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More patients are dying from blood poisoning than anticipated at 28 NHS trusts

More patients are dying from sepsis than anticipated at 28 NHS trusts in England, MailOnline can reveal.

Deaths from the silent killer at Tameside and Glossop NHS Foundation Trust are 38 per cent higher than expected over the past six years.

In real terms, 517 patients died from sepsis – a violent immune response to an infection – at the trust in Ashton-under-Lyne, well above the 373 deaths expected.

The NHS denies excess deaths are necessarily avoidable, saying the rate given for each trust is based solely on a national average.

Officials argue data a higher than expected number of deaths at any trust is just a ‘smoke alarm’, and not proof of poor care.

The UK Sepsis Trust’s chief executive, Dr Ron Daniels, said: ‘It’s unacceptable for survival from sepsis to remain a postcode lottery.’ 

The data comes as the heartbroken family of an economics student have told how she died suddenly of suspected sepsis. 

Millie Wyles died on August 21 at St Thomas’s Hospital after medics desperately battled to save her for four days. 

Deaths from the silent killer at Tameside and Glossop NHS Foundation Trust are 38 per cent higher than expected. In real terms, 517 patients died from the violent immune response to an infection at the trust in Ashton-under-Lyne, well above the 373 deaths predicted

NHS Digital releases its Summary Hospital-level Mortality Indicator, or SHMI, data every month for the previous calendar year.

The report looks at ‘excess deaths’ – the number of fatalities observed, compared to what would be expected according to national averages.

It compares the overall number of deaths from an array of conditions, including sepsis.

Eminent hospital death rates professor, Sir Brian Jarman, crunched the statistics together for each NHS trust in England over the past six years.

Data showed there were 117,439 recorded deaths from sepsis in hospital or within 30 days of discharge between April 2013 and March 2019.

There were around 3,750 more of such deaths than expected across all 28 of the trusts that recorded an excessive number of fatalities.

Dr Daniels added: ‘The figures are a cause for potential concern at the 28 trusts who seem to have a higher than average recorded mortality rate.

‘It’s important to note that practices in coding vary between hospitals, so this doesn’t necessarily mean all the hospitals named are worse than others.

WHAT ARE THE 28 TRUSTS WHERE MORE PEOPLE ARE DYING THAN EXPECTED FROM SEPSIS?

Southend University Hospital NHS FT – 14.3%

Kingston Hospital NHS FT – 13.5%

Mid Cheshire Hospitals NHS FT – 9.3%

York Teaching Hospital NHS FT – 10.5%

Aintree University Hospital NHS FT – 7.1%

Barking, Havering and Redbridge University Hospitals NHS T – 10.7%

Barnsley Hospital NHS FT – 13.7%

The Rotherham NHS FT – 17.1%       

Northern Lincolnshire and Goole NHS FT – 18%

University Hospitals Coventry and Warwickshire NHS T – 10.1%

The Royal Wolverhampton NHS T – 10%

Wye Valley NHS T – 14.8%

Norfolk and Norwich University Hospitals NHS FT – 6%

Tameside and Glossop Integrated Care NHS FT – 38.5% 

% is above national average

Great Western Hospitals NHS FT – 11.4%

The Dudley Group NHS FT – 18.5% 

Northampton General Hospital NHS Trust – 10.7%

Medway NHS FT – 9.7%

Royal Liverpool and Broadgreen University Hospitals NHS T – 15.8%

The Princess Alexandra Hospital NHS T – 11.5%

Wrightington, Wigan and Leigh NHS FT – 26.4%

Gloucestershire Hospitals NHS FT – 11.7%

East Kent Hospitals University NHS FT – 18.2%

Hull and East Yorkshire Hospitals NHS T – 22.8%

United Lincolnshire Hospitals NHS T – 20.3%

Mid Yorkshire Hospitals NHS T – 14%

County Durham and Darlington NHS FT – 15.9%

East Lancashire Hospitals NHS T – 24.3%

‘But those trusts need to urgently examine their practices, their coding and identify whether there is a real cause of concern.’ 

East Kent Hospitals University NHS FT recorded the most excess sepsis deaths (416), with rates being 18.2 per cent higher than expected.

