The government has issued a new leaflet aiming to justify the latest round of redisorganisation in the NHS. This leaflet is called ‘Working Together For A Stronger NHS’. It was produced by Number 10, it appears on the Department of Health website, and many of the figures it contains are misleading, out of date, or factually incorrect.
The leaflet begins, like much pseudoscience, with some uncontroversial truths: the number of people aged over eighty-five will double, and the cost of drugs is rising. This is all true.
Then comes the trouble. In large letters, alone on one entire page, you see: ‘If the NHS was performing at truly world-class levels we would save an extra 5,000 lives from cancer every year.’ The reference for this is a paper in the British Journal of Cancer called ‘What if Cancer Survival in Britain were the Same as in Europe: How Many Deaths are Avoidable?’
This study does not aim to predict the future: in fact, it looks at data from 1985 to 1999 – seriously – which is a very long time ago. It finds that if we’d had the same cancer survival rates – more than twenty years ago, in the eighties and nineties – as the average in the EU, then we’d have had 7,000 fewer deaths per year. Not 5,000 fewer. To put the big number in context, by this study’s calculation 6–7 per cent of UK cancer deaths in the 1990s were avoidable. Since then we’ve seen the massive 2000 NHS Cancer Plan, a new decade, and a new century. This paper says nothing about the number of lives we ‘would save’ each year by 2011, and citing it in that context is entirely misleading.
The next interesting figure misleads about a trend (we’ve seen this a lot from health ministers recently) and attempts to take the credit for a long-standing change. The leaflet says: ‘Since May 2010 the NHS has gained 2,550 more doctors and has 3,000 fewer managers.’ This is correct: full-time equivalent figures (my favourite) from NHS workforce data show 97,720 doctors in May 2010, and 100,197 in December. But NHS Information Centre figures show that between 1999 and 2009 the total number of doctors increased from 88,693 to 132,683, GPs from 28,354 to 36,085, and consultants from 21,410 to 34,654. Doctors take a while to grow, and they’ve been growing in number for a good long while.
Then we have choice: ‘95 per cent want more choice over their healthcare’. The source given is the twenty-fifth British Social Attitudes Survey. Interestingly, the government has just announced that it’s going to stop funding the health questions in the British Social Attitudes Survey, so this valuable resource won’t be around for long. The data was collected in 2007, it’s free to download, and if you do so you’ll see it didn’t ask about ‘more choice’. Question 583 asks how much choice you think NHS patients currently have (‘a lot’, ‘a little’, and so on), and Question 584 asks how much choice you think they should have.
How those responses were aggregated to get 95 per cent of people in favour of ‘more choice’ – a key justification for reform – is a mystery: many people will have said they have ‘a little’ choice, and that they should have ‘a little’ choice (we can’t see how many from the aggregated data in tables of course; we need respondent-level data, because that’s the only way we can link together an individual’s responses to a sequence of questions). I asked the government how it produced its figure, since BSA25 doesn’t have data on the question ‘Would you like more choice?’ I was told the source was table 3.1 in Chapter 3 of a book that costs £52, called Do People Want More Choice and Diversity of Provision in Public Services.
I got that book: it’s the same old BSA25 data. It doesn’t contain anything on ‘more choice’, and they got the title wrong: it’s not Do People Want More Choice … It’s Do People Want Choice … which shows how misleading they’re being, and wasted me a lot of time in the library. None of this should be difficult. The facts in this plainly political pamphlet should be clean, correct, transparent and justified. As the government defies all reason by claiming that NHS staff support its reforms, we can only fear the results of its new ‘listening exercise’.