30 January 2011

Cameron's myth number one

Someone in this country is twice as likely to die from a heart attack as someone in France.

David Cameron
Letter to doctors in England

So says Dave. As is so often the case, politicians never tell you where their data comes from - especially if it is a bit suspect. These data are, of course, very suspect. Every doctor knows that there is something odd about data on heart attacks from France. It even has a name: the French paradox. Dave's researchers have obviously trawled about for data that enable our prime minister to slag off our National Health Service in a vain attempt to justify yet another reorganisation. It cuts no ice with doctors because we all know that the country he has chosen to compare us with is a paradox.

But Dr Grumble is also prepared to play this childish game. Let's look at the trends. They are nicely depicted in the graph below.

By next year our heart attack deaths will be lower than those in France. OK. Dr Grumble knows. There is more to this than health care. But this example should never have been used to slag off our NHS. Two can play at this game, Dave.

Oh, Dr Grumble nearly forgot. We have achieved this on less spending on health care than France. According to the latest figures France spent 28% more on health than the UK. Doesn't that bust another of your myths, Dave?


BMJ 2011;342:d566


Anonymous said...

I'm impressed that the predicted curve reaches zero sometime in the next ten years.

That casts a bit of doubt over the methodology used for the extrapolation.

Dr Grumble said...

Of course you are right, anon. The surprising thing is that both lines are so straight but with different gradients. You might expect them to begin to bottom out.

But the main point is that we all know that this example is a bad one. You can make what you want of the data but quite a lot is probably not much to do with the health services of either country.

Anonymous said...

"I'm impressed that the predicted curve reaches zero sometime in the next ten years."

That will be when the machines achieve sentience...

Betty M said...

The chap from the Kings Fund could have been a bit more forceful on this on Today yesterday (I think). There are plenty of examples of slightly sharp stats picking on this just like there was on for eg Schools Sports Partnerships.

Dr Grumble said...

I heard it too, Betty M. A very great deal of the talking down of the NHS by this and the previous government has not really been deserved. They seem to have armies of people in the background trawling for damaging statistics. And then they keep throwing in this patient-centred thing as if it is something new. As a doctor I find that insulting. How David Cameron allowed that to get into his letter for doctors I don't know.

The harsh reality is that the ruling class have decided to privatise the NHS and they are hellbent on steamrollering this bill through parliament as quickly as they can and before the public fully grasp what is happening. It is, I am sorry to say, a fait accompli. A terrible aspect of it all is that GPs are going to have to take responsibility for the outcome. Fortunately I don't think the public are quite so naive as to blame their GP and I suspect that the coalition will end up having to pay the price.

And in response to your second post, Betty M, I do realise that I have now given up on this. I regret not marching as Mrs Grumble did over the Iraq war but it didn't actually stop the war. As you probably know I have been following these NHS developments for some considerable time and it has been utterly obvious to me that nothing is going to stop these people. New Labour or ConDems it doesn't really matter essentially they want to be rid of the NHS.

Anonymous said...

What they are doing appals me - and the Lib Dems, for whom I have always voted, and in whose interest I stood for parliament, should be really ashamed of themselves.

Dr Grumble said...

Sorry, Anon. Some posts aren't appearing as they should:

"A terrible aspect of it all is that GPs are going to have to take responsibility for the outcome."

Surely GPs are the only ones who can stop this from going ahead now? If GPs refuse to sign up to the proposals and the consortia then the consortia model can't go ahead.

Yet apart from Jobbing Doctor, the GPs are extraordinarily quiet on this issue. The only thing the GPs seem to be getting exercised about is changes to their pensions. Meanwhile the NHS is being torn apart.

Also I've yet to see an interviewer who can handle Lansley. None of them seem to know enough about the NHS as it stands to really challenge him.

Lansley bullies his way through every interview, leaving the average viewer with the impression that patients will get more choice, GPs will be in charge, cancer care will be improved etc. The average viewer will wonder what's not to like about the reforms.

Even Andrew Marr couldn't seem to contain the nonsense Lansley spouts.


I agree that Andrew Marr didn't make much progress. This choice thing is nonsense. Patients want good care locally not choice. It is the government that is insisting on choice so that they can have competition - which is not sensible for many services. And, as you imply, the reality will be less choice.

I can't answer for the GPs. There are definitely some who feel that they could do a better job than those thousands (did Lansley say 50,000?) in the PCTs - or PTCs as Marr insisted on calling them. But I don't think they grasp the enormity of what they are taking on.

