Zero by Jeremy Hunt
Author:Jeremy Hunt
Language: eng
Format: epub
Tags: NHS;health;avoidable deaths;shrewsbury;telford;Henry Marsh;Tony Blair;Patricia Hewitt;junior doctors
Publisher: Swift Press
Published: 2022-05-04T08:49:16+00:00
Table 4: Difference between nine trusts in infection rates for hip and knee replacement (Source: Getting it Right First Time Programme3)
This variation was linked to an equivalent variation in cost. While the standard cost of replacing a hip or knee in the NHS is around £6,000,4 the cost of cleaning up a complication can rise to £100,0005 because of the additional GP and hospital appointments, repeated surgery, long-term antibiotics and hospitalisation.
But even that additional cost is dwarfed by the litigation that inevitably follows the failures in surgery. Negligence claims at the time were rising in orthopaedic surgery, with more litigation than any other specialty and the third-highest total costs. So, using the data he had collected, Tim worked out the additional cost of litigation claims for each hospital. The average extra cost was £54 per procedure. But in the best hospitals there was no additional surcharge â while for others it was as much as £151 per procedure. This data, too, he shared with every hospital trust.
When surgeons saw their personal performance data, if the result was disappointing their first reaction was â perhaps unsurprisingly â to question the quality of the data. âTim, your dataâs rubbish,â or something similar, would be the response. But after sharing as many as twelve different data sets telling the same story, the data became impossible to doubt.
The effect of this transparency on performance was electric.
Surgeons with the higher infection rates wanted to understand why. Without any central instructions from the Department of Health or the NHS, clinical standards started to improve.
Following the introduction of Timâs âGetting it Right First Timeâ programme (GIRFT), the number of hip operations that had to be redone because the first operation was not successful fell every year. Tim believes that the reduction in orthopaedic infection rates over the first five years of the programme has prevented 60,000 patients getting an infection â or around 1,000 fewer infections every month. Each infection avoided doesnât just save on the cost of follow-up surgery or potential litigation â it saves the patient enormous stress and pain.6
Litigation costs also started to fall dramatically.
In the first four years of the programme, there were year-on-year drops in the litigation bill, as well as drops in the total number of claims against orthopaedic surgeons.7 Orthopaedic surgery ceased being the most litigated specialty. The NHS saved around £64 million, as the number of revision procedures and associated hospital stays was reduced. Further savings occurred because fewer replacement hips or knees needed to be sourced.
Clinical practice also changed. Many surgeons used to enjoy doing the occasional âcomplexâ procedure. It was professionally interesting and no doubt educational. But the data showed clearly that complex procedures done âoccasionallyâ were far more likely to lead to complications and revisions. After Timâs data was shared, âoccasional complex surgeryâ reduced significantly. Such jobs were passed on to surgeons who specialise in them â further reducing the risk to patients.
This was not transparency imposed from above. It was a much more subtle and
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