Fewer people are dying in Scottish hospitals, should we celebrate?

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John Robertson claims success for NHS Scotland

The BBC slipped in a wee bit of good news for NHS Scotland, to the lunchtime report last week, but it was too busy with bagpipes and the Celtic game to repeat it later at 6.30.  Jackie Bird brought us this great news:

‘Meanwhile fewer people are dying in Scotland’s hospitals. Between 2014 and this year, hospital mortality fell by 4.5% which is 3 000 fewer deaths than predicted.’

Oh come on BBC, surely that’s headline material and worthy of a smile? What about getting Shona Robison, SNP Health Secretary, on to be grilled by Jackie and defend herself against Tory accusations that NHS Scotland is deliberately using taxpayers’ money to improve health outcomes? As somebody who is increasingly in hospital, I’m chuffed to feck.

UnknownHere’s what the BBC website included:

‘Health Secretary Shona Robison said: “It is encouraging to see that our commitment to patient safety across the health service is delivering such strong results, especially at a time when our NHS is treating more people, with more complex needs, than ever before.

“The 4.5% drop in mortality rate since the start of 2014 shows we are making progress towards our new aim of a 10% reduction by December 2018. This is on top of the improvements in mortality already achieved since the start of the Scottish Patient Safety Programme in 2007.

“Scotland was the first country in the world to implement a national patient safety programme and is the only UK country publishing and driving improvement in our NHS through the use of mortality data in this way.”’

Now, I know comparing hospital mortality figures between NHS Scotland and NHS England is frankly insensitive and tasteless but if I don’t do it, who will? Luckily for the latter, there are no directly comparable figures. NHS England’s administrators are too damn clever to get caught out failing. However, you can still make a rough comparison using this from ‘The NHS’:

‘For the 136 trusts included in the SHMI (Summary Hospital-level Mortality Indicator) from 1 January 2015 to 31 December 2015:

15 trusts had a ‘higher than expected’ SHMI.  Of these 15 trusts, 7 also had a ‘higher than expected’ SHMI for the same period in the previous year.

107 trusts had an ‘as expected’ SHMI.

14 trusts had a ‘lower than expected’ SHMI.  Of these 14 trusts, 10 also had a ‘lower than expected’ SHMI for the same period in the previous year.’

PERIOD

So, I think we can say that for 122 out of 136 trusts, mortality rates were either static or worse. I’m going to suggest that, overall, the NHS England mortality figures did not fall and might even have increased, for the same period in which Scottish rates fell.

Add this to the other data I’ve provided in earlier NN reports (see list below) and I think we can credit the SNP government in Scotland with achievements that BBC Scotland cannot bear to credit.

NHS Scotland is demonstrably the best-performing in the UK and among the best in the World: Look at the evidence.

1. Scotland has the best and still improving A&E performance in the World. (Royal College of Emergency Medicine and Holyrood.com 1, 2)

2. Scotland has the most GPs per head of population in the UK and has had so every year since at least 2004. (Nuffield Trust 3)

3. Scotland’s GPs feel the most-satisfied, the least over-worked and the least-stressed in the UK and perhaps in the World. (Commonwealth Foundation of New York 4)

4. Scotland’s GPs are significantly more satisfied with the coordination across multiple sites and providers than in England. (Commonwealth Foundation of New York 4)

5. 94% of Scottish cancer patients rated care as ‘highly positive’ but only 61% of English cancer patients did so. (Gov.scot and NCPES 5, 6)

6. Over 100 000 treatment delays caused by junior doctor strikes in England but none in Scotland (BBC 7)

7. Bed-blocking in Scottish hospitals remains on a downward trend, with 7% fewer delayed discharges than last year. This is in stark comparison to other parts of the UK where the number of people delayed waiting to leave hospital is on the rise. (Herald, Scotsman and Jersey Evening Post! BBC 8, 9)

8. Scotland spends more per capita on health (Nuffield Trust, 10)

9. Scotland, by contrast [with England], has abolished all vestiges of the ‘internal market’. (The King’s Fund 11)

10. There is relatively little cross-border flow of patients from Scotland to England. (The King’s Fund 11)

11. Scotland specifically embraces a philosophy of ‘mutuality’ between the Scottish people and the NHS. Internally it has a highly developed approach to partnership working between the trade unions and management. The partnership’s remit stretches well beyond terms and conditions to broader issues such as quality and the design of services. (The King’s Fund 11)

