Jeremy Laurance: Lies, damn lies and health service statistics

From Jennifer's Ear to Rose Addis, individual cases have had a habit of turning on those who cited them
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The Independent Online

John Reid was at it again yesterday. The Health Secretary, eager to extol - and why not? - the achievements of the NHS after the bruising battle of Margaret Dixon's shoulder, trotted out another line of statistics in a speech to heart specialists in Birmingham.

A 27 per cent fall in premature heart deaths since 1997, two million more people taking cholesterol-lowering drugs, a doubling in the numbers treated with clot-busting drugs ...

As these very large and indubitably impressive numbers tripped from the Health Secretary's tongue, I wonder how many among his audience began to glaze over and started dreaming about the weekend.

And there is the problem for Mr Reid, Tony Blair, Michael Howard and for every other politician involved in the NHS. How do you convey a message that will stick about an organisation that is the largest employer in Europe, that has the turnover of a small country and that last year carried out 6,655,000 operations (of which 67,000 were cancelled like Mrs Dixon's)?

The way to bring debate about the NHS alive is with real stories about real people. It is what we all rely on for our opinions on whether it is getting better or worse - how a family member, friend or neighbour fared at its hands. One good anecdote is worth a thousand pages of statistics.

Michael Howard knows this, which is why he seized on the extraordinary tale of Margaret Dixon. One feature of her story stood out. Because of the high risk of the surgery - with a reported 50:50 chance of death due to her other medical problems - each time she was admitted to hospital she had to say her goodbyes as if they might be her last. The emotional strain on her and her family can only be imagined.

But as history shows, citing anecdotes for political gain is a dangerous game. From Jennifer's Ear in 1992 to Rose Addis in 2002, the cases have had a habit of turning on those who cited them. Even if Margaret Dixon proves true to her cause of improving the NHS - and she has been an impressive witness so far - she is unlikely to be the lethal weapon the Tories hope simply because her case is so unusual.

Every patient's story is unique, and no patient's experience of care is likely to be all good or all bad. It depends which bits you choose to focus on. One patient who has had life-saving treatment for cancer may complain about the quality of the hospital food. Another who has suffered unacceptable delays and cancellations may be overcome with gratitude that their hernia is finally fixed. There is no single "truth" about the NHS; there are multiple truths.

But there are trends in these stories, which reflect the ups and downs in the affairs of a national institution. A decade ago, rows about the shortage of critical-care capacity surfaced regularly in the press, with helicopter dashes by desperately ill patients in country-wide searches for a vacant intensive care bed. The number of critical-care beds has grown by a third since 2000, and these stories had all but disappeared - until Margaret Dixon.

The Daily Mail - the most implacable critic of the NHS - has quietly dropped its "Third World Wards" campaign, and the story count of NHS disasters has slowed. When even the Mail cannot find matters to criticise, it is powerful anecdotal evidence that things are getting better.

On many indicators - waiting lists, delayed discharges, heart and cancer deaths - Britain's health service is improving. So it should be, given the extra billions that have been invested. The unanswered question is whether, given the scale of investment, we have had sufficient bang for our bucks. On certain measures - MRSA rates, for example - there is still much to do.

But since we are talking anecdotes, let me conclude with one of my own. When the Government published its NHS plan in July 2000 I was as sceptical of its many pledges as anyone. To illustrate my scepticism, I described in these pages the case of a friend, who was named and pictured, and who at that time was on a 15-month waiting list for a heart operation.

Yesterday the Government announced that from next month no patient will wait longer than three months for coronary bypass surgery. By the end of December, on present trends, no patient will wait longer than six months for any type of operation.

That is still too long, of course. But in anybody's book, it's progress.