Jeremy Hunt- lies bullshit and poisoned statistics pt 2

Following one from Health Direct’s Jeremy Hunt- lies bullshit and poisoned statistics post yesterday.

Following one from Health Direct's Jeremy Hunt- lies bullshit and poisoned statistics post yesterdayHealth secretary Jeremy Hunt and the claim he made about doctors’ contracts

So, is it true? Do 6,000 people — or 11,000 — die needlessly in NHS hospitals because of poor weekend care? Nobody knows for sure; Jeremy Hunt certainly does not. It’s not enough to show that people admitted to hospital at the weekend are at an increased risk of dying there. We need to understand why — a question that is essential for good policy but inconvenient for politicians.

One possible explanation for the elevated death rate for weekend admissions is that the NHS provides patchy care and people die as a result. That is the interpretation presented as bald fact by Jeremy Hunt. But a more straightforward explanation is that people are only admitted to hospital at the weekend if they are seriously ill. Less urgent cases wait until weekdays.

If weekend patients are sicker, it is hardly a surprise that they are more likely to die. Allowing non-urgent cases into NHS hospitals at weekends wouldn’t save any lives, but it would certainly make the statistics look more flattering. Of course, epidemiologists try to correct for the fact that weekend patients tend to be more seriously ill, but few experts have any confidence that they have succeeded.

A more subtle explanation is that shortfalls in the palliative care system may create the illusion that hospitals are dangerous. Sometimes a patient is certain to die, but the question is where — in a hospital or a palliative hospice? If hospice care is patchy at weekends then a patient may instead be admitted to hospital and die there.

That would certainly reflect poor weekend care. It would also add to the tally of excess weekend hospital deaths, because during the week that patient would have been admitted to, and died in, a palliative hospice. But it is not true that the death was avoidable.

Does it seem like we’re getting stuck in the details? Well, yes, perhaps we are. But improving NHS care requires an interest in the details. If there is a problem in palliative care hospices, it will not be fixed by improving staffing in hospitals.

“Even if you accept that there’s a difference in death rates,” says John Appleby, the chief economist of the King’s Fund health think-tank, “nobody is able to say why it is. Is it lack of diagnostic services? Lack of consultants? We’re jumping too quickly from a statistic to a solution.”

“When one claim is discredited, Jeremy Hunt’s office simply asserts that another one can be found to take its place”

This matters — the NHS has a limited budget. There are many things we might want to spend money on, which is why we have the National Institute for Health and Care Excellence (Nice) to weigh up the likely benefits of new treatments and decide which offer the best value for money.

Would Jeremy Hunt’s push towards a seven-day NHS pass the Nice cost-benefit threshold? Probably not. Our best guess comes from a 2015 study by health economists Rachel Meacock, Tim Doran and Matt Sutton, which estimates that the NHS has many cheaper ways to save lives. A more comprehensive assessment might reach a different conclusion but we don’t have one because the Department for Health, oddly, hasn’t carried out a formal health impact assessment of the policy it is trying to implement.

This is a depressing situation. The government has devoted considerable effort to producing a killer number: Jeremy Hunt’s “6,000 reasons” why he won’t let the British Medical Association stand in his way. It continues to produce statistical claims that spring up like hydra heads: when one claim is discredited, Hunt’s office simply asserts that another one can be found to take its place. Yet the government doesn’t seem to have bothered to gather the statistics that would actually answer the question of how the NHS could work better.

This is the real tragedy. It’s not that politicians spin things their way — of course they do. That is politics. It’s that politicians have grown so used to misusing numbers as weapons that they have forgotten that used properly, they are tools.

From: http://www.ft.com/cms/s/2/2e43b3e8-01c7-11e6-ac98-3c15a1aa2e62.html

Jeremy Hunt- lies bullshit and poisoned statistics

On the first day of the all out junior doctors strike Health Direct reposts a Financial Times review of Jeremy Hunt’s use of poisoned statistics.

