Hospitals are 'full to bursting' and patient care is being put at risk, report warnsDr Foster, the NHS watchdog, found 12 trusts have 'worryingly high' death rates For 48 weeks of the year most hospitals are more than 90 per cent full, 'jeopardising patient care'
A third of beds are taken by patients who could be cared for elsewhere
If cost continues to be put over quality, 'patients will be in danger' it warns
12:15 GMT, 3 December 2012
Hospitals are so 'full to bursting' that staff are struggling to keep patients safe, an influential report has warned.
And death rates at 12 NHS hospitals are 'worryingly high'.
The Dr Foster Hospital Guide report – produced annually by the NHS watchdog, and part funded by the Government – also warns 'quality should not be sacrificed for cost' or patients could be in danger.
Unless there is change there could be a repeat of the Mid Staffordshire hospital scandal – where up to 1,200 patients died because of poor care, it said.
The report, which excluded specialist centres but included 145 hospital trusts, said when hospitals were too busy patient care suffered because systems started 'breaking down'
The Dr Foster guide shows how admissions were broken down by patient group across the country
The main findings of the report published today, were:
Hospitals are regularly breaching an 85 per cent bed occupancy limit set in place specifically to
protect patients.12 hospitals were reporting too many deaths after surgery and too many deaths of patients who were admitted for minor ailments or 'low-risk conditions'As people got older, their quality of care in hospital 'declined'A third of hospital beds were being taken up by patients who could have been cared for elsewhereThere are higher 'mortality rates' – or deaths – at weekends
The guide said when hospitals were too busy patient care suffered because systems started 'breaking down'
It said: 'Hospitals are under pressure from the rising numbers of emergency admissions, particularly among frail elderly patients.
'For 48 weeks a year most trusts are more than 90 per cent occupied. High levels of occupancy make it harder to provide a safe, effective service.'
Each of the 12 trusts which had high death rates fell short on two of four mortality rate indicators – 'deaths after surgery' and the deaths of patients who were admitted for minor ailments or 'low-risk conditions'.
'These measures are to be used as a warning sign that poor-quality care may be leading to a higher-than-expected mortality.
'With the rising demand for care and falling
revenues, there are concerns that trusts will focus more (or
exclusively) on cost of care rather than quality of care.
'Because of this, there is a fear that there could be another Mid Staffs. Hospital managers must ensure that they do not sacrifice one for the other.'
The Staffordshire NHS Foundation Trust is at the centre of an 11million inquiry.
As many as 1,200 patients are feared to have died needlessly at the trust between 2005 and 2009 due to poor care and medical errors.
THE 12 HOSPITALS WHERE DEATHS ARE HIGHER THAN EXPECTED
Aintree University Hospital NHS Foundation Trust
Blackpool Teaching Hospitals NHS Foundation Trust
Buckinghamshire Healthcare NHS Trust
George Eliot Hospital NHS Trust
Hull and East Yorkshire Hospitals NHS Trust
Medway NHS Foundation Trust
North Cumbria University Hospitals NHS Trust
Northern Lincolnshire and Goole Hospitals NHS Foundation Trust
United Lincolnshire Hospitals NHS Trust
University Hospitals Birmingham NHS Foundation Trust
Walsall Healthcare NHS Trust
Western Sussex Hospitals NHS Trust
The report comes as the government drives forward an 'efficiency' plan which will see 20bn slashed from the NHS budget.
Katherine Murphy, Chief Executive of The Patients Association, said: 'These distressing figures reveal bed occupancy rates are at the very limit of what is safe or indeed desirable for patients.
'Our Helpline hears day in day out from patients and relatives who are experiencing unacceptably poor care, with nursing staff telling relatives that they simply not having time to deliver the fundamentals of good care or dignity.
'The Government must consider the devastating impact its 20 billion efficiency drive is having on the number of hospital beds, at a time when we have an aging population and rising admissions.
'Moving forward care, particularly for the elderly, must be better integrated so that when appropriate it can take place in home and community settings.'
But University Hospitals Birmingham NHS Foundation Trust (UHB) – one of the 12 trusts named as having higher death rates in the two categories – raised concerns about the validity of the Dr Foster indicators.
The Dr Foster reports rank mortality – or deaths – with a measurement called the Hospital Standardised Mortality Ratio (HSMR). It measures if the death rate at a hospital is higher or lower than expected using a series of indicators.
Dr Dave Rosser, medical director at the trust, said: 'The HSMR (Hospital Standardised Mortality Ratio) is widely considered to be unsuitable for use as a comparative indicator between hospitals.
'Dr Foster frequently changes the methodology of the HSMR which, in our opinion, further reduces its credibility as a comparator.'
He said: 'In our opinion, the mortality indicator relating to conditions of low clinical risk is deeply flawed.
'To illustrate, one of the patients identified by Dr Foster to be in this category was a patient admitted into one of UHB’s specialist services with a condition called toxic epidermal necrolysis, which is known to have a mortality in excess of 50 per cent.
'Under Dr Foster’s methodology, this condition is classified as an allergy and therefore treated as ‘low clinical risk’. There are many similar examples.'
The report also found that death rates at three of the 12 hospitals have been consistently high for three years running.
Buckinghamshire Healthcare NHS Trust, The Dudley Group NHS Foundation Trust and George Eliot Hospital Trust in Nuneaton had high death rates three years in a row.
Authors of the Dr Foster report had alerted authorities to problems at the Mid Staffordshire NHS Foundation Trust – where the deaths rates were also high for a number of years.
The Dr Foster report has warned death rates at a dozen trusts are alarmingly high. It has warned 'quality must be put over cost or there will be another Mid Staffs situation', where 1200 patients died due to a lack of care
Kevin McGee, chief executive at George Eliot, said the trust commissioned an external review of its historically high mortality rates last year and acknowledged the figures had been 'unacceptably high.'
He added: 'We are obviously pleased with the improvements in mortality rates seen so far this year and it is testament to the efforts of all our staff, but we are still some distance from where we want to be.'
A spokesman for the Dudley Group said it took mortality indicators very seriously and recent reports had suggested 'a significant and sustained improvement.'
But the Buckinghamshire Healthcare NHS Trust strongly denied that it had a higher than expected mortality rate and questioned whether the hospital guide reflected new ways of operating.
Medical Director Graz Luzzi said: 'The title says it all. This is a hospital guide, but our care is also delivered at home, in the community and in a hospice. To be effective it is important to compare like with like.'
Dr Foster Intelligence's Director of Research, Roger Taylor, said: 'Given the current pressures on NHS budgets, it is no longer enough to just provide good quality care.
'Of course the best possible patient outcomes will always be of paramount importance. We have shown that there are a small number of trusts that are able to deliver high quality care in an efficient way which other hospitals should learn from.'