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Report shows hospital trusts with persistently high or low death ratios

January 29, 2014: Eighteen NHS trusts in England have been categorised as having a 'lower than expected' or a 'higher than expected' mortality ratio over two years, according to analysis from Health and Social Care Information Centre (HSCIC).

*HSCIC must be quoted as the source of these figures

Between July 2011 and June 2013, 12 trusts were categorised as having a 'lower than expected' ratio, based on Summary Hospital-level Mortality Indicator (SHMI) data and six as having a 'higher than expected' ratio.

This analysis features in an experimental report; Summary Hospital-level Mortality Indicator (SHMI) - Deaths associated with hospitalisation, England, July 2011 - June 2013, Experimental Statistics, Supplementary Outlier Report.

The SHMI compares the actual number of patients to die following hospitalisation at a particular trust with the number that would be expected to die, based upon average England figures, given the characteristics of the patients treated there4. It considers deaths taking place during a stay at a trust and also within 30 days of discharge.

SHMI values for individual trusts are categorised 'as expected', 'lower than expected' or 'higher than expected'.5 The SHMI requires careful interpretation and needs to be viewed alongside other evidence, rather than as a stand-alone verdict on a hospital trust's performance.

The trusts categorised as lower or higher than expected in both the January 2013 publication covering (July 2011 - June 2012) and the January 2014 publication (covering July 2012 - June 2013) are:

  • 'Higher than expected': 6

    - Mid Cheshire Hospitals NHS Foundation Trust

    - Colchester Hospital University NHS Foundation Trust

    - Aintree University Hospital NHS Foundation Trust

    - Wye Valley NHS Trust

    - Blackpool Teaching Hospitals NHS Foundation Trust

    - East Lancashire Hospitals NHS Trust

  • 'Lower than expected'7

    - Barts Health NHS Trust

    - Royal Free London NHS Foundation Trust

    - North Middlesex University Hospital NHS Trust

    - Cambridge University Hospitals NHS Foundation Trust

    - Guy's and St Thomas' NHS Foundation Trust

    - St George's Healthcare NHS Trust

    - The Whittington Hospital NHS Trust

    - Chelsea and Westminster Hospital NHS Foundation Trust

    - University College London Hospitals NHS Foundation Trust

    - North West London Hospitals NHS Trust

    - Barnet and Chase Farm Hospitals NHS Trust

    - Imperial College Healthcare NHS Trust

Today's report also provides additional, contextual, information on palliative care, method of admissions and deprivation10.

HSCIC chair Kingsley Manning said: "The SHMI, combined with other indicators provides a very useful insight, which should prompt trusts to undertake a further, more detailed examination of their services, but should not be seen as a definitive judgement."

Read the full report


Notes to editors

  1. The Health and Social Care Information Centre (HSCIC) was established on April 1 2013 as an Executive Non Departmental Public Body (ENDPB). It is England's trusted data source, delivering high quality information and IT systems to drive better patient services, care and outcomes. Its work includes publishing more than 220 statistical publications annually; providing a range of specialist data services; managing informatics projects and programmes and developing and assuring national systems against appropriate contractual, clinical safety and information standards.
  2. There are currently a number of mortality indicators used in the NHS. They have been designed by different organisations using different statistical methods to help identify trends that require further investigation. Following the Review of the Hospital Standardised Mortality Ratio (HSMR) in 2010 (, the Department of Health commissioned the Health and Social Care Information Centre to develop, deliver and publish the SHMI as it does all national indicators.
  3. This indicator has been developed in collaboration with a range of national stakeholders following a review commissioned in 2010 by medical director for the NHS in England Sir Bruce Keogh and chaired by Ian Dalton, then chief executive of the North East Strategic Health Authority. It involved a wide range of stakeholders, including the Department of Health, representatives from strategic health authorities and trusts, the HSCIC, the Care Quality Commission, Monitor, the Kings Fund, the Academy of Royal Colleges, the NHS Confederation, Dr Foster Intelligence, CHKS, University Hospitals Birmingham, the National Patient Safety Agency and Professor Sir Brian Jarman and colleagues from Imperial College London.  Several members have continued to support and contribute to the technical work associated with the development and construction of the SHMI as part of the SHMI Technical Working Group (including representatives from the Department of Health, the Care Quality Commission, HSCIC, Professional Association of Clinical Coders, Public Health England, King's Fund, Dr Foster Intelligence, Dr Foster Unit at Imperial College London, CHKS and University Hospitals Birmingham).  
  4. The risk of the patient dying in hospital or within 30 days of discharge is estimated from a statistical model based on the following variables: the condition for which the patient is in hospital, other underlying conditions from which the patient suffers, age, sex and the method of admission to hospital (elective/non-elective/unknown)
  5. For the purposes of this report, repeat outliers are defined as trusts categorised as either 'higher than expected' or 'lower than expected' in both the first and the last publications from the five most recent SHMI publications i.e. the January 2013 and January 2014 SHMI publications covering the periods July 2011 to June 2012 and July 2012 to June 2013.
  6. Four out of the six trusts listed as 'higher than expected' in the January 2013 and 2014 publications were also categorised as 'higher than expected' in the intervening April 2013, July 2013 and October 2013 publications. Wye Valley NHS Trust has been categorised as 'as expected' in the April 2013, July 2013 and October 2013 publications and and East Lancashire Hospitals NHS Trust was been categorised as 'as expected' in the October 2013 publication.
  7. All of the trusts categorised as 'lower than expected' in both the January 2013 and 2014 publications were also categorised as 'lower than expected' in the intervening quarterly publications in April 2013, July 2013 and October 2013.
  8. Termed in the report as 'finished provider spells'.
  9. An elective admission is an admission which is either booked, planned or from a waiting list and the decision to admit can be separated in time from the actual admission to hospital. In this report, non-elective admissions include emergency admissions and those with an unknown admission method and include transfers from other trusts.
  10. The report uses the Index of Multiple Deprivation (IMD) version 2010 as a measure of deprivation. The IMD attempts to measure a broad concept of deprivation composed of several different domains, including income, employment, health deprivation and disability, eductation, skills and training, barriers to housing and services, crime, living environment. Where the press release refers to the 'most deprived areas' these are areas defined by the HSCIC as belonging to deprivation quintile 1, the most deprived quintile.
  11. For media enquiries please contact or 0300 303 3888.
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