Chances are that no-one cares

NHS Choices comments - Wordle word clouds

2012-03-01T10:36:00.000-08:00

c.21,000 comments about hospitals from NHS Choices (01/01/2008 - 28/01/2012)

Word cloud based on comments about hospitals left under the heading 'Liked':

Word cloud based on comments about hospitals left under the heading 'Disliked':

c.4,000 comments about GPs from NHS Choices (date range not given)

Word cloud based on comments about GPs left under the heading 'Liked':

Word cloud based on comments about GPs left under the heading 'Disliked':

It's subtle, I know, but I'm getting the impression that staff might be crucial to the success or failure of the NHS...

Hey, you know what, it might even be worth listening to them.

Chris

What case for change?

2012-02-28T14:40:00.003-08:00

"I am a passionate supporter of our NHS, and that is why I understand the passionate debate it arouses. It is also why I resent those Opposition Members who seek to misrepresent the NHS, its current achievements and its future needs"

- Andrew Lansley, Wednesday 28 February 2012

"For example, if our cancer survival rates were at the European average, we know we would save 5,000 extra lives a year"

- Andrew Lansley, Wednesday 1 June 2011

"The cost of new medicines alone, for example, has been rising by nearly £600m a year"

- Andrew Lansley, Sunday 10 April 2011

Sooooo, my dual approach of tweeting and emailing has paid dividends. Well, to be more accurate the countless tweets have so far yielded nothing (thanks very much to those who re-tweeted, by the way), but a couple of emails to healthandsocialcarebill@dh.gsi.gov.uk resulted in a response after eight days (not too shabby at all).

Highlights of the response I received are below:

"Many thanks for your emails dated 20 and 27 February in which you asked to be provided with the sources for two lines from the Overview of the Bill factsheet, published on the Department of Health website
Saving 5,000 additional cancer patients’ lives each year by bringing England in line with the European average is based on the analysis of number of deaths that could have been avoided if England’s five-year survival rates matched the average European five-year survival rates
Further information about the study can be found on page 33 of Improving Outcomes: A Strategy for Cancer- First Annual Report 2011 on the Department's website at
http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_131690"

And yes, you guessed it, bottom of page 33 of that document says:

Abdel-Rahman et al, What if cancer survival in Britain were the same as in Europe: how many deaths are avoidable?, Br J Cancer. 2009 Dec 3; 101 Suppl 2:S115-24 www.ncbi.nlm.nih.gov/pubmed/19956155

I've since replied with the below:

"Thanks very much for your reply.

I'm incredibly interested as to why the 5,000 deaths figure is still being used, based on Abdul-Rahman et al's study, despite it being comprehensively discredited:

http://www.guardian.co.uk/commentisfree/2011/apr/16/bad-science-goldacre-nhs-statistics

Please can you clarify whether you disagree with Dr Goldacre's analysis, and why it is deemed appropriate to continue using the figure a year on, as if it were an accurate, contemporary 'fact' (note the use of the phrase "we would save", rather than "a study based on data no later than the year 1999 estimated that")"

So far, so predictable. However, that was only one half of the response that I received. When I emailed on the 27th of February, I also requested the source for the claim that the cost of medicines is rising by over £600m per year. Here's that part of the response:

"The estimate of £600m is based on the average growth in total drugs expenditure over ten years. The table below shows the total NHS drugs expenditure from 2000-01 to 2009-10 and draws on information contained in the Department of Health Annual Accounts, Financial Returns, and Foundation Trust year-end accounts during that period.

My reply concerning this was:

"And on the cost of medicines, please can you provide the relevant links to the information that forms the basis of that table. Apologies, but I can't find it in here:

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_130154.pdf"

Right, now for the interesting (ahem) bit... let's have a closer look at that table above.

Well, it covers the first 10 years of the 21st century. And it states that the cost of medicine in 2000/01 was £6,690m. Now, if as has been claimed by Factsheet A1 the cost of medicines is growing by over £600m per year, then the cost of medicines in 2009/10 must be at the very least more than £12,090m (£6,690m + 9 x £600m)... agreed? (embarrassingly I had that initially as 10 x £600m, but hopefully now have it right)

Hmmm, how strange. The bottom line of the table states that the cost of medicine in 2009/10 was £11,920m. That's more than £170m less than the absolute minimum figure necessary for the 'fact' to be correct.

So it's wrong. The 'fact' on Factsheet A1 is simply incorrect. Now, anyone who read my previous post on this (my wife, possibly rightly, thinks I'm getting obsessed, but there is a reason for my persistence... I'll get on to that at the end of this post) will know that not only does the £600m per year 'fact' get an airing on Factsheet A1 ('Overview of the Bill'), it also makes a repeat appearance on Factsheet A2 ('Case for change') in a slightly different guise. Such is the importance placed on this 'fact'!

Factsheet A2 states that the cost of medicine has been growing on average by nearly £600m a year. 'Nearly' is nice and vague... I might have to concede that 'nearly' in the context of the figures involved could cover a shortfall in excess of £170m.

But now I'm wondering why the last 10 years has been included, and why go for the average over that decade?

Let's have a look at that table again...

From 2001/02 to 2004/05 inclusive, the annual cost of medicine did rise by over £600m - the highest rise was in 2003/04, when medicines cost £916m more than in 2002/03. In 2005/06, there is what looks like an anomaly... possibly a data error, but also possibly down to an external factor? I don't know, and I await the raw data so I can dig into it, but according to the data supplied, the cost of medicine in 2005/06 was only £28m higher than the cost of medicine in 2004/05.

Now, here's the crucial bit. From 2006/07 to 2009/10 inclusive, the annual cost of medicine rose by less than £600m - the highest rise was in 2006/07 (the year after the likely data anomaly), when medicines cost £563m more than in 2005/06.

Furthermore, the percentage year on year increase in the cost of medicine is consistently lower in the most recent years.

And if you take 2004/05 as the starting point, rather than 2000/01, the average annual increase in the cost of medicine suddenly becomes £390m - bit of a difference from £600m, right? And the £390m is using the most recent five years of available data.

Now, to try and explain why I keep banging on and on about all this... it's because these are the 'facts' being repeatedly used to justify a monumental shake-up to the NHS. Of all the things that could have been chosen, these are what the Government view as the best possible justifications.

A study of cancer patients from the last century, which pre-dates the NHS Cancer Plan, isn't a compelling case for change. Nor is the rising cost of medicine, which is rising consistently lower in recent years than it was.

Please don't accept these 'facts' as justification for the Health and Social Care Bill. They're both incorrect and misleading.

If you want to learn about the performance of the NHS, take a look at this. Highlights include:

- Levels of public confidence and satisfaction in the NHS higher than any other country studied
- UK has one of the least expensive health systems among countries studied

And please don't be fooled into thinking that dismissing the Government's flimsy and erroneous case for change is akin to saying that the NHS is perfect and never needs to improve or adapt.

What worries me most is that if we're being misled about the reasons for the Health and Social Care Bill being introduced, what does that say about the actual content of the Bill and how it will be implemented? For me, it's like cowboy builders turning up at your house and telling you that your roof needs urgent repairs. If you get someone else to go up on your roof, see that the type of work they claimed needed doing so urgently is actually a con job, then how confident would you be in letting them go ahead and do the work? Do you think they'd do a good job?

Chris

P.S. If I've stuffed up any of the medicine cost analysis, I do apologise, and would be more than happy to correct.

P.P.S. Quick final one for nostalgia's sake - anyone remember "Someone in this country is twice as likely to die from a heart attack as someone in France"? Compare and contrast that often quoted justification for changes to the NHS with this from the Information Centre today...

The NHS IC‏ @NHSIC

Following

Heart attack patients: emergency admissions drop while death rate nearly halves in a decade:tinyurl.com/7nzl7yl

11RETWEETS

11:09 AM - 29 Feb 12 via web · Embed this Tweet

Wordle - what do my first 12 blog posts look like?

2012-02-23T07:50:00.000-08:00

With a whole 12 blog posts to my name, I thought I'd take a look at what words I've used the most...

Mostly as expected ('NHS', 'Health', 'data', and 'facts'), but some surprises in there ('just', 'time', 'people', and 'now').

Chris

Who's afraid of the big, bad risk register?

2012-02-23T04:14:00.000-08:00

I'm getting towards the age now where I can start saying that things have changed since my day. Well, let me tell you, risk registers have most definitely changed since my day. In fact, they've changed since last week as far as I can see. And their transformation has been rapid, profound, and unexpected.

A risk register used to be a run of the mill project management tool. You'd identify the risks to your project, describe them, and then assign attributes to the risk - for instance, how likely is it to occur? What would be the impact if it did occur? Who's going to take ownership of the risk? What mitigating actions is the risk owner (and others) going to take to (ideally) eliminate the risk, or reduce its likelihood and/or impact?

Sensible type stuff, right? Nothing too scary. Of course in practice the quality of a risk register can vary significantly. Some of that variance is down to what sort of project it is and what sort of project manager is in charge of it. Some of it is just down to human nature - countless projects will kick off with the best intentions, initiate the full range of approved project management tools, review the risk register once and then rarely, if ever, look at it or update it again (they'll also often be poorly formatted without the requisite level of Microsoft Excel love and pastel shading, but that might say more about me than about risk registers...).

Now that's what I understand a risk register to be. Imagine my escalating surprise over the last few days as it has morphed into a necromantical nightmare, which cannot be released for fear of melting the feeble brains of us poor plebs.

Bit of background and context - on Monday 30 January 2012 early day motion 2659 was tabled in Parliament. The motion stated:

That this House expects the Government to respect the ruling by the Information Commissioner and to publish the risk register associated with the Health and Social Care Bill reforms in advance of Report Stage in the House of Lords in order to ensure that it informs that debate.

In November 2011, the Information Commissioner had ruled that "the public interest in maintaining the exemption (the exemption being 'formulation of government policy') does not outweigh the public interest in disclosure". The Commissioner therefore required that the Department of Health release the risk register that related to the Health and Social Care Bill.

The original request made for the release of the risk register was in November 2010 - the wheels, they do turn slowly!

The subsequent debate following the early day motion happened yesterday, Wednesday 22 February 2012. In my humble opinion, and with all due respect to the honourable members, none of the major parties covered themselves in glory during this debate.

We have this gem from Julian Smith MP - "Why is the right hon. Gentleman (Andy Burnham MP) such a scaremongering buffoon?"

The Deputy Speaker even felt compelled to interject - "this is easily and by some margin the worst-tempered debate that I have chaired".

The transcript of the debate is very long, but do pick out your own highlights if you get the chance. For me, it basically boiled down to quite a lot of going off the topic of the debate, so that opposing sides could make their points about why the Health and Social Care Bill is a good or a bad thing. And also quite a lot of Labour accusing the Government of hiding something that should be released, and the Government accusing Labour of hypocrisy.

Here's Andrew Lansley MP - "Frankly this is a broken bat debate...because the shadow Secretary of State (Andy Burnham MP) is trying to suggest that this Government should do something that he as a Minister and then as Secretary of State steadfastly refused to do".

Frankly Andrew, I don't care. It's totally irrelevant what previous governments have or haven't done. The fact is that the request for a specific risk register has been made now, and the request has been upheld and endorsed by the Information Commissioner. And besides, why not take this opportunity to be better than previous governments? You remember, the whole most open and transparent government in history thing.

