Warning over hospital deaths

Figures show a dramatic rise in the number of people recorded as needing “palliative care” at the end of their lives, with some hospitals saying more than 35 per cent of their patients die this way.

Experts fear hospitals could actually be hiding the fact patients were admitted for treatment which then failed.

Some hospitals may also be “fiddling” the figures to make their death rates appear better than they actually are, they said.

Data from health analysts Dr Foster shows that, across England in 2012/13, 36,425 deaths were coded as palliative - meaning people received some sort of care to relieve suffering at the end of their lives.

This was 17.3 per cent of the total number of deaths and is almost double the 9.1 per cent (2,1130) recorded as needing palliative care in 2008. In 2006, just 3.3 per cent of deaths were palliative.

Some hospital trusts have massively outstripped this national rise. Out of 142 hospital trusts in the report, almost half (60) recorded the number of people needing palliative care in 2012 as higher than the national average.

Most of the 20 trusts with the biggest leaps in their palliative care coding have also significantly improved their performance on death rates between 2008 and 2012.

Palliative care deaths are not included in the hospital standardised mortality ratio (HSMR), which compares the expected rate of death in a hospital with the actual rate of death. Trusts that code deaths as palliative effectively “remove” deaths from being included in the HSMR.

Professor Sir Brian Jarman, from Imperial College London, developed the HSMR. He told the inquiry into the scandal at Mid Staffordshire that some trusts increased their coding of palliative care deaths to reduce overall death rates.

He said Mid Staffs was one of them - but such huge leaps could only occur if trusts suddenly became terminal care hospitals overnight. Of the latest Dr Foster figures, he said: “I can’t read their minds but when you see these really dramatic shifts you have to ask, did they become a palliative care hospice overnight?

“I am concerned that trusts know that increasing their palliative care rates assists their HSMR and am concerned that this could be the reason they are doing it.”

Roger Taylor, director of research at Dr Foster, said some trusts had changed the way they recorded deaths as a means of improving monitoring of palliative care.

But he said there were “real concerns around the gaming of indicators”, adding: “Whether or not you are doing it deliberately, the end result is that the variation in coding may disguise poor outcomes.”

He said “imprecise rules” governing how hospitals code deaths was harming patient care, may distort death rates and needed urgent review.

“The rules are too vague,” he said. “Poor quality data is harming patients because you can’t see where things are going wrong and you can’t see where there are issues.

“If the data is not being recorded consistently and, moreover, if that isn’t picked up because of a lack of auditing there is a risk that poor patient care is being disguised, and the public misled.

“We’re worried this issue is not being given sufficient priority. The bottom line is it could increase the possibility of failing to identify another Mid Staffs and potentially cost lives.”