The following year, a House of Commons committee raised serious concerns about the legality of the acquisition, describing it as a "hole and corner deal".
The National Audit Office was prompted to investigate by "a letter from an anonymous whistleblower who expressed concern about the legality of the joint venture".
[11] Committee chair Edward Leigh was reported as saying: "By pursuing its back room deal with Dr Foster LLP, the Department of Health failed in its duty to be open to Parliament and the taxpayer."
He added that Treasury guidance on joint ventures between public and private sectors was ignored – instead the deal was "handed to Dr Foster on a plate".
This was the first time that such a comparative measure of quality had been published for a national health economy anywhere in the world and it revealed widespread variation in adjusted death rates between English hospitals.
Its latest edition was published in November 2012 and it identified a number of underperforming hospitals in England and a higher risk of avoidable mortality at the weekends.