steve black - Academia.edu (original) (raw)
Papers by steve black
Emergency Medical Journal, 2022
Background Delays to timely admission from emergency departments (EDs) are known to harm patients... more Background Delays to timely admission from emergency departments (EDs) are known to harm patients. Objective To assess and quantify the increased risk of death resulting from delays to inpatient admission from EDs, using Hospital Episode Statistics and Office of National Statistics data in England. Methods A cross-sectional, retrospective observational study was carried out of patients admitted from every type 1 (major) ED in England between April 2016 and March 2018. The primary outcome was death from all causes within 30 days of admission. Observed mortality was compared with expected mortality, as calculated using a logistic regression model to adjust for sex, age, deprivation, comorbidities, hour of day, month, previous ED attendances/emergency admissions and crowding in the department at the time of the attendance. Results Between April 2016 and March 2018, 26 738 514 people attended an ED, with 7 472 480 patients admitted relating to 5 249 891 individual patients, who constituted the study's dataset. A total of 433 962 deaths occurred within 30 days. The overall crude 30-day mortality rate was 8.71% (95% CI 8.69% to 8.74%). A statistically significant linear increase in mortality was found from 5 hours after time of arrival at the ED up to 12 hours (when accurate data collection ceased) (p<0.001). The greatest change in the 30day standardised mortality ratio was an 8% increase, occurring in the patient cohort that waited in the ED for more than 6 to 8 hours from the time of arrival. Conclusions Delays to hospital inpatient admission for patients in excess of 5 hours from time of arrival at the ED are associated with an increase in all-cause 30day mortality. Between 5 and 12 hours, delays cause a predictable dose-response effect. For every 82 admitted patients whose time to inpatient bed transfer is delayed beyond 6 to 8 hours from time of arrival at the ED, there is one extra death.
British Journal of Hospital Management, 2022
One of the key characteristics of the Blair reforms of the NHS in the early 2000s was the introdu... more One of the key characteristics of the Blair reforms of the NHS in the early 2000s was the introduction of tough targets for elective and emergency department waits-nobody would spend more than 4 hours in the emergency department before discharge or admission and nobody should spend more than 18 weeks waiting for elective treatment. These targets were achieved and public satisfaction with the NHS rose sharply as a result. But the emergency department 4-hour target was subject to much criticism. Some claimed that a target would distort clinical priorities. Some claimed it was arbitrary and not based on clinical reasoning. Some claimed it was impossible to meet, given how many long waits were occurring in the system. Despite this, the target was met just a handful of years after it was set, and the NHS continued to meet it for more than half a decade. Hardly anyone attending an emergency department waited longer than 4 hours for treatment or discharge. However, performance has declined consistently since 2011 and is currently at the worst levels ever measured, with the system as a whole struggling to get even 70% of patients dealt with in 4 hours (this was closer to 60% in major emergency departments across England in December 2021 (NHS England, 2021). One result of the decade-long problems with prompt treatment or admission has been a renewed wave of criticism of the 4-hour target. The week before this editorial was written, health secretary Sajid Javid said that the 4-hour target was 'the wrong target' because it distorted clinical decisions (Kituno, 2022). NHS England (2020) has been discussing a set of replacement metrics (including the abolition of the 4-hour target) for several years, although these have not yet been implemented. Javid is not the first to suggest the abolition of 4 hours as a metric. Andrew Lansley proposed its abolition in 2010 when he became health secretary (Topping and Campbell, 2010), but was eventually talked out of outright abolition and chose to downgrade its importance and relax the standard instead. Significantly, this standard has rarely been met since in major emergency departments.
BMJ (Clinical research ed.), Jan 18, 2015
I applaud The BMJ ’s goal of exposing potential conflicts of interest in doctors,1 but the articl... more I applaud The BMJ ’s goal of exposing potential conflicts of interest in doctors,1 but the article subtly casts the debate in terms of the private sector providing doctors with financial inducements to refer patients to their facilities. This ignores the …
The Chemical Industry, 1994
Basic chemicals are the orphans of the chemical industry. They are not glamorous, like drugs, and... more Basic chemicals are the orphans of the chemical industry. They are not glamorous, like drugs, and are sometimes not very profitable (and at the very least the profits come in unpredictable cycles of boom and bust). They are not seen or used directly by the general public and so their importance is not often understood. Even within the industry their importance is often insufficiently appreciated. Without them, however, the rest of the industry could not exist.
