Press Complaints Commission decide '13,000 needless deaths' story was inaccurate

I was of a number of complainants to the Press Complaints Commission about the Sunday Telegraph story headlined 13,000 died needlessly at 14 worst NHS trusts, as the Telegraph journalists had been explicitly told by the originator of the figures, Professor Brian Jarman, that this was an inappropriate interpretation. My objections were expressed in an article in the British Medical Journal.

The Press Complaints Commission has now told me that “The Commission decided that the Sunday Telegraph had published significantly misleading information; however it had offered to take sufficient action to remedy the breach of the Code as required under the terms of Clause 1 (ii).”

This means that there is no official adjudication and no publication of the decision – this seems strange, and so I have reproduced below (with permission of the PCC) their decision.

The crucial finding was “By attributing the number of “needless” deaths to a calculation made by Sir Brian Jarman, the newspaper had failed to take care not to publish inaccurate information in breach of Clause 1 (i). As such, a correction – published promptly and with due prominence – was required in accordance with the terms of Clause 1 (ii).”

Having published this inaccurate information, the Sunday Telegraph published some clarifications. The online version does now has the 'clarification' at the bottom, but as the image below shows, still had [on November 4th] the inaccurate headline. Extraordinary.

Commission’s decision in the case of
Groves v The Daily Telegraph/ The Sunday Telegraph

The complainant considered that the newspapers had inaccurately reported that an investigation, overseen by Sir Bruce Keogh, had revealed that thousands of patients had died “needlessly” at 14 NHS hospital trusts.

Clause 1 (i) (Accuracy) of the Editors’ Code of Practice states that “the press must take care not to publish inaccurate, misleading or distorted information”. Clause 1 (ii) makes clear that “a significant inaccuracy, misleading statement or distortion once recognised must be corrected promptly and with due prominence”.

The Commission noted that Sir Bruce Keogh’s investigation into 14 NHS hospital trusts had been preceded by investigations into the Mid Staffordshire NHS Foundation Trust. These investigations – overseen by the Healthcare Commission and, more recently, by Robert Francis QC – had been launched due to the trust’s above-average Hospital Standard Mortality Ratio (HSMR), mortality statistics calculated by Sir Brian Jarman, Director of the Dr Foster Intelligence Unit. In light of Robert Francis’s conclusions at Mid Staffordshire, the Health Secretary and the Prime Minister instructed Sir Bruce to carry out a review of an additional 14 hospital trusts with “persistently high mortality rates”.

The Commission noted the complainant’s concern that the Daily Telegraph had misleadingly stated that “an investigation found that thousands of patients died needlessly because of poor care” and the Sunday Telegraph had inaccurately said “in total Sir Brian [Jarman] calculated that up to 13,000 patients died needlessly”. Indeed, in reference to HSMR and SHMI (Summary Hospital-level Mortality) statistics, Sir Bruce Keogh had said in his report that “it is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths”. He had also quoted Robert Francis QC, who had said “it is in my view misleading and a potential misuse of the figures to extrapolate from them a conclusion that any particular number, or range of numbers, of deaths were caused or contributed to by inadequate care”.

However, as also stated in the Keogh report, the Health Secretary and the Prime Minister had instructed Sir Bruce to carry out this review with the rationale that “high mortality rates at Mid Staffordshire NHS Foundation Trust were associated with failures in all three dimensions of quality – clinical effectiveness, patient experience, and safety – as well as failures in professionalism, leadership and governance”. Although the “excess deaths” had not been described as “needless” by Sir Bruce Keogh or Sir Brian Jarman, the newspapers had been entitled to their interpretation of the investigation’s results.

The Commission noted that when presenting complex statistical information to non-specialist readers, newspapers will inevitably have to summarise information. The Code does not require the publication of exhaustive information. However, the Commission made clear that it is essential that newspapers interpret such statistical information accurately, and in a manner which is not misleading. In this instance, it was for the Commission to consider whether, in the context of each article as a whole, the newspapers had made clear that the quoted numbers related to statistical analysis of above-average death rates; they did not reflect the outcome of a study into the causes of individual deaths.

