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The BMJ Editor unpicks row over Hunt's use of seven-day NHS data

March 03, 2016

Today, The BMJ's Editor in chief, Dr Fiona Godlee, unpicks the facts surrounding health secretary Jeremy Hunt's use of data to put his case for a seven-day NHS in England.

In the thick of this dispute is a paper published in The BMJ last year showing excess mortality in patients admitted at weekends.

Did Hunt, in a speech attacking senior doctors for resisting a new seven day contract, use data from the paper before it was published, asks Godlee? If so, how did he get the data? Who commissioned the study? And did the subsequent media attention subvert The BMJ's editorial process?

In order to understand who knew what and when, BMJ reporter Abi Rimmer reviewed emails obtained through freedom of information requests and spoke to the main protagonists: the authors of the BMJ paper, NHS England, the Department of Health, and the BMJ editor who handled the paper.

The picture was not always clear, but Rimmer concludes that the two main numbers used in Hunt's speech probably came from different sources.

The figure of 6,000 excess deaths seems to have been derived at NHS England from an analysis published in 2012, while the figure of 15% excess mortality in patients admitted on Sundays appears in the 2015 BMJ paper.

Godlee is not concerned that the authors shared their main findings with colleagues in other departments before publication. And as for whether The BMJ's editorial process was influenced by the media storm, Rimmer reports that the peer review process was all but complete by the time Hunt made his speech.

So the problem was not in the conduct of the study, commissioned as it was by NHS England; nor in the sharing of the information before publication, writes Godlee. It was in what Hunt chose to do next.

First, he used the information publicly without being clear about its source. "In doing so he may have breached the ministerial code and certainly caused damaging confusion," she says.

Second, he repeatedly attributed the excess deaths to doctors not being available at weekends. Yet the authors "had clearly warned that the study could not show causation nor to what extent the excess deaths were avoidable."

Thirdly, in misusing the data to beat up on doctors, "Hunt derailed NHS England's established program of work on improving services at weekends," she argues.

"Instead of working with doctors to achieve his stated aims, Hunt has pitted himself against them, characterising himself as a champion of the people despite the lack of a clear call from the public for a seven day service."

Hunt's approach "demonstrates either extreme political arrogance or an active attempt to destabilize the NHS," she adds. "Whichever, NHS staff and patients must deal with the fallout."

Even so, Godlee believes that Hunt "could redeem himself and leave the Conservatives with a truly lasting legacy."

As an able politician, "he should find a way to resolve the doctors' dispute as quickly as possible without either side losing face," she writes. He should then empower NHS England's board with real independence from government "and then step back and let those with long term accountability, expertise and experience get on with the job."


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