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Hospital mortality: report shows trusts with persistently high or low ratios over two year period

January 24, 2013: Five NHS trusts in England have been categorised as having a 'higher than expected' mortality ratio over two years, new analysis shows.

Five NHS trusts in England have been categorised as having a 'higher than expected' mortality ratio over two years, new analysis shows.

During the same period - between July 2010 to June 2012 - 11 trusts were categorised as having a 'lower than expected' ratio, based on Summary Hospital-level Mortality Indicator (SHMI) data.

This analysis features for the first time in an experimental report; Summary Hospital-level Mortality Indicator (SHMI) - Deaths associated with hospitalisation, England, Experimental Statistics Supplementary Report, July 2010 - June 2012; which is supplementary to today's standard quarterly publication of mortality ratios - or SHMI values - for all 142 non-specialist acute trusts in England.

The SHMI compares the actual number of patients who die following hospitalisation at a trust with the number who would be expected to die, given the characteristics of the patients treated there. It categorises them as; 'as expected', 'higher than expected' or 'lower than expected'.

It differs from other mortality indicators because it considers all deaths that take place in a trust as well as those taking place within 30 days of discharge. As a result, it offers a more comprehensive picture of deaths following hospital care.

The following shows the trusts categorised as higher or lower than expected in both the first and latest (fifth) SHMI publication, which both cover a 12 month period (July 2010 to June 2011 and July 2011 to June 2012)4:

  • 'Higher than expected':

- Colchester Hospital University NHS Foundation Trust

- Tameside Hospital NHS Foundation Trust

- Blackpool Teaching Hospitals NHS Foundation Trust

- Basildon and Thurrock University Hospitals NHS Foundation Trust

- East Lancashire Hospitals NHS Trust

  • 'Lower than expected':

- James Paget University Hospitals NHS Foundation Trust

- Cambridge University Hospitals NHS Foundation Trust

- Royal Free London NHS Foundation Trust

- Kingston Hospital NHS Trust

- St George's Healthcare NHS Trust

- The Whittington Hospital NHS Trust

- Chelsea and Westminster Hospital NHS Foundation Trust

- University College London Hospitals NHS Foundation Trust

- North West London Hospitals NHS Trust

- Imperial College Healthcare NHS Trust

- Barnet and Chase Farm Hospitals NHS Trust

Today's supplementary report also provides additional information about these trusts. Key findings include:

  • Of patients who died; a greater percentage had been coded under 'palliative care' at either diagnosis or treatment specialty level in both groups of trusts ('higher than expected' and 'lower than expected), compared to trusts overall.
  • The 'lower than expected' group had lower mortality rates for both elective and non-elective admissions compared to trusts overall.
  • The 'higher than expected' group had a higher proportion of cases (finished provider spells) classed as from 'most deprived areas' (quintile 1, on a deprivation scale of 1 to 5) compared to trusts in general, while the 'lower than expected' group had a lower proportion of quintile 1 cases compared to trusts in general.

HSCIC chief executive Tim Straughan said: "Today's report, based on two years of data, shows an emerging picture of which trusts are categorised over time as having higher or lower mortality ratios than expected; and indeed also shows that the vast majority of trusts in England have a mortality ratio that is as expected, based on the characteristics of the patients they will typically treat.

"As always with such a complex area, this mortality indicator should be seen as an early warning mechanism, rather than a definitive judgement, to examine the reasons why a trust's ratio is higher or lower than expected."

Today's report can be accessed at: www.hscic.gov.uk/pubs/shmijul11jun12

ENDS

Notes to editors

  1. HSCIC was previously known as the NHS Information Centre. It is England's authoritative, independent source of health and social care information. It works with a wide range of health and social care providers nationwide to provide the facts and figures that help the NHS and social services run effectively. Its role is to collect data, analyse it and convert it into useful information which helps providers improve their services and supports academics, researchers, regulators and policymakers in their work. The HSCIC also produces a wide range of statistical publications each year across a number of areas including: primary care, health and lifestyles, screening, hospital care, population and geography, social care and workforce and pay statistics.
  2. There are currently a number of generic mortality indicators used in the NHS. They have been designed by different organisations using different statistical methods to help identify trends that require further investigation. Following the Review of the Hospital Standardised Mortality Ratio (HSMR) in 2010 (http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_121328.pdf), the Department of Health committed to adopting the SHMI as the single summary-level indicator for hospital mortality. It commissioned the NHS Information Centre to develop, deliver and publish the SHMI as it does all national indicators.
  3. This indicator has been developed in collaboration with a range of national stakeholders following a review commissioned in 2010 by medical director for the NHS in England Sir Bruce Keogh and chaired by Ian Dalton, then chief executive of the North East Strategic Health Authority. It involved a wide range of stakeholders, including the Department of Health, representatives from strategic health authorities and trusts, the NHS IC, the Care Quality Commission, Monitor, the Kings Fund, the Academy of Royal Colleges, the NHS Confederation, Dr Foster Intelligence, CHKS, University Hospitals Birmingham, the National Patient Safety Agency and Professor Sir Brian Jarman and colleagues from Imperial College.  During 2011, several members have continued to support and contribute to the technical work associated with the development and construction of the SHMI (from the Department of Health, the Care Quality Commission, Dr Foster Intelligence, Dr Foster Imperial , CHKS and University Hospitals Birmingham).  
  4. For the purposes of this supplementary report, persistent outliers are defined as trusts categorised as either 'higher than expected' or 'lower than expected' in both the first and latest (fifth) SHMI publication, which each cover two full 12 month periods. The second, third and fourth SHMI publications covered the same period but on a rolling quarterly basis.
  5. For media enquiries please call 0845 257 6990 or email media@hscic.gov.uk