The South African Journal of Economics, 1969
In the March 1969 issue of this journal Professor Radel asked the question “Profit Maximization—C... more In the March 1969 issue of this journal Professor Radel asked the question “Profit Maximization—Can It Be Justified?”1 The professor would appear to answer his question in the affirmative although with some reservations. The statement “would appear” is necessary because Radel's argument does not lead to any clear, unique, answer. Since the author believes that profit maximization cannot be justified a note on Radel's article is in order. Not being able to provide an alternative theory the author will merely attempt to demonstrate that Radel's arguments are not valid. This seems to be potentially fruitful as Radel considers many of the more important justifications for profit maximization.
BMJ, 2005
Time to wake up to cancer's toll Editor-As exemplified by your theme issue on Africa of 1 October... more Time to wake up to cancer's toll Editor-As exemplified by your theme issue on Africa of 1 October, cancer has remained comparatively neglected in Africa although increasingly prevalent: 70% of people with cancer live in the economically developing world, where by 2020 the annual death toll is predicted to reach 20 million. 1 In sub-Saharan Africa measures to prevent cancer emphasised in the developed world-such as smoking cessation and screening-are not nationally adopted. One third of African cancers are preventable, but the influence of tobacco companies with mass media advertising and high crop payments is real. Traditional cancers, such as gastric and hepatocellular carcinoma, and newer cancers, such as lung cancer, breast cancer, and AIDS related Kaposi's sarcoma, are increasing in incidence. 2 3 Patients' expectations for oncological treatment are low in Africa. Lack of money, or a concern not to place their family in debt, prevents many from seeking medical help. 4 Lack of awareness of predisposing factors, warning symptoms or signs of cancer, or treatment options mean that patients present late. Cost and difficulty of travel over rough terrain also discourage service use. After diagnosis patients may tend to look for peace of mind and spiritual comfort rather than a physical cure. In Africa disease modifying cancer treatment and basic control of symptoms are largely absent. Even when analgesia is available, patients with cancer may experience severe and inadequately managed pain, as health professionals underprescribe strong analgesics, fearing drug dependency. 5 Individual sub-Saharan countries cannot tackle the challenges of cancer in isolation. A new, cooperative approach and research base are being advocated for preventing, treating, and palliating cancer to bridge the gap between developed and developing nations. 5
The Health service journal, Jan 26, 2004
1. Health Serv J. 2004 Feb 26;114(5894):34-5. Bed management. Pillow talk. Proudlove N, Black S. ... more 1. Health Serv J. 2004 Feb 26;114(5894):34-5. Bed management. Pillow talk. Proudlove N, Black S. Manchester School of Management, University of Manchester Institute of Science and Technology. PMID: 15011512 [PubMed - indexed for MEDLINE]. MeSH Terms. ...
BMJ (Clinical research ed.), Jan 24, 2013
The NHS reforms initiated by Andrew Lansley deserve much criticism, but David Hunter’s opposition... more The NHS reforms initiated by Andrew Lansley deserve much criticism, but David Hunter’s opposition to reform is ineffective because it appeals to emotions and doesn’t draw on credible evidence.1 For example, rather than discuss the evidence about whether competition among providers is good for patients,2 Hunter goes straight to the easy rhetorical point that this will lead to a system governed by “naked greed,” as in the …
BMJ, 2009
Heath understates one important issue in her observations on breast screening1: the systemic illi... more Heath understates one important issue in her observations on breast screening1: the systemic illiteracy of doctors, epidemiologists, and other health professionals in communicating statistical results. Gigerenzer pointed out just how badly professionals misinterpret risk when given the …
BMJ (Clinical research ed.), Jan 24, 2013
The NHS reforms initiated by Andrew Lansley deserve much criticism, but David Hunter’s opposition... more The NHS reforms initiated by Andrew Lansley deserve much criticism, but David Hunter’s opposition to reform is ineffective because it appeals to emotions and doesn’t draw on credible evidence.1 For example, rather than discuss the evidence about whether competition among providers is good for patients,2 Hunter goes straight to the easy rhetorical point that this will lead to a system governed by “naked greed,” as in the …
BMJ, 2007
We select the letters for these pages from the rapid responses posted on bmj.com favouring those ... more We select the letters for these pages from the rapid responses posted on bmj.com favouring those received within five days of publication of the article to which they refer. Letters are thus an early selection of rapid responses on a particular topic. Readers should consult the website for the full list of responses and any authors' replies, which usually arrive after our selection.
