I responded sympathetically to Ded’s thread about “ Losing your father “ three years ago. Losing our loved ones is something which of course happens to all of us. All most of us would wish is that our parents live to a good age and don't suffer ...if only that was always the case ... . A supportive family and friends certainly help.


I'm sure it's good whenever possible to remember the good things about our loved ones, yes ,with "rose-tinted spectacles", because they weren't perfect and neither are we !


Of the 580,000 or so people who die each year in the UK, 3/5 die in hospital, the remainder at home, in care homes or elsewhere. An " excess " of 50,000 would be under 1.5% of all hospital deaths over 10 years. Most would prefer to die at home, surrounded by family and friends.



The average life expectancy at birth keeps rising ( 79 years for men ; 83 for women ), but there are differences between areas, depending on social class, income, health and economic deprivation. Glasgow men lag behind their counterparts in Kensington and Chelsea by over 13 years, and women by about 12 years.


Professor Jarman has looked at data from England, the USA, and other countries, applying an index called “ Hospital Standardized Mortality Ratio “ ( HSMR ). This compares the expected rate of death in hospitals with actual rate. Death rate is only ONE indicator of healthcare quality. Other factors – which he and “ Dr Foster Good Hospital Guides “ try to adjust for – include age, sex, diagnosis, and emergency admissions.


HSMR, like other statistics, need care in interpretation ( “ lies, damned lies and statistics “ ). Jarman and Dr Foster therefore focus on “ outliers “ – where results are beyond the “ normal range “. A very high HMSR – such as at Mid Staffs – should be a trigger for concern and action. However, doctors and the general public need a basic understanding of statistics, including “ confounding variables “ ( false relationships between factors ).



For sure, in the past decade, quality of care and patient safety in hospitals has been the focus of increasing public, professional, political and regulatory concern. Recently we’ve had the Francis Inquiry, Berwick Report, Academy of Medical Royal Colleges Report - and, since 2001, Dr Foster Good Hospital Guides, and Bristol Royal Infirmary paediatric surgery inquiry.



No wonder there are strong public opinions ( influenced by personal experiences of healthcare ) and confusion ! Jeremy Hunt mostly speaks for England, even if what he says applies also to other parts of the UK.


People ARE living longer in the UK ( 10 years longer on average than in the Philippines ), but the quality of their health in their last years of life is often not good.


Of course we should have a “ 24/7 “ NHS ; hospital standards should be the same wherever you live ; fewer people would require hospital treatment if they looked after their own health better and were supported more by their loved ones.


A “ duty of candour “ – openness – is good ; starting with every patient having the name of a nurse and doctor above their bed so they know “ where the buck stops “ … or at least starts. Some hospital wards have had this for many years.

I will stay clear of blaming Labour or Con-Dem, save to say that the only time any politicians see the light is when they are forced to respond to a public enquiry. No one at the top of the NHS is ever accountable for anything, and the number of “ regulators “ serves only to confuse the public.


ALL this has resource implications – not just more money but also more healthcare workers. It EITHER means more taxation if the service is to remain free at the point of need ; OR pay to visit a GP, hospital outpatient clinic, get a prescription, and as a hospital inpatient ( means tested and with insurance ).


Personal responsibility for health is vital in my opinion, but it’s not for me to judge lifestyle choices. Good health to all members !



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