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No mater what the academic arguments the mortality data must be taken seriously. Interesting to note that the prime example of North Cumbria University Hospitals, already pinpointed as a big issue by the Keough review and taken over a couple of years ago by another poor performer with higher than average death rates, hse been outed by Dr Foster. So lets not just dwell upon methodologies but dig down to the facts that have already been exposed in a number of secondary care outfits right across the NHS. Stick with it Professor Jarman and of course you do have your former colleague Tim Kelsey now strategically placed in the Kremlin. Thank you HSJ for a balanced piece with I am sure more yet to come.