Letter - Death rates are no cause for alarm

WhilE it is right that your correspondent brings up the matter of higher than average expected death rates at Mid Yorkshire Hospitals NHS Trust hospitals in Wakefield, Pontefract and Dewsbury and I agree it is a cause for concern, may I assure your readers that it is not a cause for panic or alarm, but should be kept under constant watch and should be monitored more frequently.

May I list my reasons for reassuring your readers as follows: about four years ago Mid Yorkshire’s Hospital Standardised Mortality Rate (HSMR) was 114 and at that time we were very concerned and alarmed and invited the associate medical director of clinical governance and patient safety to explain the reasons for such a high HSMR.

Following that, the ratio has been around 100, which is normal. HSMR is not a very exact science, as noted by Judge Francis, who chaired the inquiry about the mortality and standard of care at Mid Staffordshire NHS Foundation Trust. He invited two experts in the field to give an opinion, and made the following recommendation: “In view of the uncertainties surrounding the use of comparative mortality statistics in assessing hospital performance and the understanding of the term ‘excess’ deaths, an independent working group should be set up by the Department of Health to examine and report on the methodologies in use. It should make recommendations as to how such mortality statistics should be collected, analysed and published, both to promote public confidence and understanding of the process, and to assist hospitals to use such statistics as a prompt to examine particular areas of patient care.”

The main factors taken into consideration are age and the co-morbidities (other health problems). Mid Yorkshire caters for three communities, namely Pontefract, Wakefield and Dewsbury and two of these have a significantly high rate of co-morbidities and also have a shorter span of life and lower cancer survival rates.

Mid Yorkshire, according to their Quality Account, have a very high clinical coding error, including that of co-morbidity (secondary diagnosis), although it has fallen from 37.5 per cent (2008-9) to 9.1 per cent (2011-12).

This coding error does affect the HSMR and finally because of capacity problems they send a large proportion of elective patients (comparatively healthy with less co-morbidity) to other districts and the private sector. Last year they sent over 2,500 to the private sector.

Lack of proper care facilities in the community sometimes necessitates inappropriate admissions to Mid Yorkshire hospitals and these patients clearly have a very high mortality rate.

HSMR methodologies should eliminate such areas of error, but proper information should be produced to Dr Foster (the agency that calculates HSMR).

Mid Yorkshire’s failure to provide such information is a cause for concern.

Finally, may I ask Mid Yorkshire to learn from good examples like that of Bradford Teaching Hospitals NHS trust, who have lower their HSMR from 94.6 in 2001 to 77.5 in 2005, their latest HSMR being 89.

N K Mathur

Patient safety champion, Yorkshire and Humberside

Patient safety lead for Wakefield LINk