The political leadership vacuum will allow more and more post-coded inequalities and deaths from acute surgery

We were warned about this 2 years ago, but now the evidence is undeniable. Despite this evidence the political leadership vacuum will not allow anyone to address the issues with honesty. As the anecdote in the Scotsman at the bottom of the post shows, the reduction in standards is across the board. You really do need an advocate beside your bed when admitted for an emergency.

Chris Smyth in the Times 11th April reports: Patients die after surgery as the NHS cuts corners

Thousands of patients are dying because the NHS cuts corners on operations for the critically ill, the Royal College of Surgeons has warned.

Life-or-death surgery is not taken as seriously as routine operations in a system with illogical targets. Patients with conditions such as a burst appendix, gallstones or abdominal problems are suffering the most unpredictable care.

In some hospitals, one in five patients dies within a month of such surgery yet elsewhere only one in twenty dies, with no clear reason for the difference, a report seen by The Times concludes. For some procedures, ten times as many patients die in some hospitals as in others. The review concludes that a large number of lives could be saved by better-organised care.

Senior surgeons said a tolerance of mediocrity by the NHS had stymied attempts to make improvements, with key guidelines routinely ignored. Meanwhile, some younger surgeons can no longer do basic operations because of a drive for specialisation.

“The college is very concerned,” said John Abercrombie, a member of the RCS council. “Emergency services for people who are critically ill have been less important in the health service but actually these are the sickest patients.”

About 10,000 patients need urgent general surgery every year but Mr Abercrombie said that public focus on high-profile conditions such as cancer and hip replacements had distorted the way NHS surgery was organised.

He said there was a “fundamental illogicality” in sending cancer patients to a critical care bed after surgery while those having much riskier general operations go back to ordinary wards.

Joyce Robins, of Patient Concern, said: “Patients will be very distressed by this. It needs some really serious thought from the NHS. Areas that cause a great deal of misery do get overlooked for something a bit more sexy. It needs to be put right.”

Mr Abercrombie urged health service bosses to stop treating emergency general surgery as an add-on. “Surgery has evolved around people who are not acutely ill,” he said.

“There’s a lot of public interest in illnesses like cancer and elective things which are much easier to measure. For a surgeon being thrashed to get your waiting list down, increasingly you define yourself as being a cancer surgeon or whatever and you just get loaned out to emergency surgery.”

Only a third of newly qualified breast surgeons have reached proficiency in a type of emergency surgery that is used to discover the source of abdominal pain, even though surgeons on call at night and weekends will often need to carry it out.

“There have been times when really terrible things have happened,” Mr Abercrombie said, citing a common procedure to deal with twisted testicles in young boys. “The child has ended up losing a testicle when that operation is completely straightforward,” he said.

Poor quality data means that hospitals have little idea how well they are doing and that allows them to get away with ignoring evidence-based guidelines, he added.

Today’s report calls for better use of key protocols that have helped some units to halve their death rates alongside staff reorganisations to have patients seen more quickly by consultants. Only half are seen within 12 hours for some types of surgery, it warns.

Candace Imison, director at the Nuffield Trust and one author of the report said: “This is a really important problem and it needs to be addressed. Solving it is not going to take a vast quantity of resources but significant determination from professionals.”

Analysis

If bad things happen to cancer patients, there will be a big stink and NHS bosses will have to do something about it (Chris Smyth writes). If an emergency laparotomy to investigate abdominal pain goes wrong, it is seen as just one of those things.

That is the essence of the problem identified by the Royal College of Surgeons and the report they commissioned from the Nuffield Trust has a straightforward plea behind its many recommendations: this needs to be taken seriously.

Waiting lists and cancer care are measured, so hospitals have structured surgery around them. What happens to elderly patients who arrive in the middle of the night with stomach pain is not measured, so such patients come second.

Without hard data, surgeons can shrug off criticism. Well-meaning guidelines can be issued only to be politely ignored by hospitals. That has just become a little more difficult.

22nd September 2014: Alarm raised over deaths from emergency surgery

21st December 2015: Plan your hospital advocate…. NHSreality warned you that it was happening near you. The problems of Mid Staffs and Sussex Mental Health services are endemic, and Christmas is not a time to be ill..

15th July 2015; Reducing standards and opportunity in Surgical Training. Trials are important..There is a vacuum in honesty, leadership and future planning…..

10th April 2014: Change has to be “turbo-charged” says NHS watchdog Monitor – and Training (reasonably in a crisis) plays second fiddle to pressures of work

22nd Nov 2015: Prolonged cultural disintegration and fear are now a fact. New deal risks junior doctor ‘brain drain’…

12th October 2015: Junior NHS staff ‘should carry out more aspects of surgery’ in NHS efficiency drive

Lizzy Buchan for The Scotsman 29th Jan 2016 reported: Whistleblower calls for help for ‘lost voices’ of NHS patients

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This entry was posted in A Personal View, Consultants, Political Representatives and activists, Professionals, Rationing, Stories in the Media, Trust Board Directors on by .

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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