The NHS is great!

[andrewducker]

Figures from a recent Guardian story:

The NHS workforce has grown at an unprecedented rate since Labour came to power in 1997. There are 10,000 more consultants (up 49%), 85,000 more nurses (up 27%), nearly 6,000 more GPs (up 20%) and 16,000 more therapists and technicians (up 36%). Most of this growth has occurred since 2000, when the government's NHS reform plan set ambitious targets for reducing waiting times and improving patient care.

was at the bottom of this piece on projected staffing level problems in 2011. The figures above do seem to indicate that the NHS is in vastly better shape than it was - anyone care to offer contradictory information?

Comments

[pisica.livejournal.com]

Last month when I was temping at the Edinburgh Cancer Centre at the Western, helping to clear their backlog of consultants' letters and notes being typed up, I came across a letter from one consultant to another agreeing that things were so backed up administratively that they only way they could guarantee that they weren't going to cause harm to the patients would be to close the clinic until things got caught up.

And you've read my rants about the massively screwed-up appointment letters.

Two points for your data graph, there.

[adders.livejournal.com]

Appointment letters arriving after the appointment had passed

People dying of dehydration in the Nofolk and Norwich hospital

Mass closure of local hospitals

The experience of most people I know who have had dealings with hospitals (and my wife works in one) is that increased numbers does not mean a better service, because those staffing increases have come at the cost of the resources they need to do their jobs.

It's a bit like having a huge army armed with water pistols: maybe a few less staff and a lot better equipment would work better.

[robhu.livejournal.com]

... and maybe they need the staff and more equipment.

There is no such thing as a free lunch, I saw in a documentary a few years ago that the Americans spend about three times per person on healthcare than us.

[pisica.livejournal.com]

Appointment letters arriving after the appointment had passed

We've never had that, but we had a) an appointment letter with the wrong date on it (they did refund our bus fares), b) an appointment letter that never turned up at all, and c) the GP's surgery getting the 'your patient missed the appointment' letter and filing it without bothering to check up on it.

According to a letter recently received for a future appointment, there's a wonderful new patient-based booking system which - gasp - actually CONSULTS THE PATIENT about when they want their appointment to be! We'll see how that goes.

[robhu.livejournal.com]

Maybe it has improved, but the quality in some places at least is extremely poor. My grandmother has been in hospital over the Christmas holidays, and the quality of care she has received has been extremely poor.

[drdoug.livejournal.com]

As other commenters have pointed out, evidence of increased staffing is not necessarily evidence of a better health service. I'd want to look at hard data about mortality and morbidity to answer that question.

Ignore totally the stats about waiting times and waiting lists and things like that. The one thing I do know from my contacts in the Health Service is that those stats are now entirely meaningless. (One contribution the NHS has made since 1997 is to the already-large stock of Business School case studies showing how insisting on single simplified performance metrics can actually make the what you really want to improve worse.)

As an example, remember that thing in the General Election where Tony Blair got cornered on Question Time about how it was impossible to get an appointment in advance to see your GP? That still goes on, and it's entire to fiddle the figures on 'patients seen on day of choice'. But fewer people can see their GP when they want to.

I genuinely don't know what the story is about mortality and morbidity. They do tend to lag performance somewhat - not least because the data take a while to collect and process. I don't have the time to dig out the data but it definitely exists and is public and would give an actual answer.

(Although, of course, they do still need to be treated with some caution - e.g. cancer survival rates are routinely quoted as number of people diagnosed who survive for five years. You can improve the figures, but not people's health, by simply diagnosing earlier and doing nothing else.)

My prediction is that there'll be a measurable improvement since 1997, but it'll be roughly in line with other industrialised countries. But I'd love someone to dig out the actual data.

[ninox.livejournal.com]

GP appointments were rigged to deter advance appointments to improve the waiting list stats. The other nifty yet annoying trick is to increase referrals to A&E. It costs more, but at least it is cheaper for the practice.

Don't know which stats you were after, but a fair few including rating individual hospital performance lurks here.

[drdoug.livejournal.com]

Argh! Those are precisely the sort of meaningless statistics I was on about. Almost all of them are not directly related to health outcomes. Sure, nobody wants to be on a waiting list for years, or to be in a hospital with an MRSA outbreak, but reducing those figures don't necessarily help people be healthier. And most of them - as you point out - are highly amenable to rigging in a way that actually provides a worse service.

For a few them - like smoking cessation - there's good evidence to suggest that improved results there will lead to improved mortality and morbidity - but they're not in themselves direct measures. And pinning all the credit for the improvement on the NHS is slippery - other changes, like ever-increasing tax and smoking bans - almost certainly help.

On a quick skim, the only one I spotted that was directly related to what I'd count as actual health outcomes was "Sexually Transmitted Infections 2004-5" That had new diagnoses up 3% on the year, including syphilis up 23% but gonorrhoea down 13%. Can't tell from those data alone whether it's improved detection or increasing infection: the former would be good news, the latter bad. From other reports I suspect it's the latter.

The maternity stuff looked promising but most of it was indirect stuff (length of stay, method of delivery, and so on) and there's no mortality data. I do know that perinatal mortality - for mothers and babies - has dropped through the floor steadily since the early 1970s, so it's even less of an issue now. (Still unimaginably awful for those it affects, mind.)

See comment lower down for some actual data!

