Is challenging Mid Staffs claims heartless?

Someone today told me that something I’d said on Twitter, in a discussion on HSMRs (hospital standardised mortality rates) and the furore surrounding Mid Staffs was

insensitive and disgraceful.

The statement in question was in response to yet another person conflating the issues of poor care – which undoubtedly did exist in some areas of Stafford hospital and which was squarely blamed by the Francis report on understaffing – and the supposedly high mortality rate at the hospital (which without any doubt was not real, but a statistical artefact).

This is what I’d said, in response to the assertion (from a different person) that ‘poor care and HSMRs must be linked. Daft & dangerous to assert otherwise‘:

CAN be, not must be. Sitting in a messed bed rarely fatal.

This is what my interlocutor considered insensitive and disgraceful. When I responded, I was then accused of being

insensitive to those who saw mums die like this

(He did afterward query that he wasn’t challenging the fact that people very rarely die from being in a dirty bed, but was just offended at the ‘crude’ way I’d expressed it).

It set me thinking. Not about whether I was being cruel in expressing what I did, how I did, because I don’t believe I was being any more direct than you have to be to express a point in 140 characters (and much less in this case because of the space taken by the names of the people involved in the discussion).

It set me thinking about the whole Mid Staffs issue and how much of that must be tied up with the idea that, if someone’s grieving, it’s cruel, or insensitive, or somehow mean, to tell them they’re wrong about something. The idea that, somehow, it’s taboo – like laughing at a funeral.

I’ve spent a lot of time over the past month or more looking into the evidence about the events at Mid Staffs and comparing it with the headlines, claims and statements made the media and politicians – and also the families of people who died at Mid Staffs.

I’ve been told by some of those people, or by their friends/supporters, that:

  • I have no right to express an opinion about what happened, because I didn’t have a loved one die at Stafford hospital
  • I’m ‘disrespecting our dead’ by questioning whether the claims that Mid Staffs was ‘killing hundreds of people’ were correct
  • I’m cruel, heartless, arrogant and other variants of the same idea for challenging their view because ‘we were there’
  • I don’t care about people starving or dying of thirst
  • I’m deluded and wasting my time saying things nobody’s interested to hear about
  • I’m a drunk
  • I’ve wasted my life
  • I’m just a ‘leftie’ who’s prepared to trample all over their feelings and the memories of their loved ones in order to vindicate my ‘beloved Labour party’

and quite a few other diatribes, including, by one particularly volatile and irrational person (who I don’t think actually lost a relative) being accused of being a chauvinist and a friend of paedophiles.

What’s notable is that, almost without exception (a riposte by a journalist that I posted and responded to on this blog), nobody actually addressed the facts or mounted a reasoned challenge to my conclusions.

Don’t get me wrong – not everybody who disagreed with me was abusive. There were a few people who repeatedly asserted that my facts and conclusions were wrong – but without providing any evidence for the assertion, even when asked to do so.

But my overwhelming impression of the last few weeks (apart from the strong support and kind words from many people) is of being attacked for merely daring to say that groups like ‘Cure the NHS’ aren’t justified in the extent of some of their claims and actions.

So, as I said, it set me thinking – about how much what’s happened around Mid Staffs has been fuelled by some misguided sense of ‘we mustn’t contradict them, they’re grieving’ and more to the point, ‘you must take everything we say seriously, because we’re grieving’.

I should say at this point that I am definitely not saying that people who lost loved ones at Stafford don’t deserve sympathy and don’t have a right to their grief. People who’ve lost loved ones anywhere, anyhow, deserve sympathy. And as I’ve written before, I watched my mother die after a long fight against cancer, so I know what it feels like.

