Failure to ensure accurately declared provenance of Freemantle 2015

“It is the responsibility of everyone involved to ensure that the published record is an unbiased, accurate representation of research.” [X1]

The failure of the Freemantle 2015 study's provenance, published in the BMJ in September 2015, to be accurately declared has been demonstrated by a significant body of evidence detailed below. As a result the study in its current form is misleading to readers. This failure to accurately declare the study's provenance has been exploited by both Jeremy Hunt and the Department of Health, who have repeatedly cited this study as 'independent' when using this study to justify their controversial 7 day NHS reforms.

The British Medical Journal (BMJ) has not to date, responded to a detailed complaint, which outlined the detailed evidence listed below which accurately details the study’s provenance. The BMJ is as an internationally respected institution and has a pedigree for quality of academic research worldwide. BMJ publications which originate from, or exert a profound influence on, government health policy should accept the same level of scrutiny, no matter the results of the study. A failure to accurately declare a study’s provenance is not adequate, whether this relates to the role of the pharmaceutical industry or any other organisation.

X1. PLoS Medicine Editors. An unbiased scientific record should be everyone’s agenda. PLoS Med2009;6:e1000038.

The petition is supported by

Dr Benjamin Dean, Professor Trish Greenhalgh, Professor Alastair Hall, Dr Phil Hammond, Dr Rachel Clarke, Dr Johann Malawana, Dr Lauren Gavaghan, Dr Dominic Pimenta, Mr Simon Fleming, , Professor David Colquhoun, Dr Zoe Norris, Dr David Wrigley, Dr Dagan Lonsdale, Dr Taryn Youngstein, Dr Jeeves Wijesuriya, Dr Louise Irvine, Dr Kambiz Boomla, Dr Jackie Applebee, Dr Anna Livingstone, Miss Stella Vig, Dr David Nicholl, Dr Jonathan Sturgeon, Dr Ben White, Professor Chris Oliver, Dr Philippa Whitford MP

Appendix of background and evidence

- The BMJ published this Freemantle study in 2015(1)
- It stated “This article arose from a request by Bruce Keogh to update our earlier analyses with more recent data” and did not mention any role of NHS England or NHS England’s CEO Simon Stevens in the commissioning of the study
- The Freemantle study has been widely, publicly cited on multiple occasions as an ‘independent’ study by the Department of Health and Jeremy Hunt(7,8)
- Bruce Keogh’s testimony from the Health Select Committee in 2016 states: “One of the challenges that Simon asked me to do was to go back and look at more recent figures to see whether the mortality still prevails”(2)
- The BMJ published an erratum in March 2016 which failed to mention the role of Simon Stevens in the origin of the study9 and a Bruce Keogh letter also failed to make clear the full origin of the Freemantle study(10)
- Letters published subsequently in the BMJ have provided further sources of evidence confirming the precise context and origins of Freemantle 2015 (3,11)
- An email sent on the 3rd February 2015 by a Deloitte employee to officials at NHS England including Bruce Keogh reveals the involvement of Deloitte and Simon Stevens(3). The main questions arising from this meeting involving Stevens, Keogh and Deloitte included ‘What is the clinical case for seven day services, especially re mortality?’ and the resulting action was documented as ‘Bruce agreed to have the mortality analysis from 2008 updated’.
- The BMJ Editor Fiona Godlee stated in August 2017 “The BMJ to which the authors have responded. They have said that this was not the case. The letters can be viewed on our website.”
- The ICMJE guidelines on conflicts of interest are clear and state "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?"
- The BMJ’s own guidance on provenance states ‘who had the idea for the article’
- The Oxford Dictionary defines commission as “An instruction, command, or role given to a person or group.”



1. Freemantle N, Ray D, McNulty D, et al. Increased mortality associated with weekend hospital admission: a case for expanded seven day services? BMJ (Clinical research ed.). 2015;351.
2. Hall A. Rapid response by Professor Alastair Hall BMJ (Clinical research ed.). 2015;http://www.bmj.com/content/351/bmj.h4596/rr-41.
3. Dean BJF. Further evidence relating to the study's background emerges. BMJ (Clinical research ed.). 2016:http://www.bmj.com/content/352/bmj.i1762/rr-1760.
4. Rimmer A. Watchdog warns pay review body over use of unpublished seven day working data. BMJ Careers. 2017;http://careers.bmj.com/careers/advice/Watchdog_warns_pay_review_body_over_use_of_unpublished_seven_day_working_data.
5. Hunt J. Hunt response to Hawking. Guardian. 2017;https://www.theguardian.com/commentisfree/2017/aug/27/stephen-hawking-nhs-wrong-policy-jeremy-hunt.
6. Hunt J. Hunt Tweet re Freemantle 'most comprehensive'. Twitter. 2017;https://twitter.com/Jeremy_Hunt/status/898666809456566274.
7. Hansard. Jeremy Hunt questions. http://www.publications.parliament.uk/pa/cm201516/cmhansrd/cm151013/debtext/151013-0001.htm#15101344000004. 2015.
8. DH. Department of Health summary of weekend effect evidence. https://www.gov.uk/government/publications/research-into-the-weekend-effect-on-hospital-mortality/research-into-the-weekend-effect-on-patient-outcomes-and-mortality. 2016.
9. Increased mortality associated with weekend hospital admission: a case for expanded seven day services? BMJ (Clinical research ed.). 2016;352(i1762).
10. Keogh B. Bruce Keogh rapid response 71. BMJ (Clinical research ed.). 2016;http://www.bmj.com/content/351/bmj.h4596/rr-71.
11. Dean B. The full political context was not adequately declared. BMJ (Clinical research ed.). 2016;http://www.bmj.com/content/352/bmj.i1762/rr.