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Rapid Responses: Rapid Responses published:
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NHS performance measurement is a downhill bicycle race
- Mike Tremblay (6 August 2002)
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NHS league tables-more spin than substance
- Colin B. Brown (16 August 2002)
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Mike Tremblay Tremblay Consulting TN27 8RF
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Prof. Klein's remarks made me think about comparing NHS performance to a downhill bicycle race. The real way to win the Tour de France multi- stage bicycle race is not to try to win each stage of the race, but to place reasonably high on each stage; indeed, one can even place quite low on some stages, as long as overall one is generally better than anyone else. But to endeavour to win each stage can lead to failure. Like the NHS, the stages of the Tour are different -- some are long distance, some are mountain climbs. It is unrealistic to expect a winner of one to be a winner of all. This much is known and this much is reality. In the real world of bicycle races, and as Klein notes, restaurants, there is a commonsensical awareness of the meaning of variance in performance, and that such variance does not always equal failure. Adopting a model of hospital performance that attempts to shoehorn the real world into a simulation model of reality (health policy, for short) will probably fail to address our real world concerns about hospital performance. The Siren call of perfect measurement is seductive and misleading. Ockham knew this, the quantum physicists know this, restaurant raters and bicyclists know this. Why doesn't the Department of Health? As for the bicycle race, the winner is.... |
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Colin B. Brown, Consultant Renal Physician Sheffield Kidney Institute, Northern General Hospital ,Sheffield S5 7AU
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NHS league tables - more spin than substance Dear Sir My hospital has just been awarded the 'coveted' top ranking of three stars in the NHS league table. Needless to say the Chief Executive and Chairman are delighted and have earned big browny points in Mr. Milburn's eyes - future honours list will be scoured for their just awards. The kidney unit in which I work has 65 patients on the waiting list to start dialysis for their kidney failure. There are 10 dialysis stations lying empty which could accomodate all of them if the revenue was forthcoming, which it hasn't been for many many months. Only when someone dies or is transplanted will a space become available. This state of affairs does not exist anywhere in Europe, even in Bulgaria , one of the poorest countries ! A number of our patients require parathryroidectomy for secondary hyperparathyroism, a well-known complication of chronic real failure. It takes 3-4 months to see the overstreached surgeon and a further 9-12 months before he can do the operation. The patients are put on a 'pre- list list ' and after 3-4 months are contacted to find out when in the next 6-9 months they would like to have the operation. This is called patients choice in selecting the date ! On that date they have to first ring the hospital to find out if there is a bed available. Not uncommonly there is no bed because of overspill from the medical wards onto the surgical wards e.g. winter bed crises, and the operation is postponed for weeks or months. A colleague of mine in Belgium tells me the waiting time to see a surgeon and have this type of operation is two weeks, yet the United Kingdom is one of the seven richest nations in the world ! These are but a few examples from just one unit in this hospital, and we got the highest position of 3 stars. I shudder to thing what it must be like in those hospitals with 2 , 1 or 0 stars. The NHS as it is currently structured, financed and managed with its politically orientated objectives has failed the public who use and the health professionals who work in it. Yours sincerely, Colin B. Brown
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