More worries about NHS wrongly coding Mortality rates.

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It’s Ok, Boss -

I’ll Cooka Da books

 

I’ve taken this article from The Daily Telegraph today; it deals with the worrying tendency for hospitals to train their ‘coders’ to alter the way deaths are recorded in their statistice. The government requires that certain outcomes (that is patients who who die) so that hospitals can be compared and bad practises spotted.

However if you come in for a hip replacement but you also happen to have cancer, your death can be recorded as ‘palliative’ (you died of cancer) even if it was really a badly performed hip replacement that was the real cause.

It means the hospital can improve its figures even if ‘outcomes’are getting worse.

	Percentage of deaths coded as palliative
	2008	2009	2010	2011	2012	Increase
East and North Hertfordshire NHS Trust	9.92%	12.31%	29.05%	38.84%	43.25%	33.33%
Guy's and St Thomas' NHS Foundation Trust	1.18%	13.89%	32.47%	31.25%	31.65%	30.47%
King's College Hospital NHS Foundation Trust	8.71%	17.49%	28.12%	40.09%	38.36%	29.65%
Royal Liverpool and Broadgreen University Hospitals NHS Trust	1.35%	9.91%	20.56%	21.91%	29.23%	27.88%
North Middlesex University Hospital NHS Trust	4.76%	10.04%	17.42%	22.58%	31.48%	26.72%
Ipswich Hospital NHS Trust	2.14%	3.65%	7.77%	9.33%	28.61%	26.46%
Central Manchester University Hospitals NHS Foundation Trust	11.34%	6.25%	10.68%	10.12%	36.63%	25.29%
Buckinghamshire Healthcare NHS Trust	7.56%	8.92%	24.64%	29.28%	32.13%	24.57%
Ashford and St Peter's Hospitals NHS Foundation Trust	0.32%	7.24%	4.00%	17.60%	23.04%	22.72%
The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust	9.91%	16.77%	32.21%	23.85%	32.52%	22.61%
Hinchingbrooke Health Care NHS Trust	1.48%	4.27%	26.24%	29.96%	22.10%	20.62%
James Paget University Hospitals NHS Foundation Trust	2.44%	4.06%	15.73%	22.63%	22.50%	20.05%
Epsom and St Helier University Hospitals NHS Trust	4.82%	16.06%	21.27%	22.18%	24.42%	19.60%
Aintree University Hospital NHS Foundation Trust	19.24%	20.18%	33.18%	39.87%	38.05%	18.82%
Sandwell and West Birmingham Hospitals NHS Trust	2.76%	0.74%	3.89%	19.24%	21.53%	18.77%
Frimley Park Hospital NHS Foundation Trust	9.51%	18.36%	16.67%	17.88%	27.89%	18.38%
South London Healthcare NHS Trust	8.04%	13.22%	24.46%	26.03%	25.95%	17.91%
Salford Royal NHS Foundation Trust	12.36%	20.89%	25.94%	29.89%	30.19%	17.83%
Peterborough and Stamford Hospitals NHS Foundation Trust	2.79%	15.04%	20.69%	17.44%	20.05%	17.26%
Milton Keynes Hospital NHS Foundation Trust	2.59%	10.98%	13.35%	8.83%	19.59%	17.00%
National Average	9.11%	14.35%	15.53%	16.05%	17.24%	8.13%

 

 

 

 

Telegraph.co.uk

 

Friday 18 April 2014

         

 

Fears that hospitals are covering up death rates

 

New data triggers fears that hospitals are 'fiddling the figures' on hospital deaths by increasing the number of deaths recorded as 'palliative' - classed as expected because a patient was terminally ill.

 By Laura Donnelly, Health Editor and Telegraph interactive team

Hospitals have been accused of “fiddling” their death rate figures by claiming patients were terminally ill, after new figures showing dramatic changes in the way mortality is recorded.

 

 

The NHS data shows a five-fold rise in the proportion of deaths being “coded” so that they barely count towards hospital mortality statistics - with some trusts now recording one in three deaths as a “palliative” case.

 

 

Last night experts said they were troubled by the “deeply concerning” trends, fearing hospitals could be hiding the fact patients had suffered poor care which contributed to their death.

 

They said the scale of the misreporting was such that it could even hide “another Mid Staffs” scandal.

 

 

Every NHS hospital has to collect and publish data showing how its death rates compare with what would be expected.

 

Crucially, if a case is coded as “palliative” it barely counts towards the rate, because it is classed as an expected death.

 

The code is only supposed to be used when a patient’s death in hospital is an inevitable consequence of their condition - such as that from a terminal illness.

 

Now new figures have triggered concern that the code is in fact being used to disguise many more deaths.

