In defence of the NHS

Did too many nurses treat too many people and caused the financial crisis? Quite clearly not yet the NHS is under major attack from all angles and who is going to save it is the question. I certainly wouldn’t trust labour to given their record in government the last time introducing foundation hospitals and PFI’s galore. The Keo report is out today and reveals some interesting findings. This below was in the Guardian today. “The NHS medical director Prof Sir Bruce Keogh, whose investigation into 14 hospital trusts follows reports of unusually high death rates. Photograph: Fiona Hanson/PA The report into unusually high death rates at 14 hospitals is to reject claims that the hospitals investigated have between them killed thousands of patients through poor care. The review by the NHS medical director, Prof Sir Bruce Keogh, will dismiss the two mortality indicators that were used to justify the probe into the 14, which was launched on the day Robert Francis QC published his damning report into the Mid-Staffordshire care scandal. Keogh's report will say: "However tempting it may be, it is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths." That is a reference to the two indicators – known as hospital standardised mortality ratios (HMSR) and summary hospital-level mortality indicator (SHMI) – which are used to flag up hospitals where apparently unusually high numbers of patients are dying. Both indicators were used by the Department of Health in February to justify the choice of those 14 hospitals for investigation. The 14 had had unusually high death rates in both 2010-11 and 2011-12, as judged by one or both indicators, it said. Keogh's dismissal in such strong terms of the measures comes after media reports that there were anything up to 13,000 excess or avoidable deaths at the 14 trusts that Keogh and his team of expert inspectors have been looking into. Members of the inquiry team have voiced concerns about the choice of the 14 on the basis of HMSR and SHMI data. One said they were "a very blunt instrument" for examining something as complex as "excess" mortality – that is, deaths that, according to a complicated range of factors, could potentially have been avoided if the quality of healthcare had been better. Inquiry team members – who include senior doctors, NHS leaders, patient safety experts and patient representatives – privately fear that the statement by the health secretary, Jeremy Hunt, to the Commons about the report, expected on Tuesday afternoon, will give an overly negative picture of the team's findings. The report will also contrast with much of the pre-publication coverage by stressing that mortality rates in all NHS hospitals have been falling for the past 10 years, with overall mortality down by an estimated 30%. Keogh's report will also note that that improvement is even more impressive when the increasingly complex caseload faced by hospitals – driven by rising numbers of older patients and those with long-term conditions such as dementia, heart disease and breathing problems – are taken into account. The report, which Keogh will discuss with the media for the first time on Tuesday afternoon, will emphasise that staffing problems were found at all 14 trusts, and stress that the geographical isolation of many of the hospitals was a factor in that. His findings may also reopen the debate about whether the NHS should have legally backed minimum staffing levels – which supporters such as the Royal College of Nursing call "safe staffing" – in order to guarantee that set numbers of nurses are always on duty, and whether the NHS in England's need to make £20bn of efficiency savings by 2015 is forcing hospitals to cut corners and potentially endanger patients. Many of the review teams which conducted in-depth inquiries into each of the hospitals found what they regarded as too few staff. Each of the 14 trusts' individual action plans will include advice on workforce issues, especially ensuring they have enough staff that has the right qualifications. Many rely on agency staff, especially overnight and at weekends, though the inability to fill rotas can see nurses moved from where they usually work to a ward or department where there are too few available. All the 14 trusts are understood to now be looking urgently at providing safe staffing levels across their hospitals at all times, following the Keogh team's visits. The Francis report came close to suggesting minimum staffing levels and showed how inadequate staffing levels at Stafford hospital were a key factor in what the then NHS watchdog the Healthcare Commission estimated to be between 400 and 1,200 extra deaths between 2005 and 2009. Sir Richard Thompson, president of the Royal College of Physicians, which represents hospital doctors, said: "It is clear that parts of the system must change to better meet patients' needs. The NHS is struggling to cope with increasing pressures on acute services, patients with increasingly complex needs, and a breakdown of out-of-hours care. Patients' demands have changed and so our hospital services must change." Thompson said the NHS's move to offering key services seven days a week rather than five, strong clinical leadership by doctors, greater use of audit data about outcomes in key treatment areas and better collaboration between NHS staff would all help. The 14 trusts under review Basildon and Thurrock University Hospitals NHS foundation trust Blackpool Teaching Hospitals NHS foundation trust Buckinghamshire Healthcare NHS trust Burton Hospitals NHS foundation trust Colchester Hospital University NHS foundation trust The Dudley Group NHS foundation trust East Lancashire Hospitals NHS trust George Eliot Hospital NHS trust Medway NHS foundation trust North Cumbria University Hospitals NHS trust Northern Lincolnshire and Goole Hospitals NHS foundation trust Sherwood Forest Hospitals NHS foundation trust Tameside Hospital NHS foundation trust United Lincolnshire Hospitals NHS trust