Fixing the figures once again.

The BBC has been doing some interesting research on Accident and Emergency departments in general, which has some relevance to St. peter's A and E, which was the original reason for starting up this Blog.

Way back when, A and E's had a target that they had to keep - 97 % of patients arriving needed to be discharged or admitted to a bed within 4 hours. It was felt this was the best way of measuring an urgent treatment department. Separate figures were kept for patients who waited longer than 4 hours to be dealt with, or longer than 12 hours.

The Conservatives, decided to reduce the target to 95% to be dealt with within 4 hours, to make it easier for the NHS to keep to it's targets.

NHS Trusts which consistently failed to meet the targets would lose money as a penalty, so it wasn't just serious for patients waiting at the hospital.

Last year, as things got worse in the NHS, the government quietly indicated that failure to meet requirements would no longer result in 'fines'.

In fact, over the last twelve months, the targets have been missed even by efficient and well run hospitals, mainly because it's now accepted that most of the NHS is underfunded and unable to manage it's targets.

Now the BBC has discovered that there has been some widespread misuse of 'Drop-in Centre's' to game the statistics.

Lets take, as an example, Ashford and St. Peter's NHS Foundation trust. It runs a traditional Accident and Emergency Department at St. Peter's where patients arrive on foot or in ambulances with problems that range from the trivial to the most serious. Obviously, on arrival they are subject o the collection of statistics leading to the figures that indicate whether the Trust can meet the four hour target.

In fact there is also a 'Drop-in Centre' next to Ashford Hospital. It's not an A and E, ambulances don't call there, it doesn't deal with emergencies.

In fact it's very useful; staffed by nurses you can go there without an appointment and get seen for minor problems. If it turns out to be serious the Nurse can arrange for a transfer to A and E. I went there to have dressings changed and it usually takes about an hour or so. In the past it was attached to a G.P's surgery which was intended by the Blair Labour Government to see people in the evenings and weekends. It's just been closed to save money.

The thing is, the Drop-in centre's statistics go into the figures for Accident and Emergency for the hospital as a whole. Now, no one attending the Drop-in Centre is going there instead of going to A and E - this is non serious problems. The kind of thing that the practice nurse at the Doctors could deal with - but you can be seen without an appointment.

So, in one way the Trust is encouraging people to come in to improve the number of people being seen within 4 hours, because most people attending have quick, simple problems. If you shut the centre, none of the people would be on their way to A and E.

In fact, the BBC has uncovered that not only is this a common practise but some unscrupulous Trusts have been including figures for patients attending Drop-in Centres that have nothing to do with them, in order to massage the A and E to look better.

This 'gaming' of statistics to make them look better is more common in the NHS than you would think - this time there may need to be a recalculation of all last years statistics to find out what the real position was at our A and E's.

The effect of this fixing of the figures makes life harder for patients and easier for over paid NHS managers.

We shouldn't let them off the hook this time.

Neil Harris
(a don't stop till you drop production)
Home: helpmesortoutstpeters.blogspot.com
Contact me: neilwithpromisestokeep@gmail.com

The worrying mortality rates at Ashford and St. Peter's NHS Foundation Trust.

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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;

 helpmesortoutthenhs.blogspot.com

‘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.com

Contact:  neilwithpromisestokeep@gmail.com