Chris Skidmore MP threatened to inject some much needed sanity into proceedings - "Members have talked today about the risk register in apocalyptic terms, as though it were a document that should remain within the confines of MI5 or MI6". Sadly he then went on to say - "The risk register that would be released is that from the time of the White Paper, before the changes were made and before the listening exercise... If the document was released, it would be out of date, inaccurate and would scaremonger among the population".

In a superb heads I win, tails you lose manoeuvre, Mr Skidmore concluded - "The Government do not have to publish the updated registers on the basis of the Information Commissioner's verdict, which was on the autumn 2010 register... The Opposition are asking for an out-of-date document. We might as well give up and go home".

Oh would you? Please. Politicians giving up and going home... what's the worse that could happen? Maybe I should start a risk register...

So Mr Skidmore, who seemed visibly delighted with his reasoning, is simultaneously saying that the risk register isn't scary but its release would scaremonger the population, and that the Government shouldn't release an out of date risk register, but won't release the most recent version. Got that? Good.

Mr Skidmore, on fire by this point, had more to offer - "We are debating whether we should release a register that is no longer relevant and that was written in autumn 2010, at the time of the request on 29 November. The topic is completely irrelevant, as the debate has moved on. We have wasted six hours of parliamentary time today discussing an out-of-date risk register".

Chris (good name, by the way) - I've got a really good idea. Why not just release the risk register and not waste any more time? Oh, and just to point out, it's taken this long from the original request because the Department of Health and the Government have fought its release every step of the way.

Ok, that's more than enough from the debate itself. As I say, the transcript goes on and on and on, so feel free to read it for yourselves.

The final quotes in this post must go to Simon Burns MP (or #SimonBurns4SOS to give him his full title - follow Andy Cowper on Twitter, @HPIAndyCowper, for more). Here's a blog by Mr Burns posted just before yesterday's debate began.

Mr Burns says that risk registers are where civil servants "contemplate the most extreme circumstances of any major government project. They think the unthinkable to ensure that the unthinkable never happens... The consequence of this is a paper trail which details some of the most outlandish and extreme possibilities that civil servants have contemplated".

I'm sorry, what? No seriously, what? That's not a description of a risk register, that's a description of a think the unthinkable register - which incidentally doesn't exist as a thing, and is a trite contradiction anyway. Or it could be a description of an outlandish and extreme register - which again doesn't exist as a thing, and would be somewhat pointless to introduce as a new project management tool.

This is pure fantasy. It's trying to persuade us that senior civil servants sat down and detailed the most extreme and unlikely things possible to do with the Health and Social Care Bill. Right, so guys, risk number one... anyone? Here's one, aliens come down and snatch Andrew Lansley's body... ok, good, now we're cooking with gas... but hang on, is that a risk or an opportunity? Hmmm, good point. Ok, well there's that Mayan prophecy about the year 2012. Oh yeah! And there's that film that backs it up. Stick it down!

Civil servants haven't thought the unthinkable on the risk register (just to note once again, that is a truly rubbish, oxymoronic phrase). Nor have they detailed the most outlandish and extreme things possible. All they've done is document what they see as the risks associated with the Health and Social Bill. Nothing more, nothing less.

Now, to end, here's a quick Q&A:

Q: Will releasing the autumn 2010 risk register associated with the Health and Social Care Bill scare the general population?

A: No, although it would be good if the media didn't try to sensationalise anything that was within it. Risk registers are what they say on the tin - they register risks that might occur, and it is a positive and responsible thing to try to document those risks.

Q. Would releasing the autumn 2010 risk register associated with the Health and Social Care Bill now be pointless?

A. No. Things may have moved on, but it should provide an accurate picture of what were the perceived risks at that time. Again, we might need the media to be responsible and recognise that.

Q. Should the Government release the autumn 2010 risk register associated with the Health and Social Care Bill?

A. Yes. They have been instructed to do so by the Information Commissioner. If they wish to also release an up-to-date register to show how things have changed and moved on, no-one is going to stop them.

Q. Should politicians pack up and all go home?

A. ...

You see, it's quite a bit about trust and faith for me. My trust and faith on things to do with the Health and Social Care Bill has long since been used up (mmmm, brains). So the Government might think that they're being smart fighting tooth and nail not to release the risk register, but actually, all it makes me think is wow, its contents must be really, really bad or it must be a really, really shoddy piece of work (or both) for them to kick up such a fuss.

Now you tell me, does that help nurture an informed and productive debate about the major changes to the NHS that are on the horizon?

Chris

P.S. I've stayed pretty focused throughout this post for a change, so here's the wandering off that you've been waiting for... and it is worth waiting for.

Here's Gareth Johnson MP during yesterday's debate - "The BMA (British Medical Association) opposed the very creation of the national health service, so we should take no lessons from such organisations".

Nice one, Gazza. Do you happen to remember who else opposed the creation of the NHS? Yes, that's right. The Conservative Party. We should take no lessons from such an organisation.

P.P.S. I can't believe I forgot to say what the outcome of yesterday's vote was! 246 MPs voted in favour of releasing the risk register, but 299 voted against. So by a majority of 53, the risk register stays safely under lock and key, and every day life can continue. You can rest easy... for now at least.

How do you kill a zombie statistic?

2012-02-21T08:18:00.000-08:00

Zombies, eh. They're all the rage. But there does at least seem to be pretty widespread consensus on how to kill them. Don't aim for the heart, you fool! As anyone who has played first person shooters knows, it's all about head shots.

Sadly, zombie statistics also seem to be all the rage. And I have absolutely no idea how to go about killing them. Oh, and if anyone thinks that zombie statistics aren't dangerous, think again! They'll eat your brain if you let them. And often, you won't even realise that they're doing it.

It's either a testament to my tedium or their resilience that I am going to write a fourth (count them - one, two, three and now number four!) blog post that includes the line "5,000 lives a year from cancer".

To borrow the terminology of the day, courtesy of The Walking Dead (you know, the one with the man-child Egg from This Life playing the husband of the wooden Dr Sara Tancredi from Prison Break), the cancer deaths 'walker' is still very much with us.

But first, a bit of wider context. Just this morning, BBC news tweeted the below:

BBC Radio 5 live poll suggests 80% of people in England don't think government's done enough to explain NHS changes http://bbc.in/xMspjN

First of all, I'm delighted to see the word 'changes' being used, rather than the usual 'reforms' or 'overhaul'. Orwellian language, innit. You reform or overhaul something because it's either plain bad or you're patently making it better. We are years away from knowing whether these changes will make anything better (and that's if we will ever know... don't laugh, it certainly wouldn't be the first time that the NHS train set had been played with by the Fat Controller of the day without any way of knowing whether it made things better or worse). For now they are just changes. Secondly, four out of five people - wow, that's a lot. The Government seem to be in a bit of a pickle, but is it fair to say that the Government hasn't done enough explaining?

Well, let's see. Yesterday we had the rapidly convened 'summit' meeting of... er, well, anyone who hasn't rocked the boat thus far really. Here is a relevant, ahem, infographic / data visualisation. And just to be crystal clear, this is definitely not what happened during the hour long meeting at Number 10. However, this did happen to the Secretary of State for Health on his way to the meeting.

So not such a good start to the week... ah well, can't win 'em all. And looky over here! What do people want? An explanation of the Health and Social Care Bill. Well, well, well, all ye doubters, look what the Department of Health bestowed upon us just last Friday - Health and Social Care Bill explained. You see, they are listening!

Not only are they listening, they've also produced fact sheets to help explain. Sheets... full of facts! Facts are good. Facts will reassure us. We love facts! Go to work on a fact. Get on your fact. We want facts, and we won't wait. In facts we trust. Keep facts and carry on.

Any Bill that requires 19 separate fact sheets has to probably have some sort of question mark hanging over it, but let's gloss over that for the moment.

Bring on the lovely facts on those lovely sheets!

First up - Factsheet 1. Nice one, just the one page. Maybe I am being unfair having a little moan about there being 19 of them. Short and no doubt sweet. Well, short anyway. On this first sheet of facts, there are in fact only two discernible 'facts' (quotes required, trust me).

The first 'fact' is that the cost of medicines is growing by over £600m per year (for information, over here are 10 facts on the cost of medicines, giving some very interesting comparisons and context). To date, and despite the lack of a primary source to check the figure against, I've just kind of accepted it when I've heard it in a kinda yeah, sounds about right, bound to be getting more expensive, grrr big pharma type way. But actually, I have no idea if it is right. SOURCE PLEASE! And I don't mean ketchup (although I do love ketchup). And this seems to cast a bit of doubt on it straight away. So is it the 'cost of medicines' or the 'cost of advances in treatments and medicines' that is growing by 'over £600m per year' or 'around £600m... every year'? COUGH UP THE SOURCE AND WE'LL CHECK IT!

The second 'fact' is our infamous walker. Somebody please aim for the head and take it down once and for all. Here are the immortal words: 'If we had cancer survival rates at the average in in Europe, we would save 5,000 lives a year'. I really don't need to say any more. This post is littered with links thoroughly debunking that claim. And the debunking started about a year ago!! And the problem now is that, faced with a Government that is happy to keep peddling a 'fact' that was outed as dodgy as Free Piece Sweet, I simply don't trust the other 'facts' that are being used in relation to the Health and Social Care Bill. Unfair? I don't think so. They've been Goldacre'd. They must know they've been Goldacre'd. And yet, they keep peddling and carry on. What they should do is apologise, of course. But that's about as unlikely as a politician answering a straight question with a yes or no answer. Failing an apology, they should at the very least stop peddling it. But they haven't. They have therefore lost my trust, and I am now skeptical of their other 'facts'.

Sooo, to sum up Factsheet 1. Until a source is supplied regarding the year on year increase in the cost of medicines, it does not contain any actual facts. That is a pretty special achievement for a fact sheet. Take a bow, Factsheet 1.

Skimming through what I have written so far, I realise that if I go through all 19 fact sheets, this post is going to get longer than either I want to write or you want to read. So let's stop at two.

Second up, and finally (for the time being at least) - Factsheet 2. This is entitled 'The case for change', so big, important stuff must be on it. It's another one pager - absolutely nothing wrong with brevity (note to self). And it opens up with a quote from Paul Corrigan.

Read it for yourself and make your own mind up, but to me it's a bit of an odd, obscure quote to choose. Don't get me wrong, Paul's often very quotable, and I often quote him, but it's just that this particular quote isn't the kind of punchy, hit you between the eyes, this is why we need this Health and Social Care Bill in a nutshell quote that you'd think the Government would be looking for. And don't forget, they could have chosen any quote from anyone over the last year and a half. Paul also happens to write a very interesting, very good, very regular (note to self) blog. I would strongly encourage you to read some of his posts, because he isn't always... how can I put this... hmmmm, the case for change for this particular Health and Social Care Bill personified. Paul is now aware that he has been quoted on the second sheet of facts, and will be responding on his blog tomorrow (Wednesday 22 February). I have absolutely no inkling what he might say (he might be both delighted and flattered), but I shall certainly be reading his response!

So on to the 'facts' on Factsheet 2. Well, we've got the cost of medicines. Again. Let's move on. Actually, hold on, more doubt cast! Factsheet 2 doesn't even agree with Factsheet 1. Engage pedantry, level 3.

