Coalition "Reform" of the NHS

Coalition "Reform" of the NHS
Approval ratings for the NHS were at a record high prior to the Coalition government. Since then there have spending cuts and a massive reorganization, despite promises to the contrary.
The Health and Social Care Act 2012 contains no provisions relating to patient safety. Moreover it abolished the National Patient Safety Agency.
Neither have the most important recommendations of the Francis Report been adopted.
The current Secretary of State for Health, Jeremy Hunt, continues to blame Labour for the state of the NHS, and seems to take no responsibility for NHS failings. Cover-ups of NHS problems at Morecambe Bay have occurred under this government's watch, although there have been attempts to put this at Andy Burnham's door too.
What have Cure the NHS to say about this record? Well far from criticizing the abolition of the NPSA, Julia Bailey tactitly approves if not positively endorses it. Instead of focussing on Jeremy Hunt's lack of deeds, she commends him for "listening". The cynical might say that this is further evidence of her tendency to seek attention. Ditto for the piece in the Washington Times, when the same smears and exaggerations in the UK press were repeated for an American readership debating 'Obamacare'.
In short, the coalition government are putting blame out to tender. Private healthcare will not be subject to FOI requests, so transparency will decrease not increase. This will give private contractors an unfair advantage. Will they be subject to the same requirements of candour as NHS providers? Where the customer pays the private provider directly or indirectly, it can be argued that 'caveat emptor' applies. The justification for treating private providers of NHS care differently is less clear.

Whistle blowers and mental health issues

Whistle blowers and mental health issues
Genuine whistle blowers have a hard time, and many of them will suffer mental health issues as a result of their treatment. There are other reasons why those who claim to be whistle blowers have mental health issues. Their difficulties at work may actually have been caused by their mental health issues which have made it extremely difficult for their colleagues to work with them. It defies all common sense for someone with self-confessed mental health issues to claim that mental health issues were invented to discredit them as a whistle blower.

Of course false allegations of mental health problems can be used to explain away the revelations of genuine whistle blowers. But just like not all people who claim to be whistle blowers should be accepted as bona fide whistle blowers, not all claims of mental health problems should be dismissed as dirty tricks.

Looking at some NHS "whistle blowers" in the limelight at the moment, it is apparent that several of them suffer mental health problems. Julie Bailey has admitted to hearing voices to such an extent that "It used to just be my mum’s voice I heard in my dreams..But now there are so many voices in my head, so many stories, they’ve all become confused". For further details see here:  http://skwalker1964.wordpress.com/2013/06/06/hounded-heroine-the-cure-the-nhs-myth/
This suggests a psychotic illness, if Julie Bailey is telling the truth. It has been suggested to me that both Julie Bailey and Deb Hazeldine may be suffering post-traumatic stress disorder. I say this with no sense of satisfaction, I'd like to see their issues dealt with rather than exacerbated by people exploiting their grief for political purposes (or to sell newspapers).

Other "whistle blowers" clearly had their mental health issues before. Kay Sheldon admits to having mental health issues. Her colleagues describe how she went missing from a meeting to be eventually found confused in an episode that sounds like an hysterical fugue, or even psychosis. "Phyllis Stein" was diagnosed with Munchhausen's Syndrome by Proxy.

Some of the people associated with Cure The NHS recklessly interfere in a way that exacerbates the mental health of some Cure supporters - one individual with mental health issues (who has threatened NHS staff in the past and is very agitated judging from his Tweets) has his anxieties heightened and validated by people only seeking to inflate their own importance.

If all the concerns of the whistle blowers are valid, then resolution offers them a way out of their situation. If however their concerns are inflated and their aims totally unrealistic, then they are truly stuck with no hope of closure whatsoever. As they come to realise that this government will not do what they want, their psychological health can only worsen.

Homicide and other issues

Homicide and other issues

Law often revolves around language, and particular words have very particular meanings. Many people believe that 'homicide' is synonymous with 'murder' or at least unlawful killing (perhaps because of American TV shows featuring the 'Homicide Squad'). In fact, homicide is simply the killing of another human being. Homicide may be justifiable or excusable, or unlawful.
So killing someone in self-defence is still homicide. Killing someone by accident is homicide. Is allowing someone to die by gross negligence homicide? Arguably not, although it can be gross negligence manslaughter.
Murder on the other hand requires specific intent to either kill a person or to cause them serious harm, or the oblique intent to kill (by doing something that was virtually certain to kill the person). Attempted murder requires the specific intent (or oblique intent) to kill.
To apply any of these terms to apparent or proven avoidable deaths in healthcare is totally inappropriate. 

