The publication of hospital mortality rates is part of the Government’s drive for greater transparency and should help the NHS drive up quality of care.

Risk-adjusted mortality rate data, such as Summary Hospital-level Mortality Indicator (SHMI) is in the public domain. While they do not tell us whether a hospital is safe or unsafe, they can act as a warning light to trusts and commissioners to take stock and take appropriate actions to improve services.

The SHMI can be used by hospital trusts to compare their mortality outcomes to the national baseline. Trusts should commit to understanding their mortality information, particularly where these indicate high mortality and commissioners should use mortality rates to highlight underlying problems which require further investigation. They should also provide contextual information in support of the commissioning process.

Regulators (for example, the Care Quality Commission) and commissioning organisations can also use the SHMI to investigate outcomes for trusts. However, the SHMI should not be used to directly compare mortality outcomes between trusts and it is inappropriate to rank trusts according to their SHMI.

The Government will be shortly setting out plans for how it will be supporting trusts and other providers to review and ultimately reduce their avoidable deaths.

The Government is committed to making real changes to the quality and availability of all NHS services and has no plans to reduce services in the areas specified.

The Department published Care in local communities: A new vision and model for district nursing, in January 2013, to provide best practice guidance to be used locally to support the provision of the district nursing services that make a real difference to the patient's experience of health and wellbeing. Community nursing teams are usually led by district nurses, and are made up of an appropriate skill mix to meet local needs and this includes specialist nurses and staff nurses, with support from healthcare assistants. Local areas are using a wider skill mix within their community nursing teams, including extending the role of health care support workers. To ensure an adequate supply of skilled district nurses in the future Health Education England has increased the number of training places for district nurses for 2015-16 by 16.5%.

The Government is committed to improving choice of place of birth, continuity of care and women’s experience of care. There are more than 1,900 full-time equivalent midwives than in May 2010 and a record number, in excess of 5,000 in training. Women can expect a range of choices over maternity services, as set out in the NHS Choice Framework for 2013-14, although these will depend on what is best for them and their baby, as well as what is available locally. Women can choose to receive antenatal care from a midwife or a team of maternity health professionals, including midwives and obstetricians. They can choose to give birth either at home, in a local midwifery facility or in hospital. Postnatal care can also be received at home or in a community setting, such as a Sure Start Children’s Centre.

Meals are provided by the 152 individual councils with adult social services responsibilities on the basis of assessed eligible need. Provision of social care services is a matter for local decision. The Department is unable to provide data on planned trends in provision. The Government has just issued a ring-fenced grant for £25 million to councils that have hard-pressed hospitals in their areas to facilitate faster discharge through additional reablement packages.

In addition, the Government has implemented a number of initiatives to minimise cases of hospital-delayed discharges. The Government has given a record £700 million this winter for 700 more doctors, nearly 4,500 more nurses and 5,000 more beds, including in social care and community settings. This money has been allocated through System Resilience Groups (SRGs), who bring together partners across the health and social care system, including acute and community providers and local authorities. Plans developed by SRGs before the funds were released, were required to include processes of good practice on reducing delayed discharges.

The vast majority of the £5.3 billion Better Care Fund, which begins on 1 April 2015, is being spent on social care and community health services. The aim is to encourage joint working between local authorities and the National Health Service to keep people out of hospital in the first place, as well as helping them to return home as soon as it is safe to do so. The national conditions in the Better Care Fund include the protection of social care and improvements in seven day working across health and social care to help quicker, more appropriate discharge from hospital. All plans must meet these conditions before being approved.

NHS England, Monitor and the NHS Trust Development Authority have advised that this information is not held centrally.

In the context of hospitals currently declaring major incidents, this refers to an emergency situation where particular facilities or resources are under pressure and special arrangements are required to maintain the delivery of some services. It would be for the organisation that had declared the emergency to de-escalate it, in line with its incident response plan.

The use of major incidents has been part of the National Health Service planning process since 2005, and they have been declared in every year since then.

There is no central definition but a major incident in a hospital might be called in:

- times of severe pressure such as winter periods or an infectious disease outbreak; and

- a period of particular local pressure such as dealing with a road traffic accident.

The current budget pressures are challenging. There are a number of changes in social care that address the needs of people leaving hospital including those that live alone.

The initiatives necessary to enable safe and timely discharge are included in the Operational Resilience and Capacity Planning Guidance and in the conditions for the Better Care Fund. For example they both require the National Health Service and local government to implement seven day working to facilitate timely discharge. Both require the effective engagement of the voluntary sector.

System Resilience plans and Better Care Fund plans take forward the rapid commissioning of care and support services to enable people who live alone to receive support and to recover. These place a significant emphasis on integration, making sure that vulnerable people have joined up care plans in which their own self-care is supported, and ensuring good communication and engagement of family and friends who may well not live with the patient. In many cases this involves collaboration with voluntary and community based networks that can provide timely voluntary assistance for people who may live alone.

