N&N investigates high rate of deaths at hospital

Published:
6:00 a.m. October 27, 2022

The largest hospital in the region carried out an internal investigation after figures indicated it had the highest death rate in the country.

The investigation was launched at the University Hospital of Norfolk and Norwich after it topped the national league table ranking of hospitals based on its ‘Summary Hospital Level Mortality Indicator’ (SHMI).

The measure, which was introduced as a way to monitor NHS trusts in the wake of the Stafford Hospital scandal, involves comparing the number of hospital deaths with a forecast based on ‘expected’ mortality rates.

NHS Digital, which compiles statistics for the health service, found that the N&N had the largest disparity between these two figures of any hospital in England, with a higher-than-expected death rate for people.

Hospital officials say their investigation found no evidence that the rate was related to the quality of care at the Colney site, and they believe its position at the top of the league table may be explained by hospitals sending their data in different ways.

However, local watchdogs say the figures are “extremely worrying” and have called for the results of the investigation to be made public.

The data shows that between June 2021 and May 2022, 3,080 people died in the NNUH or within 30 days of discharge, 510 more than the number of “expected” deaths. That figure leaves the hospital with the highest ‘SHMI’ value.

N&N officials say that SHMI collected your data in a different way than other sites.

In putting together its figures, the hospital took into account patients’ hospice status, something it says other trusts don’t do.

Officials say that if the hospital hadn’t accounted for patients who received palliative care, its level would be considerably lower, and would not be considered “higher than expected.”

A hospital spokesman said: “NNUH is a very busy hospital serving one of the oldest populations in the country and this means that our patients are frequently elderly and frail, with more than one long-term illness.

“We have investigated our high summary hospital mortality indicator (SHMI) and found no evidence to suggest that this is due to deficiencies in the quality and safety of care provided at NNUH.”

Experts also say that palliative care patients in Norfolk are more likely to die in hospitals than in the community because of the way services are provided in the county.

But Alex Stewart, chief executive of Healthwatch Norfolk, described the reported death rate as “extremely worrying”.

“Our hospitals are running at 100% bed occupancy most of the time, many with patients who could be discharged but are waiting for a community bed or social care package,” he added.

“This has an unavoidable impact on ambulance delays at what is known as ‘the front door’

“What is extremely concerning is the high mortality rate that is being reported and Healthwatch is aware that investigations are currently underway.

“We anticipate that once the results are known, we would expect the trusts to make this information publicly available.”

Meanwhile, mortality rates at the James Paget in Gorleston and the Queen Elizabeth in King’s Lynn are roughly in line with expectations.

In the James Paget, 1,440 deaths against an expectation of 1,325 deaths, while in the QEH there were 1,470 deaths compared to an expected 1,400.

How is the number calculated?

Mortality rates in hospitals are measured using a metric known as the summary hospital-level mortality indicator (SHMI).

The SHMI is calculated using two numbers: “observed” and “expected” deaths.

Observed deaths are the total number of people who died in hospital after being admitted for care.

Expected deaths is a slightly more complex figure, calculated using national averages to tell a hospital trust how many deaths to expect each year.

While the expected deaths are based on averages for England, it takes into account the demographics of patients likely to use the hospital.

NHS Digital explains that SHMI is “not a measure of quality of care”, due to the wide variety of factors that could contribute to whether or not a person dies while in hospital.

Instead, it is viewed as a “smoke alarm”, and hospitals are encouraged to look at a “higher than expected” SHMI value as cause to investigate if there is a common cause of “unexpected” deaths.