There will be howls of rage that staff cuts will be needed, of course. And lots of lobbying about the consequences for safety and performance. And the rush to make cuts quickly will have bad consequences...
Feb 20 β’ 20 tweets β’ 3 min read
The idea that government have been plotting to privatise the NHS for decades has to be the least successful conspiracy in modern British history. We can tell this by reading the notorious 1982 cabinet note that is often claimed to be its origin...
The original Cabinet Paper is accessible in the government archives if you want to read it here:
...discovery.nationalarchives.gov.uk/details/r/C133β¦
Feb 14 β’ 8 tweets β’ 1 min read
Expert consensus is often dangerous and bad for progress.
Huge medical improvement have come when iconoclasts have challenged the consensus with evidence...
For example: Semmelweis on puerperal fever, John Snow on the causes of cholera, Marshall and Warren on the role of infection in stomach ulcers all used evidence to challenge the consensus...
Nov 6, 2023 β’ 11 tweets β’ 2 min read
There are two competing models of what the job of NHSE is: 1. work out the best detailed ways for hospitals to operate and tell them what to do in long detailed reports 2. Hold them to account for understanding how to achieve the big outcomes...
The prevailing mode is 1. The result is long policy documents detailing how trusts ought to do stuff. These are observably ineffective for two big reasons...
Aug 16, 2023 β’ 11 tweets β’ 2 min read
The much heralded NHS Workforce Plan, whatever you think of it, can't impact the NHS much in the next 5 years (as its commitments are mostly about training which takes time). But it could have been different...
If it had paid attention to the non-front-line workforce, it could have made a big impact quickly.
For example, it is worth asking which support staff do the most to release front-line time for patient care...
Aug 4, 2023 β’ 17 tweets β’ 3 min read
A key symptom of NHS problems is that doctors are overloaded with work. This is often ascribed to a fundamental shortage of doctors. But there is a huge hidden factor that also contributes to overload...
Obviously fewer doctors per head compared to peer health systems is a factor in this and that is the one most often discussed. But it might not even be the largest contributor to overload...
Jul 17, 2023 β’ 11 tweets β’ 2 min read
Framing the problem wrongly and asking the wrong question often leads to the wrong answer. Nowhere more so than in NHS policy. Some examples:
...
1) "How do we reduce unnecessary attendances to A&E?" is the wrong question that already assumes the problem is attendance. But crowding and long waits are the problem and they don't depend much on attendance...
Jun 30, 2023 β’ 11 tweets β’ 2 min read
Some quick reflections on the NHS workforce plan (hardly comprehensive, but the bugger is 150 pages).
What isn't in it is more important than what is:
...
It doesn't start with a clear description of what the biggest NHS challenges are (but it is a workforce plan not a whole NHS plan, so perhaps I was expecting too much)...
Mar 10, 2023 β’ 12 tweets β’ 2 min read
Who is the biggest source of bad NHS policy in the last decade?
NHSE
The Government
HM Treasury
Hospital leaders
Other service leaders
DHSC
...
I'm not at all sure, for multiple reasons.
I've seen more sense from government insiders than from NHSE on some topics, for example. And some pretty terrible ideas from internal NHS leaders...
Mar 10, 2023 β’ 4 tweets β’ 1 min read
There are good ideas here, but a focus on staffing in A&Es is not one of them...
Looks like ICBs/ICSs are heading for a Β£6bn deficit in this year's plans. That's bad: hsj.co.uk/finance-and-efβ¦
...
So last week's tertiation (that's a decimation three times over for pedants) of ICB management costs looks timely as a response...
Mar 6, 2023 β’ 8 tweets β’ 2 min read
How the NHS solves problems: 1. Identify the problem 2. Find someone else to blame 3. Stop. Or lobby for someone else to fix the problem.
Example: 1. the problem: Many big issues are caused because too many patients are stuck in hospital beds because discharges are delayed. 2. Blame social care 3. Tell the government only they can fix this...
Feb 16, 2023 β’ 14 tweets β’ 3 min read
I complained a few days ago about this story which reports A&E performance with "headline" numbers allowing obfuscation of bad performance in major A&Es. I thought I should follow up with some numbers... @NickTriggle
The major point is that using the headline number allows trusts with terrible performance in major A&Es to dilute their headline by including the (much better) performance in type 3 units (where poor performance is rare)...
Feb 15, 2023 β’ 4 tweets β’ 1 min read
Here is an experimental chart that doesn't fit well on twitter: trust type 1 A&E performance vs the national performance, monthly since 2010...
Key message: for many trusts, relative performance persists over long periods...
Feb 15, 2023 β’ 11 tweets β’ 2 min read
Hugely important insight here for analysts and data scientists. It isn't enough to know the right answer: you have to persuade people to pay attention to it...
This is a big problem since the group of people who have the insights (the analysts) are often the least effective at persuading decision makers to pay attention and actually make different decisions...
Feb 15, 2023 β’ 6 tweets β’ 1 min read
Let's say an NHS hospital could achieve only one of three things by taking action right now: 1) 3% cost improvement next year 2) 5% more elective activity next year 3) 30% higher productivity in 5 years time
Which would be better? Which would NHSE want? ...
The are mutually exclusive alternatives. You can only have one.
Which are they incentivised to do? ...
Feb 14, 2023 β’ 8 tweets β’ 2 min read
This story in today's Times by @eleanorhayward has the headline "GP shortage means busiest doctors look after 3,000 patients" which seriously understates the problem...
The analysis averages the GP staffing across ICBs which are large regions with hundreds of GPs each. But the data exists for individual practices and the variation inside ICBs is huge...
It uses headline performance (which allows some trusts to include MIU and WIC) numbers which obscures how bad their major A&Es are...
So, for example, the Royal Cornwall goes from a bottom 5 performance in its major A&E of only 43% in 4hr to a top 10 performer with nearly 75% in 4hr including its other units...
Feb 9, 2023 β’ 22 tweets β’ 5 min read
The Reform think tank have just released an extremely interesting analysis of why A&E performance in the NHS is so poor (with rather more analysis than the recent NHSE plan): reform.uk/publications/t⦠...
What is interesting is how their conclusions echo the conclusions experts were talking about in 2013 and which were thoroughly explored in several analyses between 2014 and 2016 (notably by the Nuffield Trust and Monitor)...
Feb 7, 2023 β’ 5 tweets β’ 1 min read
The FT misses a critical point here in criticising the NHSE plan for emergency care. The plan was the first time NHSE admitted that analysis showed demand was not the problem...
They have, in fact, spent much of the last decade trying to fix emergency care by reducing demand (which failed, BTW) instead of paying attention to analysis that clearly said demand was not the problem...
Jan 30, 2023 β’ 14 tweets β’ 2 min read
Unusual bout of actual analysis in the NHSE plan for tackling the major NHS crises. This in the factors causing long A&E waits: england.nhs.uk/wp-content/uplβ¦
...
Key takeaways: 1) Attendance by "minors" is not an important driver of waits 2) "Major" attendance is far less important than bed utilisation
