Blackpool NHS Trust report

Monday, December 3^rd, 2012

PRESS RELEASE

STATEMENT: DR FOSTER HOSPITAL GUIDE – MORTALITY

EMBARGOED TO 00.01 MONDAY DECEMBER 3^rd 2012

 

FIGURES released today by Blackpool Teaching Hospitals NHS Foundation Trust show mortality rates for the area are now at their lowest levels ever and below the national average.

This is contrary to data published by the Dr Foster Hospital Guide which uses figures dating back to April 2011.

Blackpool is one of the most deprived areas in England with lower than average life expectancy. The town has higher than average deaths related to alcohol, smoking, IV drug use and heart disease.

Traditionally Blackpool has had high mortality figures and, during 2012, we have been undertaking intensive work to understand why we appear to be so badly affected and devise plans to improve.

Enhancing quality of care and patient safety is, and always has been, a priority for the Trust and standards of clinical care are among the highest in the country.

In the UK there are three common mortality measures; the Hospital Standardised Mortality Rates (HSMR), owned by Dr Foster, the Risk Adjusted Mortality Index (RAMI), owned by CHKS and the newly developed Summary Hospital Mortality Index (SHMI) which was commissioned by the Department for Health.

For all three a comparison is made between the number of actual deaths for an individual population and the expected number of deaths for the hospital population of England and Wales. A score of 100 is taken as the average.

SHMI and HSMR are different from RAMI as they do not adjust in the same way for deprivation, which can put areas such as Blackpool at a disadvantage.

The Trust has fared badly on SHMI and HSMR, so in March 2012 we commissioned an independent review of mortality data by The Advancing Quality Alliance (AQuA), a North West healthcare improvement body, which concluded there were no areas of concern relating to patient care.

Following the report the Trust highlighted two key areas for review, administrative and clinical, attention to which has now resulted in substantial improvements in mortality figures.

All three mortality indicators use internationally recognised codes derived from diagnostic information recorded on the patient’s admission to hospital. According to the mortality indicators the Trust appeared to have a disproportionate number of deaths in the ‘lower’ risk categories.

This finding was, in part, because a relatively high proportion of admission diagnostic coding was derived from symptoms and signs rather than true underlying cause. An example might be the patient whose admission code reflected only their breathlessness (i.e. the sign and symptom) rather than the true underlying diagnosis of lung cancer - making the patient appear to be low risk.

A significant amount of recent work has been undertaken to address this and other coding ambiguities to better reflect patient illness severity on admission.

The Trust has also implemented a number of further measures to help assure the quality of patient care. These measures include a recruitment drive to increase the doctor and nurse ratio per bed and care pathways targeted at high risk patient groups in order to optimise the quality of care. Each care pathway comprises one or more specific care bundles based on established best practice relating to management of the specific disease process in question.

The Trust is also one of eight NHS organisations taking part in a North West transparency pilot aimed at improving the quality and safety of patient care

Since this work started our internal monthly figures have shown significant improvement. This, however, is not reflected in the latest Dr Foster report which reflects the period between April 2011 and March 2012.

Our most recent RAMI figures are

 August 2012: 74 compared to the national figure for similar sized (peer) Trusts of 80.

 August 2011: 100 compared to a peer of 86.

HSMR figures are:

August 2012:  99 compared to a national average of 100

August 2011: 124 compared to a national average of 100

SHMI figures are:

August 2012: 96.54 compared to a national average of 100

August 2011: 131.18 compared to a national average of 100

Dr Mark O’Donnell, the Trust’s Medical Director, explained: “The AQuA report looked at a range of factors that might explain high mortality rates and highlighted that there were no areas of clinical concern for the Trust and reassured us that there were no issues around the care we give our patients.

 “While the Trust had already undertaken much improvement work there were nevertheless further steps which we believed we needed to take to tackle mortality rates.
“We are committed to improving the outcomes for patients and the safety of our services and drew up a detailed action plan which covered areas such as clinical leadership, the development of a specific mortality reduction plan and more work with primary care colleagues to improve end of life care planning.’’

The Trust has set up a Mortality Steering Group and developed an Action Plan which aims to:

·         Extend 7-day working for specialist nurses

·         Improve engagement between coders and clinicians

·         Prioritise recruitment across all clinical divisions to increase doctor and nurse ratio per bed – to date 10 locum vacancies have been converted to substantive posts and two extra emergency department consultants and two advanced practitioners have been recruited

·         Review the use of care bundles, an expected path of care pertaining to a particular condition, to improve expected outcomes through best practice standards. These have now been developed in areas such as pneumonia, lung disease, heart failure, heart disease and hip fractures.

·         Implement the scanning of existing paper-based medical records to ensure patient case notes are available on demand – this is now ongoing through our Vision programme

·         Devise training and transparency to increase awareness of standard mortality rates (SMR)

·         Increase incident reporting using the Talk Safe training programme to ensure care provided is as safe as possible and when things do go wrong the right action is taken.

Blackpool Teaching Hospitals has a strong track record in overall quality of care and safety for patients. The organisation has been recognised nationally for the considerable work done on patient safety winning two Patient Safety Awards in maternity and data information management in 2012 and was the only Trust in the country to win two awards at the National Patient Safety Awards in 2011.

Hospital infection rates have fallen to their lowest rates ever. Last year the Trust reported just two cases of MRSA and a reduction of 47.5 per cent over the year in clostridium difficile resulting in just 53 cases.

All quality and safety data on the Trust’s performance, including mortality, is publicly available on the Trust’s website www.bfwh.nhs.uk

Mortality figures August 2011 to August 2012

The Trust seem capable of publishing these complicated reports, but can they give a simple answer to a simple question?  A GP refers a patient to the Trust for a simple intrusive operation which should take about four minutes.  Why does the GP not know that the operation requested is not performed by the department to whom the patient has been sent/referred?  The patient is given several appointments and even surgery but not for the original problem/complaint.  There then ensues a protracted tennis game between the GP and the hospital about the treatment.  The patient in the mean time is seeking there own remedy by trying to find where he/she can have the procedure done quickly, probably private!  
If you think this is obscure then try being the person with hemorrhoids, piles of troubles for them and they would be grapeful for that bunch to be harvested without unnecessary delay.  Surely the message has to be, do the simple things well and remember what your ethos ought to be - CARE.  This is an administrative problem and ought to be solved by a telephone call.  Although many patients are old and infirm, many elderly people still have all their wits about them but not their youthful vigor. It is their bodies that have deserted them, not their brains.