It’s been an interesting day. First in a very good way – I attended a very interesting event ‘Journalists and the new health system’, met some very good people and ended up on the panel, and had a lot of fun.
The next part was no less interesting but somewhat less fun, at least initially. An email was forwarded to me that has been sent by Private Eye – a fairly aggressive and accusatory one (although things did mellow a little after a few responses had been exchanged) which asked whether I (and another writer who has blogged on Mid Staffs) was being paid by the Labour party to write my articles on Mid Staffs and HSMRs, and accusing me ( and the other writer) of attacking people who are ‘trying to expose poor care‘.
Both are nonsense (although I have certainly criticised the Eye’s columnist(s) for lazily assuming that the headlines about HSMRs were true instead of checking the facts first). But rather than me write on them at length, I’m going to show you the initial email, my response, and then the emails that followed, so you can judge for yourself.
I’ve deleted the details of the other parties to preserve their privacy, but the content of the emails is, as far as I’m concerned, fair game. Emphases are mine, and my responses are in blue:
From: xxxxx xxxxxx <xxxxxx.xxxxxx@gmail.com>
Date: 26 March 2013 10:57:17 AM GMT
Subject: Private EyeDear Ms xxxxx
I am writing for Private Eye and have noted both yours and Steve Pleb Walker’s tweets. Please could you tell me whether your tweeted opinions on HSMR are Labour funded – how much funding you receive from your local party – and what scientific basis you have for making any of the claims you do? Further are you linked in any way to the BMA?
It would be really helpful if you could respond, as poor care is not resolved by attacking those who might expose it. Or is it not? [sic]
Yours sincerely,
XXXXXX XXXXXX
Private EyeDear Mr XXXXX,
XXXXXX forwarded me your email. She’ll answer for her own part, but I will answer for myself. To your questions (with a few additional facts thrown in):
- I receive no funding from anyone for my blog, nor from any political party for any purpose whatever.
- My ‘claims’ are made based on evidence gathered from various sources, including the transcripts of witness evidence to the Francis inquiry. All my sources are fully stated in my articles, with links where applicable – as you’ll know if you’ve actually read them – so anyone is free to check whether what I’ve pointed out, and the conclusions I’ve drawn, are correct and valid.
- I am not linked in any way to the BMA.
- I have no link to Stafford or Cannock hospitals, no relatives work there, and I live a long way from Staffordshire.
It’s not a matter of ‘attacking those who might expose poor care’. Poor care is not at issue, at least in anything I’ve written. My articles acknowledge poor care very frankly and explicitly.
What is at issue is the mishandling and misrepresentation of statistics, and the damaging headlines that have been spun out of the misrepresentation. Media from the BBC to the Telegraph to – yes – the Eye have repeated as fact the idea that ‘hundreds of needless deaths’ occurred at Stafford hospital, but the statistics say no such thing.
Robert Francis took care to say that HSMRs cannot be used to extrapolate numbers of avoidable deaths, and Prof Jarman and Roger Taylor admitted the same in their testimony to the inquiry – yes Prof Jarman is now giving interviews to TV and press saying there were 20,000 avoidable NHS deaths on exactly the same basis that he acknowledged could not be used for Stafford.
Many of the media have a clear and negative agenda in proclaiming these headlines. I trust that is not the case with the Eye – but recent articles have still been extremely misleading.
‘Avoidable’ deaths occur in NHS hospitals every day – and in every other hospital and healthcare system in the world. Healthcare is intrinsically risky, and because it is delivered by fallible human beings things will be missed, or done incorrectly.
Did people die avoidably at Stafford? Without question. Was the poor care at Stafford resulting in an elevated death rate that could justify headlines of ‘hundreds of needless deaths’? Absolutely not.
The corrected HSMRS (reflecting proper depth of coding and fully-audited palliative care codes) were substantially below the national average.
Since the existence of poor care in parts of Stafford because of severe short-staffing (as recognised by the Francis report) is uncontested, the fact that the death rate was below average means the headlines should be telling a completely different story – one in which overstretched staff managed to hold the essentials together well enough to prevent the understaffing from increasing the death rate.
The headlines say something else, and the end result is that the people of Stafford look likely to lose their hospital altogether.
I’m trying to present the facts in a proper light to redress the balance a little, and I have attacked unfounded/ill-founded statements, shoddy interpretations and lazy/malicious journalism, not individuals.
Steve
Within a minute or two of sending my response, I received another (and answered it):
Thanks for that Steve. Perhaps you could set out your qualifications – any mathematical or statisical or medical – to make the assertions you do about lazy malicious and shoddy journalism.
