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Twelve NHS trusts have “worryingly high” mortality rates, report says

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e8282 (Published 04 December 2012) Cite this as: BMJ 2012;345:e8282
  1. Gareth Iacobucci
  1. 1BMJ

The stark variation in death rates at NHS hospitals has been laid bare by a new analysis that reports “worryingly high” mortality figures at a dozen trusts across England.

Dr Foster Intelligence’s hospital guide 2012, which assessed 145 trusts in England against four key mortality measures, praised five trusts for their low death rates but warned that others were performing below expectations.

The measures used were the hospital standardised mortality ratio, which measures deaths in hospital; the summary hospital level mortality indicator, which measures in-hospital mortality and deaths outside hospital within 30 days of discharge; deaths after surgery of surgical patients who have died from a possible complication; and deaths in low risk conditions where patients would normally survive.

Twelve trusts recorded higher than expected death rates on two of the four mortality measures: Aintree University Hospital, Blackpool Teaching, Buckinghamshire Healthcare, George Eliot, Hull and East Yorkshire, Medway, North Cumbria, Northern Lincolnshire and Goole, United Lincolnshire, University Hospitals Birmingham, Walsall Healthcare, and Western Sussex.

In contrast five trusts, all in London, performed well on three of the four measures: Barnet and Chase Farm, Chelsea and Westminster, Guy’s and St Thomas’s, Imperial College Healthcare, and the Royal Free.

Dr Foster Intelligence said that the measures did not mean that care was necessarily of poor quality but that they should serve as a warning that poor quality care might be contributing to a higher then expected mortality. “They are a signal that further investigation should be carried out,” the report said.

For the first time the guide also rated trusts on their clinical efficiency, looking at factors such as avoidable admissions, weekend working, readmissions, and patients spending too long in hospital.

The best performing trusts across 13 efficiency indicators were Weston Area Health, Royal Devon and Exeter, Ipswich Hospital, Dorset County Hospital, the Queen Elizabeth Hospital King’s Lynn, and East Cheshire.

The data were published alongside a review of the capacity of NHS hospitals in England, which found that many acute trusts were being stretched to “bursting point.”1

Andrew Goddard, director of the Royal College of Physicians’ medical workforce unit, said, “This report contributes to the growing body of evidence that suggests mortality rates are higher at the weekend. Some hospitals, based outside London and often in rural areas, are struggling to recruit sufficient doctors to provide adequate out of hours cover. We must consider how to better distribute our medical expertise around the country.”

Mike Farrar, chief executive of the NHS Confederation, which represents most NHS trusts in England, said, “It is really important that trusts do not hide behind data unnecessarily by blaming poor results on bad coding or collection. Trusts need to scrutinise their data and address any deeper issues with their quality of care. Where standards are falling behind, it is essential that swift action is taken to address the root causes.”

Notes

Cite this as: BMJ 2012;345:e8282

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