Thursday 27 March 2014

Gaming the codes - exposed in the statistics.

This is something I have Blogged about before - how hospitals have been sending their 'Coders' on courses to learn how to improve the death rates for their hospitals without actually having to save any lives - it's a miracle.

It even has a name in the NHS; Gaming.

Very simply if someone comes in for a hip replacement but dies, that's a black mark in the statistics.
If, however that person also happens to have cancer (but they died as a result of the operation, not the cancer) if you enter the code for 'palliative care', you have used the cancer to wipe out an inconvenient death.

'Do the Math';                                  



 

The way hospitals record deaths could be covering up poor treatment and costing lives, according to a new report.

Figures show a dramatic rise in the number of people recorded as needing "palliative care" at the end of their lives, with some hospitals saying more than 35% of their patients die this way.
Experts fear hospitals could actually be hiding the fact patients were admitted for treatment which then failed.
Some hospitals may also be "fiddling" the figures to make their death rates appear better than they actually are, they said.

Data from health analysts Dr Foster shows that, across England in 2012/13, 36,425 deaths were coded as palliative - meaning people received some sort of care to relieve suffering at the end of their lives.
This was 17.3% of the total number of deaths and is almost double the 9.1% (2,1130) recorded as needing palliative care in 2008. In 2006, just 3.3% of deaths were palliative.
Some hospital t rusts have massively outstripped this national rise. Out of 142 hospital trusts in the report, almost half (60) recorded the number of people needing palliative care in 2012 as higher than the national average.
At East and North Hertfordshire NHS Trust, 43.18% (785 deaths) were recorded as palliative in 2012. In 2008, just 9.92% of deaths recorded by the trust were for palliative care.
At King's College Hospital NHS Foundation Trust, 38.41% (472 deaths) were coded the same way in 2012 (compared with just 8.71% of deaths in 2008).
Meanwhile, 38.03% (610 deaths) at Aintree University Hospital NHS Foundation Trust were palliative in 2012 - almost double the 19.24% in 2008.
Guy's and St Thomas' NHS Foundation Trust in London jumped from having 1.18% of deaths recorded as palliative in 2008 to 31.65% in 2012 - a 27-fold rise.
The Royal Liverpool and Broadgreen University Hospitals NHS Trust also jumped from 1.35% palliative deaths in 2008 to 29.23% in 2012.
Most of the 20 trusts with the biggest leaps in their palliative care coding have also significantly improved their performance on death rates between 2008 and 2012.
Palliative care deaths are not included in the hospital standardised mortality ratio (HSMR), which compares the expected rate of death in a hospital with the actual rate of death.
Trusts that code deaths as palliative effectively "remove" deaths from being included in the HSMR.
Professor Sir Brian Jarman, from Imperial College London, developed the HSMR. He told the inquiry into the scandal at Mid Staffordshire that some trusts increased their coding of palliative care deaths to reduce overall death rates.
He said Mid Staffs was one of them - but such huge leaps could only occur if trusts suddenly became terminal care hospitals overnight.
Of the latest Dr Foster figures, he said: "I can't read their minds but when you see these really dramatic shifts you have to ask, did they become a palliative care hospice overnight?
"I am concerned that trusts know that increasing their palliative care rates assists their HSMR and am concerned that this could be the reason they are doing it."

Roger Taylor, director of research at Dr Foster, said some trusts had changed the way they recorded deaths as a means of improving monitoring of palliative care.
But he said there were "real concerns around the gaming of indicators", adding: "Whether or not you are doing it deliberately, the end result is that the variation in coding may disguise poor outcomes."
He said "imprecise rules" governing how hospitals code deaths was harming patient care, may distort death rates and needed urgent review.
"The rules are too vague," he said. "Poor quality data is harming patients because you can't see where things are going wrong and you can't see where there are issues.
"If the data is not being recorded consistently and, moreover, if that isn't picked up because of a lack of auditing there is a risk that poor patient care is being disguised, and the public misled.
"We're worried this issue is not being given sufficient priority. The bottom line is it could increase the possibility of failing to identify another Mid Staffs and potentially cost lives."
Mr Taylor said there had been little will at government level to deal with the issue, even though the Department of Health, NHS England and the Health and Social Care Information Centre were aware of it.
"There seems to be remarkably little desire to grapple with this problem," he said. "It does need to be dealt with much more urgently."
He added: "The trends we are seeing are troubling - they are deeply concerning. "

