Hospital guide published: death rates are 10% higher at weekends – surely we have to increase consultant cover?
November 30, 2011
Posted by:Suzanne Trask
The annual hospital guide published by Dr Foster Intelligence states that one in eight NHS Trusts has higher than expected death rates on weekends. Most hospitals have far fewer consultants on site outside of normal office hours and rely on junior doctors and nurses to treat patients.
In several Trusts, the mortality rate rises by 20 per cent or more between weekdays and weekends.
Low staffing levels in A&E have been identified as one of the long-standing problems at Stafford Hospital, where hundreds of patients died after receiving “appalling” care, and the unit will close overnight for three months starting this week.
Professor Sir Bruce Keogh, the NHS Medical Director, told the Telegraph newspaper that: “Mortality rates in the NHS are going down, but hospitals with high rates and poor outcomes in the evenings and at weekends must investigate to see where performance may be falling short and look to those with the best rates to see how they can improve.
“By working together and sharing best practice, hospitals can improve services for patients. I will be asking the NHS Medical Directors to look closely at weekend services to ensure patients admitted at weekends receive the same standards of care as those during the week.”
Death rates for NHS hospitals were developed following the Bristol heart scandal as a way to assess performance objectively. They compare the number of actual deaths over a year to a figure predicted for the types of patients treated. Some managers claim the most common measure, known as the Hospital Standardised Mortality Ratio (HSMR) is unfair because if patients choose to remain in hospital to die rather than dying at home the hospital will have a higher mortality rate. The new Dr Foster guide, available online at http://www.drfosterhealth.co.uk, counters this by including for the first time a new mortality rate, known as the Summary Hospital-level Mortality Indicator (SHMI), which includes all deaths within 30 days of discharge from hospital.
It also considers the number of deaths after complications in surgery and deaths among patients thought to have been at low risk. These may include cases of medical negligence.
The analysis of all 147 NHS acute trusts in England identifies 19 where death rates are higher than expected according to both the HSMR and the SHMI. Hull and East Yorkshire Hospitals NHS Trust does poorly on both measures and also on deaths after surgery. However the guide lists 21 trusts across the country which record better than expected mortality rates, with Chelsea and Westminster NHS Foundation Trust scoring highly on all four measures.
The new report also provides “pretty stark” evidence that the number of senior staff on duty affects patients’ survival chances.
Data shows that 30 per cent of hospitals currently have no consultants on site at night, with cover provided by less experienced colleagues. However, some Trusts have adapted to provide cover, and have simply changed consultants’ working days so that they finish at 10pm, allowing them to continue surgery throughout evenings instead of handing over to junior doctors. Having a different shift system to cover a larger proportion of the day (if not the whole day) is surely a better way to ensure better consultant cover, at no extra cost. This would be bound to save both lives and serious injuries from occurring, instead of leaving such situations in inexperienced hands.