'The cost of medicines is growing by over £600m per year' - Factsheet 1

'The cost of medicines has been growing on average by nearly £600 million a year' - Factsheet 2

Small beer? Yeah, probably. But I'm not filled with confidence in a suite of fact sheets that aren't even consistent between themselves.

The next 'fact' we have is another one that I've never thought to query before now. On the same basis again, that it sounds plausible, but I'm in full on skeptic mode now. Obesity costs the NHS £4bn per year, and will cost £6.3bn per year within the next four years. SOURCE PLEASE! Seriously, it is so, so, so, so easy to include the source. Just a little superscript number, and a list at the bottom of the page. Here's an article about obesity, which talks about £1.9-£2bn per year medical costs being added by 2030, and £5.5bn being added by 2050. But certainly no reference to £2.3bn being added by 2015/16. Here's the Department of Health quoting the £4.2bn per year figure, but again, no mention of it being £6.3bn within four years. Also, please do note the Department describing the £4.2bn figure as an estimate! COUGH UP THE SOURCE AND WE'LL CHECK IT!

The final 'fact' I'll look at is from a 2011 Royal College of Surgeons report. Of course, Factsheet 2 doesn't include a link to the source, but I will. It's here. It's a very interesting report with some very practical recommendations, but seriously, I can find no concrete reference for the 'thousands of lives could be saved if patients had better access to facilities such as x-rays, scanners and operating rooms, and better post-operative care'. If I've missed it, apologies. And I would be delighted if someone could enlighten me. But I want a specific reference to thousands of lives being saved, remember.

Right, so as per usual, this post is both longer and less focused than it should be. The title suggests that it should be just about the cancer deaths myth being wielded out again (somewhat deliciously, our PM just yesterday said it's time to do some myth busting - lock and load, C-man. Aim for the head! Take that walker down), but I've wandered off, around and all over the shop.

My excuse - there's a lot going on with the Health and Social Care Bill right now. And a lot of what's going on ain't good. All I ask as a starting point is to play fair and straight with facts and figures. Some NHS statistics are very complex and can be employed by both sides in an argument - waiting lists are a classic example. See here. But making up 'facts' to justify huge changes to the NHS is just not on.

I would end by saying, now where's my double barrelled shotgun, but that might get me into Robin Hood airport type trouble.

Chris

Consequences... or lack there of

2011-11-11T00:36:00.001-08:00

So Nadine Dorries thinks that Tom Watson "let himself down" (58mins 12secs) and "jumped the shark" (58mins 22secs) by calling James Murdoch a "mafia boss".

I wonder what she thinks about herself saying that "you let 2.2 million in" (26mins 20secs) to Rachel Reeves, shadow Chief Secretary to the Treasury, last night (Thursday 10 November, 2011) on Question Time.

This is an outrageous, wildly inaccurate claim. Googling "2.2 million immigration UK" returns a whole range of sources scotching it. 2.2 million was actually the net migration over the 12 years of the previous Labour government. It has absolutely nothing to do with a breach in security, or people entering the country without the authority's knowledge, or without having the right to do so (the context in which her comment was made).

Some relevant snippets from the Google search below:

"But under Labour, net migration to Britain was close to 200,000 per year, for most years since 2000. As a result, over Labour’s time in office net migration totalled more than 2.2 million people – more than double the population of Birmingham"

"The prime minister will open his speech, in Hampshire, by saying that immigration is a hugely emotive subject that must be handled with sensitivity. But he will then say that Labour presided over the "largest influx" of immigration in British history, which saw 2.2 million more people settling in Britain between 1997 and 2009 than leaving to live abroad".

"Between 1997 and 2009, 2.2 million more people came to live in Britain than those who left to live abroad, Mr Cameron will say"

My mum has a number of sayings that she's fond of - one of which is "No horse play on the stairs", but that's not really relevant here. Another is "There'll be consequences" - she's particularly keen on this one when dealing with naughty grandchildren.

I guess what I'm increasingly wondering is what are the consequences for MPs making false claims?

No, not false expense claims - we all know that can now carry consequences. I mean false claims like the one last night. Or these about the NHS. And also, on the same type topic, what are the consequences of refusing to answer straightforward questions, as highlighted by this sorry episode?

Are there any consequences? And if not, why on earth not?!?

Chris

P.S. I guess if I'm being strictly fair, Dorries could claim she didn't say that Labour explicitly let in 2.2 million illegal immigrants. But look at the context in which she said it, and decide for yourself. Also, the fact it went unchallenged at the time is massively damaging, as chances are, no-one cares enough to correct / clarify it, so now it's just out there... festering.

P.P.S. Oh, and don't get me started about the "statistics" (24mins 40secs; 25mins 30secs) that Dorries gave... I await full publication and open scrutiny of them! And Michael Moore MP seemed to say that the pilot was still being "evaluated" (29mins 38secs)...

Don't have a cow, man

2011-11-09T14:02:00.000-08:00

Above is a particularly rubbish attempt to link in to a post about Barts and The London NHS Trust. And here's a totally unfair, knee-jerk generalisation for you... what is it with journalists? I'm not on a crusade and I haven't got an axe to grind, but I keep finding myself in conflict with them.

And my crime? Well, reading what they write... and, um, querying what looks odd or surprising to me... and, well, that's about it really. Naively, I would think that's exactly what they'd want. When I'm a sports journalist (and surely it can only be a matter of time before a major newspaper comes knocking at my door, begging me to watch every Everton, Bath and Essex game on their time and money), I would want the self-affirmation provided by knowing that someone reads what I write, and engages with the topics that I write about. But hey, as I say, what do I know?

I've got two sagas rumbling on at the moment. The first is looking like being interminable (the Independent have now amended the offending article, but they've made it worse and more inaccurate than the original, which is pretty special of them). And the second is the topic of this blog posting. Here goes...

On the 26th of August 2011, this article was published by The Guardian - "One in 13 A&E patients return within a week - despite being seen". Now, various things about this article irritated me - for example, it muddies the picture between different data sources without any acknowledgement or proper explanation, and it presents one of those data sources, which is clearly published as provisional and experimental, as if it is robust and established. Beyond all that, there was an absolutely huge clanger in it.

It's not entirely dissimilar to the BBC clanger about A&E waiting times, with The Guardian article reporting that:

"Barts and London NHS Trust saw 95% of people waiting more than eight hours in A&E"

Now, because I know that the vast majority of people attending A&E nationally wait less than four hours, this claim leapt out at me. So in the interest of accuracy, I queried it:

Do0g1e Chris Mason

Barts & London - 95% of people waiting longer than 8 hours in A&E?!? Er, >95% spent <4 hours.

27 Aug Favorite Reply Delete

And obviously Twitter isn't always the best medium to get your point across, so I simplified my point as well (I also employed the patented Ben Goldacre tactic of being polite and humble... partly to be nice, and partly because it may well be that I've made the stuff up!):

Do0g1e Chris Mason

I could be wrong, but Barts and London para looks way off beam, and I make it 165,252 waiting >4 hours, not 165,279 gu.com/p/3xfyk/tw

27 Aug Favorite Reply Delete

Oh, and because I'm an annoying pedant, I couldn't resist one more:

Do0g1e Chris Mason

Final point, promise. No mention in the article of the A&E data being experimental and provisional.

27 Aug Favorite Reply Delete

Now, I was going to give you a blow by blow, tweet by tweet account of what happened over the next few days and weeks, but ultimately it gets very dull and repetitive. And at least a little bit odd. What I will do is give you a brief summary.

It took one day for the major mistake in the article to be pointed out, but it took over a month for it to be corrected... I say corrected, it would be more accurate to say made a lot less wrong.

During those five weeks, I was repeatedly told that I was wrong and the article was right, that I should take it up with the Department of Health, and that I should declare my interests! I in turn repeatedly explained the massive difference between '95%' and the '95th percentile', and why it's important to recognise data quality caveats.

When numerous tweets failed to get the message across, I also spent the time to write two long emails explaining absolutely everything. The email exchange is below (skim read or skip past it, see if I care! It's fascinating, honest... ahem):

Good afternoon

This should hopefully be easier, freed from the 140 character tyranny.

As you know, DH published new provisional A&E indicators on 26 August, 2011:

http://www.dh.gov.uk/health/2011/08/accident-and-emergency-provisional-quality-indicators/

They've been open and honest about the provisional and experimental nature of the data:

These A&E HES data are published as experimental statistics to note the shortfalls in the quality and coverage of records submitted via the A&E commissioning data set. The data used in these reports are sourced from Provisional A&E HES data, and as such these data may differ to information extracted directly from Secondary Uses Service (SUS) data, or data extracted directly from local patient administration systems.

Provisional HES data may be revised throughout the year (for example, activity data for April 2011 may differ depending on whether they are extracted in August 2011, or later in the year). Indicator data published for earlier months have not been revised using updated HES data extracted in subsequent months.

The excel workbook is here, with the IC repeating the caveats:

http://www.ic.nhs.uk/statistics-and-data-collections/hospital-care/accident-and-emergency-hospital-episode-statistics-hes/provisional-accident-and-emergency-quality-indicators-for-england-experimental-statistics-by-provider-for-april-2011

These A&E HES data are published as experimental statistics to note the shortfalls in the quality and coverage of records submitted via the A&E commissioning data set. The data used in these reports are sourced from Provisional A&E HES data, and as such these data may differ to information extracted directly from Secondary Uses Service (SUS) data, or data extracted directly from local patient administration systems

One of the key facts listed is:

Several organizations reported data that did not meet the data quality checks required by the A&E indicators. The 95th percentile and longest single wait information are particularly sensitive to poor data quality, outliers and data definitional issues, which contributes to why some unusually high values may be observed for these measures

On to the data itself, and Barts in particular.

Barts - row 22.
Time to departure - columns AT to BA.

Because the data is provisional and experimental, DH and the IC have gone heavy on data quality measures, which is a good thing. They want to drive up the quality before deeming the new data set to be properly robust. They've also included helpful footnotes, one of which states:

"The 95th percentile is particularly sensitive to poor data quality and definitional issues, which is why some unusually high values may be observed"

Sorry to bang on about the data quality caveats, but it is important. Your article makes it sound like it is an established data source, which it really isn't - and one of your twitter responses mentions data revisions, which are standard. But the caveats published along with the new A&E data aren't standard.

Of all the trusts listed, Barts has by far the highest proportion of departure times recorded at exactly midnight - 5.1%, compared to a national average of just 0.2%. That means they've almost certainly got a data quality problem.

Their median waiting time is 129 minutes (roughly 2 hours), shorter than the national average of 131 minutes (roughly 2 hours).

Their 95th percentile wait is 521 minutes (roughly 9 hours), much longer than the national average of 258 minutes (roughly 4 hours).

So we know that there's a data quality problem with 5% of Barts' data, and therefore it most likely follows that there will be a data quality problem with looking at Barts' 95th percentile performance.

Also, if Barts had seen 100 patients in A&E (just to keep it simple - they actually saw 11,541), and we listed them all out in order of shortest to longest wait, then the indicators are saying that:

The middle (median) person waited 129 minutes (roughly 2 hours) - in reality, Barts' middle person was actually person 5,771
The 95th (95th percentile) person waited 521 minutes (roughly 9 hours) - in reality, Barts' 95th percentile person was actually person 10,964

That's very, very different to:

http://www.guardian.co.uk/politics/2011/aug/26/patients-returning-emergency-departments

Barts and London NHS Trust saw 95% of people waiting more than eight hours in A&E.

