"The NHS's long-term plan, published today, will save nearly half a million more lives with practical action in the field of severe killings and investment in world-class advanced treatments, including genomic tests for every child with cancer."
NHS England, January 7, 2019
Last month many media reports focused on the announcement by NHS England that the new Long Term Plan & # 39; about half a million lives will save.
The long-term plan indicates the direction the NHS intends to take in England in the next ten years to have a "service fit for the future". It also indicates how the NHS intends to use £ 20 billion in additional funding that it will receive over the next five years – about which we have written here.
It is unclear how exactly NHS England has calculated the number of lives of half a million people and we have asked them a number of times for more information. There are many things that we do not know for sure: it is, for example, unclear in what time period these lives are saved while the time span of the plan is ten years, the lack of details about the calculation means that we do not know it specifically. We also do not know if there is a margin of error for the figure, or exactly how these lives are "saved" (more than a few general examples such as early detection of cancer).
We believe that important policy announcements such as these should be based on published, clearly explained figures, so that everyone can see how they are calculated and assess whether government agencies reach the goals they have set.
What do we know about how these 500,000 are stored?
In his public announcement of the plan, NHS England has given a number of extra details on how it proposes to save these 500,000 lives. It said: "the latest technology, such as digital GP consultations for everyone who wants it, combined with early detection and a renewed focus on prevention to stop an estimated 85,000 premature deaths each year."
Chief Executive Simon Stevens has indicated that new treatments and testing services will mean that three quarters of cancer patients will be diagnosed early, when the condition is easier to treat, now half less, saving 55,000 lives per year. That just seems more than half a million mark, if you add it over ten years, but as we will explain, it is more complicated than that.
Mr. Stevens added, "Approximately 23,000 premature deaths and 50,000 hospitalizations will be prevented in the course of the next decade by more than 100,000 patients with heart problems through a healthy lifestyle and exercise program each year."
The plan itself also says that the NHS will look to halve maternity-related deaths by 2025.
When we asked NHS England for more information about how the calculation was performed and what its components were, we said that: "The calculations are based on new and comprehensive services that the plan will implement, mainly new cancer treatments with previous diagnosis and interventions to cope with more strokes, heart attacks, respiratory problems. "
That did not make things much clearer, so we asked them for more information again. We are waiting for an answer.
What do not we know?
Firstly, it is unclear in which time frame these 500,000 lives will be saved – as the NHS itself says in the plan, not all the goals it sets have to be fulfilled within ten years, some are in a shorter time frame. The lack of detail also means that we do not know whether one of the goals will take longer to reach.
To put the goal in the right context, just under 500,000 deaths were registered in England in 2017. According to the Nuffield Trust think tank, based on official figures from the Office for National Statistics (ONS), about 110,000 deaths in England are one year "avoidable", either by better quality health care or healthier public behavior.
Secondly, NHS England does not mention how definitive this number is – is it a best estimate with a large margin of error around it, or is the NHS England reasonably certain that it can save so many lives through the measures planned in the next ten years?
Thirdly, as we have already mentioned, we have provided a few specific examples, but we have no indication of how the multi-annual plan will save all these lives and of the conditions and diseases it intends to address to do so. .
And finally, it is not clear from the published information what NHS England actually means when it says that it will save these lives & # 39 ;.
How to live a & # 39; rescued & # 39; defines can affect the numbers
It may seem counter-intuitive, but talk about "saving a life." can mean very different things, depending on how you define it.
The Nuffield Trust also investigated this and got some more details from the NHS about the calculations. It says that "NHS England focuses on those who are alive, counting the number of times a life is saved, while ONS targets those who died and instead counted how many of these deaths could have been prevented."
For example, a person who is prevented from dying from two separate diseases in the same year would count if one avoids death on the basis of the ONS definition. But for the NHS this can count as saving two lives.
The method you choose can affect the total number you end. NHS England says improvements in treatment and testing will save the lives of 55,000 cancer patients per year, but the US estimated that about 38,000 deaths from cancer in England were preventable in 2016.
This also raises the question of how long a patient is expected to live after his life as & # 39; rescued & # 39; is counted, and from when you measure this. The Nuffield Trust says: "NHS England also counts people who survive five years after being diagnosed with cancer as lives saved, but not all of these people will unfortunately live much longer.Performance against this measure can only improve by previous diagnoses without actually extending lives, although a previous diagnosis can obviously contribute to better results. "
We think it is inappropriate and useless for organizations such as NHS England to use figures that are not in the public domain. Figures like these must be fully published so that everyone can see where they come from, how they are calculated and whether government agencies reach the goals they have set out. Public authorities should not ask anyone to believe their word on something important.
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