On the day of the publication last week of Sir Bruce Keogh’s report (heavily and utterly misleadingly trailed by right-wing media and commentators) into 14 NHS Trusts, Health Secretary Jeremy Hunt’s statement to the Commons included an interesting referral as he tried to paint Labour as culpable for a supposed cover-up of ‘avoidable’ mortality in the NHS:
Professor Brian Jarman—[Interruption.] I think Opposition Members might want to listen to this, because it is what independent people are saying. Professor Jarman, who invented hospital standardised mortality indices, said that “the problem was ministerial pressure, even from Number 10.
It turned out that Hunt was misleading in his claims of ‘ministerial pressure’ by Labour throughout his statement, as this article by Shibley, and the letter he reproduces from Baroness Young, show. But was he right in describing Professor Jarman as ‘independent’?
He’s certainly right in implying that the Professor’s credibility on the issues surrounding hospital mortality depend on it, as any conflict of interest on the matter should render his ‘expert opinion’ inadmissible.
I’ve criticised Professor Jarman, the creator of the ‘HSMR’ statistical system for measuring NHS mortality, on a number of occasions for his apparent support of misleading media claims of ‘needless NHS deaths’, whether on Mid Staffs, on Leeds children’s heart surgery unit, on the 14 NHS Trusts investigated by Bruce Keogh, or on the NHS generally.
But I’ve read his motivation as centering around his emotional desire to defend his statistical ‘baby’, leading to an apparent agreement when interviewed by the media about ‘needless’ NHS deaths, even though his comments on Twitter have occasionally admitted that HSMRs are, at best, a prompt to “check if something’s going wrong”, which is also what he told the Francis inquiry.
Hospital Standardised Mortality Ratios, or HSMRs, have been replaced by the SHMI (Summary Hospital-Level Mortality Indicator) as the official measure of NHS hospital mortality, primarily because HSMRs only include a proportion of hospital deaths and do not include deaths within 30 days of discharge, which can lead to distorted mortality rates.
HSMRs, which are promoted by a commercial Doctor Foster Intelligence (DFI), also face competition from the RAMI (risk-adjusted mortality index) promoted by a rival company, CHKS. It would be understandable – though wrong – for Professor Jarman to want to enhance the perception and acceptance of his ‘baby’.
But is that the only reason?
DFI delivers alerts to hospitals which participate in its programme if they are suspected to have excessive mortality rates, and publishes a ‘Good Hospital Guide’ ranking hospitals by its assessment of their performance on patient mortality. As one of its directors, Roger Taylor testified to the Francis inquiry, DFI charges NHS Trusts some £35,000 a year (2011 prices, perhaps higher now) for its services. Since there are around 140 NHS Trusts in England, this represents a potentially huge and profitable business.
A couple of days ago, I was contacted by someone who, incorrectly, believed that Professor Jarman held a direct commercial interest in the perception of his system. Preferring the direct route where possible, I asked Prof Jarman directly whether this was true. His answer was prompt and precise:
However, I have also obtained additional information that makes the situation considerably less clear-cut.
DFI is part owned by the Department of Health. The balance is owned by a ‘holding company’, Dr Foster Holdings LLP (DFH). An ‘LLP’ is a ‘limited liability partnership’ – a company which any number of partners co-own, but without the unlimited ‘joint and several liability’ of ordinary partnerships. The risk for the partners is limited in a similar way to that of shareholders in a limited company – and the partners share directly in any profits of their partnership company.
A list of the partners in Dr Foster LLP can be obtained from Companies House. The list is revealing in at least one important way:
Dr Julian William Ernest Jarman is a director and ‘LLP Member’, or partner, in DFL.
Is the surname a coincidence? An extract from a 2001 ‘Health Service Journal’ (HSJ) article gives us the answer. The article can be found here, but you have to register to open it, so under ‘fair use’ rules, I’m reproducing a few lines here:
Julian Jarman is Professor Brian Jarman’s son.
The professor is interviewed regularly by the media, used by official investigations such as Bruce Keogh’s, and referred to by the Secretary of State for Health, as an ‘independent’, impartial expert in NHS mortality statistics – and presented to the public as such.
But in light of this new evidence, can a claim to impartiality be considered credible?