Even if we ignore the data quality concerns (which we shouldn't), all that could actually be said is "Barts and The London NHS Trust saw 5% of people waiting more than eight hours in A&E". We really shouldn't say even that though, as we know that 5% of Barts' data looks dodgy (5.1% of records set to a departure time of exactly midnight, 00:00 - I'm willing to wager a decent sum that that's not a departure time, it's a default setting).

Given that Barts' median (middle) waiting time is better than the national average, they really shouldn't be singled out. And it would be good if the provisional and experimental nature of the data was mentioned in your article.

Hope the above is a better, more comprehensive explanation than my poor twitter based attempts.

Cheers

Chris

Thanks for this Chris

Sorry have been busy with another set of things here.

I completely see your point. The 95 percentile is actually the data measure used by DoH so apologies for not taking the time to comb through the data. DoH pointed out that Barts was the first trust on that list not to have the 24-hour error that systematically wrecks the data. That being said it must contain a fair few of these as the average time to departure is so high. So really the story is

Dodgy data set used by DoH shows Barts top 5% longest wait was 9hours.

I will correct when next back in the office. (Tuesday i think). Why do you thnk they did not use median figure?

Thanks

Surprised that DH highlighted Barts - they should really understand the data.

Mean, median, mode, quartiles, percentiles... horses for courses, to be honest.

I personally think that you get the most value and accuracy when you report multiple measures in conjunction.

A&E is high volume, so I'd go mean (the average gives you your headline, instantly understandable figure), and then I'd keep an eye on the median, 25th and 75th percentiles (to give you an understanding of the distribution). And I'd throw in the 95th percentile if (!) I was confident that there weren't data quality issues that undermined the measure. The 95th percentile gives you a good idea about the 'tail' of your distribution.

To be honest, as the data set is provisional, experimental and in its infancy, I'd go heavy on the data quality measures and working with the trusts to understand any oddities.

Barts being a case in point!

Thanks again for taking the time to go through it all. Good to get a correction.

Cheers

Chris

So what, I don't hear you ask, was the end result of my patient, comprehensive explanation of why Barts had been unfairly and erroneously singled out? On the 30th of September 2011, one line of the article was amended to read:

"Barts and London NHS Trust saw 5% of people waiting more than eight hours in A&E"

What a load of wasted effort on my part. And how arrogant to deny, deny, fob off, fob off, deflect, deflect, and ultimately only partially correct the original major mistake after a ridiculous length of time. And not take on board any of the other points.

Am I asking too much? Do I expect too much? Am I being incredibly petty? Maybe... maybe not.

Goodnight journalism, wherever you are.

Chris

P.S. You may have guessed by the name of the post and its content that I've struggled to give it a coherent structure. I've also wrestled with whether to post it at all (hence the time elapsed), as there's obviously a clear argument that a journalist taking the time to reply is better than one that just ignores you completely. I absolutely concede that, but ultimately I guess my point is that in my admittedly very limited experience there seems to be a real resistance from journalists to being questioned. Read my stuff - great. Agree with me - fantastic. Question me - what, what?!? Who are you? Don't you know who I am? Go away. I'm very busy etc. That's a real shame. Helping correct articles is surely a good thing, and the number one concern should always be the wronged party - in this case the hard working staff at Barts and The London's A&E department. Particularly as they are so open and transparent about how they are performing... if you don't believe me, look here!

P.P.S. It would also be wrong of me not to mention the good - George Monbiot, in my humble opinion, is an absolute star. Engaging, provocative, and above all - well researched, and approachable. Look at the glorious selection of heavily referenced articles on his website:

http://www.monbiot.com/

Nothing special, you might think. But compared to others, it is a revelation. And he goes further... a lot further. A comprehensive biography, as well as helpful career advice, AND a full registry of interests:

http://www.monbiot.com/about/

http://www.monbiot.com/career-advice/

http://www.monbiot.com/registry-of-interests/

Once, twice, three times a headline

2011-08-18T06:02:00.000-07:00

Hello, is it an accurate headline you're looking for?

On the afternoon of Friday 12 August, the BBC tweeted the below:

BBCNews BBC News

A&E waiting times nearly double http://bbc.in/qaBGhr

12 Aug

I could pretend that it made me think, wow - that's shocking news! But because it is just way, way, way too far fetched to be remotely believable, it immediately made me think, oh dear, somebody's made a major gaffe.

The previous day (Thursday 11 August), the Department of Health had released the latest A&E performance data, covering Quarter 1 of the 2011/12 financial year (1 April 2011 to 30 June 2011).

The previous Government's target was for a four-hour maximum wait in A&E from arrival to admission, transfer or discharge. In practice, this used to be measured by using a 98% threshold - in other words, an NHS trust was deemed to have achieved the target if 98% or more of people attending A&E waited less than four hours.

With the change in Government, the 'target' remained. Ish. 'Target' is now a dirty word and a big no,no - it smacks of the previous regime. So the 'target' became a 'standard', and the threshold for achievement was relaxed from 98% to 95% in June 2010.

Now that we're in 2011, and a whole new financial year - the first full financial year since the change in Government - we have the Department of Health further distancing themselves from the culture of targets.... by.... well...... by using much more creative language.

We don't have targets any more.

We don't even have standards.

What we have is IPMfNOs.

Ok, so I made up the acronym, but I can only dream of coming up with the satirical masterpiece that is.... ready for it.

Integrated performance measures for national oversight.

So targets then? No, no, no - integrated performance measures for national oversight.

Standards? Nope, you're not listening. Pay attention at the back - integrated performance measures for national oversight.

Riiiiight. You say integrated performance measure for national oversight. I say target. And I'll be in Scotland afore ye.

The reason why the BBC's tweet is too far fetched to be remotely believable is that 3.6 million people attended major A&E units between April and June 2011. For the time that they had to wait to almost double would be a mind-blowingly catastrophic deterioration in service.

What the latest figures from the Department of Health actually show is that 95.5% of the 3.6 million people attending major A&E units between 1 April 2011 and 30 June 2011 waited less than four hours.

During the same period last year (1 April 2010 to 30 June 2010), 97.7% of the 3.6 million people attending major A&E units waited less than four hours.

A deterioration in performance? Yes.

A doubling in waiting times? NO.

In Quarter 1 last year, 84,439 people waited longer than four hours. In Quarter 1 this year, 161,422 people waited longer than four hours.

Ahhhh! So that's the almost doubling that the shockingly inaccurate headline is trying to address! We've got almost twice as many people waiting more than four hours this year than last year.

Interestingly, the current official figures (much more detailed data is now available, but it's very much still in its experimental infancy) don't capture how long individual people actually wait - they only look at the four hour barrier, and report those waiting less than four hours and those waiting more than four hours. So actually the 161,422 people waiting more than four hours this year might (incredibly unlikely, but might) all have only waited four and a half hours, while the 84,439 people waiting more than four hours last year might (again, incredibly unlikely, but might) have waited seven hours.

Unrealistic example, granted. But the point is that we just don't know. All we know is the volume under four hours and the volume over four hours.

I replied to the BBC after their tweet:

Do0g1e Chris Mason

Seriously BBC that is a shockingly inaccurate headline @bengoldacre @undunc RT @BBCNews A&E waiting times nearly double bbc.in/qaBGhr

12 Aug

They didn't acknowledge me, but the power of the Goldacre is great, particularly when he re-tweets you:

bengoldacre ben goldacre

yup -> RT @Do0g1e: shockingly inaccurate headline RT @BBCNews A&E waiting times nearly double http://bbc.in/qaBGhr

12 Aug

A dozen or so re-tweets later, the BBC seemed to get the message (although still no acknowledgement... and they still haven't deleted their original tweet).

Their story headline went from the diabolical:

To the rubbish and cryptic:

To the still misleading and far too generic:

And that's what's currently up there.

Three swings, three strikes.

And I used to take note of the 'Last updated' tag, believing it to be a trustworthy way of knowing whether and when stories had been amended. The fact that all three versions of the story purport to be 'Last updated at 15:11' is clearly misleading nonsense.

All in all, a pretty poor show, and a totally unfounded and easily avoidable slur on the performance of the NHS.

Always dangerous to to be sanctimonious, but you'd have to think that a 10 second reality check would have prevented the original error. You don't need to be a health expert. You just need to think for a second and say, "So does this mean that people are waiting twice as long as they used to?".

If the answer is a resounding no, then tailor your headline appropriately. And if you revise it (repeatedly), try to remember to mention A&E, and the crucial four hour barrier.

It, you know, helps.

Chris

Are politicians even capable of answering "yes" or "no"?

2011-07-20T13:15:00.000-07:00

You see, this, THIS is why I despair of politics and politicians. I’ve already made my opinions clear about the current state of politics in a previous post, but this is really the nub of the problem.

Today (Wednesday 20 July), our Prime Minister was asked two very basic questions during a lengthy session in Parliament.

Below is the sorry saga of the pathetic… hmmm, I would call it cut and thrust, but that makes it sound clever and entertaining… how about, pathetic politic speak that ensued.

Ding ding, round one. In the red corner, CUBE DX-9. Initiate question…

Edward Miliband: Let me start with BSkyB. The Prime Minister said in his statement something that he has said on a number of occasions, which is that he was excluded from the “formal” decision-making process. With respect, that does not quite answer the questions that he has been asked. Last Friday, he revealed that since taking office he had met representatives of News International or News Corp, including Rebekah Brooks and James Murdoch, on 26 separate occasions, so the first question that I have for him is whether he can assure the House that the BSkyB bid was not raised in any of those meetings or in phone calls with those organisations, and whether he can also say whether at any time he discussed the bid with the Culture Secretary or, indeed, with any of the Culture Secretary’s officials.

Got that, Dave? Red Ed is asking whether the BSkyB bid was raised in any of your interactions with News International or News Corp. It’s more or less a yes-no type question.

Cue, Dave…

The Prime Minister: I say to the right hon. Gentleman: stop hunting for feeble conspiracy theories and start rising to events… He asked about BSkyB. The Cabinet Secretary has said that there was no breach of the ministerial code. We heard the evidence of Rebekah Wade yesterday, saying that there was not one single inappropriate conversation.

Ok, ok, bit of a mis-fire there. But fear not, plenty of time to get it right. Here comes Ben Bradshaw, and he’s simplified the question, and made it very much a yes-no affair…

Mr Ben Bradshaw (Exeter) (Lab): In the Prime Minister’s conversations with the Murdochs, with Mrs Brooks and other News Corp people, was there ever any mention of the BSkyB bid?

Go, Dave…

The Prime Minister: As Rebekah Brooks said yesterday in Parliament, there was never a conversation that could not have been held, in front of the Select Committee

Errrr, right… ok.

Undeterred, let's plough on. Ding, ding - round three… here comes straight talking Den, the beast of Bolsover…

Mr Dennis Skinner (Bolsover) (Lab): In the course of the past few minutes the Prime Minister has been asked a simple question twice and refused to answer it: as Prime Minister, did he ever discuss the question of the BSkyB bid with News International at all the meetings they attended?

Right on. It’s all true. The question is simple. It has been asked twice in the past few minutes. And it hasn’t been answered.

