A dramatic rise in the number of patients being recorded as needing palliative care has been revealed in a new report out today - sparking fears of a cover up to hide poor treatment.
Palliative care includes treatment to help relieve suffering when a patient has a terminal illness, and patients who die under palliative care are recorded differently to others.
This means by recording a death as "palliative", the death is effectively removed from the hospital's mortality rate - and experts fear hospitals could be exploiting this to their advantage.
And two Midland heath trusts were named by analysts Dr Foster in the top 20 across the country for the highest increase in palliative patients.
Sandwell and West Birmingham NHS Trust went from just under 2.8 per cent of patient deaths being in palliative care in 2008, to just over 21.5 per cent in 2012/13 - more than a fifth.
Peterborough and Stamford Hospitals NHS Trust, meanwhile, jumped from 2.79 per cent in 2008 to just over 20 per cent in 2012/13.
Across England last year, 36,425 deaths were coded as palliative - 17.3 per cent of the total number of deaths. This is almost double the 9.1 per cent recorded in 2008.
The Top 20 NHS trusts where the biggest jump in palliative care patients was reported are:
- East and North Hertfordshire - from 9.92% in 2008 to 43.25% in 2012
- Guy's and St Thomas' - from 1.18% in 2008 to 31.65% in 2012
- King's College Hospital - from 8.71% in 2008 to 38.36% in 2012
- Royal Liverpool and Broadgreen University Hospitals - from 1.35% in 2008 to 29.23%
- North Middlesex University Hospital - from 4.76% in 2008 to 31.48% in 2012
- Ipswich Hospital - from 2.14% in 2008 to 28.61% in 2012
- Central Manchester University Hospitals - from 11.34% in 2008 to 36.63% in 2012
- Buckinghamshire Healthcare - from 7.56% in 2008 to 32.13% in 2012
- Ashford and St Peter's Hospitals - from 0.32% in 2008 to 23.04% in 2012
- The Royal Bournemouth and Christchurch Hospitals - from 9.91% in 2008 to 32.52% in 2012
- Hinchingbrooke Health Care- from 1.48% in 2008 to 22.10% in 2012
- James Paget University Hospitals - from 2.44% in 2008 to 22.50% in 2012
- Epsom and St Helier University Hospitals - from 4.82% in 2008 to 24.42% in 2012
- Aintree University Hospital - from 19.24% in 2008 to 38.05% in 2012
- Sandwell and West Birmingham Hospitals - from 2.76% in 2008 to 21.53% in 2012
- Frimley Park Hospital - from 9.51% in 2008 to 27.89% in 2012
- South London Healthcare - from 8.04% in 2008 to 25.95% in 2012
- Salford Royal - from 12.36% in 2008 to 30.19% in 2012
- Peterborough and Stamford Hospitals - from 2.79% in 2008 to 20.05% in 201
- Milton Keynes Hospital - from 2.59% in 2008 to 19.59% in 2012
The Dr Foster report also found that most of the 20 trusts with the biggest leaps in their palliative care coding have also significantly improved their death rates during the same period.
Prof Sir Brian Jarman, from Imperial College London, helped develop the mortality rate indicator, and gave evidence to the public inquiry into high death rates at Mid-Staffs - and told the panel at the inquiry that some trusts did increase their coding of palliative care deaths to reduce their overall reported mortality rate.
He expressed his concern about the latest Dr Foster findings.
– Prof Sir Brian Jarman, Imperial College London
I can't read their minds but when you see these really dramatic shifts you have to ask, did they become a palliative care hospice overnight?
"I am concerned that trusts know that increasing their palliative care rates assists their HSMR and am concerned that this could be the reason they are doing it.
And Joyce Robins, of Patient Concern, added:
– Joyce Robins, Patient Concern
Hospitals are clearly fiddling these figures and that frightens me.
Hospitals are just not open enough to admit what is happening - instead they dream new ways to disguise it. All the talk of transparency is just that - talk