There are a lot of potential things to write about on the stroke blog this week. The Fabulous Beth and I went to see the National Theatre of Scotland put on the first two of Rona Munro’s James plays. And I’ve been reading about the translation of the Christian Bible conceived by James I’s and II’s descendant James VI of Scotland. So I suppose you could say I’ve been thinking about Survival in its many forms.
— Ricky Brown (@ricky_ballboy) February 4, 2016
However, I think that I’m going to be setting forth my thoughts relating to the Fourteenth Century Scottish succession and awkward KJV translations in different media, so you’re spared that for now.
Fortunately, as I was rummaging through apoplectic.me’s bulging sack of mail last night (pictured above) I stumbled across a question from Mrs Trellis of North Wales:
Dear Stroke Bloke,
I’d like to be as cool as you. How should I go about having a massive stroke?
Regular readers of the blog will know that my admitting nurse advised a large serving of the cocaine as the quickest route to a mahoosive stroke. But I wanted to be responsible in my response to Mrs Trellis. When would she be most likely to survive a stroke? And then write a whimsical once-a-week blog increasingly tenuously based on the experience?
The Health Secretary, Jeremy Hunt, recently advised that people wanting to have a mahoosive stroke not it on the weekend. But he did say that the weekend is the best time to consume a mahoosive bucket of coke. Probably.
But seriously, folks. As NHS England faces another junior doctors’ strike on Wednesday, Mr Hunt has been telling celebrity stroke survivor Andrew Marr that
Mr Hunt and MC Wee Davey C, on the other hand, have been pointing out truthisms like how junior doctors’ current working arrangements mean that stroke victims are 20% more likely to die if they are admitted to hospital at the weekend.
I’m a weekend stroke survivor myself. But I suffered my stroke in Brooklyn. All my confirmed data suggests that the only way to be 100% sure of surviving a catastrophic weekend stroke is by suffering it in the pre-Obamacare United States.
So I thought, Maybe I should learn more about this.
Blog fave More or Less has been looking into Mr Hunt’s claim. More or Less, you may recall, is a BBC Radio 4 programme that explains – and sometimes debunks – the numbers and statistics used in political debate, the news and everyday life. Previously, it’s discussed how The Stroke Association has been “less than robust” in presenting data to suggest a precipitous rise in the incidence of strokes.
More or Less has in the past debunked more general versions of the government’s claims that NHS England care is more fataller at the weekend. Some part of the reason for worse outcomes at the weekend is that people try to avoid going into hospital at the weekend, and routine admissions will tend to be scheduled for weekdays
Weekend attendees therefore tend to be sicker. This “weekend effect” means that the “case mix” is different. And because weekend hospital attendees are sicker, they’re more likely to die regardless of the level of care they receive. More or Less notes that the editor of the British Medical Journal has previously written to Mr Hunt asking him to stop misrepresenting weekend stats.
But since then, the Health Secretary has upped the ante to say that “we have an NHS where if you have a stroke at the weekends, you’re 20% more likely to die.” It’s interesting to note that stroke in particular was the stat used. Adjusting for the case mix, More or Less finds that the difference in outcomes for stroke patients seems to be closer to 5%. And what does this 20% refer to, anyway?
More of Less’s Charlotte McDonald picks up the story:
Certain data shows that of 100 stroke patients admitted to hospital on a week day, 9 of them die will die within a week. But if admitted on Sunday, 11 out of 100 stroke patients will die within a week. That’s two extra deaths per 100 admissions.
Is that really a 20% spike due to a lower level of NHS England care at the weekend? Arguably not. And Charlotte McDonald goes on to say that all of the authors of the studies giving rise to these observations noted that their research was not designed to answer the question of whether there is a “weekend effect” in NHS England.
Of course, I’m picking out the most relevant snippets for a short blog post that keeps my hand in at writing for a more or less random audience, and exercises my stroke-addled brain. I’m not certainly not using to figures to allege that
the “totally irresponsible way” in which Jeremy Hunt is using this data to “spread misinformation” and say that the BMA is defending its right to kill 1 in 5 stroke patients every weekend is “incredibly disappointing”.
That would be totally irresponsible and disrespectful to anyone reading this post.
No, I’d suggest that you go and listen to More or Less, and make up your own mind.