12. Scotland has a long and honourable tradition of clinical audit that over the years, both before and after devolution, has helped inform the approach of the other countries. (The King’s Fund 11)

13. Scotland appears to have made more progress [in developing integrated care], perhaps in part due to its relative organisational stability over the past decade (The King’s Fund 11)

14. Scotland’s greater and earlier success in getting an electronic and shared summary care record in place, despite England investing vastly greater sums in its National Programme for IT (The King’s Fund 11)

15. Public satisfaction with the Scottish NHS reaches as high as 74% in Scotland but only as high as 63% in England (King’s Fund, 12)

16. Scottish nurses more confident in coping with demand than English nurses (OK I made that one up as I wait for the RCN to come clean on the data and confirm my guess)

Sources:

1. www.rcem.ac.uk/CEM/document?id=9891

2. https://www.holyrood.com/articles/news/scotland-only-uk-nation-improve-ae-performance

3. http://www.nuffieldtrust.org.uk/node/2540

4. http://newsnet.scot/commentary/scottish-gps-satisfied-least-stressed-uk-possibly-world/

5. http://www.gov.scot/Publications/2016/06/3957/0

6. http://www.ncpes.co.uk/index.php/reports/national-reports/2489-cpes-2015-national-report-pdf/file

7. http://www.bbc.co.uk/news/health-36117230

8. http://jerseyeveningpost.com/news/uk-news/2016/06/21/continued-fall-in-bed-blocking-numbers-recorded-in-april/

9. http://www.bbc.co.uk/news/uk-36466409

10. http://www.nuffieldtrust.org.uk/blog/health-care-and-scottish-election

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29 COMMENTS

  1. All these positive points – it sounds strange seeing them written down when you’re accustomed to a daily dose of how awful things are in Scotland and how badly we are governed. Maybe you could do the same for education, policing and social care?

  2. You should just be thankful they didn’t lead with, “The Scottish Government were tonight accused of causing higher unemployment in the funeral service industry…”

  3. Good one Dave! ‘Cutbacks in forestry blamed on Scottish Government!’ ‘Easier parking at Scottish cemeteries crisis!’ ‘Closures in paper hankie industry due to Scoittish Government policy!’

    Good fun?

    Next?

  4. Hello John,
    Your refs on The King’s Fund are not given at the bottom of your article.

    Great news there, maybe your articles on NHS Scotland should be printed and left in waiting rooms in Hospitals and GPs practices. We need to find a way to circumvent the media.

  5. Thanks for the list John , when it is all is one place you see how well NHS is Scotland is doing .The fact is that the BBC has a tremendous Scottish Cringe , it would never ever let people in Scotland think that we could do anything well , that’s why we get any good news tucked into a little sentence and raced through so we don’t notice ! .

  6. Thanks the other John W. Herald headline today ‘NHS staff being asked to ‘magic things out of thin air,’ warns leading surgeon’. Evidence – from one surgeon. Let’s see what Reptilian Scotland make of it today.

  7. An excellent summary and thanks, too, for the references to performance data on other aspects of social provision.
    Sadly, there seems to be something in the trading of journalists to look only for the bad results and for them to present things as a polarised dichotomy.
    Most social services are so complex and multi factorial that evaluating the data requires a lot of care. It is not beyond most people to comprehend this, once it is explained to them. And, when it is done, the public usually comes up with pretty nuanced answers.
    With our increasing longevity and the associated conditions accompanying ageing – cancers, dementia, diabetes, impaired mobility, etc. we need to adapt the NHS continuously to respond more effectively to changing demands. We also need to empower ‘sufferers’ to manage our particular conditions, better. Often this will entail the employment of trained ‘health assistants’ rather than the more expensive doctors and nurses. I am not calling for reductions in the numbers of these, but for the employment of staff who can take on many routinised services to reduce the workload pressures on doctors and nurses, who, in many places, such as A&E, are pretty stressed and, similarly in some general practices.
    This requires a better managed public debate, where organisation’s like the BMA and RCN are only some voices amongst many and are identified clearly as a ‘sectional interest’. The ‘leading surgeon’ appellation which is intended to provide the gravitas of an ex cathedra pronouncement, should be debunked. I have no doubt he or she would treat me excellently were I on the operating table, but he or she is as likely as I am to engage on special pleading in my own interest.

    • Thanks Alasdair. Excellent additional thoughts on the wider debate. Have you read Jurgen Habermas on the public sphere? I think he would have been much impressed by the extended debate we get in places like this where the starter article is soon a mere skeleton of a much fuller body. That reminds me to get back on the exercise bike!

