Smarter use of public service statistics can save lives as well as money. But anxious civil libertarians want to stop the state sharing our personal records. They must not succeedby Tim Kelsey / July 29, 2009 / Leave a comment
Brian Jarman, emeritus professor of general practice at Imperial College, is a kindly looking man. He is famous in medicine for designing the statistical model that was used to pay GPs (the Jarman Index); leading the campaign to keep Barts Hospital open; and, 15 years ago and perhaps most notably, devising a way of predicting how likely patients are to die in hospital. That analysis revealed that death rates in England, even when controlled for variables like a patient’s age or class, differed by up to 76 per cent.
Death rates are not universally accepted as the best way to measure a good hospital. But tragic events keep bringing the issue back onto the agenda. In 2001, the Kennedy inquiry into children’s heart surgery at the Bristol Royal Infirmary found that up to 35 babies may have died unnecessarily during the early 1990s. The inquiry called for more surveillance of hospital performance. This year just such an analysis uncovered another scandal at Stafford General Hospital, where receptionists rather than nurses were deciding which patients needed urgent treatment when they came to A&E. The healthcare regulator found that 400 lives may have been lost; deaths which smarter analysis of data might have prevented.
Yet the spread of such analysis in our health service has been painfully slow. Because Jarman’s original methodology used data taken from confidential patient records, the secretary of state for health had to give formal consent for its publication. This was refused for years. Politicians of both parties were nervous: how would the public respond to evidence that the NHS is a dangerous postcode lottery? Only in 2001 did health secretary Alan Milburn take a different view and authorise the publication of the hospital standardised mortality ratio (HSMR) in the Good Hospital Guide. (My company, Dr Foster, publishes this guide and provides other data about the quality of local health services.) Since then, better use of data has slowly begun to change the ways the NHS is run. Walsall hospital, for instance, had the highest death rate in 2001, recording 1,080 deaths when it should have had only around 830. By 2004 it had improved its performance dramatically through a number of innovations in clinical practice and probably saves more than 275 lives a year as a result.
Despite such early successes, we still don’t routinely know how good our doctors are—or, for that matter, our teachers…