A study about the NHS has made the headlines, yet again. Conducted here at Imperial College London, the study found that patients who underwent routine surgical procedures on a Friday had a 44 per cent lower survival rate than those having operations on a Monday. The odds were even worse for patients having weekend surgery whose survival rates plummet by 82 per cent. The study looked at over 4 million patients who underwent elective surgery over a three-year period, noting the number that died within 30 days of the procedure. Researchers suggested that the reason risk of death varied depending on the day the procedure was undertaken may be poorer quality of care over weekends. Cue the NHS bashing. Newspapers ran headlines quoting the 82 per cent, but these alarming statistics are far removed from the raw data of the study. Though such research is important, as it may highlight potential issues with aftercare, the coverage it receives negates good intentions: at best, the reportage is disproportionate to the insight the research provides provides; at worst, it is politically framed, intended to further criticise the NHS and promote its privatisation.
Dr Paul Aylin, who led the study, highlighted to the BBC the importance of immediate aftercare following operations: “The first 48 hours following a procedure is most critical and when things can go wrong, such as bleeding and infections. If you don’t have the right staff, this is likely to contribute to things being missed”. Though similar pieces of research looking at the variation in survival rates have been conducted, this was the first to cover such a wide range of planned procedures. Researchers tried to account for different patients having operations later in the week, but found their adjustments made no difference. They, like many before them, found that patient care suffers due to fewer doctors and nurses available at the weekend – the “weekend effect”. In addition, they found that the risk of death increases as the week progresses and is highest for patients who undergo surgery on a Friday – the first evidence of a “weekday effect”. Headlines proclaimed the increased risk of surgery towards the end of the week, reporting the percentage increase in risk of death towards the end of the week. But percentages are misleading.
The abstract of the research paper, which was published in the BMJ, reported the absolute figures: “There were 27,582 deaths within 30 days after 4,133,346 inpatient admissions for elective operating room procedures (overall crude mortality rate 6.7 per 1000).” The 82 per cent increased risk of having surgery on a Friday is compared to an overall death rate of 0.67 per cent. This relative risk is very different to the absolute risk of 1.2 per cent. This ‘absolute’ figure was not reported in the press, it was not even in Imperial College’s press release on the study. Though the intentions of the research may have been to highlight an important issue, by the promotion of the findings and the absence of the critical 0.67 per cent in the media is very misleading. Attention grabbing headlines facilitated by relative risk statistics polarise and distort the actual findings. Though this is to be expected, the failure to include the overall death rate in reporting shows poor statistical awareness and suggests that journalists should be more critical with their use of information.
Reports of high death rates in hospitals in Mid-Staffordshire in 2010 resulted in a government enquiry. Horrific stories emerged of severe neglect by nurses, and hospital management was immensely criticised for their failure to effectively deal with problems. The government responded by introducing trials in London hospitals requiring nurses to fill in forms to demonstrate whether they have checked if their patients require drinks or not.
I have a close friend who works in one hospital where this policy is being piloted. For her, it is infuriating. The ward she works on is regularly understaffed so the idea that she should spend extra time filling out a form to confirm that she is doing something routine seems ridiculous to her. She understands the importance of keeping her patients well hydrated, she is proud to spend time with them, to get to know them and their families, and to care for them. If her attentiveness to a patient is not absolute, it is not laziness, it is because she is fighting to save the life of another.
Studies reflecting this view are not publicised. The warnings that that imposing more rule-based regulation actually erodes the standard of patient care compared to promoting value-based self-regulation are not covered. There are also cries that similar scandals to those seen in Staffordshire could happen again.
Such concerns do not make the front page of papers because they do not have attention grabbing figures. Though many news outlets reported the number of patients that were studied and that actually died, the relative percentage risks still dominated the text. Headlines with small percentages would obviously not result in newspaper sales, but the failure to highlight the very small percentages actually being dealt with misrepresents the research.
Last year, small children and nurses in traditional uniforms jumped up and down on hospital beds as part of Danny Boyle’s Opening Ceremony for the 2012 Olympics Games in London. Boyle’s celebration of Britain included this tribute to the NHS. It was fantastical, it was idealistic, it was at times bizarre. One thing that made me particularly proud of this tribute was the confusion expressed by some American commentators. I think it is too easy to forget the importance of the NHS in Britain. It is economically draining; even when it was established it was not financially viable, and the demands on it have swelled since then. There are pervasive sentiments that private care is better and that businesses operate better in a competitive market. But all this misses the point – free health care for everyone is an amazing facet of our country, one of which we and our government, should fight harder to defend and improve.
Katherine Powell is currently studying for an MSc in Science Communication and is one of the editors of Refractive Index.