Monday, 8 March 2010
Lies, Damn Lies, and Statistics.
All Hospitals have a target time of 4 hours, from arrival in A&E, to discharge or admission. Target times are shorter still for Trauma Orthpeadic or other urgent admissions. Currently all are supposed to achieve a minimum of 98% of the target. Whether we believe in targets is irrelevent, especially to badly injured or sick patient who needs help. So the outcome does have merit.
Overall the Dataset for 2007 - 2008 shows this target is not met, failing by 2% at 96%. Curiously, 6% of these were discharged or moved elsewhere in the last ten minutes of 4 hour target. Close in fact to 147,000 patients of nearly 2.5 million. An incredible feat, one might feel, for the NHS Hospitals involved, with some having a remarkable recovery, beds being found at the eleventh hour, or perhaps just wheeled into a corridor or cupboard, as some actually relate.
Whatever the reason and jaundiced our view of this 'last orders' rush, it is quite a feat. But what has now emerged, in an independent audit of these figures, at the Nottingham Queen's Medical Centre, part of the Nottingham University Hospitals NHS Trust, is that staff 'bent' the rules to ensure targets were met, or came close to meeting the target. 1889 records were wrongly recorded, as being in target time since April 2008. A 'whistleblower' had raised the issue in 2005, but was ignored (you may have heard of this phenomena before).
Words like "enormous pressure" and "failure of systems" were trotted out by the man with the egg on his face, the Chief Executive. Dr. Peter Homa, but the Hospital already had a poor record in this area with a score of only 52 in the patient satisfaction survey on A&E waiting times. The top 20% of trusts scoring 81 with the best being 98. So they take a poor record and then 'fudge' the figures to prevent themselves from looking even worse. It makes one wonder in fact, if there is any point at all in trusting data from any Hospital or even the Dept. of Health. The figures are in fact a meta-analyses of the data provided from the Trusts. No one usually gathers the information independently, the Trusts are simply er.... trusted. Perhaps that is the first mistake.
According to the 2008-2009 data in the DoH Hospital Episode Statistics this Trust achieved the 4 hour window in 97.3% of cases, leaving 4305 patients outwith the target time. They have admitted an error of 1889 cases; that is almost half as much again ! This puts them below the target by over 2%.
This is a Teaching Hospital; an alleged centre of excellence where young Doctors and Surgeons are trained to assume the mantle of Healer. The truth is somewhat more stark. It is a crumbling monument to 60's design in concrete, decorated in... concrete. It is short of front line staff and facilities, has an ISTC built within its own grounds, that went bust before opening and arose like a phoenix under another name months later. Its car park had to be demolished as it was dangerous to use. They haven't rebuilt it because the money for the new one went elsewhere. Yet the building is contemporary to the car park if not older and hangs by a slender thread, propped up by Messrs Screw, Bodgit and Scarper's tender mercies.
Worst, it is the place, that failed me and mine, in the pursuit of justice and candour, after an appalling litany of errors in treatment and aftercare. Now we have seen, how they lie to protect themselves, from any sort of censure. This is just the tip of a very large iceberg. They deserve to founder upon it.