The mysterious Dr Foster

Many of Britain's hospitals are putting lives in danger. So says a consultancy whose dire warning dominated the weekend headlines. But is it right? And should it be allowed so much influence? Nigel Hawkes ventures a second opinion

Who is this Dr Foster, the source of the weekend's headlines about the NHS? He seems to be saying that the elaborate system for inspecting hospitals that was set up – and recently reformed – by the Government is failing to spot some pretty obvious examples of bad medicine.

Thousands of patients dying, hospitals failing to respond to safety alerts or unexpected deaths, swabs and drill bits left inside patients after operations... Isn't this the kind of thing any respectable Government inspector might be expected to pick up on? What on earth is going on?

Dr Foster is not, of course, a doctor at all, but a witty name chosen by two journalists when they set up a healthcare analysis company eight years ago, planning to exploit the mass of data churned out by the NHS (..."Dr Foster went to Gloucester, in a shower of rain")

Tim Kelsey from The Sunday Times and Roger Taylor from the Financial Times saw an unexploited commercial opportunity in the work of Professor Sir Brian Jarman of Imperial College. Professor Jarman had devised a way of measuring how well hospitals perform by using the Hospital Episode Statistics (HES) produced by the NHS.

Kelsey and Taylor's timing was good. The Department of Health under Alan Milburn needed evidence to support and monitor progress in implementing the NHS Plan and, after some initial hesitation, embraced Dr Foster warmly. The first Good Hospital Guide under the Dr Foster imprint appeared in 2001. Hospitals were under notice to collaborate with Dr Foster, however little they liked doing it.

So keen was Milburn's successor, Patricia Hewitt, on the product that she bought the company. Under a deal negotiated in 2006, £12m of public money was invested in a joint venture between Dr Foster and the NHS body, the Information Centre for Health and Social Care, to create the Dr Foster Intelligence consultancy.

The fact that this deal went through without a competitive tender raised some eyebrows, and was heavily criticised by the National Audit Office (NAO). The department had paid too much, and had failed to give others a chance to bid, the NAO ruled.

Professor Denise Lievesley, a statistician who had become chief executive of the Information Centre, protested to her bosses in the NHS, and again in 2007 when a contract to provide material to the NHS Choices online information service was awarded to Dr Foster without (in her view) proper procurement procedures. She was eased out of her job, with a gagging clause preventing her from telling her side of the story.

So the irony of the weekend's stories is that a company granted at least one sweetheart deal – and possibly two – by the Department of Health has been the bringer of exactly the sort of bad news the department would rather not have heard.

There have been hints that the department has fallen out of love with Dr Foster. The consultancy lost the contract for NHS Choices in July 2008, and set up a rival website for its Good Hospital Guide. There are suggestions that the Information Centre plans to sell its stake in the joint venture.

That said, is what Dr Foster says about the NHS to be relied on?

Professor Jarman's method of comparing hospitals is called the Hospital Standardised Mortality Ratio, or HSMR. From the HES data, the number of patients dying after a range of different procedures in hospitals is available. All things being equal, good hospitals will kill fewer patients than bad ones. The difficulty is that all things are not equal.

Hospitals vary in many ways – the area they serve, the age of their patients, the efficiency with which they record the data. The HSMR figures incorporate corrections for these variables, so that at the end of the process one hospital can be compared directly with another. Professor Jarman is a leading world authority on this subject, so nobody doubts the probity of the process.

But many do question the results. One striking feature of this year's results is a sharp fall of 7 per cent in HSMRs across England. This is good news – if slightly too good to believe without careful scrutiny – because it implies that many fewer patients are dying in England's hospitals than in previous years. But the fact that HSMRs across the board have fallen so fast means that the target has moved. The results have been rebased so that a hospital that exactly matched the national average would score 100 – those with more deaths above 100, those with fewer below 100. This means that some hospitals who know they have improved appear to have done worse, because they haven't improved quite as much as the average. Others say the Dr Foster method misrepresents how good they are.

Alternative methods for calculating HSMRs exist, and in some cases paint a much more flattering picture.

One reason for this may be that hospitals do not invariably "code" their patients fully. If a patient has four or five co-morbidities (conditions that make survival less likely) then this should be taken into account. If they are not recorded properly, then a hospital will have a higher HSMR than it should. (There may even – perish the thought – be the suggestion that clever hospitals are exaggerating the co-morbidities to improve their HSMRs. It wouldn't be the first time a target has been "gamed" in the NHS.) Another possible source of error is that Dr Foster counts only deaths that occur in hospital. If patients are discharged and die the next day, at home or in a hospice, their deaths go unrecorded.

