Ten NHS trusts have worse death rates than shocking Mid Staffordshire

Ten health trusts have worse death rates than the hospital where at least 400 patients died needlessly because of “shocking and appalling” standards of care.

A damning watchdog report detailed a catalogue of failings at Mid Staffordshire NHS Foundation Trust, including dehydrated patients being forced to drink out of flower vases while others were left in soiled linen on filthy wards.

The scandal of poor care at Mid Staffordshire was only uncovered when unusually high death rates at the hospital triggered secret NHS alerts.

The Healthcare Commission has not investigated any of the 10 trusts that currently have worse scores than Mid Staffordshire, and the Care Quality Commission, which takes over from the Commission this week, has no plans to do so either.

Campaign groups and leading experts last night called for the trusts to be investigated. Professor Sir Brian Jarman, a former member of an inquiry into the deaths of heart patients at Bristol Royal Infirmary and an expert on Hospital Standardised Mortality Ratios (HSMRs), said routine investigations of high death rates could “undoubtedly” save thousands of lives every year.

Warning that some trusts were reluctant to admit failures because of a “blame and shame” culture within the NHS, he said: “Of course the regulator should be looking into these trusts, and others with high scores.

“It is important to work with these trusts to identify any possible failures and work towards improvements.”

The Sunday Telegraph’s Heal Our Hospitals campaign is calling for mortality rates to be published widely and in more detail.

Figures from Dr Foster, the independent health information firm, show that at the height of its problems, in 2007, Mid Staffordshire’s hospitals had the fourth highest rate of unexpected deaths in Britain.

The Trust had an HSMR of 127, meaning that 27 per cent more patients died than might be expected.

When the most recent annual figures were compiled last November, Mid Staffordshire’s HSMR score had fallen to 116.

By contrast, the worst death rate was at Basildon and Thurrock University Hospitals NHS Foundation Trust, in Essex, with a score of 132.

A spokeswoman for the Basildon trust said it had responded quickly to the finding by employing more doctors and creating a dedicated ward for cancer patients.

The second worst mortality rate, of 126, was at Wrightington, Wigan and Leigh NHS Trust, in north-west England, which has now launched an action plan to tackle the problem, including moves to treat more patients on specialist wards.

Andrew Foster, chief executive of the Wrightington trust, said: “We recognised what the figures were telling us and we are delighted with the progress we have made in reducing our HSMR and to have a sustained improved performance which we intend to continue.”

The other eight trusts whose mortality rates are worse than Mid Staffordshire – based on the most recent annual data from Dr Foster – are Blackpool, Fylde and Were Hospitals (123), George Eliot Hospital, Nuneaton (120), Swindon and Marlborough (120), North Middlesex University Hospital (119), Bolton Hospitals (118), Queen Mary’s Sidcup (117), Tameside Hospital (117) and Mid Cheshire Hospitals (117).

Since the data was prepared, Swindon and Marlborough has been renamed Great Western Hospitals NHS Foundation Trust and Bolton Hospital has been renamed Royal Bolton Hospital NHS Foundation Trust.

Health trusts are not obliged to investigate or act on their own HSMR scores, and many choose instead to dismiss high scores as statistical anomalies. All of the trusts contacted by the Sunday Telegraph insisted they had made improvements in the standards of care.

Campaigners warned that the scandal of Mid Staffordshire could be repeated unless high HSMRs were examined as a matter of course.

A spokesman for the Patients Association said: “We are amazed that trusts could have these high mortality rates and yet not automatically face any action. HSMRs are a blunt instrument but even a simple follow-up might uncover wider problems.”

Geoff Martin, of the Health Emergency campaign group, said: “There should be an investigation into these trusts and others with high mortality rates and the rates should be a matter of clear public record.”

Ben Bridgewater, a leading consultant cardiac surgeon and an expert on mortality rates at the Royal College of Surgeons, said: “You might look at 10 hospitals and find nine of them are actually doing a good job, but you would at least find the one that wasn’t, and that is surely the point of regulation.

“It is hardly ever the case that high mortality rates do not indicate hospitals where patient care could be improved. Publication of mortality rates was one of the recommendations of the Professor Ian Kennedy inquiry into death rates at Bristol back in 2001, and it hasn’t been achieved for reasons I don’t understand. This information is known within the NHS but hard for patients to find.”

Cardiac surgeons already have their individual mortality rates published but this is not the case for other treatments.

Ben Bradshaw, the health minister, hinted that the labour Government was reconsidering, saying: “I have asked the medical director to review available measures that can be used by trust boards and to accelerate their publication on NHS Choices.”

Professor Sir Bruce Keogh, medical director of the NHS, ruled out investigation of the 10 trusts with high HSMRs but said: “It would be irresponsible of trust boards not to investigate high mortality ratios.

“The HSMR is an aggregate measure of mortality for the organisation and hence a rather blunt, but useful, indicator of trouble.”

The Health care Commission launched its investigation into Mid Staffordshire after receiving seven alerts about potentially serious failures of care between July and November 2007.

The alerts, based on mortality for particular conditions such as kidney failure or stroke, are sent to trusts and watchdogs but not made public.

They are compiled by experts at Imperial College, London, led by Professor Jarman, under a system introduced in May 2007.

The investigation found that Mid Staffordshire managers failed to act quickly enough because they were convinced the HSMRs were incorrect.

It called for trusts in future to “conduct objective and robust reviews of mortality rates and individual cases rather than assuming errors in data”.

Professor Jarman added: “If HSMRs are acted upon promptly then undoubtedly thousands of deaths could be avoided. We are always open to hearing ways of improving the reliability of the figures, but for now high ratios are a solid indicator that something is going wrong.”

Andrew Lansley, the shadow health secretary, said: “The public has a right to know the extent to which patients benefit from treatment in each hospital, patients’ views on the standard of care they receive as well as the views of staff about how good a service the hospital provides.”

A spokeswoman for the Healthcare Commission said it did not agree that all high HSMR scores should be investigated. She said: “We would expect a trust that had a high HSMR to already have a sense of why that would be.

“It is not a matter of ‘forcing’ them – good managers generally have a sense of why their death rates are what they are. There are many reasons why a trust’s mortality rates may be high – that is why we do not use them in our annual ratings of performance.”


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