Media treatment of the NHS

New thread, here's my contribution to kick it off:

Desperate press twists while 50k march for Stafford
(original with links at http://wp.me/p2sftc-7a5)

Yesterday, some 50,000 people packed the streets, squares and parks of Stafford to march in support of their local hospital and against plans by Monitor, backed by the Department of Health (DH) to close it and force patients to travel long distances for treatment. I live a long way from Stafford and wasn’t able to attend, but this picture (like many others) sends shivers up my spine:



This is what happens when people realise they face the threat of losing their hospital – and when they see the media headlines for the dross they generally are.

But the ‘news’papers have no intention of letting up on their ever-increasing campaign to demonise our health-workers and erode public confidence in, and affection for, our NHS. This morning, the Express and the Mail printed different but similar stories, both equally cynical and equally misleading – and very typical of how stories are slanted in the current anti-NHS campaign to appear far more damaging than they really should.

The Mail

The Mail decided to ride on the coat-tails of the ‘Support Stafford Hospital’ march, by arranging to photograph a local lady who claims that the hospital cost the lives of 3 family members as she stood in the vicinity of (but palpably not right next to) the march route wearing a home-made sign saying, “My husband drank out of a vase. Where were you then?”

Once you look at the details of the story with an objective eye, however, a very different picture emerges.

The article quotes Heather Wilhelms’ claims that the hospital was responsible for the deaths of her husband, mother and father over a period of 18 months:

They went into that hospital to get the treatment and care to make them better. Instead, one by one, they came out of that place in their coffins.

But the facts of the case, even as presented by the newspaper, do not support the assertion. Let’s look at the very sad cases in turn:

Speaking to the Telegraph at the time, she told how doctors failed to notice her mother Pauline Nicklin, 71, had two cancerous tumours on her ovaries for two years before she died in 2006.

My own mother died of ovarian cancer – a disease that has one of the worst survival-rates of any cancer, primarily because its nature and location means that it is rarely discovered until it is well advanced. Those who survive the disease are often those lucky enough to have it discovered by ‘accident’ in the course of treatment for something else. There is nothing at all in this situation to indicate any fault on the part of the hospital.

Nine months later, her father Percy went to the hospital with a deadly foot infection, but was sent home without treatment.

Convinced something was wrong, Mrs Wilhems took him back where he was diagnosed with blood poisoning and gangrene and died four days later aged 76.

Hmmmm. This gentleman clearly shouldn’t have been sent home if he had septicaemia and gangrene – but in an A&E unit as overstretched as Stafford’s is known to have been, things get missed. But did this oversight lead to his death? The article states that he was taken straight back to the hospital where his condition was diagnosed, so there was no significant period where he sat at home untreated while his condition worsened – his treatment started the same day, so we have to conclude that he would unfortunately have died anyway. The ‘sent home’ episode was irrelevant to his death.

That leaves Mrs Wilhelms’ husband, about whom the article says,

Her husband Tom was also treated at the hospital before he died from a lethal lung disease but Mrs Wilhelms again complained of appalling conditions.

The article doesn’t specify what the lung disease was, but by calling it ‘lethal’ it makes plain that he was going to die anyway. It is uncontested that there was poor care in 3 wards at Stafford – although it is largely ignored by the press and completely ignored by Jeremy Hunt, the Francis report makes absolutely clear that this was because these wards were woefully understaffed. However, it is also clear that while the poor care may have been uncomfortable and embarrassing (and as unacceptable to staff as it was to patients and relatives), it did not lead to ‘excess deaths’. It appears that Mr Wilhelms would have died no matter what the hospital did or did not do.

The article is also misleading in its photos. Mrs Wilhelm’s home-made sign about her husband drinking from a vase makes no mention of the fact that he was on ‘restricted fluids’ for medical reasons – in other words, he wasn’t permitted to drink for his own sake, but would have been receiving intravenous fluids in the right amounts for his condition. Not necessarily comfortable, but right – he might well have felt thirsty, and may have found a vase to drink from even though they were banned in the hospital since the 1990s, but his thirst was not the result of any neglect. Quite the contrary, in fact.