Come on, Dave. You can do it…

The Prime Minister: I never had one inappropriate conversation, and let me be clear: I completely took myself out of any decision making about this bid. I had no role in it and I had no role in when the announcements were going to be made. That is the point.

Mr Speaker: Order. The House again needs to calm down. The question was properly heard and the Prime Minister’s answer must be properly heard.

The Prime Minister: I have answered the question and the point I would make is that unlike the party that the hon. Gentleman has been supporting for the last God knows how many years, this party has set out all its contacts, all its meetings and everything it did—in stark contrast to the Labour party.

What? Seriously, W H A T ? ! ? No, that is not the point. And no, you haven’t answered the question, and you’ve been asked it three times now. And each time, the question has been made more and more basic, and more or more obvious that it expects, nay deserves, a yes or no answer. Instead, it gets swerved again, followed by an irrelevant dig.

Ooooh, hang on, this could be promising. Maybe it’s an accepted way of dealing with pesky Labour questions. Here comes a coalition partner! And he’s interested in the same question… (this will be the fourth time it has been asked, lest we forget)

Mr Mike Hancock (Portsmouth South) (LD): Putting aside what is appropriate and what is inappropriate, will the Prime Minister just say whether or not, in the conversations that he had, the question of the BSkyB takeover was mentioned?

Excellent. We've entered the great plains of nose and face on a clear day, people. Mike correctly recognises the appropriate-inappropriate distinction as immaterial, and eloquently requests a yes-no answer.

Come on, Dave. For the love of democracy, let’s have an answer…

The Prime Minister: The point I am trying to make is this. I had no responsibility for the BSkyB takeover. I specifically asked to be taken out of any of the decision making and any of the information because I did not want to put myself in any sort of compromising position. I was very clear about that. So much so that I did not even know when many of the key announcements were being made. That is why Rebekah Brooks was quite able to say, at the House of Commons yesterday, that there was not a single conversation that could not have taken place in front of the Select Committee. I know that many people were hoping for some great allegation yesterday that could add to their fevered conspiracy theories. I am just disappointed for them that they did not get one.

I couldn’t care less what point you’re trying to make. You can make that point whenever you like. What I want right now is for you to answer a really simple question, as this is getting very tedious and starting to make a mockery of politicians and politics in general. Why oh why can’t you provide an answer? And what fevered conspiracy theories? Do you mean the great conspiracy theorists Nike Davies and Tom Watson, who have done so much to get to the bottom of the whole stinking cesspit that is the hacking scandal? Actually, I don’t care what you mean. Just answer the freaking question.

Where four different MPs have failed, can Chuka succeed…? (sadly, this is most likely a futile attempt on my part to build tension – you already know what’s going to happen)

Mr Chuka Umunna (Streatham) (Lab): May I return to the responses the Prime Minister gave to my hon. Friend the Member for Bolsover (Mr Skinner) and to the hon. Member for Portsmouth South (Mr Hancock)? He said that he had had no inappropriate discussions with News International executives regarding the BSkyB bid. Which discussions did he have with the said executives that he deemed were appropriate, who were the executives and what were the contents of the discussions?

Hmmm, ok, we’re probably going backwards in terms of it being a really straightforward yes-no question, but I can still dig it.

Dave, over to you…

The Prime Minister: All those meetings are now published. The hon. Gentleman can look on the internet and see every single meeting that I had.

Are you sure your real name isn’t Bob (and weave) Cameron?

Jeremy – I admire your pluck, but even I don’t think you’ve got much chance with the below…

Jeremy Corbyn (Islington North) (Lab): May I give the Prime Minister another opportunity to say on what occasions, with whom and where, in the time since he became Prime Minister, he has ever discussed the Murdoch bid to take over BSkyB completely?

Dave…

The Prime Minister: The discussion I had was to ensure that I was not involved in that decision, so I did not discuss it with the Culture Secretary, I did not know about the timing of many of the key announcements—I was not involved. That was the sensible thing to do—conduct in which my predecessors did not necessarily engage.

Barry, do you really want to go there? Oh, what the hell… what harm can it do at this stage?

Barry Gardiner (Brent North) (Lab): I welcome the Prime Minister’s transparency in making available the 26 meetings with News Corps and News International. I welcome the fact that he was able to say that no inappropriate conversations took place between him and BSkyB. Can he tell us that no appropriate conversations about the bid took place at those meetings also?

Dave… (bit of an open goal for you, courtesy of Barry)

The Prime Minister: All my conversations are appropriate.

He shoots, he scores... a puerile political point. Woo hoo. Back of the net. I'll save my little victory dance for when I get home.

Right, I've kinda run out of Steve Bell cartoons, and I'm sure you're bored of my commentary by now, so here's the rest of the attempts to get an answer in quick-fire style...

Bill Esterson (Sefton Central) (Lab): Will the Prime Minister define for us what he regards as an appropriate conversation between him and News International about BSkyB?

The Prime Minister: I thought Rebekah Brooks defined it excellently—one that you could also repeat in front of a Select Committee.

Catherine McKinnell (Newcastle upon Tyne North) (Lab): Will the Prime Minister tell the House the details of any appropriate conversations he had about the BSkyB bid, specifically with Rebekah Brooks and James Murdoch on 23 December and with Rebekah Brooks on Boxing day 2010?

The Prime Minister: What I have done that no Prime Minister has done before is set out all the details of the meetings and explained that all the conversations were appropriate. That was backed up by Rebekah Brooks yesterday. If the hon. Lady wants to help, she could ask the leader of her party to be equally transparent, which he is not being at the moment.

Sorry, broken promise alert (maybe I could be a politician...). I can't help but comment at this point. Get ready for a slightly infantile question, and a really, really infantile answer...

Graham Jones (Hyndburn) (Lab): Has the Prime Minister ever uttered the word “BSkyB” in the presence of Rebekah Brooks, Rupert Murdoch or James Murdoch?

The Prime Minister: You know—urgh!

I have sympathy for Graham - he's most likely frustrated by the question not being answered over and over again. Put it this way, if he'd been first up, there is no way that he would have asked the question in that way. But as for Dave... that is the Prime Minister of our country standing up in Parliament, and saying "urgh". It's not a typo - it's exactly what he did and said.

Stand. Pause. Say two words. Pause. Make noise. Sit.

And as you'd expect, such a high brow intervention was warmly greeted by backbenchers (I kid you not).

We're the ones that should be saying "urgh" at his behaviour! It's a frackin' liberty that he feels that he can say "urgh" when he's the source of the urgh-making.

Grrrr.

Anyway, where were we...

Sheila Gilmore (Edinburgh East) (Lab): Since being elected, constituents have contacted me regularly about the BSkyB takeover and their concerns about it, particularly about undertakings being given or offered by an organisation that has been proven to break its undertakings. At any point, did the Prime Minister discuss with anyone from News International the possibility of undertakings being given?

The Prime Minister: I have answered this question. I took myself out of the whole decision-making process on BSkyB. Having looked at what has happened, I would argue that the Secretary of State for Culture, Olympics, Media and Sport has taken a series of absolutely correct decisions on the basis of the legal information that he received.

Soooo, by my reckoning, that's 11 attempts by 11 different MPs from two different political parties to get our Prime Minister to answer what is a very easy question. And all 11 attempts failed.

The crucial point is that if he'd just said "yes" or "no", or even "I need to double check some things and I'll come back with a definitive yes or no" after the initial question, it would have prevented the need for 10 follow up questions, and would have satisfied me that he's being open, honest and transparent.

At the risk of making this blog post far too long, I do just want to detail the other question that was repeatedly asked and repeatedly dodged. This one is even easier if you ask me...

Helen Goodman (Bishop Auckland) (Lab): Last week, I asked the Prime Minister whether Andy Coulson had been through the official positive vetting procedure. Instead of answering, he referred me to the rules of conduct for special advisers and the standard contract. Will he now answer the question?

The Prime Minister: He was vetted. He had a basic level of vetting. He was not able to see the most secret documents in the Government. I can write to the hon. Lady if she wants the full details of that vetting. It was all done in the proper way. He was subject to the special advisers’ code of conduct. As someone shouted from behind me, he obeyed that code, unlike Damian McBride.

Hang on a sec, that's actually a proper answer(ish). Ah, ok, here we go...

John Cryer (Leyton and Wanstead) (Lab): On 8 July the Prime Minister said that he had commissioned a company to do a basic background check on Coulson. For the fourth time, I am asking for the name of the company. It is a pretty simple question; just come to the Dispatch Box and name the company.

The Prime Minister: We did hire a company to do a basic background check, and that is an entirely appropriate thing to do, and it was an entirely appropriate report. But I have to say, the reason I hired him was above all the assurances that he gave me. That is the key part of the decision and that is what I am prepared to say.

Owen Smith (Pontypridd) (Lab): Will the right hon. Gentleman confirm that it is highly unusual for such a senior adviser to the Prime Minister not to be properly vetted? Will he confirm that it was his decision not to vet Mr Coulson fully, including by asking family and friends about his past life and activities?

The Prime Minister: No, it was not unusual at all. Andy Coulson was cleared in the normal way for special advisers. He was cleared to secret, and he was not sent papers above that level. Like former Administrations, we set out all the names of the staff we employ as special advisers. Once again, I feel that a number of hon. Members are looking for some sort of secret behind a curtain that simply is not there.

Mr Michael McCann (East Kilbride, Strathaven and Lesmahagow) (Lab): May I ask the Prime Minister a question that will both help him to be transparent and quash a conspiracy theory? What was the name of the company that vetted Andy Coulson?

The Prime Minister: The point is that we employed a company to do this work. It was not something that we were planning to publish. It is something that companies and businesses do all the time, but in the end the responsibility is mine for employing him on the basis of the assurances that he gave.

Ian Murray (Edinburgh South) (Lab): If the Prime Minister refuses point blank to tell the House the name of the company that vetted Andy Coulson, will he place the documents with regard to that vetting in the Library of the House?

The Prime Minister: Let us be clear. The responsibility for hiring him is mine and mine alone. That is the responsibility I take. The hon. Gentleman might not like the answer, but that is it.

Anas Sarwar (Glasgow Central) (Lab): If the Prime Minister cannot name the company that did the vetting of Andy Coulson, can he confirm that the company or any of its directors did not make any donations to the Conservative party?

The Prime Minister: I will write to the hon. Gentleman. I do not want to give an answer that is not accurate.

So much wasted time, so many petty exchanges. Again, when first asked the name of the company that vetted Andy Coulson, answers that would have been just fine with me include "It's called X", "I don't know, but I'll find out and tell the House", or even "I am not at liberty to say". All meaningful, direct answers. But instead, we get the run around AGAIN. This time it's four questions from four different MPs (with two other related questions), and absolutely no progress made.

Apologies if this is an over-reaction, but I honestly despair. This is obviously not a one-off. It's routine, week in, week out, accepted behaviour in Parliament. And we wonder why the general public aren't interested, and are often actively turned off, by politics and politicians.

While you're cleaning up News International and the Met, how about cleaning up your own acts as well?

If you're asked a direct question, provide a direct answer. If you fail to do so, then the Speaker should instruct you to provide an answer. And if he fails to step in, then every subsequent question should be a repeat of the unanswered question (perhaps simplifying it each time - using fewer and shorter words, working towards a Jack and Jill standard yes-no question) until an answer is forthcoming.

