INTRO RAP: [00:00:00] Stories Labels Misconceptions NHS remains a blessing created in 1948. We want it to remain great. A podcast where we share our stories explore solutions and not our glories they say its broken but its not done with your hosts Val Barrett Dr Jeremy Anderson 

Val: Welcome to Stories, labels and Misconceptions with Val Barrett. 

Dr Jeremy: I'm Dr. Jeremy Anderson. 

Val: We posed the big question, do league tables make the NHS better or just more competitive over to you, Dr. Jeremy?

[00:01:00] 

Dr Jeremy: That's a good question. When I heard about this it seems like a good idea, right? We do want to know where our NHS trusts, where they're doing well, where they're lagging, and, the idea of having some sort of ranking does make sense.

The question though is what do we use that information for? Because there's the thing that the government is saying that it's gonna be used for.

Val: What is that?

Dr Jeremy: But is that really what happens? I listened to a new segment where Wes Reading was talking about this, and I know you love Wes.

Wes is the best, but I have to say I was a little confused about something Wes said Wes was saying this was gonna give the public or patient choice, and this was gonna end the postcode lottery as if people would be able to choose their hospital based on the league table.

Val: No, 

Dr Jeremy: I don't know if that's exactly what he meant, but I don't think that makes much sense because

Val: I don't like that. ,

Dr Jeremy: I don't think patients [00:02:00] with long-term conditions can change their hospital nearly as easy as that. And number two, like what, if you're in acute need. You're not gonna be riding in the ambulance to the hospital and whipping out your league table to decide which one to go to because you're not gonna be looking to see which one has the longest A and e wait. You're not in a position to do that. It makes no sense. 

Val: And at the end of the day, the paramedics have to take you to the hospital. Exactly. They're not gonna be driving if they, oh, I know. The best place for heart attacks is Hammersmith. Even though you are in West Sussex, I'll take you all the way to Hammersmith. That's not going to happen.

Dr Jeremy: That's never gonna happen.

Val: No one's gonna drive you all the way to Hammersmith. It doesn't make sense. I understand. They need to know what hospitals are lacking. What that would tell them is where improvement needs to be made.

Dr Jeremy: Exactly.

Val: If you are looking at the one on top, you wanna bring the [00:03:00] one at the bottom up. Because if everybody runs to the top, the ones at the bottom lose money? Lose staff? Do you see what I mean? It makes no sense. Yeah. It's not like school. Even when it comes to education. That's limited unless you pay privately. The choice is in the private sector. But in the NHS, why go 40 miles out? Just because that hospital is in a better position. Than the one up the road exactly. Because I did check mine. 

Dr Jeremy: Yeah. The analogy to education is relevant. Before I came to the uk, my wife and I lived in Paris. She was working for the OECD 

Val: who, sorry?

Dr Jeremy: The OECD. The Organization for Economic Cooperation and Development 

Val: uhhuh. 

Dr Jeremy: One of the programs in the education department, that's where she was working that they do is, she wasn't involved in this program, but it's an international program where every year they they test 15 year [00:04:00] olds for countries all over the world participate in this. So 15 year olds get tested on skills they're learning in school. And what they do is they create elite table, they rank all the countries in terms of Yeah. Which education system is the best. They identify top performing countries, places like Finland and South Korea. And then other countries might be middle of the pack and then other countries are at the lower end. And one of the things my wife did was she went to one of these countries that was maybe not doing so well. Yeah. And she was looking, she was part of a, kind of an evaluation of their education system to see where they could improve.

And I won't name the country, but this country was, they were very proud of their sort of excellent schools so that the best students were streamed into. One program excelling in university. But the majority might be living in the countryside where the school didn't have plumbing electricity or heat

Val: yeah. 

Dr Jeremy: A tiny fraction of people were getting all the resources and the vast majority were not. That's what happens. You know what they said [00:05:00] is okay, if you really wanna raise your score you're gonna get more bang for your buck if you spend money lifting up.