Mrs Wilhelms has my sympathy as a bereaved person. The Mail, which has cynically exploited her for the political ulterior motive of denigrating the NHS and detracting from the impact of the ‘Support Stafford’ march, most emphatically does not.

The Express

The Express, meanwhile, ran a short but prominently-headlined article titled “No let-off for those guilty of needless deaths in hospitals“. This begs two questions, of course – were there needless deaths and was anyone ‘guilty’ of them – but the Express is hardly a stranger to unfounded assumptions.

The paper tries hard to paint a very incriminating picture of the quality of healthcare provided by Basildon Hospital, but in fact manages only to expose its own bias and ignorance. In relating the story of the sad death of a woman in the hospital, it proclaims:

RITA PACE was 56 when she collapsed in a toilet and bled to death without anyone coming to her aid.

However, the detail tells a very different story from the headline.

It sounds like the futile end of some loveless junkie.

It is, in fact, the preventable death of a beloved mother who died needlessly at Basildon Hospital in Essex from an undiagnosed aortic aneurysm.

Leaving aside the fact that the assumption that all junkies are ‘loveless’ is self-evidently untrue, the Express betrays its ignorance and its agenda.

An ‘aortic aneurysm’ is an extremely serious condition – a ‘ballooning’ of a blood vessel when the vessel wall weakens. Any aneurysm is very bad news – but an aneurysm of the aorta, part of the heart and the largest artery in the human body, is very, very, very bad news. It is also a condition that is usually unknown even to the person suffering from it until a very advanced stage or else if it is discovered ‘accidentally’ in the course of a procedure or investigation for another condition.

If an aortic aneurysm leaks, and you are on the operating table, you have a chance of survival if the leak is slow and the surgeon is prepared and very capable. If it bursts, it doesn’t matter where you are – you will be dead in moments.

The Express therefore misleads on at least three fronts:

• Mrs Pace’s death was anything but ‘preventable’. She would, sadly, have been dead seconds after the aneurism burst whether she was in a toilet or in an operating theatre.

• The article does not say whether Mrs Pace was even a patient at the hospital. She may have been visiting someone. If she was a patient, she was evidently there to be treated for something else, since the aneurysm was undiagnosed. There is no suggestion of any neglect or misdeed by the hospital, which can hardly be blamed for not detecting a condition that is basically undetectable unless you are either very lucky or specifically looking for it.

• If Mrs Pace was able to go to the toilet unaided, there is no reason to expect her to be accompanied by a nurse or healthcare assistant. An aneurysm would not make her incapable of doing so, and there is no indication that she had any condition that would. Hospitals are short-staffed even for providing essential care, so to imply that every toilet or other room in the hospital should have a member of staff constantly present is simply nonsensical.

The article then makes some wider statements that are no less seriously misleading:

Rita is among up to 2,500 patients who have died unnecessarily at Basildon in the past decade. What emerges is a shameful litany of neglect, incompetence and malpractice to rival any of the horrific cases catalogued in the Francis Report into Stafford Hospital.

We’ve already seen that Rita’s death – though unquestionably tragic – was not ‘unnecessary’ or avoidable. It was just a sad, tragic event. This should immediately raise suspicion about the claim of ’2,500 patients who have died unnecessarily’ – and rightly so.

The Express tries to damn Basildon by comparing it with Stafford – but as I have demonstrated in various articles, there was no issue of ‘excess’ or ‘needless’ deaths at Stafford. Its ‘HSMR’ mortality statistics were entirely the result of problems with the data on which the statistics were based, problems with the way the data was entered, and problems with the statistical method itself.

If this was the case at Stafford, there is no reason whatever to assume that there have been excess ‘needless’ deaths at Basildon. All hospitals have avoidable deaths, because treatment is provided by people and people are fallible – the right treatments can never be administered exactly at the right time, every time, and staff can never be everywhere at once. But the mortality statistics are so unsound that they should not, must not be used to quantify a number of ‘avoidable’ deaths – which is exactly what the Francis Report cited by the Express said.

