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 Keogh, KBE, FRCS, FRCP 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):
Mr XXXX,
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.
It would be good if Sir Bruce would contact the newspapers in question and insist they admit their mistake in headlines equal in size to the lies they told. Its maybe time for whatever the new press complaints system is to get on their case.
I can’t help wondering what he means by ” you will regret sending this email!”. I very much hope it supports your campaign, Steve, but it seems rather odd wording to use if that is his intention.
Thanks – but he doesn’t know about my campaign! He was just responding to someone else’s email – my reading of it is, ‘you’ll have egg on your face for complaining about something I didn’t say’. We’ll see, I guess!
Reblogged this on Leeds North West Constituency Labour Party and commented:
Read this – it, and the previous post referred to here, are very important rebuttals of the anti-NHS media campaign breaking this week.
Reblogged this on Adel & Wharfedale Branch Labour Party and commented:
Read this – it, and the previous post referred to here, are very important rebuttals of the anti-NHS media campaign breaking this week.
Hi Steve. Retweeted and Facebooked blog with the message to retweet and share. Also sent an email with link attached to NW Tonight who is reporting on 3 of the hospitals named (1 being Tameside). Tonight’s episode had a street interview with Prof Jarman reiterating his views. Keep up the blog Steve. Like your wife, I work in the NHS (RMN) and its hard enough as it is.
Thanks mate, appreciate it! Let me know whether/how they respond.
Thanks mate, appreciate it! Let me know whether/how they respond.
I’m staggered that they are continuing to peddle this damaging untrue nonsense! As your other commenter said why is this not in the news too? Saw Jarman repeating it last night on TV. He’s the one who will have egg on his face suggesting that all these other hospitals are as bad as mid staffs , I was shouting at the telly again.
You are as bad as him because you are saying Mid Staffs is bad. As my daughter & I stated on FB yesterday, Both she & my 86 year old mother have been treated for years here and have no complaints.!!
It has spread like a virus, the Beeb and Sky are reiterating the 13,000 stats. I hope Sir Bruce makes a statement soon. I feel so sorry for hard-working NHS staff who have already been stretched. To have this ignominy spread indiscriminately must hurt.
Trust me, it’s heartbreaking.
I have just thought that the main reason may be the rush to get the “scoop” has driven common sense from the media’s mind. Again. Why couldn’t they have just waited and analysed the report!
I think it’s far darker than that. Private health group has already admitted ‘orchestrating’ campaigns with the Telegraph to influence public opinion in favour of private healthcare:
http://skwalker1964.wordpress.com/2012/10/12/hunt-planning-massive-new-wave-of-nhs-attacks-telegraph-colludes/
I’m not surprised with the Torygraph doing that. The independent is I hope more circumspect.
The nhs was set up for the people so they would have better treatment than they got in the workhouse. It belongs to the people not the government of the day to say it is broken doesnt work etc its just not making enough money for the toffs and their pals. Nhs staff do a difficult job under difficult conditions.
Thank you for hi lighting this Steve. I am an experienced nurse and midwife having worked for the NHS for over 35 years. How infuriating to have the excellent care that I and my colleagues give, day in day out ,condemned to death by this Tory mob. They are peddling fear and distaste for a service that may not always be perfect but strives to give the best care possible to our patients and their families. Resources are at bare minimum and the government will not commit to setting safe clinical staffing levels – why? Because if they did we would have a viable health service and they would need to invest and commit to the nhs when they have decided that they want to continue their quest for an elite private health care system leaving a second rate public system.
Couldn’t agree more! Thanks for all you do – don’t let the bastards grind you down while there are still those who know to appreciate the NHS and fight for it.
I wholly support what you say. My negative experiences have been at the hands of Atos employees. The vast majority of NHS healthcare professionals are incredible and it is so sad that measures such as “10 minutes and 1 issue” in GP practices are deemed “necessary” . As a patient I see that it is stressful and goes against the grain and that it creates resentment with patients.
Within the hospital setting vital tests for diabetics are being cut- the simple urine test for kidney disease and the foot examination are two recent ones I have not had done as part of my MOT. Shame because gangrene and kidney failure are big killers and so simple to prevent in their early stages..
I’ve read my post again. I really should add that short-comings in my instance are clearly economic choices driven by management issues and nothing to do with clinical standards.
This government is merrily collecting death stats for hospitals and failing to collect them for the DWP reforms. Can any increases in death rates be linked to benefit reforms? Do people die in care more readily if they are malnourished from time spent in poverty?