In terms of total excess septicaemia deaths, it was followed by United Lincolnshire Hospitals NHS Trust (331) and East Lancashire Hospitals NHS Trust (291).

NHS England said official data shows there were fewer observed deaths than was expected in 2018/19.

WHAT IS SEPSIS? 

Sepsis occurs when the body reacts to an infection by attacking its own organs and tissues.

Some 44,000 people die from sepsis every year in the UK. Worldwide, someone dies from the condition every 3.5 seconds. 

Sepsis has similar symptoms to flu, gastroenteritis and a chest infection.

These include:

  • Slurred speech or confusion
  • Extreme shivering or muscle pain
  • Passing no urine in a day
  • Severe breathlessness
  • It feels like you are dying
  • Skin mottled or discoloured

Symptoms in children are:

  • Fast breathing
  • Fits or convulsions
  • Mottled, bluish or pale skin
  • Rashes that do not fade when pressed
  • Lethargy
  • Feeling abnormally cold

Under fives may be vomiting repeatedly, not feeding or not urinating for 12 hours. 

Anyone can develop sepsis but it is most common in people who have recently had surgery, have a urinary catheter or have stayed in hospital for a long time.

Other at-risk people include those with weak immune systems, chemotherapy patients, pregnant women, the elderly and the very young.

Treatment varies depending on the site of the infection but involves antibiotics, IV fluids and oxygen, if necessary.

Source: UK Sepsis Trust and NHS Choices

Sepsis, known as the ‘silent killer’, strikes when an infection such as blood poisoning sparks a violent immune response in which the body attacks its own organs.

It is the leading cause of avoidable death, killing at least 44,000 a year, and the Daily Mail has long campaigned for more awareness.

If caught early, the infection can be controlled by antibiotics before the body goes into overdrive – ultimately leading to death within a matter of minutes.

But the early symptoms of sepsis can be easily confused with more mild conditions, meaning it can be difficult to diagnose.

The NHS states it is ‘inappropriate’ for trusts to be ranked on their SHMI, and that an excess death count only warrants the need for further investigations.

Sir Brian did not take into account data from 20 trusts to name the worst offenders due to them not having data for the full six years.

He used the internationally recognised system, recommended by the Association of Public Health Observatories, called Byar’s confidence intervals.

A similar process helped uncover poor care at the Mid Staffordshire trust, one of the biggest scandals to ever hit the NHS.

However, the NHS uses another method, called overdispersion, which gives trusts slightly more leeway in terms of recording deaths.

Under that system, a trust is regarded as having a higher than expected number of deaths only if its SHMI is about 12 per cent or more above the national average.

In contrast, the Byar’s method is used internationally and classifies a much higher proportion of trusts as being significantly above the national average.

The NHS had used the internationally recognised Byar’s confidence intervals in the past. 

A Department of Health and Social Care spokesperson said: ‘Sepsis is devastating but good progress is being made on identifying suspected cases and improving outcomes across the NHS.

Sepsis, known as the ‘silent killer’, strikes when an infection such as blood poisoning sparks a violent immune response in which the body attacks its own organs

Sepsis, known as the ‘silent killer’, strikes when an infection such as blood poisoning sparks a violent immune response in which the body attacks its own organs

ECONOMICS STUDENT, 21, DIES OF ‘SEPSIS’ JUST FOUR DAYS AFTER GOING TO A&E WITH A SUSPECTED CHEST INFECTION 

Millie Wyles (pictured) was admitted to Medway Maritime Hospital with flu-like symptoms, but died four days later

Millie Wyles (pictured) was admitted to Medway Maritime Hospital with flu-like symptoms, but died four days later

An economics student with ‘her whole life ahead of her’ has died suddenly of suspected sepsis just days after experiencing flu-like symptoms.

Millie Wyles, was admitted to Medway Maritime Hospital A&E after being sent home from work when she started feeling unwell.

The 21-year-old, who was studying at the University of Essex, was then rushed to St Thomas’s Hospital in the early hours of Saturday August 17.

Medics battled to save the student who had organ failure, but she died four days later.

Her heartbroken family have now paid tribute to the ‘kind’ economics student.

Her mother, Annie Wyles, from Sheerness, Kent, told Kent Online: ‘She went to work and came home during the week and then she decided she wanted to go to A&E.

