Blog

  • Categories
  • Tag Archives: Keogh report

    There is much good sense in Sir Bruce Keogh’s  blueprint for urgent and emergency care across England, the latest in a long line.  It takes us back about ten years to when the Ambulance Services started to strongly develop into genuine healthcare providers rather than transporters. The move was to imbed ambulance services into the NHS rather than have them semi attached as a kind of paramilitary adjunct scooping up casualties and dropping them off at the nearest A&E.  It was about treating patients where they were as much as moving them about. It was about getting an expert to the […]
    Read More

    Tagged , |

    The Keogh Review turns out to one of the best documents produced for our NHS.  Clear, concise, brief and informed by evidence.  It doesn’t look to blame, doesn’t make overt recommendations that can be tracked and ticked off.  It just makes sense. It does not portray 14 further Mid Staffs and its forensic approach probably should make us think again about what exactly we learned from a review by lawyers. It bears no resemblance to the media coverage it received before it was published.  It draws lessons only when justified from the evidence from the 14 trusts that were examined – […]
    Read More

    Tagged |

    The review looked at 14 Acute (Hospital) Trusts, see Table 1, which had a significantly high SHMI[1] or HSMR[2] over both the last 2 years.  The use of these measures remains contested.  Given the nature of statistical investigation there will always be a group at the bottom of the distribution.  The Keogh review used clinicians to look beyond the statistics and exaggerated claims of excess deaths. The review did not look at other trusts to establish any kind of baseline.  There are trusts not in the Keogh 14 that have high mortality rates, poor finances, weak governance and quality issues.  […]
    Read More

    Tagged |

    Having written a widely-quoted systematic review on the (lack of) relationship between risk adjusted mortality rates and quality of care I think I can contribute a little to this discussion. Whilst it is clearly wise to monitor one’s mortality rate (crude and adjusted), even adjusted hospital mortality rates mean nothing in isolation. Firstly we need to understand exactly what HSMR (hospital standardised mortality ratio) and similar statistics actually mean and how they are calculated. Essentially they are the ratio of “observed” (ie actual) deaths to “expected” deaths in the hospital. Someone (the Dr Foster company in this case) has gone […]
    Read More

    Tagged , |