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High mortality rates identified at five trusts

Patient death rates at five trusts have been “higher than expected” two years in a row, figures show.

The mortality ratios at the five English trusts have been “persistently high” between July 2010 and June 2012, according to the Health and Social Care Information Centre.

The Summary Hospital-level Mortality Indicator (SHMI) compares the number of patients who die following hospitalisation at a trust with the number who would be expected to die.

Analysts said that the SHMI was higher than expected at Colchester Hospital University Foundation Trust, Tameside Hospital Foundation Trust, Blackpool Teaching Hospitals Foundation Trust, Basildon and Thurrock University Hospitals Foundation Trust and East Lancashire Hospitals Trust for two years running.

Experts said that the indicator should be seen as an “early warning mechanism” so trusts can examine why their score was higher than expected.

The SHMI data, which includes all deaths in hospital as well as deaths occurring 30 days after discharge, also shows that there were 11 trusts which had higher than expected mortality between July 2011 and June 2012.

While the majority of trusts (115) fell into the “as expected” category, 16 trusts had lower than expected mortality rates in the same time frame.

HSCIC chief executive Tim Straughan said: “Today’s report, based on two years of data, shows an emerging picture of which trusts are categorised over time as having higher or lower mortality ratios than expected.

“And indeed also shows that the vast majority of trusts in England have a mortality ratio that is as expected, based on the characteristics of the patients they will typically treat.”

He added: “As always with such a complex area, this mortality indicator should be seen as an early warning mechanism, rather than a definitive judgment, to examine the reasons why a trust’s ratio is higher or lower than expected.”

Readers' comments (25)

  • It must be difficult to analyse as some areas will have higher incidences of drug and alcohol abuse.

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  • Anonymous | 26-Jan-2013 0:34 am

    Its got nothing to do with drugs/alcohol.

    If you go to the Dr Foster website you can learn something about the complexities of calculating mortality stats.

    Trusts which exhibite persistant excess mortality should , in my opinion, be subject to a full and independent investigation.

    Unfortunately the Heath Care Commision and its expert group of investigators was disbanded in favour of the somewhat toothless CQC.

    I am hoping that the Francis report will result in some (most) of the sloth being removed from "management".

    The NHS needs rescuing from bean counters. targets and the ridiculous 6C initiative !

    It is time to repair the damage. We need to put real nurses and doctors in charge !

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  • All NHS hospitals should conform with international or European quality standards like other European hospitals and most multinational companies. Some amateurish organisation like the CQC is totally meaningless.

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  • I was on a panel for this. The data is adjusted to the population in a way that allows for local demographics like a higher presentation of substance misuse in A&E. as Jenny says it's complicated. But it's as controversial as the old measure, HSMR. We have clinicians on our panel because we use the info like a smoke alarm and investigate it using clinical opinion right down to case notes.

    I completely agree with the view that clinicians should be in charge but Mid Staffs had a medical director and a director of nursing, and the PCT had medically qualified directors of public health and GPs. But no one organisation was responsible because there are so many of them and it's so easy to push it onto someone else. Did you see the video of Jane Cummings being interviewed by the Health Select Committee? Everything's someone else's job or not within my power. Yes we need to fundamentally change the balance of that power in the NHS but we also need the nerve to stand by something and say, yes this is my fault, it's crap and let me fix it. And the organisation learns from it.

    I'm so glad they've got Colin at Mid Staffs, he's brilliant.

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  • The "brilliant" Colin heads up a service which tapes dummies into babies mouths !

    What remains to be yet exposed?

    The "brilliant" Colin has also been well versed in "management" speak ! Did you hear/read the nonsense spouted.

    " We want other hospitals to learn from this incident so that we can be sure that it does not happen to any other baby.

    "The "brilliant" Colin needs to acknowledge the unique skill set required to abuse babies !

    I very much doubt other hospitals wish to emulate the The "brilliant" Colin's standards.

    In my view The "brilliant" Colin needs to get out of the office. Go look and find out what is really going on !

    -Relying on sycophants for information is a bad idea ! They will always tell you what you want to hear !

    I am sure The "brilliant" Colin realises that this dummy incident did not occur in isolation -- he needs to take a very close look at all involved including the matrons and others charged with monitoring /maintaining standards.

