On September 11th Channel 4 news broadcast a lengthy piece on the NHS, ominously entitled ‘Death on the Wards’. It presented new figures from Professor Sir Brian Jarman about alleged high mortality rates in UK hospitals. There was a clear intention to shock the viewers. The ‘s’ word was repeatedly used by the two presenters and after describing Jarman’s figures as ‘absolutely shocking’ Victoria Macdonald then attempted to put the words into the mouth of Sir Bruce Keogh (Medical Director of the English NHS) when she asked him ‘When you saw those data were you shocked?’ To his credit Sir Bruce sensibly claimed that he needed ‘to think about it’, a basic precaution that the broadcasters would have done well to emulate.
The piece was peppered with worrying claims including one that ‘the NHS is fundamentally failing’ along with claims about patients’ likelihood of dying in a UK hospital as opposed to one in the USA. Finally the presenter compared the average UK hospital with the Mayo Clinic in the US (one of the world’s most prestigious hospitals with an annual revenue of over $8 billion) without any suggestion that comparing a Mini to a Rolls Royce might be ingenuous at best and negligently misleading at worst. This was followed by a panel discussion involving Professor Jarman, Tory MP Charlotte Leslie and Julie Bailey of Cure the NHS which was set up after the Mid Staffs disaster. Not a single person to speak up for the NHS or question the data.
Social media sites erupted in a twitter storm of protest. Dr Clive Peedell’s tweets were typical –
- Bloody hell! Channel 4 headlining on NHS deaths rates with unpublished & non-peer reviewed data! @vsmacdonald & editors should be ashamed
- Brian, you went to the media, instead of putting it out for academic scrutiny. Now look at the headlines.
The outcry was such that Channel 4 responded by inviting myself and a campaigner against medical mistakes along the next evening to examine why people were so upset about the coverage. Unfortunately, the debate was not nearly enough to undo the damaging impression that had been given of the dangers lurking in NHS hospitals.
Since then commentators including heavyweight academics have put forward good reasons why we should be wary about Jarman’s figures.
Given the gravity of the accusations that Channel 4 News were making it might have been expected that they would take note, apologize for their carelessness and at the very least avoid repeating the same errors. But a week later they were at it again, claiming once more that patients were ‘45% more likely to die in a UK hospital than a US hospital’ and suggesting that we should be looking at the US hospital system. Jeremy Hunt, on the receiving end of this, looked bemused and for once I didn’t blame him.
The puzzle is firstly why did Channel 4 peddle such an irresponsible piece of journalism and secondly why did an eminent and respected doctor and erstwhile supporter of the NHS release statistics via the media which were open to abuse and have been labelled ‘meaningless’ by those who understand them?
Jarman’s figures should be treated with extreme caution from an academic standpoint. They haven’t been published in an academic journal, nor peer reviewed. Many of Jarman’s sources are not available due to problems with ‘confidentiality’ at a national level. Professor David Spiegelhalter, Chair of Statistics and Risk at Cambridge University, commented:
“the data, methods and results do not seem to have been made available. This is a wholly inapproporiate way to discuss statistics - 'closed' data rather than 'open data'!”
We’ve been here before - earlier this year Jarman told Radio Four that “thousands of deaths could have been avoided” in some Foundation Trusts. In response a clearly irritated Sir Bruce Keogh, the English Chief Medical Officer, said “However tempting it may be, it is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths”.
Spiegelhalter had commented that “whether through ignorance or mendacity” the media were using death figures in a way “that is enough to make a statistician sob”.
But a modicum of commonsense also suggests caution.
More deaths do not necessarily equate to avoidable deaths and there may be good reasons why any one hospital has more deaths than expected. Maybe there is no hospice nearby and terminally ill patients die in the hospital – areas which make heavy use of hospitals for care of the dying will have high mortality rates. Maybe simple surgical cases are going to the private sector leaving the local NHS with complex patients with co-morbidities who are more vulnerable.
As for comparing the UK with the US - it’s dangerous to compare UK apples with US oranges. Maybe UK patients who are admitted are more ill. Our excellent system of primary care means that patients are treated effectively in the community until they really are too sick to remain at home, so only the very ill are admitted to hospital. And meanwhile in the US 60 million of the poorest – and thus most likely most ill - can’t afford to get anywhere near a hospital bed at all so are unlikely to die there. At the same time US hospitals have a financial incentive to keep the richest - and therefore healthiest - there for as long as their insurance company can be charged for it. Where do these unsavoury facts fit into the data? The list of caveats is long enough to make anyone stop and think.
This abuse of doubtful statistics would matter less if it didn’t feed into the government’s agenda of criticising the NHS at every opportunity. The Coalition seems to be getting the best of all worlds at the moment, subjecting the NHS to incoherent reforms and unjustified financial pressures and then blaming the service and staff for the consequent mess. They are happy to see figures such as those broadcast by Channel 4, which are all grist to their destructive mill. For this reason alone academics should be cautious about how they allow their data to be used, and the media need to be fair and circumspect when they interpret them for the public.
And the private sector are very quick to exploit any bad news about the NHS. Very soon after Jarman’s claims that there had been ‘tens of thousands of avoidable deaths’ in 14 NHS hospitals an advert for private health insurance appeared, citing the ‘awful statistic’ of 13,000 deaths, likely to have been a ‘tragic consequence of negligence’ as a reason to take out their insurance. There have been a number of complaints to the ASA but the public has already got the message – NHS hospitals are dangerous.
There are of course problems in the NHS at the moment, some due to political meddling, others to the culture of meeting targets at all costs and ignoring and gagging those who speak out about concerns. Failings must be recognised and addressed; patient safety and outcomes should be at the centre of all we do. But the job is made more difficult by alarmist claims which undermine staff, alarm patients needlessly and feed into the government’s constant denigration of the service.
At one point during the interview Victoria Macdonald asks Sir Bruce Keogh if he thinks the findings ‘put the NHS to shame?’ The only institution which is put to shame by such scaremongering is Channel 4 news. How about an apology Channel 4, and a half hour to tell the other side of the story? We’re up for it if you are, and it’s the least you can do.
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