      • It is a while since I read anything by Habermas, indeed, I have not read much of him at all! I will seek to remedy that.

        Provided there are no trolls, the extended debate is often creative in highlighting the interconnectedness of many issues. As has been indicated by a poster further down the page, poverty is often the connection.

    • Also, I think I have two further compensatory ‘good news’ pieces coming on this website quite soon – one on extreme debt in Scotland and one on the gender pay gap. Can you wait? Quite easily?

  8. Okay I am off to A&E as anything that remotely isn’t an SNP BAAHD story from the BBC has me in a state of paralysed shock well either that or I forgot the medication and I have read the above utterly wrong..

  9. I agree with all the comments on this good news.

    Just one little fly in the ointment: Scotland has worse health than almost anywhere else in Europe, especially amongst more disadvantaged sections of our society. Inequality is the great health scourge of our times.

    • Yes. I saw a Scottish Asian doctor explain this in an interesting way but cant find any reference. He said the highlanders and Irish who settled in the West of Scotland during the industrial revolution wereforced to live in overcrowded dampt housing with poor water supply and sanitation. The infants who survived were those with the stronger immune systems, Infortunately, those survivors then went on to develop inflammatory diseases in adulthood due to those same immune systems and died young. Capitalism kills.

      • I don’t understand why strong immune systems should damage your health though. Worrying me, as I think my immune system must be strong. Touch wood, I rarely get colds or flu. I quite frequently feel them coming on, but quickly shake them off before they get a grip. I put it down to Mum being a smoker. Which meant I was forever getting colds, bronchitis, lung infections as a kid. But as an adult, once the immune system had strengthened, hardly at all…

        I also thought the immune system helps fight against cancer?

        I do think soft water has got something to do with it too though. People living in hard water areas with minerals in their water don’t seem to have the same rates of heart disease.

        All this epigenetic stuff is very interesting. I think the Indian doctor is basically right, that Scottish health today is a legacy of the industrial revolution. And capitalism.

        Have you ever noticed that the inhabitants of Partick are six inches smaller than the average?

        I traced my family history and discovered that fortunately we by-passed the industrial revolution. My Scottish nineteenth century forebears and their predecessors were agricultural workers in East Lothian and Berwickshire. Which means we were dirt poor but at least well fed and had a healthy lifestyle.

  10. Great piece Prof (Retired). And yes, I will use this summary, excellent. It’s getting to the point where the non-believers I know will vote YES next time, just to get me off their backs.

  11. I know this isn’t really applicable to your piece John, but I have every reason to be grateful to Nicola for her decision to keep Ayr Hospital open when she became Health Secretary in 2007, because the following year I had a heart attack whilst in the area, and it was the medical staff at that hospital that saved my life.
    On a more recent note, my wife had a fall recently resulting in a serious injury, and the treatment afforded to her at Monklands Hospital, the other hospital the Lab/LibDem coalition were intent on closing, was first class, and I’m glad to say she has now made a full recovery. Goodness knows where we would be today if we didn’t have a Scottish Government who actually care about the people of Scotland, and I hear they are doing it deliberately.
    Many thanks for the links you have provided, as it all helps on the doorstep, to debunk the lies we hear daily from the M.S.M.

  12. Good to hear you’re both recovered. The Scottish NHS has become my first religion. The treatment I’ve had would have cost my house in the US. Had a wee stroke five years ago. When I described it to my mum as a Transient Ischaemic Attack she said ‘Islamic Attack!?’

  13. Living in England I fear for the English NHS.

    By design, the tories have orchestrated chaos and cultivated a belief that the only solution to the ills of the English NHS is increasing private sector involvement.

    I have worked in the NHS in England, the people working in it are hard working and dedicated people, but they are having the carpet pulled out from under them, junior doctors are one of the symptoms. Also, many who work in the NHS are immigrants, again, many from the EU. The folk from the EU span the the complete organisation from porters to senior consultants.

    Perhaps one of the opportunities for Mrs May and her cabinet on the EU is to loose all the EU folk working in the NHS and with the savings they can buy trident.

    So when someone is ill and can’t get treatment or has to join a list, they can take pride in the fact we have a nuclear deterrent and can protect ourselves from North Korea.

    On a more serious note however, spending cuts in the English NHS will have a corresponding knock on impact to funding Scotland receives from westminster.

    The NHS in Scotland should be one of our battle grounds for independence!

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