HSMR score. Mid Staffs was not using this code until 2008.


There are many more contributory factors, whose details you can find in the earlier post. The cumulative effect of all these factors was a huge inflation of Mid Staffs HSMRs.

88

When Ms Kirkbright arrived at Mid Staffs, she carried out a re-coding exercise on past deaths. This re-coding corrected the absent Z51.5 code and used the case notes to add in the co-morbidities (what is known in the jargon as ‘depth of coding’) that was missing. This brought down Mid Staffs’ HSMR to 88 – well below the national average death rate.

This fact has been completely ignored by almost all the mainstream media.

The new information

The above facts on their own are enough to show that Mid Staffs was not ‘killing hundreds of patients‘. And if the ‘excess deaths’ there never happened – then the figures at other hospitals are similarly meaningless in terms of identifying ‘excess’ deaths.

But the new information I received from Sandra Haynes Kirkbright makes the case even more watertight.

The external audit

It’s important to know that the statistics used by Prof Jarman’s system are not entered specifically for the purpose of recording mortality rates. HSMRs are drawn from codes that have to be entered by hospitals on the treatments they provide and the outcomes they achieve in order for them to be paid for their work under the ‘payment by results‘ (PBR) scheme.

In his testimony to the Francis inquiry, Prof Jarman implied that Mid Staffs had ‘gamed‘ the system to bring down its HSMR score – basically, that it was fiddling the figures in order to improve their HSMRs.

But because coding could be used to increase a hospital’s income, the government’s (now-defunct) Audit Commission (AC) carried out audits of Trusts, to make sure that their figures are legitimate.

Following the re-coding exercise, the AC arrived and audited Mid Staffs’ coding – and awarded an unprecedented score of 97-98% for accuracy. Under no circumstances could Prof Jarman’s allegations be correct.

More ‘rubbish in, rubbish out’

Ms Kirkbright told me of a Trust she knew of that was routinely ‘gaming’ its codes by 15-20% ‘so as not to appear outrageous’. This was not for HSMR purposes, but to increase its income – but it would also improve the HSMR score.

Similarly, Royal Bolton Hospital stands accused of inflating its septicaemia coding to increase its income – but again, this would impact on HSMRs.

If some hospitals in the country are playing the system because of funding pressures, then the significance of the higher HSMRs of the 14 hospitals under investigation is just as likely to mean that they are more honest as it is to mean more patients are dying avoidably. In fact, in the context of everything else, it’s more likely.

‘Receptionist triage’ – another myth

The misleading articles on Mid Staffs made much of the claim that patients were so thirsty that ‘many’ had to drink from flower vases to assuage their thirst. Flower vases have been banned at Stafford and Cannock since the mid-90s – so the story is either completely unfounded or based on one exception (most likely a confused patient).

Similarly, it has been frequently claimed that the Accident and Emergency unit (A&E) at Stafford was so badly run that triage (the initial assessment of patients) was carried out by receptionists.

This is simply untrue. To admit a patient, receptionists had to complete a set of information on the hospitals IT system. The system was configured so that users could only go to the next input page after they had completed the preceding one – including entering a name for the member of staff who had assessed the patient.

Receptionists (who thought ‘triage’ was pronounced ‘tree-ar-gee’!) often did not know or were unable to spell the name of the doctors who assessed patients, so – to save time and because they couldn’t go further without entering a name – they routinely entered their own.

That this scenario has been so distorted in reporting on the Mid Staffs situation is a very good indicator of the (abysmally low) level of reporting and investigation behind the prurient headlines.

Unqualified coders ‘drowning’

Clinical coding is a skill with its own qualification. It takes up to two years to learn the necessary skills, including procedures and conventions of coding and detailed anatomical study to ensure that notes are properly understood and coded. Ms Kirkbright was a qualified coder in the US – and then had to study again to gain the UK qualification.

For a qualified, full-time coder, the average coding rate is around 7,500 cases per year. Mid Staffs treats around 60,000 patients a year – so needed 8 full-time, qualified coders.

In the absence of the coding manager, the coders trying to keep up with the caseload at Mid Staffs numbered 5part-time and unqualified.

In this context, it’s no surprise that coding was inaccurate and lacked ‘depth’ (co-morbidities) – massively pushing up HSMRs. To get on top of the coding, Ms Kirkbright and 11 others were eventually employed to cover the hours necessary to manage the workload properly.

If Mid Staffs was unable for years to employ and train sufficient coders to code properly , it’s certain that there are many other Trusts in a similar situation (many do not even have a clinical coding policy) – making the whole HSMR ranking system meaningless.

No training

Doctor Fosters Intelligence (DFI), who publish HSMR tables in their ‘Good Hospital Guide‘, and which finances Prof Jarman’s Doctor Fosters Unit, provides no training on how to code to ensure accurate HSMRs.

It does provide training on how to use its Real Time Monitoring (RTM) tool which allows Trusts to use and monitor HSMRs. It charges £35,000 a year for this service – and Trusts with poor HSMR scores are more likely to want to purchase it.

Can you say ‘conflict of interest’?

More ‘first (mis)diagnosis’ examples

As already stated, HSMRs are based on ‘first diagnosis’. My earlier post gave an example of a diagnosis of a broken shinbone that was later discovered to be caused by bone cancer. Broken legs have very low expected mortality rates. Bone cancer does not. But the HSMR programme would measure that death against the broken leg, not the cancer.

Ms Kirkbright provided me with other examples of similar issues. For example, if a patient arrives unconscious and the ambulance driver reports ‘He fainted’, fainting would be the first diagnosis. If that patient is then discovered to have had a serious stroke and dies, that death will be recorded against ‘fainting’ – a condition with a very low death-rate – resulting in an inflated HSMR.

Similarly, Ms Kirkbright once challenged the NHSIC about the fact that post-mortem results are not included in the coding. She was told:

We don’t do death coding – we do morbidity (disease) coding

to which she responded:

Do you think he developed congestive heart failure after he died?!

The data on which HSMRs rely must inevitably be missing the real cause of death in many cases – meaning that deaths are allocated to the wrong diagnoses and making the HSMR tables meaningless.

DOA or, It’s worse than that – he’s dead, Jim!

Because of a misunderstanding of procedure, A&E staff at Stafford were admitting patients who were already dead on arrival at the unit. The correct procedure would have been to send such a patient to the recovery unit to see if they could be revived, and then admit them if they were resuscitated. But dead patients were routinely admitted as patients, declared dead – and then form part of the hospital mortality statistics even though they were already dead when they got there.

Again, this would add to the cumulative error in the statistics – and if it was happening at Stafford, it’s almost certain to be happening elsewhere.

Rocking horse droppings (or A&E coding)

As mentioned above, hospitals are not paid for ‘zero-length stays’ – people who come into A&E but are discharged on the same day or next day. A&E treatments are funded on a simple 3-tier system according to severity rather than on the specific ailment or injury. As a result Stafford’s finance manager was not bothering to send the codes forward for inclusion in the PBR data – not realising that it would have a massive impact on the HSMR scores.

Because of the low priority allocated to it, A&E had only 2 coders – neither of whom had any training, and who just entered whatever was ticked on the back of the Casualty Card, even if it made no sense, or made a ‘best guess’ if it was unclear.

This meant that A&E coding was ‘all over the place’ – and therefore generated completely unreliable HSMRs.

Measures were taken at Stafford to address all these problems, with the result that the Trust’s HSMR scores came down dramatically. But if these and similar issues remain unaddressed at other Trusts, then the data that the whole HSMR system relies upon is close to meaningles.

And it certainly isn’t solid enough to support the wild and emphatic claims made by Prof Jarman and the media that are exploiting him.

