Shaun Lintern - Nursing Statistics

There has been much debate on twitter over the last couple of days on nursing workforce.  I have written about this in the past, in fact the subject of my first attempt at writing a blog was about Shaun's use of statistics.
I now find myself having to cover this topic again due to Shaun Lintern's continual habit of quoting statistics that are at false and/or misleading.
On Tuesday 18th, Shaun Lintern co-hosted #Nurchat. During that chat Shaun tweeted

Now anyone looking at the graph would think that this graph related to band 5 and band 6 nurses with nearly 174,000 being employed. Whereas it is in fact the same graph Shaun Lintern produced in January, which encompasses all nurses irrespective of grade working in 'Acute, Elderly and General' and has nothing whatsoever to to with nursing bands 5 and 6.

The spreadsheet from which this information is taken from can be found here

You will see in this spreadsheet that there is no mention of 'bands' instead it only records levels in this format;

 Shaun was questioned over his stats and he claims they come from Individual Trust's ESRs

ESR (Electronic Staff Record) is a HR programme that records the following

You will see that it does not record nursing bands yet Shaun is adamant that the ESRs are collected by HSCIC.

Shaun failed to reply to my tweet, so I emailed HSCIC and asked for a copy of the figures from ESRs. Here's their reply:

Therefore Shaun is telling porkies- they are not on the HSCIC website, it is not published, there is no link between pay band and occupational code and therefore would be impossible for Shaun to produce any statistics and graph them!

I personally cannot fathom why a journalist would set out to deceive the public in this way and my advice to all is to treat any statistics that Shaun Lintern produces with extreme caution.

**UPDATE**

Exposing Shaun Lintern's misunderstanding/misuse of stats feels like a full-time job at times *sigh* - There is more to statistical analysis that just rhyming off a line in a spreadsheet and feel any journalist worth their salt would actually analyse the numbers, especially if they are, like Shaun, hell bent on quoting them at every opportunity in order to appear knowledgeable.

but here's another one; 

On the subject of nurses - again - Shaun tweets;

HSCIC in collaboration with the RCN (see above email) undertook a recent study into nursing bands, the datasheet they emailed me states that there are 308,776 "qualified nurses" working in the NHS, of which   245,255 were in bands 5/6.  In Acute, Elderly & General, nursing bands 5/6 amounted to 139,510; nothing near the 174,000 Shaun Lintern is reporting!

The data sheets published on the HSCIC website also includes "unknowns" into the figures. So therefore, the "nursing" figures specified do not mean "qualified nurses"!

As specified in my first blog, nursing levels peak every Autumn due to graduate intake and should level off in December.  I have asked HSCIC to clarify the definition of 'nurses' used in their data because I have a feeling some will include HCAs + HCA Student nurse pilot scheme.  I will update this blog when I receive their response.

*HSCIC state that the nursing stats (bands) are not for general publication - hence why I have not published them in full here but happy to email them to those who have an interest, excluding Shaun Lintern!

Many of you may not have seen the HoC debate yesterday on the Francis report 1 year on.  If your interested the transcript can be found here

I am still working through the transcript but I would like to pick up on something Jeremy Hunt stated:

Statistics from NHS England show that in fact, even with the 'relaxation' of the target to 5% in 2010 (Ahem); this government has presided over the worst increase in A&E patients waiting more than four hours since the 4 hour target was introduced. By Quarter 4 2012/13, the figures had risen to 9%; in Quarter 3 2013/14 the level was 6.5%.
When Andy Burnham was SOS, the number of patients who waited four hours or more was only 2% .

Mr Hunt should be called back to the House to correct the record.

Patient Complaints

Thankfully now people are starting to question the reasons and motives behind the decision to single out midstaffs for public scrutiny.

First of all we had Professor Jarman and his infamous HSMR Stats, there has been much debate about these stats and I have no personal plans to revisit them as it has already been established that they are worthless.

