Sunday 21 July 2013

Yet another review...

As promised, here's a review into how the BBC covered the Keogh report into NHS care on Tuesday.

The question, as ever, remains 'Is the BBC biased?' 

How can we tell though? How can we guard against seeing the BBC as biased even if it's actually us, ourselves, who are the ones who are really being biased (an easy trap to fall into)? 

One way might be to look back over last week and list the main talking points of the Labour Party and the Conservative Party over the story and try to see if the BBC trod an impartial course between the two sides of the story. This is for those of us who, like the BBC, care deeply about such things.

Hopefully, you will find these lists to be a fair representation of each side's main talking points:

Labour's talking points:
- That the 13,000 'needless death' figure was Tory propaganda.
- That the Tories have been playing party politics with people's lives, exploiting the Keogh report for partisan advantage.
- That the Keogh report said more about what was happening on the Coalition's watch.
- That the main problem was fewer nurses, thanks to Coalition cuts.
- That the focus should be on Lynton Crosby and his 'lobbying' of the government over tobacco packaging rather than on Labour's links to the unions. 
The Conservatives' talking points:
- That the report found there were thousands of 'needless deaths' in the NHS.
- That the Labour Party bears a lot of responsibility for what the Keogh report found.  
- That Labour was playing party politics when it was in office and suppressed concerns about poor NHS care.
- That the hospitals put into special measures had more nurses than in 2010.
- That the Lynton Crosby story is a non-story puffed up by the Labour Party. Labour's links to the unions are the real story.

Let's take each of the main Radio 4 current affairs programme's in turn - and then add Newsnight for good measure. 

Andy Burnham still looked likeliest to be "in the dock" on Tuesday morning, given the non-BBC media's (mis)reporting of the build-up of the Keogh report over the preceding day. The 6.30 discussion on Today between John Humphrys and the BBC's Adam Brimelow didn't put him in the dock at all though, not even mentioning him.

Similarly the programme's first guest on the subject (at 7.10) chose not to put Mr Burnham in the dock either. Nor was he invited to do so by John Humphrys. This was Professor John Ashton, an NHS chief in Cumbria and a prominent critic of the present government's health reforms. Professor Ashton, you may recall, got into a spat with the Conservative Party when it accused him of not being an independent spokesman on the issue, given his lifelong membership of the Labour Party. Professor Ashton refutes that totally. Anyhow, that's all ancient history and John Humphrys made no mention of any of this when introducing Professor Ashton here.

Professor Ashton said it had been hard to get a grasp on the problem until the spate of infant deaths at Barrow made the problem clearer. He blamed the strategic health authority, not the government (of the time?) for failing to get to grips with the issue. He denounced targets and the "privatising" of the health service and ended by attacking the political "game" and expressing his concerns about the "private sector in medicine", which prompted an "Mmm, sobering thought!" from John Humphrys.

Andy Burnham was the man in the dock, however, at 8.10 - and he faced the Today programme's most feared rottweiler, John Humphrys himself.

First though we heard from Professor Brian Jarman, the man behind the 13,000 'needless death's figure. He's from the Dr Foster group at Imperial College. John asked him for his views on the last Labour government and what he felt was going on at that period. Professor Jarman made his criticisms, with John Humphrys only interrupting to stop him saying what Andy Burnham had said at a meeting, and goading him on to make the charges explicit. So, the Conservative Party's main talking points were given a thorough airing here - and only here.

Andy Burnham then came on to defend himself from the charges Professor Jarman had laid out. He did so with the utmost vigour. John Humphrys wasn't quite the rottweiler he usually is here, interviewing Mr Burnham in a surprisingly gentle tone. Why? Was it because he felt that the charges against Andy Burnham being made by Professor Jarman were too serious for knockabout interviewing? In other words, was he being kind? He certainly didn't give Andy Burnham a free ride but neither did he give him the sort of grilling listeners might have expected in the circumstance. Only when Professor Jarman re-entered did Andy Burnham feel the pressure build again, as the professor quoted a dodgy e-mail from the Department of Health to Ben Bradshaw. Mr Burnham attacked the Coalition again in response.