‘They didn’t know if it was some sort of chest infection but needed to oxygenate her blood to boost the white blood cells.

‘SHMI data is one of a range of measures used by independent inspectors to rigorously monitor the quality and safety of care our hospitals provide to patients, and they do not hesitate to intervene if they have concerns.’   

A spokesperson for NHS Improvement and NHS England, said: ‘Actually last year official NHS Digital figures show there were fewer hospital deaths from sepsis than expected.

‘And in the past few years, as the NHS has become more effective at spotting the infection quickly, although more cases are being recorded, the chances of dying from sepsis have fallen.

ARE SOME HOSPITALS WAITING TOO LONG TO DISH OUT DRUGS?

NHS patients’ lives may be put at risks because hospitals are taking too long to give antibiotics for patients battling suspected sepsis, experts warned in July.

As many as one in four people thought to have the life-threatening illness are having to wait more than an hour before being treated to prevent it.

The health service says it’s crucial to take no more than an hour to give life-saving medication to anyone who may have sepsis, which can cause organ failure.

But an investigation by the BBC found some hospitals leave more than half their patients waiting longer than this.

‘This progress will be boosted by our NHS Long Term Plan, which commits emergency departments to spotting the condition more quickly, will help patients get the right treatment at the right time and reduce avoidable use of antibiotics, to keep them as effective as possible in the future.’ 

Dr Neill Hepburn, medical director at United Lincolnshire Hospitals NHS Trust, said: ‘We remain committed to ensuring we provide the highest possible standard of care to all our patients.

‘We now employ dedicated sepsis nurses as well as placing sepsis boxes in departments where patients are most often identified with having the condition, so that they can be treated quickly.’ 

Professor Damian Riley, acting chief executive for East Lancashire Hospitals NHS Trust, said: ‘The Trust has worked hard in recent years to reduce mortality raises from all disease causes.

‘And we are pleased to report that our Summary Hospital Mortality Indicator (SHMI) – as independently reported – is classed as in the “as expected” range and is lower than it has been for several years.

‘Our medical audits show the Trust now performs well in terms of rapid administration of antibiotics and fluids for life-saving treatments for those patients suspected of having sepsis. 

‘This is very reassuring for our patients, and confirms the considerable steps we have taken.’ 

Tameside and Glossop Integrated Care NHS Foundation Trust said it reviews every hospital death.

A spokesperson added: ‘The elevated septicaemia mortality figure is not related to the quality of care provided.

‘The Trust applies the latest Department of Health guidance relating to the coding of septicaemia, so that only the very sickest patients are included in this group.’

