Intended for healthcare professionals

Feature Statistics behind the headlines

Have there been 13 000 needless deaths at 14 NHS trusts?

BMJ 2013; 347 doi: (Published 07 August 2013) Cite this as: BMJ 2013;347:f4893
  1. David Spiegelhalter, Winton professor for the public understanding of risk, University of Cambridge
  1. d.spiegelhalter{at}

David Spiegelhalter examines the latest media outrage over excess hospital deaths and concludes that most of the media (and parliament) seem incapable of understanding that half of all trusts will always have above-expected mortality

Before the release of the recent Keogh report into 14 NHS hospital trusts in England with apparently high mortality,1 the Sunday Telegraph and other newspapers reported that “13,000 died needlessly at 14 worst NHS trusts.”2

And yet the Keogh report, when published in July, was notable for its careful thoroughness and said nothing whatsoever about numbers of deaths. Indeed, when discussing the use of measures of mortality such as the standardised hospital mortality indicator (SHMI) and hospital standardised mortality ratio (HSMR), Keogh said: “It is clinically meaningless and academically reckless to use such statistical measures to quantify actual numbers of avoidable deaths. Robert Francis himself said: ‘It is in my view misleading and a potential misuse of the figures to extrapolate from them a conclusion that any particular number, or range of numbers of deaths were caused or contributed to by inadequate care’.”1

So where did the “13,000” come from? It is the difference between the observed and “expected” number of deaths in …

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