Sepsis deaths certain regions 55% higher than expected

Patients are twice as likely to die from sepsis in some hospitals as they are in others, statistics obtained by MailOnline reveal.

Sepsis death rates at Tameside and Glossop NHS Foundation Trust in Ashton-under-Lyne are 55 per cent higher than expected.

At the other end of the scale, sepsis has claimed 39 per cent fewer lives than officials predicted at the University Hospitals of North Midlands NHS Trust.

When compared, it means the chance of dying from sepsis in Tameside is about twice that of a similar patient treated at the Staffordshire site.

Eminent hospital death rates expert Professor Sir Brian Jarman, who helped expose the Mid-Staffordshire hospitals scandal, was behind the analysis.

His findings, disputed by the NHS, suggest a ‘postcode lottery’ of care is consigning hundreds, or even thousands, of patients to an early grave.

It also reveals a stark North-South divide, with most of the worst performing hospital trusts concentrated in the north of England.

The worrying data shows 16 hospital trusts across the country to have a ‘significantly high death rate’, with only four situated in the south.   

The figures heighten the The Mail’s ‘End The Sepsis Scandal’ campaign, which began last year in an attempt to reduce the number of missed cases of sepsis.

Scroll down to see how your trust rated 

Sepsis death rates at Tameside and Glossop NHS Foundation Trust in Ashton-under-Lyne are 55 per cent higher than expected. At the other end of the scale, sepsis has claimed 39 per cent fewer lives than officials predicted at the University Hospitals of North Midlands NHS Trust

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. 

A patient can rapidly deteriorate if sepsis is missed early on, so quick diagnosis and treatment is vital – yet this rarely happens. 

Professor Jarman used NHS data to come to his conclusion. It involved 134 hospital trusts in England, with four not having enough statistics to meet his criteria.

The worst performers 

Sepsis deaths at Tameside and Glossop NHS Foundation Trust have been higher than expected over the past three years, given the population it serves.

At this trust, 141 sepsis deaths were recorded over a three-year period – 55 per cent higher than the expected figure of 91.

THE 10 WORST (AND BEST) TRUSTS

The worst trusts (% above expected sepsis death rates)

The best trusts (% below expected sepsis death rates)

Tameside and Glossop Integrated Care NHS Foundation Trust: 55% 

Wrightington, Wigan and Leigh NHS Foundation Trust: 43%

The Dudley Group NHS Foundation Trust: 35%

Hull and East Yorkshire Hospitals NHS Trust: 30%

Southend University Hospital NHS Foundation Trust: 29%

United Lincolnshire Hospitals NHS Trust: 27%

East Lancashire Hospitals NHS Trust: 25%

Aintree University Hospital NHS Foundation Trust: 25%

Mid Yorkshire Hospitals NHS Trust: 24%

Central Manchester University Hospitals NHS Foundation Trust: 23%  

University Hospitals of North Midlands NHS Trust: 39%

Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust: 37%

Poole Hospital NHS Foundation Trust: 35%

Brighton and Sussex University Hospitals NHS Trust: 29%

Oxford University Hospitals NHS Foundation Trust: 24%

Buckinghamshire Healthcare NHS Trust: 23%

Derby Teaching Hospitals NHS Foundation Trust: 23%

Cambridge University Hospitals NHS Foundation Trust: 22%

West Suffolk NHS Foundation Trust: 21%

Mid Essex Hospital Services NHS Trust: 20% 

In Wrightington, Wigan and Leigh NHS Foundation Trust, deaths have been 43 per cent higher than expected over the same time frame.

And a 35 per cent spike has been recorded at the Dudley Group NHS Foundation Trust, according to Professor Jarman’s analysis.

The best performers 

In terms of trusts seemingly leading the way in treating sepsis, University Hospitals of North Midlands NHS Trust leads the way.

Between 2014 and 2017 it recorded 39 per cent less deaths than expected. Some 184 people died of sepsis between the trust’s two hospitals.

The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust recorded 126 sepsis deaths, 37 per cent lower than the expected figure.

And Poole Hospital NHS Foundation Trust saw 35 per cent fewer sepsis deaths than projections estimated, with it claiming 167 lives in three years.

How were the findings calculated? 

The method Professor Jarman used to make the projections is recommended by the Association of Public Health Observatories.

He revealed the NHS has previously used the internationally recognised system, called Byar’s confidence intervals.

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

However, the NHS uses another method, called overdispersion, which gives trusts more leeway, Professor Jarman added.

Under that system, a trust is regarded as having a high death rate only if its measure, called the Summary Hospital-level Mortality Indicator, or SHMI, is about 12 per cent or more above the national average.