Yeah. The people who are not doing particularly well. I don't have a problem with league tables, as long as that's the kind of approach you're taking, you're saying we wanna lift people up. If it's just a way of directing money to the top people would get worried

Val: it's gonna be like the football league. All the money goes to the Premier League. Enough. And then little bits trickle down, and you don't want it to be like that. No. It's the NHS. And does it take into account how they care for patients? It doesn't make sense. Who actually benefits? Is it the patients, politicians or the press do league tables drive genuine improvement? Or just political point scoring? People, need to feel the change. You need to, instead of sitting for 12 hours, [00:06:00] guess what? I was only in there for seven hours. 

Dr Jeremy: Yeah. 

Val: That's a change. But it's not a change if it goes back up to 12 hours, are they just focused on easy things that they can do as opposed to really grab hold of a hard things? Yeah. So I haven't heard them talk about social care. Haven't you noticed that?

Dr Jeremy: No, they're not,

Val: nobody's talking about social care because it's the hardest thing to do. You would've thought okay, we've come in, gonna be different. Do something no other government has done. Take hold of social care. Really do it because that's what's gonna help.

Dr Jeremy: Yeah. 

Val: With A & E 

Dr Jeremy: Yeah. 

Val: To bring a and e waiting times down and quote unquote bed blockers. You've got to sort out social care first. It's the foundation of the NHS. It's not [00:07:00] the A & E You go to A & E when you are sick. We want to be a society where we're getting healthier and better. That starts in social care. 

Dr Jeremy: Yeah. I'm concerned about what these rankings mean. So it seems that the top performing NHS Trust get rewarded with greater investment and financial freedom. So it's not just more cash, but top performing trusts, get the autonomy, to reinvest surplus they might have so they can fund improvements to their equipment or services. They get more control over their spending. And they don't get as much oversight. Yeah. They become what are called foundation trust, they get an enhanced status. They get the Freedom

Val: Foundation trusts have been around for back in the day. That's nothing new.

Dr Jeremy: It's not new, but they're getting an enhanced amount too. Innovate and allocate their own resources. And [00:08:00] their bosses get higher pay because that's the 

Val: no, we want to stop the higher pay. Look, this is how I see.

Dr Jeremy: That's what they're doing right? 

Val: I don't work in the NHS. But I am a recipient. I'm a frequent flyer. Why should people be rewarded for a job they're supposed to do? That makes no sense. We already know that chief executives, managers, are already paid a lot. Some are paid more than the Prime Minister. If you are not delivering you are paid less. You are already paid for your job. It shouldn't be a pat on the back. Why go to work to fail? That makes no sense. It's not the football league. This is the NHS. For them to put it in league tables is arsenal my beloved man United. No, it's not that, this is the NHS and it's a [00:09:00] service we want to remain in its current form. But if you are gonna just keep throwing money 

Dr Jeremy: Yeah. 

Val: At people doing well give them a clap and a gold star and a high five. No, you are going to work to do the best you can because you've got sick people to take care of. That should be Your motivation.

Your motivation shouldn't be, I'm going to get more money. You get a wage slip and I'm sure they get a damn good wage. 

Dr Jeremy: I'm sure it's pretty good 

Val: so that's the people at the top get, 

Dr Jeremy: That's the people at the top. But here's the issue. Trust that are in financial deficit. That is if they're overspending by the rules, they cannot be ranked in the top segment, even if clinical performance is strong. So the question for me is what if a trust is not performing? Or what if it's in debt or in deficit? Because it's underfunded. What if management [00:10:00] is doing the best it can, but they're underfunded, understaffed. If they're in deficit they can't be ranked highly. So they can't get that autonomy, that control, 

Val: It doesn't take into consideration how patients are treated when the fundamental premise of the NHS is about patient care 

Dr Jeremy: Yeah. 

Val: Is one of those things, but we seem to be moving away from that. In the news it said, senior managers in poorly performing trusts may have pay cuts or be replaced while strong performance may bring rewards. No, 

Dr Jeremy: The key thing about the performance is linking their ranking in the tables to whether they're in deficit or not. It creates a kind of perverse incentive. There's lots of investments that a trust might wanna make. Yeah. That would put them in deficit, but would pay dividends in the future, it might also, prevent collaboration. A trust might not want to take on or share [00:11:00] patients with another trust. In fear this will put them in the red and affect their ranking. We want to be, careful about, how we rank NHS trusts in a way that could impact their and then 

Val: What about newly qualified doctors and nurses looking for jobs? Who's gonna want to work at the hospital , that's at the bottom. What staff are going to be attractive to that? It doesn't make sense. 