The Today live page that day selected only one quote to accompany this story:

Andy Burnham says care in the 14 hospitals being investigated by Keogh have deteriorated under the Coalition@bbcr4today

The World at One was being broadcast as the debate in the House of Commons was getting under way but before the report's official launch. Presenter Shaun Ley and BBC health correspondent Adam Brimelow began by anticipating the debate and the report. Adam immediately stressed staffing levels (especially nurses) as a "key area" and said that nursing levels have fallen "since the general election in 2010" by 4,000 but that "overall the number of clinical staff [especially doctors] has increased quite substantially". So that's a Labour talking point balanced by a Conservative talking point. The response of Basildon's hospital was then discussed.

The programme later featured an interview with the mother of a man whose treatment in one of the hospitals. Though she described herself as "a huge supporter of the NHS" and paid a the warmest of tributes to it, she described what she experienced with her son's treatment at the hands of one "bit" of the NHS as "degrading" and "inhuman" at times. She saw staff mocking patients, for example. "Arrogance" and "a lack of human compassion" were what she found. 

Next Shaun discussed the ongoing parliamentary debates with BBC correspondent Gary O'Donoghue, who described them as "absolutely extraordinary" in their "bitterness and rancour". He contrasted Jeremy hunts attacks on Labour (just as Labour were to do) with David Cameron's non-partisan approach earlier in the year after the Mid Staffs [Francis] report. GO'D said there "was a bit of truth in both of the analyses" [of Labour and the Conservatives] over the issue, but stressed that the government had chosen to go "on the front foot over Labour's record on the NHS" - echoing Allegra Stratton's point the previous night on Newsnight. Labour talking points outweighed Conservative ones here, but not to a significant extent. 

Next up came an interview with Radio 4's main NHS whistle-blower, Gary Walker, formerly of the Lincolnshire Trust, who wondered where the Department of Health has been over these years. He said the party political game playing was "an awful thing". Yes, he said, the last Labour government placed too much emphasis on targets and "placed reputation above patient safety" but said he'd seen an e-mail from Andrew Lansley to his local MP cautioning him against raising concerns about one of the hospitals concerned. He said that the problem was that the same leadership has been in place at the NHS for many years. Shaun raised Bruce Keogh's concerns about using the mortality rate (13,000) figure, but Mr Walker found such figures a useful warning signal. 

The programme had lined up, however, an expert who is known to be a leading opponent of the use of such mortality figures, Professor Richard Lilford of Birmingham University. He said that overall death rates are irrelevant to the debate. Preventable death rates are the thing. We should shut out "the noise" of overall death rates, he said. He denounced the use of the excess deaths figures that we all got to know so well before the report was launched (13,000 needless deaths) as "not responsible". You could say that all of this backs up a Labour talking point, despite Professor Lilford's independence. No political capital was made of it though.

Finally, Shaun interviewed Labour MP Ann Clwyd, who had painful personal experiences of poor NHS care. He asked her first about low staffing numbers, then asked her again about the number of nurses and the culture of the NHS. His third question was about the "party political bun-fight" in the Commons and whether that troubles her. She said that blaming the last Labour government is wrong and that the issue shouldn't be used as a political football. I got a strong sense that Mrs Clwyd had wanted to talk more about the problems she and others had encountered with the NHS (germane to the Keogh report) but kept getting diverted onto the issues Shaun wanted her to talk about instead.

Though much more nuanced than the edition of PM which followed, this edition of The World at One was still clearly closer to Labour's talking points than to those of the government.

PM's coverage - which was the first to follow the official launch of the review - began with a report from BBC health correspondent Adam Brimelow, concentrating initially on the political angle. 

The starting point of this report was to quote Sir Bruce Keogh's letter to Jeremy Hunt saying "Now is not the time for hasty reactions and recriminations" and calling for a focus on clear accountability". Adam then said, "But that focus on accountability has quickly descended into a political blame-game which is threatening to overshadow the review's work." Cue an immediate clip of Jeremy Hunt. 

That tallied neatly with Labour's claim that Jeremy Hunt was playing politics. Adam himself didn't make that point explicitly but the conjunction of his introductory words and that clip of Mr Hunt made the implicit as explicit as possible. 

So that's one of Labour's talking points covered. 

