Alarm over ‘high’ death rate in English hospitals – A Special Posting and advance notice of Radio 4 program

After a few weeks off and due reflection I have decided to post the occasional highly relevant news stories.

The Times’ Chris Smythe 12th September reports:
“Patients in hospitals in England are 45 per cent more likely to die than those in the US.

Death rates in the NHS are notably higher than in six other developed countries, according to an international “smoke alarm” system from an academic who helped to spot the Stafford Hospital scandal.

Professor Sir Brian Jarman (of Imperial College – and famed for many reports) says that comparisons with countries in Europe, North America, Asia and Australasia suggest that structural and cultural problems that contributed to appalling care at the hospital have been claiming lives across the country.

The warning comes as the Royal College of Physicians (RCP) sets out a blueprint for a “once in a generation” transformation of hospitals.

More than 220,000 patients die in English hospitals every year and Sir Brian’s figures suggest that many of them might have lived if care matched that in other countries.

The NHS compares particularly badly on conditions that often affect the elderly, with death rates for illnesses such as pneumonia and septicaemia respectively 46 and 27 per cent higher than the international average. ….”

….”The data looks at years from 2004 to 2010 and Sir Brian said there were signs that the NHS had been narrowing the gap in recent years when projected forward to 2012.

“We have dropped faster than other countries and we’re getting to the point where we should be,” he said. But England’s projected death rates for 2012 are still 45 per cent higher than the US.

The data looks at years from 2004 to 2010 and Sir Brian said there were signs that the NHS had been narrowing the gap in recent years when projected forward to 2012.

“We have dropped faster than other countries and we’re getting to the point where we should be,” he said. But England’s projected death rates for 2012 are still 45 per cent higher than the US.

Mr Hunt said: “This Government has shone an unprecedented spotlight on poor care. Sadly, warnings about high death rates were ignored too frequently in the past.”

The RCP report Care comes to the patient: Future Hospital

A new report from the Future Hospital Commissionrecommends that in future, care should come to the acutely ill patient, rather than the patient being moved around the hospital. 

News for Jarman death rates report

NHS death rate is one of worst in the West: Patients 50% more likely to die of neglect than in US, says study

Daily Mail ‎- 56 minutes ago

Figures obtained by Professor Brian Jarman, in an exclusive report for Channel 4 News, show that the death rates in English hospitals last year

Hospital death rates in England 45% higher than in US, report finds

The Guardian‎ – by Randeep Ramesh‎ – 1 hour ago

“More doctors needed to lower death rate

ITV News‎ – 6 hours ago

  • NHS hospital death rates among worst, new study finds – Channel 4

    1 day ago – NHS hospital death rates among worst, new study finds Numerous reports and inquiries have revealed serious failings in the Jarman was able to identify the higher than expected mortality rates at the Mid Staffs trusts.

    Do we admit more people to die than other countries? Is death at home less acceptable in the UK?If the Regional Health Service in England (note lack of comparison with Wales Scotland or N Ireland where things may be worse still) has worse death rates than the US alone, this might be understandable, as their hospitals are largely private or HMI (Health Maintenance Organisation) owned and funded by some form of individual or group Insurance. The US system is not comprehensive, These facts, and the result many are excluded, may mean the comparison is not valid, But for the English region to be 7th in the league table needs to be explained…. Is it that we exclude nobody which accounts for our results? What is the trend over the last 9 years say, at 3 yearly intervals? Givent the gagging, declining standards, ostrich like political philosophy, two syllable media and the financial pressures I will not be surprisd if the headline is factually correct.

    A graphic needs to be added…

    Just looking at the news coverage of the NHS recently and since the last posting, I include some selected articles.

    NHS staff ‘miss signs of blood-poisoning’ reports Chris Smythe on September 13th in The Times:

    “The NHS ombudsman has criticised a failure by doctors and nurses to prevent thousands of deaths each year as a result of blood poisoning.

    As many as 37,000 people die annually from sepsis, and Dame Julie Mellor said it was “time for the NHS to act and save lives”. In a report, she recounted the cases of ten patients who died after the signs of sepsis — in which the body’s immune system over-reacts to an infection — were missed…..”

    This reflects the shorter hours, leading to reducing standards of medical training and education. (Eurpoean Working Time Directive – EWTD) Doctors who work only a 38 hour week will see far less than those who work a 98 hour week.. (which my generation used to do on the week of a wekend off!) They will be less aware and suspicious of septicaemia as a diagnosis.  Interestingly, the French and the Germans don’t worry about breaking the EWTD….

    Hunt: NHS data protection fear must end – Chris Smtythe in The Times 13th September 2013 reports:

    “Jeremy Hunt has attacked a “computer says no” NHS culture that stops  doctors and nurses sharing life-saving information about patients.

    Staff will be given an explicit duty to be more open with patient records when  it could improve care, the Health Secretary announced yesterday. Mr Hunt  said it was unacceptable that patients failed to get the treatment they  needed because bureaucratic rules on data protection meant organisations  refused to share data.

