30th May 2013 

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Turn a blind eye    
News and Comment from Roy Lilley

I think you have to go back to 1882 and Mark Twain to find out where the phrase came from.  The Oxford English Dictionary first picked it up in 1995.  I'm talking about the 'Elephant in the Room'.  Well, 'not talking about it', I suppose. 


It's a bit like 'Area 51' the US Military Base containing a top secret aircraft testing facility.  It's an open secret.  Everyone knows it's there but the US Government pretends it isn't.  Just like MI5.  Everyone knew about it but it took the British government until 1994 to admit it existed.  And, The Stig, BBC's Top Gear test driver; apparently everyone knows who she is.


Elephant in the Room, Open Secret.  Perhaps Skeleton in the Cupboard might be more apposite?  Drive past any hospital at the weekend and you'll see proof of what we all know.  The staff car-park, chock-a-block during the week, is half empty at the weekend.


The NHS is not 24-7.  The NHS is 24-5 and for two days a week it pauses, gets its breath back and gets ready for another onslaught on Monday.  Saturdays and Sundays have an eerie calm.  Not in A&E I hasten to add.  Nor ICU.  But, it is true; the NHS turns down the wick on pathology, imaging and elective operations.  Probably for very good reason.  Running hot, seven days a week would melt the budgets.


However, there is more to this than meets the eye.  The big-brainboxes at the Dr Foster Unit at Imperial have ploughed through three years of data and four million outcomes and are telling us; the nearer the weekend you have your elective surgery the more likely it is you will come to a sticky end. 


The variation isn't huge; about 0.55%-0.8% but it is significant and big enough for the Daily Mail to get away with 'The Shocking Death Toll' of NHS operations.  Just.


We know Trusts are not fully staffed at the weekends and we know a lot of Consultants like to have the weekend of.  (Being on call is not the same as being on the ward).  The inevitable conclusion is; have an operation on a Friday and if something goes wrong on a Saturday - 'yer on yer own'.  It's the Open Secret and the Elephant in the Room that hospital Boards have put off dealing with for too long.


It is at this point I am desperate to avoid saying - 'I've been saying...'  I am too shy to mention it was me, me, me wot wrote; 'take every scrap of data the NHS has, put it in the public domain and let everyone else slice it and dice it.'  I do believe that simple act will change everything, for ever.


We don't need IT plans, more kit, rules, strategies and all the rest.  We just need a publicly accessible server the size of Moscow; anonymise the data and shove everything we have on it.  And I do mean everything.  The Dr Fosters of this world will do the rest.  And, pretty soon there will be other 'Dr Fosters'.  And, pretty soon we, us, the public and Parliament will know everything we want to know, all of what we need to know and a shed load of stuff we don't want to know! 


Data is like gold dust.  Someone will compare car-parking charges with missed out-patient appointments, conclude there is a relationship and make a fuss.  Will it be fair, right, just?  Who cares?  We know and it will be for us all to make that judgement.  Like, right now, if I need an operation I will refuse a tryst with the surgeon's knife on Thursday or a Friday.  And if they have any sense, so will millions of Daily Mail readers and I don't blame them.


Weekend-Gate has caused an outrage.  'Why is this?' the media demanded to know.  The NHS had some explaining to do.  It wasn't doing proper 24-7 all-grade, staff rostering.  Not re-engineering its systems and spreading workload across the entire week.  Not being creative with the use of resources to get more-4-no-moreIt is not dealing with the 'open secret', of the 'Elephant in the Board Room and in the Operating Theatres and on the Wards'.


The Le Tache and Two-Jobs think they are masters of reform, modernisation and innovation.  They are not.  All that is required is transparency.  Public opinion will do the rest.  To see the open secrets and the elephant in the room they just need to stop turning a blind eye. 

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