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| 750 avoidable deaths a month in NHS hospitals, study finds | 750 avoidable deaths a month in NHS hospitals, study finds |
| (2 months later) | |
| About 750 patients a month in NHS hospitals are dying unnecessarily, the largest review of “avoidable deaths” has found. | About 750 patients a month in NHS hospitals are dying unnecessarily, the largest review of “avoidable deaths” has found. |
| Researchers at the London School of Hygiene and Tropical Medicine said one in 28 deaths could be attributed to poor care such as inattentive monitoring of the patient’s condition, doctors making the wrong diagnosis or patients being prescribed the wrong medicine. | Researchers at the London School of Hygiene and Tropical Medicine said one in 28 deaths could be attributed to poor care such as inattentive monitoring of the patient’s condition, doctors making the wrong diagnosis or patients being prescribed the wrong medicine. |
| In February, the health secretary, Jeremy Hunt, announced that hospitals in England would be required to monitor the rate of avoidable deaths and that officials would rank trusts on this measure. | In February, the health secretary, Jeremy Hunt, announced that hospitals in England would be required to monitor the rate of avoidable deaths and that officials would rank trusts on this measure. |
| Hunt said the rate of avoidable deaths in hospitals was the “biggest scandal in global healthcare” and estimated that 1,000 patients died needlessly each month. | Hunt said the rate of avoidable deaths in hospitals was the “biggest scandal in global healthcare” and estimated that 1,000 patients died needlessly each month. |
| He said healthcare should learn lessons from the airline industry, where annual deaths worldwide had fallen from 2,000 in the 1970s to 500 now. | He said healthcare should learn lessons from the airline industry, where annual deaths worldwide had fallen from 2,000 in the 1970s to 500 now. |
| The new study said measures used by health officials to rate hospital death rates, such as the standardised mortality ratio, “should not be used to benchmark hospitals’ quality of care … [because there is] no significant association between them and the proportion of avoidable deaths in a trust”. | The new study said measures used by health officials to rate hospital death rates, such as the standardised mortality ratio, “should not be used to benchmark hospitals’ quality of care … [because there is] no significant association between them and the proportion of avoidable deaths in a trust”. |
| High death rates were used by Conservative ministers as justification for launching a public inquiry into Mid Staffs hospital trust – a process that led to its closure. | |
| Academics point out that mortality ratios are a measure of how many “excess deaths” there were in a hospital compared with a national average, but not how many were preventable. The study says similar flaws dog the summary hospital-level mortality index (SHMI), which covers deaths after hospital treatment and up to 30 days after discharge. | Academics point out that mortality ratios are a measure of how many “excess deaths” there were in a hospital compared with a national average, but not how many were preventable. The study says similar flaws dog the summary hospital-level mortality index (SHMI), which covers deaths after hospital treatment and up to 30 days after discharge. |
| Despite these flaws, an industry has grown up around death rate data. Proponents such as Sir Brian Jarman, a professor at London’s Imperial College who co-founded the hospital ratings company Dr Foster, argue that such measures are not a confirmation of poor care but rather should be seen as a “smoke alarm” in that they highlight a problem that needs investigating. | Despite these flaws, an industry has grown up around death rate data. Proponents such as Sir Brian Jarman, a professor at London’s Imperial College who co-founded the hospital ratings company Dr Foster, argue that such measures are not a confirmation of poor care but rather should be seen as a “smoke alarm” in that they highlight a problem that needs investigating. |
| The author of the paper, Helen Hogan, a former GP and public health expert, said that only by instigating an independent review into contentious patient deaths that one could describe a patient’s loss of life in hospital as “avoidable”. | The author of the paper, Helen Hogan, a former GP and public health expert, said that only by instigating an independent review into contentious patient deaths that one could describe a patient’s loss of life in hospital as “avoidable”. |
| Hogan said that, in the past, regulators had described hospitals as failing in delivering good patient care because of their apparent death rates. | Hogan said that, in the past, regulators had described hospitals as failing in delivering good patient care because of their apparent death rates. |
| Her co-author Nick Black, professor of health services research at the school, has questioned whether mortality rates take into account factors such as burden of illness and are skewed by other factors such as the availability of hospice care in the area. (Where there is less hospice care, patients are more likely to be in hospital when they die.) | Her co-author Nick Black, professor of health services research at the school, has questioned whether mortality rates take into account factors such as burden of illness and are skewed by other factors such as the availability of hospice care in the area. (Where there is less hospice care, patients are more likely to be in hospital when they die.) |
| Hogan said: “A case review of patient notes is really the only way of making a decision about the quality of care. Even then it takes the judgment of Solomon to decide whether a frail, elderly person has died because of clinical mistakes. | Hogan said: “A case review of patient notes is really the only way of making a decision about the quality of care. Even then it takes the judgment of Solomon to decide whether a frail, elderly person has died because of clinical mistakes. |
| “If you assume a hospital is failing, then you will find failure. There are lots of reasons that hospital mortality ratios stand out. The trouble is that could be with the quality of inputting hospital operations into a computer rather than the quality of hospital care.” | “If you assume a hospital is failing, then you will find failure. There are lots of reasons that hospital mortality ratios stand out. The trouble is that could be with the quality of inputting hospital operations into a computer rather than the quality of hospital care.” |
| Sir Bruce Keogh, NHS England’s medical director, said: “The findings provide us with useful additional insight and show we need to look at a whole range of methods to measure health care quality. | Sir Bruce Keogh, NHS England’s medical director, said: “The findings provide us with useful additional insight and show we need to look at a whole range of methods to measure health care quality. |
| “I have long argued for more relevant and transparent measures of individual services within hospitals. A really strong lesson that came out of my review of hospitals with high mortality is the invaluable, constructive insight brought by patients and the public of quality of care and how to improve it.” | “I have long argued for more relevant and transparent measures of individual services within hospitals. A really strong lesson that came out of my review of hospitals with high mortality is the invaluable, constructive insight brought by patients and the public of quality of care and how to improve it.” |
| • This article was amended on 25 September 2015. An earlier version referred to “Mid Staffs hospital” where “Mid Staffs hospital trust” was meant. |