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Wednesday 6 March 2013

Get Nicholson

Right now, David Nicholson, CEO of the NHS in England, will know exactly what Nick Davies meant when he wrote “I know of nothing anywhere in the rest of the world’s media which matches the unmitigated spite of an attack from the Daily Mail”. As with the earlier attack on Les Ebdon, which I wrote about at the time, the Mail is now mounting a sustained campaign to have Nicholson removed from office.

So go f***ing private like me, then, c***

So the legendarily foul mouthed Paul Dacre has ordered his obedient hackery to say whatever it takes to have Nicholson kicked out, despite the tactic failing against Ebdon – and also failing when attempted against Channel 4 recently. Key to this strategy is christening their target “The Man With No Shame, because of his brief connection to the Mid Staffordshire NHS Trust.

This is held to mean that Nicholson must have known everything that was happening at Stafford Hospital at the time when the poor care standards highlighted in the Francis Report were known to have occurred. That he was also in charge of two other trusts, and in possession of no more than the same 24 hours in a day granted to other human beings, is not allowed to enter.

Nicholson’s alleged lack of shame is, in Dacre land, down to the “1,200 deaths” meme that has already been shown to be false (as I’ve already noted, this figure was extrapolated from Hospital Standardised Mortality Ratios (HSMRs) which showed high figures because Mid Staffs NHS Trust had no coding manager at the time, and the expected death figures were lower than average after correct coding).

So today, following Nicholson’s appearance before a Parliamentary Select Committee yesterday, has come a particularly vicious assault. He is alleged to have “left MPs staggered by his evasiveness”. The Mail falsely tells readers “he admitted personal failings which led to more than 1,000 unnecessary deaths between 2005 and 2009” and “that patients were not the main priority in the NHS”.

So far, so typical: this line is then taken up by the pundits, led by “Daily Mail Comment”, the authentic voice of the Vagina Monologue. “Labour’s sick defence of the indefensible,” it thunders. “four former Labour health secretaries sprang to his defence, displaying a defective moral sense matched only by his own”. Ah, where would the world be without Paul Dacre laying claim to the moral high ground?

And so important is the occasion that the odious Quentin Letts (let’s not) attended the Committee’s proceedings, relating “After listening to Sir David for some two hours I left with a throbbing headache”. Try taking notes, Quent, so you won’t have so much to remember. And make sure you keep banking the cheques, because Dacre might not be there for much longer.

But the falsehood and misinformation will continue. No change there, then.


Dr Bryn R Williams said...

Can't understand why Nicholson didn't seem to know that the "400-1200 excess deaths" was a coding artefact if he has had 20 years in hospitals.

Is it because to dispute the 'excess deaths' line is political suicide? If he knows and he doesn't say then he is complicit in the lie, and probably should go. If he doesn't know then he has no grip on how a hospital charges PCTs for their services, and should go.
I don't like seeing a witch hunt, but there are real competency issues here.

Mike said...

Normally find this blog very interesting but there's a lot to disagree with in this post, sadly, this in particular leaps out:

"This is held to mean that Nicholson must have known everything that was happening at Stafford Hospital at the time when the poor care standards highlighted in the Francis Report were known to have occurred. That he was also in charge of two other trusts, and in possession of no more than the same 24 hours in a day granted to other human beings, is not allowed to enter."

As far as I know, no one is saying that Nicholson should have known absolutely everything. The argument is that he should have been aware of the mortality rates and the complaints from whistleblowers and patients about the standard of care.

It seems he's either incompetent or willfully complicit in trying to hide what was going on at the hospital. Not too dissimilar from the defence of various News International execs around phone hacking.

I imagine your reaction might have been a little different if Paul Staines or Harry Cole had argued Rupert Murdoch was also in charge of many other newspapers and in possession of the same 24 hours in a day granted to other newspapers so shouldn't be expected to know what was happening at the Screws.

I don't like the Mail at all, but be careful about falling into the trap of "my enemy's enemy" on this one.

Tim Fenton said...

No mention of Rupe or the Fawkes folks, though. Not sure why they are relevant.

Moreover, as I keep pointing out, these "mortality rates" were not as they seemed, as you'll see from the link provided.

So much of the Mail's attack is based on the HSMRs that it is very important to understand why the figures *suggested* a higher number of patient deaths.

The Mail turning to blatant dishonesty this morning also appears to have escaped you.

Mike said...

Whether you accept the HMSR figures or not, the fact that it was 127 in April 2007 should have rung alarm bells and been cause for concern and should have been investigated.

Did you read the report in Private Eye last week about Haynes Kirkbride's coding? They claimed her method was to change the diagnosis on a lot of patients, so if someone came in with a hip fracture and died from pneumonia due to the amount of time they had to wait for an operation then the diagnosis was switched to pneumonia (something people do die from and hence not necessarily indicative of a poor standard of care) and - hey presto - they're gone from the mortality alerts. According to the Eye, the number of people dying after fracturing their femurs went from 87% to 40% using this method, even though the number of deaths didn't actually change.

Even if you accept that there was nothing wrong with the coding, the HMSR was actually 88 and mortality rates at Mid Staffs were low, then how does that square with the content of the Francis Report and all the people whose deaths could have been wholly avoided?

