h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

Danny B said:

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In fact, it wasn't me who said this. It was Teasswill.

I also said that my wonderful experience with a particular doctor who taught me how to be an active participant in my own health care was a total stroke of luck - he just happened to be recommended to me. Had nothing to do with me being 'educated' (which I am not, at least not past high school) nor being middle class (which I am not) though I suppose I am articulate.


az

Sorry, azahar (and, indeed, Teasswill) - I really thought I'd checked who said what

I wonder how common your experience is - if my girlfriend's recent visits to our GP surgery are anything to go by, not very common at all...

Sadly, I don't think it's very common at all, Danny B. I think I was extremely lucky.

As my beloved Dr Paul used to say to me - 'hey, I'm not God on the Throne, as some of my colleagues might like to think of themselves, so if I don't know something then I'll tell you I don't know and then I'll find you someone - a specialist - who *does* know.!'

Once I went in to see him about a very strange stomach complaint and Dr Paul said - 'Well, I'll be blowed, have no idea, let's look it up together shall we?'. And he brought down some huge tome off his shelves about stomach ailments and the two of us looked it over together, with him going - 'is it more like this one or that one?' - until we found something that seemed to fit. Together.

And together we decided on a treatment. Which actually helped and required no medication. He was actually quite against prescribing drugs unless it was totally necessary. But when drugs *were* ever required he made no bones about it - that I *had* to take them or else!

I should probably also point out that he was a social security doctor, not a private practice one, so anybody could have had access to his care.

az

He sounds amazing, but I think you're right - I can't imagine there are many like him...

Did your girlfriend question her doctor, Danny B? How was it unsatisfactory?


az

danny b i am dislexic so if its ok with you i will just post the best way i know how ok

now the money thing that is what i am getting at with the pachants not customers thing, the nhs is not a buisness and should never consideitself to be one, i am not saying everyone with a cold should have 30K spent on them hpwever the cost of propper treatment and care should not be a deciding factor. yore right allot of women want to go home after a day or two but alot of others dont i know people who have begged to stay in hospital after they had there kid where kicked out and the chiuld and mother sufferd because of it all becuse the hospital did not have the cash please there has to be a better way and it starts with not having time scales or spafic bugets per pachant

I never said a word about how you post, Bob!

What is the normal hospital stay for a woman after giving birth if there are no complications or it isn't a caesarian?

az

your right danny ime sorry it was z wanst it,

and the awnswer to youer question az for first kind its between 3 and 5 days and for second it is over night for normal brths with no complications (medicaly that is they dont sem to take phsyocalogical ones in to account) caceian is longer 2 or 3 weeks

Are you sure about that, Bob?
I suspect it varies between hospitals, but 2 - 3 weeks after a caesarian sounds very long.

Having no time or budget restraints sounds wonderful, but unfortunately there just aren't the necessary resources for that and there would always be people who abuse the system.

Oooh! Hospital inpatient length of stays. Professionally, that's right up my alley

The first thing that might surprise you is that the average length of stay is not really that interesting a figure. What is far more interesting is the extreme lengths of stay for some patients.

The way that an NHS hospital is paid for inpatient activity is on a fixed tariff basis by procedure, plus an additional daily rate for any length of stay over a figure which is considered the normal maximum for that procedure (*)(**). This maximum is called the trimpoint (***).

Hospital length of stays tend to form a Poisson ditribution. This on a graph looks a bit like a bell curve, but with the maximum shoved to the left and a long tail off to the right.

To calculate the trimpoint (and this is a national figure btw) they calculate the upper and lower quartile points (Q3 and Q1) for all activity for a particular pocedure and pump it into the following equation:

trimpoint = Q3 + 1.5x(Q3-Q1)

For most hospitals, all but about 2-3% of the bed days will be under this trimpoint. So we can consider this point as the maximum length of stay in almost all cases, and that most admissions will have significantly shorter lengths of stay.

So to the question in hand: what is the trimpoint for Maternity admissions?

Well these are classified into three groups: Normal, Assisted and Caesarian. They are further classified by 'with complications' and 'without complications'. (There can be a further classification of 'elective' and 'emergency' admission, however this doesn't really apply in this case, as almost all maternity admissions are classified as emergency.)

So here are your numbers (****):

Normal w/o cc = 3 days
Normal wcc = 11 days
Assisted w/o cc = 7 days
Assisted wcc = 12 days
Caesarian w/o cc = 8 days
Caesarian wcc = 14 days

Happy now?



