He has done it again! He tweeted yesterday that a “Shocking study showing heart attacks are deadlier at the weekend. 7 day services is about saving lives”.
I will discuss the likely accuracy of this statement later but what if it does turn out to be true? Consider the effect of making this information public in this way. Patients who develop chest pain at the weekend will certainly be more anxious as a result. Some with milder symptoms may even delay seeking help until a weekday. Anxiety is a powerful emotion that has real physical effects – including increases in hormones which can have a detrimental effect on a heart under strain. Heart attacks are the archetypal example of a condition where a patient’s expectations can influence their outcome.
As a result real patients could come to harm. The numbers involved across the UK are so large that some who would have otherwise survived may actually die.
So why did he do it?
A charitable explanation is that Mr. Hunt hopes that this sort of scare tactic will lead to changes in the NHS that will improve patient care. Indeed it is his declared intent to influence negotiations with the BMA about consultant contracts so that he can remove the “opt out” clause for weekend working and so improve patient survival.
In doing this he has missed (or deliberately ignored) several important points.
- The opt-out clause refers to NON-EMERGENCY work. It has nothing to do with the emergency services that are involved in caring for patients with heart attacks.
- There is now strong evidence that less than 0.1% of doctors have used this clause to avoid weekend working so it is not a relevant issue in any real sense.
- Health professionals find his insinuations that they are lazy or self-serving insulting and may react badly. The #iminworkjeremy and #weneedtotalkaboutjeremy social media campaigns demonstrate the strength of feeling out there.
- The negotiations with the BMA, the doctors union, have already become acrimonious and this sort of political manoeuvring will only make things worse.
- His own personal reputation will suffer. Over 218,000 people signed a petition of no confidence in his abilities following his last attack on doctors.
So by picking on the hospital consultants who work in coronary care, at this time, in this way, he is unlikely to improve care for heart attack patients. Indeed it is more likely to make things worse.
At first sight putting out this tweet, after the tsunami of criticism he has received already, seems to be a very stupid thing to do – and I am sure he is not a stupid person. Many have suggested that the government’s real agenda is to deliberately undermine the NHS, reduce its value in the eyes of the British public and soften us up for a sell off. Mr. Hunt’s actions certainly seem to make more sense in the context of this argument.
Picking a fight with the BMA over issues that is they cannot possibly support is likely to lead to confrontation. Doctors are the most powerful supporters of the NHS and if the government can manage to provoke them to bad behaviour it could be used to undermine their standing with the public.
But is the statement about weekend death rates really true?
Weekend hospital mortality statistics have been discussed widely but it is so important a subject that it is worth revisiting here.
There is no doubt that for a wide range of acute conditions there is a real increase in crude death rates for patients admitted at the weekend and out of hours. This is irrefutable. The important question is why this occurs – and the studies have yet to be done that will reliably answer this question.
Patients who attend at the weekend are on average sicker than those who turn up during the week. Minor heart attacks can present with mild symptoms and patients will sometimes wait to see their GP rather than go to the emergency department over the weekend. Massive life threatening heart attacks go there straight away whatever day of the week it is. So the weekend admissions will be skewed towards the more serious end of the scale.
Acute heart attack services are almost always manned by consultants with dedicated teams on call seven days a week. They are probably among the NHS services with the least day to day variation.
The main issue though is the reliability of the research on which Mr. Hunt based his statement. The data is very old – collected between 2000 and 2013 – yet it has never been published in a main stream peer reviewed journal. It has been presented at a couple of conferences as a poster where the peer review process is nothing like as robust as that required for journal publication. The reason for this may be that although the numbers of patients involved was large, only 7 hospitals were included and the data used was hopelessly out of date.
The treatment of acute heart attacks has changed completely over the last 15 years and has now become a true 7 day, 24 hour, consultant led service. This was not the case when much of this data used for this study was collected.
In that case how on earth did the study make it into the national press?
Poster presentations at conferences rarely, if ever, make national headlines. One can only guess how this scientifically challengeable, retrospective, unpublished study came to the attention of the Telegraph and what it was that made their Health Editor, Laura Donnelly choose to write about it. As a seasoned health hack she should know something about scientific validity and the importance of peer review.
To make matters worse the public impact of the piece is spiced up with a sensationalist headline and a well-used stock photograph of an actor feigning chest pain.
You could almost believe that the Telegraph has a hidden agenda too……..
The bottom line
The NHS has always been subject to political shenanigans. While it is a big and robust organisation its staff and patients are not immune to the harm this can cause. It is about time for a grown up, civilised, open and constructive discussion about how we can all work together to improve it in future.
That is why I am supporting the NHS Survival campaign to get cross party support of a Royal Commission into the future of the NHS.
And unlike Mr. Hunt, I do not have the might of the right wing press to distribute my message for me, so please, dear reader, if you agree with my thesis then share this piece as widely as you can.