Hidden Fat could be piling on the pounds
Saturated Fats can be villains
As can “Low” Fat foods.
Supermarkets have at last woken up to shoppers’ needs, and aisles devoted to ‘free from’ food have expanded.
And for those who feel too tired to cook, you don’t have to compromise – you can now buy Gluten-free ready made pies in major stores. I was delighted to find delicious Beef and Mushroom and Chicken and Leek pies available locally, which just had to be popped in the oven or microwave – and eaten. Continue reading
Every day, yet another health guru comes out with a statement that eating XXXX will conquer cancer – usually there is a PR campaign behind the claim, and it’s made by a paid-for firm promoting whatever fruit or vegetable they
publicise. This is big business – no-one would have ever heard of various unknown berries, if the growers hadn’t been promoted via an expensive PR campaign; but the end result was massively-increased sales. So whenever I read about some miracle food, I would reach for a huge pinch of salt – what it’s useful for!
Hence I have been sceptical over the latest claim – this time for tomatoes. Having eaten tons of them from childhood on, and nevertheless got cancer, they didn’t protect me. However, evidence now comes from Harvard that, whilst not
Watercress grows in clear running water; photo shows beds at Ewelwe, in Oxfordshire, where it has grown since the time of Chaucerat least – his grand-daughter lived here and apparently he visited often.
The National Osteoporosis Society likes this vegetable, bursting with nutrients Continue reading
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.
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!
Macmillan Cancer Support have used results from the Cancer Patient Experience Survey 2011/12 to find the ten best and worst performing Hospitals. An analysis of responses to the the Cancer Patient Experience Survey 2011/12 shows that nine of the ten least satisfactory NHS Hospital Trusts fall within the London Strategic Health Authority (SHA).
Macmillan Cancer Support ranked Trusts according to their patients’ responses to questions in the 2011/12 survey, the results of which were published on 17 August, and listed the ten best- and worst-performing hospitals according to the number of times they fell within the top and bottom 20% of all Trust.
Imperial College Healthcare NHS Trust fared worst, falling in the bottom 20% for responses to 56 of the questions used in Macmillan’s analysis, and in top quintile just once.
Whipps Cross University Hospital and King’s College Hospital were ranked second and third worst respectively, completing an all-London SHA bottom three.
The highest scoring Trust was Harrogate & District NHS Foundation Trust, which appeared in the top quintile for 55 questions, and was never in the bottom 20%. South Tyneside scored second highest, and Papworth Hospital third.
Macmillan also used their ranking system to find the ten Trusts making the biggest improvement between 2010 and 2011.
Portsmouth Hospitals NHS Trust fared best, having seen its ranking improve for responses to 20 separate questions, without falling in any other areas.
Guy’s & Thomas’ also saw increased scores in 20 areas, but patient satisfaction fell for one question. Tameside Hospital was the third best according to Macmillan’s system, with 17 improved scores and no falls.
The results of the Cancer Patient Experience Survey themselves showed an upward trend in satisfaction, and 97% of the 71,793 respondents indicated that, overall, their care was either excellent (54%), very good (34%) or good (9%).
A number of areas requiring improvement were also highlighted. 38% of patients with cancer of the brain or central nervous system (CNS) were not referred to a cancer specialist until after three or more visits to their GP.
This was compounded by the fact that just 61% of brain and CNS cancer patients said their health either improved or stayed the same while they waited for their first hospital appointment – the lowest proportion across all cancer types named in the survey.
The lowest scoring question was that of whether or not patients had been offered a written assessment and care plan, with just 24% indicating that they had.
The breadth and quality of information given to patients regarding their cancer type and any operations required varied considerably between cancers.
50% of patients with sarcoma indicated they had been given written information about their type of cancer, compared to 78% for prostate cancer patients.
Patients with prostate (93%) and breast cancer (92%) said they had received written information about their operation, whereas brain and CNS patients (56%) and those with sarcoma (55%) gave the lowest scores.
CPES age comprehension Younger patients felt they were not able to understand explanations of what was wrong Illustration: Cancer Patient Experience Survey 2011/12
Disparities between age groups and ethnicities were also evident. Cancer patients aged 16-25 were shown to be the least likely to have understood the explanation given to them of what was wrong, and comprehension rates rose with each older age group.
CPES financial help More younger patients than older patients said they were informed about financial help Illustration: Cancer Patient Experience Survey 2011/12
The opposite was true of financial help, however, with a higher proportion of 16-25-year-old patients indicating that they were given information on how to get financial help than of any other age group.
CPES ethnicity 2 Differences in response acording to respondent’s ethnicity Illustration: Cancer Patient Experience Survey 2011/12