However, with regards to Midstaffs and why it was selected; the HSMR was one of the reasons.  I would like to draw your attention to a piece written in Computer Weekly as it clearly shows how wrong those stats were and in fact; 

"Mid-Staffordshire NHS Foundation Trust maintained an average rate of patient death for 17 years, according to a rational look at the numbers behind the NHS controversy"

"Mid-Staffs admitted 13,780 seriously-ill patients in 2004. By 2007, such admissions had increased by 2,654 cases, to 16,434. Yet Mid-Staff's death-rate for these high-risk patients actually fell in that time, from 6.4 per cent to 5.8 per cent"

http://www.computerweekly.com/cgi-bin/mt-search.cgi?blog_id=102&tag=Mid-Staffordshire%20NHS%20Foundation%20Trust&limit=20


So bang goes the theory of Midstaffs being the "killing fields" as describe by Cure The NHS.

Since that article was posted on twitter, Cure and their allies have tried their best to counteract the argument that Midstaffs was a set-up and today Professor Jarman posts this:

So now we are onto complainants, every hospital has complainants and these complaints can be about a variety of things; appointment delays, waiting times, food etc.

So were Midstaffs complainant figures any worse than any other ?

Midstaffs complaints*

2005/06 = 447 Complaints     82.1% resolved in 21 days with 0 unresolved by the end of year
70 Trusts had higher rates ranging from 453 - 1264 complaints

2006/07 = 339 Complaints     71% resolved in 21 days with 2 unresolved by the end of year
104 Trusts had higher rates ranging from 340 - 1322 complaints

2007/08 = No complaints recorded by HSCIC, this could be because;

Information from 23 PCTs states they did not receive returns for some practices within their area and so have submitted incomplete data.

2008/09  = No complaints recorded by HSCIC, this could be because;
Information from 35 PCTs states they did not receive returns for some practices within their area and so have submitted incomplete data

2009/10 = 0 Complaints

2010/11 = 611 Complaints, no breakdown on number resolved
43 Trusts had higher rates ranging from 613 - 1533 complaints

2011/12 = 492 Complaints, no breakdown on number resolved
56 Trusts had higher rates ranging from 495 - 1062 complaints


So yes Prof Jarman is right there were other complainants but far less than those in other hospitals.
So that just leaves "Patient Pressures" i.e. Cure The NHS in his equation but I think there is another part that needs "exposing" and that is the role the Tories and their MPs had to play;

This is an extract from one of the Francis witness Statements, Mr Ken Lownds, who worked with CTNHS and was the first to initiate the support of local Tory MP Bill Cash, a "staunch supporter" of CTNHS.

Full statement here http://www.midstaffspublicinquiry.com/sites/default/files/evidence/Ken_Lownds_-_witness_statement_and_exhibits.pdf


So here's my equation;

Tories aim to privatise NHS + Vengeful Cure The NHS = Partnership to use Midstaffs as NHS propaganda to justify the privatisation of NHS and the closure/downsizing of Trusts.






* Source: http://www.hscic.gov.uk/

NHS In Financial Crisis

I'm sure we all remember the article in the Telegraph by David Prior, Chairman of CQC;

http://www.telegraph.co.uk/health/nhs/10612450/NHS-care-watchdog-warns-of-alarming-culture.html

There was much debate on twitter about it, with most calling into question the political motivation behind it. There is no doubt in my mind that David Prior overstepped the mark.

However, I was more concerned about the nuance of the article whereby David Prior states;

"The NHS will “go bust” without radical change to drive up standards and rid hospitals of a “toxic” bullying culture that damages patient care".

"Without “transformational change”, he says, including greater private-sector involvement, hospital mergers and an end to pointless targets, the health service risks going bust”.

Yet only one of his many statements relates to finances;

"almost half of NHS hospitals expect to end the financial year in debt"

That little nugget of information was almost hidden amongst all of the propaganda.  It was also stated in the article that there was a £330 million hole in trusts’ finances.

Call me cynical but I treat all figures from the right wing media with a great deal of scepticism. So is it £330m?