Dr Jeremy: Yeah. We really don't wanna Situation Yeah. Where there's a kind of positive feedback loop 

Val: uhhuh

Dr Jeremy: where, trust that are bad, just get worse and trust that are are at the top. Just keep getting the creme de la creme, right?

Val: Yeah. I know managers get paid a lot, but I don't know who sets the pay. I don't believe people should be threatened with pay cuts when there could be other reasons why that hospital trust isn't performing well. They're not measuring other things that they could be performing well in that they can't measure. Do you see what I mean? Yes. I don't [00:12:00] like that, and I bet it's not gonna be easy for them government can write whatever they want. Government can have a wishlist of whatever they want. I remember when the Met were having problems with certain officers. Sure. And the, commissioner? Said it's hard to sack them. Yeah. It's hard is your NHS going to come across that issue as well.

Dr Jeremy: Yeah. And also, these are big institutions. The things they measure, like ranking a particular hospital on a few of these things 

Val: Yeah. 

Dr Jeremy: Doesn't necessarily reflect it. Maybe not fine grained enough, you might have a fantastic cardiology department, but the cancer department is falling behind, the urology department might be the best in the country. If everybody gets lumped in this ranking according to a single hospital.

Val: So it's flawed.

Dr Jeremy: Some room for tweaking here.

Val: Tweaking. 

Dr Jeremy: Yeah. 

Val: I think it's more than [00:13:00] tweaking. Tweaking or tinkering. I don't think it's, yes, it's still going to be good enough. 'cause as you just said, the cardiology performance could be the most outstanding cardiology department in the uk. 

Dr Jeremy: Yeah. 

Val: But another department could be bad, hence it's got a low ranking.

Dr Jeremy: Yeah.

Val: It doesn't take into account departments that are doing well. And it doesn't take into account patient care. 

Dr Jeremy: Yeah. If the A & E , is over stretched. That's gonna drag everything down 

Val: In my hometown, eventually what they did, they closed the A & E at eight o'clock. Because nobody gets sick past 8:00 PM Everyone's yeah. All of a sudden the fairy just comes along at that time. Go ding. Everybody's well, and then they have to drive, I think it's 17 miles to the nearest A & E that's no good if you Yeah. If you are having a heart attack. I've had that, thank [00:14:00] God I'm up the road from one of the best in the country. 

Dr Jeremy: Yeah. 

Val: And if having one you do not wanna be 17 miles away. Yes. Just because your nearest one has decided it's closing at eight o'clock because nothing happens after 8:00 PM. Yeah. Humans don't function after 8:00 PM in that town. So will then some hospital trust that are near the bottom have big issues with their A & E Will they do that? 

Dr Jeremy: Will they shut down their A & E or something? 

Val: No, shut it down at a particular time. 

Dr Jeremy: Yeah. I don't know. I think the claim is that trust in that segment five, in the lowest performing segment they get more what they call support. But that doesn't necessarily mean a whole lot of money. 

Val: But what is support? A telling off support means a telling off,

Dr Jeremy: I think that's the risk, right? It could be a shaming. Changing management,

Val: [00:15:00] the shame it has already taken place. 

Dr Jeremy: Yeah. And I, I can tell you as a psychologist, shame is not a fantastic motivator, everyone thinks it is, oh, you need to shame. But that makes the person doing the shaming feel good, but it doesn't actually help the person who's being shamed

Val: Uhhuh. Okay.

Dr Jeremy: And I really don't think that the people working in these underfunded hospitals that are dealing with really, complex populations, if you're in a deprived area.

Val: Yeah.

Dr Jeremy: And we know these populations have more complex needs.

Val: Exactly.

Dr Jeremy: And the infrastructure sucks. It's just harder to do the work there if you're not performing as well. We know why that's happening. It's not because people are bad and need to be shamed. It's because they're not properly funded. If there's more oversight, if there's more paperwork basically for them to fill out and explain what they're doing and how they're doing it I'm [00:16:00] not sure that's really gonna help things very much unless you're gonna expand funding.

