You should be reading Matt Black’s fantastic NHS blog

The NHS is in the news, so it’s probably time to promote the hell out of this awesome blog I found!

Point the first: There is no relationship between “rising demand” for A&E treatment and waiting times. Also, a large majority of people waiting in A&E need to be admitted, so there is no point badgering people to see their GP/go to a pharmacist/call a number instead.

Point the second: demand isn’t actually rising much, instead, we started counting people who go to walk-in clinics as A&E attenders. As a consequence, the constant initiatives badgering people to go to walk-in clinics, minor injury units, GPs, pharmacists, or just fuck off and die and don’t bother us already actually make the problem worse.

Point the third: the 4-hour wait target is part of the problem, not part of the solution, because in effect it rewards those A&Es who either maximise the number of patients waiting 3 hours, 59 minutes, or else palm off as many patients as possible on some other hospital. (The histogram is spookily like the distribution of house prices when stamp duty was levied on a similar basis.) Fascinatingly, the best-performing hospitals show less of this effect. Also, for some reason, hospital discharge processes slow right down every morning around 8am, causing queues to propagate back through the system.

Point the fourth, from a different blog it links to: the biggest cause of discharge waits and hence of queues in A&E turns out to be just handing out medicines from the pharmacy, and this could be dramatically improved by not letting the doctors touch it, because unlike the pharmacists they can’t be trusted not to screw it up.

Point the fifth: there is no shortage of A&E docs, but the Royal College of Emergency Medicine understandably likes the idea of more of them.

Point the sixth: picking fights with the docs about working weekends is stupid, because the driver of queuing is discharge, not admissions.

Point the seventh: hospitals typically discharge about 20% of their patients a day, but they do it mostly just before knocking off at 5pm, while emergency admissions seem to follow the sun and peak in the middle of the day, so a queue must mathematically exist until arrivals drop off during the night.

Point the eighth: one overriding theme in all of these is that the NHS’s tradespeople are really important and we should trust them much more relative to the docs. Ironically, though, it’s by using the tools of statistical process control and scientific management that this socially radical conclusion becomes apparent.

Point the ninth: Jeremy Hunt is still health secretary. Why?

Post a comment

You may use the following HTML:
<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>