So the Good Hospital Guide should be seen for what it is: a sincere attempt to measure something very elusive but very important. But is it more reliable than the Care Quality Commission (CQC) verdicts? Dr Foster can be said to provide an important corrective. Both approaches have their virtues, but careful scrutiny and a degree of scepticism should accompany the reading of either.

Life and Style
ebookNow available in paperback
ebooks
ebookA delicious collection of 50 meaty main courses
Latest stories from i100
Have you tried new the Independent Digital Edition apps?
SPONSORED FEATURES

ES Rentals

    Independent Dating
    and  

    By clicking 'Search' you
    are agreeing to our
    Terms of Use.

    iJobs Job Widget
    iJobs General

    Recruitment Genius: Personal Tax Senior

    £28000 - £37000 per annum: Recruitment Genius: This is an opportunity to join ...

    Recruitment Genius: Customer and Markets Development Executive

    £22000 - £29000 per annum: Recruitment Genius: This company's mission is to ma...

    Recruitment Genius: Guest Services Assistant

    £13832 per annum: Recruitment Genius: This 5 star leisure destination on the w...

    Recruitment Genius: Sales Account Manager

    £20000 - £32000 per annum: Recruitment Genius: A Sales Account Manager is requ...

    Day In a Page

    A nap a day could save your life - and here's why

    A nap a day could save your life

    A midday nap is 'associated with reduced blood pressure'
    If men are so obsessed by sex, why do they clam up when confronted with the grisly realities?

    If men are so obsessed by sex...

    ...why do they clam up when confronted with the grisly realities?
    The comedy titans of Avalon on their attempt to save BBC3

    Jon Thoday and Richard Allen-Turner

    The comedy titans of Avalon on their attempt to save BBC3
    The bathing machine is back... but with a difference

    Rolling in the deep

    The bathing machine is back but with a difference
    Part-privatised tests, new age limits, driverless cars: Tories plot motoring revolution

    Conservatives plot a motoring revolution

    Draft report reveals biggest reform to regulations since driving test introduced in 1935
    The Silk Roads that trace civilisation: Long before the West rose to power, Asian pathways were connecting peoples and places

    The Silk Roads that trace civilisation

    Long before the West rose to power, Asian pathways were connecting peoples and places
    House of Lords: Outcry as donors, fixers and MPs caught up in expenses scandal are ennobled

    The honours that shame Britain

    Outcry as donors, fixers and MPs caught up in expenses scandal are ennobled
    When it comes to street harassment, we need to talk about race

    'When it comes to street harassment, we need to talk about race'

    Why are black men living the stereotypes and why are we letting them get away with it?
    International Tap Festival: Forget Fred Astaire and Ginger Rogers - this dancing is improvised, spontaneous and rhythmic

    International Tap Festival comes to the UK

    Forget Fred Astaire and Ginger Rogers - this dancing is improvised, spontaneous and rhythmic
    War with Isis: Is Turkey's buffer zone in Syria a matter of self-defence – or just anti-Kurd?

    Turkey's buffer zone in Syria: self-defence – or just anti-Kurd?

    Ankara accused of exacerbating racial division by allowing Turkmen minority to cross the border
    Doris Lessing: Acclaimed novelist was kept under MI5 observation for 18 years, newly released papers show

    'A subversive brothel keeper and Communist'

    Acclaimed novelist Doris Lessing was kept under MI5 observation for 18 years, newly released papers show
    Big Blue Live: BBC's Springwatch offshoot swaps back gardens for California's Monterey Bay

    BBC heads to the Californian coast

    The Big Blue Live crew is preparing for the first of three episodes on Sunday night, filming from boats, planes and an aquarium studio
    Austin Bidwell: The Victorian fraudster who shook the Bank of England with the most daring forgery the world had known

    Victorian fraudster who shook the Bank of England

    Conman Austin Bidwell. was a heartless cad who carried out the most daring forgery the world had known
    Car hacking scandal: Security designed to stop thieves hot-wiring almost every modern motor has been cracked

    Car hacking scandal

    Security designed to stop thieves hot-wiring almost every modern motor has been cracked
    10 best placemats

    Take your seat: 10 best placemats

    Protect your table and dine in style with a bold new accessory