The Government has provided £700 million this year to help the NHS cope with winter pressures. This funding will provide more bed space and pay for additional clinical staff, as well as measures to prevent delayed discharges of patients. A percentage of this money is being spent to secure joint health and care solutions to safe discharge. The Government has created the Better Care Fund, now worth £5.3 billion, to promote integration across health and care. Better Care Fund plans will also contribute to reduced admissions and delayed discharge. The Social Care Action fund has committed £2 million to scale up and test social action that impacts on admissions and discharge.

No estimate has been made of the levels of repetition of wheelchair assessment, the impact on bed availability and associated costs.

The supply and maintenance of wheelchairs which fall outside the scope of Specialised Complex Disability Equipment Services are the responsibility of local clinical commissioning groups. NHS England expects that assessment of patients and the subsequent supply and adjustment of wheelchairs is carried out within a suitable timeframe and to ensure the minimum of disruption.

No estimate has been made of the levels of repetition of wheelchair assessment, the impact on bed availability and associated costs.

The supply and maintenance of wheelchairs which fall outside the scope of Specialised Complex Disability Equipment Services are the responsibility of local clinical commissioning groups. NHS England expects that assessment of patients and the subsequent supply and adjustment of wheelchairs is carried out within a suitable timeframe and to ensure the minimum of disruption.

No estimate has been made of the levels of repetition of wheelchair assessment, the impact on bed availability and associated costs.

The supply and maintenance of wheelchairs which fall outside the scope of Specialised Complex Disability Equipment Services are the responsibility of local clinical commissioning groups. NHS England expects that assessment of patients and the subsequent supply and adjustment of wheelchairs is carried out within a suitable timeframe and to ensure the minimum of disruption.

Information has been placed in the Library which shows the number of patients who were waiting to start consultant-led treatment for non-urgent conditions at the end of each month from June 2009 to May 2014 in each National Health Service trust and NHS foundation trust in England. These data are collected each month as part of the monitoring of performance against referral to treatment waiting time standards, and are known as incomplete pathways. The data do not sum to published national figures, because they exclude independent sector organisations.

Information has been placed in the Library which shows the number of patients who were waiting to start consultant-led treatment for non-urgent conditions at the end of each month from June 2009 to May 2014 in each National Health Service trust and NHS foundation trust in England. These data are collected each month as part of the monitoring of performance against referral to treatment waiting time standards, and are known as incomplete pathways. The data do not sum to published national figures, because they exclude independent sector organisations.

We have commissioned Homeless Link to undertake an evaluation of the Homeless Hospital Discharge Fund and expect to receive a full report in September.

The estimated average cost of keeping a patient overnight in an acute hospital bed was £273 in 2012-13. No information is collected centrally to estimate the equivalent cost in a negative pressure isolation room.

No assessment has been undertaken of the risk of patients and their relatives taking legal action as a result of poor outcomes at the weekends.

NHS England’s existing Serious Incident Framework makes clear the importance of full co-operation of National Health Service organisations with any external investigations of serious

incidents, which include unexpected or avoidable deaths, including police investigations. The Framework states that “Providers should.. .collaborate with external scrutiny of investigations and any remedial work required following investigations, including full and open exchange of information with other investigatory agencies such as the police, Health & Safety Executive, Coroner and local safeguarding boards.

In addition, we expect all healthcare professionals to bear in mind their professional codes of conduct when asked to co-operate with any police investigations into patient deaths in hospitals. The professional code of conduct for registered nurses and midwives, for example, states that You must cooperate with internal and external investigations.../. This is important in order for NHS staff to remain accountable and provide the best patient care.

The Government published its further response to the report of the public inquiry into Mid Staffordshire Foundation Trust on 19 November 2013. The response set out a comprehensive programme that seeks to ensure the National Health Service has a consistently safe, effective and compassionate culture of care. The response, Hard Truths: the Journey to Putting Patients First, has already been placed in the Library.

We believe that avoiding unnecessary readmissions to hospital is vital to help people to maintain their independence and to reducing pressures on the system. This is particularly important for older people who often have the most frequent contact with health and care services.

Joined-up and co-ordinated planning for a safe and timely discharge from hospital is an important part of ensuring that people are not unnecessarily readmitted. The current discharge guidance 'Ready to Go?' sets out the steps for discharge planning and ensuring that a support package is in place on discharge from hospital. We will be reviewing and refreshing our guidance around joint discharge planning as part of our work on the Care Bill.

Further, in the case of acute hospitals, the responsible National Health Service body is required to notify the relevant local authority that a patient is likely to need care and support on discharge, and the date on which they are to be discharged. The local authority is then responsible for assessing the patient and putting a care and support package in place. Should they fail to do so they are liable to reimburse the NHS body for the cost of the delay to the patient's discharge.

Between 2010 and 2015 we will invest £l billion in reablement services, which help people to regain and maintain their independence and confidence following an acute episode, thus helping them avoid unplanned readmission to hospital.