[autopope.livejournal.com]

Note also that the PPP funding fetish of the current government means that the infrastructure reconstruction costs -- new hospitals, basically, to replace clapped-out Victorian work-houses -- are going to be borne by us over the next thirty years, with compound interest to pay the private companies who did the work. The improvements are being bought on a "buy now, pay later" basis. Meanwhile, inner-city sites are being sold off and replaced by inconveniently exurban hospitals, meaning that city A&E units are being closed down. The reason? The land's cheaper on the outskirts (or alternatively, they can make enough money selling the old hospitals in the middle of town to developers to make the first down-payments on the new hospitals they've been ordered to buy from the private sector).

The long term prognosis for this kind of mis-management is Not Good. But the current government will have been out of office for decades by the time the bill comes due.

[ninox.livejournal.com]

As an NHS employee, what can I say....

They reduced the number of hours in a junior doctors working week due to European directive. This lead to an increase in the number of doctors to cover the necessary shifts. To save money they have given a package to consultants to reduce their working week, leaving them more time to freelance with private health care and university lecturing.

Hospitals are beig asked to break even with finance - very few are achieving this. More nursing staff are being employeed but only on temporary contracts or as bank staff because the jobs aren't available.

Locally to me, hospital secretaries have now been outsourced to India (North Stafford NHS Trust), we are just about to put a freeze on employing locum staff. There is also a current job freeze if anyone leaves - they will not be replaced.

The new training programme with shorter rotation time makes junior doctors less efficient with patients, and opening up to E.U. over overseas doctors has raised queries over the equitity of teaching standards. Try not to end up in hospital over August when the staff is on change over!

It isn't all negative though - Labour has produced a good plan to provide turn around. Pity the NHS is an ineffiecient institution with too many powerful unions for it's own good. Never mind it trying to catch up with technology, most hospitals are still short of computers, many staff can't switch them on. It will make the electronic patient record really interesting!

Key document to proposed changes:

NHS Executive. The New NHS – Modern and Dependable. London: The Stationary Office, 1997.

It will take time and lots of partnership working to secure funds. It is still cheaper to go private than to be treated at a NHS hospital.

Here endth rant of the day.

[sigmonster.livejournal.com]

http://www.gad.gov.uk/Life_Tables/Historical_Interim_life_tables.htm

In 1990-1992 a 50-year-old UK male / female had a residual life expectancy of 25.92 / 30.59 years respectively.

In 1996-8 these figures had increased to 27.17 / 31.32, the percentage increases being +4.82% / +2.39%

In 2002-4, the last readily comparable dataset (i.e. I'm too lazy to look at two different spreadsheets at once), a 50-year-old UK male / female had a residual life expectancy of 28.75 / 32.37 years, +5.81% / +3.35% over 1996-8.

I really didn't expect an acceleration of between 20% and 40% there, so now we need to check across broadly comparable industrialised nations to see what happened at the same years. I did try to find comparable OECD tables, but nothing yet. There's certainly a good case there that things got better faster under Labour, though.

[drdoug.livejournal.com]

Oh wow, that's actually pretty impressive on the face of it. It's not a total transformation but it does look good.

Would be very interested to hear if you do dig out OECD data.

(As an aside, I do hate when news about this gets presented as unremittingly bad. Life expectancy is going up. This is fantastic news! It's great. We're going to live longer! On average, at least. But do we hear that? No - we just get doom and gloom about "Pensions crisis" and "Ageing workforce".)

[sigmonster.livejournal.com]

OECD health statistics including life expectancy at birth and 65.

WHO life tables by five-yearly cohort, for the years 2000-2004.

So nothing directly comparable to the GAD tables, and playing with the data more closely will have to wait until I get very much more bored...

[azalemeth.livejournal.com]

Fiscally, overall, the NHS's operating defect was about £500,000,000 last year - they were £500m in the red.

Last year, the NHS spent the sum of about £600,000,000 - £600m - on management consultants, to help reduce the debt!

[ninox.livejournal.com]

oh yes this sounds familiar - we have just employed a 'turn around' team to bail the Trust out of debt. 7 staff, new office and equipment, their first action is charging for staff car parking, and OK-ing a refit of the Chief Exec's office starting with £2000 worth of carpet.

Think they will earn their keep?

[thadrin.livejournal.com]

If its anything like the Swedish health service then the average age of the staff means an acute crisis in about ten years.

Also they're probably pulling the same trick they just did in my lab: giving permanant contracts to folk who were already on temp contracts - more officially employed people, same workforce.

Our production went up 9% in 2006, with no net gain in personnell. Its daft.

[jccw.livejournal.com]

"Adding programmers to a late project makes it later"

-- Fred Brooks, The Mythical Man-Month

[andrewducker]

This is true for non-parallellisable tasks. However, the problem is with treating many thousands/millions of individual people, so there's no problem with throwing more doctors/nurses at the job.

[jccw.livejournal.com]

The task would be parallelizabe only if doctors/nurses could work independently without any infrastructure or communication. Problems like aitkendrum has been enountering don't seem to be due to shortages of personnel, but failures at an organizational level that have nothing to do with medicine.

One reason Brooks cites for the "adding programmers makes it later" phenomenon is that if you have n people working together on something, then there are O(n^2) communication channels between them. While adding doctors/nurses is certainly necessary, I don't think it's sufficient, and adding bureaucracy can make things worse. (For another glaring example, look at the Dpt. of "Homeland" "Security" in the US and its non-handling of Katrina.)