Death Rates Too High At West Herts Hospitals

16 NHS trusts in England - including West Herts Hospital NHS Trust - have higher than expected death rates, while some score poorly on at least two indicators relating to patient death, according to a major report.

The guide, from health statistics firm Dr Foster, showed the trusts - which includes the West Hertfordshire Hospitals NHS Trust - which runs Hemel, Watford and St Albans Hospitals - had higher than expected death rates among patients in hospital, down from 20 the previous year.

The indicators included a standard measure of in-hospital deaths, deaths within 30 days of the patient leaving hospital, deaths after surgery and deaths among people with low-risk conditions who would normally survive.

Using all key measures, the data also showed that 10 hospital trusts have one or more hospital sites with a death rate higher than the overall trust level.

The number of people who died in hospital in England and Wales in 2012/13 was also higher than in the previous year but lower than 2010/11.

Some 237,100 patients died in hospital in 2012/13, 4,400 more than in 2011/12 but 5,300 fewer than 2010/11.

Dr Foster director of research Roger Taylor said: "These findings reveal overall that while the number of people who are dying in hospital has risen slightly since last year it is still a much more improved picture than in the 10 years previous. This year, following the inquiry in Mid Staffordshire, the NHS has renewed its efforts to tackle avoidable mortality resulting from failures in healthcare.

"Hospital level mortality indicators can provide vital insights into where problems are worst. They also help us to monitor the extent to which outcomes for patients are improving. We are pleased that there are fewer hospitals with outlying high mortality rates this year compared to last.''

Dr Foster awarded four ``trust of the year'' awards for good performance.

One went to Guy's and St Thomas' NHS Foundation Trust in London, which scored lower than expected on all death rate measures and also had the best performance of any trust in England.

In the north, Salford Royal NHS Foundation Trust had lower than expected death rates across two indicators, as did West Suffolk NHS Foundation Trust.

In the south, Frimley Park Hospital NHS Foundation Trust in Surrey had lower than expected death rates across three indicators.

Turn around Plan Already In Place

Dr Mike Van Der Watt, Medical Director of the West Herts Hospitals NHS Trust told Heart: "We welcome the publication of the Dr Foster Hospital Guide which relates to data from April 2012 to March 2013.  The Dr Foster Hospital Guide is well respected and we're pleased to see that for the vast majority of the clinical indicators that it covers the care we provide for our patients is of the level expected (27 out of 33).

Between April 2012 and March 2013, the Trust saw an increase in its overall mortality rate which took us above the upper control limit for our hospital standardised mortality ratio (HSMR*) (our ratio is 110.77 against an upper control of 109.13).  

As a result, we instigated a significant number of measures to ensure our mortality rate remains within or below expected levels.  This included:

  • Undertaking an immediate review of mortality across all of our clinical services to identify any specific trends;
  • Establishing a monthly Trust-wide mortality review group (chaired by me as the Medical Director and involving doctors and nurses from across our hospitals) which is responsible for tracking and reviewing any variations in our mortality rates at an organisation and specialty level;
  • Undertaking a 360 degree review of all of our clinical services with support from our partners, patients, other stakeholders and staff, including our junior doctors;
  • Increasing the number of consultants on our wards, especially at weekends;
  • Investing an additional £3.9 million (annually) to recruit an extra 160 nurses to support and care for patients on our wards;
  • Changing the way that elderly patients are admitted to our hospitals to ensure they are seen by a dedicated care of the elderly consultant (geriatrician) at the earliest possible opportunity;
  • Increasing the seniority of anaesthetists who support patients undergoing more complex surgery."

It is important to note that whilst our HSMR rose above the upper confidence level in 2012/13, it remains within 'expected levels' when viewed over the last three years (2010/11 to 2012/13).

In addition, our data shows that we significantly under reported (during 2012/13) the number of patients who were treated on a palliative (end of life) care basis (11% versus a national rate of between 15% and 20%).  This would have increased our mortality rate.

As a result, we have reviewed the way that we record patients who are receiving palliative care to ensure we do not inadvertently skew our overall mortality levels (by including these patients)."