Monthly Archives: August 2013

NHS copies Big Bad Wolf

English: Little Red Riding Hood


Like Red Riding Hood

I tend to believe people.  I even believed hospital comment websites, that used to list ‘How many Patients would recommend this hospital to their friends?’.  Which would be followed by a high percentage figure.

Until I actually read the comments – and you began to wonder what sort of friends they had, as the comments that followed were generally a litany of complaints about their treatment at this hospital.

With the Mid-Stafford Hosopital enquiry published, one wonders

You have to wonder why it is that really sensible, bright people insist on doing really daft things. Let’s face it Whitehall is full of big brain-boxes and the invisibles in Leeds are no dozers either. Degrees and professional qualifications up to the eyeballs. Number 10; awash with advisors and gurus. They can’t all be stupid can they? Is it them or is it us?

David Cameron is championing the Friends and Family Test (Killer question; Would you recommend this service to friends and family?),  This is now in operational in most hospitals, but one questions how accurate it is. Everyone who knows anything about sampling and finding out what people think will tell you; the F&F Test is meaningless.

Anyone who has looked after Gran in hospital, knows what when you say you are going to complain on their behalf, she will say “I don’t want to complain”;  petrified that she will be victimised and singled out.

Before the F & F test was rolled out, our local hospital had a meeting of those us who had been discharged recently.  40 of us turned up;  we were given official postcards to fill in, asking us how we had been treated.  Two of weren’t very complimentary, and when we asked questions we were obviously singled out – even though others just nodded their heads and dutifully ticked boxes.

Returning to the room after the meeting was over, I noticed our two postcards sitting forlornly in the middle of our table;  the others had all been collected.  But when I went on the hospital’s website and looked at F & F score for that month, was surprised to see it had received a 92% rating that people would recommend the hospital to their friends.

So why is there this culture of fear allowed in hospitals?

Dr Rachel Reeves, principal research fellow at the School of Health and Social Care, Uni of Greenwich, says ‘…it is not the right test’; lack of rigour in the methodology, opportunities to skew results, bias and just about everything else you don’t need in a sample. Even Bill Morgan, LaLa’s former special advisor, wrote; ‘…(it) … is too narrow and too crude to work as a measure for shared decision-making. Retrofitting a retail-centric measure onto healthcare feels awkward anyway.’

Known in industry as the ‘Net Promoter Score’ it is designed as a measure of brand loyalty and that’s all. As the average NHS patient has little opportunity of switching brands away from the NHS, or even the local Trust, the whole exercise is hollow. In industry the NPS is seen as useless unless accompanied by a good ‘voice of the customer’ programme and the ability to dig into customer experience dynamics. Something the NHS does not have.

Business uses NPS to drive bigger-picture questions; Is increasing recommendation really the best way to achieve success? They may want decrease volumes and increase margins. The NHS can’t do that, it is demand led, can’t cherry pick and aside from fiddling the Tariff and employing serial-fraudster coders, it’s a non-starter. They’ll ask; if I lose 35% of my customer base per year, but most of those who stay would recommend, am I really in good shape? If an NHS service scored ‘35% dissatisfied’ there would already be something seriously gone wrong and the Board should be in jail.

And, there is the mother-of-all problems compounded by the DH’s own F&F guidance. Sec 3.8, Survey Timeframe: “Patients should be surveyed on the day of discharge or within 48 hours of discharge. This will ensure that the answer given reflects the patient’s informed opinion, based on recent experience.”

Wrong!  No!  Couldn’t be worse! It falls foul of the Halo Effect.

In plain English; respondents are aware that the sponsors of the survey are the very people who are providing the service. Or, even simpler; patients are being asked about the NHS experience by the people providing it. Furthermore, questions can be asked whilst the patient is still in the care of the Trust. We know the nearer to the event a survey is carried out, the more likely it is to overstate reaction. Plus, if undertaken whilst the patient is still in hospital, most answers (particularly among older patients) will be positive for fear of retribution or reprisal and the wish not to be critical, face-to-face, for fear of confrontation.

Patients will not be able to judge the experience in its own right and usually unable to make comparisons with other brands (Trusts). The DH Guidance creates a potential 56hr window to ask questions in situ or later, perhaps on the phone. This distorts results because of a lack of consistency in question framing, timing and environment. All hopelessly skewed.

 Like Red Riding Hood,

I tended to believe the Big Bad Wolf.  So, why are the big brains using a sampling system that is flawed? Two reasons. The F&F Test can be relied upon to produce generally positive scores about NHS performance. Gold dust in the run-up to the 2015 elections. Second, by publishing results, ward-by-ward, staff will start to feel proprietorial about performance. Usually that translates into a positive impact on morale and performance.

