Why hospital death rates in Wales are so important


It's difficult to think of many things more important than mortality rates at hospitals - for the public for obvious reasons and politically for the Welsh government.

Their importance was reflected on Wednesday with a huge amount said about them.

The Welsh government announced it's going to change the way the death rates are measured, and the subject came up in debates at the assembly and in the Commons. This is the story of the day.

Before we launch into it, here's a reminder of why it's been such a hot topic.

Death rates, or mortality rates, are measured in different ways in Wales and England.

That difference has been the centre of attention since the most senior doctor in England, Sir Bruce Keogh, wrote to the deputy chief medical officer in Wales, Chris Jones, to say concern about the rates in Wales merited further investigation.

'Basket of indicators'

The subject became even more inflamed when Charlotte Leslie, the Conservative MP for Bristol North West, said it echoed warnings that were ignored before the Mid Staffordshire hospital scandal came to light.

The Welsh government said on Wednesday that it is going to accept a recommendation to change the way that deaths are measured.

A taskforce set up to look into the matter concluded that no single measure can give a rounded accurate indication of how a hospital is performing.

Instead, a "basket of indicators" should be referred to.

The day started with an interview with Dr Chris Jones, deputy chief medical officer for Wales, on the Good Morning Wales programme on BBC Wales.

Presenter Oliver Hides asked him repeatedly whether the death rates can be compared between Wales and England.

Pre-emptive strike

It's a complicated subject obviously, but I think one of the key responses was this quote: "I think what I'm trying to describe is an approach that actually will take us closer in some ways.

"We should be more able to compare the 30 day mortality after a heart attack from a hospital in Wales with that in England.

"I think that is more legitimate but the single figure comparison at a whole hospital level is not legitimate."

So the answer was that comparisons will be able to be made, but between departments within hospitals, rather than entire hospitals.

There has also been a debate in the Senedd and a vote, which was defeated, to hold an independent inquiry into mortality rates at Welsh hospitals.

The Conservative shadow minister for health, Darren Millar, described the Welsh government's decision to change the way the data is collected as a pre-emptive strike ahead of the debate.

'Shameful manipulation'

He said: "The answer, minister, is not to blame the data for giving you the responses you don't like, it's to establish the causes of the higher than expected death rates and to address any problems identified."

Mr Miller did go on to say he agreed with the recommendation of the taskforce but he claimed it could not be denied that the figures should act as a "fire alarm".

After some emotional accounts from AMs describing some of their experiences in the NHS, Health Minister Mark Drakeford announced that the first set of new figures would be published on 21 March.

He said if they give rise to legitimate concerns then action would be taken and he repeated his claim that the criticism of mortality rates in the Welsh NHS had been politically motivated.

He described it as a "cynical, deliberate, Lynton Crosbie-like way in which they set out to drag the reputation of the Welsh NHS through the mud for naked, partisan political purposes".

He added: "It was a disgraceful and shameful manipulation."

Meanwhile, the same issue came up at the Commons in a debate marking a year since the Francis inquiry in the wake of the Mid Staffs scandal.

Health Secretary Jeremy Hunt told MPs that there had been a rise in pressure on hospitals in border towns because of a 10% rise in Welsh patients.

Mr Hunt said: "If this creates pressure in England, it is a tragedy for Wales. But still the authorities there continue to act as if the lessons of Mid Staffs stop at the border.

"If Labour, who run the NHS in Wales, will not listen to the government on this, they should please, please listen to their own backbencher - the remarkable (Ann Clwyd, MP for Cynon Valley) who following her own terrible family experience has campaigned tirelessly to improve standards of care in Wales, particularly with respect of mortality rates at six Welsh hospitals."

So the politicians have had their say and I suspect the issue is not going to go away as we head to the general election.

Nick Servini Article written by Nick Servini Nick Servini Political editor, Wales

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  • rate this

    Comment number 44.

    It seems Wales is the only place that has NHS problems according to certain folk. Let's get real please!! As said there's a London Tory agenda and Wales is the easy target just accept it. Granted Welsh Labour's been in power since 1997 thanks to the Welsh electorate misguided loyalty to a party that cares only for itself, Westminster obedience who wants ultimate power in perpetuity in Wales.

  • rate this

    Comment number 43.

    42: Again you use this forum for an anti Welsh language tirade. Yes Welsh Labour are a shambles but they have done some good under duress but your lot whether it would be UKIP or the Tories would be worse in power. Instead of oozing hate put what small ability have to a better cause or stay silent. Us who want better will reserve the right to vote out this lot next Senedd election if desired .

  • rate this

    Comment number 42.

    40 I think most people would agree that AM's are at best average with many verging on the incompetent WAG has made it clear that the prime function of devolution is to create bilingual nation Immediately all aspects of public life had to change and in my view not for the better We are now seeing the results of bilingual policy and no good news anywhere Welsh media SILENT Media must challenge WAG

  • rate this

    Comment number 41.

    #39 Unfortunately, the NHS isn't about democracy, apart from politicos avoiding unpopular inevitable changes.
    The managers and public don't talk the same language. Managers talk about optimising the expertise of consultants costing (not earning) over £200K p.a. Also lower mortality in specialised units.
    The public talk about kindness, visiting granny, knowing the staff, convenience.