However, in the Sunday Telegraph’s article, the newspaper had stated that Sir Brian Jarman had “calculated that up to 13,000 patients died needlessly”. In fact, Sir Brian had not calculated the number of “needless” deaths; rather, he had calculated the number of deaths over and above what would have been expected. Indeed, as previously noted, Sir Bruce Keogh had warned against using HSMR statistics “to quantify actual numbers of avoidable deaths”. By attributing the number of “needless” deaths to a calculation made by Sir Brian Jarman, the newspaper had failed to take care not to publish inaccurate information in breach of Clause 1 (i). As such, a correction – published promptly and with due prominence – was required in accordance with the terms of Clause 1 (ii).

The newspaper had offered to amend the online version of its article so that the sentence “[I]n total Sir Brian calculated that up to 13,000 patients died needlessly in that period” was replaced by “[I]n total Sir Brian calculated that up to 13,000 more patients died in that period than would have been statistically expected”. It had also offered to append the following note:

Clarification
We have been asked to make clear that, contrary to an earlier version of this report, Sir Brian Jarman’s findings reflected the number by which mortality figures exceeded what would have been statistically expected. He made no finding as to the causes of any deaths or whether they were “needless”.

In addition, the newspaper had offered to publish the following correction on page two of the newspaper:

Clarification
Following our July 14 report “13,000 died needlessly at 14 worst NHS trusts” we have been asked to make clear that Sir Brian Jarman’s findings reflected the number by which mortality figures exceeded what would have been statistically expected. He made no finding as to the causes of any deaths or whether they were “needless”.

The Commission noted that the complainant considered that the newspaper should also amend the article’s headline and the reference to “up to 1,200” patients dying needlessly at Stafford Hospital. He had also requested that the newspaper refrains from using the word “needless” in relation to HSMR statistics in future. However, the Commission reiterated that the newspaper had been entitled to its interpretation of the results of both the Keogh and Francis investigations. Furthermore, the first line of the piece had made clear that the 13,000 deaths related to "excess deaths” since 2005. Taken in context with the article as a whole, and in light of the additional footnote, the Commission did not consider that a significantly misleading impression of the investigation’s findings had been created by the headline. The suggested amendment and correction had addressed the key point: Sir Brian Jarman’s calculation did not reflect the outcome of a study into the causes of individual deaths. As such, the Commission was satisfied that the newspaper had offered to take sufficient action to meet its obligations under Clause 1 (ii), and it instructed the newspaper to amend the article and to publish the correction without delay in order to set the record straight.

The Commission then turned to consider the Daily Telegraph article, headlined “NHS inquiry: Shaming of health service as care crisis is laid bare”. In this instance, the newspaper had not given a specific number of “needless deaths”. It had said that “an investigation found that thousands of patients died needlessly because of poor care”. It had also stated that the selected hospitals had been those with the “highest recent mortality rates”. Furthermore, the newspaper had taken care to refer to the mortality statistics as “excess deaths” and it had quoted Health Secretary Jeremy Hunt as having said “no statistics are perfect but mortality rates suggest that since 2005 thousands more people may have died than would normally be expected at the 14 trusts reviewed”. In addition, the newspaper had provided anecdotal evidence of the poor care that had been identified: “some risks to patients so severe that [inspectors] were forced to step in immediately”; “decisions were taken urgently to close operating theatres, [and to] suspend unsafe ‘out of hours’ services for critically ill patients”. In the print version, this piece had also been presented alongside the findings related to the individual trusts and had clearly identified the number of “excess deaths” attributed to each one. In this instance, the Commission was satisfied that the newspaper had not given the significantly misleading impression that the Keogh investigation had examined the causes of individual deaths. The newspaper had provided adequate statistical context for its assertion regarding the numbers of “needless” deaths and therefore the basis for the newspaper’s interpretation of the relationship between mortality statistics and the level of care provided by the 14 NHS hospital trusts had been clear. As such, no correction was required and this piece did not raise a breach of the Code.