m
It’s Ok, Boss -
I’ll Cooka Da books
These worrying figures for Ashford and St. Peter’s NHS Foundation
trust come from the respected health research group ‘Dr Foster’, as quoted in a
Daily Telegraph article today (18/4/14).
You can read the whole article in full on my other Blog;
‘Coding’ is the government’s legal requirement that hospital’s
record deaths as a result of certain kinds of treatment. This is so that a
hospital can be compared with all the rest so that bad practises can be
spotted and improved.
The problem is that it is possible to abuse the system.
If you come in to hospital for say, a hip replacement and
then you die, if you also had cancer, it is possible to code the death as ‘palliative’
(you died from cancer not from the operation) and the figures look better than they
should.
The NHS has even invented a word for it; ‘Gaming’ the
figures. I call it fraud, because improved mortality rates bring greater
income.
Worst of all it means that instead of reducing unnecessary
deaths, the hospitals are choosing to fix the statistics.
Here are the figures
for Ashford and St. Peters;
Ashford and St. Peter’s NHS Foundation Trust
Percentage of deaths recorded as ‘Palliative’
2008 2009 2010 2011 2012 % Increase
0.32% 7.24% 4% 17.6% 23.04%
22.72%
Which means that in 2012 well over a fifth of relevant deaths
were down to unavoidable things like cancer – yet only 4 years before there had
been hardly any. Just as unexpected is the fall to 4 % in 2010 followed by an
instant increase.
Here’s a question for the Board – was there a change of staff
members in those years? Did they send staff on those expensive course on how to improve the figures?
Here’s an edited version of the Telegraph article;
Fears that
hospitals are covering up death rates
New data
triggers fears that hospitals are 'fiddling the figures' on hospital deaths by
increasing the number of deaths recorded as 'palliative' - classed as expected
because a patient was terminally ill.
By Laura Donnelly, Health Editor and Telegraph
interactive team
Hospitals
have been accused of “fiddling” their death rate figures by claiming patients
were terminally ill, after new figures showing dramatic changes in the way
mortality is recorded.
The NHS
data shows a five-fold rise in the proportion of deaths being “coded” so that
they barely count towards hospital mortality statistics - with some trusts now
recording one in three deaths as a “palliative” case.
Last night
experts said they were troubled by the “deeply concerning” trends, fearing
hospitals could be hiding the fact patients had suffered poor care which
contributed to their death.
They said
the scale of the misreporting was such that it could even hide “another Mid
Staffs” scandal.
Every NHS
hospital has to collect and publish data showing how its death rates compare
with what would be expected.
Crucially,
if a case is coded as “palliative” it barely counts towards the rate, because
it is classed as an expected death.
The code is
only supposed to be used when a patient’s death in hospital is an inevitable
consequence of their condition - such as that from a terminal illness.
Now new
figures have triggered concern that the code is in fact being used to disguise
many more deaths.
Data from
health analysts Dr Foster shows that, across England in 2012/13, 36,425 deaths
were coded as palliative. That was 17.3 per cent of the total number of deaths
- twice the number recorded in 2008 and five times the 3.3 per cent of deaths
recorded in 2006.
Roger
Taylor, director of research at healthcare analysts Dr Foster Intelligence,
which produced the data, 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:
“The trends we are seeing are troubling - they are deeply concerning. Poor
quality data is harming patients because you can’t see where things are going
wrong. If the data is not being recorded consistently and, moreover, if that
isn’t picked up because of a lack of auditing there is a risk that poor patient
care is being disguised, and the public misled.”
Experts
said that in some cases, patients were being counted as “palliative cases” when
they had been admitted to hospital for a broken hip, but failed to recover.
Mr Taylor
said he had called repeatedly on NHS officials to tighten the rules, and to
audit such data, so that trusts could not manipulate it, but said nothing had
been done.
“We’re
worried this issue is not being given sufficient priority,” he said. “The
bottom line is it could increase the possibility of failing to identify another
Mid Staffs and potentially cost lives.”
Joyce
Robins, from Patient Concern, said: “Hospitals are clearly fiddling these
figures and that frightens me. Hospitals are just not open enough to admit what
is happening - instead they dream new ways to disguise it. All the talk of
transparency is just that - talk.”
Prof Sir
Brian Jarman, Emeritus Professor of Imperial College London, an expert on
mortality data, said: “I don’t think these very extreme changes reflect
reality. I don’t think these hospitals have transformed into hospices to treat
the dying overnight.”
Figures
show that among the 20 NHS trusts with the steepest rise in palliative coding,
between 2008 and 2012, 17 reduced their published death rate at the same time.
This is what my favourite NHS Trust had to say to The Daily
Telegraph’s allegations;
“Ashford
and St Peter’s Hospitals foundation trust said the increase was a result of
changes to palliative care coding criteria and improved record keeping and that
it was “confident that our current data accurately reflects the trust’s specialiast
palliative activity.”
While I can, I’m going to be keeping an eye on Ashford and
St. Peter’s figures in future!
Be warned…..I'm not confident that the current data accurately reflects the Trust's true mortality rates.
Neil Harris
(a don’t stop till you drop production)
Home: helpmesortoutstpeters.blogspot.comContact: neilwithpromisestokeep@gmail.com
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