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Death Bandits

The Hospital Manager’s Association

Top Secret – Eyes Only

The Hospital Manager’s Guide to Massaging HSMRs

Members will be aggrieved to hear that the Doctor Foster Intelligence Unit and its lottery hospital standardised mortality ratios (HSMRs) are here to stay, despite several recent papers showing the methodology to be unsound.

Members will appreciate that they supply the raw data used by Dr Foster, thus providing opportunities to ‘cook’ the figures before they are passed to Dr Foster. The Association does not condone directly tampering with the data; however, faced with the intractable use of flawed statistics, the Association does believe members are entitled to ‘game’ the system to their advantage.

A Market Too Far

Jim Naughtie, interrupter-in-chief on Radio 4’s Today program, this morning scaled new heights of discourse interruptus, peppering a hapless Professor Dame Marilyn Strathern with tiresome ejaculations of febrile nuisance. One might presume that the Dame – who was until last year Mistress of Girton College, Cambridge - might be an expert in putting naughty boys in their place, but she was no match for Naughtie Jim.

The Dame was on air to talk about ‘incentivizing’ organ donors. The deal is that altruistic donation fails to produce enough organs, and that the time has come to consider what carrots might produce more kidneys. Some suggestions are out of sublime by way of ridiculous – souvenir T-shirts and mugs for example – but the bottom line is that this is about handing over lolly in return for the goods - or what the Dame coyly referred to as ‘bodily material’.

The Real Tomorrow’s Doctors

This week’s episode of Dr Who showed early promise, with khaki tea-making squaddie daleks, complete with Union Jack logos, but started to unravel the moment Ian McNeice started impersonating Robbie Coltrane, instead of playing Churchill, and descended into farce when the Lego-inspired bootylicious make-over daleks arrived. There was but one consolation: Bill Patterson, late of Sea of Souls, was finally revealed, as has long been suspected, as an alien.

The GMC, now that it has adopted dalek methodology to manufacture Tomorrow’s Doctors, has no doubt installed Pattersons in every medical school. The fruits of these alien endeavours are already abroad on our wards and in our surgeries; but in amongst the robodocs, there are some who lack dalek DNA, and who have retained their natural and human curiosity. One such doctor is a young GP, who blogs as the Pondering Practitioner.

Yes Sir, That’s My Balls-Up

The origins of the phrase ‘balls-up’ are obscure. Some say that it arises from an awkward sexual encounter, but Dr No prefers a nautical origin. A vessel aground can be said after a fashion to be anchored, in that it is attached to the sea bed; and it is also unable to manoeuvre, or ‘not under command’, as the rules have it. A vessel at anchor carries one black ball, a vessel not under command two black balls, and thus a vessel that has run aground and is in trouble carries three black balls, a situation commonly and naturally referred to as a complete balls-up.

The Council for Healthcare Regulatory Excellence, quango to the quangos, has a logo featuring not three but nine balls suspended in mid-air. It is an inspired image for a quango that not only lacks balls in the right place, but has also shown itself capable of repeated balls-up after balls-up, most recently in its eye-wateringly off-the-wall review of the GMC decision to allow the Diamorphine Queen to remain on the medical register, with only trivial and time-limited conditions on her practice.

Stiff Counting

There has been much ado about hospital death rates lately, much of it focused on the Mid Staffs hospitals, where consistently high apparent death rates were repeatedly brushed aside and ignored. The issue at stake was the validity - or not - of certain statistics produced by Sir Jar and his operatives at HI5, the Dr Foster Intelligence Unit, and one statistic in particular, the HSMR.

The HSMR, or Hospital Standardised Mortality Ratio to give it its full name, is said by Sir Jar to offer a useful marker of a hospital’s performance, by providing a single figure that summarises how many patients leave the hospital feet-first. High value HSMRs suggest more stiffs than expected, low HSMRs indicate less stiffs than expected, compared to national figures. Unfortunately for Sir Jar, the method – quite apart from a myriad of other factors that might compromise validity - he uses to determine HSMRs suffers from a flaw that severely restricts its application. While an isolated HMSR can be compared to the ‘big picture’ – in other words, the standard population to which it is being compared - comparisons between hospitals, or even the same hospital over time, are prone to errors, which can render the results at best meaningless, at worst misleading.

The Doctor and Dr No

Sometimes Dr No has wacky ideas. One of his favourites is that all of time has already happened. Like a film in a can, it is all there, beginning to end; and, like a film, we see it sequentially, frame after frame, and that is what gives us the illusion of movement, and of the arrow of time. Sometimes he goes a little further; and, seeing the film strips lying in coils side by side on the reel, wonders whether we might, just might, if the conditions were right, be able to read the film not sequentially on the strip, but radially, on the axis of a spoke, and so be able to see, perhaps even move, backwards and forwards in time.

Experts Bail Out

Unlike the well-fed DoH poodles at the RCP kennels, the unpaid members of the UK’s Advisory Council of the Misuse of Drugs (ACMD) have shown commendable backbone is standing up to the bullying ways of Home Secretary Alan ‘Hadron Collider’ Johnson. Indeed, so many advisors have now bailed out of the Advisory Council that the media, never strong on numbers at the best of times, have lost count of how many have jumped. It could be seven; or it might be eight. The latest expert to don his ’chute and jump is one Eric Carlin, citing undue political and media influence on the Council’s work.

Witchcraft Down Under

Down below is a quaint euphemism for the nether regions, and this tale is tale of trouble down below, of troublesome menses, and by coincidence it happened down under, in Oz. A family court judge ordered the hysterectomy of a severely disabled 11-year-old girl, and in so doing unleashed a storm of protest from the right-on people-first brigade, who accused the judge of sexism, of forcing sterilisation on the disabled, and, in so doing, acting in a manner ‘incomprehensible in the 21st century’.

At first glance, Angela’s case appears clear-cut, and the ruling, though delicate, defensible, and the protesters more wrong than right-on. Angela (a pseudonym) was born with Rett syndrome, a rare genetic condition that causes a raft of disabilities that means she needs constant care for just about everything. Two years before the hearing...

Counting the Dead

Dr No is hopeless with numbers. Just being in the presence of statisticians causes a pressure of incomprehension to build up in his head. When they start to talk numbers, it is as if they are speaking in tongues; and when their chalk squeaks on the blackboard, all he sees is so many hieroglyphics.

But numbers are part of the fabric of medicine, and their understanding is necessary to the practice of medicine; and so Dr No has over the years developed a habit of translating the hieroglyphics into words, and the formulae into verbal instructions. Σx becomes the sum total of all the values of x; and μ = Σx/n becomes find the average value of x by adding them together, and dividing by the number in the sample. The dark impenetrable pool of numeracy is side-stepped on the well-worn plank of words.

The Royal College of Pharisees

That smuggest of colleges, the Royal College of Physicians of London, already infamous for its part in the MMC/MTAS disaster, has of late been cozying up ever more closely to the Department of Health, and its chief pongo, Sir Liar Liar Pants on Fire Donaldsong. Earlier this week it moved still closer, issuing an right-on report damning callous smokers who kipper their kids.

The report, featuring a cover photo of a prole caught in the hideous act of kippering a bairn, contains shocking figures and urgent recommendations in bountiful supply. Passive smoking, it estimated, caused children over 300,000 UK GP consultations and almost 10,000 hospital admissions every year, at a cost to the NHS of about £23.3 million. An alarming list of childhood illness caused by passive smoking includes old favourites such as asthma and wheeze (22,000 extra cases) and middle ear disease (120,000 extra cases), as well as the reliable media magnets meningitis (200 extra cases) and cot-death (40 extra deaths).