Immediately afterwards came an amplification of that point, plus a second Labour talking point for good measure:
"When presenting his findings Sir Bruce Keogh insists that he was looking at the present not the past, but the lead-up to this review has been dominated by discussions over mortality data going back in some cases over a decade, prompting reports over the weekend of 13,000 excess deaths at the 14 trusts since 2005 - a figure that was not used by Sir Bruce; indeed, he warns that using these mortality measures to quantify avoidable deaths is 'clinically meaningless and academically reckless'. The government has denied briefing the figure to the media but the shadow health secretary Andy Burnham accused Mr Hunt of 'one of the most cynical spin operations of recent times' and 'demeaning the office of health secretary'"
Adam's report then moved onto the findings of the Keogh report and a short excerpt of a lady describing the shocking treatment her relative had received at one of the hospitals concerned. This was the shorter half of the report.

Eddie Mair then interviewed Sir Bruce Keogh. So "what makes a story?" here (in Charles Moore's words) for Eddie?

Well, he first asked Sir Bruce about the 13,000 'needless deaths' figure and where he thought it came from. Sir Bruce said the figure was "a perfectly legitimate...statistical construct" though he took issue with some of the media reports which used it to make various assumptions. [This reflected better on that 13,000 figure than might have been expected]. 

One Labour talking point down. 

Eddie then quoted Sir Bruce's own words from the report [quoted in an earlier post] denouncing those figures, encouraging him to expand on that point. 

So that's the same Labour talking point repeated.

Sir Bruce said such measures "are important and have their use" [so NOT the ringing denunciation many of us were led to believe Sir Bruce was making of the 13,000 figure and the methodology behind it] but stressed the difference between inevitable and avoidable deaths. He said we should focus on avoidable deaths.

Eddie then moved onto the issue of politicians and their "hasty reactions" - a second Labour talking point. Sir Bruce refused to oblige, despite Eddie's pressing, and said all the politicians he'd met that day had been "very helpful". He went on to praise Jeremy Hunt's reaction. 

Eddie next asked about staffing levels - the fall in the number of nurses at the hospitals in recent years...which is another of the five Labour Party talking points. Sir Bruce said that he was unsure about such a direct statistical link, though he suspected there was a relationship - but if it existed it was only a part of a range of possible causes, he said. 

The other interview in PM was with Jeremy Hunt. Someone at Biased BBC described Eddie's tone here as "prickly". That's as good an adjective as I could choose for the interview. The answer to Charles Moore's question "Who's in the dock?" here was very definitely Jeremy Hunt - and Eddie was the prosecuting barrister. For Tory-supporting listeners it must have made for an uncomfortable listen. For anti-Tory listeners it must have been a hoot. Eddie is brilliant at this sort of thing. 

Eddie began by putting to him a serious of rapid-fire questions from Peter Walsh of the charity Action Against Medical Accidents about the safety of the hospitals in question, about the robustness of the regulatory system (interrupting him while he was answering) and whether those responsible will be held to account. Within two minutes Eddie turned to staffing levels - i.e. the number of nurses. (Labour talking point, interrupting him while he was answering, twice). Eddie gave Mr Hunt ample time to answer here.

Then came the abrupt change of the issue of tobacco packaging and David Cameron's chief advisor Lynton Crosby - a fourth Labour talking point. 

Eddie had an excuse ready for this: "I want to ask you about this because no ministers were available to us on Friday"

This was a classic BBC ambush, brilliantly staged. Mr Hunt was caught somewhat unawares, though he survived the encounter during which Eddie asked him if "something funny" was going on. The questions came thick and fast. I counted 15 points in this part of the interview from Eddie. Jeremy Hunt was in the dock, and the prosecutor (Eddie Mair) turned up the heat to full intensity. Jeremy Paxman, eat your heart out!

Statistically speaking, the interview broke down as being 4 minutes 17 seconds spent on the Keogh report [the story of the day] and 5 minutes 37 seconds spent on tobacco and Lynton Crosby [the story of the previous week]. You don't have to accept any kind of wild-eyed conspiracy theory that the BBC and Labour work are working hand-in-hand to admit that the bulk of this interview would have absolutely delighted the Labour Party, were it listening.

PM had the lion's share of Labour talking points. Neither Adam Brimelow nor Eddie Mair raised any Tory talking points. 

Still, the programme did interview a Tory politician - and only a Tory politician, even though Eddie made sure that he wasn't given any space to attack Labour. 

The World Tonight began with a short report from the BBC's Danny Savage the Royal Blackburn Hospital on what the Keogh Report said about the hospital and what's likely to happen there now. 

