CQC names high death-rate NHS trusts

But few of the trusts were found to have problems with quality of care and there are concerns that publishing the information will unfairly label them as “bad apples”.

The alerts are triggered if numbers of deaths among hospital patients admitted for particular conditions or procedures are significantly higher than expected.

We’re saying that these hospitals are bad apples. I don’t think the methodology is capable of doing that

The list, produced by the Care Quality Commission and shared exclusively with HSJ, dates back to 2007 and only includes those where investigations have been closed. CQC director of intelligence Richard Hamblin said: “This gives further impetus to trusts to regularly monitor outcomes. It takes us in the same direction as quality accounts.”

Out of 85 alerts, 16 were found to be related to the way the trust collected data, 27 were due to clinical coding and 10 were down to high-risk caseloads. In 19 cases, trusts had made significant progress since the alert and excess mortality was no longer a concern, while six alerts were contradicted by other sources and four were already being addressed by regulators or a third party.

Out of 45 alerts followed up with trusts, in 29 cases convincing evidence was provided to show that quality of care was not a concern. Only eight alerts required an action plan. A further eight alerts were dealt with as part of the Mid Staffordshire trust investigation by previous regulator the Healthcare Commission, published in March. The alerts, based on information from the Dr Foster Unit at Imperial College and CQC, sparked the Mid Staffordshire investigation. None of the other trusts was found to have problems so serious they needed to be escalated to the regulator’s investigations team.

Birmingham University professor of clinical epidemiology Richard Lilford said publishing the data was “stigmatising” and revealed little about the quality of care.

“We’re saying that these hospitals are bad apples. I don’t think the methodology is capable of doing that,” he said.

“I don’t know whether the care at Mid Staffordshire is worse or not than in any other hospital. They went in on the basis of mortality data knowing they were looking at an outlier and I’m worried such investigations are subject to the bias of hindsight.”

But Dr Foster chief executive Tom Moloney said: “Publishing data produced through robust statistical processes and after the hospital has had the opportunity to investigate, promotes greater safety, quality of care and information for patients.”

The seven trusts requiring plans were:

• Barking, Havering and Redbridge Hospitals trust,
• Basingstoke and North Hampshire foundation trust,
• Mid Staffordshire foundation trust,
• Pennine Acute Hospitals trust,
• Salisbury foundation trust,
• Sheffield Teaching Hospitals foundation trust and
• University Hospitals of Leicester trust.

Mid Staffordshire chief executive Anthony Sumara said he welcomed the publication of the alerts. Mortality rates are placed on the trust’s website.

A Leicester trust spokeswoman said a clinical review had established there was “no issue over the standard of care”.

Sheffield trust medical director Mike Richmond said: “This issue related to a very short period of time and involved patients who had significant co- morbidities.” A Salisbury trust spokeswoman said a comprehensive audit had shown increased mortality rates to be caused by age and other serious underlying conditions.

A Basingstoke and North Hampshire spokeswoman said a thorough medical review revealed there were “no significant risks” for patients.

The remaining two trusts were unable to comment.