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Concern over 12 trusts' death rates

Death rates at 12 hospital trusts in England were alarmingly high last year, according to an influential report.

The number of patient deaths are above expected levels at the 12 trusts, the Dr Foster Hospital Guide found.

Patient safety is also being risked because hospitals are “full to bursting”, with many regularly breaching the 85% limit set in place to protect patients.

Figures shows that in 2011-2012 occupancy was running at 88% in midweek, while averaging 90% for 11 of the 12 months, excluding quiet periods including Christmas,

The Guardian, which has seen the report in full, added that the national level was over 85% for 230 of the 365 days of last year, and over 90% for 19.

Dr Andrew Goddard, the director of the medical workforce unit at the Royal College of Physicians, which represents hospital doctors, told the Guardian: “If you ask any doctor in this country they would say that the system is straining to burst; particularly in winter, but now it’s increasingly happening the rest of the year.

“Hospitals always seem to be full.”

The report, part of which has been seen by the Press Association, outlines concerns that there could be “another Mid Staffs” as hospitals are increasingly focusing on cost of care rather than quality of care.

Each of the 12 trusts fell short on two of four mortality rate indicators - which include deaths after surgery and the deaths of patients who were admitted for minor ailments or “low-risk conditions”.

“These measures are to be used as a warning sign that poor-quality care may be leading to a higher-than-expected mortality,” the report states.

The authors continue: “With the rising demand for care and falling revenues, there are concerns that trusts will focus more (or exclusively) on cost of care rather than quality of care.

“Because of this, there is a fear that there could be another Mid Staffs. Hospital managers must ensure that they do not sacrifice one for the other.”

The report also suggests that a shortage of senior doctors working out of hours could be linked to higher mortality rates at the weekends.

However, University Hospitals Birmingham Trust (UHB) - one of the 12 trusts named as having higher death rates in two categories - raised concerns about the validity of the Dr Foster indicators.

Dr Dave Rosser, medical director at the trust, said: “The HSMR (Hospital Standardised Mortality Ratio) is widely considered to be unsuitable for use as a comparative indicator between hospitals.

“Dr Foster frequently changes the methodology of the HSMR which, in our opinion, further reduces its credibility as a comparator.”

He continued: “In our opinion, the mortality indicator relating to conditions of low clinical risk is deeply flawed.

“To illustrate, one of the patients identified by Dr Foster to be in this category was a patient admitted into one of UHB’s specialist services with a condition called toxic epidermal necrolysis, which is known to have a mortality in excess of 50%.

“Under Dr Foster’s methodology, this condition is classified as an allergy and therefore treated as ‘low clinical risk’. There are many similar examples.”

The report, which measures mortality indicators at 145 acute hospitals in England, also found that death rates at three hospitals have been consistently high for three years running.

Buckinghamshire Healthcare Trust, The Dudley Group Trust and George Eliot Hospital Trust in Nuneaton had high mortality rates three years in a row.

Readers' comments (5)

  • Aintree, Liverpool was among these deathrate high scorers. I wonder if the LCP is to blame?

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  • This report came out on the same week as Jane Cummings CNO launched her Compassion in Practice strategy. To quote Nursing Times- ""Ms Cummings had been interrogated by the media during the first day of the conference, and eloquently and powerfully told them that those nurses who failed to care for their patients were betraying their excellent peers in the profession".
    Why did Ms Cummings not refer to this report and to the underlying causes of lack of care? The media in their reporting of her speech savaged nurses and all the emphasis of reporting was on nurse’s lack of care and compassion. It was inexcusable for Ms Cummings to have failed to highlight this report in her conference speech. How are nurses expected to give adequate care when they work in the conditions highlighted by this report? Ms Cummings seems to be more interested in covering up inadequate working conditions and government staffing cuts which are the real cause of poor care. But then I guess she does not want to upset government ministers in telling the truth, much easier for her to demonise nurses. A government poodle comes to mind.

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  • Anonymous | 14-Dec-2012 3:23 pm

    So you know for a fact do you, that Ms Cummings is deliberately covering up inadequate working conditions and government staffing cuts?

    Now I don't want to be guilty of your crime, that of making assumptions. You may know Ms Cummings personally and have reasons to believe in what you say.

    However, if you don't, then regardless of how angry you clearly feel, there is no excuse for writing this sort of thing about another human being and nurse.

    I don't believe anyone becomes a nurse because they want to deliver poor care and most of us stay in nursing because we want to deliver good care. Some of our colleagues move in to roles that may be away from the front line because they want to try to influence things and this takes courage.

    It is early days yet for Ms Cummings and yet already she has created a debate around the values we hold as nurses that despite some of the very nasty and purile comments on this site, has also inspired many more nurses than it has antagonised.

    Give her a chance and show a little compassion for your nursing colleagues who dare to put their head above the parapet.

    One final point, before you start venting so negatively, publicly and possibly slanderously, you need to search inside yourself and ask if you still hold those 6 values close to your heart? If you do, have you stopped to think that perhaps you should be applying them to how you treat people not just patients?

    I'll let you ponder that one....

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  • Anonymous | 14-Dec-2012 6:13 pm

    Anonymous | 14-Dec-2012 3:23 pm

    So you know for a fact do you, that Ms Cummings is deliberately covering up inadequate working conditions and government staffing cuts?

    Well she is certainly not highlighting them and their connection to stress and nurse burnout. With the best will in the world, nurses cannot perform miracles.

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  • More deaths occur from clinical decision making than nursing care. But both cause death. the emphasis for Jane Cummings speach is right i.e. get your house in order and leave it to others to do the same. this is not about right or wrong in singular numbers there are a lot of contributors to sub standard care and the new reforms are setting out to influence and reform to address as many as possible prior to mid staffs report. We all need to contribute and influence where we can.

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