Ben Goldacre, The Guardian, 15 April 2011
HM Government have issued a new leaflet to justify their NHS reforms: Working Together For A Stronger NHS. It was produced by Number 10, appears on the Department of Health website, and many of the figures it contains are misleading, out of date, or flatly incorrect.
It begins, like much pseudoscience, with uncontroversial truths: the number of people over 85 will double, and the cost of drugs is rising.
Then the trouble starts. In large letters, alone on one entire page, you see: “If the NHS was performing at truly world-class levels we would save an extra 5,000 lives from cancer every year.” The reference for this is a paper in the British Journal of Cancer called “What if cancer survival in Britain were the same as in Europe: how many deaths are avoidable?”
This study does not aim to predict the future: in fact, it looks at data from 1985 to 1999 (seriously) which is a very long time ago. It finds that if we’d had the mean EU cancer survival rates, in the 80s and 90s, then we’d have had 7,000 fewer deaths then. Not 5,000 fewer. And to put the big number in context, by this study’s calculation, that means 6-7% of UK cancer deaths were avoidable in the 1990s. Since then, we’ve seen the massive 2000 NHS Cancer Plan, a new decade, and a new century. This paper says nothing about the number of lives we “would save” each year in 2011, and citing it in that context is bizarre.
The next interesting figure misleads about a trend (we’ve seen this a lot from health ministers recently). The leaflet says: “since May 2010 the NHS has gained 2,550 more doctors and has 3,000 fewer managers”. This is correct: full-time equivalent figures (my favourite) from NHS workforce data show 97,720 doctors in May 2010, and 100,197 in December. Meanwhile NHS Information Centre figures show that the total number of doctors increased from 88,693 to 132,683 between 1999 and 2009; GPs have gone from 28,354 to 36,085; consultants from 21,410 to 34,654. Doctors take a while to grow.
Then we have choice: “95% want more choice over their healthcare”. The source given is the British Social Attitudes Survey. Interestingly, the government have just announced that they’re going to
abolish stop funding the health questions on the British Social Attitudes Survey. The data was collected in 2007, and if you download it yourself you’ll see they didn’t ask about “more choice”. Question 583 asks how much choice do you think NHS patients currently have, and 584 asks how much choice do you think they should have.
How they aggregated those responses to get 95% for “more choice” – a key justification for reform – is a mystery: many people will have said they have “a little” and they should have “a little” (we can’t see how many, without respondent-level data). I asked how they produced their figure, since BSA25 doesn’t have data on “would you like more choice”. They told me the source was table 3.1 in Chapter 3 of a book that costs £52, called “Do people want more choice and diversity of provision in public services”.
I got that book: it’s the same old BSA25 data, it doesn’t contain anything on “more choice”, and the title is not: “Do people want more choice…”. It’s: “Do people want choice…” This stuff matters, especially if you waste my time going to a library, but more importantly: the facts in this plainly political pamphlet should be clean, correct, transparent, and justified. As the government defies all reason by claiming that NHS staff support their reforms, I can only fear the results of their listening exercise.
More: See comment below for an attempt to calculate these figures from individual respondent-level data in the BSA. The BSA funding was cancelled, the survey itself was not abolished, correction here!