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Sound ministerial advice falling on deaf ears: (mis)leading by example!
- Nigel Dudley (15 April 2008)
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Nigel Dudley, Consultant in Elderly / Stroke Medicine St James's University Hospital,LEEDS. LS9 7TF
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Refraining from acknowledging mistakes and saying sorry to the public when they occur is not unique to trusts. The Department of Health should also improve the way it handles complaints and says sorry to patients and the public when it makes mistakes with communications and information given to patients.[1] For example, concerns have been raised with Department of Health civil servants about errors that have arisen in relation to statements published in the December 2007 National Stroke Strategy (NSS) policy document about stroke unit and thrombolysis outcomes and the referencing of the claims; there is a marked and material difference between the NSS figures and the corresponding figures in the accompanying Impact Assessment document. Those latter figures were signed off by Ms Ann Keen, MP, the responsible minister, as representing a “fair and reasonable view of the costs, benefits, and impact of the policy” and were based on the latest economic modelling work carried out by the University of Central Lancashire (UCLAN). In the NSS the statements were made that “If timely access to stroke unit care was increased to 75 per cent of stroke patients this would prevent over 500 deaths per year and result in over 200 more independent individuals” and “If 10 per cent of acute stroke patients were to receive thrombolysis, over 1,000 people per year would regain independence rather than die or be dependent in the long term”. In the Impact Assessment document the outcome figures gave a base case estimate of 549 (range 307 – 792) recovering independence with thrombolysis, 791 (range 527 – 1055) recovering independence with stroke unit care rather than being dependent, and 818 (range 545 – 1091) becoming independent rather than having a fatal stroke. The figures in the NSS and Impact Assessment documents cannot both be correct. Patient harm can come from spending money in one area that deprives other more clinically and cost effective areas of valuable, limited resources. Ms Keen considers that “Patients clearly deserve an apology when mistakes happen”.[1] This message is a sound one but one that seems to have fallen on deaf ears in the case of some civil servants in her own Department. If Ms Keen can appreciate that publishing two sets of discordant figures on the same day can lead to confusion (indicated in a letter received from a Department of Health civil servant following the raising of concerns about the discrepancies) why did civil servants in her Department fail to notice the error in the first place and why have there been no apologies and no explanations to the public and those commissioning stroke services on behalf of the public of how the discrepancy came to arise? Which set of figures should patients rely on when engaging in local decision making about stroke service developments? Should the minister be calling on trusts to apologise for errors yet not be calling on her own civil servants to do likewise? Civil servants failing to address these errors and discrepancies between the NSS and Impact Assessment document figures could leave the impression that the Department of Health is hyping up stroke thrombolysis in the face of the evidence base; in the process, this will deny limited resources being directed towards more pressing and deserving stroke service development priorities.[2] [1] O’Dowd A. Watchdog says trusts must improve their handling of complaints. BMJ 2008; 336:795 [2] Dudley N, Blacktop J. The “hype” in hyperacute stroke. Age and Ageing 2008;37:236 The views expressed are my own and not those of my employing organisation Competing interests: None declared |
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