Poor reporting on quality 'letting down' NHS - Sir Bruce

Sir Bruce Keogh told HSJ the NHS was “let down” by those not providing data on the proportion of admitted patients assessed for risk of blood clotting, known as venous thromboembolism.

Sir Bruce also revealed that a similar reporting requirement – and performance pay – were likely to be introduced to improve dementia care in the near future.

The Department of Health has required all providers of NHS care to report on VTE screening since July last year, in response to evidence that there were thousands of preventable deaths annually.

However, DH figures show that in April this year many hospitals were not providing information, or were providing incomplete and unusable figures.

Many of them are sites run by large private sector operators, including BMI Healthcare, Nuffield Health and Care UK.

The DH lists 137 independent sites not providing data, but providers said some were wrongly included in the list.

There are also six NHS trusts: Barking, Havering and Redbridge University Hospitals Trust, North West London Hospitals Trust, West Middlesex University Hospital Trust, Winchester and Eastleigh Healthcare Trust, Oxford Radcliffe Hospitals Trust, and University College London Hospitals Foundation Trust.

Many of those approached by HSJ said they had now started providing information or planned to do so. Several put the delay down to administrative or IT problems. Many said they risk assessed for VTE routinely.

However, Sir Bruce said: “The VTE work has been a highly successful initiative and we have gone from a standing start to a good position, but we are let down by trusts that fail to make returns.

“Some people see the collections as a burden, but when it is focused on the appropriate clinical areas it is an opportunity for organisations to demonstrate the quality they offer. When people fail to reveal data, others can legitimately ask whether that is a reflection of their [lack of] focus on clinical quality.”

The number of providers reporting at least 90 per cent of patients assessed has increased from 18 in July 2010 to 115 in April.

As well as the reporting requirement, from April last year the DH has linked part of providers’ pay to performance against the VTE indicator. There have also been coordinated campaigns by the Academy of Medical Royal Colleges and Royal College of Nursing to promote assessment.

Sir Bruce said he planned to introduce a similar “two pronged attack” involving DH requirements and clinical leadership to improve dementia care.

He said:  “Everyone believes dementia is not well treated. If we can do it better we will not only do well for patients but save substantial amounts of money.”

Providers responses

A Nuffield Health spokeswoman said it had been reporting from the start of its new contract, which was 1 July.

A spokesman for University College London Foundation Trust said it was compliant with the risk assessment requirement, and had been reporting to the DH since April. Previously the problem was due to an admin error, he said.

Barking, Havering and Redbridge said: ““The trust carries out thorough and regular audits of VTE risk assessments, and is achieving around 90% compliance. Unfortunately we do not have the appropriate software to carry out a full census and send this information to the DH, which is extremely disappointing when we are performing so well. We have informed commissioners and the DH that we will resolve the situation in the coming months.”

BMI Healthcare said the reporting had “not been raised as a requirement, however our focus on VTE prevention in the care of all of our NHS and private patients continues to be a priority.  BMI remains committed to keeping up with current guidance in relation to VTE risk assessment and prophylaxis… we are auditing and reporting our compliance to individual primary care trusts and we are very willing to review our reporting procedures to facilitate reporting onto the DH database if required.”

Care UK director of integrated governance Susan Marshall said: “Care UK takes the assessment of VTE risk to patients very seriously and our staff have carried out all the required patients reviews thoroughly. For the vast majority of our centres, the data has been reported promptly to the DH.  In two of our centres, data submissions for completed reviews have been delayed for technical reasons. The issue is now resolved.”

North West London Hospitals Trust said: “…it was only with the DH’s publication in December 2010 of the first results of VTE risk assessment data, that it became clear that our results were not valid, as they had been extrapolated out of samples of patients, as opposed to being a census of all patients. At the time, we were unable to provide a census. We have now established a new system that allows us to complete a full census, meeting the guidelines. We have been supplying this information since April 2011.”

Oxford Radcliffe Hospitals Trust said it had “now developed and implemented a standardised electronic system to undertake VTE risk assessment” and had been submitting data since April.

West Middlesex Trust said it had provided information from an “appropriate sampling size to reflect the organisation properly… In order to comply fully with the DH guidance, investment in an electronic system is required, which we have now implemented. This will be fully operational within the coming weeks”.

Winchester and Eastleigh said: “At present the issue is that our electronic systems do not support data collection for all patients – it was envisaged that Cerner would be able to do this by April 2011, however the wider issues of implementing that system have delayed that target date… we have had no avoidable VTEs associated with a hospital stay so far this year.”