Motives

Detective shows often make a play of the ‘trifecta’ that has to be in place before a suspect can be charged with a crime: means, opportunity and motive. Prof Jarman and the media and politicians have access to the HSMR data. They have the means to publicise their claims. But what about motive?

For the Tories and their media allies, the motive is clear enough. The massive distortions around events at Mid Staffs present a perfect opportunity to attack that Trust – and to use it as a basis for attacking others. The right has hated the NHS since its inception – protestations that they love it are for public consumption only – and the current crop is on record as wanting to end it.

As for Professor Jarman – who knows? But he testified to the Francis inquiry that he felt Labour had not treated his system with the seriousness he believes it deserves – and that the Tory-led government has been much ‘friendlier’ towards it.

Could it be revenge on Andy Burnham for the perceived slight when Burnham – with complete justification as it turns out – rejected the supposed importance of HSMRs and used other methods to assess hospitals and address their issues?

Could it be that Prof Jarman’s testimony to Francis and his subsequent comments reveal a man who is so deeply attached to his system that he can’t accept its flaws and will go to great lengths to vindicate it?

You’ll have to consider and decide for yourself. But what’s absolutely clear is that, whether knowingly or not, Prof Jarman has positioned himself perfectly to be exploited by the ideological enemies of the NHS as a tool for undermining it – and for attacking Labour’s entirely justified public perception as the founders and supporters healthcare ‘free to all at the point of use’.

I don’t doubt that Prof Jarman wants his system to work for the good of patients, but taking flawed results from one hospital and multiplying those across 14 – and then trumpeting a claim of 20,000 avoidable deaths to the media – is reckless in the extreme and has played right into the Tories’ grasping hands.

The threat is serious, because a lot of people will believe what’s being said and written just because it’s in the media and has apparent statistical/scientific support. Very few will look beyond the soundbites to see whether they stand up to scrutiny.

So please, if you’ve read this article and agree with its premise, spread the word. We need good information out their to counteract the absolute tripe that’s being force-fed to the British public.

And please also consider supporting CCGWatch, which is aimed at combating another of the key Tory attacks on the NHS: stealth-privatisation.
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Re: Mid Stafford Hospital report

Post by oftenwrong on Sun Mar 17, 2013 11:18 pm

As in any war, THE TRUTH is the first victim, and everyone feels free to grind an axe at the door of the NHS.

More people die in Hospital thn anywhere else, which is a good place for critics to begin.

The plusses tend to be the tales from individuals, that are lost in the telling. But given the choice of believing a Doctor or a Politician ...... You decide.
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HSMRs, the health minister and the kung-fu masters..

Post by skwalker1964 on Tue Mar 19, 2013 6:03 pm

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HSMRS, THE HEALTH MINISTER AND THE KUNG-FU MASTERS

My couple of posts on Hospital Standardised Mortality Ratios (HSMRs), the clearly and seriously flawed statistics that the government and media are using as a hammer to break the NHS, have started something of a storm. Since I posted my articles, I’ve been accused of:

- being disrespectful to the dead
- being henpecked by my wife (a nurse) into writing the articles (she never knows what I’m writing until I tell her afterward)
of having no right to an opinion for a) not having had a relative die at Stafford or b) not being a statistician
- most disturbingly, of being a sexist and a friend of paedophiles (neither of which could remotely be inferred from my posts, I trust!)

The nature of most of these demonstrates fairly clearly, I think, the rationality or lack of it of some of the people whose opinion is currently being used and quoted by the media and by government politicians.

Most significantly, with only a couple of exceptions, nobody has actually been able to challenge the actual facts and conclusions stated. One journalist mounted a reasoned counter-argument, but it was fairly easily answered – you can read the exchange here. The statistician who devised HSMRs, Professor Jarman, resorted to a defence on Twitter of the ‘avoidable death’ figures (which even he told the Francis inquiry could not be inferred from the statistics) that involved multiplying the single ‘excess death’ possibly identified by the case note review of 50 deaths into the total number of deaths in the hospital. To do this meant ignoring the fact that most/all of the questionable deaths were already concentrated into the case-note review group – an error that no capable statistician could possibly make without realising it.

What did come out of the discussions that have followed the articles was a fairly consistent thread that people did not really grasp why DFI’s practice of ‘rebasing’ HSMRs every year to a new level and still calling that ’100′ was a problem. That’s not surprising, since it’s complex enough to be difficult to grasp. So I thought I’d provide another illustration to help clarify why it’s a problem.

The kung-fu masters

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Imagine a tournament organised by a kung-fu martial arts discipline, which brings together the world’s top practitioners of the martial art. For the sake of argument, let’s say the top 101 masters are invited.

Those martial artists are tested for various attributes – strength, speed, precision and so on – and then ranked, from 1st to 101st. Martial artist no 50 is the ‘average’ or mean Master. He is worse than 50 of the 101 – and better than 50 others. But he’s still a Master - better than the remaining 7 billion or so people in the world at his particular skill.

Now, let’s say he comes back next year having worked hard on his speed. When the 101 masters are re-assessed, he has moved up by 10 places, to 41. But there are still exactly 50 masters ranked more highly than the new number 50, and 50 who are ranked lower. At least 10 people saw their ranking slip because of the improved performance of our former number 51.

Most importantly, at least 1 has fallen into the ‘worst’ 50 because the other guy moved up. And all 101 are still masters.

Am I saying that every NHS hospital is a world-class master? No, of course not. But the NHS is a world-class health service.

So an average is a very flawed means of measuring quality, because all the participants might be excellent – but some will rank a bit more highly. For measuring mortality, it’s a similar story – because every hospital in the world will have avoidable deaths. Some might have more, but for perfectly valid reasons (e.g. the population they serve is very old, or poor).

And, because one or more hospitals might improve between one measurement and the next, a hospital that is just as good as it was might fall down the ‘table’. It might even be doing better than it was – but others have improved slightly more.

Get the picture?

The health minister

Now, still bearing all that in mind, let me show you something I’ve come across. It’s a copy of a letter from Health Minister Norman Lamb to a whistle-blowing doctor who had written to him about HSMRs. In this letter, Mr Lamb tells what the government knows about HSMRs:

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Health Minister Norman Lamb’s ‘confession’

'The Department [of Health] is aware’ that HSMRs can be used (at best) as a prompt to go and check stuff – and that ‘HSMR data alone does not demonstrate poor care’.

Yet, ‘weirdly’, that has in no way prevented Jeremy Hunt, David Cameron and other ministers, not to mention the right-wing press, from proclaiming ‘THOUSANDS OF AVOIDABLE DEATHS’ to talk down the NHS and to attack Labour.

Since HSMRs do not mean ‘avoidable deaths’ – and, as I’ve shown, the system is so full of holes as to be basically meaningless – the real question is:

Just why are they doing that?

Plainly it has absolutely nothing to do with saving patients or improving the NHS. So there must be other motives.

Hmmmm, wonder what those could be?
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Private Eye's HSMR 'faked coding' claim - does it stand up?

Post by skwalker1964 on Thu Mar 21, 2013 9:26 pm

Original including links at: [You must be registered and logged in to see this link.]

In the most recent issue of Private Eye magaine, the Medicine Balls columnist shows a graph of figures concerning the use of the Z51.5 palliative care code for deaths at a number of Midlands hospitals. He or she claims of this graph:

Here is a pretty picture. It shows how Trusts can disguise high death rates by recoding those who die as palliative care (code Z51.5). They are then “expected to die” and disappear from the published death rates.

Here is the graph the Eye showed:

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This chart, which was taken from written evidence submitted by Prof Brian Jarman of Doctor Foster, shows 3 West Midlands Trusts, plus Medway Trust in Kent, and an average for all the other acute Trusts in England minus the 4 aforementioned Trusts.

Looks damning, doesn’t it? But does it show what we’re meant to think it shows?

