NHS Trust Dr Foster Response

Dear Member

You may have seen coverage of the Dr Foster Hospital Guide 2010 in the media over the past week or so. Unfortunately, we were listed as an organisation with a high overall mortality ratio. This is disappointing for the Trust and does not paint an accurate picture of what is happening in our hospitals. We have issued the statement below, which I hope will help explain the situation and reassure you that we take patient safety very seriously.

As a further note, may I also take this opportunity to inform anyone who is not yet aware of our change of name following our integration with community services. Our new name, which is now official,  is Buckinghamshire Healthcare NHS Trust which reflects the full range of hospital and community services we now provide.

Yours sincerely

Anne Eden

Chief Executive

Response to the Dr Foster Hospital Guide

In response to the publication of the Dr Foster Hospital Guide 2010, we would like to reassure our patients that we continue to provide safe and high quality services at all of our hospitals. We would also like to explain why the former Buckinghamshire Hospitals NHS Trust was one of 19 trusts reported as having the highest Hospital Standardised Mortality Ratio (HSMR).

The HSMR is not the only indicator that Dr Foster has looked at. The report also analyses other mortality measures and patient safety indicators where we have scored within the expected range, for example death following high-risk conditions such as heart attacks, pneumonia, heart failure, stroke and broken hips.

The HSMR is calculated by looking at the number of deaths which occur at a Trust, comparing them with the number expected. The Dr Foster report recognises that high mortality ratios may be as a result of inaccurate data. Our investigations identified that other trusts have recorded higher numbers of co-morbidities, which highlight multiple conditions a patient may have; they have also used the palliative care code for terminally ill patients more frequently than we have done in the past. This has meant that a number of cases have been included in our mortality data that should not have, significantly affecting our overall mortality ratio. The Dr Foster report states that we have a coding rate for palliative care of 8% compared to an average of 14% and as high as 45% in some trusts. An external specialist clinical coding audit has taken place and the feedback from this will inform an action plan overseen by our clinical governance committee.

We take patient safety very seriously and carefully monitor our mortality data on a regular basis, addressing any issues as soon as they arise which includes reviewing patient notes. Our ongoing analysis reveals that the actual number of people who die at our hospitals is low and there have been no significant issues with the care we provide; however, we never become complacent. It is important to note that the data used in the Dr Foster report is almost a year old and we regularly report more up-to-date figures at our Board meetings.

The Department of Health has recently announced a new mortality indicator to replace the Dr Foster methodology from next year. This will address some of the current limitations we experience with the HSMR, such as coding.

We have good governance procedures in place and patients should not be unduly worried by the Dr Foster report. We meet all the national standards set by the Care Quality Commission, have some of the lowest infection rates and we scored well in Dr Foster’s patient safety indicators.