In contrast, the Byar’s method is much stricter, classing anything with a SHMI of more than six or seven per cent above the national average as significantly high.

THE MID-STAFFS NHS SCANDAL

Up to 1,200 people needlessly died at Stafford hospital, ran by Mid-Staffordshire NHS Trust, due to poor care between 2005 and 2009.

In what is one of the worst care scandals in living memory, patients were left lying in their own excrement and so thirsty that they were reduced to drinking water from vases.

The Francis report, the inquiry into the hospital’s workings in 2013, found that box ticking bureaucrats prioritised targets over basic levels of care.

It later emerged that just one senior nurse was in charge of 84 beds at the scandal-hit hospital. The findings prompted significant changes in hospital care.

But not a single individual will be prosecuted in connection with the scandal, police admitted last year – despite a three-year investigation.

Stafford Hospital has been renamed County Hospital, and is now run by a different trust.

The expected deaths at each hospital trust is worked out by calculating how many deaths the trust would have if they had the English national average death rates.

The death rate is then calculated by dividing the actual deaths from sepsis by the expected deaths for sepsis, Professor Jarman explained. 

Only primary diagnoses of sepsis are recorded for the observed deaths, excluding thousands of cases where the violent immune response was partly responsible.

This explains why just 40,417 deaths were recorded over the three-year time frame – notably less than the 44,000 expected each year. 

What did the NHS say? 

Chris Roebuck, head of profession for statistics for NHS Digital, said, ‘We transparently publish our data in a variety of forms in order to enable others to conduct their own analysis, although we could not comment on this methodology with the information we have been provided.

‘The findings from any analysis of SHMI or its underlying data should act as a starting point for further investigation, rather than treated as a definitive view on quality of care. 

‘A variety of factors could influence Trusts’ figures, such as the way they record particular conditions. 

‘For example, we do know that sepsis has historically been recorded differently by different trusts with some clinicians coding for sepsis, while others code for the underlying infection, such as pneumonia.’ 

