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Did he take the truth with him to Gloucester?

April 25, 2007

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The Telegraph today has early publication of the Dr Foster Hospital Guide entitled The NHS: The truth , which has rated every hospital in the country according to a standardised mortality ratio (SMR). While I am delighted to see that my own hospital ranks highest in the region and amongst the best in the country, I have to say I am deeply sceptical that one can read anything into these results. There are so many factors that go into the SMR, many of which are irrelevant to the Hospitals, that they cannot really be said to reflect an individual hospital’s performance. Indeed a cursory review of the Dr Foster database shows that only about half of the consultants in our department are listed, and about half of these have the wrong specialty attributed to them. Only a small thing, but it makes me question the accuracy of their data collection.

SMRs of course are part of the funding formula used to divert money away from areas with healthier populations to those with worse health outcomes such as Birmingham and the Black Country. This formula is probably more responsible for the meltdown in our local health economy even than financial mismanagement by our local PCTs and Trusts, or even the Department of Health. So they are hugely relevant to how our local healthcare is delivered and funded.

But maybe we would be better off having worse outcomes and more money?

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8 comments

  1. I did wionder when I was reading about that Men Sana very different polutlations and problems cannot surely be simply compared


  2. Hi Newsmania, that is true whether we are talking
    health care needs, or social housing needs.

    Any solution has to be tailored
    Any treatment or surgery has to be tailored
    And as we are increasingly aware any treatment or pharmacy has to be individually tailored to the patients (1) condition, (2) stomach and digestive system, (3) metabolism, and (4) other factors …

    Cancer covers a myriad of conditions
    tooth decay could (should) be classed a ‘cancer’

    Maybe we could use advertising of patients with no cancer – you too can be cancer free and have a great smile if you use Colgate or MacCleans

    PS – If you wanted to make the mortality figures look better, Dr Foster could have compared them to Iraqi hospitals.

    But knowing that five million Americans suffer from Alzheimers, should make us consider – whether hospital performance and national health should be measured by SMR – or quality of life for the living.


  3. Well exactly, Q9. Maybe a better performance indicator would be how well people live, but unfortunately its desperately difficult to measure quality of life, and very easy (and not open to interpretation) to measure time of death, so SMR figures are favoured


  4. I heard an intersting comment last night when they were discussing the NHS on Doughty Street . Some mentioned that when the NHS was set up they though they were going to cure ill health and demand would get less. HA HA HA. Only a Socialist.

    Thats the problem limitless demand. Face up to the fact you cannot deliver the basic promise of the NHS or lie I should say and start allocating resources sensibly.

    Incidentally either Quasar or MenSana would be superb guests and far better than the ones they have had………………..


  5. I wonder if a database could be set up which would allow doctors to feed in the facts that you feel would give a much more realistic perspective on this.


  6. Possibly, Ellee, but a good hospital is a bit like an elephant-hard to describe but you know one when you see one. The place is cleaner, the reception staff are politer, everyone is better dressed, the nurses smile, the doctors are a bit sharper. Its all rather difficult to define, and not really measureable, or recordable in a database. A lot of it (nearly all of it) is about the staff and their pride in their hospital and in their job


  7. Oh and thanks NM, I saw a bit of 18DS last night-I didn’t think they were that bad! But the glare of blogger TV is not for me


  8. Hi Newmania, it’s a double edge sword.
    For generations doctors and dentists created the waiting lists on the NHS or health care.

    Don’t forget if you removed the £90 billion from the nhs, all the doctors and dentists would come crawling out of thw woodwork begin for NHS handouts.

    Then for decades we’ve been investing more into research (you know original research) with promises of cures for the incurable diseases, than we have on treating the ailments & conditiions we know we can treat (bar a few exceptions like diadetis?).

    Add to that the internal markets and false pricing which has added value and the cost of surgery or treatment beyond what any real market could afford.

    If people today had to pay for their hip replacement surgery out of their own pocket – do you think it would be so common place. If people had to pay for the cost of heart surgery or organ transplants, do you think there’d still be demand for donors?

    But dentistry we can ignore – anyone working wjo needs a thousand pound or two of dentistry, well just like buying a second hand car. But if you need it when you can’t afford it, then you are set on a slippery road to denture or false teeth land.

    And of course the industry of making false teeth has to be fed. Medicine has become like firefighters starting fires with gasoline to justify overtime.

    Medicine should have been doctors & nurses employed to ‘heal’ people and care for the sick – and their reward time off (xtra holidays) when demand is low. But in the obsession to keep doctors wages high – they created waiting lists.

    What nobody seems to appreciate is that health care in the uk counts on 90% of its budget from the NHS, 5% from private health care, 5% from charity, and an army of volunteer support workers (alas not many nuns or free labour nowdays) just overworked relatives and volunteers.

    Now how would or could Private Health care even offer anything like the NHS – if all those volunteers withdrew their free services – and all that charity fund raising stopped.

    I say scrap the nhs, and let doctors comperye for paying customers – Real Cut Throat Competition
    or
    Separate those employed by the State to provide health care services, from
    those seeking to ‘market’ health care services.

    Now that would be real choice – we can all have the best health care (including dentistry) on the nhs

    and those who want to give their money and savings or remortgage their homes to enrich private hospitals, doctors and surgeons – are free to do so.



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