Are thousands of patients dying 'avoidable' deaths?

11 November 2013

UPDATE: NHS England has confirmed that the statistics we have used are the latest available.

After the Francis report into 'avoidable' deaths at Mid Staffordshire hospitals, there has been much discussion about whether NHS patients are falling victim to critical lapses in care.

According to the latest edition of the Mail on Sunday, "More than 3,500 people died unnecessarily in NHS hospitals last year because of mistakes and blunders".

Based on the most recent published data, the Mail on Sunday's figures seem to be in the correct area, although the specific numbers quoted don't quite match up. NHS trusts report on the number of 'patient incidents' that occur on their watch, categorising each incident (anything from prescribing the wrong medication to breaching a patient's confidentiality) and noting the 'degree of harm' (from none caused through to death).

The National Reporting and Learning System (NRLS) collects this information and publishes data every six months. The idea is that the NHS is then in a better position to diagnose problems and to improve overall patient safety.

We've asked the NHS whether it's possible that these statistics have been revised or updated. According to today's Times, "NHS officials did not dispute the figures in the Mail on Sunday" but claimed that there had been improvement in the logging of incidents.

This year's figures - in context

From the latest data (released in September 2013) we can see that last year there were 1,537 deaths at NHS hospital trusts in England and Wales. In the same period (April 2012-March 2013) there were also 1,813 deaths at mental health trusts. Together with the 349 deaths recorded at other NHS institutions, we arrive at a total of 3,699 deaths. 

While the Daily Mail quotes slightly different numbers, its headline figure is an accurate reflection of the data. (Meanwhile, we've asked the NHS Commissioning Board whether the September 2013 data has been revised or updated.)

However, it's worth noting that of all the patient safety incidents recorded, 0.3% (on average) resulted in deaths, while 64% involved no harm to the patient. In the case of mental health patients, almost one in five incidents involved self-harm and one in four a patient 'accident' (although we don't know specifically how many deaths resulted from these incidents). While the NHS's duty of care extends to protecting a patient from themselves, looking at the figures in this context does help to shed some light on the cases they refer to.

The Mail on Sunday's claim that "mistakes and blunders" are to blame is a generalisation that denies the range of scenarios we're dealing with. Furthermore, an increase in the total number of reported incidents (such as that reported in the Mail on Sunday) might be a sign of greater transparency rather than proof of poor patient care. Since April 2010 all NHS trusts have been required to report any incidents that result in 'serious' harm or a fatality, while the reporting of more minor incidents is voluntary. As the National Reporting and Learning System (NRLS) has noted, "High reporting is a mark of a 'high reliability' organisation."

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