Keogh issues death rates warning

NHS England’s medical director has warned against using two statistical indicators to claim that 14 trusts are failing or that they have killed thousands of patients.

In a review of 14 trusts with high mortality rates as measured by the Hospital Standardised Mortality Ratio and the newer Summary Hospital-level Mortality Indicator, Sir Bruce Keogh says it is “clinically meaningless and academically reckless” to use either to “quantify actual numbers of deaths.”

The remarks are a sharp rebuke to Sunday newspapers, which claimed there had been up to 13,000 avoidable deaths at the 14 trusts.

These stories came amid generally negative coverage of NHS England’s attempt to kick-start a debate on the future of the NHS by setting out the scale of the gap between funding and demand by 2020.

However, the review, which is due to be published following a Parliamentary statement from health secretary Jeremy Hunt early this afternoon, did find problems at the trusts investigated.

Although review teams found that "all had pockets of excellence" they also concluded that “none was providing consistently high quality care to patients” and that they had become "trapped in mediocrity."

The Department of Health says the review found patterns of problems relating to the “professional and geographic isolation” of the organisations, low staffing levels and an over-reliance on agency staff.

It also found the trusts had a general tendency to “fail to act on data or information that showed cause for concern”, and that they suffered from an “absence of a culture of openness” and “a lack of willingness to learn from mistakes.”

The trusts will be expected to draw up plans to address the problems, which will be overseen by the foundation trust regulator, Monitor, or the new Trust Development Authority. Eleven have also been placed in “special measures.”

The HSMR is the best-known mortality indicator in the NHS, and alerted Dr Foster and regulators to the problems at Mid Staffordshire NHS Foundation Trust in 2007.

However, in his first report into the Mid Staffs scandal, Sir Robert Francis QC expressed concern about the way it was interpreted, and the existence of alternative measures.

In response, the DH set up a working party, led by Sir Bruce, which led to the introduction of the SHMI.

Earlier this year, a number of experts told EHI that questions remained about its construction and that neither measure, on its own, could be used to identify poorly performing trusts.

Today, Sir Bruce said: “Higher mortality rates do not always point to deaths which could have been avoided, but they do act as a ‘smoke alarm’ indicator that there could be issues with the quality of care.

“[The reviews for this report] have been highly rigorous and uncovered previously undisclosed problems. Mediocrity is simply not enough and [these hospitals will be expected to] improve dramatically over the next two years.”

Sir Bruce’s review was ordered by NHS England after the second Francis inquiry into Mid Staffs, which reported in January.

However, even at the time Sir Bruce said in a statement that all of the trusts involved were “working closely with a range of regulators” and that “if there were concerns that services were unsafe regulators would have intervened.”