A story of a hospital - high mortality rates

It has not been an easy time for hospitals in Buckinghamshire.  Not that it has been easy for any hospital recently.

In 2005 two previously independent hospital merged to become the Buckinghamshire Hospitals NHS Trust.  One was Stoke Mandeville Hospital in Aylesbury and the other was Wycombe General Hospital in High Wycombe, 18 miles away on the other side of the Chiltern Hills.  Suddenly the management team had to look after three sites, three PFIs and work with a Primary Care Trust that was struggling to keep within budget. The budget was one of the lowest per head in England.

In 2005 the trust closed down the A&E in Wycombe and created a minor injuries unit, much to the disgust of the local population.  Trauma services were also moved while earlier the consultant led maternity unit and children's services had also been moved.

In 2010 the trust took over the management of community services, previously managed by the PCT.

In 2012 there was a big reconfiguration of services with some moving to one hospital and others being centralised at the other. So Wycombe Hospital now has a very good Hyper Acute Stroke Unit and a cardiology department while inpatient care for emergency medicine, respiratory, gastroenterology and medicine for older people have all moved to Stoke Mandeville Hospital.

Two mergers and a major reconfiguration within 5 years must have an effect on the effectiveness of a hospital. 

At the same time as all this merging and shifting of services, not forgetting the scandals & investigations, the trust has been trying to become a Foundation Trust. 

There is more!

 Now it is one of the hospital trusts being investigated for high mortality rates.

According to the data from Prof Brain Jarman's website http://brianjarman.com  trust has been reporting higher than expected death rates in 9 out of the last 11 years. The last four years have been higher than 110. So now they will be investigated by the Department of Health.

The trust, now called the Buckinghamshire Healthcare NHS Trust, has said that it has been examining the deaths of patients for the last 2 years in an effort to understand why the rates are so high. See their press release here. 

The trust  has in the past been quite successful in improving the quality of care it provides. Following the hospital acquired infection outbreaks the board saw the Infection Control reports at every board meeting. Now the trust is one of the better performing trust in this area.

Yet after two years of an in-house investigation the mortality rates are still high. Why?

What could be the causes for the high death rates. The Francis report on the Mid Staffs high death rates found that there were many causes but meeting targets, keeping to budget and getting foundation status were some of the primary causes.

In Buckinghamshire the health and social care economy has been under stress for many years. There have been the merger of the two hospitals and then the integration of the hospital and community services. There has been the Foundation Trust application. 

Is the fact that the PCT has been managing referrals and diverting patients to alternative providers before referring to the hospital meant that patients are sicker when they do get into the hospital?

Is it that they have been poor at coding patients in the correct way?  They have had two years at least to sort that one out. 

Is the reporting and analysis of the data flawed. Not so, says Prof Jarman and Dr Foster.

So is it that the hospitals are providing poor quality care?The patients are not reporting great concern, as far as I know, to the Trust, their GPs or the Local Involvement Network, or even Patients Opinion.

So what is happening  here? Why are the mortality rates still so high?

When will the investigation start and who will be on the team representing local people?

We need a swift and effective investigation so that the patients and the public can be re-assured that the trust is providing good quality care and is a safe place for us to go to when we need to use the hospitals