Specialist subject: the bleedin’ obvious

Professor Jarman – and the Eye article – assert that the graph demonstrates how Trusts can ‘disguise high death rates’ by using the palliative care code. Prof Jarman told the inquiry that he believed the Trusts were ‘gaming’ his system to make themselves look better.

But look at the green line in the graph, the one which represents Walsall Trust.

Walsall’s line jumps from almost zero up to the end of 2006 to around 9% at the beginning of 2008 – to almost 80% by the 4th quarter of 2008. Can anyone seriously believe that Walsall Trust was trying to fool people that 4 out of every 5 people who died at its hospital were being treated for terminal illnesses?

Of course not. So that’s the ‘deliberate gaming’ theory shot down in flames just from a first glance.

TLC

What was happening at Walsall during the period where the line shoots up sharply was a misunderstanding among its coders about what constitutes palliative care.

Palliative care constitutes a defined set of treatments that are given in a defined set of circumstances, aimed at making someone comfortable during the very final stages of his or her life. The Liverpool Care Pathway, about which I’ve written previously, is one example. Administering drugs to sedate someone who is panicking because they can’t get their breath at the end of their life is palliative care – but administering similar treatment to someone who is not imminently dying is not.

The confusion at Walsall was between palliative care and what they were calling ‘TLC’ – similar care given to someone who was not imminently dying, but neither were they going to get better. Making someone comfortable, easing breathing and so on – with a view to sending them home (or to a care home etc) once they were settled, is ‘TLC’.

But Walsall’s coders were coding it as palliative care – hence the huge spike in the green line, which then drops sharply once the error was identified and corrected.

Hocus, Focus..

Now let’s strip out some of the extraneous information. We know Walsall’s line was very wrong, and why, so let’s remove that from the graph. Since Walsall’s figures must have a drastic effect on the average line for the 3 West Mids Trusts, we’ll remove that too. I’ve edited those out as cleanly as I can with my limited graphics skills, and here’s the resulting graph:

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That’s clearer, isn’t it? Without so many lines you can see more clearly. As I wrote in my first post on Mid Staffs’ HSMR mortality rates, when the palliative care code was first introduced to make the coding across the whole country reflect more accurately what was actually happening, the Trust’s coding department did not make the switch to using it.

This is borne out by the graph, which shows Stafford’s line at or very near zero until the end of 2007, while the line representing national use of the code is climbing steadily from 2004. The graph also shows that the Medway Trust in Kent failed to realise the change at first, but it caught on earlier, and its line rises from the beginning of 2007 rather than the end.

So far so good. But the lines for Stafford (and George Eliot and Medway) still look significantly higher than the national average. So surely that’s a problem, isn’t it?

Well, no – but let’s see why.

A jury of its peers?

Prof Jarman’s Doctor Foster’s, along with the Healthcare Commission (HCC) had grouped Stafford into a ‘peer group’ of other Trusts. When asked by Jonathan Pugh, Information Manager at Mid Staffs, what the basis for this grouping was, the HCC didn’t know and Doctor Foster’s didn’t say. But as Mr Pugh told the Francis inquiry in his written statement:

Mid Staffs always argued that this group was not representative of the Trust and we put forward our own peer group.

So, Mid Staffs felt that the peer group was chosen to make them look bad, but even so, as Mr Pugh testified to the inquiry:

There is always someone at the top and a graduated reduction as you go down the graph. Without Medway and Walsall you could have easily included the next 8 in the graph.

In other words, Mid Staffs was put into a group for the purposes of the graph that reflected badly on it – but even in that group, if the others in the group had been included on the graph, we would have seen a spread of lines across the graph.

Seeing an even spread of lines would show that there was considerable variation among Trusts in their use of the Z51.5 palliative code – just as there was considerable variation in the handling of all data relevant to HSMRs. So much variation, in fact, that it made the HSMR results meaningless.

It almost looks as if the candidates chosen for the graph were deliberately selected to make Mid Staffs and other West Midlands Trusts look bad – look like they were faking the figures. Could this be true?

Back to Mr Pugh. In his statement to the inquiry, he points out that

Airedale NHS Foundation Trust, in quarter three of 2006, had a peak of 3.5 times the national average for coding of deaths with palliative care.

Wow. Mid Staffs' palliative coding – at its worst – was about 3.8 times the average at the time (and less than twice the average in 2010). Surely Airedale was identified as a ‘gaming’ Trust and targeted for auditing and possible sanctions?

No. As Mr Pugh points out, Airedale had been

‘Small Trust of the Year’ in Dr Foster’s annual hospital guide on numerous occasions.

So, Mid Staffs is accused of fiddling the system while Airedale, with very similar use of the Z51.5 code, wins awards. Draw your own conclusions.

The big picture

We’ve already noted that Mid Staffs was allocated a ‘peer group’ by Doctor Foster’s – a group which the Trust disagreed with vehemently on the grounds that it made the Trust look bad. But even so, Mr Pugh’s evidence to the Francis inquiry included a table that showed a comparison of palliative care episodes for each of the peer-group Trusts, including Stafford.

That table bears close examination. Here it is:

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This table tells a very clear story – but because it’s a lot of figures, it’s quite easy to miss it. So, at great expense (well, an hour’s worth of me typing the figures into a spreadsheet and creating a chart), here’s how those figures look when put into a graph:

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What this chart shows is Mid Staffs (the red line) starting at almost zero in 07/08 and then climbing sharply as use of Z51.5 kicks in. But it is then rapidly overtaken by most of its peers and finishes 3rd-lowest out of the 7 peer Trusts (although there’s hardly anything separating most of them. So Stafford’s use of the palliative code is entirely in line with other hospitals considered its peers.

This peer group was chosen by Dr Foster’s – yet the only one they chose to show on the chart presented to the Stafford inquiry was Mid Staffs, making Mid Staffs and its neighbouring Trusts look like ‘outliers‘ – like the odd ones out, the ones that ‘must’ be up to no good, because they’re so far above the national line.

And don’t forget, the chart you’re seeing above still gives a false impression of a lot of coding – until you notice that the top of the ‘Y’ axis showing the percentages denotes only 1.2% of all the codes entered by those hospitals in those years.

If I make the top of the ‘Y’ axis 100%, here’s what it looks like:

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All the lines are so low – fractions of a percent – that you can’t even separate them.

So much for Mid Staffs ‘gaming’ the system.

The even bigger picture

You might now be thinking, ‘That’s all well and good – but Mid Staffs Z51.5 codes are still quite a bit higher than the national average. That’s still suspicious.’

I understand why you might think that – but you’d be wrong. What you can’t see from any of the tables or charts presented is what’s going on outside the figures that still affects them – and there are a factors that easily account for the difference.

What you don’t know might hurt you..

Prof Jarman presented his graph contrasting the West Midlands Trusts (plus Medway) against a line for the national average. We’ve already seen that a number of other Trusts – the ‘peer group’ that was selected, but then ignored, by Dr Foster’s – had very similar patterns of coding for palliative care. If those had been shown on the graph, Mid Staffs and its neighbouring Trusts wouldn’t have looked anything like so unusual.

But they weren’t. And if they weren’t, then it has to be asked: how many other similar Trusts were omitted which distorted the picture even further?

And at the bottom end of the range of figures lie a similarly-unknown number of Trusts with very low use of Z51.5 – and they must exist to bring down the ‘national average’ line low.

Perhaps a lot of Trusts are still not using the code as much as they should, just like Stafford and others did at the outset but later corrected. Any Trusts not using the code much – rightly or wrongly – will drag down the average and make other Trusts look worse on a graph like that presented by Prof Jarman.

And a lot will be using the code a lot less, for perfectly legitimate reasons:

The hospice factor

As I showed in my original HSMR article, HSMRs only measure people who die in hospital. Fair enough, you might think – but there is one big factor that can affect the HSMR scores among hospitals in a completely unseen way: local hospice care provision.