THE PLACES WHERE YOU ARE MOST (AND LEAST) LIKELY TO DIE OF SEPSIS
Provider trust                                                                     Sepsis death rate Death differences Observed deaths Expected deaths
TAMESIDE AND GLOSSOP INTEGRATED CARE NHS FOUNDATION TRUST 1.55 significantly high death rate 50.1 141 90.88
WRIGHTINGTON, WIGAN AND LEIGH NHS FOUNDATION TRUST 1.43 significantly high death rate 79.5 263 183.524
THE DUDLEY GROUP NHS FOUNDATION TRUST 1.35 significantly high death rate 121.9 468 346.121
UNITED LINCOLNSHIRE HOSPITALS NHS TRUST 1.27 significantly high death rate 164.0 761 596.962
EAST KENT HOSPITALS UNIVERSITY NHS FOUNDATION TRUST 1.22 significantly high death rate 201.3 1128 926.711
SOUTHEND UNIVERSITY HOSPITAL NHS FOUNDATION TRUST 1.29 significantly high death rate 88.9 400 311.138
HULL AND EAST YORKSHIRE HOSPITALS NHS TRUST 1.30 significantly high death rate 68.0 296 228.046
EAST LANCASHIRE HOSPITALS NHS TRUST 1.25 significantly high death rate 83.7 413 329.322
MID YORKSHIRE HOSPITALS NHS TRUST 1.24 significantly high death rate 78.5 406 327.541
AINTREE UNIVERSITY HOSPITAL NHS FOUNDATION TRUST 1.25 significantly high death rate 65.6 328 262.413
BLACKPOOL TEACHING HOSPITALS NHS FOUNDATION TRUST 1.22 significantly high death rate 71.8 396 324.169
BARKING, HAVERING AND REDBRIDGE UNIVERSITY HOSPITALS NHS TRUST 1.19 significantly high death rate 78.9 491 412.081
NORTHERN LINCOLNSHIRE AND GOOLE NHS FOUNDATION TRUST 1.21 significantly high death rate 68.9 399 330.136
DONCASTER AND BASSETLAW TEACHING HOSPITALS NHS FOUNDATION TRUST 1.22 significantly high death rate 58.0 323 264.965
COUNTY DURHAM AND DARLINGTON NHS FOUNDATION TRUST 1.20 significantly high death rate 63.7 390 326.349
GREAT WESTERN HOSPITALS NHS FOUNDATION TRUST 1.17 significantly high death rate 60.3 419 358.742
CENTRAL MANCHESTER UNIVERSITY HOSPITALS NHS FOUNDATION TRUST 1.23 average 25.7 137 111.313
WALSALL HEALTHCARE NHS TRUST 1.21 average 42.2 240 197.771
WYE VALLEY NHS TRUST 1.21 average 22.3 128 105.665
BARNSLEY HOSPITAL NHS FOUNDATION TRUST 1.21 average 37.7 219 181.321
SOUTH TYNESIDE NHS FOUNDATION TRUST 1.21 average 25.1 147 121.939
NORTH MIDDLESEX UNIVERSITY HOSPITAL NHS TRUST 1.18 average 23.9 154 130.053
CROYDON HEALTH SERVICES NHS TRUST 1.16 average 33.8 241 207.151
MID CHESHIRE HOSPITALS NHS FOUNDATION TRUST 1.16 average 36.6 270 233.389
GLOUCESTERSHIRE HOSPITALS NHS FOUNDATION TRUST 1.16 average 41.2 307 265.751
HOMERTON UNIVERSITY HOSPITAL NHS FOUNDATION TRUST 1.15 average 8.0 60 52.047
WORCESTERSHIRE ACUTE HOSPITALS NHS TRUST 1.14 average 50.5 399 348.531
WARRINGTON AND HALTON HOSPITALS NHS FOUNDATION TRUST 1.14 average 22.7 188 165.327
BOLTON NHS FOUNDATION TRUST 1.13 average 53.8 455 401.158
SHREWSBURY AND TELFORD HOSPITAL NHS TRUST 1.13 average 43.1 371 327.947
EAST SUSSEX HEALTHCARE NHS TRUST 1.13 average 46.2 407 360.825
UNIVERSITY HOSPITALS OF MORECAMBE BAY NHS FOUNDATION TRUST 1.13 average 29.9 267 237.136
ROYAL LIVERPOOL AND BROADGREEN UNIVERSITY HOSPITALS NHS TRUST 1.12 average 48.3 454 405.67
KINGSTON HOSPITAL NHS FOUNDATION TRUST 1.12 average 28.3 271 242.699
NORTH CUMBRIA UNIVERSITY HOSPITALS NHS TRUST 1.11 average 21.8 214 192.226
KING’S COLLEGE HOSPITAL NHS FOUNDATION TRUST 1.11 average 33.5 346 312.472
COLCHESTER HOSPITAL UNIVERSITY NHS FOUNDATION TRUST 1.10 average 37.7 399 361.323
THE ROYAL WOLVERHAMPTON NHS TRUST 1.10 average 30.4 334 303.591
UNIVERSITY HOSPITALS BIRMINGHAM NHS FOUNDATION TRUST 1.09 average 26.0 317 290.991
MEDWAY NHS FOUNDATION TRUST 1.08 average 21.9 281 259.053
LUTON AND DUNSTABLE UNIVERSITY HOSPITAL NHS FOUNDATION TRUST 1.08 average 23.4 313 289.628
