Death Rates Expose Postcode Lottery
The large disparity in mortality rates in NHS hospitals is exposed today in research carried out for The Daily Telegraph. Patients are twice as likely to die in hospitals with the highest mortality rates than in those with the lowest, according to a report from Dr Foster Research, the independent health information company.
It found that despite the Government pouring billions of pounds into the NHS, a postcode lottery exists with standards of care varying widely across the country. While death rates have been falling in hospitals overall, researchers found that the cost of poor performing hospitals in terms of patient lives was staggering.
They looked at 152 NHS trusts in England and estimated that the lives of 7,400 people could have been saved in 2005/6 if all trusts with higher than expected mortality rates had reduced them in line with the expected rate.
Patients at the Royal Free Hospital NHS Trust in north London were identified as the most likely to survive, with a mortality rate 26 per cent below the expected rate. By contrast, George Eliot Hospital NHS Trust in Nuneaton, Warks, had the highest mortality rate – 43 per cent above the expected rate.
The research did not investigate cause of death at individual hospitals but Dr Foster Research said typical factors would be medical error, infection and failure to deliver “quality of care”.
The findings will raise further fears about the spread of superbugs at a time when cases of Clostridium difficile are soaring, with a 69 per cent increase in deaths between 2004 and 2005. MRSA reduction targets are also unlikely to be met.
Patient groups described the findings as “extremely worrying” and said NHS trusts had to do more to reduce the differences that exist around the country in NHS care.
Dr Foster Research’s mortality rates, the most comprehensive ever compiled, are standardised to take into account a range of risk factors, such as the age of patients, sex, social demographics, the level of deprivation in the area and whether a patient has any other illnesses.
The ratio shows whether the number of patients who died was higher or lower than expected. The expected level is set at 100. A figure of 110 would mean a death rate 10 per cent above expectations.
Of the 152 trusts analysed, 56 were listed as having a high mortality rate, 45 had a low mortality rate and 51 had an average mortality rate. Almost all – 145 – had reduced mortality rates over the past five years.
The seven showing the least improvement included Barts and London NHS Trust, Bedford Hospital NHS Trust, George Eliot Hospital NHS Trust and Lancashire Teaching Hospitals NHS Foundation Trust.
Roger Taylor, the research director at Dr Foster Research, said: “We have seen some fantastic efforts by many hospitals to reduce mortality rates. Patients have a right to expect that all hospitals should do the same. Wide variations are worrying and indicate variable standards in the quality of care in hospitals.”
Katherine Murphy, of the Patients’ Association, said: “There should be national standards across the NHS. Patients looking at these figures will be alarmed to learn that they are more likely to die in some hospitals than in others. It’s essential that poor performing trusts learn from the experiences of better ones. The NHS is very bad at doing that.”
Andrew Lansley, the shadow health spokesman, welcomed the publication of mortality rates, saying they would allow patients to make informed choices. “But NHS trusts need to start working towards publishing mortality rates for each of their departments,” he said. “This would allow patients and GPs to make genuine comparisons across hospitals.”
Andrew Way, the chief executive of the Royal Free Hampstead NHS Trust, said: “We’re very proud to have one of lowest mortality rates. Hospital mortality rates are regarded as a very good indicator of overall clinical performance, so this is a significant achievement.”
George Eliot NHS Trust said its high mortality rate had been caused by “deficiencies in the hospital’s recording of information regarding a patient’s diagnosis and is not reflective of the quality of patient care”.
Dr Peter Handslip, the trust’s medical director, said: “We have undertaken a thorough review of the trust’s mortality data over the past year. This has resulted in a dramatic improvement in our standardised mortality rate since July 2006.”
Overall, the data indicated that the number of poor performing trusts in England has fallen from 44 in 2001/2 to 36 in 2005/6. Regional data from Scotland and Wales has only become available recently and is not yet robust enough to draw meaningful comparisons.
Nigel Edwards, the director of policy at the NHS Confederation, said: “This report will help NHS trusts to identify where improvements need to be made.”
A Department of Health spokesman said: “We would strongly advise against patients using these figures to make decisions about the relative safety of hospitals. It is impossible to condense into one number the entire performance of a hospital in a way comparable with every other hospital in the country.”