Some hospitals are situated in areas with a number of local hospices. My own area is one such, with a number of hospices situated within the catchment area of my local hospital. This means that people in the final stages of their life and who need palliative care are far less likely to receive that care in hospital – and if they don’t get it in hospital, it never shows up in HSMRs.

By contrast, some Trusts are in areas with little or no hospice provision. Their terminally ill patients are going to die either at home or, far more usually, in the hospital – and if the coding department is doing its job properly, the Z51.5 code will be used a lot.

This means we should expect a huge variation between hospitals with great hospice availability and those with poor or even none.

And Stafford? As one local resident put it, Stafford has

a piddling little hospice.

So, with very modest hospice provision you’d expect Stafford to be high on the chart for use of Z51.5 – but because some hospitals will have even less access to hospice care, not right at the very top.

Which, strangely enough, is exactly what we see in the charts – both mine and Prof Jarman’s.

Whether deliberately or not, the chart showed by Professor Jarman and his Dr Foster’s group present an extremely misleading picture – one that happens to make their HSMR system look useful while making Mid Staffs look like it must be ‘gaming’.

Unfortunately, Private Eye appears to have bought into the myth in the most emphatically wholesale fashion – and its article therefore merely adds to distortion and misunderstanding that is being foisted on the British public, to the detriment of not just Stafford, but of the NHS as a whole.

It’s taken me a few hours to look more closely at the facts and see that the tale presented by the Eye isn’t worth the paper it’s printed on. What a pity they didn’t do the same before they printed it, and avoid stoking the fires of suspicion an anti-NHS sentiment that the Tory-led government are intent on spreading for its own purposes.

Still, I had to pay £1.50 to buy the magazine and get a clear scan of its chart – so maybe for them swallowing a line is good business.
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Re: Mid Stafford Hospital report

Post by oftenwrong on Thu Mar 21, 2013 10:42 pm

The First Law of Publishing relates to paid-for copies.
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Private Eye attacks me for Stafford/HSMR articles

Post by skwalker1964 on Wed Mar 27, 2013 1:43 am

Original at [You must be registered and logged in to see this link.]

It’s been an interesting day. First in a very good way – I attended a very interesting event ‘Journalists and the new health system’, met some very good people and ended up on the panel, and had a lot of fun.

The next part was no less interesting but somewhat less fun, at least initially. An email was forwarded to me that has been sent by Private Eye – a fairly aggressive and accusatory one (although things did mellow a little after a few responses had been exchanged) which asked whether I (and another writer who has blogged on Mid Staffs) was being paid by the Labour party to write my articles on Mid Staffs and HSMRs, and accusing me ( and the other writer) of attacking people who are ‘trying to expose poor care‘.

Both are nonsense (although I have certainly criticised the Eye’s columnist(s) for lazily assuming that the headlines about HSMRs were true instead of checking the facts first). But rather than me write on them at length, I’m going to show you the initial email, my response, and then the emails that followed, so you can judge for yourself.

I’ve deleted the details of the other parties to preserve their privacy, but the content of the emails is, as far as I’m concerned, fair game:

From: xxxxx xxxxxx
Date: 26 March 2013 10:57:17 AM GMT
Subject: Private Eye

Dear Ms xxxxx

I am writing for Private Eye and have noted both yours and Steve Pleb Walker’s tweets. Please could you tell me whether your tweeted opinions on HSMR are Labour funded – how much funding you receive from your local party – and what scientific basis you have for making any of the claims you do? Further are you linked in any way to the BMA?

It would be really helpful if you could respond, as poor care is not resolved by attacking those who might expose it. Or is it not? [sic]

Yours sincerely,

XXXXXX XXXXXX
Private Eye

Dear Mr XXXXX,

XXXXXX forwarded me your email. She’ll answer for her own part, but I will answer for myself. To your questions (with a few additional facts thrown in):

- I receive no funding from anyone for my blog, nor from any political party for any purpose whatever.
- My ‘claims’ are made based on evidence gathered from various sources, including the transcripts of witness evidence to the Francis inquiry. All my sources are fully stated in my articles, with links where applicable – as you’ll know if you’ve actually read them – so anyone is free to check whether what I’ve pointed out, and the conclusions I’ve drawn, are correct and valid.
- I am not linked in any way to the BMA.
- I have no link to Stafford or Cannock hospitals, no relatives work there, and I live a long way from Staffordshire.

It’s not a matter of ‘attacking those who might expose poor care’. Poor care is not at issue, at least in anything I’ve written. My articles acknowledge poor care very frankly and explicitly.

What is at issue is the mishandling and misrepresentation of statistics, and the damaging headlines that have been spun out of the misrepresentation. Media from the BBC to the Telegraph to – yes – the Eye have repeated as fact the idea that ‘hundreds of needless deaths’ occurred at Stafford hospital, but the statistics say no such thing.

Robert Francis took care to say that HSMRs cannot be used to extrapolate numbers of avoidable deaths, and Prof Jarman and Roger Taylor admitted the same in their testimony to the inquiry – yes Prof Jarman is now giving interviews to TV and press saying there were 20,000 avoidable NHS deaths on exactly the same basis that he acknowledged could not be used for Stafford.

Many of the media have a clear and negative agenda in proclaiming these headlines. I trust that is not the case with the Eye – but recent articles have still been extremely misleading.

‘Avoidable’ deaths occur in NHS hospitals every day – and in every other hospital and healthcare system in the world. Healthcare is intrinsically risky, and because it is delivered by fallible human beings things will be missed, or done incorrectly.

Did people die avoidably at Stafford? Without question. Was the poor care at Stafford resulting in an elevated death rate that could justify headlines of ‘hundreds of needless deaths’? Absolutely not.

The corrected HSMRS (reflecting proper depth of coding and fully-audited palliative care codes) were substantially below the national average.

Since the existence of poor care in parts of Stafford because of severe short-staffing (as recognised by the Francis report) is uncontested, the fact that the death rate was below average means the headlines should be telling a completely different story – one in which overstretched staff managed to hold the essentials together well enough to prevent the understaffing from increasing the death rate.

The headlines say something else, and the end result is that the people of Stafford look likely to lose their hospital altogether.

I’m trying to present the facts in a proper light to redress the balance a little, and I have attacked unfounded/ill-founded statements, shoddy interpretations and lazy/malicious journalism, not individuals.

Steve


Within a minute or two of sending my response, I received another (and answered it):

Thanks for that Steve. Perhaps you could set out your qualifications – any mathematical or statisical or medical – to make the assertions you do about lazy malicious and shoddy journalism.

I have asked the Labour Party today who have distanced themselves from the views of yourself and XXXXX XXXXXX.

Yours sincerely,

XXXXXX

Labour will have to take a wider political view than I (happily) do. I have no qualifications other than intelligence, common sense and a certain dogged analytical bent – nor is it remotely relevant whether I do or don’t. If you can show my facts and conclusions to be wrong, do so. My qualifications have no bearing on the correctness or otherwise of what I’ve written.


and then..

Thanks for that Steve. Are you happy for me to forward this to the letters page of the Eye?

As you should be aware, HSMR is based on the coding of hospital episode statistics. That process can be “gamed” and your claim that Stafford was below average is a bizarre one which implies to me you simply haven’t looked at the HSMR figures (before attacking them).

Your point about a ratio of actua/expect as opposed to data on actual deaths is a fair one. And the media have sometimes taken a ratio to denote something else. However, HSMR do show up problems confirmed by real intelligence in the hospitals – surgeons, doctors, nurses. Even in failing hospitals there will be good doctors who are unfairly maligned. Nevertheless, apart from your general intelligence and common sense it might also be worth speaking to people who work in hospitals.

