Saturday, 16 February 2013

The friends/family test is moronic rubbish

"From April 2013 all patients will be asked a simple question to identify if they would recommend a particular A&E department or ward to their friends and family. The results of the test will be used to improve the experience of patients by providing timely feedback alongside other sources of patient feedback. It will highlight priority areas for action."

For any of you who didn't know already, the government, in its infinite wisdom, has decided to bring in a new test, the 'friends and family' (FF) test.  One would think that if lots of money were to be spent on introducing a new test like this, it would have been well tested, validated and confirmed to be of meaning in health care.  One would think that, but with the government this is often not the case, it appears that these kind of hare brained ideas are plucked from the back side of some uneducated inexpert 'special' adviser and then forced on hospitals up and down the country, without even the glance of an expert, without even a thought that this may not be a great idea.  

Sadly for us, as tax paying members of the public, the FF test is a complete waste of our money, unless Jeremy Hunt knows something that the academic experts do not know, something I think is rather unlikely, I have seen insects with more intelligence than the insincere smug Hunt.  This is taken from a recent article in the New England Journal of Medicine:

" Limiting patient-experience measurement to a single dimension may exclude the interactions that most strongly affect experiences and outcomes. This fact alone could explain why many studies show no relation between outcomes and patient experiences."

Patient surveys to measure satisfaction are excellent tools to measure various aspects of their care, there is no doubt of this, the problem is that there are certain things one must do for one's questions to lead to meaningful answers and the FF test simply fails to do these.

The FF test is one general, vague and therefore meaningless, and useless way of gathering information about the quality of health care received by patients.  It is not focused on specific aspects of the care, it is therefore likely to result in answers that are of no meaning at all, as the answers will be skewed by so many things that may or may not be of any relevance at all.  The FF test is also unvalidated in health care, it has been plucked from business and just thrown into the NHS without any testing in this context.

So the end result of all this is that a lot of completely meaningless data will be gathered and analysed to give a lot of meaningless results, and a lot of our money will have been wasted in the process.  Sadly rather than consult any of the UK's academic experts in patient satisfaction, the Department of Health has acted on the whim of an idiot or idiots.  Typical lazy slack jawed work, how very depressing.

Friday, 15 February 2013

Stafford is the result of failing government policy

The Francis report has been in the headlines for much of this week and everyone has had their opinion as to what precisely went wrong.  Certainly blaming one part of the system on its own is not sensible, many things have to fail for things to go as badly wrong as they did in Stafford.  The health care system is a very complex beast, a bit like a human body in some ways, and for something to be painful, one not only needs problems with the peripheral tissue, but one also needs pain to be signalled up to the spinal cord and then to the brain.

Many hospitals provide a very good standard of care, in fact I would say a large majority of NHS hospitals are in this category, however to pin this success on the government and the Department of Health's door is completely wrong in my opinion.  Many of the successes of the NHS are despite the terrible top down style of management led by our 'esteemed' politicians and civil servants/'special' advisers in the DH.  It is only in this context that one can understand the gross failings of certain hospitals like Stafford.

The biggest factor in Stafford's failings was the terrible autocratic top down management system that exists in the NHS.  This is led by our politicians who are closely allied with the bullies in the DH, they then feed down to the SHAs, who then enforce things in the hospitals.  This top down bullying style is in place because successive corrupt governments have only been able to push through their awful damaging privatising reforms by force.  The front line staff and the good managers care for quality and for patients, the government and the  politicians do not, they care only for themselves.  The corrupt policy being pushed through, the current example being Lansley's deadly reforms, has to be bullied through, as it is fundamentally antidemocratic and corrupt by its very nature.

Essentially our corrupt political system has led to a top down bullying system of NHS management, the so called 'command and control' model.  All three major parties are behind the current privatisation of the NHS, against the democratic will of the electorate, and all three parties are partly to blame for this terrible dysfunctional style of abusive management.  The 'command and control' style comes with top down targets left, right and centre.  One must obey or be sacked, whether a manager or clinician, the whistle blowers are gagged and buried.

The NHS has become overly bureaucratic and less efficient in the process, leaving a dysfunctional half privatised shambles in places, the simple efficient NHS that existed before the market came is no more.  The market has failed, yet the government continues to bully it through, the privatisation has failed, yet they persist in forcing it on us, the recurrent theme is obvious, unpopular antidemocratic policy has to be introduced by nasty force and nasty tactics.

The cure is obvious but incredibly unlikely given our stinking political system, he market must go, the NHS must be publicly funded and 100% publicly provided, we need local autonomy, we need the front line engaged, we need a functional bottom up system.  The problem is there is zero chance of this happening with Hunt and Cameron in power, the private sector know all they need do is throw a few pounds their way and these corrupt Tories will oblige, they will bully through more harmful disasters on the NHS like the corrupt Labour government that did the same before them.