 

Data from health analysts Dr Foster shows that, across England in 2012/13, 36,425 deaths were coded as palliative. That was 17.3 per cent of the total number of deaths - twice the number recorded in 2008 and five times the 3.3 per cent of deaths recorded in 2006.

 

Roger Taylor, director of research at healthcare analysts Dr Foster Intelligence, which produced the data, 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: “The trends we are seeing are troubling - they are deeply concerning. Poor quality data is harming patients because you can’t see where things are going wrong. 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.”

 

Experts said that in some cases, patients were being counted as “palliative cases” when they had been admitted to hospital for a broken hip, but failed to recover.

 

Mr Taylor said he had called repeatedly on NHS officials to tighten the rules, and to audit such data, so that trusts could not manipulate it, but said nothing had been done.

 

“We’re worried this issue is not being given sufficient priority,” he said. “The bottom line is it could increase the possibility of failing to identify another Mid Staffs and potentially cost lives.”

 

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.”

 

Prof Sir Brian Jarman, Emeritus Professor of Imperial College London, an expert on mortality data, said: “I don’t think these very extreme changes reflect reality. I don’t think these hospitals have transformed into hospices to treat the dying overnight.”

 

Figures show that among the 20 NHS trusts with the steepest rise in palliative coding, between 2008 and 2012, 17 reduced their published death rate at the same time.

 

At East and North Hertfordshire trust the proportion of deaths which were explained as “palliative” quadrupled - from 9.92 per cent in 2008 to 43.25 per cent in 2012.

 

Over the same time, the trust’s death rate fell from 14 per cent higher than would be expected, to 3 per cent below.

 

At North Middlesex University Hospital trust the proportion of deaths coded “palliative” rose from 4.76 per cent to 31.48 per cent, the analysis shows.

 

Meanwhile, death rates fell from 6.8 per cent higher than expected to 12.2 per cent below.

 

At Guy’s and St Thomas’ NHS Foundation trust, the percentage rose from 1.18 per cent to 31.65 per cent.

 

At Kings College Hospital Foundation trust it rose from 8.71 per cent to 38.36 per cent, while at Royal Liverpool and Broadgreen University Hospitals NHS trust, the percentage rose from 1.35 per cent to 29.23 per cent.

 

Gary Walker, a former NHS trust chief executive who lost his job after raising concerns about patient safety, said the figures looked “very suspicious” warning: “In the NHS, if it looks like a trust is fiddling the numbers it probably is.”

 

Charlotte Leslie, a Conservative MP and 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.

 

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.”

 

East and North Hertfordshire trust said it was one of only a handful of hospital groups to run an NHS hospice and that a recent external reviews showed its coding was accurate.

 

North Middlesex University Hospital trust said the increase in deaths coded as palliative was due to better recording, as did Guy’s and St Thomas’ NHS Foundation trust which also said that as one of the largest providers of services for patients with cancer, it was to be expected that it would have higher than average rates of palliative coding.

 

Kings College Hospital Foundation trust said its rise was down to improvements recording palliative care. Royal Liverpool and Broadgreen University Hospitals NHS trust said it refuted any suggestion that changes were a result of any attempt to deliberately improve mortality rates, and said it coded palliative care patients with incurable diseases accurately.

 

In total, twenty trusts saw a rise of at least 17 percentage points in the number of deaths coded as palliative between 2008 and 2012, the statistics (listed in table above) show.

 

Ipswich Hospital said it its coding levels had been lower than average until a review of cases, which found too many patients in recepit of end-of-life care had not been properly recorded.

 

Buckinghamshire Healthcare NHS Trust said it had taken over the running of an 11-bedded hospice and that its palliative care team “work very closely with our acute wards and other inpatient community hospitals to ensure our end of life patients receive high quality care.”

 

Ashford and St Peter’s Hospitals foundation trust said the increase was a result of changes to palliative care coding criteria and improved record keeping and that it was “confident that our current data accurately reflects the trust’s specialiast palliative activity.”

 

The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust said “Unlike most acute hospitals in the country, we have a specialist palliative care unit – our Macmillan Unit – on site. Locally more patients will appropriately spend the end of their life in our hospital because of the presence of this hugely respected facility.”

 

Hinchingbrooke Health Care NHS Trust said it became aware it was under-reporting palliative care mortality in 2009, and employed a palliative care consultant to jointly carry out an audit of coding practices with Dr Foster, which led to changes.

 

James Paget University Hospitals Foundation trust said the increases in coding were historical, and that coding had been improved after an external audit found the trust was not recording palliative care coding in line with national guidance.