XXXXX,

Feel free – I’m going to post the exchange to my blog, so you’re welcome to print them in the magazine (which I buy, btw).

My articles address ‘gaming’, so your inference is incorrect. Gaming at Stafford is out of the question – the hospital’s statistics were audited by the Audit Commission and by Capita and graded 97-98% accurate. Gaming at other hospitals is possible – though more likely for income purposes rather than specifically to affect HSMRs – but the fact that they can be ‘gamed’ shows the system as it stands now and stood in the critical period at Stafford to be useless in terms of actually identifying genuine problem areas.

Hospitals might conceivably have poor HSMRs simply because they’re more honest than some others and are not gaming their figures. Or they might have genuine issues – or might just not be very good at coding, since the vast majority of coders are unqualified (and usually overstretched since theirs is a ‘back office’ function likely to be an easy target for cuts by people who don’t understand the potential consequences).

This is a tragedy, since HSMRs could be a vital tool – but only if money is invested in training coders and auditing coding strictly and regularly, to ensure consistency of input. Otherwise, ‘rubbish in, rubbish out’.

I do suspect you haven’t read most of what I’ve written, though – or else you’d know I’ve spoken to a lot of people in hospitals, both on the clinical side and an in-depth interview with Stafford’s unfairly-maligned (and proven by audit to be capable and rigorously honest) coding manager, who joined halfway through the debacle and ‘righted the [coding] ship’.

There have been hospitals with poor HSMRs who had clinical problems, it’s quite true. It’s also true that there have been hospitals with poor HSMRs and no substantial clinical problems, and hospitals with great HSMRs who, on inspection, were found to be riddled with problems. That’s the problem – HSMRs are too random to be useful, because of the problems with poor coding, lack of training and auditing, etc.

Steve


The rest of the emails so far then get into details of evidence etc that won’t make very interesting reading here.

By the point in the correspondence shown above, the tone seemed to have shifted considerably and were turning into an interesting and much less confrontational correspondence. But it’s interesting, given the clear way in which much of the media (though not, I trust, the Eye) are clearly marching to a Tory-mandated, anti-NHS drumbeat, that it should be assumed that I would only be putting forward a different interpretation because Labour were funding me.

In any event, it shows that the alternative (and I would contend far more accurate) story is catching the attention of the professional media, which is great. I’ve had calls from regional BBC correspondents over the last week or so looking for more information because their hospitals are being targeted for supposed similarities to Mid Staffs, when Mid Staffs was never what it has been portrayed as being.

It’s been a fairly intense few weeks, one way or another. But if a more balanced, less damaging view percolates out into the public consciousness, I’ll consider it all more than worthwhile.
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Re: Mid Stafford Hospital report

Post by boatlady on Wed Mar 27, 2013 8:14 am

Sounds like the first green shoots there - congratulations
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Re: Mid Stafford Hospital report

Post by oftenwrong on Wed Mar 27, 2013 10:05 am

If Steve Walker's hard work turns out to be rewarded on its own merits, then the green shoots should soon be visible at the end of the tunnel.

But this government, and especially Jeremy Stunt, will undoubtedly still have some tricks up its coalition sleeve. They've had 65 years in which to prepare for the dismantling of the Welfare State.
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Spend £30m or save £53m? The insanity of closing Stafford hospital

Post by skwalker1964 on Wed Apr 03, 2013 8:39 pm

The goings-on at Mid Staffs NHS, and the events and statistics that led to them, have been a main theme of this blog for some weeks now. I’ve shown variously

  • that the hospital’s mortality statistics in no way supported the ’400-1200 avoidable deaths’ claim and how this claim has been used by government and media to attack not just Stafford hospital but the wider NHS

  • that the hospital’s mortality statistics were significantly below the national average, once the problems with coding input had been corrected

  • that Stafford should be used by Health Secretary Jeremy Hunt as a blueprint for addressing issues in the NHS – but as a model of how to turn a hospital around, not a means of closing other hospitals as he has announced he will do


I’ve also shown that Monitor’s move to put Stafford hospital into administration can only be politically motivated (and part of Hunt’s plan of attack on the NHS).

The hospital has been struggling financially – largely as a result of being underpaid for the treatment it was giving because of the same coding problems that caused the false mortality alerts – but as recently as the beginning of last year, the Mid Staffs board agreed a recovery plan with both Monitor and the Dept of Health (DH) that was to run until 2015.

For this plan – to which Mid Staffs had adhered – to be scrapped after just one year of the four it was to run by the very same bodies which had approved it, just days after the publication of the Francis report, demonstrates a level of cynical political opportunism that a child could spot.

But the Tories don’t worry about subtlety when they have an opportunity to close a hospital – let alone when they intend to use it as a pattern and excuse for closing 10% of England’s acute hospitals.

Even so, some unsubtleties are so blatant that they make your mouth hang open that even the Tories will try them.

According to Monitor’s ‘worst case’ analysis in January, Mid Staffs’ needs to save some £53m over the next 5 years. The recovery plan – agreed by both Monitor and the DH, remember – was to address this issue. The fact that Stafford’s ‘Payment by Results’ (PBR) coding is now exemplary would have gone a long way to addressing this, by increasing the Trust’s income to the appropriate level for the treatments it provides.

‘All of a sudden’ this sum – over 5 years – is unaffordable, and the only solution is apparently to break Stafford up and downgrade the remnants until the people of Stafford are effectively without a local hospital that has been there for generations.

Yet – as part of the very same break-up plan – the government is going to have to give the neighbouring University Hospital of North Staffordshire (UNHS) in Stoke at least £30m right now to enable it to cope with the influx of patients it will receive if the administrators’ break-up of Stafford goes ahead.

Here’s an example of why:

The maternity unit in Stoke is already regularly closed to new patients because it is full – patients who are on the ‘roller coaster’ of giving birth, and who don’t have the option of waiting until a more convenient time. These mothers and arriving babies have to be taken to neighbouring hospitals in order to receive the care they need.

Including Stafford hospital – which has never closed the doors of its maternity unit.

Yet now, under Monitor’s and its administrators’ plan, the never-closed unit at Stafford is going to vanish – and the slack is supposed to be taken up in Stoke, with an extra 700 imminent mothers a year using its services. So UHNS is going to need a massive extension and up-staffing of its maternity unit if it’s to have a prayer of handling the additional demand generated by the closure of Stafford’s very capable unit.

A £30m injection of cash into Stafford hospital would put the hospital on a solid financial footing to match its now-exemplary clinical performance and reduce its £53m savings target over the next 5 years to a much less daunting £23m (or probably much less, since the hospital’s PBR income has improved).

And even if the government didn’t provide the cash-injection to Stafford, it still makes more sense to keep Stafford open. Consider the options:

Option 1: spend £30m now in order to deprive a town of its hospital
Option 2: save £53m over 5 years in order to keep a hospital that serves around 300,000 people and which has been adjudged by the Care Quality Commission (CQC) as ‘meeting all the essential standards of quality and safety‘.

Even without considering all the other impacts on the people of Stafford of the closure of their hospital, this would surely merit a place in any dictionary as a perfect example of a ‘no-brainer’.