SO, HOW DOES YOUR TRUST FARE? 
NAME OF NHS TRUST DEATH RATES OBSERVED DEATHS EXPECTED DEATHS DIFFERENCE IN DEATHS
ISLE OF WIGHT NHS TRUST 0.94 505 538.14 -33.14
BARTS HEALTH NHS TRUST 0.89 1412 1579.30 -167.30
ROYAL SURREY COUNTY HOSPITAL NHS FOUNDATION TRUST 0.87 431 496.80 -65.80
WESTON AREA HEALTH NHS TRUST 0.93 403 434.96 -31.96
YEOVIL DISTRICT HOSPITAL NHS FOUNDATION TRUST 0.86 507 586.37 -79.37
UNIVERSITY HOSPITALS BRISTOL NHS FOUNDATION TRUST 0.88 554 627.84 -73.84
BRADFORD TEACHING HOSPITALS NHS FOUNDATION TRUST 0.89 510 574.98 -64.98
SOUTHEND UNIVERSITY HOSPITAL NHS FOUNDATION TRUST 1.14 794 694.55 99.45
ROYAL FREE LONDON NHS FOUNDATION TRUST 0.93 985 1059.62 -74.62
NORTH MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST 1.07 452 423.33 28.67
THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST 0.97 369 379.58 -10.58
KINGSTON HOSPITAL NHS FOUNDATION TRUST 1.13 595 524.42 70.58
TAUNTON AND SOMERSET NHS FOUNDATION TRUST 0.80 804 1003.66 -199.66
DORSET COUNTY HOSPITAL NHS FOUNDATION TRUST 1.08 338 311.90 26.10
WALSALL HEALTHCARE NHS TRUST 1.02 662 652.10 9.90
WIRRAL UNIVERSITY TEACHING HOSPITAL NHS FOUNDATION TRUST 0.99 1251 1262.21 -11.21
ST HELENS AND KNOWSLEY HOSPITAL SERVICES NHS TRUST 0.94 1108 1184.45 -76.45
MID CHESHIRE HOSPITALS NHS FOUNDATION TRUST 1.09 734 671.27 62.73
NORTHERN DEVON HEALTHCARE NHS TRUST 1.01 334 329.53 4.47
BEDFORD HOSPITAL NHS TRUST 1.05 656 622.83 33.17
LUTON AND DUNSTABLE UNIVERSITY HOSPITAL NHS FOUNDATION TRUST 1.06 755 711.54 43.46
YORK TEACHING HOSPITAL NHS FOUNDATION TRUST 1.11 1730 1565.50 164.50
HARROGATE AND DISTRICT NHS FOUNDATION TRUST 1.00 276 276.38 -0.38
AIREDALE NHS FOUNDATION TRUST 0.93 406 436.72 -30.72
THE QUEEN ELIZABETH HOSPITAL, KING’S LYNN, NHS FOUNDATION TRUST 0.83 973 1171.57 -198.57
ROYAL UNITED HOSPITALS BATH NHS FOUNDATION TRUST 0.96 860 895.38 -35.38
POOLE HOSPITAL NHS FOUNDATION TRUST 0.66 394 598.17 -204.17
MILTON KEYNES UNIVERSITY HOSPITAL NHS FOUNDATION TRUST 0.98 629 645.12 -16.12
BASILDON AND THURROCK UNIVERSITY HOSPITALS NHS FOUNDATION TRUST 0.99 1699 1721.84 -22.84
EAST SUFFOLK AND NORTH ESSEX NHS FOUNDATION TRUST 1.05 1485 1411.29 73.71
FRIMLEY HEALTH NHS FOUNDATION TRUST 0.97 1583 1629.24 -46.23
THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALS NHS FOUNDATION TRUST 0.54 299 553.84 -254.84
ROYAL CORNWALL HOSPITALS NHS TRUST 0.95 805 849.38 -44.38
AINTREE UNIVERSITY HOSPITAL NHS FOUNDATION TRUST 1.07 948 885.18 62.82
BARKING, HAVERING AND REDBRIDGE UNIVERSITY HOSPITALS NHS TRUST 1.11 1360 1229.02 130.98
BARNSLEY HOSPITAL NHS FOUNDATION TRUST 1.14 650 571.58 78.42
THE ROTHERHAM NHS FOUNDATION TRUST 1.17 412 351.73 60.27
CHESTERFIELD ROYAL HOSPITAL NHS FOUNDATION TRUST 0.98 670 686.63 -16.63
NORTH WEST ANGLIA NHS FOUNDATION TRUST 0.88 1305 1476.01 -171.01
JAMES PAGET UNIVERSITY HOSPITALS NHS FOUNDATION TRUST 0.97 538 554.69 -16.69
WEST SUFFOLK NHS FOUNDATION TRUST 0.84 839 996.52 -157.52