It could be a bit a dull and a bit weird for a while, but we'd surely make progress pretty quickly, no? In a way, it would be the exact reverse of what Ed Miliband and George Osbourne have been guilty of.

Goodnight grown up, meaningful political debate, wherever you are

Chris

P.S. Final word? It has to go our Prime Minister, and his own assessment of his performance today...

The Prime Minister: As for answering questions, I do not think that I could have given clearer answers to all the questions that Members have asked in the House. I know that a lot of hon. Members came here this afternoon trying to find some conspiracy theory—but they have looked and they have not found one.

Without proof, who knows who said what? An update on damning the Archbishop of Canterbury without evidence

2011-06-29T14:40:00.000-07:00

Totally out of the blue¸ and for no particular reason, today I’ve decided to provide an update on my first ever blog post.

It looks like Wikipedia is currently bang up to date, and may well continue to rapidly get updated depending on how extensive the fallout is over the coming days. More background reading is available from Brian Whelan, Oliver Kamm and Tim Worstall... and, somewhat bizarrely, Johann Hari himself.

Oh, what the hell, let's give the excellent Daily Mash a mention as well.

Sooo, what does Johann have to say... on twitter...

johannhari101 Johann Hari

When interviewing a writer for a 6000-word profile, accurately quoting their writing is not "plagiarism" or "cut & paste journalism"

27 Jun

... and on his own website...

Interview etiquette:

"So occasionally, at the point in the interview where the subject has expressed an idea, I’ve quoted the idea as they expressed it in writing, rather than how they expressed it in speech... Since my interviews are intellectual portraits that I hope explain how a person thinks, it seemed the most thorough way of doing it"

"This is... why, after doing what must be over fifty interviews, none of my interviewees have ever said they had been misquoted, even when they feel I’ve been very harsh on them in other ways"

"I called round a few other interviewers for British newspapers and they said what I did was normal practice and they had done it themselves from time to time. My test for journalism is always – would the readers mind you did this, or prefer it?"

"I’m open to suggestions from anyone who thinks there’s a better way of doing this"

My response to yesterday's allegations:

"When I’ve been wrong in the past – as I shamefully was over the Iraq War – I have admitted it publicly, tried to think through how I got it wrong, and corrected myself. So I’ve thought carefully about whether I have been wrong here. It’s clearly not plagiarism or churnalism – but was it an error in another way? Yes. I now see it was wrong, and I wouldn’t do it again"

"Why? Because an interview is not just an essayistic representation of what a person thinks; it is a report on an encounter between the interviewer and the interviewee"

... and how about one of his employers...

Simon_Kelner Simon Kelner

@JohannHari101 has worked at @theIndynews for 10 years. In that time, we have not had a single complaint about his misrepresenting anyone

28 Jun

So that's that then... but, but, but I hear you all ask (hello? anyone? anyone care?), what about Archbishop Michael Ramsey, and my first ever blog post? Did I ever get anywhere with getting to the bottom of what was increasingly looking like a groundless slur?

Well, yes and no.

First up, the Independent. I find it quite incredible that on Tuesday 28 June, Simon Kelner (editor-in-chief of The Independent) can claim that in 10 years no-one has ever complained about Johann Hari misrepresenting anyone. Although I guess it's easier to make such a claim when you don't bother monitoring the email address that you promote on your website for feedback.

Here's the first email that I sent to newseditor@independent.co.uk on Thursday 31 March:

Subject: Smearing the Archbishop of Canterbury

Dear Sir / Madam

I'd be interested to hear your views on whether an article in your paper smearing a dead individual should either include a link to a reliable primary source as evidence to support its claims or at the very least should be able to produce said evidence when challenged: http://alturl.com/4bcty

Let's face it, anyone can miss an email. So I emailed again on Thursday 7 April:

Hi, newseditor

Any thoughts?

And again, on Saturday 16 April - I even cc'd customerservices@independent.co.uk this time:

Hi - any thoughts?

So what response did I get? Well, the total response to my three emails, to two different email addresses was... nothing, nadda, zip, zero. Not. A. Dickie-bird. It's one way of being able to claim that you've had no complaints, I guess.

Now on to the main event. At the end of my first blog entry, I included an email that I sent to Johann Hari on Saturday 19 March.

Here's the subsequent correspondence (slightly edited to remove some, mainly personal, details).

Johann replying on Sunday 20 March:

Chris, as I said, my copy of the book is packed away because I just moved, but I got it from God Is Not Great. You can email Christopher to ask him the origin of the quote. These websites also attribute the quote to the book or to him, you may want to ask them:

http://www.generationaldynamics.com/cgi-bin/D.PL?xct=gd.e070603
http://archive.frontpagemag.com/readArticle.aspx?ARTID=26792

Best wishes

Johann x

Me replying later on Sunday 20 March:

Thanks very much for your reply, Johann

I sent you one of those links, and didn't feel the need to send the other one, as it doesn't further things at all.

As I said, I bought the book as you told me that was your source. Two of us have read it, and can't find the quote. It's definitely not in the index or references.

As I also said, I'm sorry you felt the need to block me on Twitter. Your choice obviously, but I'm not sure what I actually did to warrant it...? I thought that would be the course of action when faced with abuse or obsession. Maybe the fact that you are good at replying to people is your weakness, as it then encourages people to contact you, which in turn can look like obsession. Or maybe I was abusive, but I'm not sure how...?

I still come back to my original question - did Archbishop Ramsey say that millions of people dying is just fine or not? If he did, when did he say it, where, in front of who, and why?

Apologies for sounding repetitive, but if I'm being unreasonable, do say. Is the above not the kind of question that journalists are expected to know the answer to? As I said, you chose to include the quote. No-one made you. Don't you want to be 100% sure that it's genuine and accurate?

Thanks again for your rapid reply, and apologies for being a nuisance. I don't know why, but I feel very strongly about this. Maybe it's the fact that a dead guy might need a friend... and trust me, if he did say it, he's no friend of mine.

Cheers

Chris

Me emailing again on Thursday 7 April (maybe I am a closet stalker):

After almost three weeks, I'm getting the distinct vibe that a further response from you is not imminent.

I've emailed Christopher Hitchens today, which is something that I really hoped I wouldn't have to do. I had thought that using a quote within an article brought with it certain responsibilities to satisfy yourself of its veracity, but I guess not. I'll let you know if he replies.

I still think it's a real shame you felt the need to block me from following you on Twitter on account of me having the audacity to question a quote that you chose to include in your article.

If you do have further information, I'd be very happy to update the below - not that anyone cares anyway...

http://justanotherbleedingblog.blogspot.com/2011/03/without-proof-who-knows-who-said-what.html

Chris

Me again (cue the Psycho music) on Sunday 8 May - I had big news to share:

Good afternoon Johann

Christopher Hitchens has got back to me and confirmed that it wasn't Archbishop Michael Ramsey.

I was wondering therefore whether you would be interested in publishing a correction, as it is now clear that the quote is not attributable to Ramsey.

I also wonder whether you would agree that all this effort could be saved if you would just include primary sources within your articles.

The below article is a classic example:

http://www.johannhari.com/2011/03/29/the-biggest-lie-in-british-politics

If you start with a fact, why not reference that fact? Don't expect your readers to go away and check for it themselves - be helpful and include a reference so that it can be readily and easily looked at. You then go on to include more facts and several quotes. Given my experience of having to spend plenty of time tracking down a quote on your behalf (and finding it to be incorrect), it would also be immensely helpful if you provided references for these as well.

Cheers

Chris

Johann replying the same day:

Thanks Chris - I'll get the Indie to put a correction at the end... they have a policy of only linking to other Indie articles as sources.

Best wishes

Johann

Not knowing how long would be reasonable to allow for a correction to be published, I left it over a month, before eventually following up on Sunday 19 June:

Thanks very much for your email, Johann

I appreciate that it might take a while to correct the Indie article:

http://www.independent.co.uk/opinion/commentators/johann-hari/johann-hari-get-bishops-out-of-our-lawmaking-2218130.html

But hopefully you can correct the version on your own website quite quickly and easily:

http://www.johannhari.com/page/9

I'm also delighted to see that you are now including references in your articles on your own website:

http://www.johannhari.com/page/1

If the Indie continue to be difficult about including links to external websites, then I'd go for the George Monbiot approach:

http://www.guardian.co.uk/commentisfree/2011/may/16/cameron-blair-nhs-kitemark

• A fully referenced version of this article can be found on George Monbiot's website

Cheers

Chris

As at Wednesday 29 June (today), Johann hasn't replied, and neither version of his article includes a correction.

I'll continue to exercise patience, as I'm sure Johann has one or two things on his plate this week... I guess I'm just somewhat surprised he didn't manage to get around to publishing a correction before now, having eventually (!) accepted that Archbishop Michael Ramsey has been unfairly maligned.

Goodnight once more journalism, wherever you are

Chris

You are now entering The Twilight Zone, courtesy of Lansley, Cameron et al

2011-06-02T09:20:00.000-07:00

My third post (this is my first post - boo, it's long; and this is my second - yay, it's short) on basically the same topic. Bit boring? Yes. Repetitive? Sure. Necessary? ABSOLUTELY!

Last night (Wednesday 1 June), the Telegraph published this article, penned by Secretary of State for Health Andrew Lansley. In it, he writes:

"We know that some of our outcomes for common conditions like cancer and strokes are not as good as they should be in comparison to the rest of Europe. For example, if our cancer survival rates were at the European average, we know we would save 5,000 extra lives a year. The same can be said of heart disease, where we could save 750 lives every year if our care was equivalent to the average in Europe"

I can't help but shake my head as I read this back. And the shaking occurs no matter how many times I read it back.

I refuse to play by the rules of this particularly repugnant game. The game is called Politics. And the rules are:

1. Make unsubstantiated claims to justify your political aims

2. Convert your claims into facts

3. Use said facts as compelling evidence for your political aims

3. Ignore the small minority that bothers to check your claims masquerading as facts

4. Repeat your dodgy facts as many times and in many different places as you possibly can (even better, share the load with your colleagues, and get them to peddle the same bilge)

5. Wait for small minority to lose the will

6. Sit back and enjoy as your unsubstantiated claims are increasingly accepted as facts

A refusal to follow rule number 5 explains my third blog post on this topic.

Having done a bit more digging, the first time that I can find reference to the 5,000 lives figure is in a Department of Health press release dated 3 October 2010. After that, we've got Improving Outcomes: A Strategy for Cancer, published by the Department of Health on 12 January 2011. Page 5 of the strategy states:

"Through the approaches this Strategy sets out, we aim to save an additional 5,000 lives every year by 2014/15"

Hold on, that's not nearly so juicy. Oh no, wait. Here we go. Page 7:

"To put this in context, if England was to achieve cancer survival rates at the European average, then 5,000 lives would be saved every year"

I guess it makes perfect political sense to quickly jump from an aspiration of saving 5,000 lives per year by 2014/15 (aiming to do something years in the future - yawn, that's not a good, instant soundbite, nor a compelling fact to justify major changes) to claiming that 5,000 lives per year could be saved right now (wow! Really? Change the NHS right away. Like now! What are you waiting for?).

There are four figures that have been wheeled out repeatedly as 'facts' to justify the NHS reforms. Indeed, the Government's glossy leaflet published on 6 June 2011 states that three of these 'facts' alone "compel us to modernise and improve our NHS".

