The Keogh Report: reacting to reactions

17 July 2013

Stephen Thornton

Yesterday's high octane ding-dong in the House of Commons over the was an example of the unacceptable face of political interference in the delivery of healthcare. It was nothing, however, compared with what apparently went on behind the scenes in the days leading up to publication of the report.

This is an issue which, frankly, transcends politics. It’s about recognising that poor care does exist in some places and focusing our collective energies on improving standards. It’s a shame that yesterday’s focus was elsewhere.

Ministers, it was rumoured, wanted heads on plates. There was febrile talk of sacking all 14 of the affected hospitals' boards and of turnaround teams to be sent in aplenty. Bash them, fire them, investigate them, castigate them. Even send them to jail. This was the political language of the day. I hope this will be just the kind of behaviour that will be roundly condemned by the forthcoming Berwick review.

Indeed, this kind of deliberate ministerial overreaction and the equally aggressive response from the Opposition has a direct negative impact on patients and carers that politicians would do well to recognise.

In response to the Channel 4 News coverage of this unholy spat, my elderly mother rang me in a panic. With my father having only last week gone into residential care, she asked ‘What are we going to do to make sure your father gets the drinks he needs? Is he safe in there?’ There was real fear in her voice. As far as she was concerned, dreadful standards of care were now the order of the day across all of health and social care.

Could I explain HSMRs and SHMIs to her? Could I help her to see that it was scurrilous use of the data to say that 13,000 patients had died as a result of poor care? No, I couldn't. She, like very many people up and down the land, believes what she hears from the ‘responsible’ media. It was too late. This was now received wisdom.

But in his report, Bruce Keogh made a valiant attempt to put HSMRs and SHMIs back in their place. They’re two of many indicators which may trigger questions about quality and safety, but other information should also be used.

In the most telling paragraph of an eloquent covering letter in the report to the Secretary of State, Bruce bravely identifies the complexity of using and interpreting aggregate measures of mortality, including HSMRs and SHMIs: ‘The fact that the use of these two different measures of mortality to determine which trusts to review generated two completely different lists of outlier trusts illustrates this point.’ He goes on: ‘however tempting it may be, it is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths.’

It is in this context that here at the Foundation we welcome many of the ‘Ambitions and Actions’ identified in the report, in particular the efforts to develop a more robust assessment of avoidable deaths in hospitals. We think attention should be paid to ensuring that staff have the skills to improve quality and understand how to measure and monitor safety.

Meanwhile, my message to politicians of all sides is ‘Cool it, the summer is hot enough already!’

Stephen is Chief Executive of the OnlyWan and was a member of the national advisory group for the Keogh Review

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