Wednesday, August 22, 2007


It is turning out to be quite a week. There has been the excellent paper from the people at Sheffield showing that the further seriously ill patients are transported to hospital, the greater the risk and the higher the mortality.

Why is this so amazing I can here everybody asking? We all knew that, it's only common sense! Yes but nobody has done a careful study and proved it to be a fact until now. Now it has been done and the results are unequivocal.

Now we have the evidence it should influence policy. As a physician I always try to practise evidence-based medicine. Surely the organisation of care should be evidence-based? Indeed one of the great causes that I believe the entire medical profession would unite behind is that government should use available evidence as the basis for all its health policies and plans.

I suspect the profession would also agree that there are serious issues with the advice that government receives. This should be about "horses for courses." If you want advice on emergency medical care, ask a doctor who has a great deal of experience in that area.

Another pitfall is building your plans around a collection of individual professional perspectives. The Cancer Tsar will have one set of recommendations, the Heart Tsar another and so on. They could well pull in quite different directions. Add in various statutory requirements such as the EWTD and MMC and you have all the ingredients for a complete shambles.

Common sense and talking to patients over many years brings out the really important themes. Patients want to see their GP when they are ill. When they are acutely ill they would also like to see the GP, preferably the usual GP. Patients think continuity of care is quite important. They like doctors and nurses that understand them. People they can trust. How can you trust anybody when you have only just met them once? Trust is built over time. They do not want GPs masquerading as Consultants or vice versa. They do not want nurses replacing doctors or health care assistants replacing nurses. Informed patients understand the "concept of dumbing down" and the affluent and insured consult the internet and find their specialists.

When patients are really ill they want to go to their local hospital until they are better. They would like their common serious illnesses managed under one roof but appreciate they may have to be moved for something very clever. They do not believe that closing or downgrading their local A&E Department is an improvement and suspect ulterior motives quite rightly in my view. They are also quite rightly extremely suspicious and sceptical about treatment in or nearer their own homes. They also find this difficult to equate with losing services from the local hospital.

Now how does all this bear on City Hospital. Well under current plans the sick children and surgical adults would have to face that additional ambulance journey of six miles minimum, more if Sandwell had run out of beds. Current plans clearly do not make sense.

Lastly I hear from Louis that the Sandwell and West Birmingham Hospitals NHS Trust has blocked this website for the staff at City Hospital. I wonder why? Has hospital productivity fallen because everybody is so busy eagerly scanning this website? I doubt it. Could it be something to do with preventing the staff hearing the other side of the argument? When an organisation blocks freedom of communication warning bells should be sounding. It suggests they are on the wrong course. A healthy organisation is one open to and welcoming of criticism and confident enough in its own evidence-based decisions to allow all its staff access to all the arguments. I suspect banning us will lead to more hits than ever so we must watch the website monitor most carefully. (Update 29/08: The website appears to be accessible from Trust premises again. Someone must be paying attention!)



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