Guardian comes fully out of closet on ‘needless death’ distortions

Hot on the heels of its ‘correction’ item that represents the mainstream media’s first genuine acknowledgement that the hysterical claims of ‘needless’ deaths were as wildly incorrect concerning Stafford hospital as they were for the 14 ‘Keogh’ hospitals falsely accused by the right-wing press of causing 13,000 avoidable deaths, comes a second, more high-profile and emphatic article on the same topic,

The Guardian appears to be now fully out of the ‘mortality’ closet.

For a long time, the newspaper repeated the mortality claims about Mid Staffs as emphatically as most other media sources, but deserves great credit now for being prepared to put its error on the record and for beginning to allow some of the voices that have been exposing the ‘avoidable deaths’ myth for some time, though of course it would be even better to see the headlines as large and prominent as those that have, in various media, propagated the falsehoods.

Yesterday’s article by Guardian health editor Sarah Boseley quotes expert statistician David Spiegelhalter at length on the subject of HSMRs, SHMIs and statistical mortality measurement generally, as well as putting a major question-mark against the integrity of Professor Brian Jarman, the supposedly-independent ‘expert’ whose pronouncements have so often been at the heart of falsely-damning media headlines.


Here are some of the key quotes. On the media’s treatment of the death claims:

Dr David Spiegelhalter, who is Winton professor for the public understanding of risk at the University of Cambridge, said newspapers and politicians are wrong in their widespread use of the number.

He gave as an example the Sunday Telegraph stating that “13,000 died needlessly at 14 worst NHS trusts”, but other papers ran similar claims.

On the blatant misrepresentation that an above-average HSMR or SHMI (hospital standardised mortality ratio/summary hospital-level mortality indicator) means any kind of avoidable-death phenomenon:

The crucial fact is that both the SHMI and HSMR are standardised to recent national performance, and so we would expect at any time that around half of all trusts would have ‘higher than expected’ mortality, just by chance variability around an average. Indeed, for the SHMI between January 2012 and December 2012, 56% of trusts (80/142) had above expected mortality.

On the phenomenon of hysterical NHS mortality claims in general, and on the ludicrous Mid Staffs claims in particular:

“So what about the ‘1,200 needless deaths’ at Mid-Staffs?” he writes. “A recent BBC news story claims: ‘Data shows there were between 400 and 1,200 more deaths than would have been expected between 2005 and 2008.’ But there are no published data that show this, as fully discussed in the first Francis report. Like the ‘1,200’ at Mid-Staffs, ‘13,000’ threatens to become a ‘zombie statistic’ – one that will not die in spite of repeated demolition.

The first couple of statements are relatively muted and scholarly – as you’d expect, but more so than the issue deserves – but the last is incredibly forceful for an academic, and leaves no room for misunderstanding:

The claims about Mid Staffs – and NHS mortality in general – are zombies. Dead, rotten, lifeless, stinking and malevolent – and continuing to move even though they’ve been absolutely demolished.

And by the SKWAWKBOX first of all. It’s good to be shown to be right, and even better that the word is now starting to get out – but the fact that most of the media continue to use these stats as if they’re not thoroughly debunked means that there’s no room to ease up in pressing home the point.

The article also gives a fascinating insight into the mentality and motives of Professor Jarman, who has relentlessly promoted his HSMR statistical system in spite of its known and massive flaws.

Ms Boseley had an email exchange with Prof Jarman on the topic of the media abuse of his statistics in which he responded:

I am very grateful to the media, of all political persuasions, for helping us to get people to take our data seriously – it has been a long struggle for over a decade … … we have been doing no more than ask that people use the data as a trigger to look further – to use SMRs, mortality alerts, individual patients, staff and patient surveys etc. We would like to take it out of the political arena and look at the data rationally. So, no, I don’t regret the use of our data by the press and media although I would like them to be more precise – it may be my fault that I am not persistent enough in explaining a rather complicated subject

Can you imagine another academic being happy at his statistics being wrongly used, let alone grossly misrepresented? Yet the Professor is – and has done a lot more than ‘ask people to use the data as a trigger to look further’.


And more besides. The Guardian follows Jarman’s comment with Spiegelhalter’s opinion, which is already partially shown above:

But Spiegelhalter said: “The crucial fact is that both the SHMI and HSMR are standardised to recent national performance, and so we would expect at any time that around half of all trusts would have ‘higher than expected’ mortality, just by chance variability around an average. Indeed, for the SHMI between January 2012 and December 2012, 56% of trusts (80/142) had above expected mortality.

It would be absurd to label all these as outliers, and yet a BBC news item claims that: ‘Outliers are trusts which have a higher than expected number of deaths.’ It is enough to make a statistician sob.”

A serious statistician, at least. Yet Professor Jarman is happy about it – because it’s got people taking notice of his statistical system again.