On the first day of the all out junior doctors strike Health Direct reposts a Financial Times review of Jeremy Hunt's use of poisoned statisticsWe have more data — and the tools to analyse and share them — than ever before. So why is the truth so hard to pin down?

Thirty years ago, the Princeton philosopher Harry Frankfurt published an essay in an obscure academic journal, Raritan. The essay’s title was “On Bullshit”. (Much later, it was republished as a slim volume that became a bestseller.) Frankfurt was on a quest to understand the meaning of bullshit — what was it, how did it differ from lies, and why was there so much of it about?

Frankfurt concluded that the difference between the liar and the bullshitter was that the liar cared about the truth — cared so much that he wanted to obscure it — while the bullshitter did not. The bullshitter, said Frankfurt, was indifferent to whether the statements he uttered were true or not. “He just picks them out, or makes them up, to suit his purpose.”

Statistical bullshit is a special case of bullshit in general, and it appears to be on the rise. This is partly because social media — a natural vector for statements made purely for effect — are also on the rise. On Instagram and Twitter we like to share attention-grabbing graphics, surprising headlines and figures that resonate with how we already see the world. Unfortunately, very few claims are eye-catching, surprising or emotionally resonant because they are true and fair. Statistical bullshit spreads easily these days; all it takes is a click.

On July 16 2015, the UK health secretary Jeremy Hunt declared: “Around 6,000 people lose their lives every year because we do not have a proper seven-day service in hospitals.  You are 15 per cent more likely to die if you are admitted on a Sunday compared to being admitted on a Wednesday.”

This was a statistic with a purpose. Hunt wanted to change doctors’ contracts with the aim of getting more weekend work out of them, and bluntly declared that the doctors’ union, the British Medical Association, was out of touch and that he would not let it block his plans: “I can give them 6,000 reasons why.”

After negotiations between the Government and the British Medical Association lasting four years failed to reach a final agreement on February 11 2016 in London, Jeremy Hunt then announced in the House of Commons that new contracts would be imposed on Junior Doctors from August 1st 2016.

Despite bitter opposition and strike action from doctors, Hunt’s policy remained firm over the following months.

Yet the numbers he cited to support it did not.

In parliament in October, Hunt was sticking to the 15 per cent figure, but the 6,000 deaths had almost doubled: “According to an independent study conducted by the BMJ, there are 11,000 excess deaths because we do not staff our hospitals properly at weekends.”

Arithmetically, this was puzzling: how could the elevated risk of death stay the same but the number of deaths double? To add to the suspicions about Hunt’s mathematics, the editor in chief of the British Medical Journal, Fiona Godlee, promptly responded that the health secretary had publicly misrepresented the BMJ research.

Undaunted, the health secretary bounced back in January with the same policy and some fresh facts: “At the moment we have an NHS where if you have a stroke at the weekends, you’re 20 per cent more likely to die. That can’t be acceptable.”

All this is finely wrought bullshit — a series of ever-shifting claims that can be easily repeated but are difficult to unpick. As Hunt jumped from one form of words to another, he skipped lightly ahead of fact checkers as they tried to pin him down.

Full Fact concluded that Hunt’s statement about 11,000 excess deaths had been untrue, and asked him to correct the parliamentary record. His office responded with a spectacular piece of bullshit, saying (I paraphrase) that whether or not the claim about 11,000 excess deaths was true, similar claims could be made that were.

Part two is reproduced by Health Direct tomorrow: Jeremy Hunt- lies bullshit and poisoned statistics pt 2 .

Obese smokers denied surgery

The Royal College of Surgeons found a third of local NHS health bosses put restrictions on surgery for smokers and the obese.

The Royal College of Surgeons found a third of local NHS health bosses put restrictions on surgery for smokers and the obeseThe Royal College of Surgeons (RCS) has been increasingly alarmed about the rationing of surgery in the NHS in the tough financial climate. However, some local NHS groups criticised in the report say their polices are based on good evidence.

