National media: Keogh says 13k NHS deaths! Keogh: er, no I don’t

Please share widely, as this is huge and needs to become well-known before the report is published tomorrow.

As I wrote yesterday, the national media is running massive headlines claiming that a report by Sir Bruce Keogh, Medical Director of the NHS, will state that 13,000 people died ‘needlessly’ in the 14 NHS hospitals currently under special investigation for supposed high mortality rates.


As I pointed out, the death claims are completely unfounded and based on the misuse and misrepresentation of a deeply-flawed statistical system, and would still be completely unfounded even if the system were not deeply flawed. For more details of why, read here.

Well, it turns out that the report’s author, Sir Bruce Edward KeoghKBEFRCSFRCP himself, also disagrees with the headlines about his own report. A SKWAWKBOX reader wrote this email to him to challenge his supposed assertions after reading my article on the ‘needless death’ claims:

Dear Mr Keogh,
The Telegraph is running a front page splash today based on your estimate of 13,000 avoidable deaths in some UK hospitals.
The Francis report called using HSMRs in this way ‘unsafe’ and ‘an abuse of figures’. So I’d be grateful if you could explain why you disagree with Francis about the use of HSMRs to produce lists of estimated deaths.
Do you have 13,000 named individuals, Mr Keogh, who have had their case histories examined to see what role neglect or mistreatment may have played in their deaths? Or re you using HSMRs?
I would draw your attention to this abstract, from the University of Birmingham: (http://qjmed.oxfordjournals.org/content/early/2013/05/07/qjmed.hct101.abstract)
“The Mid-Staffordshire Public Inquiry has published its findings. The initial investigations were triggered by an elevated hospital standardized mortality ratio (HSMR). This shows that the HSMR is being used as a screening test for substandard care; whereby hospitals that fail the test are scrutinized, whilst those that pass the test are not. But screening tests are often misunderstood and misused and so it is prudent to critically examine the HSMR before casting it in the role of a screening test for ‘bad’ hospitals. A screening test should be valid, have adequate performance characteristics and a clear post-test action plan. The HSMR is not a valid screening test (because the empirical relationship between clinically avoidable mortality and the HSMR is unknown). The HSMR has a poor performance profile (10 of 11 elevated HSMRs would be false alarms and 10 of 11 poorly performing hospitals would escape attention). Crucially, the aim of a post-test investigation into an elevated HSMR is unclear. The use of the HSMR as a screening test for clinically avoidable mortality and thereby substandard care, although well intentioned, is seriously flawed.”
The Francis report called using HSMRs in this way ‘unsafe’ and ‘an abuse of figures’. So I’d be grateful if you could explain why you disagree with Francis, and the paper cited above, about the use of HSMRs to produce numbers of estimated deaths.
Thanks very much.

To his credit, Sir Bruce responded almost immediately, in spite of it being a Sunday, as follows (highlighting mine):


Thank you. I agree with your sentiments entirely. Not my calculations, not my views. Don’t believe everything you read, particularly in some newspapers.

I am very well versed in this topic, including the abstract you attach.

When you read my report you will regret sending this email!

With best wishes, Bruce Keogh

So we have a situation in which the media is reporting, in the most emphatic terms, a story that is deeply damaging to the NHS – yet which is completely at odds with the reality, Sir Bruce not only disavows the death claim (“not my calculations, not my views”) but says that his actual report is so different to the media claims that his correspondent will regret sending his complaint once he reads it.

This is exactly the same pattern seen with media’s (and that of certain so-called ‘patients’ groups’) treatment of Stafford hospital, in which death figures are repeated ad nauseam until they’re assumed to be fact – even though the Francis inquiry and even the creators of the statistics, DFI, say that any assumptions about death numbers would be ‘an abuse of the data’.

Mud sticks, and the media are flinging it in abundance at the NHS. But can there really remain even the slightest doubt that it is being flung with a definite agenda in mind?

An agenda to take any and every opportunity, no matter how much the facts have to be stretched and twisted, to attack the public’s affection for, and confidence in, the NHS – so that there will be less protest when it is effectively ended by being ‘saved’ by privatisation.

But the abuse of the facts here is far simpler to understand than the statistical abuses that were used to create the ‘Mid Staffs scandal’. If word gets out on this and is picked up by enough people, the lying anti-NHS media might just have over-reached. Let’s make sure they’ve shot themselves in the foot.


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