My mission statement

The times we are working in now need a great deal of accelerated change and there must be no negotiating that down. So my mission statement for this part of my consultancy career is to be clear that there needs to be and will be a lot of change from the work that I do with individuals and organisations and if organisations don’t want that, then it is probably best to go somewhere else.

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Hospitals on the edge?

Filed Under (Hospitals) by Paul on 24-09-2012

The week before last the Royal College of Physicians started a consultation on the future of hospitals with the above title. The most significant thing about the document is the front page which has a cartoon of a hospital falling off a cliff and crumbling as it does so.

It’s a disturbing image with doctors in scrubs hanging onto window ledges as the building falls – but even more frightening are the beds, with their patients spilling out of a broken side, and falling down the cliff.

OK, this is a cartoon which takes some dramatic licence, but this is the Royal College of Physicians portraying the state of British hospitals, not some ultra-left group trying to frighten the public about privatising the NHS

Before coming to the consultation, it’s worthwhile commenting on whether this striking image has any validity. Of course our hospitals are not falling over cliffs but – to take the single issue of variations between hospitals – there are signs that some of them have become very problematic as organisations.

Last Friday the Independent reported on an audit of abdominal surgery operations. Last year there were 35,000 such operations. The audit showed that in one hospital four out of ten people died after their operation and in another, one in twenty-eight. This is a 12 fold variation.

The editorial in the Independent said the following,

“The figures that we report today showing a 12 fold variation in death rates following emergency abdominal operations are shocking. This is the sort of risk that would be alarming in a developing country never mind in 21st century Britain”

Most people inside and outside the NHS would agree with this assessment. This is a shocking set of statistics which the makes a loud case out for stronger quicker NHS reform.

It is of course one of the stranger aspects of the Government’s failure that they have not used these shocking statistics to make their case for reform.

The RCP makes the case that we must design services.

“We must make difficult decisions about the design of services where this will improve patient care. In some areas this will require service reconfigurations. Decisions about service redesign must be clinically led and clinicians must be prepared to challenge the way services – including their own service- are organised”

Linking these two stories, the abdominal operations were almost certainly not carried out by RCP members, but by members of their fellow college, the Royal College of Surgeons.

The surgeons, as a group and as individuals, will know about these variations and need to publicly recommend how service redesign will stop them.

The RCP have set up a future hospitals’ commission on which they welcome comments at,



One Response to “Hospitals on the edge?”

  1. And I assume that someone has checked that these stats are comparable and there aren’t any valid reasons for the variation in outcomes between the organisations? Like say, the age of the patients, comorbidity, riskiness of the procedure?

    If the stats are comparable then there is still a case to be made that the kind of reform that you advocate (supply side privatisation) will do anything to address this.

    These supposedly shocking statistics may make a case for reform, but not necessarily the reform you commonly advocate.

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