CAMBRIDGE UNIVERSITY HOSPITALS NHS FOUNDATION TRUST 0.79 731 924.35 -193.35
ROYAL DEVON AND EXETER NHS FOUNDATION TRUST 0.93 631 675.03 -44.03
UNIVERSITY HOSPITAL SOUTHAMPTON NHS FOUNDATION TRUST 0.87 817 943.45 -126.45
SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST 1.01 1211 1197.12 13.88
PORTSMOUTH HOSPITALS NHS TRUST 0.95 1278 1349.88 -71.88
ROYAL BERKSHIRE NHS FOUNDATION TRUST 0.97 803 824.88 -21.88
GUY’S AND ST THOMAS’ NHS FOUNDATION TRUST 1.01 300 297.16 2.84
CROYDON HEALTH SERVICES NHS TRUST 1.06 829 785.05 43.96
ST GEORGE’S UNIVERSITY HOSPITALS NHS FOUNDATION TRUST 1.00 773 771.35 1.65
SOUTH WARWICKSHIRE NHS FOUNDATION TRUST 0.85 415 489.66 -74.66
NORTHERN LINCOLNSHIRE AND GOOLE NHS FOUNDATION TRUST 1.18 1074 910.51 163.49
EAST CHESHIRE NHS TRUST 1.06 410 387.02 22.98
COUNTESS OF CHESTER HOSPITAL NHS FOUNDATION TRUST 1.03 681 661.03 19.97
KING’S COLLEGE HOSPITAL NHS FOUNDATION TRUST 1.03 1119 1083.15 35.85
SHERWOOD FOREST HOSPITALS NHS FOUNDATION TRUST 0.92 1028 1111.60 -83.60
UNIVERSITY HOSPITALS PLYMOUTH NHS TRUST 0.87 751 867.29 -116.29
UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE NHS TRUST 1.10 935 849.52 85.48
WHITTINGTON HEALTH NHS TRUST 0.76 299 393.04 -94.04
THE ROYAL WOLVERHAMPTON NHS TRUST 1.10 909 826.92 82.08
WYE VALLEY NHS TRUST 1.15 465 405.06 59.95
GEORGE ELIOT HOSPITAL NHS TRUST 0.96 355 368.74 -13.74
NORFOLK AND NORWICH UNIVERSITY HOSPITALS NHS FOUNDATION TRUST 1.06 1514 1428.00 86.00
SALFORD ROYAL NHS FOUNDATION TRUST 0.98 828 842.03 -14.03
BOLTON NHS FOUNDATION TRUST 1.06 1042 982.58 59.43
TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST 1.38 517 373.42 143.58
GREAT WESTERN HOSPITALS NHS FOUNDATION TRUST 1.11 1123 1008.51 114.49
HAMPSHIRE HOSPITALS NHS FOUNDATION TRUST 0.97 793 821.04 -28.04
DARTFORD AND GRAVESHAM NHS TRUST 0.95 642 674.72 -32.72
THE DUDLEY GROUP NHS FOUNDATION TRUST 1.19 1056 890.77 165.23
NORTH CUMBRIA UNIVERSITY HOSPITALS NHS TRUST 1.07 681 636.16 44.84
KETTERING GENERAL HOSPITAL NHS FOUNDATION TRUST 0.93 395 422.52 -27.52
NORTHAMPTON GENERAL HOSPITAL NHS TRUST 1.11 835 754.29 80.71
SALISBURY NHS FOUNDATION TRUST 0.92 316 341.69 -25.69
DONCASTER AND BASSETLAW TEACHING HOSPITALS NHS FOUNDATION TRUST 1.06 882 834.12 47.88
MEDWAY NHS FOUNDATION TRUST 1.10 910 829.43 80.57
ROYAL LIVERPOOL AND BROADGREEN UNIVERSITY HOSPITALS NHS TRUST 1.16 1111 959.39 151.61
MID ESSEX HOSPITAL SERVICES NHS TRUST 0.97 999 1031.28 -32.28
CHELSEA AND WESTMINSTER HOSPITAL NHS FOUNDATION TRUST 0.98 613 624.85 -11.85
THE PRINCESS ALEXANDRA HOSPITAL NHS TRUST 1.11 552 495.24 56.76
HOMERTON UNIVERSITY HOSPITAL NHS FOUNDATION TRUST 0.94 199 212.20 -13.20
GATESHEAD HEALTH NHS FOUNDATION TRUST 0.97 673 690.73 -17.73
LEEDS TEACHING HOSPITALS NHS TRUST 0.99 1028 1039.12 -11.12
WRIGHTINGTON, WIGAN AND LEIGH NHS FOUNDATION TRUST 1.26 729 576.79 152.21
UNIVERSITY HOSPITALS BIRMINGHAM NHS FOUNDATION TRUST 1.01 1909 1886.31 22.69
UNIVERSITY COLLEGE LONDON HOSPITALS NHS FOUNDATION TRUST 0.87 280 323.48 -43.48