Val: is the problem always funding? Money is thrown at the NHS but not thrown in the other direction. Social care. 

Dr Jeremy: Yeah,

Val: it never is. And then what they'll do is come the election. Say, oh, now we're going to listen to you, we should have learned. You should be doing that now. They know the answers. I can't wait to see the palava. It's going to happen this winter, because they're going to be surprised the fact that it's going to be cold. They're gonna be taken by that surprise. And already 2 million people have said they're not turning the heating on. That's gonna factor in 

Dr Jeremy: because they can't afford it. 

Val: Yes. But that will have an impact, especially if you are older, living with a lifelong condition. You are vulnerable. That will impact on [00:17:00] look, perhaps spending a night. And the NHS will keep you warm. I know that sounds weird, but bloody hell. Yeah. And you'll get fed. Yeah. As bad as the food be, it's better than nothing. Yeah. So again, it's got to be social care. It's got to be helping people stay at home. If it's about what we mentioned before, the heating.

Dr Jeremy: Yes. The home heating prescription plan.

Val: Heating prescription. 

Dr Jeremy: Yeah. 

Val: But when people look at the amount of money it costs they think, oh no, we can't spend that amount. 'cause they look at it upfront and it's a whack of money. Didn't have problems with HS2 and look what happened there. Yeah. So they look at that amount of money, but they don't have foresight if we spend 5 million now let's say it's five, it's gonna probably be more. In the long term, [00:18:00] this will help bring down people, A & E bed blocking free up spaces get people healthier. It will save us money. In the NHS? 

Dr Jeremy: Yes, 

Val: because we're spending in social care, all the issues people have, mold and damp in their home, can't afford heating. Can't afford decent food. Give more money in benefits. Yes. Say yes because we know trickle down economics don't work because I went out there and brought my yacht we know it doesn't work. 

Dr Jeremy: I was looking,

Val: I'm join it. 

Dr Jeremy: Yeah. Don't they allocate funding according to need? You would think more deprived areas need more funding. The formula for NHS funding is needs based and equitable they use weighted population data. For age deprivation and health status. And then they have it, it varies depending [00:19:00] on what kind of care we're talking about. Is it acute care, mental health maternity or ambulance services or something like that? Yeah. Then there's what they call market forces. There's regional cost differences, like if you're in London or in, you're in a rural area, they have a specific health inequalities adjustment.

They target funding to try to reduce disparities in outcomes. And that all sounds great except that in like it does adjust for deprivation and unmet needs, and it's all supposed to make things even, but in practice it's not enough. I have a figure here saying that GP practices in deprived areas receive 10% less funding per patient even after adjusting for the need.

There's a formula for determine general practice funding, but the claim is this formula is outdated and doesn't reflect deprivation. And the complexity of the patients. And so trusts [00:20:00] or GP practices in deprived areas have higher demand, fewer staff of course structure. And so of course they're going to score lower on performance tables. Yeah. Even if it's just because they're in the red, because, they've got high demand without enough funding. 

Val: And then they can't attract staff as well. Of course you can. Nobody wants to work there. 

Dr Jeremy: Yeah. So we're at risk of compounding the problem, right? 

Val: I'm looking here at some of the trusts. Moorfields Eye hospital NHS trust. Rank one amongst trust in England. 

Dr Jeremy: Yeah. 

Val: It only deals with eyes. 

Dr Jeremy: Yes. It's a specialty center.

Val: So if you have a trust that only deals with one issue as opposed to the Imperial College healthcare, NHS trust, that deals with multiple issues. 

If you have a trust that's more of a general hospital versus a specialty center.

Yeah. But where I'm going with this is, [00:21:00] wouldn't it be easier for Moorfields to rank higher because it's only focused on one thing. There's not other departments. letting it down. Do you see what I mean? 

Dr Jeremy: Absolutely. If you don't have an A & E you can't be criticized for long waits. 

Val: Yeah. So is that fair against the rest? Is it really 

Dr Jeremy: Good question. I don't know how they deal with that. If you're an eye hospital, I suppose your urgent care I don't know how many eye related emergencies you're dealing with. I've got loads but presumably people are not waiting for, seven or 12 hours so it's easier. I don't know how they adjust for that. 

