The report lists trusts which have a higher than expected score
on two or more different mortality indicators including the
hospital standardised mortality ratio, deaths after surgery and
deaths in low risk conditions.
Most of these are District General hospitals but the list
includes University Hospitals Birmingham Foundation Trust. The
report points to a 20% higher rate of mortality, 40% reduction in
MRI scanning and a similar reduction in endoscopies.
Of significance is the fact that 66% of consultants interviewed
consider that care at the weekend is poorer and nearly 75% of
junior doctors came to the same conclusion.
There is a slight overlap between some of the trusts mentioned
and those identified as part of the Sir Bruce Keogh review earlier
this year. The Keogh enquiry looked at a number of different
factors with a broader review including mortality, safety,
workforce and leadership.
11 of the 14 trusts identified in the Keogh review were placed
in special measures which force them to publish an improvement
plan, have its leadership reviewed, be under scrutiny and be given
Once again therefore the attention is on failing trusts and on
inadequate care for patients. For the vast majority of us who
don't need to access health care regularly this is not an issue
albeit a concern. For those who need medical treatment or for those
who suffer an accident, the choice of trust and the time of
admission suddenly become relevant. These are not necessarily
things over which someone has control.
For clinical negligence lawyers some trusts are already
associated with poorer record keeping, more limited care and
failures to follow up. Some hospitals rightly or
wrongly are just known for problem care. They come up time and
again in client consultations.
Now routinely we look at the day of the week and whether that
impacts on the care received. For non urgent cases the lack of
weekend scanning may be of no importance. For an emergency having
to be transferred to elsewhere for a scan causes delay and may
exacerbate an already difficult situation.
Increasingly the difference in weekend care is raised as an
excuse or a reason for the lack of investigation. I have had
several trusts raise the issue that weekend cover cannot be
expected to be (in essence) more than cursory. More often
trusts are relying on differences in service availability as
reasons why patients do not receive the care they need at a time
when they need it. A lesser standard of care will become accepted
if trusts are permitted to run and win this argument.
Whether or not a trust is listed, whether or not it requires
special measures, patients are entitled to proper care at the
Highlighting the problem is a good start, but for patients with
little or no choice and more likely little or no information at the
time of admission, it does not address the issue. Knowing there is
a problem doesn't solve it. Nor should trusts be permitted to
use the widespread recognition of the problem to defeat legitimate
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