Its report is based on freedom of information returns from nearly all of the 209 clinical commissioning groups in England and all seven health boards in Wales.

While some CCGs have voluntary policies in place, where patients are encouraged to stop smoking or lose weight, others have introduced mandatory policies, which means patients have to meet fixed criteria before surgery.

The college says mandatory policies are “a cause for concern” and it fears patients with a high body mass index (BMI) or who smoke are becoming “soft targets” for NHS savings.

The report reveals 31% of CCGs and one health board in Wales have at least one policy requiring people to lose weight or stop smoking before they can be referred for routine surgery.

The report suggests one in five CCGs has mandatory policies on BMI levels before hip and knee replacement surgery, while 4% have mandatory policies on getting patients to stop smoking before hip and knee replacement surgery.

Of the CCGs that responded, 22% reported having at least one “voluntary” policy in place.

The Royal College of Surgeons said any blanket ban on surgery based on a patient’s weight or whether they smoked was wrong and not supported by national guidance.

Instead, president RCS Clare Marx said, patients should be encouraged to sign up to programmes to help them stop smoking and manage their weight while awaiting surgery.

“NHS surgical treatment should be based on clinical guidance and patients should be dealt with on a case-by-case basis,” she said.

“In some instances, a patient might need surgery in order to help them to do exercise and lose weight. While it is difficult to categorically prove such policies are aimed at saving money, it is unlikely to be a coincidence that many financially challenged CCGs are restricting access to surgery.”

She added National Institute for Curbing Expenditure (NICE) guidance did not support these mandatory bans for routine surgery.

British Orthopaedic Association president Tim Wilton said there was no clinical or financial justification for refusing to fund hip or knee replacements.

“Good outcomes can be achieved for patients regardless of whether they smoke or are obese, even at BMIs of over 50, and these surgeries are highly cost effective, typically delivering sustained pain relief for a cost that equates to just £7.50 a week,” he said.

“Hard and fast rules also undermine the NHS’s ability to involve patients in decisions about their own care, and are a distraction from the task at hand: making sure patients receive the best possible advice and care, to enable them to make the best possible decisions for their health – including losing weight and stopping smoking where appropriate.”

Doctors want new cosmetic surgery laws

Surgeons want new laws to protect patients undergoing cosmetic surgery

Surgeons want new laws to protect patients undergoing cosmetic surgeryThe Royal College of Surgeons (RCS) has called on the government to introduce legislation in the next Queen’s Speech to protect patients undergoing cosmetic surgery, as the organisation and the General Medical Council (GMC) publish new standards on cosmetic procedures.

The RCS’s new Professional Standards for Cosmetic Surgery are intended to improve patient safety and standards in the industry, by stipulating that only surgeons with the appropriate training and experience should undertake cosmetic surgery, as well as the ethics and behaviour expected of them.

They supplement new guidance the GMC has published today for all doctors who carry out cosmetic interventions, including non-surgical procedures such as Botox and hair transplants, and are intended to be read alongside it.

However, to help make the regulation of cosmetic surgery as robust as possible, the RCS believes the government should also give the GMC a new regulatory power to highlight to the public and employers which surgeons have been certified by the RCS to carry out cosmetic surgery.

Mr Stephen Cannon, Chair of the Cosmetic Surgery Interspecialty Committee and Vice President of the Royal College of Surgeons, said:

“Cosmetic surgery is a booming industry, but the law currently allows any doctor – surgeon or otherwise – to perform cosmetic surgery in the private sector. This can make it difficult for patients to identify an experienced, highly trained surgeon from someone who should not be practising.

“To correct this, we will launch a new system of certification later this year which will help patients to find a certified surgeon, who has the appropriate training, experience and insurance to carry out a procedure – such as a tummy tuck or nose job.

