I'm mad as hell and I'm not going to take it any more.| policyskeptic.blogspot.com
A quick, critical look at the key ideas in the new UEC plan [NB: updated with extra comments on June 8] The new NHS plan for improving em...| policyskeptic.blogspot.com
New data from the ONS on their analysis of mortality and A&E waits has enabled new, better calculations on the magnitude of excess deaths ...| policyskeptic.blogspot.com
In the movie The Matrix, where people live in a fake virtual world, Morpheus offers Neo a choice. He says, “You take the blue pill... the story ends, you wake up in your bed and believe whatever you want to believe.” But taking the red pill means you wake up in the horrifying real world and have to face the consequences.| policyskeptic
The structure of the data as released and the interactive tool to visualise it are a mess of bad choices that get in the way of helping other analysts derive useful understanding from the data. They could do much better. | policyskeptic
The NHS is a microcosm of the British economy| policyskeptic
[Update: I need to issue an important caveat about the analysis in this post. When published, I had just been made aware of new and very detailed data sources about hospital prescribing, monthly sources with detailed analysis of volume and indicative price. The analysis was based on those sources and was consistent with a longstanding NHS Digital annual report on the total cost of hospital prescribing. But when the analysis attracted some attention, it was pointed out that the indicative pric...| policyskeptic
It sounds intuitive that having a good model of the NHS workforce would be useful for solving many observable problems in the current NHS. But there are reasons to assume any such model would not be as useful as expected and could even be harmful. More importantly, the starting point suggested for the model is wrong in multiple ways that almost certainly guarantees the model would fail to solve the real problems.| policyskeptic
In debates about what the NHS should do to improve its performance it is common to see benchmarks of staffing or bed numbers versus comparable health systems. The argument is that the system needs more doctors/nurses/beds. This is not the biggest problem. The NHS has suffered far more from a failure to invest in capital, innovation or management. | policyskeptic
Last week the government released a report on overprescribing that suggested perhaps 10% of prescriptions issued by GPs were unneeded or harmful. The media headlines tended to frame this as another reason to attack GPs. The Telegraph, for example, had this headline: "GP's needless prescriptions push drugs bill to £9bn…"| policyskeptic
In a gobsmacking interview with the Institute for Government, Andrew Lansley revealed his reflections on his notorious health bill. He doesn't seem to have learned much. Had he been in charge in 1940 Britain would have lost the Battle of Britain. This is important as his mistakes are still prevalent in government thinking about how to run the NHS. And we need to learn from his mistakes or we will lose the battle for the NHS.| policyskeptic
[NB this was submitted to the BMJ as a possible blog in March 2021. They rejected it as not topical enough. But the relevance of the topic has increased a great deal in April and May as GPs have seen record workloads. So I thought i'd post it here to to remind me what I was thinking then before I write about the latest developments in the debate.]| policyskeptic
There has been a huge amount of comment in recent discussions about GPs being overwhelmed by the current level of demand. Many have proposed turning off their online systems to hold back the wave. This is problematic for many reasons but has highlighted many deep misunderstandings about total triage and online tools.| policyskeptic
Everyone has a plan until they get punched in the mouth| policyskeptic
The brilliant HBO/Sky drama Chernobyl tells the story of the world's worst nuclear accident. The accident was avoidable. It happened because previous dangerous events in reactors of similar design (including one of the other reactors at Chernobyl) were suppressed by the Orwellian Soviet government because they didn't want to admit their technology designs were flawed. | policyskeptic
While the NHS and many other public services need more resources this might not be the best path to big improvements in quality and performance. Not least because deploying extra resources in the wrong place might yield only small improvements. Maybe we should start by spending more on getting the data and analysis required to understand where the biggest problems are and what interventions might solve them. And then focus on installing effective performance management throughout the system s...| policyskeptic
AIs won't take over the world because they won't be able to work out how to do it. But they won't solve our big problems either. The hype machine behind current AI investment is founded on an unwarranted extrapolation from recent AI successes that doesn't apply to most real world problems. We need to learn where AI can work and where it can't or we will waste money on systems that can't possibly work. | policyskeptic
Our GPs are probably grossly overworked. There is plenty of evidence that this is true, but recent data collected by NHS Digital paints an ambiguous picture. Many GPs have reacted to my analysis of that data with incredulity, claiming NHS Digital don't know what they are doing. Or that the data is meaningless and too much of a burden to collect. The real situation is more complex and won't be fixed by NHS Digital alone but requires GPs to pay more attention to how they collect data and why it...| policyskeptic
Several popular news stories in the last couple of weeks have shown that attention-grabbing headlines do more to distract than they do to improve the NHS. You have to know what the problem is before you fix it and too many popular discussions on the system's problems identify the wrong problem and get in the way of actual improvement.| policyskeptic
The current proposal by NHSE to replace the 4hr A&E target is muddled and confusing. It isn't strongly supported by evidence. It will, most likely, make the experience of patients in A&E even worse. Worse still, if things do get worse we won't have the available public data to measure the deterioration. If they paid any attention to history or the experts in emergency medicine, they could have done a much better job.| policyskeptic
There is a bigger problem than Brexit that is demolishing the public trust in political promises. The pervasive problem affecting all sides of the Brexit debate is that politicians have been making policy proposals and selling them to the public with neither any analysis nor any admission of the trade-offs they entail. This corrupts and degrades political discourse and leads to a public that rates politicians below gutter journalists in trustworthiness. And the result is that real problems of...| policyskeptic
It helps to understand how A&E works as a system before proposing how to change the public measurements used to manage it. There is little e...| policyskeptic.blogspot.com
Long waits in A&E kill patients. A new analysis of mortality and A&E waits by the ONS–despite issues in the analysis and presentation of the...| policyskeptic.blogspot.com
I wrote a blog in 2015 about how badly what the NHS calls "strategy" stacks up against what any reasonable definition of strategy would sug...| policyskeptic.blogspot.com