In 2015-16 these reablement monies will form part of the £3.8 billion Integration Transformation Fund, which will be shared between the NHS and local authorities, and spent on the basis of joint plans. This fund will support localities to focus on preventing readmissions, but also on preventing people reaching the crisis point which causes them to be admitted in the first place. This ambition is being supported through the work on the Vulnerable Older People's plan, which is looking to improve care for our most vulnerable and elderly patients through more proactive care management in general practice, and more integrated, coordinated care outside hospitals.

The department does not hold this information.

Data are not collected in the format requested.

The following tables show the number of discharges of patients aged over 70, where the patient was dead and where the patient was live, at the Basildon and Thurrock University Hospitals NHS Foundation Trust and the East of England, London and South East England regions in each year since 2008.

The data represent the number of discharges by finished consultant episodes, including discharges for patients who might have been admitted and discharged on several occasions. Therefore, the data are not representative of mortality rates.

Number of deaths¹ that occurred in Basildon and Thurrock University Hospitals NHS Foundation Trust and in providers² in selected strategic health authorities (SHAs) in England where the patient was over 70 years of age³—2008-09 to 2011-12⁴

Please refer to the “Footnotes” tab for more information on this table

Activity in English National Health Service Hospitals and English NHS commissioned activity in the independent sector.

Count of discharges

2008-09

2009-10

2010-11

2011-12

Provider/SHA Code

Provider/SHA Name

Dead

Live

Dead

Live

Dead

Live

Dead

Live

RDD

Basildon and Thurrock University Hospitals NHS Foundation Trust

1,357

16,267

1,228

16,727

1,270

17,560

1,204

18,117

Q35

East Of England Strategic Health Authority

19,851

354,523

18,935

389,079

18,377

393,382

17,887

407,338

Q36

London Strategic Health Authority

21,834

418,427

20,671

434,405

19,392

460,240

19,188

470,573

Q37

South East Coast Strategic Health Authority

15,325

279,303

14,513

286,747

14,801

304,830

13,760

315,850

Death as % of all discharges

2008-09

2009-10

2010-11

2011-12

Provider/SHA Code

Provider/SHA Name

RDD

Basildon and Thurrock University Hospitals NHS Foundation Trust

7.7%

6.8%

6.7%

6.2%

Q35

East Of England Strategic Health Authority

5.3%

4.6%

4.5%

4.2%

Q36

London Strategic Health Authority

5.0%

4.5%

4.0%

3.9%

Q37

South East Coast Strategic Health Authority

5.2%

4.8%

4.6%

4.2%¹ Deaths—Discharge method (dismeth = 4) has been used for counting deaths in hospital. All other discharge methods have been classified as discharged ‘LIVE’.² Hospital Provider A provider code is a unique code that identifies an organisation acting as a health care provider (e.g. NHS Trust or primary care trust. Data from some independent sector providers, where the onus for arrangement of dataflows is on the commissioner, may be missing. Care must be taken when using this data as the counts may be lower than true figures.³ Age—the patient’s age at the start of the final episode (startage) of care has been used. Patients aged 71 and over at the start of their final episode of care have been included.⁴ Assessing growth through time (Inpatients)—Hospital episode statistics (HES) figures are available from 1989-90 onwards. Changes to the figures over time need to be interpreted in the context of improvements in data quality and coverage (particularly in earlier years), improvements in coverage of independent sector activity (particularly from 2006-07) and changes in NHS practice. For example, changes in activity may be due to changes in the provision of care.

Provider spells:

Provider Spells have been used for counting the number of deaths in hospital and ‘LIVE’ discharges. Provider spells are single or groups of finished consultant episodes that have the same healthcare provider code, HES patient identifier, admission date, and provider submitted spell number.

Finished Consultant Episodes (FCE):

A finished consultant episode (FCE) is a continuous period of admitted patient care under one consultant within one healthcare provider. FCEs without a valid admission date are excluded as they cannot be used to create provider spells. Data are allocated to a financial year (HES year) based on the date of the discharge episode.

Episode status:

Only finished consultant episodes (epistat = 3) have been used for identifying discharges

Patient Classification:

Only ordinary admissions, day case admissions and mothers and babies using delivery facilities have been included (classpat = 1, 2, 5). Regular day and night attenders have been excluded.

Usage:

No age/sex standardisation or casemix adjustments have been applied to the data. When comparing death rates it is strongly recommended that the Summary Hospital-level Mortality Indicator (SHMI) is used: www.ic.nhs.uk/SHMI.

Interpretation notes:

The table shows the number of hospital discharges where the patient was dead and where the patient was alive in Basildon and Thurrock University Hospitals NHS Foundation Trust, and where the SHA of treatment was in London and the South East of England.

It should be noted that Basildon and Thurrock University Hospitals NHS Foundation Trust is included in the total for Q35 - East of England SHA.

It should be noted that while patients can only be discharged dead once, they can be discharged live several times during a year so this should not be described as a count or percentage of people.

No age/sex standardisation or casemix adjustments have been applied to the data. When comparing death rates it is strongly recommended that the Summary Hospital-level Mortality Indicator (SHMI) is used: www.ic.nhs.uk/SHMI.