The "hate campaign" against Julie Bailey

The "hate campaign" against Julie Bailey 

Julie Bailey has on many occasions alleged a hate campaign against her by Stafford people. She even goes so far as to name individuals as being behind the campaign. She has stated on Twitter and in the press that she has had death threats against her, her mother's grave was desecrated, people would shout at her in her cafe, in the street and in the supermarket, and that various remarks were made on the internet.

Staffordshire police investigated these allegations - although they were not contacted by Ms Bailey or anyone else. Strange if this campaign was so vicious and sustained, you might think. They concluded their investigation by stating that there was insufficient evidence to progress against any one individual. 

Now I suspect many of us have been in the situation where we have reported a crime and the police are not able to identify a suspect. The lack of evidence to pursue the inquiry further does not mean that all the allegations are fabricated. There certainly have people expressing their anger at the issues for their local hospital. One person expressed the wish that Ms Bailey be taken ill and have travel a long distance to hospital, since Stafford Hospital was closed. This was described as a "death threat". I do not know if there have been other incidents, but Stafford police were not happy with the description "death threats", a very reliable source tells me. 

Of course there have been people that are unhappy with Ms Bailey, and it's quite conceivable that some individuals might have vandalized her mother's grave (although again we have no evidence of this). The issue is whether there has been an orchestrated or sustained campaign, and there simply is no evidence of this. In particular, there is absolutely no evidence that Labour activists are behind this, and the accusations are simply directed at those who dare to challenge the narrative of Ms Bailey and Cure the NHS. 

The 'Monstering' of Andy Burnham

The 'Monstering' of Andy Burnham

One theme of the current debate on the NHS is the 'monstering' of Andy Burnham. In this, Cure the NHS and the Secretary of State for Health Jeremy Hunt have been singing from the same hymn sheet. An incredible amount of misinformation and personal abuse has been directed at Andy Burnham, despite the fact that he ordered the original Francis Inquiry within a month of assuming responsible for health. 

No doubt it vexes both Cure the NHS and Jeremy Hunt that Andy Burnham is very credible on the NHS and shone at the Labour Party conference. He also confounded expectations he would moved in the shadow cabinet reshuffle. Jeremy Hunt on the other hand has presided over a massive loss in public confidence. Remarkably for a SoS he feels his job is not to take responsibility for problems (and let's not forget the coalition must surely now stop blaming Labour for all problems, 3 years into government) but criticize the NHS.
We know that CTNHS has pursued individuals quite openly. Julie Bailey's cafe had a "hit list" on the wall (something which the various media outlets have strangely glossed over). 

CTNHS claim that Andy Burnham:
 - refused to order an inquiry; not true, although he didn't order a public inquiry
 - only ordered a secret inquiry; not true, the first Francis inquiry resulted in the publication of a report
 - has refused to apologise; no, he has apologised publicly in Parliament
 - refused 81 requests for a public inquiry; not clear where the 81 requests came from - if they are all from CTNHS directly or indirectly, amount to pestering rather evidence of widespread concern
Credit to Gabriel Scally for the above refutations.
Earlier in the year this hate campaign was highlighted here:
http://www.sochealth.co.uk/2013/08/26/fairly-standard-hate-campaign-labour-andy-burnham-nhs-went-badly-wrong/
This has all come to a crescendo this week with the Tweet from Jeremy Hunt:

Jeremy Hunt ‏@Jeremy_Hunt4 Oct

Shocking revelations on @andyburnhammp’s attempts to cover-up failing hospitals. We’re legislating to make sure this can never happen again.