Today’s new Professional Standards for Cosmetic Surgery will underpin the new system of certification. By adhering to the RCS’s new Professional Standards for Cosmetic Surgery, surgeons will ensure that the needs of individual patients are at the centre of the consultation discussion, and that they are fully informed about the potential risks and likely outcome of the procedure.

The proposed cosmetic surgery guidelines recommend that:

  • Surgeons performing cosmetic surgery should be certified in the area in which they practise.
  • The operating surgeon should lead the consultation with the patient to outline the risks of the procedure, likely outcome and to provide the information that will help them decide whether or not to undergo surgery.
  • The operating surgeon must also obtain written consent from a patient themselves – and not delegate it to a colleague.
  • Patients should be offered a cooling off period of at least two weeks before they consent to an operation to give them time to reflect on a decision.
  • Surgeons must make sure they have appropriate indemnity insurance to cover the procedures they are undertaking.
  • Surgeons should refrain from using financial inducements such as time-limited offers and discounts.

Health Direct approves of anything that will end botched and unethical healthcare procedures. These guidelines appear to be an overdue common sence step in that direction.

Fourth Junior Doctor strike hits Health Service

Junior doctors in the NHS are taking part in a fourth strike in their long running contract dispute.

Junior doctors in the NHS are taking part in a fourth strike in their long running contract disputeThe 48 hour strike started at 08:00 this morning as the doctors prepare legal challenges to the government’s decision to impose changes to their pay and conditions from this summer.

Doctors are again providing emergency cover- but 5,000 operations and procedures have been postponed.

The latest action means the total number of treatments that have been delayed has now hit 24,500 during the dispute.

The Patients Association has come out in support of junior doctors despite the disruption, saying the government should not be imposing the contract.

But despite pleas from them and other organisations for both sides to get back round the negotiating table, the government and British Medical Association (BMA) have remained adamant they will not budge from their positions.

The BMA said it had been left with “no choice” in its fight against the government’s plan to impose a new contract in which, it said, the profession had “no confidence”.

Ministers have said the changes, which will see doctors paid less for working weekends while basic pay is increased, are needed to improve care at weekends. This is disputed by the BMA.

How the Junior Doctors dispute reached stalemate

  • Talks at conciliation service ACAS broke down in January
  • A final take-it-or-leave it offer was made by the government in February but was rejected by the BMA
  • Ministers subsequently announced the contract would be imposed in the summer
  • It will reduce the amount paid for weekend work, but basic pay is being increased
  • The BMA wants a more generous weekend pay allowance and more investment for more seven-day services –
  • the government is not increasing the overall budget for junior doctors’ pay
  • Two legal challenges are being pursued by doctors against the imposition
  • Hospitals are pushing ahead with the new contract – offers are expected to go out in May
  • The government is refusing to reopen talks, arguing it made compromises earlier in the year but the BMA did not

Over the past few weeks, a host of organisations, including patient group National Voices and the Academy of Medical Royal Colleges, have come forward to call on the government to drop the imposition and the BMA to stop the strikes and reopen talks.

As the latest strike got under way, Patients Association chief executive Katherine Murphy said the imposition was “not at all helpful”.

“Junior doctors are the backbone of the NHS and it is vital that they are able to provide the safe and effective care that patients need. Such a highly trained and valuable part of the NHS should not be disregarded so lightly.

“At a time when financing the NHS is already at breaking point, we should not further risk losing more doctors whose training is funded by the public purse.”

BMA junior doctors’ leader Johann Malawana said: “By pursuing its current course, the government risks alienating a generation of doctors.

“If it continues to ignore junior doctors’ concerns, at a time when their morale is already at rock bottom, doctors may vote with their feet which will clearly affect the long-term future of the NHS and the care it provides.

“Responsibility for industrial action now lies entirely with the government. They must start listening and resume negotiations on a properly funded junior doctors’ contract to protect the future of patient care and the NHS.”

Health Direct notes that when the Patients still back the Doctors, the politicians should reflect on their own dogmatic intransigence and get back to the negotiating table.