Wednesday, March 18, 2009

Healthcare Commission ends its time with "appalling" report

At the end of the month the Healthcare Commission gets taken over by the Care Quality Commission. In its dying pangs, it's published an investigation report criticising Mid Staffordshire NHS Foundation Trust for significant failings in emergency healthcare, leadership and management. As I've noted before in this blog, Ian Kennedy, the outgoing chairman, really does think the Healthcare Commission has improved quality of health care.

The Commission in its press release says that it began the investigation at the trust in March 2008 "in response to concerns from local people and when it became clear that the trust stood out statistically in terms of the high death rates of patients admitted as emergencies". They've produced findings from the investigation but don't say how those findings compare with other hospitals. For example, are they sure the Trust was the only hospital where A&E triage is routinely carried out by receptionists? Is A&E consultant cover any worse than anywhere else, producing inadequate supervision of juniors? Was it the only hospital to have had "dumping grounds" to avoid breaching the A&E 4 hour target? Was it really the only hospital not to have enough nurses to care for emergency patients or inadequately trained EAU nurses? Or where there were delays in operations? I could go on. At least the Commission admits the findings are potentially relevant to the whole NHS. And this is the Commission that Ian Kennedy says has improved the NHS!

The trust’s data on outcomes for patients had caused the Dr Foster Unit at Imperial College, London to bring concerns to the attention of the trust and the Healthcare Commission. Dr Foster’s Hospital Guide showed that the trust had a hospital standardised mortality ratio (HSMR) of 127 for 2005/06. For the three years from 2005/06 to 2007/08 that the Heathcare Commission examined, the trust’s SMR for patients admitted as emergencies aged 18 and over varied between 127 and 145, statistically significant at the 5% level. There are trusts with a higher HSMR. Dr Foster says it has the fourth highest HSMR for 2003-6. Where are the inquiries into those Trusts with a higher HSMR? I'm not saying Mid Staffs is a particularly good Trust but someone's got to be at the extremes of a distribution of HSMRs.