I'm not here to stick up for the Mail or anyone else, if they were being blatantly dishonest about something it wouldn't surprise me in the least but I don't think Nicholson or anyone else should be let off the hook either, or that he should be taken for his word when he sits in front of a select committee and says he had no idea anything was going on.

Tim Fenton said...

The Francis Reports also include the referral of contentious deaths, and on this point Steve Walker's post detailing the process proves instructive.

That process found "perhaps one" excess death.

I subscribe to the Eye, but know that it does not always get the right story. The coding exercise - also covered by Steve's post - was meant to go back over patients' notes and code the input fully. He explains this in some detail.

If you're suggesting that there was some kind of delay in surgical procedures at Stafford, then perhaps you could say so explicitly.

Ms Kirkbride, as far as I am aware, was known to be very "text book" about the coding exercise, to the extent of reporting one person who attempted to have her analysis changed.

Mike said...

If you could provide a link that would be good, particularly on that point that there was "perhaps one" excess death.

I'm pretty astonished that your underlying tone seems to be everything was fine at Mid Staffs and it's all a load of tosh cooked up by the media.

Tim Fenton said...

It's linked from my post last weekend responding to the Mail's article about the Royal Wolverhampton. See here http://zelo.tv/Wyu9T0

My underlying tone is nothing of the sort. There were instances of poor care at Stafford Hospital, as detailed by the Francis Reports, substantially caused by inadequate staffing levels.

But the "1,200 deaths" meme is rubbish.

Mike said...

I'm still not seeing a link that proves only 1 person at the most died unnecessarily at Mid Staffs. Help me out!

Tim Fenton said...

The link is in the last full paragraph of that post. But nobody is claiming to "prove" anything.

Mike said...

OK, I read that a few days ago and it makes interesting reading, but it's also based on 40-50 cases. I don't see how that disputes what was published in Private Eye about coding, or why Nicholson shouldn't be expected to know that one of the hospitals he was in charge of had an HSMR of 127.

On a slightly more emotional note, it seems a bit disrespectful to the families to band around that "perhaps one" quote. This is excess we're talking about too, so I don't see why an HSMR of 88 should be believed more than one of 127. A kind interpretation might be that we don't know exactly how many people may have died unnecessarily but there was certainly a lot of patients who suffered horrendous pain and indignity, and the standard of care went down due to the pressures put on staff by bosses and the need to meet targets and cut costs. That's the bottom line for me.


Tim Fenton said...

What the "perhaps one" conclusion was based on is a review of all cases where deaths were considered contentious, and where relatives requested examination of the record.

What the Eye published is conjecture, although it is undoubtedly intended to have a positive impact.

Neither I nor Steve Walker takes issue with Francis' analysis and conclusions.

Mike said...

The fractured femur stats going from 87% to 40% whilst the number of deaths remained the same does seem to stand up what was written in the Eye. I've not seen that contested anywhere.

If this re-coding is the basis for their definition of a contentious death then its not surprising only 40-50 cases were reviewed (as Walker acknowledges in his blog post), I'd be interested to know how many families knew they could ask for a review as well, or how many had faith that anything short of a judicial inquiry would get to the bottom of what went on.

Tim Fenton said...

Of course the number of deaths remained the same. How can an actual number of deaths be changed retrospectively?

The recoding is not the basis for the definition of a contentious death. I don't know where you get that from.

We could play "yeah but" all evening, and I suspect you would still be taking issue with something I either did not say, or something someone else did not.

Mike said...

gah! the point was it doesn't seem to be disputed anywhere that the percentage of deaths from fractured femurs went down. If the recoding was going on and they decided people died from pneumonia instead then why would they class that as contentious? It doesn't make sense.

You're right, I suspect we could go on all night. I still don't understand the defence of Nicholson if I'm honest. Keep up the good work with the rest of the blog.

Steve said...


The extreme change in fractured neck of femur outcomes postdated the contentious period at Staffs and was identified as a cause of their climb to one of 'most improved' status in Dr Foster's Good Hospital guide. The inside word on the Texan coding manager is that she was absolutely straight up.

The Mail can't have it both ways - they use her integrity to cast suspicion on Wolverhampton, but ignore it when it comes to Stafford.

Your comment on the 40-50 cases misses the point. In fact, around 120 cases were reviewed and Dr Laker personally reviewed those 40-50. But the invitation to ask for a review was extended to every patient treated at Stafford during the period in question, and to every family of a patient who died.

The fact that only 120 thought their case was doubtful enough to merit a review shows the 400-1200 figure to be fantasy. Out of those 120 cases, 40 or 50 were doubtful enough to be passed to the review-leader for checking. Of those, 'perhaps one' was an avoidable death.

The 'set' of cases put forward for review was already filtered so that all the thousands of other cases would contain zero dubious deaths, or very close to it.

The Francis report emphatically does NOT refer to avoidable deaths caused at Stafford. Discomfort, pain, embarrassment etc yet - those are the consequences of severely understaffed wards and units, as nurses are forced to prioritise life-threatening cases over those of mere comfort or dignity.