Which is extremely telling about the whole sorry mess of distortion and ulterior motivation that has led to a hospital, its staff and even its town being demonised while those who do the demonising posture as heroes.

No, no room for letting up on the pressure at all – not until this issue is finally brought out into the sunshine to be disinfected of its poison.


  1. Today I wrote to Channel 4 news pointing them in the direction of your blog and The Guardian’s article because yet again within the last few days they referred to the 1200 excess deaths at Mid Staffs. I hold out very little hope of anyone ever taking much notice, but all we can do is try. There are enough good journalists working for Channel 4 who should be able to investigate this story and right some of the wrongs.

  2. The tide continues to turn, and about bloody time. Hope that certain individuals and groups, the BBC and the media at large are paying attention. This myth needs to be permanently dispelled, but as far as Stafford Hospital is concerned I feel the damage has already been done.

    1. The damage has been done Shaun but the people of Stafford aren’t we will continue to fight four hospital!

  3. Is the answer for all hospital trusts to review every death to see if it was avoidable. The irresponsible media care nothing for the understanding of data, their agenda is to sensationalise to sell newspapers. Now the tide is turning it may equally sell newspapers to sensationalise how wrong it was and then hopefully turn on the Cure tactics. If these stat measures were generally not published and kept within the DH then more rational responses would occur.

    1. Only if you want to triple the NHS budget, I suspect! Would definitely like to see those sensational headlines working for the right cause for a change, though.

      1. A welcome change would be making it easier to get a coroner’s post-mortem. Again there would be budgetary issues.

  4. I know this is a serious subject but this Keogh guy, was he the one that invented Keogh surgery – or is that old hat in the NHS?

    1. Not sure whether this is supposed to be a joke, but presume you mean “key hole” surgery – so NO.

  5. The various DFI figures appear to have just wormed their way to the newspapers of their own accord. They clearly have a life (if not nine) of their own:

    ‘At some point..’ [the 1200 Mid Staffs, the 13000 in 14 Trusts since 2005 & the more than 20000 in 14 Trusts over a decade, figures] ‘..were used by bodies giving evidence to Francis and then “found their way” into some newspapers’. [my double quotes]

    Subject: Mid Staffs 1200 deaths figure now wrong
    Date: Thu, 8 Aug 2013 01:26:25 +0000
    To Chris Elliott – Guardian readers’ editor

    Could you please tell me where the figure of 1200 Mid Staffs deaths, now admitted as incorrect, came from?

    Was it just a mistake by the author (journalist and doctor Luisa Dillner), perhaps picked up from other newspapers or innocently selected from the Dr Foster’s Good Hospital Guide – referred to in the article (a – see below)?

    I’d appreciate not just the acknowledgment (b) that this misleading figure didn’t appear at all in the Francis report but, as it didn’t, the justification for its original inclusion in the article.

    Was it fed to the author via a briefing from No.10 or elsewhere?

    Clearly serious faults have been occurring in various hospitals over a long period and a culture of denial and cover-ups has had a devastating effect on many relatives and families attempting to understand and clarify the causes of the suffering or death of a family member.

    However, if the Guardian aims to help relatives understand and clarify the causes, rather than help mislead with this figure, why did the editor not challenge it before publication?

    Why should readers trust the Guardian in future if editors fail to challenge such reckless use of statistics? Do editors still edit now or is that no longer part of the job description?

    The same figure was mentioned (‘up to 1,200 people are thought to have needlessly died’) in this Guardian article..
    ..which also referred to the ‘13,000 unnecessary deaths’ in 14 hospitals. The article implied this claim was inspired by Lynton Crosby &/or Jeremy Hunt and expressed by ‘Conservative officials’.

    (1) Did a Guardian journalist attend any briefing at which this 13,000 figure was promulgated?

    In an earlier Guardian article, its headline included the quote:
    “ignored NHS hospital warnings cost 20,000 lives”
    and indicated more than 20,000 lives could have been saved at just 14 Trusts over a decade

    Although later articles have discussed these claims of 1200, 13000 & 20000 ‘avoidable’ deaths in more rational terms and in a wider context, does the Guardian consider these numbers from DFI (Prof Jarman) to be reasonably accurate estimates or merely inspired by briefings of ‘low politics’ or, like Keogh, just figures which ought not to be believed (“Don’t believe everything you read”)?

    Prof Jarman of DFI has, in effect, confirmed no fewer than 3 times in writing (see attached) that a false claim (‘13000 needless deaths’) is “better” than the truth, as long as an iniquity he regards as more important is investigated.

    His logic to me is identical to saying:

    If 1 paedophile had existed in the Ted Heath Cabinet (eg), a Telegraph headline like ’13 members of Cabinet are paedophiles’ is “better” than the truth, as long as a more important iniquity is investigated, such as the habits of Jimmy Savile.

    Prof Jarman would therefore have had no qualms if 12 (or all) members of the Cabinet were smeared and their careers likely ruined, as long as he personally believed that, by acquiescing to the false headline rather than challenging it, this would have ensured that Savile was investigated (even if it didn’t & he wasn’t).

