The BBC has, for months, joined in with the united – and completely misleading – media chorus about events at Stafford hospital. Every bulletin on the BBC News channel and every article on its website has stated, as fact, that there were
hundreds of needless deaths at Stafford hospital
in one variant or another.
Yet, in May 2010 – just after the coalition government took office – Radio Four’s ‘More or Less‘ dedicated a large section of its programme to the issue of HSMRs, the mortality statistics that fuelled the furore around the hospital, and specifically to the question of whether the statistics really did justify the lurid headlines.
The programme is remarkable for its balance, which is in itself a grim judgment on the quality of the BBC’s portrayal of health issues. You can listen to the whole thing by clicking here and listening from the 3-minute mark to the 14m mark. But in case you don’t wish to do that, here are a few highlights.
Presenter Tim Harford first notes that the claim that HSMRs showed 400-1200 avoidable deaths at Stafford is not mentioned anywhere in the HCC’s report – it had been removed because the authors of the report knew that the statistical nuances and uncertainties would be ignored and great misunderstanding would result, but was leaked later.
He then goes on to question Richard Hamblin, Director of Intelligence at the Healthcare Commission (HCC):
TH: Does it show that 400-1200 people died as a result of poor care?
RH: I think the answer is no.
Hamblin is then asked how he felt when the figures leaked and the headlines began:
Personally I was gutted.. I was really annoyed.. because we were very very clear.. that this is an inappropriate figure..because we were absolutely clear that we had not demonstrated that poor care led to..excess deaths.
Doesn’t seem much room for doubt, there, does there?
We then hear from David Spiegelhalter, Winton Professor of Public understanding of risk at Cambridge:
Half of all hospitals will have excess deaths – half of all hospitals are below average.. Hospitals can be extreme for a lot of reasons.. There is always variability between hospitals that isn’t taken into account.. not least of which is that we assume that factors such as age, and ethnicity, deprivation have exactly the same effect in every hospital in the country.. You can’t claim that excess mortality is due to poor-quality care.
So, even if the statistics were reliable (which they absolutely were not), you still couldn’t use them to support a figure for avoidable deaths or deaths linked to poor care. And even if the statistics were correct (which they absolutely were not), ‘rebasing’ them to 100 to portray an average figure every year will automatically make half of all hospitals appear to substandard.
For balance, we hear at the end from Prof. Brian Jarman, the creator of the HSMR system. Professor Jarman has recently claimed that his statistics show that 20,000 people died unnecessarily in the NHS, just as it supposedly showed 400-1200 deaths at Mid Staffs. Yet in 2010, his story was a little different:
We don’t claim ‘this is the number of people that were killed’, as it were’.
Quite a different tune. Mr Harford then challenges Prof. Jarman that his organisation is just assuming numbers of avoidable deaths from statistics that don’t show any such thing.
Predictably – since he has done so at every opportunity even though the flaws in the system (especially the data going into it but also with the system itself, which counts some deaths twice, for example) – Prof. Jarman defends the usefulness of his ‘baby’.
But he makes once incredible admission:
about 24% is random variation.
Throughout the period in which it had high HSMRs, Stafford’s figures only once went more than 24% above average – and that was shown to be down to a change in methodology that Stafford’s coders didn’t know about.
24% potential random variation is huge. Yet these statistics have been used to state, as if it were incontestible fact, that Stafford hospital was causing ‘hundreds of needless deaths’.
The more I look at the Stafford situation and at HSMRs in general, the clearer the flaws and weaknesses of the system and its results become – and the more obvious, blatant and culpable the media distortions around them. And it’s absolutely clear that my sceptical view of them is far from a new one.
A balanced, nuanced BBC view in 2010, when the Tory-led coalition had only just taken office – and a shamelessly emphatic statement as fact in 2012 and 2013 of a myth that is incredibly damaging to the NHS and to public affection for it.
I wonder what that could have been caused by..