  • rate this

    Comment number 40.

    The issue isnt about party politics or the Welsh Language it's simply that our rulers in the Bay cannot / wll not (delete as appropriate) admit that there is ever a problem with ANYTHING. Not only is it immature but it is also very dangerous.PS why has no one got back to me to explain how Wales plans to annex the Old Severn Crossing? Are we going for the M6 Toll and Dartford crossing next?

  • rate this

    Comment number 39.

    Back in 2007 Labour took an election hit over their management of the NHS.
    Today we see the same policies being enacted, but spun differently, and even though large sections of Wales deeply object to what is going on.
    The Welsh Electorate do not seem to be blaming or punishing Labour, despite them simply forcing through the same policies rejected by large sections of the electorate in 2007.

  • rate this

    Comment number 38.

    Death rates in hospitals are important - but with the centralisation of hospital provision, there other metrics important to show how the Welsh NHS is serving the population of Wales

    But when you have a 100mile + round trip for an outpatient visit
    Long ambulance journeys when your very sick, perhaps close to death and no chance of visitors when an inpatient.
    Seems uncompassionate and inhumane

  • Comment number 37.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 36.

    Drakeford sounds more like Salmond every day. No I don't mean his accent - it is his assertion that it is all a Westminster conspiracy.
    Many on this site, have correctly pointed out there are dangers in simplistic comparisons, We should however have an idea of how mortality rates compare. The change to our system suggests that we had in wrong in past. Why not just say so Drakeford?

  • rate this

    Comment number 35.

    Firstly: I had a post removed just because I said there was a difference between Welsh Fluency and being able to say "Bore Da". Pretty harmless comment I thought.
    Secondly Wales did NOT have a problem with education prior to devolution. We outperformed England over decades. England caught up in 2002 and overtook us.

  • rate this

    Comment number 34.

    I see our WLC has used our money to compel NS&I to continue to provide any or all of its services in WM to all of 107 customers at a cost of ~£100,000. Since it was a WL court enforcing Welsh law, I suggest that NS&I set up an independent Welsh subsidiary, HQ in Camarthen. Then the patriots can deal in WM and the costs fall on the voters who permit this nonsense.

  • rate this

    Comment number 33.

    18 Mab For the record, Labour have never held a majority at CB. They have been supported and kept in power by PC and or the Lib/Dems. So the ridicule and derision you talk about should be aimed at PC.
    As an open minded and fair Welshman I am sure that you will agree that PC has done immense damage to Wales through their unthinking support of the W A G

  • rate this

    Comment number 32.

    #21 " A pre-devolution education, Cardiff996? "

    If we are going to indulge in personalia, and criticise other's grammatical correctness, you could study with interest the blogs of Mab - your co-Y-Fro protagonist. HIs use of 'its' and 'it's' is fascinating: invariably wrong. And his punctuation would be eccentric even in Somerset.

  • rate this

    Comment number 31.

    Maybe hospital death rates in Wales are so bad because for many operations, waiting times are 12-18 months compared to just 2-3 months in England.

    This extended wait makes the elderly people who live alone particularly vulnerable and they are clearly in need of an operation, for longer.

    Come on WG - sort the NHS!

  • rate this

    Comment number 30.

    Mab, in your pavlovian defence of any criticism of Cardiff Bay retirement home you miss the point. i dont want to nit pick Englands shortcomings. i want to see policies that enable the first minister to stand up and say with pride that we have a better performing health/ambulance/education/employment /job creation or whatever service. Not the present embarassment at every unimaginative initiative

  • rate this

    Comment number 29.

    Of course the english system has very big problems. I cannot abide however the arrogance denialist stance of WG presiding over the ghastly mess they have made of the NHS in Wales. On every conceivable measure we are lagging further behind. Its embarrassing frankly. To point to positive patient satisfaction is absurd! Many patients in wales not aware of their deficit in rights compared to england

  • rate this

    Comment number 28.

    26: There's been far more medical catastrophes in England than in Wales and the whole idea of the Tory sniping in London/ Cardiff bay was a big pre-election attack on the Labour party scripted by Cameron's cronies word for word. Oddly none are made about Scotland's or NI health systems ( I watch both NI & Scottish questions) as they are terrified of the Scots Independence vote backfiring.

  • Comment number 27.

    This comment was removed because the moderators found it broke the house rules. Explain.

  • rate this

    Comment number 26.

    Those pointing the finger at Mid Staffs, Bristol etc / gen England NHS miss the point. The statistics there showed a problem and inquiries were held with improvements recommended. The data is either not captured, wrongly captured or ignored in Wales. That is the crux of this issue. The steps to right wrongs in England are not being taken here. Of course the English NHS is not without problems.

  • rate this

    Comment number 25.

    It's easy to be an armchair devo critic whining constantly about anything Welsh or Wales but the want to further ones nation and by this I mean sweeping politically out the tired old guard to enable a fresh start where the unionist Labour & Tory parties have stagnated Wales is harder but a worth while cause. Our "fiscal mouse" Carwyn Jones has no vision and like Chud stares obediently to London.


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