In early 2009, in the days before the release of the Health
care commission report on Mid Staffs there was a gathering of some of the most
powerful people in the health service in Richmond House. At that meeting a last
minute appendix to the HCC report was produced.
We do not know the detail of this, because it was never published. It was the consensus of the meeting that it
could not be published because there was serious concerns about the reliability
of the material, and because it was accepted by all that the contents would
cause widespread public concern.
The material was not published and therefore could not be openly
questioned, but the leaks based on this document are the source of the 400-1200
excess deaths which have formed the central argument in virtually all press
reporting of Mid Staffs over the last 4 years.
It is only now, after the publication of the Francis report
which does detail some of the major questions that need to be asked about these
figures, that detailed discussion of the excess deaths and the Hospital
Standardised Mortality Rate is beginning to be heard quite widely.
Let us look at some
of the documents that are circulating.
First, there is an academic study published in the BMJ http://qualitysafety.bmj.com/content/early/2012/07/06/bmjqs-2012-001159.full.pdf+html
Which indicates that we may have been overestimating the
number of preventable deaths. It also maps preventable deaths against life
expectancy. The study also makes the point that harm is done to the public by
raising anxiety about “preventable deaths”.
The study questions if mortality rates are actually the most effective
means of measuring quality of care.
Quote
There are also
implications for policy. While the spectre of preventable hospital deaths may prove
helpful in raising interest in patient safety and a commitment to improvement,
overestimating the size of the problem and the risk to patients may induce
unjustified levels of anxiety and fear among the public. In addition,
confirmation of the relatively small proportion of deaths that appear to be
preventable provides further evidence that overall hospital mortality rates are
a poor indicator of quality of care.
This article for Computer weekly takes a look at the
statistical information considered by the Mid Staffs Public Inquiry and comes
to the conclusion that it was selective, and has therefore given a misleading
impression. The evidence considered by
the inquiry fails to show the major improvements made in mortality rates at the
hospital from 2007 onwards and therefore fails to give credit to the work done
at the hospital to tackle its problems.
Steve Walker has developed a strong interest in the issues
surrounding the Mid Staffs mortality rates and has written this challenging
article, which raises major questions about the reliability of story believed
by so many people about Mid Staffs.
This was distressing to one of the journalists who had been
deeply involved in telling the story and this is a debate between them on some
of these issues.
http://skwalker1964.wordpress.com/2013/02/28/mid-staffs-death-rate-debate-with-hsjs-shaun-lintern-2/
One of the huge puzzles about the Public Inquiry is that the coding officer who had
been employed to sort out the coding issues in the trust in 2007 was never
called as a witness. What is even more surprising is the discovery that she
would have liked to have been called. This article begins to explore the story
behind the Mid Staffs mortality rates.
The following article gives us some useful background
information to the level of deaths and it is shows us in the second graph a
dramatic representation of what happened to HSMR in Mid Staffs during the
period in question. If read in conjunction with the coders story this begins to
make perfect sense.
The debate is really only just beginning. We are currently
seeing 14 hospitals under investigation because of their mortality rates, and
the suspicion by many is that this is tied in with the plans to downgrade
smaller hospitals.
There is a whiff of conspiracy theory and talk of making it
a criminal offence to falsify mortality data. If we look at what actually
happened in Mid Staffs, and the shortage of skilled coders in the country then
this looks like a massive red herring.
It may be worth looking at other possible causes for variation of data
quality before calling in the police! http://www.telegraph.co.uk/health/healthnews/9934211/New-criminal-offence-to-stop-NHS-hospitals-fiddling-figures-to-be-introduced.html
This letter from Professor Black http://www.guardian.co.uk/society/2013/mar/15/deaths-at-mid-staffs
politely but firmly makes a point with
relation to Mid Staffs.
As Robert Francis made clear
in his first report: "It is in my view misleading and ... a potential
misuse of the figures to extrapolate from them a conclusion that any particular
number, or range of numbers, of deaths were caused or contributed to by inadequate
care." Some patients experienced appalling care for which those
responsible must be accountable. But for politicians and journalists to
repeatedly claim the actions of staff caused what would amount to the largest
corporate manslaughter in modern times is unjustified
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