The leaves are coming down, the temperature is dropping and adverts for the flu jab have started to appear.
Winter is coming. November to March is always the most difficult time of year for the NHS and as if to underline the fact, the Scottish Government has just released figures showing that deaths last winter represented the highest number of winter deaths in the last four years.
Generally, death rates are dropping: in fact, last year, the sixth lowest number of deaths were registered in Scotland in 60 years, since records began. Closer inspection of mortality figures, however, reveals the rather less cheering picture. The report from the National Records of Scotland shows that there were almost 800 more deaths last winter than during the same period the year before. In addition, the mortality rate calculated for Scottish Hospitals - which takes in all deaths following a hospital admission - climbed last winter and there were 453 more deaths between October 2012 and March 2013 compared with the same six months the previous year. This is in spite of the fact that 2012/13 was a mild winter, not an ice-bound period of freezing weather.
Why should this be? It is well known that A&E departments struggled to cope with demand last winter, particularly from the growing elderly population. The Herald's NHS: Time for Action campaign has revealed that hundreds were left waiting for 12 hours or more in A&E. Does holding people on trolleys and moving them many times between wards impact on their health and, if so, could this have contributed to higher mortality rates? Is pressure on NHS staff and facilities, caused by budgetary constraints, having an effect? These are questions that ought to be looked at.
There has been been a big and successful push on patient safety in the NHS which has helped contribute to the long-term trend, up until now, of falling mortality rates. Strategies to tackle hospital infections have made a big difference, but with an ever bigger proportion of the population aged over 65, many with complex health problems, it is unlikely the downward long-term trend can continue indefinitely. What is hard to quantify is the extent to which stress on staff and facilities within the NHS could impact on mortality rates.
The Scottish Government has been a little quiet on last winter's Scotland-wide mortality rates, in contrast to its response in August after news emerged of higher-than-expected death rates at two specific Lanarkshire hospitals, when it ordered a "rapid" investigation. Are ministers confident they fully understand the issues impacting on the rate of deaths? If not, they should investigate before this upward blip turns into a trend.
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