Editorial Monday 15 July 2013: 'Bring out your dead' - the eve of Keogh and The Politician's Syllogism
Tomorrow, Health Secretary Jeremy 'Bellflinger' Hunt will take the last session of Health questions of this session of Parliament. He will then give a statement to the Commons on the Keogh review.
At such a politically-charged moment, it is always good to cite The Politician's Syllogism from the BBC classic 'Yes, Minister':
1. Something must be done.
2. This is something.
3. Therefore this must be done.
Back in early February this year, Prime Minister David Cameron asked Professor Sir Bruce Keogh to review the quality of care and treatment provided by 14 NHS trusts and NHS foundation trusts that are persistent outliers on mortality indicators for the last two consecutive years on either the summary hospital-level mortality indicator (SHMI) or the hospital standardised mortality ratio (HSMR).
There are strongly-held and conflicting views among statistical experts, health economists and practitioners about the relative merits of SHMIs and HSMRs (here is an excellent article by Paul Taylor in the London Review of Books), but it seems reasonable to conclude that trusts who have spent sustained periods as an outlier on performance merit closer attention.
This would seem to be the responsibility of a quality regulator, and also of an economic regulator tasked with oversight in this area. Hello, CQC. Hello, Monitor.
The politics, the whole politics and nothing but the politics
It seems probable that we will be treated to another bout of the broadly unedifying spectacle of the Labour and Conservative benches engaging in a Mid-Staffs-style shitfight over the review.
There's a existential problem with getting into a shitfight: you're going to get some shit on you by the very act of throwing some at others. You may get a bit more on them than on yourself, but even if so, you end up stinking, shunned and in need of a big shower.
The Conservative line will try to land Labour's target culture (presided over by uber-gripping centraliser Comrade Sir David Nicholson) with the blame.
Labour's Mascara Kid Andy Burnham and team will, in return, will ask what the Coalition health team have been doing about high HSMRs / SHMIs for the past three years in an NHS presided over by, erm, uber-gripping centraliser Comrade Sir David Nicholson.
More specifically, Labour will probably ask what provisions or innovations in the 2012 Health and Social Care Act will be used to deal with the troubled fourteen. What new tools did Andrew Lansley put in the box using the politically capital-intensive Act?
What, in short, is the Secretary of State for Health going to do about this problem?
Jeremy Hunt has shrewdly made a virtue of the bully pulpit bequeathed to him by the 2012 Act, in reinventing his role as the patient's champion. Yet in so doing, Mr Hunt exposes himself to the risk of a public perception that he is (as Norman Lamont memorably bitched about John Major) in office, but not in power.