NHS READMISSIONS ‘SCANDAL’: WHY THE ONLY SCANDAL IS HOW THIS ARTICLE APPEARED.

Whichever way you cut it, this piece from the Telegraph does not mark its finest hour

The lead piece in today’s Telegraph is an interrogation by Robert Winnett (above) of the statistics relating to emergency readmissions to hospital following NHS treatment. It’s a disturbing article, suggestive as so often of the braindead nature of New Labour’s target culture being applied to NHS outcomes…the interpretation being that patients have been rushed home too early (a) to make beds free and (b) to make the timeline statistics look better in the Blairite culture.

Having clashed with NHS bureuacracy and discovered its innate dishonesty, nothing in the piece surprises me. But from the outset, there was something  about this article that had The Slog’s bollocks-detectors twitching. Let me try and explain why I’m now certain those instincts were right.

First of all, the interpretation made is somewhat cavalier. Winnett refers to the figures ‘sparking allegations that patients are being “hurried through the system” so the NHS can meet waiting-list targets’. This may well be true in some cases, but the only person sparking allegations right now is Winnett himself; and there are other even more disturbing possibilities – for instance, the treatment had been incompetent, and thus required a readmission. Only ten days ago, a study showed that 3,000 NHS doctors are believed to be incompetent. But the Torygraph didn’t seem interested in that part.

Second, the statistics focus on raw numbers. That makes them sound big, but doesn’t put them into any kind of context. Thus, while the investigation Telegraph analysis is fair in sticking strictly to emergency readmissions, it does simplify the picture, and thereby mislead the reader.

In 2009/10, there were 16.8 million hospital admissions in the UK. The new survey suggests that circa 660,000 people were brought back to hospital last year within 28 days of leaving. That makes the running rate 3% – hardly an epidemic. Most private hospitals would, I suggest, be happy with a 97% in and out rate.

There is (you won’t be surprised) a specialist quango called the HES (Hospital Episode Statistics) to record all this sort of stuff. While some of this can be written off as pinstripes and bighair protecting themselves, the HES site notes that ‘ the entire patient pathway should be taken into consideration. Take a readmission to hospital with an infection following a hip replacement, for example. Was the infection as a direct consequence of the original procedure/interventions, or was it to do with the level of aftercare, or the patient’s own actions?’

All perfectly sensible, I would’ve thought. More to the point, the HES doesn’t even consider ‘rushed treatment’ as a significant factor. But the Torygraph does. Why?

On the surface, one excellent point being made by Robert Winnett, of course, is that the emergency readmission syndrome is on the increase. His piece records: ‘The figures show that 620,054 patients had to be readmitted in 2009-10 – compared to just 348,996 a decade before, a 78% increase’.

But here, the Telegraph is being unpardonably naughty: between 2000 and 2009, there was a 38% increase in admissions per se – which more than halves the real rate of increase.

Not only naughty, but also dim. One of the biggest rises in patient type over that period was demographic in nature – lots more old people. As the NHS stats clearly show, the number involving 60 to 74-year-olds also rose rapidly – by nearly 50%…and 66% for those over 75.

And this is the clincher: 7.8m of all 16.8m admissions were elderly people. Now you don’t have to be a brain surgeon to work out that complications are far more likely to occur among old than young people. Indeed, NHS Information Centre chief executive Tim Straughan says,“This [analysis] gives an insight into the changing demands placed on England’s hospitals, which are getting busier every year. It is clear that the effects of England’s aging population are being felt in secondary care”.

Not only is the Winnett piece thus shown to be largely tosh, it also misses the point it should have made: that aged care is going to have a bigger and bigger impact on our society. But it seems to me that the article had an aim in mind long before a word was written.

Let us consider the political background to this. The Coalition in general and Andrew Lansley in particular are in a serious pickle over the NHS. The policy is, you might say, in need of a brain transplant - and has been from the off. There are two key things to note about the article over and above those mentioned above:

1. The main subhead says that ‘the Daily telegraph can disclose’ the information we’re given. Then in very small type under the main shot, it says ‘The Department of Health has released’ the information. Neither the Guardian nor the Independent, however, seem to know anything about it. To any old head, this means but one thing: the Daily Telegraph has been given the data by friendly hands.

