Wiltshire health matters: behind the headlines - checking the health of our NHS

Written by Tony Millett.

Nationally the NHS has come in for some dreadful headlines in recent weeks.  Indeed it’s quite hard to keep up with the flow of reports and statistics – both official and unofficial.

Late on Monday evening (October 17)  the Guardian’s  main online headline ran: “Revealed: how NHS cuts are really affecting the young, old and infirm – Services slashed affect patients on frontline such as pregnant women and elderly despite assurances they would be protected.”

Leaving aside the headlines about the passage through Parliament of the coalition government’s Health and Social Care Bill and the dire warnings from some of its critics and from health professionals, we can dig through the data behind the headlines to run a quick health check on some of our local health care provision.

Waiting for treatment

August’s figures for the time taken from referral to treatment showed a rise in the number of patients waiting longer than the all-important recommended maximum ‘waiting time’.  Across England there was a forty-eight per cent rise in patients waiting more than eighteen weeks to be treated in hospital: “Sharp rise in NHS patients waiting more than 18 weeks for care”.

Nationally the average waiting time for those completing referral to treatment in August was 8.1 weeks for those admitted to hospital and 4.1 weeks for those who did not need to be admitted to hospital.

For NHS Wiltshire patients admitted to hospital, the average (median) waiting time from referral to treatment was 10.9 weeks – only eight PCTs recorded longer waiting times.  But the percentage of NHS Wiltshire patients admitted to hospital and treated within the eighteen week target was a respectable 93.5 per cent against the national average of 90.4 per cent.

For those not admitted the average (median) waiting time was 4.8 weeks with 97.7 per cent completing referral to treatment within the eighteen week ceiling.

For Great Western Hospital the average (median) waiting time between referral and treatment for patients admitted to hospital was above the national average at 12.7 weeks. Yet the average (median) waiting time from referral to treatment for those not needing hospital admission was 3.6 weeks – well below the national average.

And 98.1 per cent of non-admissions were treated within the eighteen week limit – against the national average of 97.3 per cent.

Care of the elderly by hospitals

Some of the most alarming and outraged headlines concerned the Care Quality Commission’s (CQC) report on the care of the elderly in hospitals.  Based on unannounced inspections in April this year, this looked at two elements of that care - patient dignity and nutrition.  The report did not look into the elderly’s medical treatment.

The headlines were damning: “Treatment of the elderly is a national disgrace” (The Independent.)  Under the headline “Our nurses must go back to basics”, the Mirror’s veteran columnist, Paul Routledge, said: “Making nursing a graduate profession has been a medical success and a caring disaster.”

The Great Western Hospital was among those criticised in the report – but not as harshly as were some hospitals. For the full story and GWH’s response, read Marlborough News Online here.

While the CQC’s national report was very worrying indeed, there was also worrying news about the capability of the CQC to monitor care properly.  While the coalition government has cut the CQC’s budget by about one third, its remit has been widened to include GP’s premises and it currently has about two hundred staff vacancies.

The wait for diagnostic tests

August’s monthly data from the Department of Health showed a growing number of people in England were not getting one of the fifteen key tests - like scans and gastroscopies – within the NHS’s recommended six week waiting time: “Patients waiting too long for NHS scans”.

NHS Wiltshire scored well in this data even though  August’s figures are liable to reflect appointments postponed because of holidays and specialists on leave.  Out of a total of 4,427 tests in the fifteen categories, nineteen were performed beyond the six week wait and three were beyond thirteen weeks.  Some of those may have been based on rogue data recorded by the first time use of new software.

To take one of the more common diagnostic tests as an example: out of 1,633 non-obstetric ultra sound tests commissioned by NHS Wiltshire, 1,233 were completed within four weeks and none ran over the six week waiting time.

The NHS’s budget

On October 7, NHS managers called on the government to be more honest about the financial challenges facing the NHS in England.  They fear that the public will hear the government’s claim to have increased spending in real terms and not understand when cuts have to be made.

The Primary Care Trusts are facing cuts to their staff, huge savings and the intricacies of the government’s developing and changing restructuring plans.

When in April a Marlborough News Online writer challenged Devizes MP Claire Perry’s upbeat press release  – “Claire Perry welcomes £19 million extra for NHS in Wiltshire” – the Conservative Research Department did finally agree that the increase over inflation was “marginal”.

In fact it was 0.1 per cent.  To call the 0.1 per cent an increase at all increase was optimistic based as it was on an inflation figure of 2.9 per cent with a 3 per cent funding increase.  That was what the promised ‘real terms’ increase meant.

Even with pay freezes and job losses, the NHS has to cope with the steep increases in fuel and energy costs and other inflationary pressures.  At the same time, NHS Wiltshire has to meet its share of the national target of £20billion in savings and to pay off the debt inherited from its predecessor care trusts.

And lurking in the background is the Health Secretary’s forthcoming ruling on the changed emphasis of the government’s competition rules that may wipe out much more than that ‘marginal’ increase in Wiltshire NHS’s 2011-2012 budget.