Val: No, Hammersmith doesn't have an A & E but yeah I think the tweaking. Needs to be around. They've got one list. So you'll have the Royal Marsden, which is cancer. Moorfields Eye yeah. So [00:22:00] what I'm trying to say, the ones that just focus on one particular thing 

Should have their own league, if that makes sense. Yes. And then you've got another list of trust that don't have an A & E and then you have a list of trusts that do have A & E 'cause most of the times it could be the A & E that's the issue. 

Dr Jeremy: Yeah. 

Val: So it makes it unfair. It doesn't make sense. Yeah. It's I remember this speech. I'm trying to think of the name of the man that did it that said it. Sorry. It was Margaret Thatcher. In the comments and the speech was, bye. Oh, I think it could be Geoffrey Howe I will have to check. I, it was a brilliant speech. See how old I am? 

Dr Jeremy: Yes. This is before my time, in the uk. I was in Canada at the time. I don't think I would've been paying attention 

Val: Yeah, it was Geoffrey. [00:23:00] Howe when he resigned 13th of November, 1990. And a part of the speech, but he said something he did an analogy around cricket. Sending. Batsman to bat without the battle. Something like that. I know I'm not saying it but it was absolutely brilliant I remember that speech. There were certain iconic speeches of a moment that go down in history, and to me that was one of them. We're on about the league, the NHS, not the football. 

Dr Jeremy: Yes. 

Val: It seems unfair that you have a hospital trust that just deals with eyes and then you have some that deal with everything. How can you make a comparison? You said before cardiology could be, I know in Hammersmith, they are a designated heart specialist in the country. Okay. They're one of six. They were brilliant with [00:24:00] me. The ambulance radioed in, and as soon as I got there, they were ready. And then you hear horror stories where someone's having a heart attack and they're left on a trolley.

Dr Jeremy: Yes. 

Val: So my experience could have been really good because I was taken to Hammersmith. 

Dr Jeremy: Yeah. 

Val: And they went straight to work. 

Dr Jeremy: Yeah. So you had a good experience. Yeah. You know when you were in hospital. And I guess, if we're going to rank hospitals or evaluate them to see what's working, what's not. Why do some do well and some don't? 

Val: I don't go to every single one. 

Dr Jeremy: Yeah. 

Val: I don't know if the ranking is done by each department how they then rate that to an overall performance. The indicators and all that. But does that take into account, patient care? How can you measure the outcome of [00:25:00] patient care now supposing 

Dr Jeremy: Yeah. 

Val: Hammersmith was at the bottom, but then I say brilliant care. 

Dr Jeremy: Yeah. 

Val: In cardiology, I wasn't kept waiting. They were waiting at the doors. It was absolutely brilliant. Would that be taken into consideration? No, because the other parts let it down. 

Dr Jeremy: Yeah. 

Val: How can that be? 

Dr Jeremy: I guess I was wondering if you just thought about just a particular service, right? If a service isn't running well, yeah. What are all the factors could be contributing to it? Running poorly, it might be that it's mismanaged. But that's not, yes, that's, it could be. By no means is that the only reason, it could be bad staff, but probably not, there's training standards, everyone's trained the same way. You could have more complicated patients, right? Yeah. Yeah. Like in some areas [00:26:00] people are just dealing with a lot more problems and a lot more complex problems. I can totally imagine.

Val: I've looked at the worst it says here. Example of the worst and what they face. 

Dr Jeremy: Yeah. 

Val: Queen Elizabeth Hospital. In Kings Lynn Norfolk. That doesn't sound like a deprived neighborhood to me. Yeah, some, yeah. Kingsland contains some of England's most deprived areas. I would not have thought of that. 

Dr Jeremy: So that could be an example of a trust and I don't know anything about this trust. Yeah. But, if they're in a really deprived area. If they're dealing with a high need, very complex patient population with a whole lot of different problems and they don't have maybe good infrastructure, or if they're underfunded we can understand why that hospital is underperforming or in deficit. Because if they're not getting enough funding and [00:27:00] they've got a huge amount of need, they're gonna be struggling. 

Val: I think it's weird how they are ranked. I don't like what the best ones get and the lower ones get what is the support that they're gonna get? What is it? Like I said, I will keep singing the same old tune, same old song. Social care. 