I have asked the Labour Party today who have distanced themselves from the views of yourself and XXXXX XXXXXX.
Yours sincerely,
XXXXXX
Labour will have to take a wider political view than I (happily) do. I have no qualifications other than intelligence, common sense and a certain dogged analytical bent – nor is it remotely relevant whether I do or don’t. If you can show my facts and conclusions to be wrong, do so. My qualifications have no bearing on the correctness or otherwise of what I’ve written.
and then..
Thanks for that Steve. Are you happy for me to forward this to the letters page of the Eye?
As you should be aware, HSMR is based on the coding of hospital episode statistics. That process can be “gamed” and your claim that Stafford was below average is a bizarre one which implies to me you simply haven’t looked at the HSMR figures (before attacking them).
Your point about a ratio of actua/expect as opposed to data on actual deaths is a fair one. And the media have sometimes taken a ratio to denote something else. However, HSMR do show up problems confirmed by real intelligence in the hospitals – surgeons, doctors, nurses. Even in failing hospitals there will be good doctors who are unfairly maligned. Nevertheless, apart from your general intelligence and common sense it might also be worth speaking to people who work in hospitals.
XXXXX,
Feel free – I’m going to post the exchange to my blog, so you’re welcome to print them in the magazine (which I buy, btw).
My articles address ‘gaming’, so your inference is incorrect. Gaming at Stafford is out of the question – the hospital’s statistics were audited by the Audit Commission and by Capita and graded 97-98% accurate. Gaming at other hospitals is possible – though more likely for income purposes rather than specifically to affect HSMRs – but the fact that they can be ‘gamed’ shows the system as it stands now and stood in the critical period at Stafford to be useless in terms of actually identifying genuine problem areas.
Hospitals might conceivably have poor HSMRs simply because they’re more honest than some others and are not gaming their figures. Or they might have genuine issues – or might just not be very good at coding, since the vast majority of coders are unqualified (and usually overstretched since theirs is a ‘back office’ function likely to be an easy target for cuts by people who don’t understand the potential consequences).
This is a tragedy, since HSMRs could be a vital tool – but only if money is invested in training coders and auditing coding strictly and regularly, to ensure consistency of input. Otherwise, ‘rubbish in, rubbish out’.
I do suspect you haven’t read most of what I’ve written, though – or else you’d know I’ve spoken to a lot of people in hospitals, both on the clinical side and an in-depth interview with Stafford’s unfairly-maligned (and proven by audit to be capable and rigorously honest) coding manager, who joined halfway through the debacle and ‘righted the [coding] ship’.
There have been hospitals with poor HSMRs who had clinical problems, it’s quite true. It’s also true that there have been hospitals with poor HSMRs and no substantial clinical problems, and hospitals with great HSMRs who, on inspection, were found to be riddled with problems. That’s the problem – HSMRs are too random to be useful, because of the problems with poor coding, lack of training and auditing, etc.
Steve
The rest of the emails so far then get into details of evidence etc that won’t make very interesting reading here.
By the point in the correspondence shown above, the tone seemed to have shifted considerably and were turning into an interesting and much less confrontational correspondence. But it’s interesting, given the clear way in which much of the media (though not, I trust, the Eye) are clearly marching to a Tory-mandated, anti-NHS drumbeat, that it should be assumed that I would only be putting forward a different interpretation because Labour were funding me.
In any event, it shows that the alternative (and I would contend far more accurate) story is catching the attention of the professional media, which is great. I’ve had calls from regional BBC correspondents over the last week or so looking for more information because their hospitals are being targeted for supposed similarities to Mid Staffs, when Mid Staffs was never what it has been portrayed as being.
It’s been a fairly intense few weeks, one way or another. But if a more balanced, less damaging view percolates out into the public consciousness, I’ll consider it all more than worthwhile.
In our local campaign @NHSour we follow your forensic analysis closely and wish the national media did the same. A number of us buy PE and we look forward to seeing how they report this exchange. Keep the good work up. We do get out a lot and as such will continue to maintain our subscription to the SKWAWKBOX. Mike Campbell (Save Our NHS)
Thank you!
Hopefully another great result by SKW and confirmation of ‘national treasure’ status for brilliant, dogged, fair, clear & acute research & analysis. Fantastic level-headed presentations which disentangle misguided interpretations of facts which professional well-paid journalists have lazily repeated and amplified, often with tragic results. Most blogs here by SKW apply an urgent corrective to politically motivated PR-instigated distortions. If only more of them could be absorbed through rusty hypodermics into the brains of hide-bound politicians before their frequent spells of rabid vindictiveness wreak the usual but not always reversible destruction.
