- Nick Black, a leading expert in estimating preventable deaths, said trusts are “kidding themselves” on the number of avoidable deaths they are reporting
- At least 26 trusts found zero avoidable deaths in the latest quarter published
- Lack of consensus between DHSC and health experts on how policy can be implemented
A flagship policy that requires trusts to publish data on the number of avoidable deaths is “misconceived”, said a leading expert, after data showed many trusts reporting zero.
In late 2016, Jeremy Hunt announced plans for the UK to “become the first country in the world to publish data on avoidable deaths at a hospital by hospital level”.
However, the policy has been dogged with delays, criticisms and U-turns on key parts of the plan. Trusts had to start publishing data in 2017-18.
Analysis by HSJ suggested at least 26 acute trusts (around one in five) reported zero avoidable deaths in the most recent quarter available up to January 2018. These providers had together reviewed almost 10,000 deaths.
Professor Nick Black, from the London School of Hygiene and Tropical Medicine, said: “Zero is not what one would expect. Our best estimate, which fits with other studies, is that four per cent of deaths from any random sample are avoidable. A recent study in Norway also confirmed that figure. If trusts are not finding that then they are sort of kidding themselves.”
In December 2017, the Department of Health and Social Care said it expected trusts to find between 1,250 and 9,000 deaths per year.
System-wide avoidable death numbers were difficult to confirm because HSJ found wide variation between trusts in terms of the data reported, the format it is reported in, and the timing and place of publication. Most other acute providers each reported a handful of avoidable deaths.
DHSC declined to comment on whether the policy would be reviewed.
It has already made two concessions to its plans. Trusts’ data will no longer be compared in a league table and is not being “collated nationally” despite the health secretary announcing a year prior that this would have allowed the “whole NHS [to] learn more rapidly from individual incidents.”
Trusts that reported zero avoidable deaths were approached for comment. A handful responded and said they had implemented appropriate training and structured review programmes.
There is also a lack of consensus on how the policy should be implemented.
National guidance published last year said a “death due to a problem in care [is one] that has been clinically assessed using a recognised methodology of case record/note review and determined more likely than not to have resulted from problems in healthcare and therefore to have been potentially avoidable”.
Although it said different review methods can be used, the guidance said acute trusts “will receive training to use Royal College of Physicians’ structured judgement review case note methodology”.
A spokeswoman for NHS Improvement confirmed it has commissioned the RCP to help trusts train staff to review the quality of care offered to patients who have died.
However, a spokeswoman for the RCP told HSJ its SJR methodology “does not allow the calculation of whether a death has a greater than 50 per cent probability of being avoidable”.
She added: “Over the life of the programme, the RCP has continually advised NHSI, the health quality improvement partnership and the DHSC of the lack of a validated methodology to calculate avoidable deaths”.
Professor Black said: “The [avoidable deaths] policy is misconceived, if you want it to work then you have to do what we did in our reviews and use completely independent reviewers. To do that routinely is prohibitively expensive so DHSC has gone for something feasible where the cost lies with the trust.
“It is still possible trusts are learning from the process but how you show this is pretty difficult.
“The worry is they are not learning and it’s just a tick box exercise. Or worse, that the non exec directors are reassured by the process and that could induce false or unjustifiable complacence, so it could make the situation worse.”
The avoidable deaths policy was introduced in response to a damning report by the Care Quality Commission into investigating deaths that occurred in the care of the NHS. A CQC Spokesperson said: “CQC has never set out an expectation about the number of deaths trusts should be reporting.”
Information provided to HSJ, and analysis of published data
Data from the latest quarter available up to January 2018