    “There are examples where people have been overzealously interpreting rules on  data protection without thinking about what the interests of the patients  were,” he said.

    Senior doctors complain that data protection has become the “health and safety  of the NHS” as inflexible procedures get in the way of common sense.  Patients arriving in A&E often suffer because staff there struggle to  access GP records on allergies and existing conditions because of IT  failures and confidentiality concerns.

    “Older people tend to have multiple conditions so for them the ability to talk  to people who know their medical history is incredibily important,” Mr Hunt  said.“The default should not be ‘computer says no’.”

    A review  on patient data was led by Dame Fiona Caldicott, who said: “The culture  in the health service has unfortunately become one of anxiety, some say fear  [over data protection laws].”

    She carried out an earlier view in the 1990s which led to tightening of rules  on patient confidentiality but she said an “aura” had since built up that  scared health workers away from sharing data when needed.

    Her review sets out principles of how NHS staff should protect confidential  patient data and affirms patients’ right to opt out of having their  information shared. However, it also found that some patients had been  denied access to their own records because NHS bosses were so scared of  fines for breaching data protection laws.

    In a  response published yesterday, the Department of Health said: “The duty  to share information can be as important as the duty to protect patient  confidentiality.

    “The common law ‘duty to care’ includes a requirement to share information but  often professionals and staff are prevented from doing this by their own  organisation’s procedures.”

    Paul Hodgkin of the campaign group Patient  Opinion said: “The stories we get are people saying, ‘I had to tell my  medical history 15 times’, or ‘When my husband went to a new hospital they  couldn’t access his notes and X-rays’.

    “There are concerns about privacy but people are bothered by care that isn’t  as good as it should be because Dr X couldn’t read their notes.”

    Tony Calland, of the British  Medical Association ethics committee, said: “I would agree with Jeremy  Hunt that there has been too much of the ‘computer says no’ culture … but  to imply that data should be flying around all over the place is not  helpful.”

    The first duty of a doctor is to put the patient at the centre of his concern. Surely this should be true of the profession as a whole?

    It is 30 years since my own GP surgery computerised. About 10 years later I suggested that all GPs in my area moved to one computerised notes system. (The one type of notes needed everywhere in the health services is the Primary Care notes… and if one system is dominant everyone: casualty, Intensive Care etc etc will move to it. Suddenly the profession is “putting the patient at the centre of its concern”…. If readers wish to read more on medical Ethics I suggest Daniel Sokol’s site.

    The Independent’s Alex Delmar-Morgan , following a survey of 1000 health workers done by the Chartered Institute of Personnel an Development (CIPD) reports 9th September:

    “Doctors and nurses say they feel ‘bullied and under pressure’

    and as a result Chris Smyth in the Times infers that:
    On 7th September the BBC and the Cambridge News (specially relevant for David Gray’s family) reported that:
    It’s about time that the communication skills and cultural awareness tested for in General Practice licensing exams were applied at all doctors.
    If you wish to hear Clive Anderson interviewing Lawyers on Whistleblowing there are two opportunities on Radio 4:
    Wed 18 Sep 2013 20:00 & Sat 21 Sep 2013 22:15
    The BBC Wales (Daniel Davies) reports 9th September:
    Well of course gaming (playing a system for advantage) are going to happen in a system which denies choice (see my advice page) and assumes that all hospitals provide the same standard of care, and fails to subject itself to other regional comparisons. The refusal to allow patients choice in Wales will inevitably lead to increasing inequalities, exactly the opposite of what the Welsh Assembly says it would like to achieve.
    The BMJ deputy editor in the edition 24-31st August 2013 comments “The NHS in the age of anxiety, rhetoric and reality” on an essay by Rudolf Klein which says that:
    “A dangerous gap is opening up between rhetoric and reality as the NHS faces a grim fiscal future, Rudolf Klein argues. High flying ambitions for transforming the NHS are not matched by achievement, and austerity will compel a new agenda of minimising harms rather than maximising benefits”.
    So its not just Wales which will have to tolerate lowest common denominator medicine.. At least the pain is to be shared around.. The editor could have replaced “anxiety” by “fear and referred back to Aneurin Bevan and his 1952 book, and why the then National Health Service was founded.
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About Roger Burns - retired GP

I am a retired GP and medical educator. I have supported patient participation throughout my career, and my practice, St Thomas; Surgery, has had a longstanding and active Patient Participation Group (PPG). I support the idea of Community Health Councils, although I feel they should be funded at arms length from government. I have taught GP trainees for 30 years, and been a Programme Director for GP training in Pembrokeshire 20 years. I served on the Pembrokeshire LHG and LHB for a total of 10 years. I completed an MBA in 1996, and I along with most others, never had an exit interview from any job in the NHS! I completed an MBA in 1996, and was a runner up for the Adam Smith prize for economy and efficiency in government in that year. This was owing to a suggestion (St Thomas' Mutual) that practices had incentives for saving by being allowed to buy rationed out services in the following year.

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