This week’s (24th October 2015) BMJ carries a news piece about Secretary of State for Health Jeremy Hunt’s misuse of weekend mortality data. The editor, Fiona Godlee, has written to Mr Hunt criticising his continuing statements that excess deaths at weekends were the result of poor staffing. Several months ago the GP and columnist Margaret McCartney pointed out that although the figures showed an increased mortality there was no proof that this was related to staffing issues, and Godlee has now stated “What it [the quoted study] does not do is apportion any cause for that excess, nor does it take a view on what proportion of those deaths might be avoidable”.
The government’s rather weak defence is to shelter behind a spokesman who said that “clinical experts have said this is likely to be a consequence of variable staffing levels”
Likely? Maybe. Certainly? No. Hunt implied the problem was a medical one. Presumably he was not briefed that medical staff require access to investigations which require non-medical staff, such as radiographers and laboratory workers. He has also not been told, I assume, that shift working results in things getting missed at handovers, and lack of clinical continuity is not a result of low staffing levels but of limited working hours that require the imposition of shifts. And it is often lack of continuity that results in serious problems. If you assess a patient regularly over several days you will spot subtle changes. If that same patient is supervised by four, five or more doctors all the subtleties will be overlooked. Noes are often brief; I recall getting out of a nasty medicolegal case when the complainant’s GP notes had a throwaway remark that they were going scuba diving in Fiji – something that was quite incompatible with the pain, distress and functional limitation she was claiming. But sadly it appears that even at the very pinnacle of medical expertise, in government or in ivory towers, folk jump to unwarranted conclusions. Dare I? Yes! The case of misrepresentation of statin benefits is another example of a failure to assess literature properly.
My advice to Mr Hunt is to get better advice than he has at present, preferably from more than one source and certainly from people without vested interests or conflicts of interest. The risk of a foot-in-mouth situation will be significantly mitigated, and many doctors will feel less threatened (largely as efforts to blame them for everything will diminish).
And that brings me to something else the government needs – a psychologist. Not for themselves necessarily, but so that they understand that bullying imposition of targets, financial plans and contract changes are softened. It’s hardly surprising that trainee doctors have reacted vigorously to Mr Hunt’s attempted imposition of a contract that will cut their pay and worsen their conditions, not least when his response to their complaints has been opinionated and boorish. Could he not have foreseen there would be a spat? Is it really in his, or the government’s interest to alienate doctors? It’s bad enough that changes to pension calculations will result in today’s trainee doctors getting a pension that’s roughly half what people of my generation are getting. And having to work longer to get it.
So come on Mr Hunt. Nice works better than nasty. And as I have said before, how can you increase staffing levels when there’s no money to pay for them all?