    Many rational people feel that, in order to expose a paedophile, smearing innocent bystanders isn’t advisable.

    Many people agree that, in order to expose a witch, burning innocent women isn’t recommended.

    Many think that exposing DoH denials of NHS issues doesn’t necessitate, and isn’t helped by, new lies.

    Clearly Prof J doesn’t though.

    He’s also clearly not particularly bothered if readers were misinformed by the Telegraph ‘13,000 deaths’ headline, as he dismisses those deceived, somewhat sarcastically, as “Poor dears” (also attached).

    Uncannily like many Tories, he probably thinks, if U.S. drone aircraft kill 20 children for each ‘terrorist’, that’s just a price ‘we’ are jolly well obliged to pay for our security.

    (2) Did a Guardian journalist attend any briefing at which the ‘1200 preventable Mid Staffs deaths’ figure was disseminated?

    Thank you
    Best regards
    – Rob

    (a) http://www.theguardian.com/lifeandstyle/2013/jul/28/know-if-local-hospital-any-good
    (b) http://www.theguardian.com/theguardian/2013/aug/06/corrections-and-clarifications

    Date: Thu, 8 Aug 2013 11:12:43 +0100
    Subject: Re: Mid Staffs 1200 deaths figure now wrong
    From: reader@guardian.co.uk
    To: Rob McM

    In fact those figures are discussed in the Francis report but Francis makes very clear that they are totally unreliable when trying to assess the numbers of unnecessary deaths. They were originally in a draft of the earlier HCC report but were withdrawn in draft stage. At some point they were used by bodies giving evidence to Francis and then found their way into some newspapers.

    Best wishes
    Chris Elliott
    Follow us on Twitter: @GdnReadersEd


    1. Fantastic post. Yes, the idea that misleading information is OK if it serves a particular purpose must be exposed as nonsensical. It also smacks of rank hypocrisy from the campaigners like Cure who insist on “transparency”!

      1. Indeed John – they will either say nothing or claim it makes no difference. A climbdown over the figures will simply not happen because they are too entrenched in their version of “the truth”.

      2. Oh I totally agree! Like all similar situations, nothing will change until all of a sudden they realise their beliefs are no longer sustainable. Might never happen, but if it does it will be a sudden process. it’s like “de-programming” someone who is a member of a cult.

      3. Yes, if the infantile logic dredged from the dark ages that misleading information is ok if it serves a particular purpose can, as you say, be exposed as nonsensical, puerile & destructive, Steve could then demolish their many & various justifications with his incisive yet balanced analysis.

        This reply to the Guardian response above is as yet unanswered:
        To: reader@guardian.co.uk
        Subject: RE: Mid Staffs 1200 deaths figure now wrong
        Date: Thu, 8 Aug 2013 23:17:09 +0000

        Chris Elliott –

        Hi. Thank you for your quick reply and clarification.

        You say the 1,200 Mid Staffs, 13,000 ‘needless’ & 20,000 ‘over a decade’ figures ‘..then found their way into some newspapers’.

        Yet this Guardian article..
        ..implied Keogh knows that the Tories’ “political operation” and their smear campaign was ‘led by’ Conservative MPs and officials, perhaps Jeremy Hunt (among others) and Lynton Crosby (among others), respectively, as both are named.

        And this Guardian article..
        ..asked ‘Where did that 13,000 come from?’
        ‘Not from Keogh’s meticulous report.’
        With an innocent face, the health secretary, Jeremy Hunt, protested:
        “I don’t know how that number was put out there.”
        and Polly Toynbee then states ‘It came from No 10 briefers’

        Did anyone associated with the Guardian (journalist, freelance contributor etc) attend a briefing at which the ‘1200 preventable Mid Staffs deaths’ figure or ‘13,000 needless’ figure or the earlier ‘over 20,000 in a decade’ figure was disseminated?

        Why did even the Guardian quote these figures (even though it is now leading the way in disavowing them) if, as you say, ‘Francis makes very clear that they are totally unreliable..’?

        Best regards
        – Rob

  6. When you see things saying that a hospital has higher than average death rates couldn’t it just be that they deal with people who are sicker? Would we want our hospitals to avoid treating patients with low chance of survival in case it makes their statistics look bad?

    1. The *claim* is that the stats adjust for ‘case mix’. The problem is that nobody knows how well they do that, and DFI don’t release the exact methodology for commercial reasons. One more reason not to trust mortality headlines!

      1. If it hasn’t been validated properly and robustly and published in peer-reviewed journals, the claims must be treated with extreme skepticism. Perfectly possible to protect IP whilst publishing.

  7. BBC Trust still considering a Stage 4 complaint regarding the irresponsible use of the Stafford “1200” and similar statistics over a prolonged period – and the lack of editorial care that might be implied by it.

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