Figures from a FOI request to the Department of Health paints a different picture in that collectively, NHS trusts (2012/13) are in debt to the tune of £5.1bn.

The DH states in the FOI:
"We have interpreted ‘debt’ to mean the total amount reported by each NHS Trust in their Balance Sheet in respect of bank overdrafts, current and long term loans, obligations under finance leases, Private Finance Initiative (PFI) and Local Improvement Finance Trust (LIFT) arrangements. These are the items most readily identified with the term ‘debt’ in accounting terminology.

Org code	Org Name	Total       Operating revenue	Total Debt
		£000's	£000's
RVN	Avon and Wiltshire Mental Health Partnership NHS Trust	194,649	(47,367)
RF4	Barking Havering and Redbridge Hospitals NHS Trust	439,072	(261,608)
RVL	Barnet and Chase Farm Hospitals NHS Trust	358,530	(40,911)
RRP	Barnet Enfield and Haringey Mental Health NHS Trust	190,575	0
R1H	Barts Health NHS Trust	1,324,546	(865,552)
RC1	Bedford Hospitals NHS Trust	223,069	(8,222)
RYW	Birmingham Community Healthcare NHS Trust	249,124	0
TAD	Bradford District Care NHS Trust	135,925	(4,306)
RY2	Ashton Leigh and Wigan Community Healthcare NHS Trust	175,326	0
RXH	Brighton and Sussex University Hospitals NHS Trust	606,159	(37,135)
RXQ	Buckinghamshire Healthcare NHS Trust	350,954	(66,761)
RYV	Cambridgeshire Community Services NHS Trust	162,804	0
RYX	Central London Community Healthcare NHS Trust	193,341	0
RYG	Coventry and Warwickshire Partnership NHS Trust	205,910	(30,437)
RJ6	Croydon Health Services NHS Trust	243,581	0
RN7	Dartford and Gravesham NHS Trust	177,219	(73,263)
RWV	Devon Partnership NHS Trust	140,932	0
RYK	Dudley and Walsall Mental Health Partnership NHS Trust	71,330	0
RC3	Ealing Hospital NHS Trust	234,113	(494)
RWH	East and North Hertfordshire NHS Trust	350,574	(8,116)
RJN	East Cheshire NHS Trust	185,752	0
RXR	East Lancashire Hospitals NHS Trust	405,107	(123,643)
RX9	East Midlands Ambulance Service NHS Trust	155,065	(50)
RYC	East of England Ambulance Services NHS Trust	235,594	0
RXC	East Sussex Hospitals NHS Trust	387,425	(1,224)
RVR	Epsom and St Helier University Hospitals NHS Trust	343,599	(229)
RLT	George Eliot Hospital NHS Trust	122,531	(1)
RX5	Great Western Ambulance Service NHS Trust	74,677	0
RY4	Hertfordshire Community NHS Trust	129,108	0
RQQ	Hinchingbrooke Health Care NHS Trust	110,581	(14,218)
RWA	Hull and East Yorkshire Hospitals NHS Trust	497,193	(61,717)
RYJ	Imperial College Healthcare NHS Trust	971,561	(4,373)
RGQ	Ipswich Hospital NHS Trust	236,761	(28,924)
R1F	Isle of Wight NHS Trust	168,776	0
RXY	Kent and Medway NHS and Social Care Partnership Trust	172,961	(17,335)
RYY	Eastern and Coastal Kent Community Health NHS Trust	213,850	0
RAX	Kingston Hospital NHS Trust	208,667	(28,622)
RR8	Leeds Teaching Hospitals NHS Trust	1,002,529	(211,458)
RT5	Leicestershire Partnership NHS Trust	281,926	(8,756)
RY1	Liverpool Community Health NHS Trust	146,710	0
RRU	London Ambulance Service NHS Trust	303,186	(950)
RWF	Maidstone and Tunbridge Wells NHS Trust	367,421	(222,113)
TAE	Manchester Mental Health and Social Care NHS Trust	106,335	0
RW4	Mersey Care NHS Trust	208,598	(5,056)
RQ8	Mid Essex Hospital Services NHS Trust	275,234	(158,483)
RXF	Mid Yorkshire Hospitals NHS Trust	460,870	(327,940)
RYH	NHS DIRECT NHS TRUST	139,265	0