😀
I’m getting more and more worried by Private Eye. Hislop is a known LibDem supporter and so therefore by default, is presumably a coalition sympathiser.
Not good for a supposedly satirical magazine to be a government supporter I would have thought.
Keep up the good work!
I read your original post on Mid-Staffs with great interest, and have been dismayed (understatement) to hear the continuing and growing received wisdom on every political programme, in every debate, and passing comments, that contradicts what you have shown. This exchange with PE is encouraging, I hope it leads to greater awareness of the real issues (basically understaffing and the talking down of the NHS by the government and the media, on top of their determination to break up the NHS so that the wealthy will no longer have to fund a service that they never use) among people who don’t have access to real information as opposed to propaganda and newspeak.
Thank you – couldn’t agree more!
Firstly, I have always found everything you say – evidence based. As a person who has always been concerned about statistical accuracy, it has been a breath of fresh air to read all your step wise logical analysis. From my side of things, I don’t care what your qualifications are, you could be the homeless man on the street with no qualifications to your name – your logic and evidence still make more sense than many who have medical degrees and postgraduate qualifications. You have always made more sense than Prof Brian Jarman. I have had endless correspondence with him. I don’t know you personally and as you know I have never asked about your background – it is irrelevant. Degrees doth not maketh the man.
My second point this this – Private Eye is a Satire Magazine. This means everything it is is taken with a pinch of salt. Indeed, you will not know this but their “spectacular” whistleblowing piece written by MD had one fatal flaw, it featured my ex Consultant as a whistleblower. Of course, once I told MD that he was no whistleblower while quietly outlining a minor matter of a GMC warning on this man’s record, MD was forced to back down and remove that section of the story. That is the extent of their “fact checking”. I have all the evidence for this as you know. MD feels sheepish about this. The rest of the tale of my experience with this outfit is dealt with here http://edm2031.blogspot.co.uk/2012/05/life-and-times-of-peter-bottomley.html . I have resisted the emails between Private Eye, Bottomley and the Bar Council or Bottomley to the GMC or what they told the police. That would be for a rainy day when MD’s hair will truly require the Belgravia centre.
We can then move to MD’s Patients Association “figures” that were dissected and discredited by Channel 4 Fact Check. The list is endless. http://www.channel4.com/news/articles/uk/factcheck+patient+neglect+numbers/3323197.html . Amazing they couldn’t get the figures right there either. No one questioned the junior doctor at the Patients Association or Sandy Macara or MD about these “figures”.
Anyway, one must not place MD in a compromising position really because he has always been believed. No one has sought to challenge him. The fact is – despite being a cambridge graduate and a comedian amongst everything else, he doesn’t always get it right. On the issue on HMSR – you have analysed the matter perfectly. Cambridge graduates backing Cambridge graduates as MD is with Jarman shows that they are nothing more than sheep chasing each other around the pen. Now that the border collie has arrived 🙂 – that is you Steve, the sheep have no idea what to do.
I am unclear why Private Eye is ” attacking” you. Perhaps they feel rather insecure of your intelligence and ability to cut through the smokescreens. If I were you, I would ignore Private Eye and just carry on – afterall, they are just a satire magazine fit for “boys”.
You really are providing material on this website fit for real men and women I guess:) :).
Many doctors back you – including all my medical friends. You just keep doing what you do. Good Luck.
Dr Rita Pal
http://themedicaljournalistoncall.blogspot.co.uk/
A real whistleblower – not the usual “makeshift ones that Private Eye backs” :).
Fascinating! And thank you very much! 🙂
Looks like you’ve managed the impossible Steve…….. Generating some interest in THE REAL STORY of MidStaffs. Well done!
Thank you! 🙂
Very grateful as usual. Things are hotting up in Stafford as you may know with residents gradually waking up and attacking on all fronts. The public here are in no mood for closure of acute services and the gloves are coming off. It would be handy if the national bodies like KONP and NHS Federation realised what an important line in the Sand Stafford is (and how defensible) – and put their resources/expertise in. Also, and I know I keep harping on about it but Mr Burnham has been vindicated in his approach to Stafford (including today when Mr Hunt seemed to accept that more nurses might be needed; without offering to pay for them of course) – and ought to realise what an opportunity the recovery of, and subsequent threat to Stafford is, to create clear blue water between Labour and the government – come on Andy – get the facts and become involved!
Yes – his ‘not a byword for failure but a catalyst for change’ is deeply ironic as he’s executing it in exactly the wrong way!