Dr Jeremy: Yeah. 

Val: Stupid. It really is. They should have been the first thing they tackle. But it can't be because it's too hard. They don't have the answers. They really don't. I generally, believe no government has the answers for social care. 

Dr Jeremy: That's a good point. 

Val: They don't. 

Dr Jeremy: And that comes down to a demographic problem. We have an aging population, mostly older people and not enough younger people.

Val: Absolutely. Whether they take tackle it today or tomorrow, [00:28:00] we're still going to have an older population that are living longer. 

Dr Jeremy: Exactly. 

Val: Not enough people in work. 

Dr Jeremy: Yeah. And by no means to pay for social care that's not just the uk that's a worldwide problem. Not everywhere, but in Europe, North America, Russia, China East Asia, it's huge. China is looking at a total demographic balm in the coming years. South Korea, apparently it's, it's a huge problem.

Val: But even though we have this problem what happens is because we're not tackling this problem that's not going to go away. 

Dr Jeremy: Yeah. 

Val: We're creating a money pit into the nhs. 

Dr Jeremy: Yeah. 

Val: Because A & E is gonna get worse. Wintertime, bed blockers. 

Dr Jeremy: Yeah. 

Val: People that are well enough to go home, cannot go home 'cause there's nobody to care for them. Money on that bed. [00:29:00] Somebody's waiting for a new hip, they can't go in. Guess why there's a bed blocker on that bed. But the bed blockers there, not by choice. But because there's nobody to care for that person when they come home. Because guess what? There's no social care. So we don't really care. Not really. 

Dr Jeremy: No. 

Val: It has to begin in social care. Whether we have the answer today, there has to be a start we live in a society where man has gone to space people get new hearts. We are curing this and that, and we can't sort out social care.

Dr Jeremy: Yeah. 

Val: Bloody noura. What is that? Whether or not they need it. , One day they might, but they've got money to go private. It's fine, but the majority of us don't. The majority of us are reliant on the system that will help us. [00:30:00] Most of us do not own a home. Where the sale of that home will pay for our social care. It is a shame there isn't anything in place yet. They've had 14 bloody years to think of this. It sounds like somebody dragged them off the street and said, do you wanna work in government? You've had 14 years. Stop the writing, stop the slogans. And sort out social care. I'm sure some people wouldn't mind something like national insurance, for social care. 

Dr Jeremy: A new tax To pay for social care? 

Val: Let's not use the word tax. 

Dr Jeremy: A new

Val: because it makes people uneasy. 

Dr Jeremy: A value surcharge. 

Val: Something that goes in the kitty. 

Dr Jeremy: Yeah. 

Val: For just social care. 

Dr Jeremy: Yeah. 

Val: There's social care kitty. 

Dr Jeremy: Okay, let's imagine that we have plenty of money for social care. You gotta find people to work in that sector. People who wanna do social. Oh, yes, 

Val: They're [00:31:00] deporting them. Yeah. That's, oh yeah. They're getting rid of all the immigrants that worked in social care. 

Dr Jeremy: So we still have the demographic problems, but even if we had the money, we don't necessarily have the people to do the work. That's the issue, right? There's a tension between our concerns about overpopulation. I think you and I are both of an age where, like when we were growing up the discussion was overpopulation. The world population is skyrocketing. And, I can't remember when it was, they said, you'll need seven Earths to if everybody lived like we do in the West. We just don't have enough resources on the planet to support everybody. And overpopulation, iss a huge problem. We're cutting down the rainforest, all this kinda stuff. Uhhuh ecological collapse. And on some level that's true. There is a finite amount of space on the planet. We can't keep multiplying indefinitely. 

Val: Okay. 

Dr Jeremy: But that puts us in conflict with our economic model. That requires more people at the bottom paying into those at the top so I don't [00:32:00] know how we match those because we can't keep having more people and, not have ecological collapse. 

Val: We do have, as they said, a big unemployment list. Young people unemployed. We have gaps in social care.

Dr Jeremy: I think a big part of the problem that governments are facing with funding things like healthcare and social care and everything really is our demographic problem. We've got good demographics for reducing human impact on the environment over time, because there's gonna be less of us. Which is great, but terrible for our economic model. That's what we're dealing with right now. 