SURREY AND SUSSEX HEALTHCARE NHS TRUST 1.07 average 21.9 315 293.149
KETTERING GENERAL HOSPITAL NHS FOUNDATION TRUST 1.07 average 10.1 147 136.887
HARROGATE AND DISTRICT NHS FOUNDATION TRUST 1.07 average 6.9 101 94.07
CALDERDALE AND HUDDERSFIELD NHS FOUNDATION TRUST 1.07 average 11.9 190 178.091
BURTON HOSPITALS NHS FOUNDATION TRUST 1.07 average 7.7 125 117.313
THE PRINCESS ALEXANDRA HOSPITAL NHS TRUST 1.06 average 10.8 178 167.176
THE NEWCASTLE UPON TYNE HOSPITALS NHS FOUNDATION TRUST 1.06 average 16.0 266 249.997
ASHFORD AND ST PETER’S HOSPITALS NHS FOUNDATION TRUST 1.06 average 18.1 304 285.933
EAST CHESHIRE NHS TRUST 1.06 average 9.7 172 162.343
SOUTHPORT AND ORMSKIRK HOSPITAL NHS TRUST 1.06 average 11.8 211 199.171
GEORGE ELIOT HOSPITAL NHS TRUST 1.06 average 6.6 120 113.37
NORTHERN DEVON HEALTHCARE NHS TRUST 1.06 average 7.3 133 125.655
CITY HOSPITALS SUNDERLAND NHS FOUNDATION TRUST 1.06 average 14.8 272 257.192
WIRRAL UNIVERSITY TEACHING HOSPITAL NHS FOUNDATION TRUST 1.06 average 28.7 534 505.274
GUY’S AND ST THOMAS’ NHS FOUNDATION TRUST 1.05 average 3.9 78 74.119
ST GEORGE’S UNIVERSITY HOSPITALS NHS FOUNDATION TRUST 1.05 average 13.8 295 281.184
COUNTESS OF CHESTER HOSPITAL NHS FOUNDATION TRUST 1.04 average 9.9 274 264.145
ROYAL CORNWALL HOSPITALS NHS TRUST 1.04 average 8.6 245 236.379
HAMPSHIRE HOSPITALS NHS FOUNDATION TRUST 1.03 average 11.1 359 347.865
SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST 1.03 average 12.8 436 423.215
NORTHUMBRIA HEALTHCARE NHS FOUNDATION TRUST 1.03 average 10.5 427 416.543
YORK TEACHING HOSPITAL NHS FOUNDATION TRUST 1.02 average 15.8 685 669.249
DORSET COUNTY HOSPITAL NHS FOUNDATION TRUST 1.02 average 2.0 132 130.023
THE ROTHERHAM NHS FOUNDATION TRUST 1.01 average 1.0 90 89.002
ROYAL UNITED HOSPITALS BATH NHS FOUNDATION TRUST 1.01 average 3.9 363 359.081
HEART OF ENGLAND NHS FOUNDATION TRUST 1.01 average 3.3 604 600.689
UNIVERSITY HOSPITAL SOUTHAMPTON NHS FOUNDATION TRUST 1.00 average 1.0 253 252.006
NORTHAMPTON GENERAL HOSPITAL NHS TRUST 1.00 average 0.4 210 209.561
PORTSMOUTH HOSPITALS NHS TRUST 1.00 average -0.1 474 474.125
THE HILLINGDON HOSPITALS NHS FOUNDATION TRUST 1.00 average -0.2 82 82.183
IMPERIAL COLLEGE HEALTHCARE NHS TRUST 1.00 average -1.6 325 326.578
LANCASHIRE TEACHING HOSPITALS NHS FOUNDATION TRUST 0.99 average -6.8 496 502.783
FRIMLEY HEALTH NHS FOUNDATION TRUST 0.98 average -11.1 717 728.102
SANDWELL AND WEST BIRMINGHAM HOSPITALS NHS TRUST 0.98 average -3.1 191 194.145
SALFORD ROYAL NHS FOUNDATION TRUST 0.98 average -5.7 315 320.713
ROYAL BERKSHIRE NHS FOUNDATION TRUST 0.98 average -6.1 278 284.075
AIREDALE NHS FOUNDATION TRUST 0.98 average -2.4 106 108.441
SHERWOOD FOREST HOSPITALS NHS FOUNDATION TRUST 0.97 average -10.2 390 400.209
WESTON AREA HEALTH NHS TRUST 0.97 average -3.3 123 126.34
BEDFORD HOSPITAL NHS TRUST 0.97 average -7.1 212 219.084
NORFOLK AND NORWICH UNIVERSITY HOSPITALS NHS FOUNDATION TRUST 0.96 average -19.7 531 550.676
ROYAL FREE LONDON NHS FOUNDATION TRUST 0.96 average -13.7 331 344.708
GATESHEAD HEALTH NHS FOUNDATION TRUST 0.96 average -12.5 274 286.494
CHELSEA AND WESTMINSTER HOSPITAL NHS FOUNDATION TRUST 0.95 average -7.2 149 156.204
UNIVERSITY HOSPITALS OF LEICESTER NHS TRUST 0.94 average -32.8 535 567.804
LEWISHAM AND GREENWICH NHS TRUST 0.94 average -24.2 383 407.191
SOUTH TEES HOSPITALS NHS FOUNDATION TRUST 0.94 average -38.9 593 631.897
EAST AND NORTH HERTFORDSHIRE NHS TRUST 0.94 average -12.4 185 197.382
NORTH TEES AND HARTLEPOOL NHS FOUNDATION TRUST 0.93 average -14.3 200 214.271
