Dr Foster report questions operation and mortality rates

The recent Dr Foster review has highlighted mortality rates and operation ‘rationing’ as areas of concern at NHS hospital trusts.

As the Dr Foster research group published the results of their latest analysis of NHS services, two areas were highlighted as causing concern: key operations and mortality ratios.  

By analysing the rates of what are deemed ‘life-enhancing’ operations (knee, hip and cataracts) and those of “ineffective” procedures such as tonsillectomies, the report suggested that, in a bid to cut costs, key operations were being ‘squeezed’ while non-elective procedures continued.

“Money is being wasted on care that has no benefit” declared Roger Taylor, co-founder of health analytics firm Dr Foster, with “ineffective” operations increasing in certain areas concurrently with the “sharp slow-down in activity” of knee, hip and cataract operations despite the increasing elderly population.

Colin Howie, vice president of the British Orthopaedic Society, said the results were “very concerning” and suggested that seeking short-term savings by limiting these key operations would “cost the NHS and society in the long-term.”

The NHS, in response to the findings, said that while the data “raises important questions”, such ‘key’ operations as knee, hip and cataract operations could often be “overused”, and “it should not be taken as a given that the figure should automatically increase” over the years.   

To add additional gloom to the report, Dr Foster published a list of thirteen hospital trusts with “worrying high” mortality rates and called for further investigation at these sites. The research focused on four different mortality indicators, including deaths post-surgery and in high-risk conditions, with results showing that more than a dozen trusts nationwide scored below expected on two or more indicators.

As with previous reports by the health analytics firm, many hospital trusts have responded to Dr Foster’s results by criticising the firm’s methodology, which differs from the national guidance for assessing mortality rates.

Karen Jackson, chief executive at Northern Lincolnshire and Goole Hospitals Foundation Trust – a trust on the ‘black list’ – raised concerns over “Dr Foster’s decision to use a different interpretation of the SHMI that is at odds with the official nationally published figures.”

“This is very confusing for both NHS staff and the public”, she said.

The NHS are currently developing new measures for assessing mortality rates, with professors Lord Darzi and Nick Black conducting a study on the relation between mortality rates and actual avoidable deaths in a bid to make the indicators more accurate. There is also talk of commencing ofsted-style inspections of hospitals, while a ‘family and friends test’ will be in place from April 2014 to seek the opinions of patients on their local services.   

Health secretary Jeremy Hunt, who has long maintained that reducing premature death rates is a priority for the health department, said he expected “all hospitals to examine this data carefully and take action wherever services need to improve.”

Despite the seemingly alarming findings, the Dr Foster report concluded that mortality rates were falling nationally – twenty hospital trusts were highlighted as having high mortality rates last year, with only thirteen for 2013 – thanks to “better treatments”, “improving safety” and “falling rates of hospital infections”.