When you add the four figures together, they amount to a claim that we could save 8,300 lives per year (5,000 lives from cancer; 2,000 lives from respiratory disease; 750 lives from heart disease; 550 lives from chronic live disease and cirrhosis) right now.

This is a huge claim. And to date, only one source has been made available to support a single one of the disease groups. And that source, relating to the 5,000 lives from cancer, was debunked (a tad harsh - nothing wrong with the actual source. The problem is how it has been twisted and used by politicians) weeks ago both here and here.

I first asked the Department of Health for the sources of their lives saved per year figures almost two months ago. Since then, I have asked both the Department and Number 10 for the sources more than two dozen times.

So far, I have received one reply, which by anyone's standards is a bit rubbish:

Do0g1e Chris Mason

Yep, that's the one - missing sources re death figures RT @DHgovuk: @do0g1e are you referring to 'Working together for a stronger NHS'?

9 May Favorite Reply Delete

Come on now - somebody, somewhere must have the will and the clout to put Cameron, Lansley, Burstow or Burns on the spot, and make them justify and provide the sources for these incredible claims.

Failing that, do at the very least join me in a daily 15 second task to tweet the Department of Health and Number 10 requesting the sources:

Do0g1e Chris Mason

@Number10gov @DHgovuk Please can you provide the sources for the deaths saved per year figures in our PM's speech seventeen days ago.

7 hours ago Favorite Reply Delete

Chris

A Groundhog Day speech that left me speechless

2011-05-18T00:35:00.000-07:00

On Monday 16 May 2011, our Prime Minister delivered a speech at Ealing Hospital in which he included the following:

"If we had cancer survival rates at the average in Europe, we’d save 5,000 lives a year"

"If we had respiratory disease care equivalent to the average in Europe, we’d save 2,000 lives a year"

"If we could prevent and treat chronic liver disease and cirrhosis as well as the European average, we could save 550 lives a year"

I find this truly astonishing. I wrote a blog post about this on Saturday 9 April, highlighting that the cancer 'fact' was incredibly dodgy, and that neither the Department of Health nor Number 10 has even provided a source for the respiratory disease 'fact'. For over a month now I have been requesting a source and I am still waiting.

The 550 lives a year 'fact' is a new one and wasn't one of the three 'facts' included in the glossy pamphlet published on Wednesday 6 April. Out goes 750 lives saved from heart disease, in comes 550 lives saved from chronic liver disease and cirrhosis. Whichever 'fact' you look at however, the fact is that neither has been referenced or sourced.

Now, don't get me wrong, I'm not deluded enough to think that anyone in power reads or cares what I write or say. But when Ben Goldacre subsequently published this article in The Guardian on Saturday 16 April, I did think that maybe, just maybe this would give the Coalition Government pause for thought (and what more fitting time to pause for thought than during a 'natural' break in the passage of the NHS reform bill, and even better - during a national listening exercise!) and reflection as to whether they really want to keep quoting such unsubstantiated and potentially misleading figures.

Am I the only one who gets incredibly, unbelievably and supremely annoyed, irritated and ticked off about all this?

Fiddle your expenses and you'll get pilloried. Peddle dodgy facts and if you do it enough times and for long enough, then the minority that query them either lose the will or have no voice to challenge them in the first place (or both).

Dear David Cameron - if you are claiming that right now we could save 7,550 lives per year, please could you provide full referenced and sourced material to explain and substantiate that fact. If you can do that, then I for one couldn't care less if you've got one of these behind your back or stuck down your trousers.

Chris

Give us some credit and stop pretending that AV is rocket science

2011-05-01T14:12:00.000-07:00

Cliché alert, but a picture really can be worth a thousand words, so let's kick off with a couple and save my fingers and your eyes. It is a true mystery how such an incredibly complicated system like AV can be so easily explained not once, but twice, using only beer, coffee, sweets, and excrement as props.

If you want more detail, there's this excellent dissection of the No campaign's offensive leaflet, and this incredibly helpful and straightforward explanation of AV.

I'm not a particular fan of how either side has conducted themselves during the run up to the referendum, but I did just want to highlight a couple of quotes from those heading up the No campaign:

David Cameron - "(AV) is obscure, it's unfair, it's expensive, it could mean that people who come third in elections will end up winning... I feel in my gut that AV is wrong"

I feel unqualified to comment on what Cameron's gut may or may not tell him (maybe Matt Baker knows more than me, thus prompting him to ask our PM how he slept at night), but it is fair to say that it is possible for a candidate to come third in the initial count and end up winning when all alternative votes have been counted. Possible, but very unlikely in practice. The claims that it is unfair and expensive are much easier to dismiss - AV is neither. If anyone tells you that it is, ask them to explain how and why. Despite having a bone to pick with him on a totally separate matter, I have to hand it to Johann Hari for his excellent recent article - if you get the X Factor, you get AV. And the Independent has published a clear, concise and compelling article to support its Yes to AV stance.

William Hague - "It would be unBritish to change to a system (AV) that is unclear and more expensive and would produce many problems"

14 pints a day Hague goes one up on his boss. It's not his (beer) gut that is against AV, but rather AV is against the very essence of being British. Oh please. And I love the fact that the "many problems" alluded to go undefined.

Baroness Warsi - "... there is an even bigger problem with AV: It gives more power to extremists. Why? The whole system is so complicated the problem is all too easily obscured"

So complicated in fact that The Sun requires a small box containing fewer than 80 words to explain it:

What is AV?

On May 5 the nation votes in local elections AND the referendum on AV.

Under our first-past-the-post system, the candidate with the most votes is elected. Under AV, voters rank candidates in order of preference.

If no candidate achieves 50 per cent or more of the vote, the one with the fewest votes is eliminated and their votes are redistributed according to second preferences.

This continues until one candidate achieves 50 per cent.

That really is honestly it. Fewer than 80 words to not only explain AV, but to also explain FPTP and remind us when to vote. All the obscurities, all the complications. The lot.

And why oh why, if AV gives more power to extremists, is the BNP urging its members to vote No to AV on Thursday 5 May?

Between now and the referendum, I urge you to visit both the No to AV website and the Yes to AV website.

Refresh your memory of the actual posters used by the No to AV campaign (and do have a play at making fake posters), and why not read what a fair dinkum, green and gold aussie has to say about it all - some absolutely fantastic blog posts from someone with experience of dozens of Australian elections using a system similar to AV, including debunking many of the myths peddled by the No campaign.

No, Australians aren't looking to dump their election system. No, Australia didn't have to introduce compulsory voting as a result of adopting their election system. If you only read one of Antony Green's blog posts, read this one.

And please do take the opportunity to vote on Thursday 5 May!

Goodnight grown up, honest political campaigning, wherever you are

Chris

P.S. A late honourable mention to the below:

P.P.S. Final word to the invariably excellent Sir Charlton of Brooker.

NHS reform: from liberating, to modernising, to pausing - but has anyone ever been listening?

2011-04-09T12:25:00.000-07:00

Relax, I'm not going to even attempt to assess the proposed NHS reforms in anything like full. If you're looking for a much more learned analysis, then I would recommend the following Twitter luminaries:

@Paul_Corrigan

@HPIAndyCowper - Editor of Health Policy Insight

@ProfAlanMaynard - Professor of Health Economics, University of York

@DrEvanHarris

@nedwards_1

@jappleby123 - Chief Economist at the King's Fund

@martinmckee - Professor of European Public Health, London School of Hygiene and Tropical Medicine

What I am going to try to do is look at whether genuine efforts have been made to listen and address legitimate concerns that have been raised since the Con-Dem Government came to power on 12 May 2010 and the proposed NHS reforms were first pursued with gusto. I’m also passionate about the abuse of ‘facts’ to further political agendas, so that might also get a mention or two (if it’s a straight choice, for me, you can keep your dodgy expenses, but don’t try to get away with your dodgy facts – and definitely don’t trot them out over and over again once they’ve been outed as dodgy!).

The now infamous White Paper 'Equity and excellence: Liberating the NHS' was published by the Department of Health on 12 July 2010 (just two months after the Coalition took power - whatever your political hue, that's a very quick turnaround time to propose such major changes to such a major institution).

On the same day, Secretary of State for Health Andrew Lansley made a statement to Parliament concerning the White Paper. The statement lists challenges facing the NHS, including an increasing and ageing population, advances in medical technology and rising expectations.

On the very next day (13 July 2010), Sir David Nicholson, Chief Executive of the NHS, wrote a letter to all NHS Chief Executives and Chairs entitled ‘Liberating the NHS - Managing the transition’. This is a very significant letter. Depending on your point of view, it could represent good boy scout style planning (dib, dib, dob, dob, be prepared), or it could totally undermine a three month consultation period by telling all senior NHS staff the day after the consultation is launched that they better get on and deliver the key reforms, as time is of the essence, there's no alternative and there's no point in waiting.

The consultation period concerning the White Paper ran from 12 July to 5 October 2010, with a commitment made to publish all responses received in full. All of these groups responded.

On 15 December 2010, the Department of Health published its response to the consultation. It states that "substantial feedback" was received that "reaffirms the strong commitment to the reforms", with the document including various snippets from various responses.

Since January, I have been pursuing publication of the individual responses to the consultation. It was a brave and bold commitment to make by the Government, something that should be applauded. However, for the applause to start, the commitment must be honoured. I am yet to receive either a confirmation of when the responses will be published, or an explanation as to why the responses now won't be published. Cherry-picking certain responses to be included as evidence of support is very different to committing to publishing all responses received, unedited and unsanitised. In my humble opinion, anyway.

Fast forward to 6 April 2011, and we have this - Government launches NHS listening exercise. I have no idea what makes this pause a natural pause (seems like a supremely unnatural, exceptional pause to me), but leaving that aside, we have the Prime Minister David Cameron, the Deputy Prime Minister Nick Clegg, and the Secretary of State for Health Andrew Lansley all declaring their love for the NHS.

We've also got Lansley saying that 90% of local authorities have signed up to play their part in improving services for patients (the only surprise here is surely why it isn't 100%, given the incredibly directive letter from the head of the NHS, David Nicholson, back in July 2010... or am I being unfair and cynical? The best analogy I've heard about this is that just because the lifeboats on the Titanic were used doesn't mean that the passengers approved of the ship going down).

To complement the launch of the ‘natural’ pause / ‘listening’ exercise, we were blessed with a leaflet. The first interesting thing about this leaflet is that it's not produced by the Department of Health, but by the Prime Minister's Office (make of that what you will).

The next interesting thing about this leaflet is that almost the first words in it are "We love the NHS" in big, bold letters. What the founders of this website make of the appropriation of that emotive phrase, I can only guess at.

The leaflet then goes on to explain that the population is ageing (hang on, didn't Lansley explain that back in July last year when the White Paper was launched?). It has a brilliant summary to ram home the point:

"For the first time ever there are more pensioners in this country than there are children under 16. Clearly this is something to be welcomed..."

Really? Doesn't that depend on whether you prefer old people or children? And wouldn't lots of people actually have a neutral view of whether they'd prefer there to be more old people or children in England? It also has the much loved by some “No change is not an option” claim.

The leaflet then explains that advances in medical technology are making some treatments increasingly expensive (hang on, didn’t Lansley explain that as well back in July last year when the White Paper was launched?).

