(c) News Group Newspapers Ltd
On 30th December, STV uncritically allowed the ill-informed views of Tory shadow health secretary, Miles Briggs (above), to completely misrepresent the scale and the effects of a small reduction in the number of beds available in Scottish hospitals. See:
Today, the Scotsman lazily takes its turn to act as the uncritical friend, for any Unionist party with another free story, from Briggs, of how ‘Scotland should look to Norway to help our ailing NHS.’
‘On a recent trip to Norway, I saw first-hand how the country has been able to eradicate delayed discharge – they have a fully integrated patient information system so that doctors and carers are able to see live information on people to deliver the best care and perhaps most importantly take into account what care and support patients want.’
Now, neither Miles nor the Scotsman offer any hard research evidence. We just have to take his word based on a wee trip and being shown, presumably, a few good examples. However, when I saw the Norwegian link, I immediately remembered a 2015 research study from the US Commonwealth Foundation which did not rate their service as highly as the NHS (all of it). I’ll return to that below. However, I thought I should find something more recent too. See this on delayed discharge in Norway, from 2016. Titled ‘Using fees to reduce bed-blocking: A game between hospitals and care providers’ by Snorre Kverndokk (it is quite a sleep-inducing read) and Hans Olav Melberg, the research is very critical of the system being used in Norway to achieve the results Miles Briggs was so enamoured with. There’s a strong hint in the title. Here are two short extracts from the conclusions:
‘To reduce bed-blocking, a fee was introduced (NOK 4000) that the municipalities have to pay the hospitals for patients who are ready to be discharged to municipal care services, but unable to leave because the municipalities do not provide the necessary services. To be eligible to receive the fee, the hospitals have to notify the municipalities in advance of patients who need municipal services. In this case, the fee applies from the first day the patient is considered ready to be discharged.’ (p27)
So, using Scottish terminology, our local authorities would have to pay a fee to our hospitals if they could not accommodate the patients being discharged. Reading on, we see:
‘The increase in municipal activity was almost the double of what is indicated by the net effect. One interpretation of the results may be that the financial incentives count more than the health incentives.’ (p28)
So, the hospital management is incentivised to discharge as many patients as possible and as early as possible to get as much income from the local authorities as they can. That’s just what happened in Norway.
Imagine the Unionist media reaction to such a scandal in Scotland?
There’s more. A 2015 study of primary care in ten countries carried out by the Commonwealth Foundation in New York found the NHS across the UK to be better than most and, notably, better than that in Norway on most indicators. See these few examples especially relevant to this topic of discharges and care in the community:
- Primary Care Doctors’ Communication with Emergency Department and Hospital: Percent who report they always receive notification when a patient is seen in the ED and when a patient is discharged from the hospital: UK 32%, Norway 25%
- Practice Uses Nurses or Case Managers to Monitor and Manage Care for Patients with Chronic Conditions: UK 96%, Norway 65%
- Practice Staff Frequently Make Home Visits: UK 84%, Norway 20%
- Doctor Routinely Receives Computerized Reminder for Guideline-Based Intervention or Screening Test: UK 77%, Norway 10%
Footnote: I was able to get a breakdown of the UK data to reveal that NHS Scotland was the best-performing of the four UK areas. To read more on this see:
I rest my case.