Concerns over palliative death recording

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 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% (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.

At East and North Hertfordshire Trust, 43.2 per cent (785 deaths) were recorded as palliative in 2012. In 2008, just 9.9 per cent of deaths recorded by the trust were for palliative care. It has strongly disputed the suggestion of any wrongdoing (see statement below).

At King’s College Hospital Foundation Trust, 38.41 per cent (472 deaths) were coded the same way in 2012 (compared with just 8.71 per cent of deaths in 2008).

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.

Sir Brian Jarman, who led development of HSMRs, said of the figures: “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.

A Department of Health spokesman said: “The NHS needs high-quality mortality data. We would expect that all NHS trusts have robust auditing systems in place.”

East and North Hertfordshire chief executive Nick Carver said in a statement: “The trust does have a high level of palliative care coding. This is because we are one of only a handful of hospital groups to have an NHS hospice, plus possibly the only NHS trust in the country to offer a seven-day-a-week palliative care service to local people.

“Despite it being clear that having excellent palliative care services will always mean our coding levels are higher than most NHS trusts, we have sought to reassure ourselves that how we do our coding is right. A recent external review of the quality of our work showed that we code the care we provide accurately and within the guidance set nationally - something we audit on an on-going basis.”