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Revealed: Seven trusts remain death rate outliers for second year in a row

Seven trusts in England have experienced higher than average patient mortality rates for two years in a row, according to newly published data from the Health and Social Care Information Centre (HSCIC).

The Summary Hospital-level Mortality Indicator (SHMI) is the ratio between the actual number of patients who die in hospital at the trust or within 30 days of hospitalisation and the number that would be expected to die on the basis of average England figures, given the characteristics of the patients treated there.

The figures show that in 2015, 15 trusts had a higher than expected SHMI, of which seven were also higher than expected in 2014: Blackpool, East Sussex, Medway, North Tees and Hartlepool, South Tyneside, Tameside and Wye Valley.

Dr Deepak Dwarakanath, medical director at North Tees and Hartlepool NHS FT, said: “Naturally these figures are a cause for concern and we have had a number of external organisations working with us to understand these figures and to suggest areas for improvement.

“So far we have been assured we are doing everything that could be expected of any healthcare organisation. However we are continuing to investigate why our mortality ratio is higher than expected.”

He added that North Tees and Hartlepool is unusual because it sees nearly 20% of emergency medical patients in the ambulatory care unit, meaning that they aren’t counted in inpatient figures.

The results also show that 107 trusts had an as expected SHMI and 14 had a lower than expected, of whom 10 were also lower than expected outliers in 2014.

The data did not indicate a correlation between levels of deprivation and SHMI ratio.

Six of the higher than expected outliers had a mean IMD (Index of Multiple Deprivation) Overall Rank over all finished provider spells for patients which was lower than the national average, indicating a higher level of deprivation, but so did seven of the lower than expected outliers.

However, Professor Mark O’Donnell, medical director at Blackpool Teaching Hospitals NHS FT, said the influence of deprivation was still worth considering.

“Any discussion around SHMI figures must recognise a number of factors including the health of the local population,” he said. “Although there are pockets of affluence, the population of Blackpool is one of the most deprived in England. Furthermore, levels of HIV infection, drug misuse, alcohol misuse and antidepressant prescribing are amongst the highest in England and male life expectancy is the lowest in England.’’

He said that Blackpool Teaching Hospitals was “working extremely hard” to reduce mortality rates and was in the top 25% of improving trusts nationally

The SHMI is one of a core set of indicators which must be included in a trust’s Quality Account, which is an annual report produced by each NHS healthcare provider. However, the HSCIC stressed that it is not a measure of quality on its own or a measure of avoidable deaths.

Dr Shaz Wahid, medical director at South Tyneside NHS FT, said that the trust had already hired the North of England Commissioning Support Unit to carry out an internal review of the figures.

The results, which were also published and approved by the North East Quality Observatory Service, found that South Tyneside’s SHMI is normal when deaths of patients in St Benedict’s Hospice, who did not otherwise receive care from South Tyneside, are excluded.

“There is absolutely no evidence that services in South Tyneside District Hospital are unsafe, nor that there are excessive deaths in the hospital,” Dr Wahid said. “We can assure people that the death rates in South Tyneside are not raised but, also, that we have robust systems within the hospital to constantly review all deaths to ensure care is of the best standard.”

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