This section of the Board meeting covering May is just a bit
less reassuring than it should be:
“1
Executive Summary
The Trust
is mindful of the need to increase its efforts to improve quality performance,
in particular its in-hospital mortality and the experience of patients using
its emergency services.
The Board’s
attention is therefore drawn to three key issues discussed in the paper.
1. The
challenge of reducing the amount of people who die in hospital;
Mortality
reviews are being carried out at Divisional level but not on 100% of deaths as
per the Trust’s aspiration. Therefore the performance of 97
deaths in hospital against a month’s target of 76 is disappointing. However, at a more Trust-wide level, the Clinical
Outcomes Steering Group continues to provide in-depth analysis of the mortality
data. There is more to be done to get all deaths reviewed in a standardised way
and this is being tracked by the Integrated Governance and Assurance Committee.”
That’s 21 more deaths in one month than the target – how can
we work to improve that figure, to improve patient outcomes?
I know, let’s have another look at the figures:
“The
Medical Director and Chief Nurse introduced the Quality Report. This presented
the quality dashboard with associated commentary on exceptions and the best
care dashboard.
The
following points in the report were highlighted:
The SHMI
and RAMI target should be 73 which represented the proportion of in-hospital
deaths. The RAMI had gone up to 83 in the month but on further
investigation this was due to 30 patients who had not been coded appropriately;
Crude
mortality for the month was 2.06% with a year to date figure of 1.66%. The
increase towards the end of the year was a common seasonal peak with the year
to date figure slightly above the planned 1.6%”
‘Coding’: I’ve had a bit to say about that in this Blog before
– here’s an article I wrote which quotes from ‘Private Eye’ and The Daily
Telegraph on this subject;
One section, ‘Change the diagnosis’, deals with how a hospital
can change the cause of death from an illness which shows up in a category that
rings alarm bells to one that doesn’t. You cook the books by altering cause of
death so it doesn’t show up in the standardised mortality rates.
So, if someone comes in with a broken femur (that’s very
treatable) but dies later of pneumonia (that’s not good) resulting from the
break, you record it as caused by pneumonia and not the break. Then it doesn’t
show up as a death that should have been prevented by better treatment.
So, the ‘Eye’ shows that in 2009 Mid Staffs Hospitals
patients with hip fractures were 5 times less likely to die from that cause
than the English average, even though the Hospital was losing far more patients
with hip fractures than it should have done. It was credited as being one of
the 5 ‘most improved’ trusts in 2009 as a result.
Well, they are all at it again!
Check out this Daily Telegraph report;
Wednesday
27 February
The head of
an NHS trust has "stepped aside" amid fears that staff tried to mask high
mortality rates by recording the wrong cause of death for patients. Dr Jackie
Bene, medical director and acting chief executive of the trust, has 'stepped
aside'
By Stephen
Adams, Medical Correspondent6:30PM GMT 27 Feb 2013
2011,
Bolton NHS Foundation Trust recorded a large spike in septicaemia deaths, which
are not included in official mortality figures, at the Royal Bolton Hospital in
Greater Manchester. During the same year, it also recorded a significant
improvement in death rates and was given an award for the “most improved”
trust.
But a
recent audit demanded by local doctors has unearthed evidence that these
improvements may have been fictional. On Monday staff were told that Dr Jackie
Bene, medical director and acting chief executive of the trust, had “stepped
aside” to “allow a fully independent view to be taken". The report is
expected to be completed by March 6.
Professor
Sir Bruce Keogh, medical director of the NHS, last night (Wed) said hospitals
“must behave openly and honestly about their performance”, while campaigner
Julie Bailey said: “It’s fraud in my mind.”
Until 2011
the Bolton trust had been one of the worst performing hospital trusts in
England, with death rates well above the national average. But that year its
mortality rate plummeted, leading to the award. Last December it was ranked as
having death rates that were “better than expected”. Yet between April 2011 and
March 2012 some 800 deaths from septicaemia were recorded at Bolton - four
times the number one would expect in a trust of that size. A septicaemia coding
also means the hospital would have received more money for that patient.
Dr Wirin
Bhatiani, lead GP for the Bolton Clinical Commissioning Group, said he first
became aware of the "unusually high" number of septicaemia cases in
October. The group has commissioned the hospital rating firm Dr Foster to carry
out an independent audit looking at 200 cases. Dr Bhatiani said interim
findings based on 50 cases showed “cause for concern”. He said: “While we are
keen to wait for the final report, we are sufficiently concerned by the interim
findings to commence further investigations.”
David
Wakefield, chairman of the trust, said it wanted to "rule out any serious
issues as soon as possible" and make sure the way patients were coded met
the"highest quality standards". He was brought in by Monitor, which
regulates semi-autonomous foundation trusts, after it put Bolton in the highest
risk rating for governance and finance.
A trust
spokesman emphasised the issue was solely with the way “some causes of death
were recorded”, and did not change the number of people who had died. Neither
did it mean patients’ death certificates were inaccurate, she added. Julie
Bailey, founder of the Stafford group Cure the NHS, said the Bolton situation
showed “each and every hospital” should be vetted to find out “just how many
unnecessary deaths there have been”. She said: “We are hearing more and more
instances of people apparently ‘gaming’ the data to mask high death rates. If
that’s what’s been going on here, it’s fraud in my mind.”
Professor
Keogh said: "If we're to have an open and accountable NHS, where patients
and the public know how NHS hospitals are doing, those hospitals must behave
openly and honestly about their performance. "These allegations have been
picked up by the local NHS working together and scrutinising what has been
going on - with support from the Care Quality Commission and Monitor. As yet,
there is no evidence that any patient has been harmed. But we will be
monitoring the situation and learning any lessons." Bolton is not one of
the 14 trusts currently being examined for apparent high death rates. However,
a Department of Health spokesman said Prof Keogh “reserves the right” to call
it in if he felt it necessary.
=======//========
Why get told off for failing patients when you can just move
a few figures around, get out of trouble and get paid more money as well?
How many more ‘trusts’ are doing this?
Probably all of them.
========//=======
That’s how I ended the Blog back in February.
30 deaths re-coded – that really worries me.
Neil Harris
(a don’t stop till you drop production)
Home: helpmesortoutstpeters@blogspot.comContact: neilwithpromisestokeep@gmail.com