BMJ, 2010
The centralised drive to meet the politically attractive target of cutting management (there is n... more The centralised drive to meet the politically attractive target of cutting management (there is no public lobby for more bureaucracy) runs a serious risk of undermining the capacity of the new NHS to improve and spend its money well.1 We need some people who know how to spend NHS money wisely. Primary care trusts spent 1-2% of …
Emergency Medical Journal, 2022
Background Delays to timely admission from emergency departments (EDs) are known to harm patients... more Background Delays to timely admission from emergency departments (EDs) are known to harm patients. Objective To assess and quantify the increased risk of death resulting from delays to inpatient admission from EDs, using Hospital Episode Statistics and Office of National Statistics data in England. Methods A cross-sectional, retrospective observational study was carried out of patients admitted from every type 1 (major) ED in England between April 2016 and March 2018. The primary outcome was death from all causes within 30 days of admission. Observed mortality was compared with expected mortality, as calculated using a logistic regression model to adjust for sex, age, deprivation, comorbidities, hour of day, month, previous ED attendances/emergency admissions and crowding in the department at the time of the attendance. Results Between April 2016 and March 2018, 26 738 514 people attended an ED, with 7 472 480 patients admitted relating to 5 249 891 individual patients, who constituted the study's dataset. A total of 433 962 deaths occurred within 30 days. The overall crude 30-day mortality rate was 8.71% (95% CI 8.69% to 8.74%). A statistically significant linear increase in mortality was found from 5 hours after time of arrival at the ED up to 12 hours (when accurate data collection ceased) (p<0.001). The greatest change in the 30day standardised mortality ratio was an 8% increase, occurring in the patient cohort that waited in the ED for more than 6 to 8 hours from the time of arrival. Conclusions Delays to hospital inpatient admission for patients in excess of 5 hours from time of arrival at the ED are associated with an increase in all-cause 30day mortality. Between 5 and 12 hours, delays cause a predictable dose-response effect. For every 82 admitted patients whose time to inpatient bed transfer is delayed beyond 6 to 8 hours from time of arrival at the ED, there is one extra death.
British Journal of Hospital Management, 2022
One of the key characteristics of the Blair reforms of the NHS in the early 2000s was the introdu... more One of the key characteristics of the Blair reforms of the NHS in the early 2000s was the introduction of tough targets for elective and emergency department waits-nobody would spend more than 4 hours in the emergency department before discharge or admission and nobody should spend more than 18 weeks waiting for elective treatment. These targets were achieved and public satisfaction with the NHS rose sharply as a result. But the emergency department 4-hour target was subject to much criticism. Some claimed that a target would distort clinical priorities. Some claimed it was arbitrary and not based on clinical reasoning. Some claimed it was impossible to meet, given how many long waits were occurring in the system. Despite this, the target was met just a handful of years after it was set, and the NHS continued to meet it for more than half a decade. Hardly anyone attending an emergency department waited longer than 4 hours for treatment or discharge. However, performance has declined consistently since 2011 and is currently at the worst levels ever measured, with the system as a whole struggling to get even 70% of patients dealt with in 4 hours (this was closer to 60% in major emergency departments across England in December 2021 (NHS England, 2021). One result of the decade-long problems with prompt treatment or admission has been a renewed wave of criticism of the 4-hour target. The week before this editorial was written, health secretary Sajid Javid said that the 4-hour target was 'the wrong target' because it distorted clinical decisions (Kituno, 2022). NHS England (2020) has been discussing a set of replacement metrics (including the abolition of the 4-hour target) for several years, although these have not yet been implemented. Javid is not the first to suggest the abolition of 4 hours as a metric. Andrew Lansley proposed its abolition in 2010 when he became health secretary (Topping and Campbell, 2010), but was eventually talked out of outright abolition and chose to downgrade its importance and relax the standard instead. Significantly, this standard has rarely been met since in major emergency departments.
BMJ (Clinical research ed.), Jan 18, 2015
I applaud The BMJ ’s goal of exposing potential conflicts of interest in doctors,1 but the articl... more I applaud The BMJ ’s goal of exposing potential conflicts of interest in doctors,1 but the article subtly casts the debate in terms of the private sector providing doctors with financial inducements to refer patients to their facilities. This ignores the …
The Chemical Industry, 1994
Basic chemicals are the orphans of the chemical industry. They are not glamorous, like drugs, and... more Basic chemicals are the orphans of the chemical industry. They are not glamorous, like drugs, and are sometimes not very profitable (and at the very least the profits come in unpredictable cycles of boom and bust). They are not seen or used directly by the general public and so their importance is not often understood. Even within the industry their importance is often insufficiently appreciated. Without them, however, the rest of the industry could not exist.
