Agenda item

This report provides an update on hospital mortality statistics for Medway NHS Foundation Trust (MFT) and an overview of clinical governance systems and indicators of clinical quality at the Trust. A Hospital Mortality Working Group has been established to oversee an improvement in the mortality statistics at MFT and provide the Board of MFT assurance that all aspects of quality of care and factors that may affect or contribute to the current mortality rates are addressed. 

Discussion: 

The Public Health Intelligence Manager introduced the first section of the report relating to the Dr Foster mortality report which had identified Medway NHS Foundation Trust as being tenth worst ‘hospital standardised mortality ratio’ (HSMR) in the country out of 145 hospitals.  He explained how the crude hospital mortality rate was calculated and how the hospital compared with trusts from a similar cluster identified by the Office for National Statistics.  The crude mortality rate was improved and converging with the national average.

He stated that the HSMR was a ratio of the number of deaths observed divided by the number of deaths expected.  The number of deaths expected was calculated by applying national mortality rates to the characteristics of patients eg age, deprivation and risk of death based on what was recorded in the patient’s notes.

Having looked at the possible causes of the high HSMR the Public Health Intelligence Team concluded there was no link with deprivation but could possibly be an issue with coding.  It was also vital that the correct information was recorded in the patient’s notes to ensure issues such as co-morbidities (other conditions the patient has) were appropriately documented.

He stated that the most recent monthly HSMR was always at least 3 months behind. Hence the problem might be resolved but the Trust could still end up with a high HSMR when the next Dr Foster report was published in November 2013.

Responding to a Member query he stated that it was not possible to track national mortality statistics to see any emerging trends as these were not available until later in the year.  He also confirmed that the coding used at the hospital was that recommended by Dr Foster but acknowledged that more needed to be done to ensure consistency of recording across the hospital.

Dr Smith-Laing, then introduced the information relating to the governance measures which the hospital has in place to ensure board to ward governance signifying that the hospital took the issue very seriously.  He also emphasised that the serious incident system had been greatly strengthened with additional training in root cause analysis for fifty people across the Trust.  He stated that the quality of the reports had improved but there was still an issue about timeliness.  A Patient Safety Programme had been introduced earlier this year which encouraged staff to take seriously the threat of sepsis. 

He then informed Members that the Trust had been running Enhanced Revalidation for the last two years in paper format, which was now moving to a fully electronic format.

The Director of Public Health then discussed the action plan which had been developed following a meeting of a working group set up at the request of the Hospital to look into the HSMR data.  She stated that the working group comprised senior staff from the three North Kent CCGs, the Medical Director from the National Commissioning Board Area Team, Board and Governing Body representatives from the Hospital Trust and was chaired by herself.   The plan agreed included the following:

• Case note review of deaths in 10-20% risk group with pneumonia, hip fracture, stroke
• Case note review of deaths of patients readmitted within 7 days of discharge
• Review coding practice
• Promote key messages from Board to staff about importance of quality of care
• Listening into Action – a programme to facilitate patient safety conversations with staff and identify solutions
• Ensure lessons are learnt from complaints
• Ensure clinical audit leads to improvement in quality
• Consider external exemplar input

Responding to a query on staffing levels and how they impact on mortality rates the Chief Executive of Medway NHS Foundation Trust stated that Medway Maritime Hospital benchmarked their staffing levels against national figures and they were set at the national average.  He referred to investment in critical care outreach nurses operating 24 hours a day seven days a week since October last year which had proved very helpful in supporting other staff.  He also stated that consultants worked till midnight in the Emergency Department rather than the standard day worked in most other hospitals.  Following a subsequent question he stated that the Trust listened to front line staff and took account of the issues they faced and barriers identified to improvement.

Further to an issue raised about ways of preventing pneumonia, the Director of Public Health explained some of the simple means of prevention which included ensuring that ‘flu and pneumococcal immunisations had been administered by GPs, encouraging people to stop smoking etc. 

The Director of Public Health explained that the second meeting of the working group would take place next week.

Members raised with the Chief Executive of Medway NHS Foundation Trust the issue of negative publicity brought about by the media obtaining headline information and publishing it without the context or any real explanation.  He stated that he would give more thought to a suggestion of the Trust promoting more positively the work of the Hospital but explained that this was not an easy situation to resolve.

Decision:

The presenters of the report were thanked for their helpful and informative presentation and requested to provide the Committee with six monthly updates on the action plans by means of briefing notes.