Another quote about the future I came across a year or two ago is from Ambrose Bierce's "Devil's Dictionary", a book of satirical and cynical definitions.
"Future, n. That period of time in which our affairs prosper, our friends are true and our happiness is assured."
A slightly different blog to usual. Karine spotted an article in the Guardian - NHS Mandate article yesterday about the consultation period for the NHS Mandate which is updated every year. It doesn't seem to have been publicised very much and the consultation period seems quite short.
There is a link to the Mandate in the first paragraph of the article, it's quite short and you can comment on it. Not being able to sleep because of the steroids I stuck down a few randomn thoughts last night. They don't always address the questions asked but I went ahead anyway! Comments positive and negative welcome!
4. Do you agree with our aims for the NHS Mandate to NHS England?
The aims seem very worthy but so general that they don't address the grass roots problems of the service as seen from the patient's point of view or from the staff's perspective.
5. Is there anything else we should be producing in sending these to NHS England?
Firstly, please please stop reorganising/restructuring the service every 2-3 years or so. Each reorganisation is a huge distraction and a waste of clinical and administrative time. They rarely achieve what they claim to. Equally they are less catastrophic than some of their critics would have us believe. As a doctor for over thirty years I very quickly learnt that if I kept my head down each new reorganisation would be replaced quite soon by another one and that the basic organisation would carry on very similarly.
Secondly, to relieve the huge pressure on the secondary care service we need proper funding of primary care, proper funding of mental health care, proper funding of social care and proper funding of the Public Health Service. Without all of this the hospital service will continue to face increasing pressure on its workload, staffing levels, financial situation and most importantly the quality of care received by patients
6. What views do you have on our overarching objective of improving outcomes and reducing health inequalities including by using new measures of comparative quality for local CCG populations to complement the national outcomes in the NHS Outcomes Framework?
Any new measures of validating CCGs need to be properly evaluated before being introduced. Evaluation should include looking at outcomes, mortality and morbidity rates as we'll as patient experience of the service.
Whatever measures are introduced should impose little or no extra administrative load on administrative and clinical staff.
7. What view do you have on our priorities for the health social care system?
Weekend Mortality:
The reason for the the different mortality figures for Sunday admissions needs to be properly investigated and understood before coming up with solutions. The BMJ article that sparked this debate was an epidemiological study that highlighted the association between the day of the admission and different mortality rates. The authors made it very clear they were claiming an association and not any cause and effect.
The government seems to have already made up its mind that making doctors work weekends is the answer to the problem. It doesn't seem at all interested in finding why this is happening, but seems much more interested in a simplistic once size fits all quick political fix. The vast majority of doctors do weekend work anyway. Interestingly patients kept in over the weekend have lower mortality rates suggesting that they receive good quality care over the weekend.
Why is the mortality rate higher for Sunday admissions? Here are a few possible reasons....
- Difficulty accessing primary care services.
- A different clinical mix of patients are admitted on Sundays, if so how are they different and why is there a difference?
- Differences in the amount of medical staff, consultants and juniors, on duty
- Levels of of nursing staff on duty.
- Just having the right numbers of staff is not enough, many nurses and doctors are specialised. Each unit in the hospital needs an adequate supply of such nurses. Quality of care will suffer if a psychiatrically trained nurse has to cover an oncology ward, or a chemotherapy trained nurse has to do weekends in psychiatry.
- Over reliance on locums and bank nurses at weekends compared to during the week.
- Reduced access to investigations.
There may be different solutions for different specialities. There is evidence that the level of nursing care in stroke units and ITU may be the important factor.
Finally the government is presuming that all these excess deaths are avoidable.
8. What views do you have on how we set the objectives for NHS England to reflect their views in this consultation?
It is not clear to me that NHS England has been involved in the drafting of the Mandate but rather that it will be imposed on them and that what will be imposed will be what the Department of Health and the Treasury decides. NHS England's input seems to have been the very important Five Year Forward Plan but nothing after that, I hope I'm wrong!
9. Do you have any other comments?
This consultation has been very poorly publicised. I only found out about it because someone else pointed it out to me and I am someone who reads the medical press. Either I need to be more attentive or the department needs to improve its publicity.
Whilst we're in political mode this week's BMJ reports that Andrew Lansley, now a member of the House of Lords has become an advisor to Roche Pharmaceutical amongst other health related companies. Guess who introduced the Cancer Drug Fund and guess which drug company was one of the main beneficiaries of this policies. David Cameron said in 2010 that he wanted to put a stop to this revolving door between government and industry!
As a cancer patient I have a rather personal interest in having the best drugs available for treating cancer but not at the expense of other specialities and other patients. Didn't someone say 'we are all in this together', it doesn't always seem like that. What makes cancer more special than say another fatal disease such as heart failure? - nothing at all I would suggest but it is a populist policy and good for catching votes.
Enough, rant mode off!!
By the way, I'm doing fine!
* Shakespeare - not sure where in Shakespeare.
It turns out this is a misquote from Julius Caesar! - "The fault, dear Brutus, is not in our stars,
But in ourselves, that we are underlings."
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