This publication of the SHMI relates to discharges in the reporting period October 2013 to September 2014.
The SHMI is the ratio between the actual number of patients who die following hospitalisation at the trust and the number that would be expected to die on the basis of average England figures, given the characteristics of the patients treated there.
It covers all deaths reported of patients who were admitted to non-specialist acute trusts in England and either die while in hospital or within 30 days of discharge.
To help users of the data understand the SHMI, trusts have been categorised into bandings indicating whether a trust's SHMI is 'higher than expected', 'as expected' or 'lower than expected'.
Further background information and supporting documents are available on the SHMI homepage (see Related Links).
Key Facts
Of the 137 trusts included in the SHMI for the period from 1 October 2013 to 30 September 2014:
• 9 trusts had a 'higher than expected' SHMI, compared to 8 trusts for the same period a year previously.
• Of these 9 trusts, 5 also had a 'higher than expected' SHMI for the same period a year previously.
• 112 trusts had an 'as expected' SHMI, compared to 116 trusts for the same period a year previously
• 16 trusts had a 'lower than expected' SHMI, compared to 17 trusts for the same period a year previously.
• Of these 16 trusts, 9 also had a 'lower than expected' SHMI for the same period a year previously.
Notes:
1. There is a shortfall in the number of records in the Hospital Episode Statistics (HES) data for discharges in the period October 2013 - September 2014 for the following trusts: Royal Free London NHS Foundation Trust (provider code RAL), South Warwickshire NHS Foundation Trust (provider code RJC) and Sherwood Forest Hospitals NHS Foundation Trust (provider code RK5). Further details are provided in the corresponding HES Admitted Patient Care data quality notes (see Related Links). This has a negligible impact on the SHMI at national level. However, the SHMI values for the affected trusts will be based on incomplete data and should therefore be interpreted with caution.
2. Following the closure of Mid-Staffordshire NHS Foundation Trust (provider code RJD) on 31st October 2014, the activity previously undertaken by this trust has now transferred to University Hospitals of North Midlands NHS Trust (provider code RJE) and The Royal Wolverhampton NHS Trust (provider code RL4).
As the SHMI is published to reflect current organisational structures, activity submitted by Mid-Staffordshire NHS Foundation Trust is mapped to these two providers prior to the calculation of the SHMI. For the period October 2013 - September 2014, there are 2,037 finished provider spells in the SHMI dataset which do not contain sufficient information for this mapping to be carried out.
These records have been included in the statistical models which are used to determine the SHMI national baseline, and so there is no impact on the SHMI at national level. However, these records are not reported in the SHMI publication as they cannot be assigned to any current provider. Therefore, the SHMI values for University Hospitals of North Midlands NHS Trust and The Royal Wolverhampton NHS Trust could be based on incomplete data and should therefore be interpreted with caution.
3. The Royal National Hospital for Rheumatic Diseases NHS Foundation Trust (provider code RBB) became part of Royal United Hospitals Bath NHS Foundation Trust (provider code RD1) on 1st February 2015. However, as this change occurred after data processing for the April 2015 SHMI publication began, data for The Royal National Hospital for Rheumatic Diseases NHS Foundation Trust has not been included in the SHMI for Royal United Hospitals Bath NHS Foundation Trust for this publication. From the July 2015 SHMI publication onwards the SHMI for Royal United Hospitals Bath NHS Foundation Trust will also include data submitted by The Royal National Hospital for Rheumatic Diseases NHS Foundation Trust.
4. It has come to our attention that there may be several trusts who are unable to record still births with a discharge method of 'Baby was still born' on their patient administration system (PAS) and are instead coding these records with a discharge method of 'Died'. This means that such records will be included in the calculation of the SHMI where they should have been excluded. We are currently reviewing this issue with initial investigations suggesting that the impact on the overall SHMI value for affected trusts is small.
5. The SHMI methodology has been designed for non-specialist acute trusts and so trusts which solely provide community services are excluded from the SHMI. However, integrated acute and community trusts (which provide both acute and community services) are included in the SHMI and some patients will move from acute care to community treatment. In such cases, the SHMI would consider the time period from the patient's admission into acute care until 30 days following discharge from the community service. If the patient had instead been treated first at a trust providing only acute services and then transferred to a community trust then the time period considered by the SHMI would be from admission to the acute trust until 30 days following discharge from the acute trust. This has led to concerns that trusts are not being compared on a like-for-like basis.
It is not possible to identify community activity in the HES dataset and so it is not possible to identify the number of trusts affected by this issue, or the potential impact on these trusts. The number of affected trusts may increase over time as more trusts move to an integrated model of service provision and the impact is likely to vary depending on the nature of the community services provided e.g. rehabilitation services compared to palliative care. Trusts which only provide outpatient community services will be unaffected. The HSCIC will continue to review this issue with the SHMI Technical Working Group as part of the longer term development of the indicator.
6. The total number of trusts has decreased by four from the same period a year previously due to the acquisition of Barnet and Chase Farm Hospitals NHS Trust (provider code RVL) by the Royal Free London NHS Foundation Trust (provider code RAL), the establishment of the London North West Healthcare NHS Trust (provider code R1K) following the closure of Ealing Hospital NHS Trust (provider code RC3) and North West London Hospitals NHS Trust (provider code RV8), the acquisition of Heatherwood and Wexham Park Hospitals NHS Foundation Trust (provider code RD7) by Frimley Health NHS Foundation Trust (provider code RDU) and the closure of Mid Staffordshire NHS Foundation Trust (provider code RJD).
