Prof Jarman: REALLY an ‘independent’ expert on NHS mortality stats?

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Hospital Standardised Mortality Ratios, or HSMRs, have been replaced by the SHMI (Summary Hospital-Level Mortality Indicator) as the official measure of NHS hospital mortality, primarily because HSMRs only include a proportion of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?


  1. Im not Brian Jarman’s biggest fan but this is so lame. CoIs dont necessarily render evidence inadmissible. They demand that special scrutiny be given to those claims.

  2. Reblogged this on Vox Political and commented:
    Before reading this, please note that the findings in this article are NOT conclusive, nor are they presented as such. They raise serious questions about the independence of an ‘expert’ who has dragged Labour into disrepute, but further proof is needed before any direct assertions may be made.
    In fairness, if Prof Jarman does have financial links to Doctor Foster, and through them, to the Department of Health, now’s the time to admit it.

  3. Presumably you could re-ask him, with “Do you own” replaced by “Do you, or any members of your immediate family, own”.

  4. skwalker1964 –
    I sent a general brief email question to the DWP about when they expected an update on the previous ‘Deaths of Recipients’ but received an answer from the IGS Fredom of Information Team!

    The answer was quite long but didn’t really address the issue of vulnerable, ill people but talked about the usual suspects ‘…being fair to everyone… … also taxpayers …’ but ‘… no plans to directly update the report…’ and an awful lot of repition about ‘…monitoring… looking at … factors taken into account … carefully considered … ‘

    It concludes that in future I should ‘…go to the GOV.UK site…’ .

    I am relatively new to blogging but thought a full copy of the Q and A might be interesting for you and others to take a look at, but I’m not sure of the protocol to submit the emails to you.

    If you are interested in the full exchange then please advise how I might pass this on. (Maybe I’m being a little too precious as you may have already received a copy of the same yourself 😉

  5. The Francis report did point out a commercial interest DFI had in producing negative data:

    “..it was objectively in DFI’s interests to demonstrate publicly that HMSR ratings identified poorly performing hospitals, so as to increase the incentive for trusts to purchase DFI’s services and obtain a better opportunity to protect their reputations..”

    In the unlikely event that the fearless DFI were tempted to demonstrate data negatively publicly (perhaps as ‘needless’ or ‘avoidable’..), and a habit did form, some old habits may conceivably take far greater fearlessness to challenge and flush from ones own system.. 😐


  6. Dr Foster Holdings has an amazing number of listed directors for such a relatively small company. One or two of these have interesting connections. There’s Sir Robin Urquhart Young ex senior civil servant turned business man who’s currently a director at A4e and a guy called
    Jake Arnold-Forster who has a finger in a lot of pies some of which are private healthcare related. Check out this link to one of those companies called COBIC Solutions which he helped set up since the new Health Bill came in. The little video on the page linked to sounds like it could have been scripted by Jeremy Hunt.

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