Misinformation ? 1200 needless deaths ?

"Fury as hospital staff let off over 1,200 needless deaths"

Newspaper readers on the morning of 7  February 2013 were asking themselves how  it could be that nobody had been called to account for the needless deaths of 1200 patients at Britain's North Staffordshire Hospital.  Few will have seen the need to ask the question "how do we know that?"   After all,  the statement that there had been 1200 needless deaths was attributed to the highly authoritative report of a public inquiry the Francis Report .  In fact, however, there was no such statement in the Francis report, only an expression of regret that the figure had been publicised

("It is unfortunate that the figure of 400-1200 excess deaths became so widely  publicized and sensationalized. These estimates are derived from 95% confidence intervals around the SMRs, and the intention was to redact them from the final report because of concerns that the public would not understand them" Appendix 8 par 5).

 The evidence  collected in the Francis inquiry had  consisted of witness statements  by patients about malpractices at the hospital.           The hospital's mortality rate had been the subject of an earlier  health commission inquiry).  A statistical study had been commissioned by that inquiry to find whether  its above-average mortality rate  over the period 2003-2006 could be attributed to any of a range of  "external" factors such as the age of its patients.  The study had concluded that a  residual number of deaths  remained unaccounted for,  after allowing for all such external influences - and that those deaths were  presumed to be attributable to factors internal to the hospital.  The study concluded that there was a 95 percent probability that the size of that residual lay between 400 and 1200,  after allowing for uncertainties  concerning the effects of the  external influences.  

         Thus the evidence concerning  what happened at the hospital is (a) evidence of persistent malpractice -  attributed by the Francis report to the hospital's "culture" ; and (b) the evidence of  a substantial number of deaths attributable to factors internal to the hospital.  What the Robert Francis  had added to that information was the judgement that the association between (a) and (b) had been that of cause and effect - in other words that the unnecessary deaths had been the result of the hospital's "culture". His statement at paragraph 55 of the report further suggested that what had happened at North Staffordshire might be happening throughout the NHS: 

("There are those who have  given evidence or written to the Inquiry suggesting that Stafford is not an isolated case, and that, on the contrary, similar stories could  be uncovered in other parts of the NHS. Clearly, it has not been a function of this  Inquiry to undertake a survey of the NHS  as a whole and therefore   I cannot draw conclusions about this understandable concern. However, patients’ stories very  similar to those I have  heard have  been reported from elsewhere  and with some frequency; examples can be found in the recent Patients Association report.")

That speculation prompted further media conclusions such as the Times headline "The NHS is run for the benefit of the staff, not the patients".

 Misinformation?  Certainly! Damaging? Possibly :  the phoney 1200 figure is unimportant compared with the harm that could arise from an attempt to solve the problem by assigning blame and imposing punishment.

         The possibility of harm arises from neglect of the possibility that some of the needless deaths had arisen for reasons other than a culture of uncaring self-interest.  Some might, for example, have been the outcome of the selfless endeavours of people who were overworked, underqualified or otherwise ill-equipped for the tasks they were assigned.  It would  be damaging  to deter such people from reporting what happened as a warning to others, or seeking advice about how their mistakes could have been avoided.