The South African Journal of Economics, 1969
In the March 1969 issue of this journal Professor Radel asked the question “Profit Maximization—C... more In the March 1969 issue of this journal Professor Radel asked the question “Profit Maximization—Can It Be Justified?”1 The professor would appear to answer his question in the affirmative although with some reservations. The statement “would appear” is necessary because Radel's argument does not lead to any clear, unique, answer. Since the author believes that profit maximization cannot be justified a note on Radel's article is in order. Not being able to provide an alternative theory the author will merely attempt to demonstrate that Radel's arguments are not valid. This seems to be potentially fruitful as Radel considers many of the more important justifications for profit maximization.
BMJ, 2005
Time to wake up to cancer's toll Editor-As exemplified by your theme issue on Africa of 1 October... more Time to wake up to cancer's toll Editor-As exemplified by your theme issue on Africa of 1 October, cancer has remained comparatively neglected in Africa although increasingly prevalent: 70% of people with cancer live in the economically developing world, where by 2020 the annual death toll is predicted to reach 20 million. 1 In sub-Saharan Africa measures to prevent cancer emphasised in the developed world-such as smoking cessation and screening-are not nationally adopted. One third of African cancers are preventable, but the influence of tobacco companies with mass media advertising and high crop payments is real. Traditional cancers, such as gastric and hepatocellular carcinoma, and newer cancers, such as lung cancer, breast cancer, and AIDS related Kaposi's sarcoma, are increasing in incidence. 2 3 Patients' expectations for oncological treatment are low in Africa. Lack of money, or a concern not to place their family in debt, prevents many from seeking medical help. 4 Lack of awareness of predisposing factors, warning symptoms or signs of cancer, or treatment options mean that patients present late. Cost and difficulty of travel over rough terrain also discourage service use. After diagnosis patients may tend to look for peace of mind and spiritual comfort rather than a physical cure. In Africa disease modifying cancer treatment and basic control of symptoms are largely absent. Even when analgesia is available, patients with cancer may experience severe and inadequately managed pain, as health professionals underprescribe strong analgesics, fearing drug dependency. 5 Individual sub-Saharan countries cannot tackle the challenges of cancer in isolation. A new, cooperative approach and research base are being advocated for preventing, treating, and palliating cancer to bridge the gap between developed and developing nations. 5
The Health service journal, Jan 26, 2004
1. Health Serv J. 2004 Feb 26;114(5894):34-5. Bed management. Pillow talk. Proudlove N, Black S. ... more 1. Health Serv J. 2004 Feb 26;114(5894):34-5. Bed management. Pillow talk. Proudlove N, Black S. Manchester School of Management, University of Manchester Institute of Science and Technology. PMID: 15011512 [PubMed - indexed for MEDLINE]. MeSH Terms. ...
BMJ (Clinical research ed.), Jan 24, 2013
The NHS reforms initiated by Andrew Lansley deserve much criticism, but David Hunter’s opposition... more The NHS reforms initiated by Andrew Lansley deserve much criticism, but David Hunter’s opposition to reform is ineffective because it appeals to emotions and doesn’t draw on credible evidence.1 For example, rather than discuss the evidence about whether competition among providers is good for patients,2 Hunter goes straight to the easy rhetorical point that this will lead to a system governed by “naked greed,” as in the …
BMJ, 2009
Heath understates one important issue in her observations on breast screening1: the systemic illi... more Heath understates one important issue in her observations on breast screening1: the systemic illiteracy of doctors, epidemiologists, and other health professionals in communicating statistical results. Gigerenzer pointed out just how badly professionals misinterpret risk when given the …
BMJ (Clinical research ed.), Jan 24, 2013
The NHS reforms initiated by Andrew Lansley deserve much criticism, but David Hunter’s opposition... more The NHS reforms initiated by Andrew Lansley deserve much criticism, but David Hunter’s opposition to reform is ineffective because it appeals to emotions and doesn’t draw on credible evidence.1 For example, rather than discuss the evidence about whether competition among providers is good for patients,2 Hunter goes straight to the easy rhetorical point that this will lead to a system governed by “naked greed,” as in the …
BMJ, 2007
We select the letters for these pages from the rapid responses posted on bmj.com favouring those ... more We select the letters for these pages from the rapid responses posted on bmj.com favouring those received within five days of publication of the article to which they refer. Letters are thus an early selection of rapid responses on a particular topic. Readers should consult the website for the full list of responses and any authors' replies, which usually arrive after our selection.
BMJ, 2010
The centralised drive to meet the politically attractive target of cutting management (there is n... more The centralised drive to meet the politically attractive target of cutting management (there is no public lobby for more bureaucracy) runs a serious risk of undermining the capacity of the new NHS to improve and spend its money well.1 We need some people who know how to spend NHS money wisely. Primary care trusts spent 1-2% of …