Good day to you. Very rainy here.

But never mind - we have a bracing new dose of The Maynard Doctrine for your pleasure.

Maynard's discussion of clinical variations and quality issues could not be more timely with yesterday's cover feature in The Observer on a report about serious clinical problems at Birmingham Children's Hospital NHS Foundation Trust.

You can download the report here.

The trust has issues a statement, saying "An article appeared in The Observer on 9 Nov about Birmingham Children’s Hospital. This was very misleading and based on the views of a small minority of consultants, most of whom are not employed by this hospital. The report referred to in the article has not been authenticated or seen by any member of staff at the hospital. We refute it.

"We have been working closely with the local Commissioners on an action plan to make some operational improvements that are required as the hospital expands and treats more children who require our specialist clinical services.

"We would like to reassure all parents and families of our patients that there is no need for concern and we have total support from the Commissioners who are assured that there is no immediate risk to patient safety at Birmingham Children’s Hospital.

"This story does not represent our staff, relationships between clinicians and managers are very good and cooperative, and it certainly does not reflect the very high standard of clinical care offered by this pioneering specialist hospital."

Evasive response
Now this is not a terribly good response, and it smacks of evasiveness. More to the point, the report is quite clearly not prepared for the trust - it is for the commissioners - who should authenticate the document unless it is a forgery.

No institution has no problems, but at the very least, the 'incident reporting' procedure allegations - that there is a "why bother?" culture at the trust - should be of great concern.

However, I've just reviewed the Healthcare Commission's annual health check report for 20-07-8 on the Birmingham Children's Hospital NHS Foundation Trust. Which makes interesting reading.

2007-8 AHC overall score - Fair (quality) / excellent (use of resources)
2006-7 AHC overall score - Excellent (quality) / excellent (use of resources)
2005-6 AHC overall score - Fair (quality) / fair (use of resources)

In 2007-8, Birmingham Children's Hospital NHS Foundation Trust's core standards score was deemed ‘fully met’; the existing national targets score was judged ‘partly met’; and new national targets score was reported to be ‘good’.

Monitor will already have been on the phone, and are probably at the trust as I write. However, it does not necessarily fill us with confidence about the annual health check.

And finally ...
That is a heavy way to start the week. On a happier note, I also warmly recommend Richard Smith's excellent piece for The Guardian about polypills and the prevention paradox.