    The "brilliant" Colin needs to be quick - he has associated himself with a failed organisation which has a history.
    I very much doubt that all the bad and dead wood has been removed 1











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  • The Manager

    The stats will always be imperfect.

    However, they do provide a vital red flag facility !

    Any Trust or Hospital with a persistently high mortality rate when compared to similar institutions needs to take notice.

    Taking notice requires strength of character and a determination to expose root causalities. Rarely, if ever, will a single, isolated cause be found for a high mortality rate-----these issues are complex and mutifactorial.

    Some "managers" (and it has to be said , clinicians) when faced with a "poor" set of stats will immediately become defensive and seek to challenge statistical methodology (As happened at Mid Staffs).

    Perhaps such a defensive reaction is only human but that it happens should be acknowledged.

    Indulging in academic debate about mortality stats may be interesting but such indulgence wastes time and maybe lives.

    An independent investigation of persistently high mortality rates would have the advantage of removing parochialism thus allowing an objective view to be taken.

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  • Jenny Jones | 27-Jan-2013 2:41 am

    I hear your passion! Yes, it was an appalling incident. But the nurse has been suspended, as have others, and an investigation is being carried out. I'm not defending what happened. But I still think Colin is a good Director of Nursing. You can't sack or suspend everyone (although some people have said the hospital should be shut down) and it takes time to root out bad apples. Is it possible to run a hospital where there are no accidents or mistakes? At least he has changed the reporting culture, where staff were afraid of reporting incidents, but there is a long way to go, as you say.

    And as the previous poster says, having external clinical peer review is best. I've been through too many reorganisations, but didn't the Healthcare Commission work like that? More experienced clinicians and less tick boxes.

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  • The Manager

    You are correct and if you have "lived through" ,many reorganisations you should know exactly how the HCC operated !

    However --- the HCC exposed Mid Staffs for what it was (?still is) but more importantly hung one C.Bower out to dry !

    In honourable NHS fashion the exposed and disgraced Bower was promoted ! -- to the CQC !

    This kind of behaviour by senior NHS management is by no means isolated. Please do not challenge me or I will embarrass you with a list of example all of which can be verified !

    Anyway the CQC acquired a new but somewhat besmirched CEO who very rapidly took her revenge on the investigation team who exposed Mid Staffs. Guess what --- they were declared surplus to requirement ! they were got rid of , dumped !

    Management in action I bet you were proud !

    I hope Robert Francis fires some very well aimed rockets at NHS "managers" and follows up with Rentokill there are a lot of vermin to be removed !

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  • the Manager

    Is there any reason why the NHS could not use International or European Quality standards as do many large companies and hospitals in other western European countries? They seem to give a far clearer and more concise picture of excellence to all concerned including patients, the public and front line staff than the CQC which appears rather vague, woolly and controversial and so many healthcare organisations seem to slip through their net.

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  • Jenny Jones | 27-Jan-2013 2:12 pm

    Believe me Jenny, I've seen what you describe all too often not to dream of challenging you, and your posts clearly show not just that you care but you really know your stuff. Yes, Heather and her team were shoved out of the HCC. Yes, many CQC inspectors have a social care background and the organisation seems to prefer quantity of inspections over quality. Yes, Heather's interview in today's Sunday Times says she knows there are other hospitals like this but that haven't been found out yet. And yes, the culture of bullying top down target focused know the price of everything but the value of nothing managers has led to that, and I am a manager. I hope that the letters that went out from lawyers last year and the publication of the Francis report will show once and for all, a case for corporate manslaughter. Which would put the fear of God into management, as the result would be prison sentences. No, I am not proud of some of my colleagues or (sometimes) being an NHS manager. But I am proud to work with bloody good strong nurses like yourself who never stop fighting for what's right. More power to your elbow!

    As for us using better comparative data, yes, it would be sensible, but both HMSR and now SHMI have proved controversial and as another poster says, some organisations just get very defensive once the press get hold of the numbers. There is a lot of data in the NHS but not all of it is useful or collected properly. There was a similar panic in primary care with Shipman. How to you legislate against a psychopath? Whatever the stats and however we collect data, there is still no replacement for independent clinical peer review.

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  • Anonymous | 27-Jan-2013 2:19 pm

    European and International "standards" organisations in return for money will certify that an organisation has voluminous amounts of paperwork which detail the "systems" which are allegedly in place to ensure "Quality".

