Chief executive of East and North Herts NHS Trust responds to ‘higher than expected’ death rate report

Lister Hospital in Stevenage, run by the East and North Herts NHS Trust.

Lister Hospital in Stevenage, run by the East and North Herts NHS Trust. - Credit: Archant

The NHS trust which runs Lister Hospital in Stevenage has recorded a higher death rate than expected, according to a national report.

Of the 137 acute hospital trusts in England, 11 had more patients die than expected last year, including the East and North Herts NHS Trust which runs the Lister.

This is based on the Summary Hospital-level Mortality Indicator, which is the ratio between the actual number of patients who die after being admitted to hospital at an NHS trust and the number that would be expected to die on the basis of average England figures, given the characteristics of the patients treated there.

In 2014, this SHMI figure was calculated as 1.133, where the expected average is 1.0.

In the report, commissioned by the government and complied by the Health and Social Care Information Centre, it says: “A higher than expected SHMI should not immediately be interpreted as indicating bad performance and instead should be viewed as a ‘smoke alarm’ which requires further investigation by the trust.”


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The SHMI does not make an adjustment for palliative care and the East and North Herts NHS Trust is one of a handful of hospital groups in the NHS that has a hospice and a seven-day-a-week palliative support service, leading to more patients dying within the NHS trust’s care.

Trust chief executive Nick Carver, responding to the report said: “Over the years several different ways of measuring mortality rates have been developed – of which the three most commonly used in the UK being: the crude mortality rate; hospital standardised mortality ratio and most recently the SHMI.

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“Each of these statistics looks at different things. The crude mortality rate is a simple percentage of the number of patients dying for every 1,000 admitted to hospital. Whilst it provides the most up-to-date picture, it’s very hard to use crude mortality to make comparisons between hospitals. This is one of the reasons why statistical ratings like HSMR and the SHMI were created.

“HSMR takes into account a range of different variables to create a rating score that helps people understand whether or not mortality rates may be better or worse than might be expected. Usually HSMR ratings are produced three months in arrears, giving a more historical picture of performance. Although SHMI looks at fewer variables, it does include those deaths that happen within 30 days of discharge from hospital (which HSMR does not take in to account) but does not adjust for end-of-life care. SHMI ratings are produced usually six to nine months in arrears.

“Over time, the NHS trust’s crude mortality and HSMR ratings have been falling broadly, placing us among the better performing NHS organisations.

Its SHMI rating, however, has remained higher than average – which is due, in part at least, to the fact that the NHS trust is the only NHS organisation with a seven-day palliative care service in Hertfordshire and one of only a handful to have a NHS hospice, based at the Mount Vernon Cancer Centre.

“When the NHS trust has had its SHMI score adjusted to take in to account end-of-life, the rating drops to broadly the national average.”

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