Letters Mid Staffs inquiry

More questions than answers in Mid Staffs mortality investigation

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1173 (Published 05 March 2013) Cite this as: BMJ 2013;346:f1173
  1. David I Ben-Tovim, clinical epidemiologist1
  1. 1Flinders Medical Centre and University, Bedford Park, South Australia 5042, Australia
  1. david.ben-tovim{at}health.sa.gov.au

One indication of the problems at Mid Staffordshire Hospital was a consistently raised hospital standardised mortality ratio (HSMR). Hawkes investigated whether the BMJ was used as part of a “concerted effort” to discredit the HSMR.1 Hawkes examined the actions of all parties except those of the BMJ itself.

The 19 March 2009 edition of the BMJ contained a report of the Healthcare Commission’s damning criticism of Mid Staffordshire Hospital and a research paper that questioned the validity of HSMRs on statistical grounds, using data from named hospitals including Mid Staffs.2 3 The authors stated that any claims that variations in HSMRs “reflect differences in quality of care are less than credible.” An editorial broadly endorsed that view. The BMJ continued to publish articles that criticised HSMRs. Taken together, those critiques have had “a noticeable influence on clinical opinion.”4 Yet the events at Mid Staffs clearly show that it is only too credible for a raised HSMR to point to poor standards of care.

Public reporting of hospital performance is controversial. It is legitimate for journals like the BMJ to look carefully at the measures involved. It is the timing of the initial critical articles that raises questions.

The BMJ’s editor, Fiona Godlee, stated that the 2009 article critical of HSMRs was published on the same day as a Healthcare Commission report into Mid Staffs “at the authors’ request.”5 Was the BMJ aware of the Healthcare Commission’s findings when it agreed to the request? Does the BMJ usually publish articles on specific days at the request of authors? Is this a service offered to all authors? If not, why on this occasion?


Cite this as: BMJ 2013;346:f1173


  • Competing interests: None declared.