Trusts blame high SHMIs on poor coding

Published for the first time yesterday, the Department of Health approved SHMI identified 14 outliers with a higher than expected number of deaths when figures were adjusted for over dispersion.

Nine trusts reported concerns with coding. Four of them - Hull and East Yorkshire Hospitals Trust, East and North Hertfordshire Trust, Northampton General Hospital Trust and York Teaching Hospital Foundation Trust - drew attention to the fact the SHMI does not adjust for patients receiving palliative care.

In a statement, Blackpool Teaching Hospitals Foundation Trust said it was at a disadvantage under the SHMI as it does not take into account levels of deprivation unlike other indicators.

The steering group set up by the DH to build consensus on a methodology decided against adjusting for palliative care, although HSJ understands that may change as the SHMI develops.

East and North Herts branded the SHMI “misleading” and claimed the trust was being “penalised” for having a cancer centre and hospice on site. Under Dr Foster’s hospital standardised mortality ratio measure, which adjusts for palliative care coding, the trust scores 99.2.

Both East and North Herts and York have challenged the NHS Information Centre data.

York medical director Dr Alastair Turnbull told HSJ the trust was not being complacent but believed the trust’s SHMI had been distorted by the accidental inclusion of data from a hospice, which although on the site and using the same software as the hospital was not run by the trust.

He said they had been “surprised and concerned” when first sent the SHMI score by the NHS Information Centre but had not been able to identify the problem in the week they were given to validate the data.

It was only when they were sent SHMI analysis from Dr Foster and they saw the problem was in elective admissions that they began to suspect it had been influenced by the hospice.

Dr Turnbull said: “The way the SHMI was published made it extraordinarily difficult to validate the data; it’s very opaque about how you go about doing that and to be honest I think we have been a victim of that.

“I feel very strongly about that because our organisation has been portrayed in a way that doesn’t reflect [the reality].”

Many trusts pointed to good performance on hospital acquired infections as evidence safe, good quality care was being provided.

The Care Quality Commission has unresolved concerns with eight of the 14 outliers, the most serious being University Hospitals of Morecambe Bay Foundation Trust, which was given until 21 November to comply with regulations around risk assessment following a series of unannounced inspections in July.

Chief executive Tony Halsall said there had been problems with recording information and he expected the SHMI to improve next year now this had been rectified. However, doctors have been asked to review all deaths within the hospital “to ensure appropriate care was given in each case.