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

Coding, once more.

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.

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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.

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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.com
Contact:    neilwithpromisestokeep@gmail.com