(*) Hospital length of stay is calculated by the date of discharge minus the date of admission. If that figure is equal to zero, then it is date of discharge minus date of admission plus one. (The maths really doesn't work if you've got a length of stay equal to zero )

(**) Any part of a inpatient admission that is spent in an Intensive or Critical Care Unit is taken away from the length of stay calculations as that is charged separately on a bed day basis.

(***) one would have thought that it should be spelled 'trim point', but no, the NHS wants to spell it as 'trimpoint'.

(****) These lengths of stay relate to the mother. The baby is assumed to come along as part of the same package of care and will travel through the system with Mum. If the baby is ill and has to be admitted to SCBU or worse still NICU, then that will form a new package of care which will be charged for separately.

I forget who said this now - but think it was Raymondo - "Not that I'd for one moment suggest that the government's IT contracts go to the lowest bidder, reagrdless of quality, who then fails to be any bleedin' good."

You'd be wrong if you suggested that - most government contracts are awarded on the recommendation of "advisors" I could suggest you look at a list of Labour Party donors, or who some of the prime-minister's "advisors" used to work for, if you wish to determine who gets what.

Certain contracts have been so badly mismanaged that it has been recommended that certain companies should be taken off the approved suppliers list. Yet to happen.

Well, government IT projects being a shambles pre-dates this government, and truth be told probably the one before that.

Though of course as the Tories *still* want to kerep secret the names of some of their backers we shall never know what affect they had on government spending, shall we?

>>"yore right allot of women want to go home after a day or two but alot of others dont i know people who have begged to stay in hospital after they had there kid where kicked out and the chiuld and mother sufferd because of it all becuse the hospital did not have the cash"

It rather depends whether someone has a medical need to stay in hospital. If they don't, they are taking up space or other resources that could be used by someone else.

Yes, why were they begging to stay in?

Don't start me on IT consultancies....

>> the nhs is not a buisness and should never consider itself to be one

I agree with you on that one Bob, but... (y'all knew there was going to be a "but" didn't you?).

What I'm quite intrigued about, and BG/GD may be able to tell me, is how the NHS and other public bodies do their accounting. I've been doing some business-type studies recently, and it seems to me that all the models and mathematical tools we have for understanding how organisations work financially are based on businesses - and mainly on manufacturing businesses at that. They presuppose that "income" = "sales", that there are things called "stock" and "work in progress" etc, etc, etc.

Not only are these concepts irrelevent to public bodies, but - far more disturbingly - they mean that we cannot see the things which *are* relavent, because we are tracking them through metaphor rather than directly. Of course I cannot think of an example of what I mean.

But I am curious to know whether the impression that I have gained is right or wrong that the standard corporate "Profit and Loss" and "Balance Sheet" are not appropriate tools for the job, and that it is like trying to hammer in screws or knit with skewers?

Ben

unfortinatly (from my experance as the husband to the pa of a buisness mangare in mersycare one of the nhs trusts and a frequant visater to hospitals) they do seem to go one the old things, obvasl the profit part cannot be takin in to account but all sorts of formula like adveradge cost per pachant and that sort of things are used wich i feel are just wrong.

and in responce so someones comment about why the new mothers wanted to stay in hospital it was becsue they where not happy with there abilaty to raise the chiuld, feed the ciuld bond with the chiuld and basically be a mother with out more help so yea i know you have healthvisaters and comunaty mid wives but they are only there for an houre or so so it is not enough if you are not confidant

>> all sorts of formula like adveradge cost per pachant and that sort of things are used

Mmmmm.... but what you cannot measure you cannot manage. It is important that money is not wasted and you cannot tell if it is being wasted if you don't keep track of it.

There is not an infinite amount of money in the NHS, and there will shortly (in two or three years time) be significantly less than there is now. All the more reason to spend what there is as wisely as possible, and to spend it wisely you do have to keep track of things like average cost per patient.

B

Ben, the issues, problems, and to be quite frank, the terrifying variances that exist on a supposed 'average cost per patient episode' are way beyond explaining with my 7wpm typing abilities.

However, if you ever fancy to have a chat face to face / Skype / whatever on the subject, then I'll be able to talk at extreme length, and will make your hair curl at the sheer horror of the financial control knife-edge that the NHS sits upon.

Hair curling on the NHS? Yep, I'm up for that sometime, GD.

B