Scunthorpe General Hospital - new measures are working but still a way to go
Health chiefs at the trust that serves the region's hospitals admit they have still got a long way to go in improving mortality rates, but are confident the measures they have put in place are working.
The health bosses were speaking in the wake of the latest figures revealed by the NHS Information Centre, that still found the trust to be among the worst in the country for mortality rates.
The figures, for the period April 2010 to March 2011, showed no real change in the trust's position, with their Summary Hospital Level Mortality Indicator (SHMI) figure standing at 117. The previous year's figure was 116.
However, health bosses say the figures do not take into account the positive work that has been undertaken by staff at the trust following the previous SHMI report and the damning Transforming Health document.
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Karen Jackson, chief executive at the trust, said mortality rates remained the key priority.
"The impact of this activity will not necessarily be reflected in the SHMI figures for some time due to the indicator's retrospective nature," she said.
"However, we continue to monitor our progress rigorously and I, along with the trust board, am fully confident the SHMI figures improve.
"This is the absolute priority, we are green in everything else.
"We will again be an outlying trust and this is not a place we aspire to be.
"What I can say is that we have been working on this for an awful long time, both clinical staff and non-clinical.
"The actions that we were taking, the things from the Transforming Health review, plus the things that people within the organisation and staff have done, will take time.
"We need to make sure that people are properly supported when they are transported from our organisation.
"There are social issues that need addressing such as mobility and social housing that as a community is critical to be involved in this process so people are supported when they get home.
"We need people to go home well enough to be cared for at home well and safe."
Mrs Jackson said the positive work by the trust could be seen by the Risk Adjusted Mortality Index (RAMI) figures.
The RAMI figures are different to the SHMI figures as they only include deaths within the trust. They can also be broken down to deaths within each of the hospitals that make up the trust.
RAMI figures for September 2011 to August 2012 show there to have been 45,113 discharges from Scunthorpe General Hospital and 732 deaths, giving a crude mortality rate of 1.62 per cent.
This was down on the figure for the same period the previous year that stood at 1.82 per cent. Deaths had also fallen by 43 from 775. There were 42,595 discharges.
The RAMI indicator had also fallen from 139 to 103.
Mrs Jackson said positive work by the staff could be seen by the fact that despite 2,500 more discharges from Scunthorpe General Hospital, the number of deaths had fallen.
"With RAMI I can see the effects of the actions that we took last month whereas SHMI is measuring a period of six to 18 months," she said.
"We have had a change in our RAMI figures and that is a credit to our staff.
"The plan has helped the whole community focus more clearly on SHMI and how we could do things around SHMI.
"We have integrated this report from Transforming Health together with the actions we have already taken from going out and have identified lots of other things that can make an impact.
"The interesting thing is the number of increasing discharges and despite an increase of more than 2,500 the number of deaths has fallen.
"With that pressure on the system that is a real testament to the quality of care being given."
Dr Liz Scott, medical director at the trust, said it would be some time before the SHMI figures came back in-line with the RAMI figures due to the time delay.
She said: "Because the information is configured by the Office National Statistics (ONS) there will always be a six-month delay in our SHMI figures being released.
"Our RAMI figures are coming down quite significantly. We will still work to do better but what the RAMI is showing is the work the director of nursing, the nurses and all the staff are doing, it is going in the right direction.
"The RAMI figures show we have made good progress but there is still work to.
"But it is going to take longer for the SHMI figures to come down."
Because the SHMI figures include deaths up to 30 days after being discharged from hospital, the trust has said it must continue to develop relations with the local community.
The trust has said this is an issue for the whole health community and it is working hard within the organisation and with GPs to make sure all possible factors are addressed.
Dr Scott said the provision of care for elderly and vulnerable people have the right care in the community was a priority to help reduce mortality rates.
"The community links, the GPs, working locally with the community services, we must make sure that people are in the right place," she said.
"If someone becomes unwell, can we care for them in their own home? For the elderly coming in to hospital it can be quite confusing. Hospitals are very busy places and if we can keep them in their own home then we will.
"We will only bring people in to hospital when they really need it.
"When they have had their treatment we can get them back in to their own home. This is much better for the person.
"Making sure there are people with chronic conditions get as much of that care in the community is also a priority.
"Diabetes, high blood pressure, these conditions need to be done in the community, keeping them out of hospital and keeping them well."
Dr Scott said that positive work in certain areas of the hospital are ensuring that mortality rates will start to fall, but work is still to be done in others.
"We still have more work to do but our stroke mortality rates fell and have come down a long way. The stroke teams are doing a fantastic job in improving them.
"Cardiology was not as high as strokes but was below the national average.
"There is work to be done around pneumonia and making sure people get the right care from the minute they come in to hospital.
"This is the same for every patient when they come in to us."
The report highlighted other areas of concern at the trust such as issues around staffing levels on the wards.
Karen Dunderdale, chief nurse at the trust, said she felt the nursing staff continue to carry out excellent work on the wards and that all the help possible was being given to them.
"Staffing levels are not just about nursing," she said.
"This is a priority focus but we have invested a lot in nursing through E-rostering, our virtual ward teams to deliver teams of nurses.
"I am absolutely confident we have the process in place in the trust.
"We are clear with what we need to do to deal with any area of concern. This may be related to absence from the ward due to illness.
"The nursing staff do work extremely hard with an ever-increasing demand."