WESTERN SUSSEX HOSPITALS NHS FOUNDATION TRUST 0.93 average -42.3 578 620.257
MILTON KEYNES UNIVERSITY HOSPITAL NHS FOUNDATION TRUST 0.93 average -15.4 204 219.445
ISLE OF WIGHT NHS TRUST 0.93 average -16.5 210 226.521
ST HELENS AND KNOWSLEY HOSPITAL SERVICES NHS TRUST 0.92 average -28.4 337 365.389
BRADFORD TEACHING HOSPITALS NHS FOUNDATION TRUST 0.92 average -11.8 137 148.775
DARTFORD AND GRAVESHAM NHS TRUST 0.92 average -20.0 220 239.977
EPSOM AND ST HELIER UNIVERSITY HOSPITALS NHS TRUST 0.92 average -29.2 321 350.191
STOCKPORT NHS FOUNDATION TRUST 0.91 average -21.1 220 241.08
PENNINE ACUTE HOSPITALS NHS TRUST 0.91 average -20.8 216 236.802
CHESTERFIELD ROYAL HOSPITAL NHS FOUNDATION TRUST 0.90 average -18.7 177 195.69
BASILDON AND THURROCK UNIVERSITY HOSPITALS NHS FOUNDATION TRUST 0.90 average -86.5 812 898.483
LEEDS TEACHING HOSPITALS NHS TRUST 0.90 average -38.2 335 373.216
LONDON NORTH WEST HEALTHCARE NHS TRUST 0.90 average -46.4 399 445.372
NORTH BRISTOL NHS TRUST 0.90 average -26.8 229 255.845
PLYMOUTH HOSPITALS NHS TRUST 0.89 average -41.7 340 381.716
NORTH WEST ANGLIA NHS FOUNDATION TRUST 0.88 average -70.8 508 578.827
MAIDSTONE AND TUNBRIDGE WELLS NHS TRUST 0.88 average -35.5 251 286.51
BARTS HEALTH NHS TRUST 0.87 average -52.2 364 416.214
SALISBURY NHS FOUNDATION TRUST 0.87 average -19.1 123 142.063
UNIVERSITY HOSPITALS BRISTOL NHS FOUNDATION TRUST 0.86 average -36.4 233 269.422
YEOVIL DISTRICT HOSPITAL NHS FOUNDATION TRUST 0.86 average -29.3 176 205.267
UNIVERSITY HOSPITALS COVENTRY AND WARWICKSHIRE NHS TRUST 0.85 average -34.0 192 225.96
THE WHITTINGTON HOSPITAL NHS TRUST 0.85 average -24.0 134 158.018
ROYAL DEVON AND EXETER NHS FOUNDATION TRUST 0.85 average -36.5 202 238.461
SOUTH WARWICKSHIRE NHS FOUNDATION TRUST 0.84 average -28.3 147 175.274
WEST HERTFORDSHIRE HOSPITALS NHS TRUST 0.84 average -29.8 151 180.774
UNIVERSITY HOSPITAL OF SOUTH MANCHESTER NHS FOUNDATION TRUST 0.83 average -31.6 149 180.585
UNIVERSITY COLLEGE LONDON HOSPITALS NHS FOUNDATION TRUST 0.81 average -16.6 69 85.552
ROYAL SURREY COUNTY HOSPITAL NHS FOUNDATION TRUST 0.80 average -30.2 123 153.249
JAMES PAGET UNIVERSITY HOSPITALS NHS FOUNDATION TRUST 0.80 average -36.8 146 182.827
CAMBRIDGE UNIVERSITY HOSPITALS NHS FOUNDATION TRUST 0.78 significantly low death rate -43.6 158 201.592
IPSWICH HOSPITAL NHS TRUST 0.82 significantly low death rate -59.8 273 332.794
NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST 0.88 significantly low death rate -115.4 858 973.406
THE QUEEN ELIZABETH HOSPITAL, KING’S LYNN, NHS FOUNDATION TRUST 0.83 significantly low death rate -75.9 368 443.905
TAUNTON AND SOMERSET NHS FOUNDATION TRUST 0.81 significantly low death rate -68.7 288 356.728
MID ESSEX HOSPITAL SERVICES NHS TRUST 0.80 significantly low death rate -67.8 274 341.759
WEST SUFFOLK NHS FOUNDATION TRUST 0.79 significantly low death rate -62.9 237 299.877
OXFORD UNIVERSITY HOSPITALS NHS FOUNDATION TRUST 0.76 significantly low death rate -83.6 267 350.555
BUCKINGHAMSHIRE HEALTHCARE NHS TRUST 0.77 significantly low death rate -134.2 462 596.222
BRIGHTON AND SUSSEX UNIVERSITY HOSPITALS NHS TRUST 0.71 significantly low death rate -73.8 177 250.847
DERBY TEACHING HOSPITALS NHS FOUNDATION TRUST 0.77 significantly low death rate -155.5 525 680.477
POOLE HOSPITAL NHS FOUNDATION TRUST 0.65 significantly low death rate -89.5 167 256.488
THE ROYAL BOURNEMOUTH AND CHRISTCHURCH HOSPITALS NHS FOUNDATION TRUST 0.63 significantly low death rate -75.5 126 201.533
UNIVERSITY HOSPITALS OF NORTH MIDLANDS NHS TRUST 0.61 significantly low death rate -115.6 184 299.588

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