Then it was only the 13,000 'needless deaths' figure. We heard again from Professor Nick Black of the Keogh review team. He attacked the mortality rate figures and accused Brian Jarman of being "irresponsible", "very cruel" and of "lacking compassion" in scaring people over this. Ritula Shah asked him why he thought the government "allowed that discussion to continue unchallenged" and said "even today" Jeremy Hunt had been claiming thousands of avoidable deaths. Professor Black denounced Mr Hunt as being "out of order". He describes it as "reckless". He was not happy with the political debate that day, though he explicitly defended Andy Burnham, saying he had no alternative but to respond in the way he did. 

To further discuss the political debate, Ritula then talked to Conservative MP Stephen Dorrell (a "friendly critic" of the government's health reforms) and Labour's Andrew Gwynne (another, rather less friendly critic of the government's health reforms). Ritula began with those 13,000 'avoidable deaths'. As he did on the previous night's Newsnight and the following morning's Today, Mr Dorrell remained resolutely non-party political - unlike Labour's Mr Gwynne, who attacked the government and robustly defended his own party.  Ritula did suggest to Andrew Gwynne that Labour might have raised the debate by acknowledging the issue earlier. She then asked Stephen Dorrell if he was "dismayed" at Jeremy Hunt's "politicisation of the debate". He didn't defend Mr Hunt. 

As you can see, must of The World Tonight's coverage focused on the nature of the political debate and on that 13,000 'needless deaths' figure.

Moving mediums, that night's Newsnight immediately sprung onto those "lurid" headlines at the weekend about the 13,000 'needless deaths'. The report found "mediocrity" instead. 

Susan Watts's report began with the "political blame game". 20 seconds were given to Jeremy Hunt's attack on Labour, 32 seconds to Andy Burnham's assault on the Conservatives. [Former Labour advisor, not mentioned] Chris Ham of the King's Fund attacked the political squabble. Susan then outlined the review's findings. We heard from the boss of George Eliot Hospital NHS trust, outlining its response, and from someone from the Dudley Group NHS Trust, accepting the findings. Sir Bruce Keogh then appeared reassuring us all that immediate safety issues have now been resolved. The '8 achievable ambitions' were then outlined. Susan then discussed the review's scepticism about the mortality rates (13,000 'needless deaths') data. We heard from Professor Nick Black of the Keogh review team again [see The World Tonight], who "doesn't set much store" by such figures. He prefers case reviews instead. 

Emily Maitlis then interviewed Jeremy Hunt (and only Jeremy Hunt). He was firmly in the dock again. 

Emily's opening question expressed a Labour talking point:
"Jeremy Hunt, this is a major report today into an issue of major concern for the entire country. Why would you choose to make such blatant political capital out it?"
Her three following questions followed up on this same point.

She then moved onto a second Labour talking point and pressed him (with many an interruption) on the 'excess deaths' figure (five questions, at least).  

She moved onto pressing him on long it would take for progress to show up.

Then, just as happened on PM, Emily switched to the next Labour talking point - Lynton Crosby - and pressed him on that. She made a mere 9 points to him about it, compared to Eddie Mair's 15. That part of the interview took up 1 minute 52 seconds, the earlier part 5 minutes 15 seconds....

...but the programme then moved onto its next the wake of Jeremy Hunt's denials about Lynton Crosby...

...lobbying. The report from Zoe Conway again mentioned Lynton Crosby, tobacco, lobbying and Labour accusations about the Conservatives. Yep, Lynton Crosby.

When the discussion between Lord Bell and Sarah Wollaston MP followed, Emily immediately began by asking Lord Bell about Lynton Crosby. Yep, Lynton Crosby. Her questions then returned to the Lynton Crosby story again and again. Lynton Crosby, Lynton Crosby, Lynton Crosby.

"What makes a story?", as Charles Moore might say.

I think we can safely say that Newsnight reflected Labour talking points much more than it reflected Conservative talking points, despite the presence of a number of Conservative spokespeople on the programme (Jeremy Hunt, Lord Bell, Sarah Wollaston). The "Who's in the dock?" and "What makes a story?" questions outweighed the guest selection question here. 


Well, my review was probably about as impartial as an edition of the Today programme! You will have to listen for yourselves (while you can) to judge the fairness of my reviews. 

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