18th September 20
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What does he do for an encore?  
News and Comment from Roy Lilley
If you read this in the morning the NHS will have killed about thirteen people. If you read this in the afternoon the NHS will have killed another 13 people. If you read this, this evening just over 26 people will have, deliberately, inadvertently, neglectfully or somehow been slaughtered by the NHS.


It is unlikely the police will have been involved, no record made. The identity of the dead will be known only to the families who will be unaware of how their loved one might have met their end. Death certificates will offer little clarification.


By the end of the week 190-ish people will, by accident or design, be slayed by the NHS. In the course of the year... ten thousand.


How do I know? The Daily Telegraph tells me. They offer no evidence, only the word of the Chairman of the CQC, chief flat-earther and high Tory, David Prior. The Guardian makes the same claims based on the same vapour.


In response the CNO at the Carbuncle, Jane Cummings said; "The NHS treats millions of people every year and the overwhelming majority of our patients receive great care from staff who are pulling out all the stops. We do need to do more, but the quality of care is better now than at any point in the history of the NHS."


In other words *&%%$�-off.


The NHS deals with over 1 million patients every day and a half. In that time, Prior tells us, 39 of that million will have been killed. One death is too many, let's get that straight, right from the off, but do his sensationalist allegations hang together? What exactly does he mean? Does he know?


It appears Prior is basing his comments on this old Telegraph story which is a complete over-reporting of a not very good academic study. 


Mortality amenable to healthcare is an international measurement. Research requirements in diverse countries, different ways of recording death, often poor data and so-on means the information is not last week's. This is from the OECD; out of 31 countries the NHS is rated in the middle, 19.


Preventable mortality is a different matter and probably what Prior is talking about. The most recent and authoritative study (2012) the source of the Telegraph story, was funded by the National Institute of Health Research conducted by researchers from the London School of Hygiene&Tropical Medicine, the National Patient Safety Agency, Imperial College and the Uni of Newcastle.


It's a review of the patient records of just 1,000 adults who died in 10 hospitals across England, five years ago, in 2009.  It concluded that one death in 20 had a 'greater than 50% chance of being preventable'... poor diagnosis or inappropriate treatment; mostly occurring in the frail elderly with multiple other medical problems. This raises debate over whether these deaths were actually "preventable".


The researchers extrapolated their results, multiplied them up and made an educated prediction on the national picture.  Guestimate, conjecture, supposition.  When academics guess we are supposed to genuflect... I used to... not any more.


The study reviewed medical records, which may not be accurate. Previous, similar studies have produce estimates ranging from 840 to 40,000 deaths a year. They highlight adverse events but cannot say if they contributed to death and are, in any event a subjective view. They excluded paediatric, obstetric and psychiatric hospital admissions.


Here's the cracker that Prior ignored; the researchers concluded '... the incidence of preventable hospital deaths in England is lower than previous estimates'. In truth - we still have no idea.  There is more interesting stuff here that concludes death is probably not the best measure of quality care.


If you are with me so far you will be far better informed than the Chairman of the Flat-Earthers and better able to talk intelligently on the matter.


Prior has form for saying unevidenced things. Here and here. It looks to me, from the CNO's comments that the Carbuncle is fed up with him. I know for a fact a lot of his staff and some of his Board think he's an embarrassment. Monitor just ignore him.  As the election comes nearer I expect the Tories will be sick of him, too.


On Prior's watch the CQC struggles: to recruit; to justify sending 79 people to inspect a hospital; cannot defend inspection as a technique to improve quality; has trophy-senior-inspectors with no management qualifications; has a Board that lacks grip and has had to row back on its strategic objectives; recruited inappropriate staff it can't sack; has an eye-watering budget; mired in legal cases; has no evidence that it is improving Trust performance; publishes no meaningful peer reviewed data and has a hot-head for a chairman who can't control his organisation any more than he can control himself when faced with a journalist.


What does he do for an encore?


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