From: Adrian Boyle <[log in to unmask]>
To: [log in to unmask]
Sent: Friday, 20 March, 2009 20:49:30
Subject: Re: Stafford Hospital
What really galls me about the Stafford thing is the way the statistics are being manipulated. The media has picked up on the excess deaths, with a range of 400 to 3000 (precise!) The strongest predictor of these Dr Foster mortality figures is the affluence of the local population. I don't know the Midlands well at all, but I'm guessing that the catchment is post industrial deprived with significant unemployment, early age of first infarct and so on.
While we're at it (base populations and so on) , can't we have an adjustment for case-mix in the target? We have no MAU, so we put all the GP referred
medical patients under the four hour target, yet we are expected to compete with hospitals that hide these patients elsewhere.
Despite all this, I did enjoy telling one of my more pushy bed managers that she was proposing a 'Stafford' .....she was a little quiet after that
Adrian
On Fri, 20 Mar 2009 18:51:10 +0000
"Brown, Ruth" <
[log in to unmask]> wrote:
> Interesting....I believe there are more than 2% of patients who need just a bit longer, not least because they waited at the front end of their journey due to the tidal surges of patients arriving,or take a bit more head scratching thought to get the diagnosis and treatment right, but who don't need full blown observation ward /cdu admission. Unless you are fortunate enough to have excess capacity in your cdu to temporarily accommodate them, these patients
will breach. 95% wouldn't preclude you reaching 98% in your department! Bw ruth
>
> -----Original Message-----
> From: McCormick Simon Dr, Consultant, A&E <
[log in to unmask]>
> Sent: 20 March 2009 12:18
> To:
[log in to unmask] <
[log in to unmask]>
> Subject: Re: Stafford Hospital
>
> Should we be reducing the target to 95% or improving the systems to ensure it gets met?
>
> My department sees just over 200 patients a day and I'm not convinced there are 4 patients a day who NEED to be in the ED for more than four hours so 98% could be considered reasonable. If
the standard was dropped to 95% then I'm sure I would feel a little less stressed for a while (and like many of you I guess, that would be gratefully received) but the problem of bed waits, delays for specialties to see patients, transport problems etc would still exist but there would be less incentive for the Trust to try and do something about them.
>
> The big problem of course is investment and whether pushing the four hour standard gives value for money... probably not. That is why it isn't invested in and why so many of us are forced to work round it and concentrate on quantity rather than quality.
>
> Simon
>
>
> -----Original Message-----
> From: Accident and Emergency Academic List [mailto:
[log in to unmask]] On Behalf Of Brown, Ruth
> Sent: 20 March 2009 06:45
> To:
[log in to unmask]> Subject: Re: Stafford Hospital
>
> Dear all
> I am just catching up so someone may have commented already but "College" in the form of John Heyworth, has had multiple press opportunities since this story broke and is working on a statement for our members of advice re the issues. it is an opportunity to point out the benefits of more EM consultants in the ED to provide supervision, support and safer systems. We also know from talking to one of the new consultants who are in post there now, that there have been major improvements already - a point that should also be brought out.
> Sadly targets appear to be here to stay - and JH is making the point that more realistic targets (95%) would reduce the need to push sick people through an inflexible system.
> Ruth
>
>
>
-----Original Message-----
> From: Accident and Emergency Academic List [mailto:
[log in to unmask]] On Behalf Of S M Mason
> Sent: 19 March 2009 13:40
> To:
[log in to unmask]> Subject: Re: Stafford Hospital
>
> You obviously inhabit the nice part of the NHS (I didn't know there was one)! We
> are still being oushed about 98% daily and have recently been told by the PCT
> that they want to introduce 2 hours for all patients! Very worrying in my
> opinion.
> Sue Mason
>
> Quoting Steve Meek <
[log in to unmask]>:
>
>> the important thing is, overzealous enforcement of target
culture is now
>> dead...and target culture itself on the backfoot, probably long term.
>> In the southwest we were facing the imposition of a 2 hour target for
>> certain categories so hopefully now that will be buried - general election
>> has to be in the next 14 months doesn't it?
>>
>> --- On Wed, 3/18/09, Martyn Hodson <
[log in to unmask]> wrote:
>>
>> From: Martyn Hodson <
[log in to unmask]>
>> Subject: Re: Stafford Hospital
>> To:
[log in to unmask]>> Date: Wednesday, March 18, 2009, 9:03 PM
>>
>> >
-----Original Message-----
>> > From: Accident and Emergency Academic List > [mailto:
[log in to unmask]] On Behalf Of Suzanne Mason
>> > Sent: 18 March 2009 09:50
>> > To:
[log in to unmask]>> > Subject: Re: Stafford Hospital
>> > > > Maybe I missed something, but what I cannot understand is > that this was a > hospital-wide problem, but that the government and press seem to be > focussing on ED! I know we are an easy target (ha ha), but > wonder whether > college should be saying something in our defense? I am > thoroughly sick of > being told we are to balme for many of the shortcomings that > arise as a > result of pushing patients out of the ED to a silo
elsewhere > within the > hospital where god knows what happens to them! It is about > time that the DH > realised the ED is a SAFE place for many patients to receive > their treatment > and that we are the experts in managing the undifferentiated > patient! Rant > over...
>> > Sue Mason
>>
>> especially as the blame is on management but also on the absence of
>> properly run Assessment units and acute medicine services.
>>
>> The 4hour target is classic ZaNuliarbour spin ... I know that you know that
>> , we as in members of ACAD-ae-,ed and many other listsand sites know that
>> ...
>>
>>
>>
>
> IMPERIAL COLLEGE HEALTHCARE NHS TRUST NOTICE: This message may contain confidential information and is intended only for the individual named. If you are not the person or
entity that it is addressed you should not review, disseminate, distribute or copy this e-mail. Please notify the sender immediately by e-mail if you have received this by mistake and delete this e-mail from your system. E-mail transmission cannot be guaranteed to be secured or error-free as information could be intercepted, corrupted, lost, destroyed, arrive late or incomplete. The sender therefore does not accept liability for any errors or omissions in the contents of this message, which arise as a result of e-
> mail transmission. The views and opinions expressed in this e-
> mail message are the senders own and do not necessarily represent the views and opinions of Imperial College Healthcare NHS Trust.
>
> IMPERIAL COLLEGE HEALTHCARE NHS TRUST NOTICE: This message may contain confidential information and is intended only for the individual named. If you are not the person or entity that it is addressed you should not
review, disseminate, distribute or copy this e-mail. Please notify the sender immediately by e-mail if you have received this by mistake and delete this e-mail from your system. E-mail transmission cannot be guaranteed to be secured or error-free as information could be intercepted, corrupted, lost, destroyed, arrive late or incomplete. The sender therefore does not accept liability for any errors or omissions in the contents of this message, which arise as a result of e-
> mail transmission. The views and opinions expressed in this e-
> mail message are the senders own and do not necessarily represent the views and opinions of Imperial College Healthcare NHS Trust.
