An analysis of the 14 hospital trusts being investigated by the Department of Health over higher than expected death rates has highlighted medical staffing as a possible cause.

The 14 trusts were identified because they had higher than expected death rates - based either on the hospital standardised mortality rate or the summary hospital-level mortality indicator - for two successive years. They are currently subject to a review led by NHS medical director Sir Bruce Keogh.

Analysis for HSJ of those in the group showed they had an average of 56.1 doctors and 19.7 consultant doctors per hundred beds, compared with 67.5 doctors and 24 consultants per hundred beds at trusts which are not not being investigated.

Trusts being investigated had 18 cleaning staff per 100 beds, while trusts not being investigated had 23, researchers from the University of Plymouth found.

But the academics found little difference in the number of nurses between the trusts being investigated and those that are not. The rates were 136.8 and 143.3 per 100 beds respectively.

The 14 trusts, identified by the NHS Commissioning Board following the publication of the Francis report, are: North Cumbria University Hospitals, United Lincolnshire Hospitals, George Eliot Hospital, Buckinghamshire Healthcare, Northern Lincolnshire and Goole Hospitals, The Dudley Group of Hospitals, Sherwood Forest Hospitals, Medway, Burton Hospitals, Colchester Hospital, Tameside Hospital, Blackpool Teaching Hospitals, Basildon and Thurrock University Hospitals and East Lancashire Hospitals.

HSJ asked the researchers to make the comparisons. It was carried out by Sheena Asthana, professor of health policy and the University of Plymouth, and Alex Gibson, who is also based at that university.

Separately, they have also analysed - and found a significant relationship between - hospital funding in a health economy and its “organisational stress”, measured by mortality rates and staff survey results. That suggests a relationship between national decisions about how much funding an area will be given, and the quality of care provided. HSJ will publish these findings in coming days.

The news comes as a report by the Royal College of Physicians today said pressure on medical registrars was putting patient safety at risk.

The college’s research said 37 per cent of medical registrars viewed their workload as “unmanageable” and concluded the “balance between specialist and generalist skills” in the medical workforce needed to be addressed “urgently”.

Hospital Indicators for hospital trusts under investigation compared to all others

  Being Investigated   Not being investigated  
 Hospital Indicators Mean (n=14)   Mean (n=133) Sig. 
Summary Hospital-level Mortality Indicator (SHMI) 113.3   98.7 **
Hospital Standardised Mortality Ratio (HSMR) 111.4   98.4 **
Percent catchment population aged 65+ 17.6%   16.5%  
Funding Context (£ per capita) £1,358   £1,392  
Number of cleaning staff per 100 beds 18.0   23.1 **
Number of nurses  per 100 beds 136.8   143.4  
Number of doctors (all grades) per 100 beds 56.1   67.5 **
Number of consultants per 100 beds 19.7   24.0 **
Percent staff feeling satisfied with the quality of work and patient      care they are able to deliver 72.4%   74.2%  
Percent staff who ‘agree’ or ‘strongly agree’ that:        
‘There are enough staff at this trust for me to do my job properly’ 29.0%   30.1%  
‘Care of patients / service users is my trust’s top priority’ 51.6%   58.5% **
‘I am able to deliver the patient care I aspire to’ 66.9%   69.8%  
‘I am able to do my job to a standard I am  personally pleased with’ 60.9%   62.3%  
Senior managers where I work are committed to patient care’ 45.0%   50.5% **
Difference of means t-test significant at 0.01=** and at 0.05 =*        


** Difference of average is t-test significant at 0.01