In today’s i newspaper (the cut-down tabloid version of The Independent) Ian Birrell uses his column to lambast the junior doctor for having the cheek to defend their salaries and working conditions.
He says the BMA has ‘behaved like an old-fashioned trade union’ as if that was an insult. How dare an organisation set up to represent doctors have the affrontery to … represent the interests of doctors. Shame on the BMA.
Birrell trots out the Conservative party line about ‘compelling evidence of higher death rates at weekends’. This is a blatant misuse of statistics, that any half-qualified statistician could explain to Birrell is deliberately misleading. What is this compelling evidence?
Firstly, take Birrell’s claim of higher death rates at weekends. Simply untrue. According to Dr Chris Roseveare, a consultant in acute medicine at University Hospital, Southampton, the day with the highest mortality rate is Wednesday. If you want to look at the issues in the NHS you need to look at the facts dispassionately, and not with your Conservative-tinted glasses. Because there are genuine issues with organising NHS services to match the needs of patients. But these issues require a more considered approach than explaining differences in mortality rates by blaming doctors.
The truth is that there is a higher mortality rate associated with hospital admissions at weekends. Not a higher rate at the weekends. As I said, the highest mortality rate occurs in the middle of the week, when the NHS is fully staffed (or as fully as the cutbacks permit).
There have been several reports on mortality rates and weekend admissions published over the last few years. The most often quoted one was produced by Dr Foster Intelligence. But even they did not suggest that variations in mortality rates could be ironed out by a single measure. Only a PR specialist like David Cameron, or an unprincipled politico like Jeremy Hunt, would try and simplify the issue.
A more responsible attitude was expressed by Andrew Goddard, director of the Medical Workforce Unit at the Royal College of Physicians, and Peter Lees, founding director of the Faculty of Medical Leadership and Management. They wrote an article for the BMJ which stated:
The Dr Foster report raises more questions than it answers and calls for greater insight into community out of hours services, hospital staffing, and workforce configuration. “All need to be reviewed against the knowledge of which conditions are associated with increased mortality at the weekend. This is an opportunity that, if tackled intelligently, will improve the care of some of our sickest patients for many years to come.
‘If tackled intelligently.’
Now look at David Cameron’s intelligent contribution to the discussion.
It is a shocking fact that mortality rates for patients admitted to hospital on a Sunday can be 16% higher than on a Wednesday. While the biggest numbers of seriously ill patients arrive at the weekend when hospitals are least well equipped to handle them. So seven-day care is not just about better care for the patient, it’s also about saving lives.
But David, the same statistical returns would have told you that more people die in hospital on a Wednesday than on either Friday or Saturday. And the 16% increase he refers to does not mean what he wants you to think. Assume a 1% mortality rate for people admitted on Wednesday. Cameron’s quote is shocking, because it makes you think the rate at the weekend is 17%. It is not, it is 1.16%. That is your 16% increase. It is still a significant difference, but not what David Cameron wants you to believe.
Scaremongering is not tackling an issue intelligently.
So what are Cameron and Hunt up to? They have their own agenda in negotiating the new doctors’ contracts, which expire very soon. And they are using statistics in the way mealy-mouthed politicians usually do – to obfuscate and drive their own political objectives.
So Ian Birrell swallows the Conservative Central Office propaganda uncritically, and regurgitates it to write a ‘think-piece’ on the NHS dispute. Once again a columnist demonstrates his abject prostration at the feet of politicians. Perhaps a career as media advisor to Central Office beckons?