Reblogged this on nearlydead.
but its just the start of the tory attack on the nhs ready to privitise it jeff3
In a report co-authored by Professor Jarman “Monitoring Hospital Mortality – A response to the University of Birmingham report on HSMR’s” http://www1.imperial.ac.uk/resources/1133EEEE-5AE7-4E07-9940-CEA0E5F2120D/ the authors themselves admit:
“The HSMR is a summary figure, designed to give an overview of mortality within a trust, and will hide a considerable number to give an
overview of mortality of difference in the risk profiles across different factors in the model”.
“It is widely acknowledged that all statistical models are flawed (“all models are wrong but some are useful”).
This stinks of a Lynton Crosby “attack-dog” war of attrition on the NHS!
Sorry, TYPO,…What Prof Jarman and colleagues stated in report was:
“The HSMR is a summary figure, designed to give an overview of mortality within a trust, and will hide a considerable number of differences in the risk profiles across different factor is the model”
“It is widely acknowledged that all statistical models are flawed (“all models are wrong but some are useful”).
statistical models are flawed(“all models are wrong”).
Also, good link below to an excellent “unbiased” article on HSMR “Mortality Rates don’t tell the whole story” (By Roger Stedman) :
http://www.hsj.co.uk/opinion/mortality-rates-dont-tell-the-whole-story/5057035.article
The HSMR has always been flawed. On the one hand it is too much of a “blunt instrument” (Ref: http://www.lrb.co.uk/v35/n07/paul-taylor/rigging-the-death-rate) and yet what’s left unsaid in that article is that DFI and not just its competitor CHKS often “advise” trusts on alternative methodologies for coding HES data. They certainly did when I worked at an NHS trust. One suspects that my former employers were not one of “the fourteen” solely because they were (and presumably still are) very good at following the “advice” of CHKS and DFI.
Yes, commercial conflicts of interest are inevitable.
Any idea when or where this report will be released so we will finally be able to read it?
I believe it’s now available online.
Here you go (courtesy of KathyB who can’t currently post comments for some reason): http://t.co/1d9AKgjyDW
Reblogged this on Vox Political.
I found the report… and a summary on the ITV web site which says “upto 3000” rather than the bandied 13,000 (woops) however it doesn’t identify or clarify the 3000 within the report from what I can tell… they are “maybe” stats (unless there is more detail elseware? so not genuine cases of identifyable results of death that should not have happened.
Please forgive the typos, for some reason the text entry box doesn’t expand so I end up typing blind :-/
The old adage of “mud sticks” springs to mind.The Tories and their media stooge’s have been firing broadsides at the NHS even since their re_election,effectively it is dying.
If the great British public don’t wake up from their slumber soon, than I’m afraid it May be too late.
The Tories really have a bare-faced cheek when it comes to the NHS. They left it in n almighty mess the last time they were in government and given the chance again they’ll try and finish it off this time. They left our hospitals crumbling wrecks and the services starved of investment. We had the Bristol baby deaths scandal and other hospitals removing organs from dead babies without the knowledge of the parents and storing them in jars and also giving some to private Pharma companies in exchange for ‘donations’. Labour may not have turned the NHS into a perfect model but at least they tried and they spent the money
The report by the Kings Fund – A high performing NHS paints a completely different picture to what the Tories would have us believe.
From the report
The situation before 1997
Data about the scale and nature of patient safety incidents in the 1990s was patchy, with evidence particularly lacking in primary care (Department of Health 2000d). There were no national standards for identifying safety failures, and rates of incident reporting varied widely. One study showed that one in five NHS trusts did not have reporting systems, and one in three offered no training to staff on what to report (Dineen and Walsh 1999).
In 2000, the evidence was collated in an independent report for the government, An Organisation with a Memory, which serves as an approximate baseline. It found that adverse events in which harm is caused to patients occurred in 10 per cent of admissions to NHS hospitals (about 850,000 adverse events each year). Meanwhile, there were around 6,610 adverse incidents related to medical devices each year, including 400 deaths or serious injuries. Annually the NHS paid around £400 million in settlement claims (Department of Health 2000d)
http://www.kingsfund.org.uk/sites/files/kf/high-performing-nhs-progress-review-1997-2010-ruth-thorlby-jo-maybin-kings-fund-april-2010_0.pdf
The pillow-biter and tree-hugger, Hunt, tries to pin what is happening now all on Labour and turn this into a politica battlel and I’m glad Andy Burnham had the courage to stand up and point out the facts that the mortality rates were in fact based on 2011 and 2012 – false that they were.
Reblogged this on paul8ar.
Where did the media get this figure of 13K from? Most of the mortality statistics are percentages or ratios, have the media attempted to do their own fuzzy logic of the ratios based on population? Has anyone managed to find the source of these quoted statistics?
Never mind…I just realised a few of the comments above covered my question…that’ll teach me for not reading all the comments before commenting myself. Thanks! 🙂
My god, have you seen the morning papers for Wed ? Dacre has excelled himself this time – utterly revolting. He is assisted naturally by the Times and the Telegraph.