Unless, of course, you have an ulterior motive: a lust not just to close one hospital but to use the methodology to close at least 14 others.
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Re: Mid Stafford Hospital report

Post by tlttf on Thu Apr 04, 2013 7:28 am

Steve, came across your remark "have I seen this thread lately" on one of the others. Yes is the answer, sorry but I've been pretty busy at the moment so haven't joined in (got slaughtered lately). As I mentioned previously, great thread and enlightening, but you don't need me to pat your back. Got to go again. Very Happy

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Re: Mid Stafford Hospital report

Post by skwalker1964 on Thu Apr 04, 2013 12:51 pm

tlttf wrote:Steve, came across your remark "have I seen this thread lately" on one of the others. Yes is the answer, sorry but I've been pretty busy at the moment so haven't joined in (got slaughtered lately). As I mentioned previously, great thread and enlightening, but you don't need me to pat your back. Got to go again. Very Happy

Oh, not looking for a pat on the back (or anywhere else! lol) - just remembered you'd expressed an interest and wanted to know whether you'd seen it. You'd be as entitled to disagree as to agree, let alone applaud!
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Re: Mid Stafford Hospital report

Post by skwalker1964 on Sun Apr 07, 2013 12:34 am

A GP comments on my 'Real Mid Staffs story' (via Dorset Eye):

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Stafford nurses speak out

Post by skwalker1964 on Thu Apr 11, 2013 6:43 pm

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I had the privilege yesterday of meeting some of the nurses from Stafford hospital. I’ve written various articles about what has gone on at and around Stafford hospital, from the massive media and political misrepresentation of the mortality statistics to the Tories’ cynical use of Stafford as a tool to hammer the wider NHS in spite of ludicrously-flawed data, to Jeremy Hunt’s remarkable omission in his statement on the lessons of the Francis report and the near-flawless assessment of the hospital’s performance in two recent inspections by the Care Quality Commission (CQC), and far more besides.

I've also written a couple of pieces titled ‘A day in the Life of an NHS nurse’ and one on the crucial importance of context for a proper understanding of any story or situation – context ignored by the media.

If you were to believe what you read or hear in much of the media, you might think that the nurses at Stafford hospital have horns and pitchforks, or at the least are heartless, cruel people who either took pleasure in inflicting suffering on helpless patients or at best just didn’t care.

So I asked to meet some of the nurses from Stafford hospital and for them to come prepared to tell me their stories. Since the staff at the hospital have been ordered not to speak to the media, they were taking a significant risk in doing so – and showing a degree of trust in me that I found very humbling, to present the stories carefully and properly.

I met them all in a small room in one of the pubs in Stafford town centre. When I looked around the table, I didn’t see any horns or pitchforks; nor did I see any callousness. What I did see what a group of people who managed the very impressive feat of being completely ordinary and yet very remarkable at the same time.

As the conversation started to flow, the emotions that have been mostly pent up until now were mixed but unmissable. Pain and grief stood out. So too did pride – and at the same time shame. Not the shame of people who’ve been caught out doing something they shouldn’t, but the shame of people who feel a genuine vocation to care for others and have found themselves prevented from fulfilling that mission as they would wish. The shame of people who know that they are scapegoats and not culprits, yet are unable quite to excuse themselves as fully as they would be entitled to because their sense of responsibility and obligation to those who rely on them is so strong, so deeply ingrained.

I’m going to try to convey just a little of what I heard in a way that conveys some truths about what went on at Stafford that you won’t hear from the media or from some campaigners. I’m going to add little to what they say, as they deserve the chance to speak for themselves.

I hope I do them justice and give them their voice.

Denial’s not a river in Stafford..

Time and again I heard some variation of

Every time we challenge anything, they say we’re just in denial. We’re not in denial – we know there was poor care, and it broke our hearts go home knowing we were unable to provide the care we wanted to give. But we’ve never been allowed to tell our story and give a balanced view, and if we try to say anything we’re just shouted down or banned from speaking. Please get the word out, so people don’t just believe there’s no other side to the story.

There but for the grace of God..

One theme that came out strongly all through the discussion was the conviction that Stafford was not some grotesque exception or freak occurrence. Nurses reported in turn how they had received supportive comments from nurses at many other hospitals that grasped hands and said ‘There but for the grace of God go we’.

One nurse told me of speaking at a conference of the Royal College of Nurses (RCN). In the couple of days of the event before she spoke, she and her colleagues were shunned by some of their fellow nurses. But when she stood up to speak, in 15 minutes the atmosphere transformed as the audience understood that these were not monsters but victims of circumstance – and that any one of those listening could, with a little worse luck, easily have found himself or herself facing the same vilification.

The factors that robbed some of Stafford’s nurses of the opportunity to provide the care that they wanted to, and robbed some of its patients of the care they deserved, are being imposed on almost every ward in almost every hospital.

Short-staffing, overloading, reduction in bed numbers but not patient numbers stretching physical and mental resources to the breaking point; these are not exceptions but the rule under this government. The miracle – and the tribute to the calibre and heart of the majority of health workers – is that there are not more cases of ‘appalling care’ in an environment that is being systematically, cynically starved.

Apologies and viciousness

Several of the nurses told me of their frustration at the media’s acceptance of the claims by campaign group Cure the NHS (‘Cure’) that nobody from the hospital had apologised to them for the poor care they felt their relatives had received. Two nurses told me that they had apologised in person to Cure leaders – even though they were apologising for something beyond their ability to prevent – and had been thanked for doing so.

One nurse told me of a day that she had worked an extra 12-hour shift at the hospital because there was no one else available to provide cover. As she left the ward, exhausted, at the end of a shift she wasn’t obliged to do, she saw that someone had scrawled on the notice board,

ALL A&E NURSES ARE BITCHES!

There was a sense of helplessness to put forward a counter-view, as all staff had been banned by the new chief executive from making any positive statements or responses on the grounds that it would be ‘insensitive to the families’. Yet when staff appealed to him to stop people from coming into the Accident and Emergency unit and abusing staff, he told them,

I can’t do that.

Staff are still banned from speaking out, especially to the press. But there was no such restraint in the opposite direction. One nurse was spat upon in the street several times, while others were called murderers as they walked with their young children. As I heard these stories, the outrage I felt was barely mirrored in the faces of those telling them. Instead there were red eyes, and tears – a sense of hurt and grief more than resentment.

These were not hard-hearted harpies, but kindly, capable women treated like monsters for circumstances outside their control. One told me:

They said everyone was responsible – but it wasn’t true. There was a lack of resources, a lack of numbers, a lack of even the right forms – how can we be responsible for that?

The enemy within?

The abuse didn’t just come from families and other members of the public. One nurse, her own eyes filling with tears for the first time even though I sensed she wasn’t someone who cried easily, told me of a governors’ meeting, at which

We were verbally abused until we just stood and cried.

Nurses were so scapegoated that even doing the right thing could be a cause for persecution. One nurse, who struck me as extremely tender-hearted, told me that she had called the CQC to warn them that staff numbers were falling dangerously again. After she had finished her shift, they arrived to inspect the situation. Early the next morning a friend had called her:

I just wanted to warn you – your name’s out there.

Almost breaking down, she described what happened when she arrived at work:

Medical staff hunted me down – hunted me – demanding ‘What have you said?!’

Another – the one I suspect doesn’t cry easily – told me of even worse occurrences:

I’ve put in IR (incident report) after IR. I once had to put a lady in a slightly inappropriate place – on a monitor but in a room off a corridor so that we couldn’t keep a constant eye on her. Not the best place, but we just had nowhere else. She passed away. I was never asked to the coroner’s inquiry – and the IRs were never discussed. They had disappeared.

Another picked up the thread:

We were told we didn’t follow the escalation process, but we did. The information was blocked and diverted. One relative queried the circumstances of a patient’s death after a buzzer wasn’t answered. The buzzers weren’t working – but the IR about them was ignored, and later removed.

Then I heard a couple of accounts that seemed to encapsulate the problems faced by health staff trying hard to do the right thing. One nurse told me that he had trained his staff in infection-control procedures, and a representative of the Healthcare Commission (HCC) came onto the ward:

You’ve trained all these people – why aren’t they wearing gloves and aprons?!

I told them, “We haven’t got any” – and we didn’t have. The last ones had been used and were scrunched up in a pile for disposal. We escalated the problems. We told the HCC – and all that happened was that senior staff came down demanding to know who had spoken to them.

