Jeremy Hunt: the wrong battle and the right one

Thank you for your many comments on the last blog about chronic and acute primary care, a good debate which has made me think.  Favourite comment:  ‘minor’ is a retrospective diagnosis.  Last week on holiday, but today back in the saddle (cycle club outing this morning while wife at work, obviously, she’s a hospital doctor and it’s Saturday).

Which brings us to the Jeremy Hunt speech.

All the noise is around 7 day working, a great shame as he has picked the wrong battle.  It’s based on the statistic, “You are 15% more likely to die if you are admitted on a Sunday compared to being admitted on a Wednesday”.

The minister has not got the difference between absolute risk, 1.3% deaths in 30 days, and relative risk.  Where are his advisors?  Read the conclusions on NHS Choices, “we don’t really know.”

Sigh.  Better look instead at the main thrust of the speech:

“Our focus should be different: not top-down targets but transparency and peer review.

“I want the NHS to be somewhere where you are able to focus on patient care and where you can challenge, learn and improve

“How about ‘more human’ … Because the truth is that decades of building processes around system targets and system objectives, often with the best of intentions, has demoralised staff

“If you help people understand how they are doing against their peers and where they need to improve, in most cases that is exactly what they do. A combination of natural competitiveness and desire to do the best for patients mean rapid change – without a target in sight.

“To power this we need to foster an inquisitive, curious and hungry learning culture.

And finally: “How we can increase take-up of new digital innovations in health?”

——————–

Wow.  A friend asked whether I had written it.  Not guilty, though I have banged on about A&E targets. There’s a logical problem:  if targets don’t work then the right thing is not fewer, but none.

Is this all motherhood Jeremy, or do you mean it?  Here is the test:  abolish the 4 hour A&E and 18 week targets today.  

Replace them with measures of median time to treat.  Easy to do, achieves your objectives without having to negotiate with the BMA.  We could even call it “intelligent transparency” if you wish.  This matters to patients, it will stop gaming and drive improvement.

Lansley talked about cutting targets and did nothing.  You will have a battle with the NHS establishment, and a howling press, but we are with you, and it’s the right battle.

You will never have a better opportunity.

Harry Longman

PS for examples of what people achieve without a target in sight, instead with a method and the right simple measures, try the Dover collection.

Another one last week, in Fife, day 1 the practice manager writes, “The launch day has gone extremely well, with great teamwork”.  Day 2, a GP, “I am surprised that after only two days the difference in the frantic pace in the surgery.”  A patient, 72, “system unbelievable marvellous”.

2 responses to “Jeremy Hunt: the wrong battle and the right one”

  1. Allen Wenner says:

    First, Jeremy Hunt has it right about the health care system not being patient (human)-centric. That applies everywhere. Doctors have always been in control. Doctors set available hours daylight M-F. People get sick 168 hours per week, but they can call their doctor only 18% of the time (less if the surgery closes for lunch). The senior (best) doctors don’t work on weekends (or Friday afternoons). The majority of medical malpractice cases in America occur Friday, Saturday, and Sunday. So if patients get sick Friday after 1100, they will try to wait until Monday or will see a strange doctor who doesn’t know them. Some patient can’t make it and go to hospital Sunday. The higher death rate is either the doctor without the data or delayed care. Does it really matter if the patient dies? Is it access on weekends that is the problem or is this too superficial an analysis of the problem?
    Second point, Jeremy Hunt is right about giving patients real control of their own health and care. It could happen with internet technology. People in-extremis on Sunday afternoon often did not get that way suddenly. For heart failure, as an example, they probably began to notice leg swelling at least a week before, shortness of breath at night for several days, increasing fatigue and maybe more angina – all in gradual increments. They know the calling queue at the surgery, the long wait time, and transportation challenge to get to the surgery, so they hope the problem will wait until their regular appointment or will resolve on its own…sometimes it doesn’t. Maybe they finally call Friday afternoon, or simply try to wait until Monday. The result is the same. Could treatment have been initiated earlier? Would earlier treatment have altered the Sunday hospital admission? What if the patient or the patient’s family had 24/7 access to the GP via a website that triaged their complaint and presented the data to the GP for decision making? Or what if the GP knew her patients at high risk and could use internet based tools to triage them for her prospectively and automatically at any interval she prescribed? Would the GP having the data Thursday decide to change therapy or see the patient before the weekend? Would it make any difference?

  2. Harry Longman says:

    From William Wyatt-Lowe:
    One of the interesting things in today’s clin perf cttee papers was a philosophical paper about translating overarching emphasis on measurable outcomes for outcomes, satisfaction levels, financial performance, all in terms of being in the top decile, and measurable only at the end of a year, into specific ‘do-ables’ at a department level. Such issues do not grab the hearts and minds of staff, while quality and safety do.

    We need a new art of explaining how quality-oriented processes will lead to better outcomes – and to be prepared to quote the evidence that this works.

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