Jeremy Hunt- lies bullshit and poisoned statistics pt 2
Following one from Health Direct’s Jeremy Hunt- lies bullshit and poisoned statistics post yesterday.
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.