800 cases of septicaemia recorded
Average for similar trusts is just 200
For six years, Bolton recorded poor death rates
In 2011, it was said to be "most improved" for mortality
Septacaemia receives higher payments than other infections
AN investigation into death rates at the Royal Bolton Hospital has been launched after an independent watchdog claims to have discovered “significant discrepancies” in the hospital’s data.
Bolton NHS Foundation Trust’s Acting Chief Executive, Dr Jackie Bene, has “stepped aside” following the discovery that an unusually high number of patients had been “coded” as having had septicaemia in a year.
Septicaemia, a severe infection that enters the blood stream, is coded, or tagged, in a different way to other illnesses and infections. This means deaths caused by septicaemia do not affect mortality figures.
The Trust recorded 800 cases of septicaemia between March 2011 and April 2012 — a similar sized trust would expect to have just 200.
Dr Bene, as former medical director, was in charge of recording the information.
Independent health researcher Dr Foster and Bolton’s Clinical Commissioning Group (CCG), are currently investigating 200 cases.
Their report, which is supported by NHS Commissioning Board and Professor Sir Bruce Keogh, the UK’s national medical director, is expected to be completed on March 6.
It is too early to say why the Trust had so many cases of septicaemia, but the CCG said its interim findings for 50 of the cases show “cause for concern”.
It is believed patients’ records could have been coded incorrectly causing the “discrepancies”.
If some of the Trust’s deceased patients have been coded incorrectly as dying from septicaemia when they had a different cause of death, it could have a drastic impact on the Trust’s death figures.
Each year, Dr Foster compiles mortality statistics for all trusts.
In December, Bolton NHS Foundation Trust’s results were “better than expected”. This followed an award for “most improved” trust in 2011.
But for the six previous years, Bolton was one of the worst performing trusts for death rates, with figures massively above the national average.
The coding could also affect income as hospitals receive money for results and types of illnesses. Septicaemia receives a higher payments than other infections.
On Monday, the Trust’s interim chairman David Wakefield informed staff that Dr Bene had “stepped aside” to “allow a fully independent view to be taken”.
Mr Wakefield, who was appointed by health watchdog Monitor after the Trust was put in the highest risk rating for governance and finance, said an independent team would be brought in to look at coding practices.
He added that Deloitte, which is currently part of a £1 million financial turnaround plan at the Trust, would extend its work load to look at quality governance.
Mr Wakefield said the Trust wanted to “rule out any serious issues as soon as possible” and make sure the way they code patient outcomes meets “highest quality standards”.
He stressed the 50 cases would be reviewed by clinical staff to rule out any serious issues, and if there were any concerns with care then families would be contacted.
But he added: “We do not believe that there are any clinical concerns regarding the care of patients, but rather there are questions that need answering about how the trust reports information about their care for administrative and financial purposes.
Dr Wirin Bhatiani, chairman of Bolton Clinical Commissioning Group, said it first became aware of the “unusually high” number of septicaemia cases in October and commissioned Dr Foster to carry out an independent audit.
CCG chiefs discussed concerns with the Trust, Monitor, quality experts from the Strategic Health Authority in the North, NHS Greater Manchester and the Care Quality Commission on January 24.
Dr Bhatiani said: “While we are keen to wait for the final report, we are sufficiently concerned by the interim findings to commence further investigations, and to inform the chair of the trust.
“When the final report is available on March 6, we will present the findings openly and transparently, reflecting the fact that the Bolton public are our main concern and priority.”
The 50 cases will be reviewed by clinical staff and if any concerns arise with the care provided in them the hospital says it will directly contact their families.
The Trust said: "As always our PALS team is available to provide information and assistance on 01204 390244."