• South Essex trusts launch mortality review to address ‘higher than expected’ rates
  • Basildon also carries out review following ‘sustained rise’ since 2014-15 ‘nadir’
  • Group MD ‘not concerned’ by Basildon rise, but warns group improvement will ‘take time’

Three Essex acute trusts establishing a new “group” model to run their hospitals have launched a mortality review in a bid to address “higher than expected” ratios and “sustained” rises across its sites, HSJ has learned.

The joint working board for the group, which comprises South Essex success regime trusts Basildon and Thurrock University Hospitals, Southend University Hospitals foundation trusts and Mid Essex Hospital Services Trust, discussed the review this month.

Group medical director Celia Skinner presented a report which said: “It is possible to approximate what the group’s combined [summary hospital level mortality indicator score] would be…1.0786 [For the most recent SHMI period October 2015 to September 2016], which would be higher than expected (SHMI band 1).

“The group would have the highest number of observed deaths in England (5,700) making it difficult to identity peers. Based on the number of observed deaths and the number of spells the closest comparator hospitals would be University Hospitals of Leicester Trust…and/or Heart of England FT.”

Board papers said that while quality and patient safety was being managed at trust level, mortality was being managed group-level, so possible causes could be established and a “co-ordinated” approach could be developed.

Southend had the fourth highest SHMI in England as of the last nationally published figures which cover October 2015 to September 2016. Basildon has seen a “sustained” rise in recent years, while HSJ understands Mid Essex is also considered by senior managers to be in need of significant improvement (see table below for performance of all three trusts).

Dr Skinner has also led a separate mortality review focusing on Basildon, where she is medical director, HSJ has learned. The trust was one of the original group of 14 trusts placed in special measures as part of the Keogh mortality review in July 2013, but was widely praised for the speed and manner in which it turned itself around.

Since then the trust’s mortality score has been “within expected limits” but both the SHMI and the hospital standardised mortality ratio have been rising since 2014-2015.

A Basildon mortality report from its April board meeting said its SHMI had “reached a nadir” of 0.92 between April 2014 to September 2015, but there had been and a “sustained rise” from April 2015 (see table).

”The most recent publication is 1.02 for the period October 2015- September 2016, and remains within expected limits. The trust is ranked fifth out of 17 amongst East of England peers,” it added. 

TrustSHMI scoreSHMI bandingRating out of 136 trusts
Oct 2015 - Sept 2016      
SOUTHEND 1.1539 1 4th
MID ESSEX 1.0607 2 39th
BASILDON 1.0216 2 62nd
Oct 14 - Sept 15      
SOUTHEND 1.1272 1 12th
MID ESSEX 1.0644 2 34th
BASILDON 0.9238 2 119th
Oct 13 - Sept 14      
SOUTHEND 1.0473 2 39th
BASILDON 1.0327 2 52nd
MID ESSEX 1.0227 2 65th
Oct 12 - Sept 13      
SOUTHEND 1.0322 2 9th
BASILDON 1.0942 2 32nd
MID ESSEX 1.0806 2 90th

Source: SHMI data compiled by HSJ from the national SHMI data set. Bandings range from 1-4, where 1 is the highest.

Dr Skinner told HSJ the trust was “not concerned about” the direction travel of SHMI, which remained with expected limits, despite the rise. She said she was confident it would not rise above expected limits in the foreseeable future.

This was underlined by data gathered via the trust’s internal SHMI proxy, which has a two month lag behind, rather than the six lag of the nationally reported data, she said.

Regarding the group’s overall review, she said: “Improving the quality of care is the main priority for our group of hospitals and we are using mortality performance to demonstrate improvement. Our experience at Basildon where we have remained within expected levels since 2014 gives me confidence we can improve but I recognise this will take time.

“The local plans at Southend and Mid Essex have been reviewed and we are sharing best practice across the three hospitals. Standardisation of processes and pathways is key to our local improvement. An updated plan will go back to the board in the autumn.”