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST 1.05 772 736.15 35.85
GLOUCESTERSHIRE HOSPITALS NHS FOUNDATION TRUST 1.12 975 873.45 101.55
NORTHUMBRIA HEALTHCARE NHS FOUNDATION TRUST 1.02 1128 1105.42 22.58
UNIVERSITY HOSPITALS OF DERBY AND BURTON NHS FOUNDATION TRUST 0.86 1942 2257.16 -315.16
OXFORD UNIVERSITY HOSPITALS NHS FOUNDATION TRUST 0.85 904 1058.60 -154.60
ASHFORD AND ST PETER’S HOSPITALS NHS FOUNDATION TRUST 1.00 667 664.78 2.22
SURREY AND SUSSEX HEALTHCARE NHS TRUST 1.05 845 802.85 42.15
SOUTH TEES HOSPITALS NHS FOUNDATION TRUST 1.00 1245 1239.67 5.33
UNIVERSITY HOSPITALS OF MORECAMBE BAY NHS FOUNDATION TRUST 1.00 741 738.67 2.33
NORTH BRISTOL NHS TRUST 0.85 747 876.02 -129.02
EPSOM AND ST HELIER UNIVERSITY HOSPITALS NHS TRUST 0.91 857 940.81 -83.81
EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST 1.18 2697 2281.05 415.96
NORTH TEES AND HARTLEPOOL NHS FOUNDATION TRUST 1.06 977 919.08 57.93
SOUTHPORT AND ORMSKIRK HOSPITAL NHS TRUST 0.94 616 657.59 -41.59
PENNINE ACUTE HOSPITALS NHS TRUST 1.04 1212 1164.59 47.41
HULL AND EAST YORKSHIRE HOSPITALS NHS TRUST 1.23 928 755.92 172.08
UNITED LINCOLNSHIRE HOSPITALS NHS TRUST 1.20 1968 1636.12 331.88
UNIVERSITY HOSPITALS OF LEICESTER NHS TRUST 0.96 2077 2169.46 -92.46
MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST 0.90 724 802.59 -78.59
WEST HERTFORDSHIRE HOSPITALS NHS TRUST 1.05 1006 956.61 49.39
EAST AND NORTH HERTFORDSHIRE NHS TRUST 1.01 652 645.57 6.43
STOCKPORT NHS FOUNDATION TRUST 0.96 684 711.84 -27.84
WORCESTERSHIRE ACUTE HOSPITALS NHS TRUST 1.06 1119 1058.71 60.29
WARRINGTON AND HALTON HOSPITALS NHS FOUNDATION TRUST 1.04 655 628.01 26.99
CALDERDALE AND HUDDERSFIELD NHS FOUNDATION TRUST 1.03 788 763.60 24.40
NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST 0.94 2162 2307.02 -145.02
EAST SUSSEX HEALTHCARE NHS TRUST 1.03 1184 1150.93 33.07
MID YORKSHIRE HOSPITALS NHS TRUST 1.14 1139 999.16 139.84
BRIGHTON AND SUSSEX UNIVERSITY HOSPITALS NHS TRUST 0.86 664 773.90 -109.90
SANDWELL AND WEST BIRMINGHAM HOSPITALS NHS TRUST 1.06 554 523.08 30.93
BLACKPOOL TEACHING HOSPITALS NHS FOUNDATION TRUST 1.04 1090 1049.23 40.77
LANCASHIRE TEACHING HOSPITALS NHS FOUNDATION TRUST 1.00 1567 1573.79 -6.79
COUNTY DURHAM AND DARLINGTON NHS FOUNDATION TRUST 1.16 1180 1018.10 161.90
BUCKINGHAMSHIRE HEALTHCARE NHS TRUST 0.83 880 1057.79 -177.79
EAST LANCASHIRE HOSPITALS NHS TRUST 1.24 1489 1197.98 291.02
SHREWSBURY AND TELFORD HOSPITAL NHS TRUST 1.03 964 939.57 24.43
IMPERIAL COLLEGE HEALTHCARE NHS TRUST 0.91 937 1034.46 -97.45
WESTERN SUSSEX HOSPITALS NHS FOUNDATION TRUST 0.92 1519 1650.09 -131.09
The death rates can be converted into percentages, with 1 being the baseline – meaning a figure of 1.2 shows death rates are 20 per cent higher than the national average. A figure of 0.8 shows death rates are 20 per cent lower than the national average

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