If this seems really snappy it’s because I’ve taken it
directly from the Channel Four News website and posted it unedited. It’s the transcript
of a programme I watched, with some sadness, on Wednesday 11/9/13 and it’s more
groundbreaking work from Professor Jarman.
Of course, looking at the Mayo Clinic is both good and bad.
Good because it’s the best in the world and that’s what you need to learn from.
Bad because many people in America can’t afford any hospital treatment, let alone
the Mayo.
So, the hospital patients are an unrepresentative group –
they are rich enough to pay or to be insured. Those who are untreated or
untreated until it is too late don’t figure. The poor get worse outcomes.
Our NHS treats everybody
regardless.
All the same, if you can’t learn from other countries you are
doomed to go on making the same mistakes;
Wednesday
11 September 2013 UK
Victoria
Macdonald
Health and
Social Care Correspondent
NHS chief
Sir Bruce Keogh says he is taking very seriously figures revealed by Channel 4
News which show that health service patients are 45 per cent more likely to die
in hospital than in the US.
Numerous
reports and inquiries have revealed serious failings in the National Health
Service. From the Bristol heart babies to Mid Staffordshire, fundamental
problems with care have been exposed.
But what
Channel 4 News can now reveal is previously unpublished data which shows just
how badly our hospital mortality rates compare with other countries. And never
more so than for the elderly.
The figures
prompted Sir Bruce Keogh, medical director of the NHS, to say he will hold
top-level discussions in a bid to tackle the problems.
"I
want our NHS to be based on evidence. I don't want to disregard stuff that
might be inconvenient or embarrassing...I want to use this kind of data to help
inform how we can improve our NHS," he told Channel 4 News.
We still
have too many patients dying in our hospitals when their relatives were
expecting them to come home. Sir Bruce Keogh, NHS
"I
will be the first to bring this data to the attention of clinical leaders in
this country to see how we can tackle this problem."
The data is
the work of Professor Sir Brian Jarman, who pioneered the use of hospital
standardised mortality ratios (HSMRs), as a way of measuring whether death
rates are higher or lower than expected and which are adjusted for factors such
as age and the severity of the illness.
It was by
using HSMRs that Professor Jarman was able to identify the higher than expected
mortality rates at the Mid Staffs trusts.
For more
than a decade, Professor Jarman has also been collecting hospital data from six
other advanced economy countries, adjusting them where possible to take into
account the different health systems.
What he
found so shocked him, he did not release the results. Instead, he searched - in
vain - for a flaw in his methodology and he asked other academics to see if
they could find where he might have gone wrong. They, too, could not find
fault.
'Shocking'
findings
So now he
is releasing the findings. And they are shocking. The 2004 figures show that
NHS had the worst figures of all seven countries. Once the death rate was
adjusted, England was 22 per cent higher than the average of all seven
countries and it was 58 per cent higher than the best country.
That meant
NHS patients were almost 60 per cent more likely to die in hospital compared
with patients in the best country.
"I
expected us to do well and was very surprised when we didn't," Professor
Jarman told Channel 4 News. "But there is no means of denying the results.
They are absolutely clear."
Of course,
that was nearly 10 years ago and the NHS has been through several reforms and
had record amounts of money poured into it until recently.
When
Professor Jarman projected the figures forward to 2012, the hospital death
rates in all seven countries had improved - England's faster than some.
However, it
is still among the worst and has death rates 45 per cent higher than the
leading country, which is America.
NHS medical
director Sir Bruce Keogh told Channel 4 News: "The fact is we have a
health service that is admired around the world, founded on the cradle to grave
principle.
"But
the other fact is, we still have too many patients dying in our hospitals when
their relatives were expecting them to come home."
Why is
America doing better?
Because of
confidentiality issues we are not allowed to name the other countries. But
America stands out in the data for its lower mortality rates. So we went to
find out why.
At the Mayo
Clinic Hospital in Phoenix, Arizona, they are in the best two per cent in the
country. It is an impressive hospital, with piano music playing in the lobby
and sunshine streaming into the rooms.
And around
the hospital are signs extolling their ethos: the patient comes first. To this
end they have introduced a number of safety systems, including a check and
recheck system between the pathology labs and the operating theatres.
For years
they have had multi-disciplinary team rounds in which everyone from the
consultant to the physio, from the nutritionist to the social worker is
involved in the care of that patient.
It means
better communication. Everyone is treated as an important part of the team,
rather than deferring, in the traditional way, to the consultant.
Professor
Richard Zimmerman, a neurosurgeon at the Mayo Clinic Hospital, acknowledges
that this can be labour intensive with a dozen or more people involved in each
round for each patient, but he said it is cost efficient in the end.
If you go
to the States, doctors can talk about problems, nurses can raise problems and
listen to patient complaints. Professor Jarman
"It is
less expensive than having a lot of deaths and having admissions that last
longer because you don't do it right the first time," he said.
Nevertheless,
critics will say that it is difficult to compare the American hospitals with
the NHS and it is true that in the US more money is spent on equipment, drugs,
staffing levels. And it has an expensive, much-criticised insurance-based
healthcare system.
And yet,
American hospitals results are better. They have more per staff per patient,
for instance. But what stood out at the Mayo was the attitude to mistakes or
near misses. Staff are actively encouraged to report these. Whistleblowers are
welcomed. Because they do not want these mistakes repeated.
"If
you go to the States doctors can talk about problems, nurses can raise problems
and listen to patient complaints," Professor Jarman said.
"We
have a system whereby for written hospital complaints only one in 375 is
actually formally investigated. That is appalling, absolutely appalling."
'Appalling'
figures for elderly deaths
What is
equally, if not more appalling, though are Professor Jarman's HSMRs for the
elderly (in this case classified as over 65).
For
conditions which kill a large number of patients in hospitals and most often
affect the elderly like pneumonia and septicaemia, patients are significantly
more likely to survive in an American hospital.
Indeed, it
was this data that Professor Jarman said encouraged him to speak more openly
about his concerns about the NHS.
"It is
not to say that we do not have some very good quality hospitals but we also
have some very poor hospitals," he said.
In
Professor Don Berwick's recent report on patient safety, he described HSMRs as
a smoke signal - a warning that something may be wrong. Yet they do also raise
questions that go to the heart of our cradle to grave care.
Are elderly
people overlooked, treated with derision, even, that they die so much more easily
in our NHS than elsewhere? And have we settled for mediocre when we could and
perhaps should have the best?
Watch the
Channel 4 News Cradle to Grave special report on Wednesday 11 September at 7pm”
Neil Harris
(a don’t stop till you drop production)
