Dispute over claims unexpected deaths tripled at Lincolnshire hospitals

A study claiming unexpected deaths at hospitals in Lincolnshire have tripled to almost 360 a year has been argued as ‘misinterpretation’ by the NHS trust responsible for them.

The study claimed that hundreds more patients died unexpectedly after United Lincolnshire Hospitals Trust was put into special measures in 2013.

Under the measure, instigated by NHS England Medical Director Professor Sir Bruce Keogh, improvements should have been seen at the hospitals under the trust’s management.

Professor Sir Brian Jarman, co-director of the Dr Foster Unit at Imperial College in London is quoted in the Mail Online as discovering that ULHT has much higher death rates in 2015/16 than in 2013/14.

Using a Summary Hospital-level Mortality Indicator (SHMI), which reports on the actual number of patients who die following time in hospital and the number expected to die on the basis of average country-wide figures, the study suggested ‘unexpected deaths’ tripled from 129 to 357.

ULHT came out of special measures in March 2015, concluding that improvements under the ‘special measures’ status had been effective.

According to Professor Jarman, problems with unpredicted deaths are ongoing at ULHT and neighbouring North Lincolnshire and Goole NHS Foundation Trust – where he concluded unpredicted deaths rose from 159 in 2013/14 to 192 in 2015/16.

Interpretation dispute

When referring to mortality rates, ULHT also records data using the Hospital Standardised Mortality Ratio (HSMR), a scoring system which takes a hospital’s crude mortality rate and adjusts it for factors including population size, age and the range of operations and treatment provided.

A ULHT spokesperson said:

“We don’t accept Prof Jarman’s interpretation of our mortality figures. It’s important to point out that higher than expected HSMR and SHMI rates don’t necessarily mean that there were unnecessary or avoidable deaths.

“Mortality rates act like an alarm and they tell you to check things out and where to look for possible issues. A report published last year by Hogan, Zipfel, et al (2015) showed that there is no significant association between avoidable deaths and HSMR.

“Our HSMR is currently 97.5 and therefore in line with what’s expected for a trust of our size. The number of expected deaths in our hospitals is reducing and HSMR shows and over the last few years we have had fewer deaths than expected.

“SHMI is higher than expected but the data is nearly a year out of date and includes deaths that occurred out of hospital too – up to 30 days after being discharged from hospital and includes patients at the end of their life.

“The quality and safety of patient care is the trust’s number one priority and we take patients’ deaths seriously.

“We ensure that patient deaths are reviewed by a senior doctor who hasn’t been involved in the patient’s care and any deaths where there is a potential cause for concern are reviewed by a mortality group which is chaired by our deputy medical director.

“As a trust, we are always looking to improve the quality of care we give our patients”.

Hospitals failing to investigate deaths

Questions over NHS trusts’ processes and investigations of patient deaths surfaced again this week after the publication of a country-wide report from NHS watchdog the Care Quality Commission.

The damning report, commissioned by health secretary Jeremy Hunt, highlighted a number of failings by trusts to investigate deaths and insensitive treatment of bereaved relatives.

Assessments paid particular attention to deaths of patients with mental health conditions and learning disabilities.