PATIENT death rates across Wye Valley Health Trust rose so fast in a single month as to be amongst the worst in the UK.

While the number of deaths seems to have stabilised since soaring from 78 to 133 between October-November last year, the county’s new GP-led Clinical Commissioning Group (CCG) - now responsible for commissioning health and social care services wants more “transparency” from the Trust over what such statistics show.

Up until recently, the death - or Hospital Standardised Mortality Rate - at the Trust had fallen consistently to a highly regarded 78 by October last year. But November saw a significant variance from that trend showing a rise to 133 or up 57 over the month.

The Trust went to work on the figures with national health and social care intelligence provider Dr Foster to recommend that any review of the rise focused on septicaemia and palliative cases.

Submitted for recalculation, the figures identified five cases as incorrectly coded. But the CCG has requested that in future the Trust tells of any other such reviews to ensure transparency.

Every death across the Trust is reviewed and the CCG meets monthly with the Trust around this. National leads have approved the CCG approach to death rate scrutiny which also includes reviews of primary care performance.

Information sharing between all health agencies has led to heightened concerns over quality performance at the Trust and, in response, high level assurances are now being sought.

Though widely acknowledged as subject to severe financial pressures, the Trust has kept up consistently high scores in performance quality measures including patient safety and clinical effectiveness.

The publication of the second part of the Francis report into Mid Staffordshire NHS Foundation Trust in February triggered a
number of national assurance programmes, including a detailed scrutiny of death rates at all NHS Trusts.

Initially five Trusts were identified as significant statistical anomalies, with another nine added to a national programme of scrutiny launched by medical director of the NHS Sir Bruce Keogh.

During the previous year, the Trust had seen a worsening death rate but subsequent improvements saw it left off the Keogh programme. Then the figures showing that jump to 134 were released putting the Trust amongst those most significant statistical anomalies.

Had the Keogh programme started then, the Trust would have been included, but, at present, the programme has no plans to expand. Instead, the focus is be on work between the Trust and the CCG to bring the death rate down.

March marked a slight decrease to 117 but numbers were back up by April to top 129.

At present, the CCG is satisfied that wider assurances are available to counter concerns of “immediate and profound risk” to patient safety, but will undertake “a more rigorous and focussed” level of scrutiny.

David Farnsworth, CCG Executive Nurse responsible for Quality and Safety said the group took the issue “very seriously” and was working closely with the Trust and other regulators, including NHS England and the Trust Development Agency to monitor and improve the death rates.

Trust medical director Dr Peter Wilson said death figures can “go up and down from month to month” so trends needed to be monitored over time rather than through specific months so as not to be seen out of context.

“While mortality figures are complex and reported retrospectively, over the last eight years, the Trust’s average baseline mortality rates have improved significantly. More recently, much work has taken place to fully understand the figures - we’ve worked closely with the Dr Foster Unit and put a large number of actions into place to make sure we have robust lines of review for each in-hospital death,” he said.