There was unquestionably poor care at Stafford – in only 3 wards out of many. But this poor care did not lead to ‘excess’ deaths – once the data was corrected, the hospital’s death rate was significantly below average. There may well have been poor care in some instances in Basildon – but that does not mean that ‘avoidable’ deaths happened that would not have happened with the best possible care.

But then, the Express has never been shy of overreaching in its attempts to distort and prejudice.

The only real value in either of these reports is that they give away so clearly the blatant bias of the right-wing press – and its blatant agenda to blacken the public’s perception of, and affection for, the NHS that almost all of us rely on, or soon enough will.

It’s vital that we don’t fall for the shameless, distorted propaganda. So please spread the word and let’s shine a spotlight on these ridiculously twisted articles for what they are.

This post, which I published last night before the Keogh report was published, has gone somewhat viral. We need it to get out there even further, as most of the media are ignoring it even though a very few are now picking it up, so please spread the word and link to the original, which is at http://wp.me/p2sftc-8if. Thanks.

As I wrote yesterday, the national media is running massive headlines claiming that a report by Sir Bruce Keogh, Medical Director of the NHS, will state that 13,000 people died ‘needlessly’ in the 14 NHS hospitals currently under special investigation for supposed high mortality rates.



As I pointed out, the death claims are completely unfounded and based on the misuse and misrepresentation of a deeply-flawed statistical system, and would still be completely unfounded even if the system were not deeply flawed. For more details of why, read here.

Well, it turns out that the report’s author, Sir Bruce Edward Keogh, KBE, FRCS, FRCP himself, also disagrees with the headlines about his own report. A SKWAWKBOX reader wrote this email to him to challenge his supposed assertions after reading my article on the ‘needless death’ claims:

Dear Mr Keogh,

The Telegraph is running a front page splash today based on your estimate of 13,000 avoidable deaths in some UK hospitals.

The Francis report called using HSMRs in this way ‘unsafe’ and ‘an abuse of figures’. So I’d be grateful if you could explain why you disagree with Francis about the use of HSMRs to produce lists of estimated deaths.

Do you have 13,000 named individuals, Mr Keogh, who have had their case histories examined to see what role neglect or mistreatment may have played in their deaths? Or re you using HSMRs?

I would draw your attention to this abstract, from the University of Birmingham: (http://qjmed.oxfordjournals.org/content/early/2013/05/07/qjmed.hct101.abstract)

“The Mid-Staffordshire Public Inquiry has published its findings. The initial investigations were triggered by an elevated hospital standardized mortality ratio (HSMR). This shows that the HSMR is being used as a screening test for substandard care; whereby hospitals that fail the test are scrutinized, whilst those that pass the test are not. But screening tests are often misunderstood and misused and so it is prudent to critically examine the HSMR before casting it in the role of a screening test for ‘bad’ hospitals. A screening test should be valid, have adequate performance characteristics and a clear post-test action plan. The HSMR is not a valid screening test (because the empirical relationship between clinically avoidable mortality and the HSMR is unknown). 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.”

The Francis report called using HSMRs in this way ‘unsafe’ and ‘an abuse of figures’. So I’d be grateful if you could explain why you disagree with Francis, and the paper cited above, about the use of HSMRs to produce numbers of estimated deaths.

Thanks very much.

To his credit, Sir Bruce responded almost immediately, in spite of it being a Sunday, as follows (highlighting mine):

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

So we have a situation in which the media is reporting, in the most emphatic terms, a story that is deeply damaging to the NHS – yet which is completely at odds with the reality, Sir Bruce not only disavows the death claim (“not my calculations, not my views”) but says that his actual report is so different to the media claims that his correspondent will regret sending his complaint once he reads it.

