29 September 2011

Why the Royal College of Surgeons report is a good news story.

I woke to the radio telling me what appears on the face of it another terrible story about the NHS. The Royal College of surgeons report on the Higher Risk Surgical Patients has been issued and shows the real possibility that substantial numbers of seriously ill patients, who perhaps could have been saved, may have been dying.
First let me give some well deserved praise to the BBC Radio 4 Today Program. This is a story which lends itself to the kind of sensational reporting that I as a close observer of how the Mid Staffs story am all too familiar with.  Today gave the story time. They gave it two separate slots  http://news.bbc.co.uk/today/hi/today/newsid_9602000/9602878.stm and http://news.bbc.co.uk/today/hi/today/newsid_9602000/9602924.stm
They attempted to get behind the alarming headline figures and explain that this is about very seriously ill patients whose low risk of survival might possibly have been improved by better organisation of the way in which the hospitals work.
They avoided blaming the problem on junior doctors, and allowed it to be seen in the context of how hospitals work and the priorities the NHS has needed to follow over the last decade.  
There have been enormous improvements in elective surgery over the last 10 years, largely as a result of getting huge waiting times down,  but this might have happened in part at the expense of the Accident and Emergency systems, which are now showing signs of stress, as the report shows, throughout the country.  It is clear that as surgical techniques have improved the possibility of helping people who would have been seen as beyond help some years back is now real, and should be acted on to give people the best chance of survival.  
One particular thing I would praise the BBC for is that in the second interview they had two specialists being interviewed together. This completely changed the dynamic of the interview and allowed a much more balanced picture to emerge. Well done BBC. Please do this again!
The papers were perhaps less nuanced Here are a few reports.
My personal feeling is that this report is some of the best news I have heard on the health service for some time.
Viewed from the perspective of Mid staffs It certainly put the most worrying problems that the #midstaffsinquiry has mentioned into a very different perspective.  The problems that did occur in Midstaffs A&E need to be viewed as problems of the whole care pathway in the hospital, but also to be seen as something that is common across the country as a whole.
I have been watching with interest as the Care Quality Commission develop their Specific Mortality Alert system and I think this is what has made it possible for the Royal College of Surgeons to begin to pin point the problems that are occurring. If so this is a positive story for the amazing strides being made with NHS information systems.
It is clear listening to the #midstaffsinquiry that many specialists have close links with specialists in different parts of the world and are actively looking to how performance can match the best the world can offer. So this is a positive story of international co-operation.
The Midstaffs story has been a nightmare for anyone from Stafford, where we found ourselves at the heart of a confusing media storm, but it has had positive effects. The Public Inquiry has done much to show where there were real causes for concern, and even if the general public does not yet know this, many within the NHS know that many of the problems that occurred in Stafford are common throughout the NHS. So this is a positive story of an NHS ready to be much more self aware.
The big positive effect of Midstaffs will I think be that Clinicians will assert themselves. They will  see the point of raising concerns themselves, and demanding the support they need to take the right actions.  
The RSC report is of course a tragedy for all those very ill patients that could not be saved, but it is a moment of real hope for a very positive future.