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The Guardian view on heart surgery failings in Birmingham: numbers up The Guardian view on heart surgery failings in Birmingham: disdain for the data
(35 minutes later)
Facing the facts is not always easy to do. When things are particularly disturbing, the human instinct is very often to look away. But around the turn of the century, the NHS learned a singularly brutal lesson in the consequences of denial. Whatever the pain for professionals in facing up to their deficiencies, it was as nothing compared with the loss of the parents whose babies died needlessly, after being treated at a Bristol infant heart unit which lacked any grasp, or even recognition, of its own failings.Facing the facts is not always easy to do. When things are particularly disturbing, the human instinct is very often to look away. But around the turn of the century, the NHS learned a singularly brutal lesson in the consequences of denial. Whatever the pain for professionals in facing up to their deficiencies, it was as nothing compared with the loss of the parents whose babies died needlessly, after being treated at a Bristol infant heart unit which lacked any grasp, or even recognition, of its own failings.
A British Medical Journal editorial, headed “All changed, changed utterly”, summed up the shock before Sir Ian Kennedy’s report, which later documented the deadly results of denial. A consensus developed around the presumption that public safety now required the collation of proper data and an open culture for its handling; a culture in which warning lights would flash brightly and lessons would be learned. The force of this consensus overpowered the traditional deep-seated objections.A British Medical Journal editorial, headed “All changed, changed utterly”, summed up the shock before Sir Ian Kennedy’s report, which later documented the deadly results of denial. A consensus developed around the presumption that public safety now required the collation of proper data and an open culture for its handling; a culture in which warning lights would flash brightly and lessons would be learned. The force of this consensus overpowered the traditional deep-seated objections.
Surgeons used to argue, and they had a point, that crude death rates could be misleading, because the most complex cases, at most risk of dying, would often be referred to the very best surgeons. Before Bristol, such anxieties had left so-called outcome data languishing in the “too difficult” box. But in the wake of the scandal, the professional body of the heart surgeons cooperated with the statisticians, producing numbers that made proper allowance for the various risk factors that could dog a particular case.Surgeons used to argue, and they had a point, that crude death rates could be misleading, because the most complex cases, at most risk of dying, would often be referred to the very best surgeons. Before Bristol, such anxieties had left so-called outcome data languishing in the “too difficult” box. But in the wake of the scandal, the professional body of the heart surgeons cooperated with the statisticians, producing numbers that made proper allowance for the various risk factors that could dog a particular case.
This cardiology precedent has since been followed in other disciplines, from vascular surgery to bariatrics, which now keep proper tabs on the operations that go right and go wrong, creating the sense of an irreversible tide running towards transparency. The in-principle argument for mortality data has been won. But now a Guardian investigation into Queen Elizabeth hospital in Birmingham reveals how – in practice – these data are still not reliably treated with the respect they deserves. The families of 77 Birmingham patients who died after surgery now confront the cruel thought that their loved one might have been among the 17 who, the statistics suggest, should have survived if the hospital had been up to par. And this would not seem to be some quirk of the data: inspectors have identified dangerous problems, including the failure of medics to communicate properly during the crucial transition from the operation itself to intensive aftercare.This cardiology precedent has since been followed in other disciplines, from vascular surgery to bariatrics, which now keep proper tabs on the operations that go right and go wrong, creating the sense of an irreversible tide running towards transparency. The in-principle argument for mortality data has been won. But now a Guardian investigation into Queen Elizabeth hospital in Birmingham reveals how – in practice – these data are still not reliably treated with the respect they deserves. The families of 77 Birmingham patients who died after surgery now confront the cruel thought that their loved one might have been among the 17 who, the statistics suggest, should have survived if the hospital had been up to par. And this would not seem to be some quirk of the data: inspectors have identified dangerous problems, including the failure of medics to communicate properly during the crucial transition from the operation itself to intensive aftercare.
Running through the story is the sense – at best – of a continuing casualness towards the numbers, and – at worst – of statistical spin. One surgeon has conceded that he was recording the raw numbers from memory, rather than checking against notes. Allegations that he was manipulating them are yet to be tested, but even if not, there are echoes of the great scandal that clouded the children’s heart unit at Leeds General Infirmary, which ended up looking so dangerous that it was threatened with closure, principally because it failed to keep proper tabs. If patient safety truly is the priority, then medics cannot be allowed to treat data that safeguards it as an afterthought. The surgeon in question has now been dismissed, but that has not produced any spirit of candour. The Queen Elizabeth talks about his numbers contaminating its averages, even though things remain amiss even with his data excluded. It also argues for including the work that some of its surgeons do at a private hospital, for which it is not responsible.Running through the story is the sense – at best – of a continuing casualness towards the numbers, and – at worst – of statistical spin. One surgeon has conceded that he was recording the raw numbers from memory, rather than checking against notes. Allegations that he was manipulating them are yet to be tested, but even if not, there are echoes of the great scandal that clouded the children’s heart unit at Leeds General Infirmary, which ended up looking so dangerous that it was threatened with closure, principally because it failed to keep proper tabs. If patient safety truly is the priority, then medics cannot be allowed to treat data that safeguards it as an afterthought. The surgeon in question has now been dismissed, but that has not produced any spirit of candour. The Queen Elizabeth talks about his numbers contaminating its averages, even though things remain amiss even with his data excluded. It also argues for including the work that some of its surgeons do at a private hospital, for which it is not responsible.
Patients, surely, deserve an NHS that works to the mantra of face it, then fix it. Two decades on from Bristol, however, it seems that the health service continues to harbour some dangerously defensive instincts.Patients, surely, deserve an NHS that works to the mantra of face it, then fix it. Two decades on from Bristol, however, it seems that the health service continues to harbour some dangerously defensive instincts.