RY3	Norfolk Community Health and Care NHS Trust	124,843	0
RVJ	North Bristol NHS Trust	529,984	(9,456)
RNL	North Cumbria Acute Hospitals NHS Trust	235,326	(52,816)
RAP	North Middlesex University Hospital NHS Trust	184,011	(134,529)
RLY	North Staffordshire Combined Healthcare NHS Trust	79,598	(14,098)
RX7	North West Ambulance Service NHS Trust	261,390	(80)
RV8	North West London Hospitals NHS Trust	380,272	(63,257)
RNS	Northampton General Hospital NHS Trust	271,319	(669)
RBZ	Northern Devon Healthcare NHS Trust	220,696	(17)
RX1	Nottingham University Hospitals NHS Trust	813,301	(21,149)
RHA	Nottinghamshire Healthcare NHS Trust	425,742	(16,957)
RHX	Oxford Learning Disability  NHS Trust	23,246	0
RTH	Oxford Radcliffe Hospital NHS Trust	821,894	(292,809)
RW6	Pennine Acute Hospitals NHS Trust	569,981	(71)
RK9	Plymouth Hospitals NHS Trust	405,853	0
RHU	Portsmouth Hospitals NHS Trust	451,946	(253,311)
RQW	Princess Alexandra Hospital NHS Trust	184,592	(1,433)
REF	Royal Cornwall Hospitals NHS Trust	323,372	(1,601)
RQ6	Royal Liverpool Broadgreen  Hospitals  NHS Trust	440,858	(11,080)
RD1	Royal United Hospital Bath NHS Trust	233,623	(375)
RL4	Royal Wolverhampton Hospital NHS Trust	385,001	(9,316)
RXK	Sandwell and West Birmingham Hospitals NHS Trust	433,153	(30,177)
RCC	Scarborough and North East Yorkshire Health Care NHS Trust	31,582	0
RXW	Shrewsbury and Telford Hospitals NHS Trust	309,382	0
R1D	Shropshire Community Health NHS Trust	79,694	0
RYQ	South London Healthcare NHS Trust	451,633	(183,264)
RQY	South West London and St Georges Mental Health NHS Trust	163,244	0
RVY	Southport and Ormskirk Hospital NHS Trust	181,123	(8,586)
RJ7	St Georges Healthcare NHS Trust	641,867	(54,337)
RBN	St Helens and Knowsley Hospitals NHS Trust	278,623	(277,953)
R1E	Staffordshire and Stoke On Trent Partnership NHS Trust	372,793	0
RTP	Surrey and Sussex Healthcare NHS Trust	226,042	(328)
RDR	Sussex Community NHS Trust	188,015	(501)
RY8	The Derbyshire Community Health Services NHS Trust	188,435	0
RY9	The Hounslow and Richmond Community Healthcare NHS Trust	59,353	0
RY6	The Leeds Community Healthcare NHS Trust	139,943	0
RJ2	The Lewisham Hospital NHS Trust	241,490	(50,381)
RY5	The Lincolnshire Community Health Services NHS Trust	108,802	0
RAN	The Royal National Orthopaedic Hospital NHS Trust	120,809	(141)
R1C	The Solent NHS Trust	192,177	0
RY7	The Wirral Community NHS Trust	66,506	0
R1G	Torbay and South Devon Health and Care NHS Trust	142,186	0
RWD	United Lincolnshire Hospitals NHS Trust	422,861	(627)
RJE	University Hospital of North Staffordshire NHS Trust	473,629	(348,054)
RKB	University Hospitals Coventry and Warwickshire NHS Trust	509,243	(285,947)
RWE	University Hospitals of Leicester NHS Trust	758,742	(13,633)
RBK	Walsall Hospitals NHS Trust	228,417	(147,312)
RWG	West Hertfordshire Hospitals NHS Trust	278,273	0
RKL	West London Mental Health NHS Trust	233,798	0
RFW	West Middlesex University NHS Trust	154,205	(39,806)
RYA	West Midlands Ambulance Service NHS Trust	152,633	0
RYR	Western Sussex Hospitals NHS Trust	367,805	(2,732)
RA3	Weston Area Health NHS Trust	96,800	0
RKE	Whittington Hospital NHS Trust	281,403	(36,463)
RWP	Worcestershire Acute Hospitals NHS Trust	348,811	(79,560)
R1A	Worcestershire Health and Care NHS Trust	170,870	(114)
RLQ	Hereford Hospitals NHS Trust	175,825	(60,038)
RX8	Yorkshire Ambulance Service NHS Trust	209,822	0

