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A seven day NHS

BMJ 2016; 352 doi: (Published 02 March 2016) Cite this as: BMJ 2016;352:i1248

Rapid Response:

Undeclared competing interests do not ‘worry’ the BMJ’s editor

I read the BMJ’s recent coverage of the controversial Freemantle 2015 study with great interest1, 2. It is revealing that it does not strike the BMJ editor-in-chief Fiona Godlee as ‘ worrying’ that the authors did not reveal that their study was commissioned by NHS England itself. The remarkably close working relationship between NHS England, the Department of Health (DH) and No10 has been revealed in recent months.Saliently there have been more than one example of NHS England and the DH collaborating to produce somewhat misleading press releases to serve the government’s and authors’ interests in the coverage of the Freemantle study, while the DH have stated that “the government is in constant dialogue with NHS England on all important NHS issues, which obviously includes seven day services.”3, 4. Abi Rimmer’s article makes it clear that this shambolic collusion is far from being adequately explained “It remains unclear, however, why two versions of the same figure were calculated”1. Notably the BMJ uses the ICMJE’s competing interests declaration form which asks:

“Are there other relationships or activities that readers could perceive to have influenced, or that give the appearance of potentially influencing, what you wrote in the submitted work?”

It is difficult to see how the undeclared commissioning of the work by NHS England cannot constitute a clear undeclared conflict of interest. The fact that this work was commissioned by NHS England as part of their extensive body of work on 7 day reforms, following on from previous unpublished work by Deloitte, should have been declared openly to readers to reveal the true political context for the study. Fiona Godlee tries to gloss over this failure1:

“The fact that one of the authors was NHS England’s medical director would anyway indicate the origin of the idea for the reanalysis.”

This is deeply inadequate, one cannot expect readers to guess who commissioned research from one of the affiliations of the many authors, as authors should be expected to honestly declare such basic information. The fact remains that the authors did not reveal who had commissioned their study, and moreover the statement “This article arose from a request by BK to update our earlier analyses with more recent data” can be argued to be overtly misleading. Events have proven that NHS England does not act in an operationally independent manner from the DH3, 4, and as such the Freemantle study cannot be perceived as independent of NHS England, and by extension the government. Jeremy Hunt has tried to gain political capital by misleadingly referring to the Freemantle study as ‘independent’5 and in this context Fiona Godlee should be deeply worried by the failure of the authors to openly declare who commissioned the study. At bare minimum the study should be formally amended to declare this clear competing interest.

1. Rimmer A. The BMJ paper and seven day services. BMJ (Clinical research ed) 2016; 352.
2. Godlee F. A seven day NHS. BMJ (Clinical research ed) 2016; 352.
3. Sturgeon J. A new collaboration with the Department of Health. BMJ (Clinical research ed) 2016;
4. Sturgeon JD, BJF. No copy of the paper was shared with the Department of Health by ‘any of the authors’ in advance of publication. BMJ (Clinical research ed) 2016;
5. Campbell D. Guardian 2015;

Competing interests: No competing interests

04 March 2016
Benjamin JF Dean
Orthopaedic Registrar
Professor Alastair Hall, Jonathan Sturgeon