It is surprising that the Guardian gives any credence to the statistics of hospital mortality promoted by Sir Brian Jarman on Channel 4. Hospital death rates, particularly if followed over time, can give useful warning of problems, as Sir Bruce Keogh has stated. However comparison of such data internationally is fraught with difficulties, as we found when we first published the European Atlas of Avoidable Deaths in 1988. Since total mortality rates in the UK are similar, or lower, than in the United States, as a large proportion of the population in both countries die in a hospital such a difference seems unlikely.
To compare hospital mortality rates between hospitals, whether in one or more countries , it is necessary to take into account such factors as length of time in hospital, availability of discharge facilities, e.g. hospices, hospital admission criteria and many other procedural and cultural factors. Comparison of outcomes for individual conditions is even more difficult because of differences in diagnostic and coding procedures which have been illustrated many times. Unfortunately the data presented by Jarman in both your paper and Channel 4 is inadequate to determine the validity of the conclusions or the methods used. This is a striking media story but, unfortunately has not been subjected to proper scrutiny.
Walter Holland.
MD, FRCP, FFPH
Visiting Professor
London School of Economics