Denis Naughten TD has today reiterated his claim that the figures to be presented in the hospital mortality report (‘Health Care Quality Indicators in the Irish Health System: Examining the Potential of Hospital Discharge Data’) are incorrect, and must be clarified without delay by Minister James Reilly.
“In July 2011 the Minister presented incorrect figures to the Dáil which claimed that patients were four times more likely to die at Roscommon County Hospital than at Galway University Hospital.
“At the health committee meeting on 8th December 2011, Dr. Jennifer Martin of the Department of Health, in the presence of the Minister, admitted that the damming statistics used by the Minister was in fact erroneous due to the quality of the data and not a reflection on the quality of care provided at the hospital [see extract below].
“This flaw in the data was brought to the Minister’s attention last July at the Health Committee and in Seanad Éireann by Prof. John Crown (see attached) but to date that Dáil record has not been corrected.
“In December 2011, I asked the Minister for Health to correct this error (see attached letter) on the basis that it reflected badly on every person who worked in Roscommon Hospital.
“This error was indirectly admitted by Minister Reilly in a reply to me in the Dáil in May 2012, when the Minister himself questioned the accuracy of some of the data being collected from hospitals on their mortality rates.
“Now, because of the manner which the figures were collected, and the Ministers determination to save face, the good name of excellent staff at Roscommon County Hospital, is again being dragged through the mud”.
“In fact the actual figures show that a person treated for a heart attack at Roscommon Hospital had better chance of recovery than those attending University Hospital Galway, and the was before patients from Roscommon were forced to travel 1 ½ hours to Galway for treatment” concluded Denis Naughten.
1) Letter to Dr James Reilly and Committee extracts attached.
2) Prof. John Crown position after hearing the evidence
3) Dáil reply May 2012
1) Letter to Minister Reilly
19th December 2011
Dear Minister Reilly,
I am writing to you to request that you come before Dáil Éireann and correct the record pertaining to your comments of the 5th July 2011 in Dáil Éireann and the Joint Oireachtas Committee on 21st July 2011 regarding the mortality rates at Roscommon County Hospital.
Regarding your comments of 5th July 2011 in Dáil Éireann that the mortality rate at Roscommon County Hospital as follows “One set of statistics shows that a patient attending Galway University Hospital has a 5.8% mortality rate compared with a 21.3% mortality rate in Roscommon, which is four times greater”, it is now clear from the evidence of Dr. Jennifer Martin at the Health Committee on 8th December, in your presence, that this is factually incorrect.
As you are aware I pointed out that “Dr. Martin has stated the assessment was related to the quality of data, not the care provided, but the contents of the report have been used in assessing the quality of care provided in Roscommon County Hospital, as the committee will be aware from the debates in the Dáil and here”. In response Dr. Martin said “While the report never aimed to do so, when a number came up in relation to Roscommon County Hospital, it would not have been in the interests of patient safety to ignore it and say, “Yes, we are convinced it is due to the quality of data.” Subsequent analysis and work undertaken by the hospital highlighted limitations in the quality of data and have been more reassuring on the quality of care provided”.
As you are aware this is a clear admission that the data rather than the care at Roscommon County Hospital was flawed, a fact that was both to you attention in Seanad Éireann by Dr. John Crown and again in your presence on a number of occasions at the Joint Oireachtas Committee meeting of 21 July 2011 where it was pointed out that that the average, mortality rate between 2009 and 2011 was 4.92%, making Roscommon, based on that statistic, a safer hospital than Galway.
The error in these figures have now been brought to your direct attention on the public record on more than one occasion, an error which has done irreparable damage to the reputation of the hospital and as a result its staff, and in order to restore the good name of all involved, I would be most grateful if you could immediately ensure that you correct the Dáil record on the first available opportunity, which is 11th January next.
While, I am sure that you initial remarks were given with the best intentions, the fact that this error has been brought publically to your attention, and I’m sure privately by your own officials, I do now hope that you will correct the record without any further delay.
Denis Naughten TD
….Deputy Denis Naughten: At the time of the last review on 24 November the Minister said he would ask Dr. Devlin to respond on the matter I had raised concerning the report on coronary death rates at Roscommon County Hospital and other accident and emergency departments across the country. Unfortunately, there was no opportunity to give a response on that day. Can this issue be dealt with today?…….
…….Deputy James Reilly: There are a number of other issues. Dr. Martin will deal with the mortality rate issue raised in the report to which Deputy Naughten referred with reference to Dr. Devlin.
The roll-out of the helicopter emergency medical service which I first mooted in June-July has been under consideration since. I will ask Mr. Gilroy to update the committee on the matter.
Dr. Jennifer Martin: I thank the committee for giving me the opportunity to comment on the report. I might clarify that the report we are finalising looks at quality indicators or the potential for using the high data system or the biggest data system in the country that collects information from all hospitals. While one of the indicators at which we are looking is mortality rates after a heart attack, the aim of the report is to look at the quality of the data, not the care provided.