2. Mr Lansley himself seems to have been remarkably available for comment. And his comments in the Winnett column do rather give the game away.

“Having to be readmitted and treated all over again is hugely distressing. These figures show how Labour’s obsession with waiting time targets meant that patients were treated like parts on a production line to be hurried through the system rather than like people who need to be properly cared for,” asserts the Health Secretary.

But all that statement shows is the degree to which Lansley is either unaware of, or skating over, the real reasons – demography and incompetence – why the NHS readmissions rate is escalating: he is a Minister in a corner, distracting attention away from a potentially disastrous future towards a rewritten past.

This ‘scandal’ (an increasingly worn-out word at the Maily Tabloidgraph) is a scandal only in the sense that, yet again, we are served up something here described as ‘news’ that is merely propaganda. This is increasingly apparent in Britain’s predictably biased news media: it is most risibly obvious in the Guardian, frequently apparent at the BBC, and always blindingly obvious at the Daily Mail. And it is the reason why online readers read sites like The Slog.

Only ten days ago, I produced a withering attack on the Guardian and its Feedmeister Lord Mandelson. This site has never and will never have any bias in favour of any political Party, for the simple reason that it wants shot of all of them, and exists to deconstruct bollocks.

But the worst bollocks of all is disguised, planted bollocks – the ultimate hidden agenda. That’s what Robert Winnett has consented to write in this piece, and that’s why I will view all his work from now on with suspicion.

Readers have a right to the news they paid to read, and news media have a duty to supply that news without fear or favour. Until we get away from a situation where major titles are under the thumb of Left wing Trusts or ultra-Rightist expat egomaniacs, discerning news consumers will need to be constantly on their guard. I do not see any reason why they should have to work that hard purely to see through dissembling journalism.

Related: Give mutuality a chance in the NHS

The inverse correlation between Guardian copy and reality (scroll to relevant piece)

25 thoughts on “NHS READMISSIONS ‘SCANDAL’: WHY THE ONLY SCANDAL IS HOW THIS ARTICLE APPEARED.

  1. Thanks for that deconstruction, John. I smelled something nasty when I first heard the “readmissions” story break and get discussed on air over the last couple of days. It’s like the first time I heard the phrase “Weapons of Mass Destruction” from the Ministry of Truth. Deeply suspicious. Like anything from Lansley nowadays.

  2. My late father (79) was one of those ‘emergency readmissions’ statistics in the last 2-3 years with heart and pancreatic failure, then lung cancer. We were told by staff that the quickest way to get him seen, admitted and treated was to call 999. And I guess we used that method over 10 times during that period, though not every time as his regular appointments were done in the usual manner (54 times this year alone). It was also the best way to get to choose which hospital he was taken to. Heart and pancreas problem to one, cancer to the other, though often the symptoms were inter-changeable.

    So you are quite right in your analysis of the main reason being the aging population and more so where there are multiple potentially fatal issues to be taken care of. Point scoring between parties doesn’t solve the issues. But then grandstanding like this is what passes for the government actually doing something these days. Assuming they even know what to do in the first place. Think that speaks for itself.

  3. Statistics involving percentages are nearly always suspect as they are the easiest things to manipulate and to baffle idle brains. A recent example involved a certain cancer scare “Red meat increases risk by 25%”.

    Technically correct but hideously misleading. The actual ‘risk’ was something like 0.4%, increasing to 0.5% (25%) after a juicy medium rare sirloin. Thus the actual risk increase was 0.1%, not the 25% as reported.

  4. I think originally the definition of readmission related to the original reason for the first admission. I believe that the definition of readmission was subsequently changed to include any reason for a subsequent admission within 30 days. For example a patient is admitted for a minor procedure which goes according to plan. However, within a month the patient falls and fractures a hip. This counts as a “readmission”. This is not particularly helpful if you wanted to cone down to study in detail locally the reasons for readmissions.

  5. All reporting on the NHS is so full of b*****ks that I have given up on it. My default view is that it’s just going to get endlessly more complicated but less workable, no one is going to seriously take the problem on because they don’t want to fight the unions or take the political heat, so we are just going to have to accept an ever growing bureaucracy and an ever shrinking service. Maybe I’m being unfair but I spend so much of my time trying to get to grips with the financial situation that I can’t find the motivation to unpick what’s going on in the NHS. Thanks to John as usual for the deconstruction but I must admit I just skipped passed the article in the telegraph anyway because I knew it would be a load of old….

