Annual review of avoidable deaths in hospitals
Recent figures have shown there to be a staggering 1,000 estimated unnecessary and avoidable deaths in NHS hospitals every month, which are being caused by negligent medical errors and failures to monitor patients properly.
Health Secretary Jeremy Hunt called the current rates of avoidable deaths in hospitals “the biggest scandal in global healthcare” and questioned why the health industry has not tried to tackle improvement in safety records before. Hunt has pledged that attempting to improve the safety record of hospitals will be his “most profound change” during his time in charge as Health Secretary. He states that the key to improvement is “about changing behaviour and the way everyone works in the NHS.”
What this will involve in practice
England will be the first country in the world to introduce this system to monitor the extent of avoidable deaths. There will be a yearly study of a sample of around 2,000 medical records of patients who later died to determine whether any mistakes had been made and to see whether or not more should have been done to save their lives. This will work out the percentage of deaths that could have been avoided. These statistics will then be used to establish a national rate of avoidable deaths.
The Department of Health announced that each hospital will be placed into a banding system, depending on the number of deaths estimated locally. By March 2016, every hospital board will have the first set of annual figures of projected avoidable mortality rates.
The Health Secretary will require every the chair of every hospital to write to him upon receipt of their annual figures to update him with their plan on how they aim to improve these figures and how they will look to eradicate avoidable deaths within their organisation.
What this should achieve in theory
The Department of Health hopes that the annual reporting of figures will inform and drive local improvement of mortality rates. Hospital mortality rates expert Professor Nick Black said that the review would “provide a basis for stimulating quality improvement in each individual hospital.”
As clinical negligence specialists, we welcome any initiative that aims to improve patient care but question whether this is going far enough and whether this is not as satisfactory as, perhaps, having a mandatory case review for every death that occurs in a hospital. Measuring the levels of avoidable harm has the benefit of hindsight but action needs to be taken to prevent avoidable deaths from happening in the first place.
‘Special Measures’ reduces deaths
18 months ago in the wake of the Mid Staffs enquiry, 11 hospitals were placed into a new ‘special measures’ system amid concern that poor care was fuelling their death rates. These were among 14 trusts that were probed when mortality rates showed 13,000 more deaths than would have been expected over seven years.
A recently published report by healthcare analysis organisation Dr Foster found a significant reduction in the overall death rate in 11 NHS Trusts that were put into special measures, a system that has now been credited for saving hundreds of lives. The report found that around as many as 450 lives may have been saved by this system.
Clinical Negligence claims
Latest figures show claims for clinical negligence have almost doubled in the last four years. Patients should welcome the push by the NHS and the government for change in attitudes towards openness which, with the annual reporting of these new figures, should continue to drive the improvement of patient care – or at least transparency in how trusts aim to make these improvements. We empathise with the Health Secretary’s concern that “even one life lost to poor care or safety error is too many.”
If you have any questions in relation to this article or if you or a member of your family have been affected by an avoidable hospital death, please get in touch to speak to one of our specialists to explore your concerns further. Email Clinical Negligence partner Joanna Laidlaw at [email protected].
Posted on May 1st, 2015 by Lyons Davidson