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Charles Tallack @CharlesTTHF
Joined March 2016
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Charles Tallack@CharlesTTHF
27 Jan 2023
The argument that’s often made for why we need an alternative model to the NHS or radical reform is that the NHS is unsustainable. The latest to make the argument is Sajid Javid. But *is* the NHS unsustainable? A Friday🧵
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Charles Tallack retweeted
𒊓𒅂𒁓𒐗𒐕𒐗 Steve the skeptic@sib313
22 Apr 2025
The NHS leadership needs to use reliable metrics for improvement programmes. Propaganda will blur the ability to tell failure from success: hsj.co.uk/daily-insight/the-…

The mythbuster: Propaganda won't drive improvement in the NHS

The government has hailed the FF20 elective recovery scheme as a major success - but a closer look at the data tells a different story. If the new NHS leadership is serious about real improvement, it...

hsj.co.uk
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This week the government announced that after only 5 months in power, it had met its promise of 2 million extra appointments in its first year. What does this mean for the related pledge, to achieve 18 week waits by 2029? A 🧵
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So it seems like the extra appointments haven’t resulted in as many extra treatments as we’d expect. Is this an example of a target distorting behaviour? Whatever, on the plus side, 2m was hit after 5 months. So there’s plenty of time for even more appointments if money allows.
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Hitting the 2m early tells us little new about progress on 18 weeks. The key figure here is the growth in waiting list treatments. From Jul-Nov 23 to Jul-Nov 24 that was 2.6%. This is in line with our estimate of growth rate needed to achieve 18w by 2029. health.org.uk/reports-and-an…

Government’s plan for 18-week NHS waiting times: is it realistic?

How realistic is restoring the 18-week standard for elective care? And what increase in treatments would be needed to achieve it?

health.org.uk
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Charles Tallack retweeted
Jean Fisch@Jean__Fisch
28 Jan 2025
I rarely venture outside my focus but this is so brilliant that it has to be shared People quickly found that Deepseek had a Chinese censor filter and that the filter worked AFTER the text was written The data wizards from @spectator found a great way to bypass the filter!😅
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To end, here are details of my calculations of the number of deaths associated with 12hr waits. We could do better with extra data from the ONS, but think these calculations give us a reasonable approximation using what they’ve published 9/12
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Doing this for all waiters over 12 hours, and summing gives us a figure of 11k deaths from 353k waits. That’s 1 excess death per 31 waiters over 12 hours. For 8-12 hour waiters it's 1 in 61. 11/12
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With 1.77m 12hr waits in 2024 that’s 57,000 deaths last year, or around 1100 a week. If we included 8-12h waiters the figure would be higher still. /end @RCEMpresident @sib313
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And why do some conditions seem much associated with a much greater relative risk from long waits? Skin, and head & neck stand out even after wide confidence intervals are taken account of. 7/12
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Even though this study can’t prove causality there are good reasons why long waits in A&E could increase the chance of death. The ONS study is evidence, and we shouldn’t dismiss it and conclude that there’s no proof that long waits are more than an inconvenience 8/12
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The big question is whether long waits are *causing* these extra deaths. Factors which lead to long waits (age, condition) could also lead to a higher mortality rate. ONS control for many but with there’s always the chance that some factors (eg complexity) are missing. 5/12
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Some things in the ONS analysis raise questions about the causal mechanism. For example, the older a person is the lower the relative increase in risk of dying from a long wait? (age 20-30 bucks this trend – but confidence intervals are large) 6/12
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That’s a lot more than the 300/week RCEM estimated for 12hr deaths in 2023. That’s mostly because their figures are from an earlier study with lower estimates of the increased risk of death, which only covered patients subsequently admitted (ONS also includes non-admitted). 4/12
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Last week ONS published analysis showing that an A&E wait of 12-13 hours is associated with a more-than-doubling of the chance of death within 30 days, compared to a wait of 2-3 hours. But how many deaths is that? 🧵 1/12 ons.gov.uk/peoplepopulationa…

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My calculations (details later) point to 12h A&E waits being associated with more than 1100 deaths a week in 2024. That’s 1100 deaths that can’t be explained by the range of factors that ONS took into account. 3/12
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How bad a doubling is depends on the absolute risk i.e. whether it’s a doubling from 1 to 2 in 1000, or from in 1 to 2 in 10. ONS don’t tell us that so we need to do some calculations using the slightly sketchy and incomplete data they’ve published. 2/12
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