Andy Burnham responded with a demand for an apology or he would consider legal action. Tweets are not covered by parliamentary privilege. If the allegations were made in the House of Commons, he would have had the chance to refute them personally.
Despite a letter to Andy Burnham in which he states (bizarrely) that he never doubted Andy Burnham's personal integrity or accused him personally of covering up, this Tweet has still not been deleted.Baroness Young, formerly of the CQC, has already explicitly stated that Andy Burnham did not put any pressure on her to cover up anything. The facts are really quite clear.

Politics and Mid Staffs

Politics and Mid Staffs

Cure and supporters claim that their campaign is not political (presumably they mean not 'party political) but simply a campaign centred on and motivated entirely by a desire to improve patient care. They contradict this purported purity of purpose by their focus on "accountability" by which they mean a search for criminal punishment, in some case for people who are really quite remote from any connection with poor care at Mid Staffs.

For all their disclaimers, Cure have stated in the past that they would be a "thorn in the side of Labour"at the general election (see comment here: http://skwalker1964.wordpress.com/2013/08/25/julie-bailey-on-linkedin-delusions-of-grandeur/ ). The public inquiry was granted by a Conservative-led coalition, with the support of Tory MP Bill Cash. A public inquiry is entirely a political exercise, and it achieved very little over and above the original Francis inquiry. They have made sustained attacks against local Labour activists on the basis of no evidence whatsoever, and indeed have taken issue with their local MP, Conservative Jeremy LeFroy, for not supporting those claims of harassment. In fact, the issue of Stafford Hospital is a non-partisan issue in local politics, which seems to irk Cure.

Their inital attacks on Andy Burnham fell flat because they relied on the misuse of statistics from the Keogh Report. Their use of minor Tory backbencher Charlotte Leslie to repeat their libellous allegations under the cover of parliamentary privilege has made her look like a patsy for Cure. She could only have got these allegations from CTNHS, directly and indirectly, and it sullies the office of member of parliament to simply repeat such unfounded allegations that arise out of personal vendettas in the House of Commons. The Secretary of State for Health, Jeremy Hunt, has granted Cure what they wanted entirely because it suited his agenda. He has not however implemented the recommendations of the Francis Report yet.

The CTNHS campaign against "Labour activists" shows that they have well and truly hitched their wagon to the national Conservative party (while continuing to disparage local Conservatives including the Stafford MP Jeremy Lefroy). They have served as "useful idiots" for the Conservative privatization agenda.

95% Confidence Intervals

95% Confidence Intervals

In the area of clinical medicine, there is considerable interest in statistics - and considerable abuse of them. Statistics are not always easy to understand. The easier type of statistic is the descriptive statistic. A cardiac surgery unit can look at all its patients and all the deaths related to surgery and produce a statistic for surgical mortality. This would be a descriptive statistic.

Often statistics are used to tell us about things where we can't reasonably look at everyone - a classic example is an opinion poll. We might want to know how many people will vote Labour at the next election. So we take a random sample of the population and ask them how they will vote at the next election, and see what percentage respond "Labour". 

The random sample by chance are unlikely to vote exactly like the population we're trying to study. So we can calculate a 95% confidence interval. For example, our survey might find that 45% of people will vote Labour, with a calculated 95% confidence interval of 40-50%. What does this mean? 

It means that the chance that the actual percentage of the population (known as the parameter) that will vote Labour is between 40 and 50% is 95%. To put it another way, there is only a 5% chance that the percentage in the population is outside the 40 to 50% range.
Another example might be if we want to find out if people with John Smith Syndrome have a higher serum rhubarb than the general population. The normal range for serum rhubarb is 950-1050, the average being 1000. We take a sample of people with John Smith Syndrome and find their average serum rhubarb is 1075, with 95 CIs of 1051-1099. We can say that it's 95% likely that the serum rhubarb in John Smith Syndrome is above the normal range. However, this statistical significance doesn't mean that the raise in serum rhubarb is clinically significant. It might be that serum rhubarb has to be higher than 1200 to cause a problem. 

There are some caveats. If our sample isn't random, then we cannot make these assumptions. If we know about the respondents social class and age, we may be able to correct for certain biases in selection by mathematical corrections. Also if the respondents do not respond accurately about their voting intentions (they may be loath to admit voting for a particular party), then again we cannot make these assumptions.

So these methods may tell us that the blood pressure of one population is 95% likely to be higher than another. What they cannot tell us would be why there is this difference.