Val: But it's the fact that. It hasn't been mentioned in a long time. 

Dr Jeremy: No. No one talks about it.

Val: Yeah. So it hasn't really been mentioned, which is why every minute they're coming out with something about the NHS. Which hasn't really done anything 

Dr Jeremy: it [00:33:00] look like they're doing something, but it's not, you're not dealing with a hard problem.

Val: Yeah. They're just writing pen pushing telling people what they already know, but this could backfire put people off from applying for jobs patients might not have faith. In the local hospital, would you, if you lived beside the worst 

Dr Jeremy: honestly, that's a good point. 

Val: It's off putting. He doesn't give you much hope. You look up the road or the next one around the corner, you think, oh, that one's better. I'll go there. 

Speaker 4: Let's say West Streetings pitch was actually correct that somehow people were actually able to go to whichever hospital they want to based on the league tables. What's gonna happen if everybody leaves the low ranking hospitals? And goes to the high ranking ones. 

Val: The waiting [00:34:00] list is gonna be longer, the high ranking one, then the rank's gonna get lower. 

Dr Jeremy: The whole system's gonna collapse. It will on the poorly performing ones.

Val: Much as I love Wes, I don't know where he is talking from. Sometimes I have to ask myself, 'cause I have high hopes. 

Dr Jeremy: That was a messaging thing, a communication strategy 

Val: it really did. That was the bottom ranking. Communication. The bottom. Ranking. So it's going to create a lot of fear. Anxiety and inequality, the high ranking ones. They're gonna get more perks. Their manager's gonna get more money, the low ranking ones through whatever reason why they're low. Get a pay cut. That's when you know they're talking a load of crap. Because it's not gonna be that easy. I'm sure the unions are gonna be all over that. 

Dr Jeremy: Yeah. 

Val: It's not gonna be that easy. And if they say, okay, we are gonna change the contracts for the new [00:35:00] intake, they're gonna have a load of shit then.

Dr Jeremy: Yeah. They don't, I don't think they're talking about cutting the wages of the rank and file, it's more about cutting the bonuses of the

Val: No, he says cutting pay. That means money. You've signed a contract that says this is the amount of hours you should do. This is the amount of pay you should get. I wonder if in that contract it says, if you don't deliver X, Y, Z, you lose a certain percentage. I bet it doesn't state that. 

Dr Jeremy: No, and I don't because it wouldn't. No. And the government isn't gonna be so fine grain that they allocate the money at the national level to NHS England or whatever the department distribute that money to the integrated care commission boards, ICBs and the ICBs distribute the money locally.

Val: But also it says here, they don't take into account the social determinants, staffing shortages or the complexity of local populations. So of course you are going to have [00:36:00] differences. Regardless if the care in that trust is really good, it's going to rank lower because of those issues. 

Dr Jeremy: Yeah. I'm also, getting back to the education analogy and the way these rankings work. My wife was telling me about when China started participating in these rankings I guess they weren't originally scoring too high, or at least it was Shanghai participating 

Val: Shanghai, 

Dr Jeremy: Shanghai in particular that was pretty,

Val: you missed, did you miss that? I know you are not British and the British have a weird sense of humor. 

Dr Jeremy: Oh no, I missed that.

Val: We're ranking high shanghai.

Dr Jeremy: Oh my God. No I did not get the reference there. But what she was saying is when they look at schools some were ranking highly, some were ranking low. And they took the staff from the high ranking. Schools, 

Val: They placed them with the low

Dr Jeremy: and moved them to the low ranking ones, to improve those ones. 

Val: What happened? 

Dr Jeremy: Their overall [00:37:00] ranking improved dramatically. Okay. It was quite effective. But you can only do that when you have a, let's say authoritarian kind of government that can just tell people, you go over here and do this, and it's kinda a weird situation. Because you effectively punish good teachers by sending them to the worst schools.

Val: The teachers at the worst school, they're like having a day out. Exactly. And they're like saying, wow, is this what it's like? 

Dr Jeremy: Yeah. It was a weird situation. I don't know if you could because in this country, you can't command people to work a particular job where they do it, but but what did work for them was actually putting the best resources and people where needed. That did result in improving their overall ranking. 

