Thirteen hospital trusts have higher than expected mortality indicator scores, according to a recent report by Dr Foster Intelligence.

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 extensive support.

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 appropriate time.

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 legal claims.

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