NHS: It’s the Wonder of the World it is!

More than 1,500 heart attack victims are dying needlessly every year in Britain due to substandard care and delays in treatment, a study in the Lancet has found.

The research found that a failure to ensure patients in this country receive quick treatment and good aftercare has cost at least 11,000 lives in the last seven years, with death rates one third higher than elsewhere.

No, this isn’t about cuts, privatisation, marketisation or anything else.

It’s just that the NHS simply isn’t very good at health care.

Which is a pity in a health care system really.

In detail, it’s about Sweden adopting the new methods of treating heart attack patients faster than the NHS. And isn’t that a surprise? A country where the health care system is decentralised (the Swedish one is run by the counties), a country where they quite happily buy in services on the government cash from private providers, is more efficient at adopting new technologies than a vast and national bureaucracy.

Just amazing, isn’t it?

13 thoughts on “NHS: It’s the Wonder of the World it is!”

  1. Nono, that’s not it at all: it’s the evil capitalists and neoliberals who don’t give the NHS enough money. All we need is more central planning and more money thrown at it

  2. Isn’t this actually highlighting one of the great weaknesses in the NHS (rather than the central command fallacy)? The split between the hospital side (which is also badly divided between A&E, surgical and long-term) and primary care. Judged to different criteria, managed by different people, largely funded through non-connected budgets (so you can’t pass savings in one area to improvements in another) and desperately incapable of communication.

  3. There’s a thing today about the recording of waiting times that just shows how dreadful it is as an organisation.

    Out of 650 orthopaedic cases, 281 had the correct time recorded and with evidence to support it. The rest either didn’t have the evidence, or had errors. And the ones with evidence showed an error of approximately 3 weeks.

    What the fuck are all those 600,000 non-clinical staff doing all day?

  4. Tim Almond asked “What the fuck are all those 600,000 non-clinical staff doing all day?”

    Inventing false waiting time statistics to make it look like the NHS has met its targets?

  5. More than 1,500 heart attack victims are dying needlessly every year in Britain

    This is just wrong: it should be in the past tense. Go to the bottom of the story:

    the UK was slower than Sweden to introduce angioplasty between 2004 and 2010, but that there had been rapid uptake of the procedure in the years since

    The paper (free registration required) gives numbers:

    The use of primary PCI to treat STEMI in the UK lagged behind that in Sweden; the rate in 2010 in the UK (53%) was similar to that in Sweden in 2005 (50%). Primary PCI was more effective than fibrinolysis in a meta-analysis, and this finding was reflected in guideline recommendations in the USA in 2004, and in Europe in 2005. The UK did not have a national policy for primary PCI until October, 2008, which could explain the rapid increase in the use of this treatment from 2008 onwards, but it took until 2011—12 for rates to exceed 90%.

    So the delay in introducing this treatment in the UK was caused not by insufficient local initiative but by a slower decision than in other countries to change the guidelines at a national level.

    The reasons for this excessive caution seem to have been primarily financial. To make the treatment effective, balloon angioplasty needs to be performed within about two and a half hours of the heart attack. So you need treatment centres running round the clock, and ambulances need to take patients directly to those centres. It’s a major commitment, and the DoH wouldn’t make it until the data from other countries became very clear.

    There are two lessons. One is that centralized management of healthcare allows the UK and Sweden to gather the statistics needed for this sort of analysis. So at least some of the bureaucracy is proving beneficial in allowing the NHS to find out where it should improve – in other countries there would be no way to know. The other is that the funding model is always going to make the NHS conservative in adopting new treatments, so it should make a point of monitoring developments in other countries so as to adopt best practice as soon as it becomes apparent.

    Let’s applaud the increased transparency in the publication of this sort of data. It’s what the NHS needs to get better.

  6. @ PaulB
    This supports the complaints that I have been making about NHS bureaucracy for twenty years. Ever since we took no 2 son to be assessed whether he was autistic (the expert had already decided so he could have sent us a letter involving him with less than 5 mins dictation and a typist with less than 5 mins typing instead of the three of us spending the best of two hours on journeys plus waiting) : our wait didn’t worry me but I was *shocked* that the others in the same waiting room were pregnant women who were *all* required to be there by 9 am so that there could be no waiting by the doctor who was checking them from 9 am to 12 noon or a bit later. Demanding that heavily pregnant women just sit there waiting for three hours, occasionally more, because NHS management *can’t be bothered* to set up a decent queuing system is unacceptable. None of my few visits to hospital have required that sort of wait, not even the totally unnecessary one when my wife panicked over dehydration.
    NICE is supposed to make the NHS swift and efficient but the media is swamped with examples of how this does not happen.
    I do agree that stupid accountants in the NHS are making things worse.

  7. john77: the nonsense of telling the whole list to turn up for the start of a clinic shouldn’t happen any more – there have been various commitments (in local charters) that outpatient appointments should not usually be delayed for longer than 30 minutes, so clinics should not be exceeding that by design.

    However, that’s nothing to do with NICE, which makes recommendations about what treatments are best and decides whether drugs are worth their price.

    I didn’t call anyone stupid. (I hope I am wary of criticising experts who act without the benefit of hindsight.) The NHS made a quite early decision to roll out thrombolysis for reperfusion, it was unlucky that it quite soon became apparent that PCI was usually better. Meanwhile, Sweden was an early adopter of PCI, so the comparison there is particularly unfavourable. Figure 1 here, from 2010, is interesting. The UK had a comparatively low rate of PCI, but a quite high rate of using one or other reperfusion treatment – much better than France for example.

  8. @ PaulB
    I didn’t mean *all* the accountants are stupid but some are and some of those *are* making things worse. Today’s tabloid headline is about many NHS Trusts refusing to give expensive cancer treatments on those above a certain age regardless of general health and fitness, assuming everyone of any given age has the same number of future years of healthy life. No actuary or life assurance company would do that.
    Secondly, while it wouldn’t make financial sense to run a PCI unit in Lerwick or Stornaway or Fort William, someone should have tried one in Leeds, another in Manchester, Birmingham, and somewhere in London instead of waiting to see results from Sweden which meant a far longer wait than necessary (because of the time between gathering data and publishing conclusions). An *intelligent* accountant could and should have thought of this.
    Thirdly NICE seems to have zilch to do with Clinical excellence and an awful lot to do with cost/benefit ratios. The trouble here is that NICE seems not to take account of PPRS/VPRS/whatever they now call it where the *effective* cost to NHS per treatment of a UK-researched, developed and produced drug is the manufacturing cost rather than the sale price.
    I was going to say fourthly the direction or encouragement to prescribe generic drugs in preference to out-of-patent UK branded drugs, like Ventolin actually increases the cost to the NHS unless the sale price of the generic product exceeds the manufacturing price of the branded product, but that was the fault of Blair’s government not the NHS accountants.

  9. @ PaulB
    Thanks for the reference.
    But, but, but, in that case why didn’t they set up primary angioplasty units in every large metropolitan area in 2006?
    (And make Thrombolysis the treatment of choice where there weren’t enough patients in the catchment area to justify a primary angioplasty unit).
    Why wait for results from, other countries?

Leave a Reply

Your email address will not be published. Required fields are marked *