Mid Staffs death rates – poor care not poor data

A trust that tried to blame high death rates on inadequate systems for recording patient data is to be condemned for “appalling” standards by the Healthcare Commission.

Dr Foster’s monitoring unit, based at Imperial College in London, noticed that Mid Staffordshire NHS Foundation Trust’s mortality rate was higher than the national average in summer 2007. It alerted the Commission, which launched an investigation in March 2008.

When this happened, however, the trust issued a statement saying: “We have worked with the strategic health authority and investigated the apparently high mortality rate and concluded that it was due to problems in the way we were recording and coding information about patients.”

The trust’s then chief executive, Martin Yeates, said the trust had employed more coding experts and “as a result there has been a significant improvement to our standardised mortality ratio.”

He also sought to assure local people that: “If we thought the trust was unsafe, we would already have taken action. There is no cause for alarm.”

However, the Healthcare Commission’s report, which is due to be published tomorrow, but which is already being widely reported, rejects this explanation.

Instead, it says that between 400 and 1,200 more people died than would have been expected at the trust over a three year period and that this was due to “shocking” care for patients admitted through A&E.

Its investigation, which involved 300 interviews and the examination of more than 1,000 documents, found the trust had become over-focused on meeting targets and achieving cost savings, at the expense of basic patient care.

It found staff were inadequately trained and supervised, with receptionists left to assess patients in A&E and heart monitors left unused in the emergency assessment unit because nurses did not know how to use them.

It also found more general failures of care, with patients left unwashed, unfed and without access to medicines. Sir Bruce Keogh, medical director of the NHS, has been quoted by the Press Association as saying there had been a “gross and terrible breach of trust" of Mid Staffordshire’s patients.

Yeates and the trust’s chair, Toni Brisby, both left last week, with a new chief executive, Eric Morton, appointed as interim chief executive. Morton, a veteran manager who started his career in finance, has apologised for his new trust’s failings.

However, Mid Staffordshire is to come under further scrutiny, as health secretary Alan Johnson has reportedly launched three inquiries in response to the Healthcare Commission’s report.

Professor Sir George Alberti, an academic at Imperial College London who advises the Department of Health as national clinical director for urgent and emergency care, will review its emergency work.

Dr David Colin-Thome, the NHS’s national director for primary care, will investigate standards at the trust from 2002 to 2007 "to determine how the obvious failings were allowed to continue for so long."

Speaking on Radio 4’s PM programme, Johnson indicated that one issue Colin-Thome would look at was why local organisations became "bogged down" in debates about coding and data.

"There was an argument going on about coding for years. The Healthcare Commission went and looked at what was actually happening in the hospital," he said.

The NHS’s National Quality Board will also look into the wider effectiveness of early warning systems within the health service.

Liberal Democrat health spokesman Norman Lamb has already called for "a cultural change so that every trust has open and transparent systems in place to ensure patient safety.”

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