Scottish hospital death rate sparks inquiry

Death rates at a Scottish hospital are being investigated after it reported higher than average mortality levels.

Forth Valley Royal Hospital saw aboveaverage death rates. Picture: Jane Barlow

Healthcare Improvement Scotland (HIS) said Forth Valley Royal Hospital had been identified as having a mortality ratio higher than the Scottish average during one quarter of 2013.

It has started discussions with the £300 million hospital, which opened in 2010, to try to identify why deaths are higher.

The latest investigation into death rates follows an investigation last year into high mortality at hospitals in NHS Lanarkshire.

A report into the Lanarkshire rates found that staff shortages and poor quality of care could have been behind problems found in the board.

Hospital Standardised Mortality Ratios (HSMR) are a calculation based on the number of deaths predicted at a hospital, based on its size and other factors, compared with the actual number of deaths.

Across Scotland, the average HSMR in April to June last year was 0.88. But the figures for Forth Valley Royal Hospital in Larbert, which also include data from the community hospitals in Stirling and Falkirk, showed that the rate stood at 1.03.

The figures emerged this week after adjustments were made to provisional statistics published last year. Figures for the following quarter, July to September, in Forth Valley showed the rate had dropped to 0.92, closer to the Scottish average of 0.86 for that period.

A spokesman for HIS said it had “initiated a dialogue” with NHS Forth Valley, which was standard practice for considering mortality ratios that are higher than average.

The spokesman said: “In doing so, NHS Forth Valley is being asked to provide a response to these data, describing how the data are being considered and interpreted locally and, where necessary, acted upon.

“This is a standard procedure. HIS will then consider the response in order to decide if any further action is required.

“Hospital mortality ratios are not in themselves a measure of safety of quality of care. However they are a potentially valuable tool in drawing attention to potential areas of further review.”

Jason Leitch, the Scottish Government’s clinical director, said the situation in Forth Valley was different to Lanarkshire in that it related to a single period rather than high rates in multiple quarters. He said the board had also seen a big fall in death rates since 2006, while Lanarkshire had seen much smaller declines.

“The medical director has been investigating and reviewing with his clinicians and I am reassured completely that they are doing all they can to see if there is a clinical element,” he said. Dr Leitch added: “It is not an exact science so there is always room for improvement in avoidable mortality. So it is no bad thing for Forth Valley to spend some time reviewing how the service is running.”

In a statement, NHS Forth Valley said: “Providing safe, high-quality care is a key priority and we closely monitor our HSMR figures and other quality measures to identify any potential issues.

“HSMR rates vary from quarter to quarter and NHS Forth Valley acknowledges that the HSMR for Forth Valley Royal Hospital was higher than the Scottish average for the quarter April to June 2013.

“However latest published provisional figures for July to September 2013 suggest a considerable improvement.”

The board said it took the figures “very seriously” and had been analysing them in detail to find any areas for improvement.