What I am saying, though, will probably be contentious enough:

  • the fact that someone believes their relative died through poor care doesn’t make it true. It might be – or they might be wrong. Even if there was poor care in a particular case, that doesn’t mean it killed someone. They might have died anyway, and their death had nothing to do with the poor care. As the statisticians say, ‘correlation does not equal causation’ – that 2 things coincide doesn’t mean one caused the other – and few if any of the bereaved at Stafford had medical training.
  • the fact that someone is grieving over the death of a loved one does not mean that their conclusions and wishes about wider aspects of healthcare carry weight and must be acted upon. Grieving people are rarely thinking with perfect clarity and might easily make wrong or unfair conclusions – and a grieving person who wants a town to be without its hospital because of their grief is definitely not thinking rationally
  • the calls of grieving people for action are not necessarily right or wise – and are not the best basis for policy decisions unless objective, dispassionately-considered facts also indicate the same actions are necessary
  • the fact that someone’s grief is genuine does not mean that person cannot be exploited by the unscrupulous for very bad ends. The fact that the bereaved of Stafford have a genuine cause for grief does not mean they are not being exploited by their local MPs and by government ministers to attack the NHS in a completely unjustified fashion

Am I being ‘heartless’ by stating these things plainly? I don’t believe I am. There has been so much emotion (and so much of it whipped up and used by media and politicians to further very bad plans) that someone has to challenge the emotional ‘emperor’s new clothes‘ phenomenon that’s taking place and present a few facts and a different view of events and their significance.

After all, if I saw someone so devastated by grief that they were about to set themselves on fire and burn down a building that contained a lot of other people, you’d think me heartless if I didn’t stop them – for their sake and the sake of all the people they’d be about to harm. And if I saw someone egging them on for their own amusement or enrichment, you’d expect me to want to grab that person and pin them down until the police arrived. You wouldn’t call me ‘crude’ for shouting ‘FIRE!’ to the other people about to be affected instead of speaking in soft and gentle words.

Likewise, if I saw someone so angry that they were about to throw their stuff off a bridge with people walking below, you wouldn’t think I was out of order to try to stop them wrecking their possessions and hurting others – or for shouting to the people below what was happening and to get out of the way.

Similarly, saying that: the grieving relatives in Stafford are not necessarily to be treated as uncontradictable arbiters of how the NHS should be run; that their view of events might not fit with the facts; that the poor care in a few parts of Stafford hospital was not resulting in an increased HSMR death rate (because it wasn’t, in spite of constant media headlines claiming ‘hundreds of needless deaths’) – or even that you almost never die from sitting in your own mess for a while – is not cruel, heartless or disrespectful of the dead.

They’re simply true. There is constant conflation by the media, government and some campaign groups of the issue of poor care in a couple of parts of Stafford hospital and the high mortality statistics that have since been shown – including by the Francis report – not to mean there were unnecessary deaths. And I repeat, once the mortality codes were entered properly, the mortality rate at Stafford was below the national average – which means that in spite of understaffing that led to very imperfect care on occasions, the staff of the hospital were actually working wonders to keep people safe.

Considering grief and emotion so sacrosanct that nobody dared gainsay them has led to a witch-hunt – and has handed to an NHS-hating government on a plate the opportunity to close not only Stafford hospital but another 14 (and more to come) around the country. It’s not heartless or insensitive to draw attention to the facts in the frankest terms – it’s an obligation and an imperative.

The people who are disrespecting both the dead and those left behind are those who are, mischievously and maliciously, exploiting them for their own ends – the Tory MPs and ministers who are so desperate to destroy the NHS and to destroy the public perception that Labour are the friends and protectors of it, that they will – with mock sensitivity and faux-sympathy – shamelessly exploit the bereaved and their dead, and foster utterly incorrect conceptions of what happened at Mid Staffs and what the statistics showed.

They’re the ones who have an end in mind that will be bad for the bereaved in Stafford and bad for almost everyone else, and they’re encouraging grieving people to fan the flames to achieve it.

If you want to see what ‘heartless’ really looks like, take a closer look at them.


  1. Would you suggest the Francis report was therefore unnecessary? Surely thorough clinical investigation would without doubt conclude how many deaths were avoidable.

    1. Once the public frenzy started, the inquiry was necessary. But before that, essentially yes. As someone in Stafford (not at the hospital) put it, without the HSMRs, all that would have been left was some complaints about the complaints procedure. Handling those better and carrying out clinical investigations where appropriate would have been enough.

      1. Complaints about the complaints procedure would have been enough? Interesting. No complaints about the standards of care?