Tory MP Charlotte Leslie, a member of the House of Commons health committee, said: "This is very worrying data.
"We already know that at the time of the Mid Staffs scandals, hospitals were fiddling the figures to massage their mortality rates.
"These figures suggest that hospitals are still fiddling the figures to put their own reputation and that of their managers ahead of patient safety.
"We need strict scrutiny of this and we should hold anyone deliberately fixing the figures to account. Deliberately hiding the truth must be a punishable offence in our NHS."
Joyce Robins from Patient Concern said: " Hospitals are clearly fiddling these figures and that frightens me. Hospitals are just not open enough to admit what is happening - instead they dream new ways to disguise it. All the talk of transparency is just that - talk."

Whistleblower Gary Walker, the former head of United Lincolnshire Hospitals Trust, said: "In the NHS, if it looks like a trust is fiddling the numbers it probably is."
He claims he was sacked because of a row over a waiting times target when he tried to flag up problems.
He said: "Between 2008 and 2012, many consultancies advised NHS trusts to increase the rate of palliative care coding in order to 'more accurately reflect their particular death rate'.
"But with most NHS trusts reporting one in 10 palliative care deaths and some here reporting almost one in two, there is something very suspicious going on.
"The Department of Health should investigate whether this is gaming to make death rates look better than they really are."

A Department of Health spokesman said: "The NHS needs high-quality mortality data. We would expect that all NHS Trusts have robust auditing systems in place.

Neil Harris
(a don't stop till you drop production)

Home:        helpmesortoutthenhs.blogspot.com

Contact: neilwithpromisestokeep@gmail.com
 

Monday 3 March 2014

No comment for legal reasons.


For legal reasons I’m just reprinting this article without making any comment except to say that whatever the rights and wrongs, Mrs Haynes-Kirkbright did all of us a great service when she made her allegations;

March 3, 2014 9:00 am

Wolverhampton Express and Star.

 

Wolverhampton New Cross Hospital death rate whistleblower faces sack

 

A whistleblower who alleged she had been brought in to ‘fix’ mortality rates at a Black Country hospital has been told she ‘behaved recklessly or negligently’ in going public with her allegations and now faces being sacked.

 

Sandra Haynes Kirkbright claimed last year that she was ‘head-hunted’ by the Royal Wolverhampton NHS Trust, which runs Wolverhampton’s New Cross Hospital, to cover up the true extent of the problem.

 

Mrs Haynes-Kirkbright claimed that ‘every rule in the book’ was broken to try to improve mortality rates, and alleged that she was suspended from her post as a senior health coder after refusing to take part in a cover-up.

 

The trust rejected the allegations of altering the death rates, calling them an ‘outrageous slur’, and said independently-verified evidence ‘categorically disproved’ her claims. The hospital’s chief executive, David Loughton, said at the time: “Improvements in the hospital’s mortality rates have been audited and independently verified.”

 

Mrs Haynes-Kirkbright was suspended by the trust after allegations of bullying, harassment, persistent swearing and unprofessional behaviour were made against her by colleagues through their union in 2012.

 

She has now been ordered to attend a disciplinary hearing. In the letter sent by email, hospital managers claimed she had ‘behaved recklessly or negligently in disclosing information regarding the Trust to an external source without the Trust’s authorisation to do so’, and accused her of breaching employment contracts by speaking to the press. She was warned: “This may result in formal disciplinary action, not excluding dismissal.” The threat raises further questions about protection for whistleblowers following the Mid Staffordshire scandal.

 

Mrs Haynes-Kirkbright ,a health coder, previously said she recorded details of the care received by patients and claimed conditions at Wolverhampton were as bad or worse as those at the Stafford trust.

 

She believed that the hospital wanted to ‘fix’ its death rates rather than improve patient care, and claimed coders were recording too many deaths at the hospital under ‘palliative care’, which as they were classed as ‘unavoidable’ would not alter the hospital’s mortality rate.

 

Responding at the time, Mr Loughton said they categorically denied all the allegations and that any suggestion of any wrong-doing were simply not true.

Neil Harris

(a don’t stop till you drop production)
Home: helpmesortoutthenhs.blogspot.com
Contact: neilwithpromisestokeep@gmail.com