Another told me,

I blew the whistle about something. The next thing, I was ‘named and shamed’ in a staff meeting, with minutes and everything. I rang the NMC (Nursing and Midwifery Council) and the RCN in flood of tears and was told:

“You can fight it – but it’s Stafford. You won’t get anywhere.”

Broken hearts and stubborn dedication

The cumulative effect of all this was no less tragic for being predictable. One account typified:

I’d achieved the goals they set me. I had lots of letters of thanks from patients and relatives – and then they sacked me from my position of responsibility. I was so fragile by then, I just didn’t have the heart to fight it.

Yet in spite of everything, commitment and dedication refused to die:

We only put ourselves through all this because we care about our patients and the people we work with.

My husband and kids say to me, “why don’t you take your bed and live there?” – but we can’t do any less. We give it everything – because we’re nurses.

It was an incredibly moving time. All through that discussion, that mix of pride, grief and unwarranted shame was clearly in evidence. There was remarkably little resentment toward those local people who had acted and spoken so hurtfully – but there was a strong sense of betrayal that those who should have spoken up for them and their colleagues had not only failed to do so but actively contributed to the witch-hunt.

It was a betrayal that went up to the highest levels.There is much more I could tell you from the discussion, but I’m going to end with a quote – with a question, in fact – and then you can make your own mind up whether the front-line staff have been fairly condemned, or unfairly scapegoated by those with their own agendas.

This quote was from the small, tough nurse that I suspect doesn’t cry easily – but who has, I don’t doubt, shed a lot of tears nonetheless:

Why did our Prime Minister take hearsay and accusations with no evidence to support them and just put it out to the world as fact? How could he do that when he must have known better? I can never forgive that.

If she’s right (and I am certain that she is), then the public’s anger has been directed at the wrong people – and we shouldn’t forgive the misdirection either.
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Re: Mid Stafford Hospital report

Post by oftenwrong on Thu Apr 11, 2013 7:22 pm

The public anger ebbs and falls in accordance with media coverage of a given topic.
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Mid Staffs administrators - spot the difference? Staggering..

Post by skwalker1964 on Wed Apr 17, 2013 1:18 am

With staggering arrogance, Jeremy Hunt rushes through legislation authorising Monitor to appoint the people who made the decision to put Mid Staffs into administration as the 'independent' administrators to review their own decision.

Spot the difference? Mid Staffs 'independent' administrators?!
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A Stafford consultant speaks out

Post by skwalker1964 on Sat Apr 27, 2013 3:52 pm

A Stafford consultant speaks out [You must be registered and logged in to see this link.]

I’ve received a copy of a letter that a consultant from the Accident & Emergency Dept at Stafford hospital has sent to the British Medical Journal (BMJ). He doesn’t know whether the BMJ will publish it, but has given permission for it to be shared.

I’m publishing it, in full, here without further comment from me, in order to ensure that he gets a public hearing:

It must be made clear at the very outset that many patients suffered unacceptably in Stafford Hospital during the last decade and I sympathise with them. Some died and their deaths were considered avoidable. To their families and friends I can only extend my deepest condolences. But equally, many tens of thousands of patients attended Stafford Hospital during 2005-9 and found no cause to complain. Many of these would have been on the brink of death but were successfully resuscitated, treated and discharged. Must these patients and their families now see the hospital that saved them being maligned and prepared for closure? Do their positive experiences count for nothing?

I commenced work in Stafford Hospital only a year ago and am on the verge of retirement, with no axe to grind and little to fear in this new age of candour. Working in the A&E department, I meet local people on a daily basis and many of them recount how well they were cared for during their previous admissions. So it is with considerable angst and much concern that I watch the reputation of a locally much-liked institution being slurried in the dog-eat-dog world of the general media.

Whilst there is little I can do to encourage balanced coverage in the national press and politic, there is, surely, room for more sanguine consideration of the facts in professional journals such as this one.

1. How has it come to be that Stafford Hospital is commonly associated with 400 to 1200 deaths from 2005 to 2009? I am not being complacent when I question the derivation of these figures. It’s my training. I instinctively question ranges of 300%. And if I find even one avoidable death distressing, what do I make of a thousand? That’s carnage! People must have been dying in droves. No! As expected, the numbers are projections and estimates based on opinion, best scenario-worst scenario arguments and grossly inexpert coding. I sympathise with the view that when coding is corrected and is accurate, the death rate in Stafford during 2005-9 actually falls substantially and possibly below the national average:

“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.”

Further analysis of this subject and the fallibility of mortality ratios (HSMRs) is available here: [You must be registered and logged in to see this link.]

2. Unlike death, Care is a perceived quality. If people don’t feel cared for, that’s the end of the argument. It’s unacceptable. Standards of care did lapse significantly in Midstaffs. But how significantly? We don’t know, because to measure such parameters objectively we need to study an unselected sample. We need to look at representative groups, not only a group of complainants. To exclude the silent majority is to select to the point of a foregone conclusion. It’s like asking 100 patients with headache whether they have headache.

3. Many myths have grown out of the Midstaffs saga. A large section of the British population, for example, still believes that patients drank out of vases, even though Francis is clear that he heard no such evidence. ( Final report: Independent Enquiry into Midstaffs pg 48. Vol 1) And what of the more-recent mudsling about a baby who had a dummy taped to the mouth? It’s a story now known to be highly questionable, but the mud’s been slung and it has stuck. The media have walked away. Job done.

4. Is Stafford Hospital financially insolvent? Like all small Trusts Midstaffs does indeed have its back to the wall. However, its losses and rate of financial degradation are small compared to its much larger neighbours and broadly comparable to foundation hospitals of comparable size (Bolton, Kettering, Milton Keynes, Peterborough, Sherwood Hospitals) as well as non-foundation hospitals (Burton, Nuneaton and Lichfield). [You must be registered and logged in to see this link.] . If the Dept. of Health acting through its henchmen wishes to close Midstaffs on financial grounds, so be it. I hope they are brave enough to be candid with the local population. To my mind it makes no sense at all because all the surrounding hospitals are in similar financial jeopardy and none has the capacity to take on Mid staffs workload.

5. Is Stafford underperforming ? After its latest unannounced visit the CQC found the hospital to be performing very well on all standard criteria. The A&E department in particular was found to be meeting all its targets satisfactorily. [You must be registered and logged in to see this link.]

The West Midlands Deanery seems quite happy if the JEST surveys are anything to go by. Again, the A&E department, now tagged for closure, has actually received very upbeat reviews from F2 interns.
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And even when it comes to lofty work such as Research and Innovation, the hospital has received some recent accolade. ( Prof Wallwork 2010 para 13.3).

Given the above, it is clear that downgrading Stafford Hospital is not going to be an easy call. Monitor has labeled it unsustainable on clinical grounds despite positive Deanery and CQC reports. It has also been labeled as ‘financially non-viable’ even though its finances are in a better state than those of many hospitals in the Midlands.

To close such a hospital will only serve to deprive good, decent, local folk of their local hospital, and it will further over-burden adjacent hospitals. It will save nothing but fools’ gold because the neighbouring Trusts have no additional capacity and are already in the red.

But allow me to embrace the new age of candour and think out loud: Perhaps all of this was avoidable. It is possible that if Midstaffs’ management had come out fighting at the outset and rejected the flawed methodology, a more balanced outcome would have prevailed. It seems to me that Management was petrified in case it was seen to be complacent and conniving.

Compare and contrast the robust defence Sir David Nicholson mounted when he felt he was being unfairly attacked. He kicked. The HSJ printed articles in his favour: [You must be registered and logged in to see this link.]