The leaflet then moves to what should be incredibly safe territory, but manages to make it potentially the most controversial ground. It starts off with the assertion that we want to have the best health service in the world. Well, ok, so far, so good (but seriously, which country wouldn’t want to have the best health service in the world?!? Obvious. Stating. The. Bleeding). We then have three figures that are presented as “facts”. This is absolutely critical, as the leaflet states:

“These facts alone compel us to modernise and improve our NHS”

Wow – sit up straight, concentrate. You’re about to see three facts that on their own justify the NHS reforms. Drum roll, please.

‘Fact’ one: if our NHS was world class, every year we would save an extra 750 lives from heart disease

No source is provided for this ‘fact’, which is a shocking omission. I therefore have been deprived the primary source with which to review and comment on this ‘fact’. I therefore do not view it as a ‘fact’. If you want me to engage with you, then engage properly with me. Don’t claim things if you can’t back them up. Mouth. Trousers.

‘Fact’ two: if our NHS was world class, every year we would save an extra 2,000 lives from respiratory disease

Different disease, different number of lives, but same fundamental problem and shameful omission. No primary source. I therefore do not view it as a ‘fact’. Money. Pudding.

Bad start (to put it mildly) – two out of three ‘facts’ down, one to go.

‘Fact’ three: if our NHS was world class, every year we would save an extra 5,000 lives from cancer

Different disease, different number of lives, and by jove, we have a source! The source is Abdel-Rahman et al, BJC Supplement, December 2009.

Before we look at the source, take a quick look at David Cameron’s speech on 6 April 2011, at the launch of the ‘listening’ exercise.

Hmmm, he’s steered clear of the heart disease figure completely (interesting? Possibly, possibly not). And he describes the other two figures as estimates. No wait, he’s calling them ‘facts’. No wait, he’s calling them both!

“But if our NHS was performing at truly world-class levels, we could save literally hundreds more lives every week. It's estimated we would save an extra 5000 lives from cancer every year. An extra 2000 lives from respiratory disease every year. These facts alone compel us to modernise and improve our NHS”

Am I alone in seeing a fundamental difference between estimates and facts? With apologies for the undergraduate style of referring to dictionary definitions, but it feels just about justifiable in this instance.

“Fact:

- something that actually exists; reality; truth

- something known to exist or to have happened

- a truth known by actual experience or observation; something known to be true”

“Estimate:

- to form an approximate judgment or opinion regarding the worth, amount, size, weight, etc., of; calculate approximately

- to form an opinion of; judge

- to make an estimate;

- an approximate judgment or calculation, as of the value, amount, time, size, or weight of something”

A difference? You decide.

Anyway, where were we… oh yes, ‘fact’ three and Abdel-Rahman et al. Having a source in the leaflet allows us to look at the source for ourselves. And me including the source in this blog allows you to look at it for yourselves, and not just take my view on it, or the excerpt that I choose to quote (a certain national journalist who chose to block me on Twitter might want to take note… not that I’m bitter or bear a grudge or anything).

What’s that you ask? Which excerpt would I personally choose to quote? Well, this one, as it goes:

“We set out to estimate how many cancer deaths would have been avoided within 5 years of diagnosis if survival among patients diagnosed in Great Britain (England, Scotland and Wales) during 1985–1989, 1990–1994 and 1995–1999 had been equivalent either to the mean survival or to the highest survival seen in other European countries. Cancer survival has been improving in most European countries, so comparison with a shifting baseline is appropriate. Trends in avoidable mortality can be seen as an overall comparative measure of progress in cancer control between Britain and the rest of Europe”

Actually, there’s more I would choose to quote, so I will (my dull blog, my dull rules):

“For several cancers, survival in Britain was slightly higher than the mean survival in Europe”

“Avoidable premature mortality among cancer patients diagnosed in Britain during 1985–1999 has represented 6–7% of cancer-related mortality compared with the mean survival in Europe. Compared with the highest levels of survival in Europe, the reduction from 12.2% to 10.6% of cancer-related mortality reflects small but steady progress over the period 1985–2003”

So, in summary, we’re making steady progress on cancer survival rates, and the study doesn’t look at any data beyond the year 2003. Hmmm, well, it’s 2011 now. The latest cohort of patients looked at in the study were diagnosed with cancer between 1995-1999.

Since then, we’ve had the NHS Cancer Plan, published on 27 September 2000. It includes the following:

“Despite the best efforts of the NHS staff and cancer patients across the country, decades of under-investment alongside outdated practices mean that survival rates for many of the major cancers lag behind the rest of Europe”

Well that sounds like it roughly tallies with what Abdel-Rahman et al estimated in their study. Lest we forget, their study came out in 2009. That’s one of the problems with healthcare. It’s complicated, and it takes a long time to review and study very complicated areas, like cancer survival rates.

The NHS Cancer Plan goes on:

“The Cancer Plan is a practical document for the NHS and its partners, setting out the actions and milestones that will deliver the fastest improvement in cancer services anywhere in Europe over the next five years. By 2010, our five year survival rates for cancer will compare with the best in Europe”

What, what?!? You mean the idea of looking at outcome measures, like survival rates, didn’t start with the new Coalition Government? Well I’ll be. And hang on a second, I’ve got a crazy idea… if Abdel-Rahman et all were able to provide interesting estimates about cancer survival rates in 2009 based on a cohort of patients between 1995-1999, maybe, just maybe we need to wait a while longer to know whether the NHS Cancer Plan has delivered what it set out to deliver.

Instead, what we get is a 2011 Government leaflet telling us that the NHS reforms must happen based on an historic estimate dressed up as a current and ongoing fact. Annoyed? Irritated? Disappointed? Me too!

I’m almost done (I’ve got some Jehovah’s Witnesses to bother), but just a couple more snippets from the 2000 NHS Cancer Plan:

“The Plan will be supported by new funding, rising to an extra £570 million a year for cancer services by 2003/04. By 2006 there will be approaching 1,000 extra cancer specialists, more radiographers, more nurses, and targeted action to respond to shortages of other staff who contribute to cancer diagnosis and treatment. In partnership with voluntary organisations, with the New Opportunities Fund, and others, we shall extend the range and accessibility of cancer services right across the country. We cannot make all the changes overnight. But as the Plan is rolled out and milestones are reached, people will begin to see the improvement that will mean we no longer lag behind Europe, and in time will compare with the best in Europe”

Now, honestly, hand on heart, politics aside, I really like the above paragraph. Why? Well, it’s easily understandable, it’s compelling, and above all, it’s realistic.

It’s basically saying, yeah, we know we’re not doing so well right now, not as well as we’d like, and certainly not as well as the best. So we’re going to splash some cash (quite a lot of cash!), we’re going to hire some extra staff (quite a lot of extra staff!), we’re going to work with others, including volunteers (extra, extra, read all about it – Big Society spotted 10 years earlier than thought!), and we’re not promising immediate improvements, but we’re working to a longer term plan.

Common sense and realism, innit. I can buy into that. Now what would be a fitting reward for such common sense and realism? Well, what wouldn’t be fair is if in the year 2011, one year after the deadline for the NHS Cancer Plan, we have a Government leaflet telling us that the NHS reforms absolutely have to happen because of our poor performance on cancer.

Even worse, the ‘fact’ in the leaflet pretty much pre-dates the NHS Cancer Plan being introduced.

Apologies, as I’ve droned on a bit about this one, and I could do a bit more, but I won’t (phew).

The leaflet then explains that we’ve now got more doctors (doctor graphic = white figure, with stethoscope) and fewer managers (manager graphic = black figure, with tie).

I could bang on about this as well, but I will leave it to the magnificent @RealDMitchell

and his astoundingly good article on this general topic.

Oh, just one point (sorry – indulge me). Yes, the leaflet does indeed more frequently refer to managers as bureaucrats (boo, hiss! They’re behind you, in front of you, beside you, getting in the way and being annoying).

What else is in the leaflet… well, in terms of fetching infographics, there’s one more doozie for me:

“95 per cent of people want more choice over their healthcare”

Not exactly groundbreaking stuff (who are the 5% that don’t want more choice?!? – I could have every sports channel known to mankind, and my wife would claim I already do, but if someone asked me if I wanted more choice of sport to watch, I’d still say yes), but the source is the really interesting part. It’s a figure from the 25^th British Social Attitudes Survey.

This is a survey that has been running for more than two decades, providing a fantastic comparative source of exactly what it says on the tin – British social attitudes. It includes a range of questions about the NHS and healthcare.

The reason why it’s so interesting is that the Government leaflet has chosen to quote the figure from the survey just weeks after the Department of Health withdrew funding for said survey. Little bit weird? Little bit shifty? Little bit dodgy? The survey is good enough to provide a source for why the NHS reforms must happen, but not good enough to be funded, despite such funding having been in place for more than 25 years.

Thankfully the King’s Fund are going to step in to help save some of the questions in the survey.

Check out the stats and graph from the latest (27^th) survey, and make your own mind up about whether there may be more to it than just a minor cost saving as to why the Government no longer wants to fund the survey (hint: that worm is on a steep upward trajectory over the last three years. If it was a cricket run chase, you'd think someone like Boom Boom Afridi or Bash Bash Sehwag was having a grand old time - are they about to get clean bowled?). "I can't get no satisfaction" doesn't seem to be the theme song of the NHS in recent years - don't take my word for it, have a look at this.

Right, enough is surely enough. This was supposed to be a short, concise, focused entry. It’s got away from me, and I sincerely thank anyone who has made it this far.

My closing comments would be that I am incredibly unimpressed with what has happened over the last few months. We’ve had a public consultation that was looking like being open and transparent, but ended up being almost immediately undermined by behind the scenes directives, and a failure to publish what key groups thought about the proposed reforms. And we’ve now got a public listening exercise that still has the potential to be meaningful, but is already in danger of being undermined by behind the scenes directives… yes, David Nicholson’s at it again... a leaflet that some feel is nothing more than crude propaganda… and an ongoing failure to actually listen.

Listening does not mean talking more slowly. Listening does not mean using smaller words or bigger font. Listening does not mean converting a parliamentary statement from July 2010 into a glossy leaflet, resplendent with infographics, in April 2011. And listening absolutely does not mean pausing and then continuing regardless.

Oh, and if I'm wrong (it happens..... a lot), then tell me how you are listening. Show me what you are doing in response to what you're hearing. Because I'm hearing a lot, and it's not what I'd call universally supportive and positive. This fantastic piece from Paul Corrigan's invariably excellent blog is inspired - basically casting Larry Labour (who can be over controlling and bossy, and likes a bit of Tina Targets action on the side) as the NHS' childhood sweetheart, and Tony Tory as the NHS' childhood bully, now saying that he's seen the error of his ways, has totally changed, and has fallen in love with the NHS. But what is the basis of this new found love? Conceptual only? And if Tony Tory loves the NHS so much, why is he wanting her to change so much?

As for the two pronged approach of vilifying bureaucrats and relying upon the frequent use of dodgy facts, I can only make a very simple plea. Stop doing it. Now.

The former is completely unfair to the thousands of committed individuals who work incredibly hard, no matter what the Government of the day is, and despite the axe of redundancy or the spectre of job insecurity hanging over or around them. And the latter is an affront to our intelligence and a very dubious way to conduct any kind of business, let alone business that affects every single person living in England.

Goodnight meaningful political engagement and appropriate use of evidence to support claims, wherever you are

Chris