This clearly shows the NHS is in financial crisis, not due to "culture" but due to the lack of investment this Government has made over the years.

Shaun Lintern has published lots of graphs and announcing in typical fashion that the NHS has more staff now than it ever has and a plug for Julie Bailey, even stating that it’s down to her. 

Of course these stats must be looked at to ensure they are factually correct.

Now, any analyst worth their salt knows the golden rule in presenting proper statistics such as these is to ensure that a year by year comparative study is carried out consisting of 12 months in each year. 
Shaun however made the classic schoolboy error and included an extra month, by starting with September and ending in October it distorts the figures.  So either he does not know his axis from his elbow or is deliberately trying to mislead the public.

Looking at the same source* and taking the figures from September 09 - September 13, we find a very different outcome;

Sept 09 -  307,749 nurses

Sept 10 – 309,139 nurses

Sept 11 – 306,346 nurses

Sept 12 – 305,060 nurses

Sept 13 – 307,692 nurses

So his claim that there is "an overall rise since 2009" is completely false. There are less nurses than in 2009 i.e. 57.

Now if we take like-for-like again using October 09 - October 13 we see that the number of nurses has fallen quite considerably;

Oct 09 - 352,887
Oct 10 - 353,678
Oct 11 - 350,825
Oct 12 - 348,831
Oct 13 - 351,221

1,666 less nurses than in 2009


Lies, damned lies, and statistics, is a phrase describing the persuasive power of numbers, particularly the use of statistics to bolster weak arguments.

Overall though what can’t be distorted is the fact that the amount of FTE nurses has dropped under this coalition government.

Statistics and pretty line charts are one thing but to fully appreciate their context one must also look at other factors in determining if we have enough nurses e.g. population growth (2009 = 51m; 2013= 56m) plus the increase in people aged 65+ increasing from 1 in 10 (2009)  to presently 1 in 6 of the population, birth rate etc.

Its easy to see from these figures that the coalition do not value the NHS, unlike Labour who from 1999 - 2009 increased the amount of nurses by *74,667 !

**UPDATE**

You may have seen the twitter debate between Shaun Lintern and I over his use and misinterpretation of the figures.  Shaun even produced a "right to reply" ....ahem... even the figures in that reply were wrong.  Once I pointed that out to him;

 his "right to reply" changed from this;

to this;

such was his hurry to rectify he left the cursor after the word "three" - hilarious !

So why the increase in nurses from September to October?  the answer is new intakes. The number of nurses have increased every autumn 2009/2013;

2009 = 1,447
2010 =    292
2011 =    787
2012 =  1,719
2013 =  2,076

So the *cough* "Francis Effect" *cough* amounts to 357 more A,E and G nurses!


To add insult to injury, Jeremy Hunt's article in the Telegraph also quotes the wrong figures;

http://www.telegraph.co.uk/health/nhs/10617243/Jeremy-Hunt-Why-the-NHS-is-crossing-the-Rubicon.html

did Shaun Lintern and Jeremy Hunt attend the same maths class or just share the same PR team?

* source http://www.hscic.gov.uk