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The mysterious Dr Foster

BMJ 2009; 339 doi: (Published 02 December 2009) Cite this as: BMJ 2009;339:b5242
  1. Nigel Hawkes, freelance journalist
  1. nigel.hawkes1{at}

    A consultancy’s dire warnings about safety in many of the UK’s hospitals dominated the weekend headlines. But were their warnings right? Nigel Hawkes reports

    Who is this Dr Foster, the source of the weekend’s headlines about the NHS? He seems to be saying that the elaborate system for inspecting hospitals set up—and recently reformed—by the government is missing some pretty obvious examples of bad medicine.

    Thousands of patients dying, hospitals failing to respond to safety alerts or unexpected deaths, swabs and drill bits left inside patients after operations ... isn’t this the kind of thing any respectable government inspector might be expected to spot? What on earth is going on?

    Dr Foster is not, of course, a doctor at all, but a witty name chosen by two journalists when they set up a healthcare analysis company eight years ago to exploit the mass of data churned out by the NHS (“Dr Foster went to Gloucester, in a shower of rain…”).

    Tim Kelsey from the Sunday Times and Roger Taylor from the Financial Times saw an unexploited commercial opportunity in the work of Professor Sir Brian Jarman of Imperial College. Measuring how well hospitals perform is not an easy task, but Professor Jarman had devised a way of doing it by using Hospital Episode Statistics (HES), data produced in huge volume by the …

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