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He mobilized his support in the Civil Service and the DoH and it is possible he has prevented his own burning at the stake of pseudo-science by the popular press. In any event, he introduced a degree of balance. Should Midstaffs not have done the same?
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Major new post: New Stafford NHS scandal - the Dept of Health and the falsely-dated report

Post by skwalker1964 on Tue Aug 13, 2013 11:50 pm

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NEW STAFFORD NHS SCANDAL: THE DEPT OF HEALTH AND THE FALSELY-DATED REPORT

I have a feeling this is going to be very big, and very significant for the Stafford hospital fight and the wider NHS. Please share as widely as you can.

As you will know if you follow this blog, or NHS news in general with any closeness, on 31 July the ‘Trust Special Administrators’ (TSAs) appointed by the government to formulate proposals (if that’s really the right word for something about which one of the TSAs was heard to mutter, under pressure from an angry crowd at a public meeting, “This is not negotiable.”) on the future of health services in Stafford, and of Stafford hospital in particular.

The proposals involved the dissolution of Mid Staffs as an NHS Trust, and major downgrades to services such as maternity, paediatrics and critical care, and the confirmation of a part-time ‘A&E’ as a permanent feature. The changes were such that, while the hospital has not been closed outright as yet, it can surely be only a matter of time before the government claims that its partial, part-time services are not viable and that ‘for the safety of patients’ the hospital must be fully absorbed into its neighbouring Trusts.

The public ‘consultation’ is not yet halfway through its duration, but it’s becoming ever plainer that the ‘proposals’ are, in fact, a plan – with possibly a slight chance of ‘saving’ maternity or paediatrics as a sop to the people of Stafford in the hope that they’ll then acquiesce to the remaining measures that will in reality seal the long-term fate of the hospital.

To most informed people, the ‘consultation’ is no more than a sham and it’s now inevitable that the future of acute hospital services in Stafford will depend on a legal challenge to the decision.

The recent court victory of campaigners in Lewisham, in which a judge ruled that Health Secretary Jeremy Hunt had exceeded his powers in decreeing the downgrade of Lewisham’s hospital because (supposedly) of problems at a neighbouring but completely separate Trust, has given many Stafford campaigners hope that a legal challenge to the TSA’s decision might also succeed.

The information I’m about to reveal might just make that hope a little more concrete.

The SKWAWKBOX has learned that the Department of Health (DH) has issued an urgent request, to a number of contract consulting companies, for bids to provide a report relating to Stafford’s services. The specific scope of this report, for which the bid deadline is this Friday, 16 August, is:

to look at the loadings that the proposed planned future housing numbers have on services, not just hospital provision but the full network to include transport, schools and social infrastructure.
As one of those who contacted me about the bid request explained to me:

Normally we would be commissioned to do this body of work either by the Local Authority, County Council or the Department for Communities and Local Government but this request came from DH.
So clearly something unusual is going on.

The ‘proposed planned future housing’ can only relate primarily to the addition of the 1st and 16th Signal Regiments to the 22nd Signal Regiment that is already based in the town, when they are ‘rebased’ from Germany in 2015.

Either figure means a huge additional demand for services – including health services. A key excuse for the decision to downgrade the hospital is that it serves too small a population to be viable – so the arrival of so many new residents is a massive factor that should be taken into account.

The TSAs’ draft report claims emphatically that the arrival of the armed forces personnel has been considered in its proposals – but claims that this will represent,

a potential increase of some 1,040 service personnel who would bring with them ca. 420 families with 600 children.
A quick bit of arithmetic (1040 personnel, of whom 420 are married, plus 600 children) shows that the TSAs are expecting just over 2,000 additional people in Stafford after the rebasing. However, local Tory MP Jeremy Lefroy’s website quotes the following government figures relating specifically to the Stafford move:

The government is investing £1.8 billion in the new basing plan and £1 billion of this will be spent on building brand new accommodation. This will see around 1,900 new family homes being built and more than 7,800 new rooms for single soldiers, along with over 800 upgraded rooms for single soldiers and over 450 upgraded homes for families.
That’s 2,350 family homes, plus 8,600 rooms for single soldiers. Even assuming only one child per family on average, that’s a minimum of 15,650 extra people.

By the time you add on additional civilians who’d move in to provide services to the military and its personnel, this means a very cautious estimate of the increase in the town’s population of 17-20,000 people - an increase of around 30%, or around 16% of the population of the wider borough.

Numbers that would radically increase the demand for acute hospital services in Stafford.

Something doesn’t add up. The TSAs claim that they’ve taken into account the known future developments in Stafford, but seem to have underestimated the numbers hugely. But we haven’t come to the most incriminating evidence.

As you can imagine, this massive influx of people into Stafford is something that has been raised vociferously by the local people attending the TSAs’ public meetings – yet it has been, to quote one local man, ‘sidestepped’. I’ve been unable to locate anyone who attended the meetings who has felt that any kind of substantive answer has been provided to the question – let alone a satisfactory one. Clearly the TSAs did not want to address the issue – or even acknowledge it in the public meetings.

I’ve already mentioned the report, for which the government has asked various contractors around the nation to bid. But there’s something I haven’t mentioned.

The invitation to bid states specifically that the report must be ‘backdated’ – and that it must be completed by a specific deadline.

To give you a proper idea of the importance of this piece of information, I need to set the two specified dates out against two key dates relating to the TSAs’ ‘proposals’, and the ensuing ‘consultation’ period.

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The proposals for Stafford hospital were announced 31 July. The new report into the impact of new arrivals is to be dated 5 days before the announcement.

The ‘consultation’ closes as 30 Sep turns into 1 Oct. The new report must be completed no later than 30 Sep.

These dates can only mean two things:

  • that no proper analysis of the impact of the major population influx was carried out – perhaps no real analysis at all

  • and that the TSAs and DH want to be able to present, as soon as the ‘consultation exercise’ is complete, a report into the population impact that appears to have been completed before the TSAs’ recommendations were made.


Or, in simple terms:

the government and its agents want to cover up the fact that no proper analysis was done before the recommendations were announced – and consequently that far from being evidence-based proposals, the ‘recommendations’ are, in fact, a pre-ordained set of decisions made for ulterior motives which have nothing to do with the best interests of the health and wellbeing of the people of Stafford.

The government has attempted, in a cynical political move that even one of its own MPs specialising in health condemned as disgraceful and dissociated himself from, to convince the public that the Labour government attempted a cover-up at Stafford. A cover-up of ‘hundreds of needless deaths’ that never actually occurred.

But now the government, and specifically its dire, odious excuse for a Health Secretary, has been caught red-handed trying to cover up an omission that exposes the sham nature of the TSA process and which could, if these ‘proposals’ go ahead, really cost hundreds of lives, even thousands over the coming years.

Stafford campaigners and their legal advisors are already working on a legal challenge to these proposals-cum-decisions. The fact that the decision was made without properly taking into account a massive change in the circumstances of the town must surely mean that no judge could support it.

The fact that the DH has tried to cover up its incompetence/malignancy must surely seal the deal – and should ensure that no right-thinking person of any political persuasion could ever contemplate believing anything this government says about the NHS, let alone ever voting for them again.
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Re: Mid Stafford Hospital report

Post by oftenwrong on Wed Aug 14, 2013 9:26 am

Keep nipping at their ankles, Steve. The NHS administrators are not used to having their secret decisions challenged. There are probably other little details still to emerge.
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Re: Mid Stafford Hospital report

Post by Ivan on Wed Feb 11, 2015 8:27 am


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Re: Mid Stafford Hospital report

Post by oftenwrong on Wed Feb 11, 2015 10:22 am

A parallel situation to the disclosure in 2010 that British Banks were hiding money in Switzerland on behalf of tax-dodgers.

Ministers were only informed of that last weekend, THEY SAY.
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Re: Mid Stafford Hospital report

Post by oftenwrong on Thu Feb 12, 2015 12:42 pm

Update:
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This is where the wheels come off the Tory election wagon.
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Re: Mid Stafford Hospital report

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