  2. Very well put – and sensitively done.
    It is undoubtedly the case that MSFT has been in apology mode for 4 years as a matter of policy. This may have been an understandable strategy to engage Cure the NHS for the good of local services and for them (I don’t think they have yet visited the hospital to see the improvements) – as well as feeling sad about it all.
    What was a very bad idea, and a major contribution to worsening the (mainly financial) situation was staying in apology mode in relation to the interventions by all the regulators who felt under pressure to put the boot in over that period (many more visits, more detailed and aggressive and unforgiving examinations). It is said that regulators were pressurised to visit even if one wasn’t scheduled for a year or two or if indicators routinely collected suggested a visit wasn’t necessary (few resisted I imagine).
    If you take away the extra costs implicit in these visitations, the (known) extra risk management costs incurred and the loss of some patients/referrals to outside the catchment area on account of this and the attendant publicity, is it any wonder that while the quality agenda was (successfully) addressed, there were problems in some areas of recruitment and in the finances. It’s a bit of a miracle, and much to the credit of the staff, that such a good outcome has been achieved in the face of this and the on-going anxiety and aggro concerning the CPT report/administrator and the recent announcement that the CEO (Mrs Hill-Tout) is retiring. She was supposed to do 5 years of developmental work (not 2) and then retire at 60. Has she been pushed? (Certainly the staff would prefer she stayed).
    What a learning opportunity for the NHS!

  3. There’s another way of looking at it — the more viscious the response, the closer to the bone your argument is ESPECIALLy when your argument is being ignored.

    I think you made the observation somewhere else that often relatives behave selfishly, such as demanding attention for their own loved ones at someone else’s expense. I can relate, to them.

    The problem really lies not with the politicians you would expect to exploit them but the responsible journalists you would hope would not be *played so easily …

  4. You are presumably protected by some sort of Whistleblower’s charter aren’t you? Err …..

  5. SKWalker1964, you are absolutely right to question the use of HSMRs to denounce hospitals that happoen to fall on the wrong side of an arbitrary point. And no I personally dont believe you were heartless and uncaring to suggest that deaths ina high HSMR hospital are due to poor care – provided of course that poor care has been well evidenced from other source, or that the high HSMRs allow one to calculate the number of so-called ‘unnecessary’ deaths.

    Indeed I have gone further in my BMJ letter to suggest that hospitals with low HSMRs may well be led into a state of complacency and thus overlook poor care and actual harm and even deaths of patients due to acts of omission or commission.

    As a public health doctor I am appalled at the way this statistic has been used by all and sundry to plug their own narrow point of view ignoring the larger picture. Its a pity the statisticians and public health folk havent come out more strongly to explain the misuse of such summary measures.

    None of this is to condone poor care or neglect of patients or harm to patients. That should never happen and should always be tackled directly. But if you want to monitor the general level of care and quality in a large and complex organisation like a hospital then a) HSMR is a pretty crude tool – it has to be since it epends on so much statistical manipulation and adjustment for poorly understood and variably recorded variables; and b) there are other more direct means that are better but unfortunately are also more expensive.

  6. Another exceptionally accurate, logical and sensible article. It seems to be the case that you and all of staff at Stafford hospital can be abused and accused by ‘certain people’, in addition to the press and politicians. But when the myth and negligent sensational stories are challenged by fact and common sense, we constantly accused of being in denial. It is true that Mid-Staffs have been in apology rather than challenge and honest explanation mode since 2009. I believe that this has made the myth more believable by the public and allowed stories to be embellished over time. Thank goodness for people like you, who have dared to expose the REAL facts and try to have the truth heard. But how will this be broadcast widely enough to truly explode the myth. The press will not print it, as to do so will be to admit that they’ve been lying for 4 years.

    1. Thank you! I should be clear that I don’t work at Stafford nor even in the NHS – I don’t even live anywhere near Stafford!

      I just have a certain way with figures and analysis, and hate to injustices, including seeing falsehood presented as shocking fact.

      I’m working hard to get this information noticed. It’s starting to be picked up at a regional level by the BBC, and by one or two local radio stations – hopefully, this will be the first step toward getting it picked up at a national level.

      We’ll see – but any help is always welcome!

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