Two papers by Dr Matthew Dunnigan (who has been a co-researcher with the likes of Allyson Pollock) have been brought to my attention recently. I think they deserve a wider audience.
The first is a compilation of waiting time statistics comparing 11 elective procedures across the UK. These were obtained from the Office of National Statistics and the results are very interesting. The country that comes top? Scotland. Yep, the reds under the beds, socialistic, market rejecting troublesome Scots. Here's the table below;
| | England | Scotland | Wales | N. Ireland |
| | | | | |
| | 50th percentile of days waited (rank order) | |||
| 2005-06 | 89 (2nd) | 86 (1st) | 133 (4th) | 125 (3rd) |
| 2006-07 | 86 (2nd) | 72 (1st) | 128 (4th) | 104 (3rd) |
| 2007-08 | 65 (2nd) | 59 (1st) | 107 (4th) | 90 (3rd) |
| 2008-09 | 49 (1st) | 53 (2nd) | 83 (4th) | 82 (3rd) |
| 2009-10 | 50 (2nd) | 48 (1st) | 72 (4th) | 70 (3rd) |
| | | | | |
| 90th percentile of days waited (rank order) | ||||
| 2005-06 | 180 (1st) | 191 (2nd) | 298 (3rd) | 334 (4th) |
| 2006-07 | 157 (2nd) | 152 (1st) | 254 (4th) | 242 (3rd) |
| 2007-08 | 128 (2nd) | 121 (1st) | 213 (4th) | 183 (3rd) |
| 2008-09 | 99 (1st) | 100 (2nd) | 166 (4th) | 153 (3rd) |
| 2009-10 | 100 (2nd) | 97 (1st) | 149 (4th) | 139 (3rd) |
Average waiting times between referral and admission for 11 elective hospital
procedures1 2005-06 to 2009-102
1. Procedures:- Angioplasty, Angiography, Bypass Surgery, Cataract Surgery, Hip Replacement, Knee Replacement, Endoscope of Bladder, Endoscope of Upper Gastrointestinal Tract, Hernia Repair, Tonsillectomy and Adenoidectomy, Varicose Surgery.
2. United Kingdom Health Statistics 2010; Tables 6.6 a-f; Edition No 4; Official National Statistics
For a fuller explanation of his method, you can click here.
But it's the second paper in conjunction with this that grabs my attention. It's called 'Clinical Activity in the English and Scottish NHS Before and After Devolution'. (The accompanying tables are here.)It shows that there has been a huge increase in clinical activity in England co- inciding with the introduction of Foundation trusts and payment by results. In spite of this, Scotland has still been able to perform better on elective procedures than England and has a stable model of growth for its NHS. Is this an indication that a lot of unnecessary procedures are going on, prompted by 'payment by results'? You'll have to decide, because Dr Dunnigan doesn't say it out in the paper, but this is well worth a read. And pass it on. And this is worth a look as well...
1 comment:
Of course, 'payment by results' has fostered increases in patient numbers. The utilitarian principles that have predominated Healthcare since the Neo-Liberal 'revolution' in the English NHS brought about by Tony Blair, have made this inevitable.
New sectors of the population have been 'medicated' due to continual lowering of surrogate (rather than real) markers of disease, that were adopted as a paradigm for treatment as a political goal, rather than a scientific one. If you incentivise an activity to the extent that occurs under QOF you will consequently find larger and larger cohorts to treat.
This has been the case in England and Wales but Scotland seems to have rejected most of the marketisation and privatisation with, it seems, better statistical outcomes as a result. As an unreconstructed socialist I welcome this, although I have reservations about all correlation as being evidential as to outcomes at actual patient level.
England's NHS has indeed lost it's way. Perhaps to the extent of it being incapable of salvation without a complete cleansing, after the Moaist model.
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