You see; they’re not so stupid after all!

Silver Surfers

Senior Couple on Computer - Vertical 

Silver Surfers have trouble with computers.

Had a problem yesterday, so I called Eric, the 11-year old next door, whose bedroom looks like Mission Control and asked him to come over.

Eric clicked a couple of buttons and solved the problem.

As he was walking away, I called after him, ‘So, what was wrong?

He replied, ‘It was an ID ten T error.’
I didn’t want to appear stupid, but nonetheless inquired, ‘An, ID ten T error? What’s that? In case I need to fix it again.’

Eric grinned… ‘Haven’t you ever heard of an ID ten T error before?

‘No,’ I replied.

‘Write it down,’ he said, ‘and I think you’ll figure it out.’

So I wrote down:

Looking Good is Good for YOU

Rose et amour....rosa y amor ....rose d'amour ...

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English: This is an image of Donald Berwick, w...

Berwick Report another waste of NHS resources

Scratching around for any excuse to justify poor health care, latest imported US guru – Don Berwick (imported at vast expense) –  has come up with a report, saying much the same thing that he said last time he was overpaid to tell us what is wrong with NHS.

He says what everyone else has been saying, from Gerry Robinson, Lord Darzi et al, for past decade.  And yet still the Whitehall Mandarins sign their over more scarce NHS cash to pay for what any junior doctor or nurse could point out for free.

I dread to think what the bean counters will extract from this report.  Yes – money will be found for yet another crack-pot ‘initiative’. which is so silly that it reminds one of the Emperor’s clothes kid’s story.  And by the time the ‘initiative’ is quietly dropped, yet more of our money will have been wasted.

Have just come off the phone after 30 minutes with an A & E Matron, trying to explain to me why my care was so lacking last time I was in there.  This was second waste of hers and my time, over what was a simple case of incompetent admin.  But when will hospitals realise we don’t want apologies AFTER the event – what we want is basic good medical care whilst we are being treated.

Until that day, Whitehall mandarins will desperately scratch around for anyone who can be asked to prepare a “report” that might justify why they don’t have to get off their backsides and get down to old-fashioned work.  But I fear they don’t have the brains to recognise the truth if anyone tells them getting back to basics is what the NHS needs.

But then, taking a taxi down to any hospital and asking patients (when no staff are able to over-hear) what they think needs to be improved – that’s old fashioned.

Want to know what report we have paid for says?  

Dept Health has just issued press release today, saying

“Patients Will Have Confidence In A Safe NHS And Staff Will Be Supported To Make Safe Care The Priority
NHS staff should be supported to learn from mistakes and patients and carers must be put above all else in an attempt to make the NHS a world leader in patient safety, an independent report will say today.
Professor Don Berwick, a renowned international expert in patient safety, was asked by the Prime Minister to carry out the review following publication of the Francis Report into the breakdown of care at Mid Staffordshire Hospitals.
The report, led by Professor Don Berwick, follows five months of intensive work to examine the lessons for NHS patient safety from healthcare and other industrial systems throughout the world.
His four key findings are that:
The quality of patient care, especially patient safety, should be paramount
Patients and carers must be empowered, engaged and heard
Staff should be supported to develop themselves and improve what they do
There should be complete transparency of data to improve care
Recommendations in the report include:

The NHS needs to adopt a culture of learning

IF YOU WANT MORE, GET ON TO DEPT HEALTH.  They obviously have plenty of time to issue statements repeating the obvious.


Another waste of taxpayer’s money?

Government seems to have scored another own goal.

Having announced that they are going to reform benefits they have put the proverbial bull into the china shop, managing to upset thousands of genuinely disabled people, whilst leaving the shirkers with a “they’ll never catch me” smirk.

First, they appoint a French company, Atos, to handle the assessments.  Judging by reports, they don’t seem to understand the word ‘disabled’, and managed to place many of the assessment offices in buildings with no easy access.

I am lucky enough to qualify for various allowances;  I would much prefer to be able to walk around and jump on buses – but mustn’t complain;  I get ten taxi trips a month, which take me off to hospital appointments in black cab comfort, so I am lucky.

However, a month ago I was phoned by an ‘Assessor’.  Did I mind doing a telephone assessment?  Obviously not, as I can’t climb stairs.

First question:  What disabilities did I have?

I list as many as I can remember early in the morning.

What is ‘oldest’ one? And when did I have it?

Polio – in 1956.

“Oh” replies bright-as-a-button assessor.  “You are obviously well over it by now, so we can disregard that”.

When I was able to close my open mouth, I left her in no doubt that she obviously wasn’t qualified to carry out a medical assessment, and slammed down the phone.

So if one of these incompetents phones you, and you are worried, tell your MP.