Val: The US has a crack team, the FBI and the FBI get called into where wherever they need to [00:38:00] go. Yes. I'm wondering if the support is going to be like there's a crack team or specialist that will be parachuted into a trust. To sort it out. I don't know. Yeah. Because it doesn't say what the support is. 

Dr Jeremy: It says more oversight, but it doesn't say what that means. 

Val: Or it could be a visit for Westing bad people. I don't know. I suspect say it doesn say much. 

Dr Jeremy: I suspect it means more middle manager paperwork and management.

Val: That's all we 

Dr Jeremy: need. Yeah. 

Val: So what I wanted to say, yeah. They could parachute a crack team in to sort things out. You never know. 

Dr Jeremy: Yeah. I don't know what the plan is. We'll have to see what we'll have to keep doing. Keep 

Val: eyes Yeah. On this let's end this. 

Dr Jeremy: Okay. 

Val: We've got the story Dr. Jeremy, what's your labels and misconceptions?

Dr Jeremy: In terms of label, let's talk about the idea of support, the government says that low performing trusts are going to get increased support. [00:39:00] What does support mean? Does it mean they're gonna get more money, or someone looking over their shoulder? An extra layer of approving funding for programs, it's not exactly a misconception, but it's certainly if people think that means one thing, they might be wrong because we don't really know yet. 

Val: Okay.

Dr Jeremy: That's where I would what's your story, label and misconception today? 

Val: I don't like a trust being labeled, I don't like the bottom versus the top. 

Because then the misconception is that the one at the bottom is the worst. The care is bad. When in, in fact, the care could be brilliant at the worst and worse at the top. Do you see what I mean? When it comes to care for patients?

Because that isn't measured, right? That's one of the things that isn't measured. So in a [00:40:00] patient's eyes, they may think the lowest one, it's given them this fear this anxiety. Once they're walking, they won't be walking out alive again. That it's bad for everything, 

Dr Jeremy: right? 

Val: Do you see what I mean? This blanket, right? This is the worst, that's the part I don't like, 

Dr Jeremy: right? 

Val: I don't like the fact that on your doorstep all around you, deprivation. You can't get, and I know I'm going off a bit, you can't get an appointment at your GP you can't get a good school for your child. You can't get a job and then you are told your hospital's bad, everything you are told is bad. 

Dr Jeremy: Yeah. 

Val: And I think that's not good for anybody to hear because I can't control Yeah. The school up the road. I can't control the hospital up the road. I think there are some [00:41:00] things that the government just need to keep for themselves so they can sort out and Yeah.

And it's how they put that message across to us that doesn't create fear and panic, not just for patients. But for nurses looking for a job newly qualified doctors so hospitals aren't left with even less staff because nobody wants to work there

Dr Jeremy: sure. 

Val: Yeah. 

Dr Jeremy: Yeah, that's a really good point. One of the reasons for the rankings and releasing them publicly is for there to be public transparency, but why does the public need to know maybe government should keep this to themselves.

Val: I didn't need to know. 

Dr Jeremy: Yeah. 

Val: I because if I was using, as I say, quote unquote the worst, but I felt like I had brilliant care. Now they've told me it is the worst. How am I gonna feel now? 

Dr Jeremy: You're gonna wonder how much [00:42:00] better it would've been elsewhere. 

Val: It changes people's perceptions. Once you see it in black and white and your government and it's got all these rankings. 

Dr Jeremy: Yeah. 

Val: Like your football team being relegated. It ain't nice. 

Dr Jeremy: Yeah. 

Val: No. 

Dr Jeremy: Okay. 

Val: So my Thought for the day . To wrap it up. League tables might look like simple scores, but behind every ranking are real people. Patients worried about their care and staff fighting to do their best.

And we'll leave it at that. Dr. Jeremy, as always been a pleasure. Great. Though, I will keep your secret when daddy left the room. Okay. Your secret is safe with me. Aw, great. He said he's leaving you. Okay. Oh no, he's never Oh, shut [00:43:00] time.

Enjoy the rest of your day. 

Dr Jeremy: Okay, thanks. Thanks. Thank you for 

Val: listening and don't forget to follow us. Bye. 

Dr Jeremy: Okay, bye-bye everyone.