My blog about Jeremy Hunts manipulation of data to undermine the NHS has been read by 25,000 people in the first 24 hours. I was struck by one response to my post on Facebook from Rae Andrew. She is a clinician and an expert in this area.
The emotion, hurt and sense of injustice expressed in her response is palpable. I reproduce it here (with permission). It is unedited and not reformatted in any way. Just the way it came out. It is a clear example of the damage that Mr Hunt can do with his politicking – not only to NHS staff and patients but also to his own credibility. Please read it – it is important.
The study she refers to can be found here.
Manipulating data, misleading the public, discrediting the NHS and scaremongering patients – yes Mr Hunt is at it again. This time his latest attention grabbing sound bite is aimed at Cardiac services with the alarmist tweet “shocking study showing heart attacks are deadlier at the weekend. 7 day services is about saving lives”.
Let’s examine that statement for moment. As someone who has worked in this field for the last 12 years I have a few comments which I would like to direct to Mr Hunt:-
Mr Hunt, if you were interested in the truth, you would be aware that broadly speaking there are 2 types of heart attack – the “deadliest” (or largest), to which I assume you are referring we call an ST-elevation myocardial infarction (STEMI). If you were interested in the truth you would also be aware that Cardiology services are probably one of the most evidenced based specialties. If you were interested in the truth, you would be aware that every day of every year, heart attack centres across England & Wales participate in the Myocardial Ischaemia National Audit Project (MINAP) and publish the results of this National Audit annually. If you were interested in the truth, you would know that the MINAP project has audited the care received and clinical outcomes of >1.25 Million patients with heart attacks, making it the largest clinical Audit in the world. This is so we clinicians can seek to improve patient treatment year upon year. If you were interested in the truth and had read the evidence, you would also know that the risk of a patient dying from a STEMI is a third less than it was 10 years ago due to improved treatments (unadjusted 30d mortality now 8% in patients receiving PPCI). If you were interested in the truth and had read the evidence you would be aware that MINAP is in agreement with that seen in clinical trials internationally which suggest a “very good standard of treatment for this type of heart attack in Britain”. If you were interested in the truth, you would know that our national cardiology guidelines recommend patients with this type of heart attack should be offered and have COMPLETED keyhole surgery (called primary PCI) to unblock the blocked coronary artery within 90minutes of the ambulance arriving at the hospital door. This is called the “door to balloon time”. If you were interested in the truth, you would be aware that in England >98% of patients with STEMI have access to primary PCI and the median “door to balloon” time is 40minutes, with some centres having a door to balloon time of 24minutes (ie excelling and exceeding current recommended standards). You are obviously not aware of this, so let me explain how this is achieved – our interventional heart attack centres have excellent links with our fantastic paramedics who diagnose the patient by ECG in the ambulance and phone the centre on route. There is a dedicated cardiac team consisting of Consultant Cardiologist, cardiology registrar, cardiac nurses, cardiac physiologist and specialist radiographer standing by scrubbed up and ready to operate before the patient even arrives at the hospital door. This team is available 24hours a day 7 days per week and has been FOR YEARS so they are very experienced. Members of this team meet the patient at the hospital doors (special entrance), explain the diagnosis, procedure and risks and take the patient straight to the Cath lab (their cardiology operating theatre) where the rest of the team is already there and ready to get started and the procedure is performed as rapidly, effectively and safely as possible, because the team are completely focused on saving their patient’s life. And usually they do – irrespective of the time of day or night.
If you were interested in the truth Mr Hunt, you would already be familiar with the study I have attached to this post, a study written by colleagues of mine and published in the internationally renowned and peer reviewed European Heart Journal. I will assume, that as you seem more pre-occupied with political sound bites, than the truth, that you have not read the study, so please let me summarise it for you:
It is a study designed to look at the risk of death in patients who received treatment for heart attack (STEMI) during 8am-6pm Monday to Friday compared to those who received treatment for heart attack (STEMI) out-of-hours including overnight and weekends. Of 2571 patients studied 60% had their heart attack and received treatment out-of-hours. 95.5% survived the initial heart attack due to prompt treatment (in hospital mortality 4.5%) with NO SIGNIFICANT INCREASE RISK OF DEATH between the “routine” hours group and the “out-of-hours” group. There was also NO DIFFERENCE in long term mortality between the 2 groups.
You see Mr Hunt, interventional tertiary cardiology centres already work 24/7 because staff recognise, that when it comes to STEMI heart attacks (I’ll save the NonSTEMI pathway for another post), that prompt treatment saves lives. I sincerely hope your alarmist comments don’t undermine public confidence in NHS specialist cardiac services and delay patients calling for help when they develop chest pain. Furthermore, the proposed 24/7 day NHS reforms to which you are referring in your tweet (which we all support but you appear to be refusing to fund) are for “Elective (ie non-urgent) care”. I understand that you have no medical qualifications and no medical experience and appear to have a lack of understanding of the inner workings of the NHS, but surely even you recognise that a heart attack cannot be classified as “non-urgent”?
Mr Hunt, we, the NHS staff, are dedicated, hardworking, caring, reasonable and forgiving people – please, please, for the sake of our patients, stop trying to discredit us and start working with us. We have a wealth of knowledge between us and lots of ideas of how to improve the 24/7 services we already have. We understand the NHS in a way that career politicians cannot. Your current approach is not working. Please listen to us and let us help. Improving (not destroying) the NHS should be a common goal for us all.