National mortality statistics at health trust pubclished

Mortality rates for Northern Lincolnshire and Goole NHS Foundation Trust (NLaG) remain in the '˜as expected' banding.

Dr Robert Jaggs-Fowler

NHS Digital has today published the Summary Hospital-Level Mortality Indicator (SHMI) statistics for the period October 2015 to September 2016. NLaG has a figure of 111, which is within the ‘as expected’ banding.

The previous SHMI issued in December was 110 (for the period July 2015 to June 2016) and showing the SHMI continues to remain relatively stable.

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The SHMI figures are published quarterly and always refer to a 12-month time period. It provides a useful ‘smoke alarm’ for the entire health community to make sure that patient pathways always operate in the best interests of patients whether inside or outside the hospitals.

Following the acquisition of the University Hospitals Birmingham’s Healthcare Evaluation Data (HED) reporting product, the Trust is able report on more up to date SHMI data which allows for a breakdown of the data to an in-hospital and out-of-hospital level. For the 12 months to October 2016, the in-hospital SHMI is 99 and the out-of-hospital SHMI is 142. ‘Out of hospital’ figures relate to patients treated in hospital who are discharged into the care of a community service but die within 30 days of that discharge.

The Trust’s medical director Mr Lawrence Roberts said: “It is reassuring to see that the Trust has again maintained a position of as expected mortality rates.

“Patient safety and good quality care remains our top priority and we will continue to work with our local partners in the healthcare community to examine pathways of care to ensure that patients are being seen and treated in the most appropriate place.”

Jan Haxby, director of quality and nursing at NHS North East Lincolnshire Clinical Commissioning Group (CCG), said: “We have carried out a great deal of work over the past three years across the local health and care system to make sure we all work better together to support people, especially the frail and elderly, to get the best outcome. For most people this means recovering from a period of illness or an accident. For others it means reaching the end of their life in the place of their choosing.

“While we realise there is a still more work to be done, the most recent Summary Hospital-Level Mortality Indicators (SHMI) show that progress is being made towards making sure people living in North and North East Lincolnshire can expect the best outcomes in their own circumstances.”

Dr Robert Jaggs-Fowler, medical director at NHS North Lincolnshire CCG, said: “While we cannot necessarily link SHMI statistics directly to the quality of care, it is positive to see that the mortality rate remains in the expected range. It is important everyone involved in providing health and care services is doing the most they can to support people to stay well and independent for longer and, whenever possible, to ensure those who are reaching the end of their life are able to die in their preferred place; which usually means in their own home, or in a hospice or residential home care.”

What is the SHMI?

This publication compares the actual number of deaths following time in hospital with the expected number of deaths, using the Summary Hospital-level Mortality Indicator (SHMI).

The expected number of deaths is estimated using the characteristics of the patients treated, such as age, sex, method of admission, current and underlying medical condition(s). It covers patients admitted to hospitals in England who died either while in hospital or within 30 days of being discharged.

Where a trust has an ‘as expected’ SHMI, it is inappropriate to conclude that their SHMI is lower than the national baseline, even if the number of observed deaths is smaller than the number of expected deaths. This is because the trust has been placed in the ‘as expected’ range because any variation from the number of expected deaths is not statistically significant.

The difference between the number of observed deaths and the number of expected deaths cannot be interpreted as the number of avoidable deaths for the trust. Whether or not a death could have been prevented can only be determined by a detailed case-note review. The SHMI is not a direct measure of quality of care.

A ‘higher than expected’ SHMI should not immediately be interpreted as indicating bad performance. Instead, it should be viewed as a ‘smoke alarm’ which requires further investigation by the trust. Similarly, a ‘lower than expected’ SHMI should not immediately be interpreted as indicating good performance. The SHMI requires careful interpretation and should be used in conjunction with other indicators and information from other sources (eg patient feedback, staff surveys and other similar material) that together form a holistic view of trust outcomes.

The SHMI cannot be used to directly compare mortality outcomes between trusts and, in particular, it is inappropriate to rank trusts according to their SHMI. Instead, the SHMI banding can be used to compare mortality outcomes to the national baseline. If two trusts have the same SHMI banding, it cannot be concluded that the trust with the lower SHMI value has better mortality outcomes.