The Hospital Manager’s Association
Top Secret – Eyes Only
The Hospital Manager’s Guide to Massaging HSMRs
Members will be aggrieved to hear that the Doctor Foster Intelligence Unit and its lottery hospital standardised mortality ratios (HSMRs) are here to stay, despite several recent papers showing the methodology to be unsound.
Members will appreciate that they supply the raw data used by Dr Foster, thus providing opportunities to ‘cook’ the figures before they are passed to Dr Foster. The Association does not condone directly tampering with the data; however, faced with the intractable use of flawed statistics, the Association does believe members are entitled to ‘game’ the system to their advantage.
Jim Naughtie, interrupter-in-chief on Radio 4’s Today program, this morning scaled new heights of discourse interruptus, peppering a hapless Professor Dame Marilyn Strathern with tiresome ejaculations of febrile nuisance. One might presume that the Dame – who was until last year Mistress of Girton College, Cambridge – might be an expert in putting naughty boys in their place, but she was no match for Naughtie Jim.
This week’s episode of Dr Who showed early promise, with khaki tea-making squaddie daleks, complete with Union Jack logos, but started to unravel the moment Ian McNeice started impersonating Robbie Coltrane, instead of playing Churchill, and descended into farce when the Lego-inspired bootylicious make-over daleks arrived. There was but one consolation: Bill Patterson, late of Sea of Souls, was finally revealed, as has long been suspected, as an alien.
The origins of the phrase ‘balls-up’ are obscure. Some say that it arises from an awkward sexual encounter, but Dr No prefers a nautical origin. A vessel aground can be said after a fashion to be anchored, in that it is attached to the sea bed; and it is also unable to manoeuvre, or ‘not under command’, as the rules have it. A vessel at anchor carries one black ball, a vessel not under command two black balls, and thus a vessel that has run aground and is in trouble carries three black balls, a situation commonly and naturally referred to as a complete balls-up. 
There has been much ado about hospital death rates lately, much of it focused on the Mid Staffs hospitals, where consistently high apparent death rates were repeatedly brushed aside and ignored. The issue at stake was the validity – or not – of certain statistics produced by 
Sometimes Dr No has wacky ideas. One of his favourites is that all of time has already happened. Like a film in a can, it is all there, beginning to end; and, like a film, we see it sequentially, frame after frame, and that is what gives us the illusion of movement, and of the arrow of time. Sometimes he goes a little further; and, seeing the film strips lying in coils side by side on the reel, wonders whether we might, just might, if the conditions were right, be able to read the film not sequentially on the strip, but radially, on the axis of a spoke, and so be able to see, perhaps even move, backwards and forwards in time.
Unlike the well-fed DoH poodles at the