This is exactly the same pattern seen with media’s (and that of certain so-called ‘patients’ groups’) treatment of Stafford hospital, in which death figures are repeated ad nauseam until they’re assumed to be fact – even though the Francis inquiry and even the creators of the statistics, DFI, say that any assumptions about death numbers would be ‘an abuse of the data’.

Mud sticks, and the media are flinging it in abundance at the NHS. But can there really remain even the slightest doubt that it is being flung with a definite agenda in mind?

An agenda to take any and every opportunity, no matter how much the facts have to be stretched and twisted, to attack the public’s affection for, and confidence in, the NHS – so that there will be less protest when it is effectively ended by being ‘saved’ by privatisation.

But the abuse of the facts here is far simpler to understand than the statistical abuses that were used to create the ‘Mid Staffs scandal’. If word gets out on this and is picked up by enough people, the lying anti-NHS media might just have over-reached. Let’s make sure they’ve shot themselves in the foot.

We already know about George Osborne's "way with figures" and it seems he's passed on some of the technique to government colleagues.

Original including links at http://wp.me/p2sftc-8iN

It’s not up on Hansard just yet, as it wasn’t quite 3 hours ago yet, but I’m told that I was ‘named and shamed’ by Tory MP Charlotte Leslie today in Parliament, for my ‘venom’ in challenging the claims, actions and attitudes of Julie Bailey and her ‘Cure the NHS’ group (Cure):

I am equally perturbed and disturbed that a lot of that venom is coming from two Labour Party Members locally – Diana Smith who has worked for David Kidney and Steve Walker and I would very much like to know that the party opposite will condemn those actions.

(Edit: you can now get the full Hansard record here, and I’ll take this opportunity to thank everyone for the kind wishes and support!)

Ms Leslie needs to check her facts, since I’m not a Stafford local and only visited the town some time after I’d published my article “The real Mid Staffs story – one ‘excess death’, if that”, so I had and have no axe to grind with Ms Bailey and Cure apart from their lamentable actions and woeful misrepresentation of fact.

Diana Smith, on the other hand, is indeed a local lady – and a very honourable, mild-mannered one who has been libelled shamelessly by Ms Bailey and others, yet has responded with constant attempts to find common ground. She has told the truth fearlessly and deserves better.

All that aside, to be ‘named and shamed’ by Ms Leslie and her colleagues bent on the destruction of the NHS, or for that matter by Ms Bailey and Cure, who are aiding and abetting in that destruction by their reckless hystrionics, is something I consider a badge of honour. If I’m getting up their collective nose enough to merit such a mention, then I must be doing something right.

My stance on the fallacy of the Mid Staffs ‘needless deaths’ and all the other ridiculous and ill-founded NHS mortality accusations since has also been publicly vindicated by the Keogh report in the day or so. Bruce Keogh’s report, which I’ll digest fully and comment on when time allows, made the following stark condemnation of the bogus mortality claims of the media, politicians and Professor Brian Jarman:

However tempting it may be, it is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths.

Or, as the Guardian summarised it:

Report into 14 NHS hospitals rejects claims that poor care killed thousands

In spite of the insults of Cure and its supporters and latterly Ms Leslie, and the continued strident insistence of the right-wing or suborned media on using the spurious Stafford numbers, the Keogh report has – at last – brought the truth about the ‘excess death’ claims into the mainstream: they didn’t happen, and none of the data that has been claimed to support them actually do so.

I don’t consider my stance on Mid Staffs and mortality statistics in the wider NHS to be brave, or noble, or anything particularly praiseworthy. If you see truth being abused and are in a position to say something, you have an obligation to do so. As for ‘venom’, read my posts on these issues and judge for yourself. I’ve striven to be forthright and to pull no punches, but there’s been no ‘venom’.

Given the tenor of the Tories’ and Cure’s comments about NHS staff and about anyone who dissents, the irony is substantial. Apparently, disagreeing with them is intrinsically rude and disrespectful, even venomous – but those with the most sullied consciences often put a great emphasis on respect and manners from others, as if etiquette can insulate them from their actions, and the Tories’ conscience on the NHS must be as black as pitch.

