Monday, 15 July 2013

A right to be furious.

After a weekend of looking at press coverage of the Keogh report, a number of people feel pretty furious

Let us think about this. We have seen huge headlines in most of the Sunday nationals telling us about thousands “Doomed to die by the NHS” We are told “Devastating report to reveal thousands dying needlessly as 21 hospitals probed in scandal that eclipses Mid Staffs Horror”

The front pages, and the media interviews are very interesting in that all of them are about a report that no one has yet seen because it won’t be published until Tuesday.  This mirrors the way in which the Mid Staffs report was highjacked in 2009 by people with an agenda leaking selective information to a very receptive press.

It reflects the way that all the reporting of the major milestones of the Mid staffs story have been handled, but this time is different because it is clear now that this is a national issue.

So what is the Keogh review?

Sir Bruce Keogh is a highly respected expert on quality in health care, who has played a prominent role working with the Department of Health for many years. He is a careful, mild mannered man, with the interests of the NHS at his heart.

One of the key things that triggered the investigation of Mid Staffs in 2008  was concern about mortality figures, produced by Professor Jarman’s system. The HCCs year-long investigation at Mid Staffs, began with these concerns, looked at everything with a fine tooth comb, and unsurprisingly found things to be worried about.

As with the Keogh review the HCC report was preceded by sensational leaks of figures that never appeared in the report. The media circus ensured that the HCC report led to the Alberti report, the Colin Thome report, the Francis Independent Inquiry and the Francis Public Inquiry. This also then made Mid Staffs a prime candidate for potential downgrade which led to the Contingency planning team report on “sustainability” which recommended bringing in the Administrators. We are currently waiting with various degrees of patience for the Administrator’s recommendations.

Sustainability is the current big theme for the Department of Health. They are asking the basic questions are the hospitals safe now and in the future, and can we afford to run them. This often boil down to the single question, can we afford the staffing that we need to run the service safely. The answer appears in a growing number of cases to be “No”. The direction of travel that the Department of Health has chosen is to centralise acute care in big hospitals with small cottage hospitals providing local care.  This is the downgrade threat that we face in Stafford now.

The Bruce Keogh review was set up to make a judgement about the sustainability of individual hospitals within the health service, perhaps as a justification for rolling out more downgrades. As a starting point they took 14 hospitals with apparently high mortality rates based on the Jarman figures, and sent in teams to investigate.

It will not come as any surprise to those who understand the detailed picture at Stafford, if the Keogh review finds pretty clearly that Mid Staffs is certainly not a one off, and that a number of other hospitals are facing very similar challenges. We expect this.  

The national press obviously have a bit of a problem with this. After years of trashing Mid Staffs as the worst hospital there ever was we are now coming round to variations of “Stafford was appalling and the worst but all these others are just as bad”.  

We are already hearing that Sir Bruce has let it be known that his report does not use the 13,000 deaths figure that the press are headlining. Of course it will not. Robert Francis’s report tried to make it clear that there is a major difference between “excess death figures” that are a statistical product that is affected by the quality of coding which is very variable, and “avoidable deaths” which can only be determined by detailed case note analysis. “Avoidable deaths” which do of course happen in all hospitals, are generally going to be in small numbers. The media seem unable or perhaps unwilling to grasp this.

I personally expect that the report will have something pretty useful to tell us about the real problems that hospitals are facing. It might even, if Sir Bruce is brave tell us something about data quality issues. It is just rather unlikely to be anything very sensational.

I believe that Sir Bruce cares about the NHS, and is seeking to find ways to make it “safe and sustainable” for the next 20-30 years. His review is an essential tool for finding out something about the current state of the NHS, and I think his review method is far better for the hospitals than the highly disruptive process that Stafford was subjected to in 2008. It is however perhaps unfortunate that the review comes at a time when there are huge financial problems that the NHS must face and when there are also undoubtedly individuals and organisations that do not wish the NHS well.

When I began the first petition for Stafford in 2011 because of the night time closure of A&E I had two main aims. I wanted it to be clear to the people of Stafford that the problems of our hospital were by no means unique, and I wanted it to be clear that downgrading of our hospital was part of a wider plan to downgrade hospitals nationally, and that it needed to be the subject of a national debate.

When the Keogh report comes out tomorrow I expect both of these points to be satisfied.

I do not know what plans Sir Bruce has for the release of his report. I hope that he will prompt the debate that we need on the future of the NHS, and indirectly on the future of Stafford Hospital.

I hope he will also have something to say about the way that the media has handled his report.  Sir Bruce is a very mild mannered man, but he has every right to be furious!

Some more blogs on waiting for Keogh - Roy Lilley

& Steve Walker

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