Duncan’s posterous

Earlier studies on the influx of new doctors have been inconclusive

Researchers say they have found a small but statistically significant increase in the number of patients who die each year when junior doctors start work.

An Imperial College team looked at 300,000 emergency patients admitted to English hospitals between 2000 to 2008.

They compared death rates between the first week of August, when new doctors arrive, and the previous week in July.

After adjusting for various factors, they report in PLoS One that the August patients were 6% more likely to die.

The period when an influx of newly qualified doctors enters the wards has sometimes been dubbed the "killing season", but studies to establish whether there is any truth to this have been inconclusive.

The researchers from Imperial College London stressed they were unable to draw firm conclusions about the reasons for the increase, but that it was significant, if small.

Comparisons of the raw figures showed little difference, but when factors including age, sex, socio-economic deprivation and existing medical problems were taken into account, a discrepancy began to emerge.

'Rigorous training'

The differences were most pronounced among medical patients - those not requiring surgery and not suffering from cancer. For this group, death rates increased by 8%.

Our study does not mean that people should avoid going into hospital that week. This is a relatively small difference in mortality rates, and the numbers of excess deaths are very low Dr Paul Aylin Imperial College

"Our study does not mean that people should avoid going into hospital that week. This is a relatively small difference in mortality rates, and the numbers of excess deaths are very low," said Dr Paul Aylin, from the Dr Foster Unit at Imperial College.

"It's too early to say what might be causing it. It might simply be the result of differences between the patients who were admitted."

But the report notes that if these differences are due to the changeover of hospital staff, "then this has potential implications not only for patient care, but for NHS management approaches to delivering safe care".

FROM THE TODAY PROGRAMME More from Today programme

Doctors' representatives sounded a note of caution.

"This study has to be judged alongside many previous studies looking at mortality rates before and after junior doctors start their new jobs, which have not shown any differences," said Dr Shree Datta, chair of the junior doctors' committee at the British Medical Association.

"Clearly even a small increase in death rates is of great concern and we need further research to see whether this is a real effect or an anomaly."

Hugh Williams, of Action Against Medical Accidents, said: "I think some junior doctors are thrown in the deep end and are expected to get on with it.

"It would be interesting to know how quickly this effect wears off and how different hospitals deal with the intake of junior doctors every August."

A spokesperson for the Department of Health said: "Patients should be reassured that junior doctors undergo rigorous training and they undertake direct clinical care in areas where they have been trained and assessed as meeting the required competency.

"Local hospitals must ensure that they responsibly manage the introduction of new junior doctors each August by providing appropriate senior cover and supervision."

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But seriously - 8 years of research to tell us what we probably already knew/guessed was logically the case anyway... Junior doctors have to practice on real patients sometime!

Health policy for those like me with a short attention span!

So here's the thing - isn't this just a rerun of the Blair-Mandleson-Gould pre 1997 era?

Given this, aren't we in danger of entering into another first-term of stagnation as fear of the polls restricts creative policy development...

(2) David Cameron's fascination with mastering public opinion

80% of the time I ask a member of the Cameron operation a policy question I get a political answer.  They are doing 'x' because that's where public opinion is.  They are doing 'y' because it will wrongfoot Brown.  They are pursuing 'z' because they don't want to upset a particular constituency of voters.  Insiders talk of David Cameron's fascination with opinion polls.

This fascination has to be understood in the context of the last two decades.  Excepting John Major's surprise victory in 1992 the Conservatives have been struggling in the opinion polls since 1988.  William Hague, Iain Duncan Smith and Michael Howard are the only modern day Tory leaders not to become Prime Minister.  Tories have now been out of power for 12 years at a national level and some had wondered if the party would ever govern again.  The electoral success of the Cameron machine is yet to face its ultimate test at the General Election but most grassroots Tories - members of the party often styled as the natural party of government - will forgive the political focus if Mr Cameron enters Downing Street next year.

The question is whether the political calculations that are necessary to end the electoral drought are largely tactical or have they entered into the DNA of the team that surrounds David Cameron?  Has the party leadership become resigned to following public opinion, rather than leading it?  Chief policy adviser to David Cameron Oliver Letwin - once referred to as the Gandalf of the leader's circle - is known to believe that opposition parties cannot change public opinion other than in one or two areas if they push very hard and in a very single-minded way.  It is much easier to make great arguments in government.

 

 

There are two great forces in the Cameron project - the fascination with mastering public opinion and David Cameron's broad commitment to the whole conservative coalition.  Only in government will we know which of those forces gets the upper hand.

 

 

Andy Burnham: "I want the best to be available to everyone, not according to where they live"

- So when's this idea going to be available to parents too?

Any job losses are a tragedy for the individuals and families involved, but surely the Union must be able to see that a strike will only make things worse?

Times are tough and alternatives exist - a strike will onle increase the use of electronic communications and other mail delivery services as people get upset with RM's service.

« The problem with happiness... | All Posts | Magazine Rack - Issue 500 »

September 14, 2009

The nastiest anti-Obama protest?

Tens of thousands of conservatives have gathered in Washington to protest against Obama’s policies. And a whole lot of them have brought banners with them.

So finding the least acceptable and most loathsome was no mean feat. Still, I think I've managed it.

The winner of the 'Most Hideous Political Banner Award' goes to this woman, and a homemade creation to make Blue Peter blush:

 

On Sunday, Robert Gibbs was moved to announce that the President did not believe that the protestors were motivated by race.

Looking at this gallery of protesters' banners, I find it increasingly difficult to match his faith.

