AS doctors, nurses and other healthcare professionals we are expected to make evidence-based decisions – but the same standard does not seem to be expected of politicians.
Many claims are raised on a weekly basis about our NHS which are taken to be based on facts.
However, often these facts are misinterpreted and packaged to promote an underlying political agenda despite there being no evidence to support such assertions.
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The Evening Times this week reported a story by the Scottish Conservatives claiming that a 16 per cent rise in child admissions to hospital between 2010 and 2017 had its roots in a lack of availability of access to general practice.
Whilst superficially the assumption here doesn’t sound implausible, it does not address the underlying complexity of issues around interpreting hospital admission rates.
To those who understand the normal process of hospital admissions the flaws in this argument seems very clear, but those who don’t have an understanding of the inner workings of the front door of the hospital may be easily (and possibly intentionally) misled.
To clarify, it helps to break down how a patient is usually admitted to hospital for emergency or ‘unplanned’ care.
An unwell patient makes contact usually with one of the three “front-line” services; NHS 24, primary care (general practice or out-of-hours), or Accident and Emergency.
The patient is assessed by a suitably trained practitioner, GP or emergency department doctor.
That person will assess, investigate and initiate immediate management of the condition and then will either discharge the patient, or refer them to specialist in-patient services (in this case paediatrics).
A paediatric specialist trainee will assess the patient and, in conjunction with possible discussion with their consultant, admit the patient to the paediatric ward.
In most hospitals GPs and emergency department doctors do not have “admitting rights” to the paediatric wards, and so any patients admitted there have usually been seen by a paediatrician.
In the event that there may be limited capacity in the emergency department to keep the patient there to be reviewed, the paediatric doctor may ask the patient to be sent to the ward for assessment, and they may be discharged – this is still recorded as an admission.
The take-home point here is that paediatricians on the whole make decisions about which kids are admitted to paediatric wards, and that this is entirely clinically appropriate.
You could argue that attendances in A&E departments may be seen to rise as a result of reduction in general practice numbers, but without further analysis of the underlying medical problems necessitating in-patient admission it would be completely frivolous to suggest that this is based on a lack of primary care resources. The overall trend in admissions in Scotland over the last 10 years across all specialities has shown more people are being admitted to hospital.
Miles Briggs, health spokesperson for the Scottish Conservatives, says that this was due to lack of access to general practice. Again, it is hard to see how this conclusion has been arrived at without any additional information other than a statistic on admission rates. For him to imply that there is an issue with increasing hospital admissions being undertaken by paediatricians implies he feels that this number is too high. For any politician to attempt to unpick the clinical autonomy of doctors in assessing and admitting appropriate referrals is a very slippery slope.
The State of Child Health (2017) report by the Royal College of Paediatrics and Child Health has shown that child health in the UK continues to improve and has done over the last 10 to 20 years albeit at a rate behind much of Western Europe.
There are a number of challenges identified for the Scottish NHS to address, as is the case of all four of the NHS bodies across the UK.
The comments by the Tories suggesting that the clinical decision-making of those pediatricians having admitted patients to hospital as the ‘wrong’ action in any political forum is a dangerous attack against the autonomy of medical practitioners. We would like to see increased criticism of unfounded claims against the NHS and to challenge those making statements.
NHSforYES has recently launched a resource centre on our website aiming to collect good high-quality, independently funded research and peer reviewed and developed policy of confirmation.
We would hope that as doctors, nurses and other allied health professionals continue in their evidence-based practice, the same high standard be applied to our elected representatives.
This was first published on the NHS for Yes website. Join today!
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