On the timing of the report, the reason it has been somewhat delayed is that when we went to a number of hospitals in which a good deal of work was done in looking at the data which add a great deal of information and learning to the report, there were some unforeseen time delays which we are still working through with the HSE and hospitals. We hope to have the report finalised shortly.
Deputy Denis Naughten: Will it be finalised very shortly?
Dr. Jennifer Martin: It will be finalised as soon as we can clarify the issues involved with the HSE and hospitals.
Deputy Denis Naughten: The reason I ask is that in July we were told the report would be available “very shortly”. Will it be another six months?
Dr. Jennifer Martin: When we went to hospitals they had done much of the work themselves which accounts for an entire second aspect of the report which people will appreciate really adds learning to it. We are much closer and I hope the report will be available very shortly.
Deputy Denis Naughten: To clarify—–
Deputy Denis Naughten: —–Dr. Martin has stated the assessment was related to the quality of data, not the care provided, but the contents of the report have been used in assessing the quality of care provided in Roscommon County Hospital, as the committee will be aware from the debates in the Dáil and here.
Dr. Jennifer Martin: While the report never aimed to do so, when a number came up in relation to Roscommon County Hospital, it would not have been in the interests of patient safety to ignore it and say, “Yes, we are convinced it is due to the quality of data.” Subsequent analysis and work undertaken by the hospital highlighted limitations in the quality of data and have been more reassuring on the quality of care provided.
Deputy Denis Naughten: That is an important point. Does that mean we will have an opportunity to correct the Dáil record as regards the data provided? I am sure the Minister did it in good faith; I am not questioning that aspect. The data were related to the quality of care and what Dr. Martin is telling the committee is that following their reassessment, particularly the data for Roscommon County Hospital, in terms of the question marks over it and the scale of the issue of quality of care, the impression given will not match what will be in the report. That is a serious matter regarding the information given in the Dáil at the time on the closure of the accident and emergency department at Roscommon County Hospital. I seek clarity in that regard, as it was such a fundamental issue in the public debate on the matter.
Dr. Jennifer Martin: The report will show that the information input by hospitals into the HIPE system was reported on in the Dáil. The same numbers are in the report.
2) Jan 2012: Dr Reilly must set the record straight about Roscommon care -Prof John Crown
3) Dáil reply
Denis Naughten (Roscommon-South Leitrim, Independent)
Question 490: To ask the Minister for Health when he will publish his Department’s report on mortality rates at acute hospitals; if he will accept that his failure to acknowledge the inaccuracy of the figures at Roscommon County Hospital has damaged the reputation of the hospital and its staff; and if he will make a statement on the matter. [23949/12]
James Reilly (Minister, Department of Health; Dublin North, Fine Gael)
It is essential to have a health system that is transparent and accountable. Information needs to be collected, analysed and intelligently interpreted in order to allow the health system and population it serves to monitor what it is doing, recognise where improvements are occurring and identify potential problems, so that actions can be taken to rectify them.
It makes sense to use available data and information to support important issues such as patient safety and quality of the care. The Hospital Inpatient Enquiry Scheme (HIPE) system is the largest system providing information on hospital care in this country. With this in mind, the Chief Medical Officer of my Department has been working on a report entitled ‘Health Care Quality Indicators in the Irish Health System: Examining the Potential of Hospital Discharge Data’. This includes the measure of recorded 30 day in-hospital mortality rates following heart attack. The work to date demonstrates the value of using HIPE as a tool to derive knowledge and understanding of health care quality. However, this work has also uncovered variation in the accuracy of data as reported through the HIPE system. Some individual hospitals have looked into the origin of this variation and attributed it to inaccuracies in both the medical chart and the subsequent coding of information that is then inputted by individual hospitals in the HIPE system.
I am concerned about this finding in relation to data quality given its potential patient safety implications. I believe that, arising from this, there is a duty on all hospitals to address measures that can ensure that the information which they record and report is accurate. Concerns have been raised by certain hospitals and clinicians that the report, which seeks only to examine quality of data, could be either inadvertently or deliberately misinterpreted as making inferences on quality of care. I understand this concern. However, I do not accept that the solution is to disregard these data. Where that source of information is found to be flawed the solution is to improve it. These data have been collected by hospitals and the hospitals themselves must be accountable for the quality of them. Therefore, the CMO, in conjunction with the HSE, is now in the process of further augmenting the analysis of the indicators to date with data for 2011 and 2012. Every public hospital in the country has been written to in order that they can ensure that the information they record and report for 2011 and 2012 is accurate. The Economic and Social Research Institute, who manage the HIPE system, provide checking and audit tools to enable hospitals to ensure the quality of their data. The CMO expects to publish the ‘Health Care Quality Indicators in the Irish Health System: Examining the Potential of Hospital Discharge Data’ report in the near future.