(Hat tip: The Wonkette)

Posted by Hattie Garlick on September 14, 2009 at 11:18 AM in American Politics | Permalink

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is this the best you can do?

Posted by: grace the collie | 14 Sep 2009 11:55:45

I submit my entries for the racist:

...for the idiotic puppetry:

...and for the downright stupid:

There's probably a reason that last one was lying on the ground and not in someone's hand.

Posted by: Chris Cherry | 14 Sep 2009 12:12:40

That's really absurd.

Posted by: HM | 14 Sep 2009 12:48:41

If you are happy a black man is in the White House - is that not racial? What else would that be based on? Are you happy that a black man is in the White House instead of a white man? Are you prejudice against white people?

Arguments about race are circular.

- not what we need to be discussing at the moment. The issues of race in America do not need to be debated and rolled into a bill which will have a direct bearing on 18% of our GDP in the next couple months... whatever the new timeline is to avert all out crisis this time.

There will be plenty of time to chase the race around the keg.

Posted by: Frank | 14 Sep 2009 13:24:36

Oh for gods sake...clearly you have had your eyes closed for the last 8 years. Most likely so you wouldn't have to look upon that abomination that ruled amerika before the light bringer came to power!

What Barry is receiving today is nothing compared to the vilification that was dealt to George Bush.

For christ sake, if you find the image you posted disgusting then its probably best that you close your eyes again...just in case you see something really nasty! Then again, why not just say what you mean, that you find anyone protesting against Barry's healthcare plans racist!

You know, I always thought lefties were sooky bubba's :)

Mailman

Posted by: Mailman | 14 Sep 2009 13:35:48

I would love to presume this is meant to be ironic... sadly, given that this protest seems to have really scraped the bottom of the barrel and come up with some unbelievably racist, offensive and just plain stupid lowest denominator cretins, I think it may be sincere.

Posted by: Amelia | 14 Sep 2009 13:36:35

I can only echo grace: if `Lyin' African' is the most `racist' you can come up with, this Garlick really does reek.

Posted by: R.B. Glennie | 14 Sep 2009 13:52:35

And what about it even if it was racially motivated? Who on earth has right to cry for Obama against racism, a White supremacist liberal?

President Obama is the least Black man in the world to need sympathy from desperate self-righteous white men and women.
As a president he should be ready to absorb the worst insults.
Would the same race police moaning about this have moaned in the same manner, if President Bush had a similar joke from Black campaigners?
Of course, we remember that George Bush was called all sorts of unprintable names, called racist when he clearly was not (being the first American President to promote Black Americans to the highest positions) and demonized for his policies.
Sometimes, I say that I hate White hypocrites (mainly liberals who cry for us more than us) more than I hate racist!

Posted by: John Iteshi | 14 Sep 2009 13:59:29

Nothing to add - its just incredible really.

On the Today programme this morning Peter Mandelson said that he had asked Nick Robinson:

When exactly the Prime Minister had defined things as simply and crudely as Labour investment and Tory cuts and Nick was unable to find the quote.

Perhaps the First Secretary will regret describing this approach as crude, because Nick found the quote from the Commons on 17 June 2009:

Prime Minister: "The issue is that the Conservatives will cut current expenditure in real and cash terms. It is exactly what I said - Tory cuts, Labour investment."

But this was minor stuff compared to Lord Mandelson's main argument.

He said that the Conservatives want to embark on a public services reduction programme, whereas Labour wants to embark on a deficit reduction programme:

And therein lies the difference between us.

A fascinating assertion. Let's unpack it.

One might regard there as being four ways to reduce the deficit without large tax rises.

The first is to keep services just as they are but hope that by staring at the services a little harder, waste can be discovered that hasn't been discovered on the last two goes round. This seems unlikely to yield much money.

The second is to reform the provision of these services, probably by allowing greater private involvement, an approach Lord Mandelson eschewed, arguing that it is the sort of things that the Tories would do.

The third alternative is to "reduce public services". This is a meaningless phrase, really. But it might cover two things. There is reducing the number of things government does. And there is reducing the funding to those things government does.

So where might the gap between the parties be?

Well, both can be expected to find what waste there is with broadly the same amount of enthusiasm and competence. There is no division here.

But the amount will not be enough to deal with the deficit problem.

By Lord Mandelson's own admission, the Tories will try to save money by reform and Labour will be, at the very least, extremely cautious.

In the short run I expect the amount of money saved like this will be small. Strangely Lord Mandelson - to make his argument about Tories salivating over cuts - needs to suggest that it will be large.

This leaves both to save money by "reducing public services". But Labour will have to save more, by rejecting the reform option.

Finally there may be a difference on how to reduce public services - by cutting some of the services themselves or by reducing funding to them. The more you do the former, the less you do the latter.

If Lord Mandelson is to be believed, Labour will do the latter.

So what Lord Mandelson's new dividing line amounts to is a promise to reduce the funding of existing, broadly unchanged services by more than the Conservatives.

I am not, incidentally, playing games here.

I am just trying to work out what he really meant.

So this is the opening salvo (and Danny Finkelstein's analysis) in the electoin battle. Enough with the phony war. Enough with the test lines of 'Tory Cuts v Labour Investmentr'. We now have the more powerful and (if the Today and R5 Live interviews are anything to go by, more potent) arguments in play.

What was particularly interesting was how Mandleson was trying to suggest that electing a Tory government could lead to civil unrest similar to the early 80s strikes. Really? Its an interesting and possibly emotion grabbing argument that could re-energise the Labour base, but does anyone think that that is on the cards, especially given how carefully Cameron is being about where investment and cuts may fall?