There are always people prepared to take anything on for extra money. And governments have other ways of reward people who play ball.

Anonymous said...

Another factor in all of this is that some small-minded GPs like the idea of being in charge of hospitals and consultants. That and the fact that patients trust GPs makes this a very clever government tactic.

Onus Probandy said...

Perhaps I'm being extremely dim...
Doesn't that graph show exactly what David Cameron said?


1. Further, you might reasonably argue that the UK is improving faster, but improving something that is dreadful is universally easier. As an example: are we surprised that a 29 stone person loses 2 stone pretty easily; while a 15 stone person finds it hard to lose the same 2?

2. Using total spending on health care as a measurement to compare improvement in one tiny area of health care is seriously dodgy. What if France has allocated it's health budget such that it spent less on heart attack survival than did the UK? (but more in another area) The bottom line departmental spending irrelevant.

3. A linear extrapolation of these lines is just wishful thinking. As anon pointed out, they aren't going to hit zero. Therefore concluding "By next year our heart attack deaths will be lower than those in France." is pretty brave of you.

Dr Grumble said...

By True Lies I intended to mean that the facts as stated are true but the example is the most absurd one you could take. I don't think anybody thinks the French paradox is much to do with health care.

What was worrying me was that people would believe that the NHS is really bad compared with other health care systems. I really don't think the evidence that it is bad (given the amount we have been spending on it) is really there.

We had a constant barrage of data from the previous government saying how bad the NHS was, how poor the service from GPs was and so on and in response to this I trawled through some of the data that they collected. I came to the conclusion that for some reason New Labour wanted to talk down the NHS. The reason was clearly that they knew that to make big changes to the NHS they would have to persuade the public that there was something really wrong with it.

The ConDems are now doing the same. I have done my best to point out that the French paradox is not something anybody should be drawing conclusions from. As for the cancer data, most of the figures date back to a time when the NHS was grossly underfunded. And it is still not as well funded as Cameron would like you to think. That's is yet another myth but I just haven't had time to debunk them all.

Fortunately, it is clear that the public really doesn't believe much of the propaganda. They may well not forgive the ConDems for these changes.

Anonymous said...

Thanks for reproducing this Grumble, I've summarised some more clear criticism of Lansley's myths at http://tinyurl.com/2u7t3tp Commissioning (I'm discovering)is going to be very different from what GPs expected. More on this later this week.

Cockroach Catcher said...

The French even gave their prisoners red wine. Now I know it is to compete with Dave.

...."In charge of Hospitals and consultants"....

The truth of the matter is that there is world wide a shortage of specialists. All private providers make their money on specialists. Soon when the majority of hospitals are privately run there will be an outcry.

My family recently had to have major procedures: one in a private facility via the NHS and one in a major teaching hospital. The consultants both worked for the NHS and the private sector although we did not have to pay for the private one. I can see the attraction to many of the better surroundings of the private facilities.

For the teaching hospital operation, it was within 2 weeks of diagnosis and I was told that there was no point in paying for it to be done privately.

Some told me it was because I have worked as a consultant myself. I doubted that. It was the best of the old NHS.

But the system could have worked if the specialists are paid the market rate to work entirely for the NHS. What went wrong before was allowing the same consultant to have a foot in both. Kaiser Permanente did not allow doctors to work outside of their organization and there is no internal market. But then for many conditions you are on your own after 100 days!

I suspect it is all too late now. Specialists know their worth and too much micro-management have finally killed off the good will. Private companies know they have the best commodity on their hands: well trained specialists.

The Health bill is not about letting doctors decide, it is about letting doctors (GPs) take the blame.

The blame will come sooner than later.

Dr Grumble said...

We have tended to spend much less on healthcare than equivalent countries (France, as I have said, spends 28% more) yet we have a reasonably satisfied public. This is despite the fact that we have tended to provide patients with what they need rather than what they want (until recently anyway). A sensible government would see that as a triumph.

English Pensioner said...

Depends which day of the week on which it occurs. And if it happens to be, say, Good Friday, I think you will be as good as dead!
Our emergency services in my view, out of hours, are abysmal.

Dr Grumble said...

"Our emergency services in my view, out of hours, are abysmal."

Yes. They were destroyed by New Labour. Yet they are probably still better than in most equivalent countries.