Only telling half of the story

The Mail headline is pretty damning:

Things are equally grim in the story itself:

Up to two in three patients are unhappy with the care they are given on the NHS, an alarming report has found.

Many of those treated by the Health Service complain that they were dehumanised, humiliated and embarrassed by the doctors and nurses who were supposed to be looking after them.

The survey of almost 12,000 patients found that staff were criticised for being rude, arrogant and lazy – too often refusing to treat their patients with dignity or compassion
And only a third of those polled said they were content with the standard of care that they had received on an NHS ward or at a surgery.

Dig a little deeper, however, and it quickly becomes clear that this is just the latest Daily Mail attack on the NHS – an institution the paper has previously criticised both for spending too much on supplies and not spending enough on supplies.

The first port of call is the “alarming report” on which the story is based. It is published by Patient Opinion, an independent website that collates individuals’ experiences of the NHS and passes on their comments to politicians and health service managers. Today’s report is a compilation and analysis of the various comments received by Patient Opinion over the past decade.

Despite what the Mail says, it is not a “survey” and nobody was “polled”. Patient Opinion merely asks patients to come to them with their own experiences – and as even the Mail admits (tucked away at the bottom of the story):

“…since many of its contributors are likely to log on because they are unhappy with their care, it is difficult to quantify exactly what proportion of all NHS patients are similarly disgruntled.”

In other words, people who comment at Patient Opinion are entirely self-selecting. There’s no way of knowing how representative of all patients the site’s visitors are – it’s a bit like trying to get a statistically valid handle on society’s views based solely on the comments left on the Daily Mail website. It’s certainly interesting to see what so many people have to say, but to use it as the basis of a claim that “two in three patients are unhappy with the care they are given” is somewhat more dubious – the claim should be that “two in three patients who use a certain website” are unhappy.

The Mail is also factually wrong when it claims that “almost 12,000 people” were surveyed for the report. As we’ve already seen, the report is not a survey. And, as anyone who bothers to read the methodology of the report will see, its findings were not based on all of the comments received since it launched in 2005:

“The analysis used a sample of 537 accounts from patients and carers. The analysed data was sampled by initially collating: All public postings made on Patient Opinion since February 2008 that had a criticality score of three, four or five; all concerns received prior to February 2008 that were over 500 characters in length, to give the fullest example of patient feedback in this period. This gave us 1,790 accounts, of which 30 per cent were randomly selected, creating a final sample total of 537 accounts.”

The “Our Reasoning” section adds:

“Since February 2008, Patient Opinion has categorised all posts made on a scale of zero to five, with five being the most severe. For this report, the research team selected stories with a severity threshold of three or more, to ensure that the most serious concerns were prioritised. For concerns submitted prior to February 2008, they included entries longer than 500 characters. This gave a dataset of 1,790 stories, with a 30 per cent sample size of 537 stories (from the overall total of 15,605 posted on Patient Opinion in this time period).”

In other words, the researchers deliberately only chose comments from people with more extreme views, with the result being that the study was based on just 537 comments – roughly 3.4 per cent of the 15,605 “stories” left during this period. And it’s entirely possible that the same person commented more than once.

But even if you don’t mind the issues with the report itself, the Mail’s quoting of it is selective in the extreme. Yes, it identifies many problems with the NHS, and calls on health service managers to improve the situation. However, other findings that the Mail couldn’t find room for include:

Out of 11,982 stories posted, 33.1 per cent were positive, 45.6 per cent were neutral and just 21.1 per cent were negative (p9)

79 per cent of the stories on Patient Opinion talk about a positive experience of the health service “indicating that the NHS continues to provide excellent care to patients and their families all over the country.” (p8)

Staff attitudes are the most common aspect of the very best care experienced by patients and their carers (p3)

To Patient Opinon’s credit, they’re open about the fact that the report is not statistically ideal as it based on subjective accounts of individuals’ experiences rather than objective quantifiable data. The researchers are also happy to make clear, on page eight, that that they have deliberately focussed on negative aspects at expense of the positives:

“This report is intended to prompt change and drive improvements. We have therefore focused on examples where improvements can be made within the NHS … There will always be room for improvement though, and this analysis exposes these areas.”

However, all such caveats are missing from the Mail’s coverage. The Mail is also happy to reproduce harrowing accounts from patients who felt they were treated badly. In the report itself, each comment is followed by a response from the NHS, usually expressing horror, apologising profusely and explaining what steps have been taken to remedy the situation so it doesn’t happen again. But of course the Mail can’t find room for these, either.

As usual, if the facts don’t fit the paper’s narrative, they are conveniently ignored.

Mail gets its knickers in a twist over your cervix

The Mail is so delighted with its latest miracle cancer breakthrough that the story gets splashed across page one:

The £15 cervical cancer test that could save thousands of women's lives
Thousands of women’s lives could be saved by a dramatic improvement in testing for ­cervical cancer. The test delivers overnight results and is vastly more accurate than the smear test which is currently used to spot early signs of the disease, according to researchers.

