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LETTERS: Colin B Brown NHS league tables are more spin than substance BMJ 2002; 325: 596 [Full text]

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NHS League Tables

Michael K Almond   (14 September 2002)

timr to stop colluding

David J Maconochie   (15 September 2002)

NHS League Tables 14 September 2002
Michael K Almond, Consultant renal physician Southend Hospital, Prittlewell Chase, Westcliff on Sea, Essex, SSO ORY Send response to journal: Re: NHS League Tables	Editor - Like Colin Brown (1) I too am a renal physician. Unlike him I work in a hospital he 'shudders to think what it must be like', a two star Trust. In my renal unit however we have no patient waiting to start dialysis and no patient waiting, other than for clinical reasons, for surgery related to complications from kidney failure. We can and do in fact provide parathyroid and other renal related surgery to patients from our neighbouring three star hospital! Usually within a few weeks of referral. My point? The same as that of Colin Brown. The star rating system provides no useful information to a patient with a specific medical problem and does not reflect the ability of a particular unit within a Trust to provide a service. I agree, the star system satisfies no one working for or using the NHS. Michael K Almond consultant renal physician Southend Hospital Prittlewell Chase Westcliff on Sea Essex SSO ORY mka@mikeblenheim.demon.co.uk 1. Brown CB. NHS league tables are more spin than substance. BMJ 2002;325:596. (14 September) I can confirm no competing interest
timr to stop colluding 15 September 2002
David J Maconochie, GP locum Somerset Send response to journal: Re: timr to stop colluding	First may I say that although the contents of this letter may appear to be critical of Dr Colin Brown, I have enormous sympathy for his position and also for the plight of his patients. I must however observe that Dr Brown, by continuing to work under the circumstances described, is colluding in the system of trading the lives of his patients for the financial probity of the dialysis unit. The vast majority of us are guilty of the same sin of collusion in one way or another when we fail to protest at the third rate health care visited on our patients and when we fail to inform patients that we and they have other options. What options do patients have? They might accept that their lives are valued financially at a rate somewhat less than the cost of running a dialysis machine. They might alternatively look for private care, complain to their MP, demand treatment abroad if it is not available here, or even sue the NHS. So what are our other options as doctors? First we can all continue with the status quo, covering up the failings of our particular section of the NHS by explaining the failure to treat as "not clinically indicated", "long waiting lists" or "other tests needed first". How about telling patients the truth, that their lives are subject to the whim of administrators whose position and income depend on a) sticking within budget b) manipulating the statistics to prove they are doing a good job. The honorable course of action is to blow the whistle, state the self evident, advertise the hypocrisy of the situation and take the consequences. As I said, I sympathise hugely with Dr Brown. I do however sympathise more with those on his dialysis waiting list who might, if I worked in Sheffield, be my patients also. competing interests: I am a member of the Independent General Practitioners Association.