    • I can’t understand how we have ended up stuck with this rotten 1948 model health service, set up for all the right reasons with perfectly good intent that has now morphed into this ghastly bureaucratic cold heartless system. Its only the politicians that seem to think its wonderful (for them it probably is as they get special treatment) everyone else knows that it could be so much better if we simply admitted the model no longer works and moved to privatised system with a social insurance scheme. I can remember David Mellor talking on LBC radio about his time as a Health Minister during the Thatcher era. He had endless NHS vested interest parties telling him that if only the Government would spend a few extra billion here and and a bit more there they could have a world class health service. Fast forward the clock 25 years and Labour doubled the entire NHS budget throwing money everywhere to try to make the model work. The same old problems of bed shortages, waiting lists and dirty hospitals have however persisted. We are now spending at a European average and yet the system is still largely crap. Money alone cannot solve the problem we need to change the model. No politician seems to have the courage to actually do anything.

      Just wait till the Government has to raid the NHS budget to prop up the banks when they start falling over again. I suppose only then will a crises finally force a change.

      • Mark, totally agree. There is a simple solution, look at a country with a good service and just copy it. I would suggest Holland, my experience there was excellent. Of course this is not allowed because they have heavy private sector involvement and it would involve the end to thousands of union non jobs

      • Spot on, Mark.
        Nye Bevan’s vision was for a localised service like the clinic he had as a kid. He did not like big except as a means to an end: he said “The purpose of power is to give it back”.
        He was right.

      • @Soap

        There is a lot to be said for the Dutch model, there are niggles, but they are but niggles. It is also strongly unionized, as are most things Dutch. The unions need not fear private ownership if the government has sensible regulations in place – oh, and competent management that is able to deal with unions sensibly. That last part may be the sticking point in the UK.

      • Mark Couldn’t have said it better. Everyone working inside the NHS is working against sorting this issue out. My daughter is a doctor, and full of the “wonderful NHS” despite spending half her time when home complaining about bureaucracy. She is also being bombarded by the BMA over pensions. We nearly had a family falling out over it, until I had convinced her that even if they cut even further she would still have a pension I could only dream of, despite having worked in Management most of my life. And when I asked where all the money came from she hadn’t thought that one through.

        And John saying some doctors are incompetent is the understatement of the year. My wife has nearly been killed 3 times in recent years by these goons, by them not listening to us and thinking they know it all, or in the last instance, not knowing anything and not consulting someone who did. And some of the student and young doctors I have meet through my daughter I wouldn’t let operate a lawn mower. Part of the issue is the selection to med school via the universities. They only take the very top academic achievers and what medicine needs are doctors that are technically minded and practical as well.

  6. Every time I see an attack on the NHS in the Telegraph I can’t help but suspect that the privatisers have planted the story. It’s a huge pot of money and they’d love to get their hands on it. Sure it’s got it’s problems but I don’t believe the money boys give a monkey’s about folk’s health. It’ll end up like the railways.

  7. Sorry to join the “me too-ers” brigade, but when i read the story in the Torygraph, it had the distinct smell of much ado about not much at all.
    The quality of the Torygraph has consistently decined (with the exception of two or three mainly financial columnists). Whatever he may have been, the Torygraph was better when old Conrad owned it (or the bias was much more subtle).

  8. The concept of home care for the sick and the elderly must be the logical starting point for all the right reasons.

  9. Back in the seventies reports in the US were of massive medical fraud via diploma mills, which for 5 to 25 thousand dollars would produce sheepskin on demand. The New York Times reported that 6% of doctors in NY State at the time were of this sort of provenance, more or less — we’re they counting the freshly hatched or kit and caboodle? Does it matter? Yes, that was 3 out of every 50, or every seventeenth MD or so. Agents were reported to have raided a large hospital in TX to take away a phoney neurosurgeon, only to be told that not only was he inconveniently in surgery, but was the best man on the staff.