    Which of course explains why the "Horse-burger" scandal arose !

    Google TÜV Rheinland and see Tesco's involvement in the Quality Standards certification process you will be impressed but it wont prevent you eating horse-meat!

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  • Manager

    Read your post again !

    Whilst I appreciate some of what you say ----- Take care! Adopting a patronising approach to people it can provoke a devastating response from which you will find recovery difficult if not impossible !

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  • Hello Jenny - I sincerely apologise if you felt my post adopted a patronising approach to people, it was not remotely meant as such. I was trying to show my agreement with your views. I have learnt a lot from your posts. I was trying to rattle off a list of all the things that had happened that I could think of that proved your point. Sorry if that came across differently to you.

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  • Anonymous | 27-Jan-2013 2:47 pm

    what is wrong with eating horse meat? everybody else in Europe does.

    I believe the problem there was it was not indicated on the packaging and it may have been substandard but eating the lean and nutritious meat itself is not a problem beyond perhaps a cultural one as it is not part of the usual English diet.

    I was am also hoping for a response from the Manager who may have knowledge of quality in health care and its measurement through the standards I mention above which are a highly successful indicator used throughout Western Europe and seem more satisfactory than current controls in the UK.

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  • Manager

    OK

    Now take a look at this !

    http://www.telegraph.co.uk/health/healthnews/9824260/Persistently-high-death-rates-at-eight-large-hospitals.html

    Can you imagine the shear panic which is now engulfing "management" including the Head Honcho "Sir" whatsisname !

    To paraphrase an advert "I am goin to be lovin it " !





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  • Hello Anon 3.38. Sorry, I've been trying to find out how to post the links.
    This is the Department's plan for quality from 2013:

    http://tinyurl.com/aulvgbk
    And this is how they plan to set up the quality forums:
    http://tinyurl.com/b4yb2ht

    I nearly wept when I read it. More layers and obfuscation. The best thing I can suggest is to try and join your local surveillance group and influence what they measure.

    A cynical part of me thinks that the current Govt doesn't want us to use proven European measures because what it might find is unpalatable and contrary to their desired "reforms".



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  • Anonymous | 27-Jan-2013 3:38 pm

    If your a Nurse and you are concerned about "quality" why don't you explain what impresses you about

    " International or European Quality standards as do many large companies and hospitals in other western European countries"

    Whilst your doing that you could also explain what these standards are and who polices them !

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  • Thanks Jenny! We don't know each other but you'd be exactly the kind of nurse I'd be following and supporting at my trust.
    Yes, I saw that article and it is sending shivers of fear down a lot of senior manager spines. I'm sure you've got a lot better things to do but the HSJ is the managers trade mag and it's full of speculation about the wave of top level resignations that we're going to be seeing soon, and lots of anonymous comments like ones we get here.
    And a lot of managers and families who've lost loved ones will be raising a glass to celebrate their going. I hope there will be a lot of strong nurses like your good self to put things right.
    Thanks for your reply, and best wishes!

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  • Jenny Jones

    The Manager


    http://www.smithersregistrar.com/healthcare/page-iso9001-solution-healthcare-quality-management.shtml

    http://www.saiglobal.com/Assurance/healthcare/ISO9001.htm

    http://www.efqm.org/en/Home/TheEFQMExcellenceModel/tabid/132/Default.aspx

    http://www.ncbi.nlm.nih.gov/pubmed/10537859

    http://www.bqf.org.uk/efqm-excellence-model

    British branch of the EFQM

    These explain the ISO and the EFQM related to healthcare

    http://federation.fhf.fr/en/Federation/Missions
    The French Hospital Federation


    The Manager

    yet another long and complex document and costly research and commission. It seems to me that the NHS complicate everything but maybe it is because of its size.

    To me it makes sense that there are equivalent standards for healthcare right across Europe and these organisations provide specialist and ready made instruments for testing them which are probably much simpler. In Europe healthcare facilities such as hospitals always striving for excellence and engage their staff in the process which is a very good motivator.

    the French Hospital Federation is also an excellent resource which offers audits of other hospitals abroad

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  • The Manager

    I'm sorry. I meant to say thank your for the links at the beginning of my first para. but then got too involved looking for mine and then pasting them!

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