A badge of honour from the NHS-haters and a confirmation from on high. Quite a week, and well worth the continued opprobrium from those who just can’t accept that their hidden agenda isn’t hidden any more.

Get this information OUT into the public arena. The national press didn't even report the march at all. A decent, newsworthy and readable red-top newspaper is a gap in the market.

Why the BBC chose the government over the NHS
 
Extracts from an article by Oliver Huitson:-
 
There are a number of theories. Some senior BBC staff have links with the healthcare industry. Mike Lynch, a member of the BBC’s executive board, has links to a number of firms in the health sector, including Apax Partners. BBC Chairman, Lord Patten, is on the board of Bridgepoint, which has substantial healthcare interests. One company acquired by Bridgepoint in July 2010 is Care UK, which donated £21,000 to the personal office of Andrew Lansley.

Cameron’s director of communications is Craig Oliver, whose prior job was as a news editor at the BBC. An email sent by a BBC employee to Marcus Chown suggests the BBC had “pages and pages of text on the opposition to the bill” but simply didn’t run the material. That suggests a deliberate effort to distort  coverage of the bill and the strength and nature of opposition to it.

The NHS bill had a central role in the Conservatives’ wider vision, in which the entire state “except the military and judiciary” is to be opened to the private sector. Break up the NHS and everything else falls; it is the totem of the post-war social democratic settlement, the antithesis of market values. This government is a one term project, and its members are attempting to forge a new political settlement that will outlast their inevitable 2015 eviction.

Maybe under Tory pressure the BBC buckled, hoping that appeasement on the NHS would protect the BBC. For years the Conservatives made plain their desire to substantially reduce the scope and influence of the corporation; Cameron even described his cuts to the BBC as “delicious”. All considered, fear, compliance and a misguided vision of self-interest seem to have left the BBC incapable of challenging abuses of governance.
 
http://www.opendemocracy.net/ourbeeb/oliver-huitson/how-bbc-betrayed-nhs-exclusive-report-on-two-years-of-censorship-and-distorti

Ponder the word "Establishment".

Would you ever have thought to exclude Aunty Beeb from that category?

Why did the national media ignore the unprecedented NHS rally in Manchester?
 
Sunday’s massive anti-austerity rally through the centre of Manchester, which coincided with the start of the Tory Party conference, received shockingly scant coverage. You’ve got to wonder why the main BBC news that night gave the event just 20 seconds of airtime, contained no clips of organisers or participants, and had us believe it was just a load of protesters shouting “Tory scum”.

Greater Manchester Police went out of their way to praise the “peaceful and lawful” crowd, which also makes you wonder why Sky News focused much of its fleeting report on a single arrest – which represented half of the total number of two arrests. ie. 0.004% of the crowd.
 

 
Full article here:-
http://liberalconspiracy.org/2013/10/01/why-did-the-media-ignore-the-unprecedented-nhs-rally-in-manchester/

The big question is whether British Electors can recognise it when they are being conned.

I was telling my sister that I was involved in a Twitter protest at the BBC's lack of coverage on NHS privatisation and the demo at the Tory Party Conference. She said, "What demo?" That said everything! How could the state broadcaster with cameras INSIDE a building not have some OUTSIDE it where over 50,000 peaceful protesters had come to voice their anger at the systematic destruction of the NHS?

A twitter exchange starting with disgust at the media's collusion on this matter soon threw up suggestions of a fight-back- withholding BBC licence fees?- too ambitious, a boycott of the BBC?- stood a chance of success.

A core group of 4 started on 2nd October to tweet followers asking for support for a one-night boycott of the BBC on Monday 7th from 6pm. At time of writing, 36 hours on, the campaign is building fast with increasing numbers responding with tweets, retweets, articles & images. A webpage has been created and the hashtag #NHSboycottBBC is hopefully building towards a trend on Monday.