 

Epsom and St Helier University Hospitals Trust said: “The percentage rise in deaths coded as palliative care since 2008 reflects increased education and training of clinical staff to communicate appropriate end of life care plans for the dying patient and better documentation in the patient notes.”

 

Peterborough and Stamford Hospitals NHS Foundation Trust said its coding department “works extremely hard with our palliative care team to ensure that documentation is clearly marked” and had improved the accruacy of its data, which accounted for the change.

 

Sandwell and West Birmingham Hospitals trust said it “has embarked on a programme of work systematically looking at the causes of death in hospital which has resulted in a substantial reduction in avoidable mortality.”

 

Aintree University Hospital NHS Foundation Trust said: “Aintree has an excellent palliative care service, as recently noted by an independent external clinical review. "

Neil Harris

(a don’t stop till you drop production)

Home:   helpmesortoutthenhs.blogspot.com

Contact: neilwithpromisestokeep@gmail.com

Halving avoidable harm and saving 6000 lives

This is from a Department of Health press release dated 26/3/14 reporting a speech made by the Health Minister a couple of days before. I'm indebted to Carole Murphy for sending this to me - unfortunately in my own dispute with a hospital it has come 2 years too late.

 

 

Halving avoidable harm and saving 6000 lives 

 

A new ambition to reduce avoidable harm in the NHS by half over the next three years, cut costs and save up to 6,000 lives has been outlined by Jeremy Hunt. In a speech at Virginia Mason Hospital in Seattle, the Secretary of State has announced details of how NHS organisations can work together to improve patient safety and save money.

Each NHS organisation will be invited to ‘Sign up to Safety’ and set out publicly their ambitious plans for reducing avoidable harm, such as medication errors, blood clots and bed sores over the next three years. The NHS Litigation Authority, which indemnifies trusts against law suits, has agreed to review the plans and, when approved, reduce the premiums paid by all hospitals successfully implementing them. Every year the NHS spends as much as £1.3 billion on litigation claims.

The government will also introduce a Duty of Candour, making openness and honesty the norm across all health and social care organisations. It will mean providers must notify the patient about incidents where ‘significant harm’ has occurred and provide an apology.

Health Secretary Jeremy Hunt said:

It is my clear ambition that the NHS should become the safest healthcare system anywhere in the world. I want the tragic events of Mid Staffs to become a turning point in the creation of a more open, compassionate and transparent culture within the NHS.

We now have a once in a generation opportunity to save lives and prevent avoidable harm – which will empower staff and save money that can be re-invested in patient care. Hospitals are already “signing up to safety” as part of this new movement - and I hope all NHS organisations will soon join them.

Hospitals are now being approached to pledge their support to the movement and all trusts will receive an invitation to join over the next few months.

Other plans to improve patient safety as part of the package include:

• Consulting on the threshold for duty of candour to include significant harm, as part of the Care Quality Commission’s (CQC) registration requirements (as recommended by the Dalton-Williams review)
• Recruiting 5,000 safety champions as local change agents, identifying where there is unsafe care and developing solutions to fix it
• Creating a new Safety Action for England (SAFE) team that will consist of senior clinicians, managers and patients with a proven track record in tackling unsafe care. They will ensure that fast, flexible and intensive support is available where it is needed most
• Launching a dedicated section of the NHS Choices website in June called ‘How Safe is my Hospital’. The online tool will give everyone the ability to compare hospitals in England across a range of patient safety indicators
• Developing new reliable measures of avoidable hospital death rates and severe harm

A strong reporting culture, where safety incidents are reported and monitored is essential to improving safety. The measures announced today are likely to lead to an increase in the numbers of reported harm in the NHS even though care will be getting safer. NHS England will lead a project to accurately assess whether a hospital is reporting fewer, more or an expected number of incidents.

After an avoidable patient incident where a woman was accidently injected with cleaning fluid around ten years ago, Virginia Mason hospital in Seattle has turned itself around to become one of the safest hospitals in the world.

Virginia Mason Chairman and CEO Gary S. Kaplan, MD said:

Patient safety is our number one priority. We’re honored that the Health Secretary is advancing changes in England’s health system based in part on the value he sees in our commitment and dedication to always putting patients first.

Background information

1. In a consultation on the Duty of Candour, published today, it is proposed that the Care Quality Commission (CQC) will include the Duty of Candour as part of its registration requirements. This will mean every organisation registered with the CQC will have to be open about all cases of significant harm including death, severe harm and moderate harm, including prolonged psychological harm.
2. Virginia Mason hospital in Seattle employs more than 5,600 people and includes a 336-bed acute-care hospital; a primary and specialty care group practice of more than 460 physicians

 

 

 

 

 

 

 

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