NHS report author says claim of "13,000 needless deaths" is a misrepresentation

Bruce Keogh, the author of the report into 14 NHS trusts, writes: "Don’t believe everything you read, particularly in some newspapers."

The claim that there have been "13,000 needless deaths" at 14 NHS trusts since 2005 led several of the weekend's papers and has prompted 10 Conservative MPs to call for the resignation of shadow health secretary Andy Burnham, who was responsible for the NHS between 2009 and 2010. In an open letter they write:

It is clear now that the last Labour government oversaw thousands of unnecessary deaths in our NHS Hospitals and failed to expose or confront these care scandals. The patients we represent were betrayed. It would be an outrage if Andy Burnham were ever to return to the role of secretary of state for health.

But while the Tories have seized on the claim for political purposes, the man responsible for the report in question, NHS medical director Bruce Keogh, has entirely rejected the basis for this allegation. 

The figure of 13,000 is based on Hospital Standard Mortality Ratios (HSMRs), which are used to measure whether the death rate at a hospital is higher or lower than expected. But while HSMRS are able to tell us this much, they are, on their own, unable to tell us whether the deaths were due to poor quality care (and therefore avoidable) or other factors. The only way to judge whether or not the deaths were "needless" would be to study each individual's case notes. 

It was for this reason that Robert Francis QC, the author of the report into the Mid Staffordshire NHS Trust, warned that it was "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" and that "it would be unsafe to infer from the figures that there was any particular number or range of numbers of avoidable or unnecessary deaths at the Trust."

In addition, as academics at the University of Birmingham have noted, "The HSMR has a poor performance profile (10 of 11 elevated HSMRs would be false alarms and 10 of 11 poorly performing hospitals would escape attention). Crucially, the aim of a post-test investigation into an elevated HSMR is unclear. The use of the HSMR as a screening test for clinically avoidable mortality and thereby substandard care, although well intentioned, is seriously flawed."

When these points were put to Bruce Keogh, the author of today's report, by a reader of the Skwawkbox blog, he replied: 

Mr XXXX,

Thank you. I agree with your sentiments entirely. Not my calculations, not my views. Don’t believe everything you read, particularly in some newspapers.

I am very well versed in this topic, including the abstract you attach.

When you read my report you will regret sending this email!

With best wishes, Bruce Keogh

Having chosen to go on the offensive even before the report has been published, claiming not just that there were "thousands of unnecessary deaths" but that Burnham was to blame, the Tories may well be forced to backtrack when Keogh's conclusions are published in full at 2pm today.

Ambulances are seen at the Accident and Emergency department of St. Thomas' Hospital in London. Photograph: Getty Images.

George Eaton is political editor of the New Statesman.

Photo: Getty Images
Show Hide image

There are risks as well as opportunities ahead for George Osborne

The Chancellor is in a tight spot, but expect his political wiles to be on full display, says Spencer Thompson.

The most significant fiscal event of this parliament will take place in late November, when the Chancellor presents the spending review setting out his plans for funding government departments over the next four years. This week, across Whitehall and up and down the country, ministers, lobbyists, advocacy groups and town halls are busily finalising their pitches ahead of Friday’s deadline for submissions to the review

It is difficult to overstate the challenge faced by the Chancellor. Under his current spending forecast and planned protections for the NHS, schools, defence and international aid spending, other areas of government will need to be cut by 16.4 per cent in real terms between 2015/16 and 2019/20. Focusing on services spending outside of protected areas, the cumulative cut will reach 26.5 per cent. Despite this, the Chancellor nonetheless has significant room for manoeuvre.

Firstly, under plans unveiled at the budget, the government intends to expand capital investment significantly in both 2018-19 and 2019-20. Over the last parliament capital spending was cut by around a quarter, but between now and 2019-20 it will grow by almost 20 per cent. How this growth in spending should be distributed across departments and between investment projects should be at the heart of the spending review.

In a paper published on Monday, we highlighted three urgent priorities for any additional capital spending: re-balancing transport investment away from London and the greater South East towards the North of England, a £2bn per year boost in public spending on housebuilding, and £1bn of extra investment per year in energy efficiency improvements for fuel-poor households.

Secondly, despite the tough fiscal environment, the Chancellor has the scope to fund a range of areas of policy in dire need of extra resources. These include social care, where rising costs at a time of falling resources are set to generate a severe funding squeeze for local government, 16-19 education, where many 6th-form and FE colleges are at risk of great financial difficulty, and funding a guaranteed paid job for young people in long-term unemployment. Our paper suggests a range of options for how to put these and other areas of policy on a sustainable funding footing.

There is a political angle to this as well. The Conservatives are keen to be seen as a party representing all working people, as shown by the "blue-collar Conservatism" agenda. In addition, the spending review offers the Conservative party the opportunity to return to ‘Compassionate Conservatism’ as a going concern.  If they are truly serious about being seen in this light, this should be reflected in a social investment agenda pursued through the spending review that promotes employment and secures a future for public services outside the NHS and schools.

This will come at a cost, however. In our paper, we show how the Chancellor could fund our package of proposed policies without increasing the pain on other areas of government, while remaining consistent with the government’s fiscal rules that require him to reach a surplus on overall government borrowing by 2019-20. We do not agree that the Government needs to reach a surplus in that year. But given this target wont be scrapped ahead of the spending review, we suggest that he should target a slightly lower surplus in 2019/20 of £7bn, with the deficit the year before being £2bn higher. In addition, we propose several revenue-raising measures in line with recent government tax policy that together would unlock an additional £5bn of resource for government departments.

Make no mistake, this will be a tough settlement for government departments and for public services. But the Chancellor does have a range of options open as he plans the upcoming spending review. Expect his reputation as a highly political Chancellor to be on full display.

Spencer Thompson is economic analyst at IPPR