Edinburgh Festival – rants with references

Fringe show starts tonight….and here are the references. If you are coming and I know you from twitter, that means I know you, so please come and say hello.

  1. Early day motion to support homeopathy


2.  Weekend ‘effects’

“someone is 15% more likely to die if admitted on a Sunday than on a Wednesday because we do not have as many doctors in our hospitals at the weekends as we have mid-week”

“According to an independent study conducted by The BMJ, there are 11,000 excess deaths because we do not staff our hospitals properly at weekends.”


11,000 more people die each within 30 days of admission to hospital on Friday, Saturday, Sunday or Monday compared with Tues/Wed/Thurs

It is not possible to ascertain the extent to which these excess deaths may be preventable; to assume that they are avoidable would be rash and misleading.”

National Statistics Authority response 

BMJ editor response 

Hunt effect 

“Its findings also show no proven link between weekend mortality rates and consultant presence, and suggests that other investment is more necessary.” costing 900 million a year

“”And at the moment we have an NHS where if you have a stroke at the weekends, you’re 20% more likely to die. That can’t be acceptable.”

except: “Recent audits of stroke outcomes in London show that there is no longer any excess of hospital deaths in patients with stroke admitted at the weekend” (link to ST letter currently not working)

coding bias for ‘ weekend effect ‘

“There are fewer deaths following hospital admission at weekends. Higher mortality rates at weekends are found only amongst the subset of patients who are admitted.”

Lancet study finding no association between medical staffing and mortality 

This cross-sectional analysis did not detect a correlation between weekend staffing of hospital specialists and mortality risk for emergency admissions.”

the estimated cost of implementing 7-day services is £1.07–£1.43 bn, which exceeds by £339–£831 m the maximum spend based on the National Institute for Health and Care Excellence threshold of £595 m–£731 m. There is as yet no clear evidence that 7-day services will reduce weekend deaths or can be achieved without increasing weekday deaths. The planned cost of implementing 7-day services greatly exceeds the maximum amount that the National Health Service should spend on eradicating the weekend effect based on current evidence.

3. “Currently, across all key specialties, in only 10% of our hospitals are patients seen by a consultant within 14 hours of being admitted at the weekend.

however  the average is 79% (should have said that 10% of hospitals are meeting target to have 90% patients seen within 14 hours of admission in key specialities)

impossible to extract weekend data from this 

not the 6th biggest funding increase in NHS history, but the 28th since 75/76

too early in the morning 

confidential info on twitter 

told off for phone fiddling 

google your rash 

imposes contract as Chilcot published

2) Things that don’t work and waste money

a) HSCA  supposedly supported by this  but this  and

Gwyn Bevan, professor of management science at the London School of Economics, who carried out a review of patient choice and competition, said he is “perplexed” by Andrew Lansley’s emphasis on the role of choice and competition because “the evidence is very weak and contested”.

“In fact, I would argue that we don’t have any strong evidence of that effect. To my mind, the jury is at best still out on whether choice and competition will improve quality of care in the NHS,” he said.

cost of HSCA

b) PFI  intérêst rates 

c) dementia DES 142 million 

d) health checks 165 million annually – every year 1 in 4762 chance of avoiding MI/stroke if attend

e) Cancer Drugs Fund – 416 million annually 14/15

f) management consultancies over 600 million annually

g) NHS IT: care data , care connect – 1,600 per query,  again,  again,

3) Pre-diabetes 


multimorbidity and guidelines 

primary care and guidelines 

adverse medication effects and admissions

CT scans 

osteoporosis cochrane and  discussion,  and James Bond

lead time bias  

natural frequencies , we’re not that good at risk 

dementia screening 

false positives in MRI 

peanut allergies and MRI 

CPR on US TV , including UK series 

survival in OOH cardiac arrest 

survival after CPR when terminally ill 


If I end up talking about something not listed here I will rush home and add it.


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