    Won’t trouble you with the tale of coming down with some bug and finding myself feverishly weak in a metropolitan NY emergency room, in an ER bed, when, to my horror, the constables brought in a man who had just thrown himself on the subway tracks and somehow barely survived being run over by a train, placing him directly to my left, one of his feet dangling by a thread. The young intern in charge, who had just been prevented by the nurse who over-ruled his instant command for injection of epinephrine to the chest from killing a middle-aged man directly to my right who had come in presenting with chest pains and shortness of breath, because the man was, to the intern’s way of looking at things of such a low socioeconomic class that he needn’t be listened to — the man was saying “doctor there is one drug I cannot have under any circumstance” … the nurse had filled the needle but protested subtly and doggedly enough to suggest it might perhaps be a good idea to at least take off the man’s shirt at least and take a jab at compiling a working history… she dextrously managed this while enduring glares of arrogance and rage from Dr. Intern …somehow she did … and as the doctor showed he had remembered something suddenly he paused, looking absolutely mortified while under so much stress that he’d realized he’d nearly killed his patient, asked aloud “oh, er, yes, ah, sir, ah, have you ever perhaps in your life had open-heart surger…?” … but before he could complete his sentence the nurse and the poor man too, horror-stricken as he immediately understood the implications of the wielded hypodermic, had managed to reveal the scar on his chest which screamed “yes, sir I have had open …” . But where was I. Oh yes. The man to my left. Horribly mangled, and as the policemen lingered a while, bemused and no doubt wondering, given what was going on, at the fate of their heroic rescue efforts … the chagrined internist, utterly befuddled at this horrific case and seeing himself watched by at least me, the police, the nurse, and the man he’d nearly managed to kill through his arrogance just a moment ago, decided, wheeled and said in a commanding voice : “call neurosurgery, and, uh, put him in that room across the hall.” Out went the call, in across the hall but within sight went the mangled near suicide, and eventually two men in white coats appeared. ‘Neurosurgery” presumably. They chuckled, shone a light in the man’s eyes after prying open his eyelids, and wrote something down on a clip-board — the man’s case file. As they left, chuckling and lighting up cigarettes, I managed to distinctly make out their conversation as the one neurosurgeon said to his colleague: “I don’t remember actually–do you?–is it circles within ellipses or ellipses within circles?”

    “It is a tedious world gentlemen” as Gogol concludes his tale of the two Ivans. And you can trust JW when he tells you, as my late papa himself never ceased to warn me: “nearly all the time it is incompetence, C, plain, simple incompetence.”

    Happy New Year to All you Sloggers, and best of health in the one to come! Only found this place a few weeks ago and must say it is as wonderful a tonic as can be found on the world wide websicle.

  10. Sir,
    Goodbye everyone, a thousand sorrys for all my nonsense, it’s over now. I promise.
    The kommandant and I are going to live on a sunny island with lots of goats and chickens.
    Happy new year everyone xx

  11. John a great piece and as always your own slant on things. However, apart from the obvious ‘ lets diss the NHS so the private companies can get feet in doors’ there is ANOTHER reason for this information. Yes , It has been put badly, however from a clinical point of view. The fact remains that people ( not just the eldertly) are being dischagred too early to free up beds. This is shocking as it is leading to premature death in the worst case scenario. I myself was admitted to hospital I was very ill I had no idea who I was or where I was. I was given infusion of water as I was diagnosed as having a particual bad cold. I was wheeled out to a cold waiting room in my night attire – as I was ill for previous 7 days – The taxi came appx I hour later. I was readmitted within 5 hours dying with pneumonia. Yes I do mean dying! My legs were almost triple in size – I am not over weight any one could see this was not right. I was in hospital for 6 weeks – as I also had pluracy and then contracted C diff. Four members of my immediate family have died due to wrong diagnosis/ being sent home with’ flea in ear’. It was with this shocking realisation that figures had to be obtained. But this was to improve the service from within – now it is being used for the wrong reasons. It is also worth remembering that still births were never recorded so no one knew the rate of care being administered by Gynies and Mid wives. They got paid regardless of competence, which is shocking! Whistleblowers are a plenty in the NHS BUT… well, it is a career loser to be sure. We really do need to stop this pandering to the Private Sector and using stats to boulster their claim. My argument has always been – the public sector should be run like a private company (which it is in real terms).

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