If the campaign is a success it could begin a wider protest against the media's selective reporting. It's too early to gauge how much appetite the people have for this kind of protest, but there are other areas of disquiet- e.g. the Scottish "Yes" Campaign which also suffers from a media bias. I think it's worth the effort. Please help in any way you can to further this campaign. Spread the word- The BBC don't speak for us- we won't listen to them.

Reminds me of the Green Bowling club in Southampton which fell out with the Council over whether their playing-surface was level.
Members launched an escalating series of no-shows until one day they returned to find the turf replaced by bedding-plants.

Mr. Murdoch has repeatedly tried to remove the competition to Sky which the BBC represents, so why not give him a hand?

The question that gets regularly asked at every protest against this government's dismantling of the NHS:-
 

https://pbs.twimg.com/media/BKkG-OUCIAASRPk.jpg

I don't think it's necessarily a case of the BBC being hand-in-glove with the Tories, rather them being absolutely terrified of upsetting a government which has already lowered the licence fee and cut their budget. This is against a backdrop of the Jimmy Savile (et al) scandal(s) and an environment where News International, The Daily Mail etc. will fervently support any further measures the government decides to take against the BBC. One of the main reasons for this is that, with their website, the Beeb have, in effect, one of the biggest (free) online newspapers in the world. If you look at the Mail (which is now the biggest or one of the biggest online newspapers) and the Times, for example (which you now have to subscribe to to read online) then you can see where the various vested interests lie. I realise that this effectively makes the BBC pro-government (at least to an extent) but I do think it's worth stating the subtle difference between their acting out of self-interest as opposed to being 'pro-Tory'. The corporation is a lot weaker than it was only a few short years ago.

It's the best broadcasting service we've got. The mystery is that some of the most vociferous criticism of the BBC comes from people who resent paying the licence fee - many of whom voluntarily pay £50 to £70 a MONTH for a satellite or cable subscription.

It seems an identical argument to the one put forward by Tories who resent "paying twice" for health and education because they have elected for the private version as well.

I remember being sat at work when I was working over in Northern Ireland and there was a lad ranting on about the licence fee and why should he have to pay it? etc. He was on his lunch and looking at the sports pages of the BBC website at the time. I shit thee not.

"Give a man enough rope and he'll hang himself."
That is, let a man keep talking, or let him have his way without hindrance, and he'll eventually screw up bigtime. Suppose, for instance, you are investigating a crime and interviewing a suspect; if you let him talk freely, he may incriminate himself. Or if you let a politician keep on with his manipulations, he may just manipulate himself into real trouble.

Softly, softly, catchee monkey.

The NHS fraud story would be terrible, if it were true
 
Extracts from an article by Zoe Williams:-
 
Terrible, isn't it, that the NHS loses £5bn a year through fraud, according to data presented on Panorama. But like so many fables of recent history, we can file this under "It would be terrible, if it were true".

So where did the £5bn figure come from? Roy Lilley, health policy analyst and a former chairman of an NHS trust, says: "They took data from a lot of other countries, over a long period, crashed it all together, and then said 'This is the average percentage lost through fraud – if the NHS is average, then this is how much they lose'." Even taking an average like that was methodologically flawed – the sample was small and the range was huge.

Our healthcare is free at the point of use. There simply aren't as many transactions within it, as there are in an insurance-based system, for fraud to creep into. What possessed Panorama to run something on such weak evidence? Has it had its budgets cut? Does it have an anti-NHS mole at the highest level? Someone should do a Panorama into what's going on at Panorama.

This government has denigrated the NHS so persistently that I find it impossible to believe it didn't have a hand in these trumped-up fraud claims, yet simultaneously it's relatively easy to believe that it has poisoned the well against the health service so effectively that conspiracy is unnecessary. The anti-NHS mood music has been set; now it can stand back and let that other (once loved) public institution, the BBC, do the work for them.
 
For the whole article:-
http://www.theguardian.com/commentisfree/2014/mar/25/nhs-fraud-story-terrible-if-true?

?

Jeremy Hunt and Theresa Dismay treat NHS staff like lemmings.

Oh