Here you go – the evidence of the last Private Eye antic on NHS mortality and quality of care http://themedicaljournalistoncall.blogspot.co.uk/2013/03/private-eyes-chosen-one.html
What depresses me about the correspondence, apart from the arrogant and patronising tone that suggests being a journalist somehow elevates them above you, is the idea that ‘speaking to someone in a hospital’ would somehow make your assertions any more or less true.
This is exactly the approach that leads to poor journalism – relying on individual anecdote or reporting the claims of various camps without any attempt to check the basis of what they assert. It also suggests that the accuracy of someone’s claims rests on their qualifications, not on the evidence they are presenting (something you wouldn’t do in the sciences).
Yes – both seem to be very standard fare for the objectors!
This sounds like the work of Andrew Bousfield. A quick Google search will tell you everything you need to know about him. His bullying and arrogance are matched only by his desire to expose wrongdoing. Unfortunately on this occasion he has done a very good job of exposing himself.
I couldn’t possibly comment! 🙂
Keep up the good work Steve. Very pleased to hear that the Eye is challenging you and to see that you are robust in your responses. Everyone I speak to believes the 400 to 1200 unexpected deaths figures and all media outlets keep repeating these figures as fact on a daily basis even though they never came from the Francis report itself. Ditto the drinking from flower vases. I do hope that the Eye guy reads all your stuff, I found it compelling. It is great if he is challenging you now and then realises that you have been spot on. Getting the consequential support that should then be forthcoming from the Eye would give your campaign the real oxygen that it deserves to get the wider publicy it very much needs. Best of luck. Charles
Thank you! That’s what I’m hoping for – I think it could just need one mainstream media ‘pebble’ to start an avalanche and actually impact on wider public perception.
I admire your dogged tenacity. Well done, for doing what is right.
Dear Steve,
While the Eye generally does a lot better than the press in general when it comes to investigative journalism, it has made some egregious mistakes. Backing the anti-MMR hysteria springs to mind immediately. That can be seen as a genuine mistake, but their pigheadedness in sticking to their angle when it was clear that it was wrong was more damning. I too have been dismayed at the uncritical reporting of Mid Staffs and of their general NHS bashing.
Anyway, what I want to say is well done for your work in writing such detailed blogs and standing up for our health service. I wish you every success and I hope you manage to persuade the Eye to be a bit more perceptive in their reporting.
Regards,
Simon Birnstingl
68 Manor Road Upper Beeding BN44 3TJ
Confidential message intended for the addressee only. Please do not forward without my permission.
Thank you! You might want to edit your comment if the information at the end wasn’t meant to be included (given the confidential part of the statement).
Steve
I found this interesting as only yesterday I had a letter from my Tory MP in which she tried to link 38 Degrees with the Labour party as if I would give a toss. It came about because I signed a petition condemning the coalitions NHS reforms as little more than back door privatisation.
The MP spent two small paragraphs dealing with my fears, disingenuously I might add, and the rest smearing 38 degrees, she closed by saying she will not be replying to any emails from constituents which have been generated by social media.
I do wonder what your correspondents political affiliations are, and whether Tory HQ have a campaign going to claim all critics are led by the nose by the LP, just to be clear I am not and never have been a member of the LP.
Keep up the good work
Mick
Very interesting! As I understand it, 38 Degrees are more aligned with the Greens if anything, but seem very determined to remain independent of any political party.
Would you be prepared to send me a scan of the letter?
Yes, but would need an email address.
Mick
I’ve sent it to you – or tried to. Hope I got it right!
You may like to know that I too have had to look into the coding issue closely when I was asked to explain unexpected movements in Dr Fosters league tables. Plus I even managed a clinical coding department for a while.
From where I stand it is entirely plausible that Mid staffs could have provided poor care but that they were average or better than average in its HSMR performance. That was the conclusion I came to in another hospital.
But what it does is blow the bad apple theory; and takes away from looking at HSMR rates as a catch all indicator of quality. As an aside the whole controversy does not reflect well on Dr Foster who must have known that there are serious methodological issues involved in the use , interpretation and the timeliness of the league tables they produced.
Also I have engaged in discussion with Private Eye in the past (on PFI)
and they are difficult to shift from their own ideological stance so don’t be alarmed at their tone.
Keep up the good work and as Keynes said “when the facts change be prepared to change your ideas”. Until then stick to your guns.
Thank you! I’d be interested to discuss in more detail in a day or two when I get some clear air, if that’d be ok?
you can look up my contact details on http://www.healthcareaudit.co.uk.
I’d be delighted to talk further and to help.