Not yet. Have an early meeting, remind me to take a look!
The Report
http://www.nhs.uk/NHSEngland/bruce-keogh-review/Documents/outcomes/keogh-review-final-report.pdf
Many thanks for the link to the Keogh Report – it makes very interesting reading. As Sir Bruce Keogh said himself in the report “However tempting it may be it is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths.” My husband heard Sir Bruce reiterate this on Radio 4 yesterday afternoon. I find it unbelievable that journalists and politicians can continue to misquote from this report and can only say that once again I feel the utmost sympathy for those people working in the trusts involved – I know how I would feel were it my trust and believe me we have had enough troubles of our own down here in sunny Cornwall.
Surely this pins it on the pillow-biter and tree-hugger, Hunt, and his cronies.
‘The 14 NHS trusts which fall within the scope of this review were selected on the basis that they have been outliers for the last two consecutive years on one of two well-established measures of mortality: the Summary Hospital Level Mortality Indicator (SHMI) or the Hospital Standardised Mortality Ratio (HSMR). This report summarises the findings and actions resulting from the reviews into the 14 hospitals.’
With a name like macpolly you should be up here in Scotland where, according to the Tories , everything is free and it’s the Daily Mail readers that have to pay for us lol
Sorry the “mac” part of macpolly comes from my husband – I am Cornish through and through! However, I agree with your sentiments regarding the misinformation about Scotland put forward by the Tories. It is however, a beautiful country, particularly the Orkney Islands which is where my husband’s roots are. On my last visit there were very few Tory supporters up there on the islands and I’m hoping that their numbers dwindle all over the country and we can get back to some sensible government with at least some semblance of caring for the people!!
Reblogged this on paurina and commented:
don’t believe all you read in the papers…
I don’t know if this merits a thought. What role has the management of the 14 trusts got to do with the higher than expected death rates? I am not talking stats so much as the choices to cut costs. It doesn’t really get discussed.
We have a case pending re NHS and New Cross hospital Wolverhampton – so I say where there is smake you are going to get flames – a quote from part of the letter we recieved from the hopital “we will take your daughters case and use it as a example for training ” (words to that effect) say that to a mother with a now disabled daughter – I felt total rage.
Reblogged this on HUMAN RIGHTS & POLITICAL JOURNAL and commented:
In Solidarity!!
Please help us save Prof J for the nation – he may still retain sufficient honesty to muster courage to recant lame resistance to misuse of 13k fig.
We’d love to arrange meeting of Prof J with SKW for calm discussion. Pistols only. Anyone else think timely?
Once Prof J & SKW thrash out joint communique, might NHS yet be salvaged?
https://twitter.com/WikiPickie/statuses/357962527843434496
NB: PricewaterhouseCoopers were paid £2,773,614 to run the Keogh review into high mortality rates at 14 NHS trusts.
This sum was not disclosed in the 61-page report.
Since Cameron became leader, PCW has made non-cash donations worth £545,000 to the Tories in “staff” and “consultancy services”.
Who says Cameron isn’t grateful for the NHS?
(http://www.mirror.co.uk/news/uk-news/david-cameron-conflict-interest-row-2067934)
Not only did Sir Bruce distance himself from HSMRs, but when I listened to the R4 10 o’clock news on that day, Nick Black (v eminent academic on these things) was on totally rubbishing this data in no uncertain terms and in very strong language. He was on Sir B’s group so you can imagine that behind closed doors he’s been giving them a piece of his mind!
Now lie back with some relaxing music and imagine what it’s been like to work at Stafford Hospital where this stuff has been dropping down not for a few days but for years.
The same Black who is teaming with Darzi for the mortality data review? If so, that’s cause for optimism!
Getting warm..!
https://twitter.com/AlanRosenbach/statuses/358708267804921857
I hope Julie Bailey reads the Guardian story, Steve. Wonder if she’ll realise that the ‘unknown’ email correspondent of Sir Bruce mentioned in the story is one of the very same ‘activists’ she (probably) got Ms Leslie to condemn – the much maligned Steve Walker. Maybe she won’t be so sanctimonious in future. Well done, Steve.
Thank you! But I was only the author of the article, not the email. I took his name out to protect his ID but still expect an attribution for the article – professional etiquette and all that! 🙂
Yes, noticed ref. to Steve in article last night but kept mum – was trying to avoid more idolatry in Commons from charming Tory MPs unable to distinguish truth from friction..! ;-|
Am afraid little chance brilliant Titanic engineer is willing to warn operators that route via icebergs advertised in Telegraph as ‘chance of a lifetime’ was misleading/reckless though – despite navigation boss colleague already having done so:
https://twitter.com/WikiPickie/statuses/358899131953065986