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Hospital trusts are 'fiddling' patient mortality data, claims report

The way hospitals record patient deaths could be covering up poor treatment and costing lives, claims a new report from data analysts.

Figures show a dramatic rise in the number of people recorded as needing “palliative care” at the end of their lives, with some hospitals saying more than 35% of their patients die this way.

Healthcare analysts Dr Foster claim in their report that hospitals could be hiding the fact patients were admitted for treatment which then failed.

Some hospitals may also be “fiddling” the figures to make their death rates appear better than they actually are, they said.

Data from across England in 2012-13 showed 36,425 deaths were coded as palliative – meaning people received some sort of care to relieve suffering at the end of their lives.

This was 17.3% of the total number of deaths and is almost double the 9.1% (2,1130) recorded as needing palliative care in 2008. In 2006, just 3.3% of deaths were palliative.

Some hospital trusts have massively outstripped this national rise. Out of 142 hospital trusts in the report, almost half (60) recorded the number of people needing palliative care in 2012 as higher than the national average.

Most of the 20 trusts with the biggest leaps in their palliative care coding have also significantly improved their performance on death rates between 2008 and 2012.

Palliative care deaths are not included in the hospital standardised mortality ratio (HSMR), which compares the expected rate of death in a hospital with the actual rate of death.

Trusts that code deaths as palliative effectively “remove” deaths from being included in the HSMR.

Professor Sir Brian Jarman, from Imperial College London, developed the HSMR. He told the public inquiry into Mid Staffordshire Foundation Trust that some trusts increased their coding of palliative care deaths to reduce overall death rates.

He said: “I am concerned that trusts know that increasing their palliative care rates assists their HSMR and am concerned that this could be the reason they are doing it.”

“The end result is that the variation in coding may disguise poor outcomes”

Roger Taylor

Roger Taylor, director of research at Dr Foster, said some trusts had changed the way they recorded deaths as a means of improving monitoring of palliative care.

But he said there were “real concerns around the gaming of indicators”, adding: “Whether or not you are doing it deliberately, the end result is that the variation in coding may disguise poor outcomes.”

He said “imprecise rules” governing how hospitals code deaths was harming patient care, may distort death rates and needed urgent review.

“The rules are too vague,” he said. “Poor quality data is harming patients because you can’t see where things are going wrong and you can’t see where there are issues.”

Tory MP Charlotte Leslie, a member of the House of Commons health committee, said: “This is very worrying data.

“We already know that at the time of the Mid Staffs scandals, hospitals were fiddling the figures to massage their mortality rates.”

Readers' comments (22)

  • Tip of the iceberg...

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  • Well! I am surprised, not.

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  • michael stone

    There are issues over EoL deaths - for example, the NHS has got an objective to identify 'final year of life patients', as part of ACP. But if you ask the statistics folks 'what are the figures, then' they currently tend to not exist - the statistics they do have, are very limited.

    If the 'rule' were that on admission (i.e. within 24 hours of admission) any 'dying phase' patients had to be recorded as such (and if not so recorded, the patient was considered as not 'dying phase' [using the terminology here, 'not palliative']), then subsequent fiddling wouldn't be easily possible, would it ?

    I have some issues around the word 'palliative' - it can lack clarity of meaning, too often.

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  • tinkerbell

    no longer surprised by any of this sadly. It just keeps going on and on and ...................on.

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  • Good logo, Tinkerbell, looks professional, businesslike and assertive. well done.

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  • tinkerbell

    Anonymous | 28-Mar-2014 7:07 pm

    thanks, it's from the NHS rally.

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  • tinkerbell | 28-Mar-2014 9:59 pm

    'impressive' would have been a better adjective than good. the best words and phrases do not always come to mind when posting. an edit facility would be useful as would voting and reply options.

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  • tinkerbell

    the caption on the peanut bowl reads 'for well behaved monkeys' re: frozen paycut.

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  • what is the point of meaningful data collection and statistics if it is not standardised across the NHS? yet another tragic story contributing to the failing health services.

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  • tinkerbell

    Anonymous | 28-Mar-2014 10:54 pm

    sorry have now removed the SAVE OUR NHS avatar and replaced with the latest load of old tosh to garner our vote at the next election. Unbelievable!

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  • michael stone

    Anonymous | 29-Mar-2014 3:23 pm

    Not only is some NHS data not 'standardised', but the meaning of certain words used within the NHS and healthcare in general frequently lacks consistency and clarity.

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  • tinkerbell | 30-Mar-2014 12:52 pm

    what makes you say that cutting the bingo tax is tosh?

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  • michael stone | 30-Mar-2014 1:24 pm

    from Anonymous | 29-Mar-2014 3:23 pm


    for example?

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  • tinkerbell

    Anonymous | 30-Mar-2014 5:02 pm

    apologies if you play bingo or drink beer and nothing against that but we need a bit more incentive to vote tory - surely, like stop privatising OUR NHS, stop freezing our wages and stop dumbing down everyone's education and keeping others from having a decent education because they can't afford to go on to further education.

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  • tinkerbell | 30-Mar-2014 6:53 pm

    from Anonymous | 30-Mar-2014 5:02 pm

    I always thought bingo was rather more a labour thingy. i had lotto in my toy box. is that the same thing?

    drinking beer seems to be a Farage thingy as he more often than not appears in photos with a glass in his hand?

    how has all of this crept into dealing with all the other serious issues. were these tory ideas? perhaps they are trying to deflect from any mention of the introduction of private insurance in the final stages of the reforms until after the elections as, although it has been proposed by both cons and lab, nobody wants to be responsible for introducing it for fear of the reactions of the public.

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  • tinkerbell

    this campaign by the tory poster for 'hard working people' is the feel good factor. Are we feeling better now there's a penny off a pint?

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  • tinkerbell | 31-Mar-2014 8:43 am

    yes, people can afford to drink themselves faster into oblivion!

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  • michael stone

    Anonymous | 30-Mar-2014 5:03 pm

    For example:

    'Palliative' - this means 'non curative'. But you can be curing a patient of a condition while also providing 'palliative' treatments, such as morphine for pain relief. The NHS has got a tendency to describe final-year-of-life patients, once identified as 'last 12 months', as 'pallaitive patients' - but such patients could still be receiving curative treatments for some illnesses. This isn't all that 'clear'.

    'End-of-Life' - this term can mean final year of life (predicted), final 6 months of life (predicted), or in some cases people use it to mean 'final days of life'. The statistics people, usually only have retrospective data, harvested post-mortem: so the statistics tend to retrospectively describe as 'end-of-life' patients from 12 months before their (known as opposed to predicted) death.

    'Dead' - most/many paramedics describe any person who they find in cardiac arrest but not 'very clearly long deceased' as 'dead': they attempt CPR, and sometimes bring 'dead' pateints back to life. I don't consider that resuscitation can work on dead people - my definition of 'dead' would be 'beyond the point at which any treatment could restore the person to life'.

    I'm sure that there are loads of others, but it is the EoL stuff that I read, so that is where I can give concrete examples from.

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  • michael stone | 31-Mar-2014 2:29 pm

    Anonymous | 30-Mar-2014 5:03 pm

    go and work on the wards for a few years and find out for yourself!

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  • George Kuchanny

    When we get to 'palliative care' we find that it is too often a euphemism for 'sedate to death'. These are two very different things. Check out what the Belgians mean by 'palliative care' quite remarkable.

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