Potentially excellent news. But why is the Daily Mail so happy about this? After all, just last month the very same paper was up in arms at one health authority's attempts to get girls vaccinated against cervical cancer - a move that, to use the paper's phrase, could save thousands of women's lives. Back then the paper branded it a "promiscuity scheme" that would encourage teenage girls to sleep around. Why does a test that makes it easier to identify cervical cancer not have the same effect?

For reasons I can't begin to understand, the paper seems to believe that it's better for women to get cancer and then have it detected early than not to get it all. It's often said that prevention is better than cure, but it appears that such tried and test logic has no place in the pages of the Daily Mail.

Mail condemns hospital for taking Mail's advice

Back in August I took a look at a Mail article that attacked the NHS for spending lots of money on sterile surgical screws instead of picking up them up at B&Q for 20p a pop. At the end I pondered what the Mail's reaction would be if it discovered that a hospital was carrying out operations using equipment purchased on the cheap at an out-of-town retail park.

Today we find out:

Burns victim's amazement after NHS hospital staff wrap his blistered hand in a TESCO freezer bag
A burns victim was left stunned after NHS staff wrapped his blistered hand in a Tesco freezer bag. Nicholas Robertson, 38, was treated for the injury - then medical staff needed to wrap his hand in a protective and sterilised plastic bag. But he was amazed to see the word Tesco stamped across the bag.

It appears that someone at the Cardiff and Vale University Health Board thought the Mail's procurement advice was actually pretty sensible, which of course prompts outrage from the, er, Daily Mail. And, perhaps more justifiably, from the burn victim himself*:

"Is this what the NHS has come to? I know there are Government cuts - but wrapping patients in Tesco freezer bags is not acceptable."

Protecting a properly treated burn with a plastic bag bought at Tesco and sterilised at the hospital = unacceptable. Using B&Q screws to bolt someone's hip back together = common sense.

The Mail must be a very confusing place to work sometimes...

*My sympathy for the victim was diminished slightly when I discovered that he had burned himself after "accidentally spilling lighter fluid on his hand close to a naked flame". Oh dear.

Daily Mail takes a "Do it yourself" attitude to healthcare

I try to make a rule of not blogging about the Daily Mail talking bollocks more than once a day because, quite frankly, it's even easier than predicting when a Pakistani fast bowler will send down a no-ball and, as such, not much fun. But hey, as Salman Butt would probably say, rules are there to be broken.

Today's paper has a special investigation into how the medical industry over-charges the NHS for products, an expose written by a medical sales rep. The headline?

In B&Q they cost 20p. So why does the NHS spend £99 for a screw to put in your hip?

Now, I'm no expert in medical matters. I watched a couple of episodes of Grey's Anatomy once (in my defence, I was drunk) and at university I lived next door to a couple of medical students (who, most of the time, were drunk), but that's about it. Yet I think even I can probably hazard a guess why the NHS's finest orthopaedic surgeons don't pick up their supplies at B-AND-FUCKING-Q on the way to work each day.

Even if you're not a complete fucking moron and still can't figure out why the NHS doesn't use bamboo garden canes from Homebase in lieu of hypodermic needles, you only have to make it to the fifth paragraph of the story for the author to answer his or her own question:

"We sell screws that are barely any different from the ones you see in B&Q, priced five for £1. Yet ours cost between £30 and £40 — each. And while they cost us, at most, £10 to make, we justify the mark-up because they are slightly finer. Oh, and sterile. "

Right. So they cost you £10 to make, and you sell them for between £30 and £40. Charging three times the manufacturing cost is certainly a hefty mark-up but it's not totally off the scale - nor does it compare to the 495-times difference mentioned in the headline. Plus, of course, the £10 cost of "making" a surgical screw does not take into account the scientific development and so forth that have to be paid for too. Nor the £100,000 salary of the sales rep - your average B&Q sales stacker isn't on quite that much, and your average B&Q screw is not super-fine (something that is more complicated and costly to achieve without losing structural integrity) and is not produced (and shipped and stored) in a sterile environment.

There's the root of a potentially interesting article here - the paper could take a serious look at the problem of medical suppliers charging unjustifiably large prices to the NHS, driving up the cost of treatment and reducing the number of patients who can be treated as a result. But this doesn't fit with the Mail's agenda. Far from it. The paper despises the NHS, seeing it as a socialist construct packed with "pointless" managers and bungling foreigners.

So this story draws the staggering conclusion that the problem lies with the NHS and that the only way to overcome it is for the NHS to learn "smarter shopping". The deranged commenters agree, one saying that supermarket managers should be brought in because they know how to drive down costs (chiefly by bankrupting farmers, but that's another story). The angle here perfectly reflects the paper's take on Avastin, the bowel cancer drug that costs £21,000 per patient. All coverage focussed on how evil bureaucrats at NICE were denying people the drug because it's too expensive. At no point did they question WHY it's so expensive.

As a final thought, can you imagine the horrified Mail headlines if it was revealed that the NHS WAS buying its hip screws at B&Q?