I don’t think there could be a much clearer example of the concerted, deliberate and wantonly inaccurate media campaign to undermine the NHS and achieve ulterior motives than today’s BBC News headline about the Leeds Children’s Heart Unit (CHU). It’s also perfectly in line with the track record of media and certain health interests in sullying the reputation of Leeds’ crucial and much-loved unit – a continued demonstration of the determination in certain quarters to see Leeds close even if there is no justification for it. There are too many articles on various facets of that story to link them all here, but if you want to see more a search of the blog for ‘Leeds’ will yield plenty of reading material.
The BBC long ago abandoned any pretence of impartiality on the NHS, instead contributing with gusto to the disinformation on issues like the A&E crisis, or even virtually ignoring major stories like the almost unanimous condemnation of the then-NHS bill (now Health and Social Care Act) or the astonishing march of 51,000 people through the streets of Stafford in support of their wrongly-maligned and now-threatened hospital.
And so it continued with Friday’s ridiculous article on children’s heart surgery at Leeds General Infirmary (LGI), which quoted Professor Brian Jarman:
The headline couldn’t be more emphatic. The only small problem is that it’s completely untrue.
Even according to the same BBC article.
The damning verdict begins
A leading expert on hospital mortality data has told the BBC he would not send his child to the Leeds children’s heart unit because of its death rates.
Prof Sir Brian Jarman of the Dr Foster research group at Imperial College said mortality rates for planned operations at Leeds were the worst in England.
But further down (far enough to avoid the notice of casual readers), it contradicts itself:
The only other hospital with a worse-than-expected death rate was Guys’ and St Thomas’ in London where five children died from its 442 admissions compared with an expected figure of 4.10 (a relative risk ratio of 122.04).
Last time I looked, London was in England. Let’s just double-check:
Yup, there it is.
So, the BBC puts up a strident, absolute headline – and then shows itself beyond doubt to be a liar a few sentences later.
Except it’s still lying.
The article draws on Prof Jarman’s ‘Hospital Standardised Mortality Ratios’ for all England’s CHUs, measuring statistically-adjusted (always to be treated cautiously!) death-rates in children’s cardiac surgery from 2009 to 2012.
Prof Jarman, not long ago, send me a link to a file he had created to depict HSMRs in English CHUs. The file included the graph below, which shows the mortality rates from 2009 to the beginning of 2013 – if you can’t make it out clearly, click on the image to see a larger version:
No, you’re not misreading. Not only is Leeds not the highest, there is not only Guys & St Thomas that is as high or higher. The mortality rate at Alder Hey in Liverpool is not only higher than at Leeds – it’s fully 50% higher.
Yet we don’t have a screaming headline that Alder Hey has mortality rates far, far higher than any other hospital in England, nor do we have Prof Jarman saying that he wouldn’t send his children there.
Well, it ought to be. But it makes perfect sense if there is a campaign at the top to make sure that the thwarted attempt to close Leeds against all the evidence and against common sense succeeds at last.
Prof Jarman’s ‘wouldn’t send my children’ claim is uncannily similar to claims by Roger Boyle, then head of NICOR (the body which styles itself as the ultimate authority on children’s heart surgery statistics) in April.
Boyle was forced to resign for his statement, which was as unprofessional as it was unfounded: the original, detailed report on LGI’s CHU concluded that:
the review team found no reason for on-going closure of the Unit.
It seems that, whoever wants Leeds closed and whatever their reasons, their determination to see it done no matter what is matched only by their lack of imagination and creativity.
So why would Professor Jarman misrepresent the situation in this way?
I’ve had some interactions with Sir Brian on Twitter. Even though we disagree vehemently about his HSMR method and its use/abuse regarding Stafford hospital, he strikes me as a decent man. As pointed out, he has provided me with useful information when I’ve asked for it.
Prof Jarman’s HSMRs were used to falsely smear Mid Staffs NHS Trust as having killed 400-1200 patients. That claim that has now been thoroughly debunked not only on this blog but by the ‘Straight Statistics‘ group, Computer Weekly and even one tiny BBC News web article – and by an important scholarly article which concluded flatly:
The findings of the Mid-Staffordshire Inquiry do not uphold the use of hospital standardized mortality ratios as a screening test for ‘bad’ hospitals
HSMRs were revealed as flawed and unreliable, even aside from the risks that apply to any statistical mortality measurement because of their dependence on data that can be wildly inaccurate and inconsistent (and it must be noted that NICOR knows and has put on record that there are serious problems with its ‘CCAD’ cardiac data, so even the best statistical system will produce wrong results).
But even in ideal circumstances, HSMRs are intrinsically weak because of gaps in the data sets on which they are based. Because of this, they were replaced by a new measure – SHMIs – as the official mortality statistics of the NHS.
Professor Jarman’s credibility as a medical statistician is tied to his system – and his system is widely considered flawed. His job may also be tied to it. The professor is based at the Doctor Foster Unit (DFU) at Imperial College, London – and his unit provides statistical analysis to a commercial company, Doctor Foster Intelligence (DFI).
In his testimony to the Francis public inquiry, Professor Jarman made a crucial admission. The following day, when examining Roger Taylor of DFI, counsel to the inquiry Tom Kark phrased it thus:
When Professor Jarman gave evidence yesterday, he was talking not just about the HSMR, but also about the real-time monitoring tool and all the information that Dr Foster overall can provide. But he seemed very, very unsure about whether the government wanted all of the information that DFI could provide, and went so far as saying that without DFI the government would have shut the unit, Dr Foster Unit, down.
Without DFI’s commercial use of the statistics, the government would have closed down Prof Jarman’s unit.
DFI took DFU’s statistical analyses, used them to create a league table of hospital death rates – and then sold its monitoring system to hospitals for £35,000 a year to help them improve their position in the league table.
Roger Taylor, astonishingly, claimed that this did not represent a conflict of interest – and even more staggeringly, this was accepted by the inquiry. But it obviously is one, nonetheless.
Prof Jarman therefore finds himself in a very difficult position. I believe him to be an essentially honest man – but he is facing great pressure, and an inevitable conflict of interest, to vindicate his system and restore its status as a credible measure of hospital mortality.
This has led him onto shaky ground before. Again to the BBC, to a TV interviewer as well as on the BBC News website, Prof Jarman claimed that there were 20,000 avoidable deaths in the NHS – even though he himself agreed with me on Twitter that HSMRs cannot be used to calculate numbers of avoidable deaths.
A professor with a deep-seated need to justify his magnum opus, NHS executives that appear determined to close the unit at Leeds in spite of judicial rulings against it, misrepresented reports and flawed data. However these factors combined, it’s unmistakably clear that the media portrayal of surgical safety at LGI is deeply unreliable and based on hidden agendas – and that it fits perfectly with an overall strategy to undermine and demonise the NHS in the public perception.
LGI’s CHU is too important to the people who depend on it for us to fall for the ruse. And that’s even more true of the wider NHS.
Don’t be fooled.