Intended for healthcare professionals

Analysis

Increased mortality associated with weekend hospital admission: a case for expanded seven day services?

BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4596 (Published 05 September 2015) Cite this as: BMJ 2015;351:h4596

No copy of the paper was shared with the Department of Health by ‘any of the authors’ in advance of publication

‘Around 6,000 people lose their lives every year because we do not have a proper 7-day service in hospitals. You are 15% more likely to die if you are admitted on a Sunday compared to being admitted on a Wednesday.’
- Jeremy Hunt, King’s Fund Speech, 16/07/2015. [1]

‘the 6,000 figure is an estimate of additional deaths in hospital, based on an analysis of 2013/14 HES data that is due to be published in the BMJ shortly’
- Department of Health Statement, 16/07/2015. [Figure 1], corroborated by [2].

Many individuals have raised the question as to how the Secretary of State for Health knew the conclusions of this paper for his statement/press release on 16th July 2015 [3] [4], when the BMJ only made a provisional offer to the authors to publish the paper on 29th July 2015 following peer review, and there was a BMJ embargo on any publication before September. Prof Pagano has stated ‘no copy of the paper was shared with the Department of Health by any of the authors in advance of publication’ [5].

Through Freedom of Information requests, we have acquired an email sent by NHS England saying that for his statement on 16/07/15 the Secretary of State was briefed by the firm Deloitte, who had seen the upcoming Freemantle paper as part of modelling work for NHS England [Figure 1]. Prof Pagano, Sir Bruce, and Prof Freemantle all received this email. Prof Pagano even recognised the events of the 16th July ‘may seem to interfere with the peer review process’ [Figure 1].

If this email is correct, it would be difficult now to assess the impact of any disclosure on the peer-review process, and the ensuing integrity of the paper. It is not stated the extent or precise nature of the disclosure to Deloitte, or what the Secretary of State was briefed on. There could however always be the possibility that the peer-reviewers or BMJ editorial team might have been inadvertently influenced by the intense media coverage at the time, not knowing it was the data in front of them that was being quoted. The BMJ editorial team were also denied the opportunity to consider whether this government link, governmental pre-planned politicisation of the results, or breaking of the BMJ embargo could have affected the integrity of the paper in any other way.

Yes, Prof Pagano may be word-for-word correct by saying it was not ‘any of the authors’ who shared the paper with the DoH, but ultimately the DoH must have obtained the study's key data indirectly from the authors via a mechanism that has yet to be clarified.

What we need is a full and frank declaration from the authors which specifies exactly what data from this paper was shared, by whom, when, and with whom for this incident (and any others that occurred) so the medical community and the public can make up their own minds. For example, there still remains to be found how the DDRB knew about the paper's results before publication. The independent DDRB report describes the 2013-14 mortality data in Table 2.1 and cites NHS England as the source [6]. Should any new declaration from the authors reveal issues incompatible with a correctly peer-reviewed, unbiased paper, I hope the BMJ will consider retracting the paper.

Dr Jonathan P Sturgeon
Paediatrics Trainee
South London

Mr Benjamin JF Dean
Orthopaedic ST5
Thames Valley HEE
@bendean1979

(1) https://www.gov.uk/government/speeches/making-healthcare-more-human-cent...
(2) https://twitter.com/janedreaper/status/621698323473399808
(3) Hall AS. Re: Increased mortality associated with weekend hospital admission: a case for expanded seven day services? Rapid response to BMJ 2015;351:h4596
(4) Dean BJF. Questions need answering...... Rapid response to BMJ 2015;351:h4596
(5) Pagano D. Re: Increased mortality associated with weekend hospital admission: a case for expanded seven day services? Rapid response to BMJ 2015;351:h4596
(6) Contract reform for consultants and doctors and dentists in training – supporting healthcare services seven days a week. Review Body on Doctors' and Dentists' Remuneration and Office of Manpower Economics. 16th July 2015.

Competing interests: JS – Member of the BMA, and Junior Doctor providing weekend care. BD – no competing interests

03 February 2016
Jonathan P Sturgeon
Paediatrics Trainee, London
Mr Benjamin JF Dean
London SW12