High death rate trust given 40 ways to improve

Northern Lincolnshire and Goole Hospitals NHS Trust was one of only nine in England singled out in April over figures analysing deaths in hospital and within 30 days of discharge.

The trust had 316 excess deaths in its total of 2,285, and its Summary Hospital Level Mortality Indicator (SHMI) rating of 115 was one of the highest in the country. The SHMI is an indication of whether the numbers of observed deaths at a hospital trust are as expected, or higher or lower, when compared with the national baseline.

An independent review of the trust, which runs Diana, Princess of Wales Hospital in Grimsby, Scunthorpe General Hospital and Goole and District Hospital, has now identified a series of concerns – but warns there is no “magic bullet” to resolve it.

One of the issues highlighted by Transforming Health Ltd was the tangled nature of the way its services are managed.

The report said: “The review team were struck have been struck by the high complexity of the healthcare system(s) in Northern Lincolnshire which results in there not being a single trust perspective or single commissioner’s perspective.”

It described end of life care as “fragmented”, which was possibly a result of those complexities.

The review also identified a “lack of consistency” across GP practices and trust clinical teams in complying with nationally recognised models of care for patients at the end of their life.

It said the work on the deteriorating patient was “some way” behind other trusts and should be relaunched as a more formal project with accountability for action clearly identified.

The review team also raised a concern about staffing levels during visits to wards, although they noted the trust had provided details showing they were in accordance with planned and funded levels of staffing and had been verified as safe.

The authors could not make any direct recommendations regarding the complexity of the system, but the authors returned to the issue in concluding their executive summary of the report and suggested it may also impede efforts to respond and bring about the necessary improvements.

They said: “Whilst the complexity of the systems in which NLAG operate has been challenging for this review, that pales into insignificance to the impact this complexity has on the trust trying to provide cohesive leadership and excellent care for its patients.”

In a statement responding to the review, trust medical director Dr Liz Scott said: “This is an issue for the whole health community and we are working hard within the Trust, with our colleagues in primary care, and with surrounding academic institutions – the Yorkshire and Humber Public Health Observatory and the Hull and York Medical School – to make sure that all possible factors are addressed.”

She said the trust had set up a Mortality Task Group that will review every death to see if anything could have been done differently, and added: “Mortality measures are subject to many factors, some of which are within our control and some which are not. Their purpose is for us to monitor progress over time to make sure that we do all we can to provide the highest quality of care.”

In a joint statement, North Lincolnshire Clinical Commissioning Group and North East Lincolnshire Commissioning Group said they understood people may have concerns about the report but wanted to reassure people that as the commissioners of health care in the area the CCGs would be working with the wider health community, including hospital trusts, to make sure the services available are safe and of a high quality.”