Supplementary note to the Chairman of
the Committee by Lord Dazi of Denham KBE
I am writing up to follow up my appearance before
your committee on 25 October. At that hearing, two points were
raised that I said I would take away and return to you on. If
I may, I would also like to clarify a couple of the points I made.
1. How many people died from hospital acquired
diseases last year?
We do not have figures relating to all healthcare
associated infections. The Office for National Statistics collects
data on deaths associated with MRSA and C.difficile from death
certificates and publishes the figures each February. The latest
year is 2005 so last year's data is not yet available. Tables
setting out the data are below.
MRSA Death Certificate Data
Number of death certificates with Staphlyococcus
aureus and MRSA mentioned, and those with MRSA as the underlying
cause, England and Wales 2001-05
| | |
| | |
| 2001 | 2002
| 2003 | 2004 |
2005 |
| | |
| | |
| All Staphylococcus aureus | 1,211
| 1,221 | 1,403 | 1,623
| 2,083 |
| Mentions of MRSA on death certificate | 734
| 800 | 955 | 1,168
| 1,629 |
| Number of these where underlying cause of death is MRSA
| 254 | 248 | 321
| 360 | 467 |
| | |
| | |
| Source: ONS Health Statistics Quarterly, 22/2/07
| | | |
| |
C. Difficile Death Certificate Data
Number of death certificates with C. difficile mentioned, and those with C. difficile as the underlying cause, England and Wales 2001-05
| | | |
| |
| | |
| | |
| 2001 | 2002
| 2003 | 2004 |
2005 |
| | |
| | |
| Mentions of C.difficile | 1,214
| 1,428 | 1,788 | 2,247
| 3,807 |
| Number of these where underlying cause of death is C.difficile
| 691 | 756 | 958
| 1,245 | 2,074 |
| | |
| | |
| Source: ONS Health Statistics Quarterly, 22/2/07
| | | |
| |
| | |
| | |
MRSA or C. difficile infection will be included on a death
certificate if the certifying doctor considers it to be the underlying
cause of death. However, many patients who become infected with
an HCAI have other serious and potentially fatal underlying medical
conditions.
It is a matter of individual professional judgment whether
the doctor lists MRSA or any other HCAI as a contributory cause,
and this will depend, generally, on whether the doctor thinks
that the patient would have survived for a significantly longer
period if they had not developed an HCAI.
There is a duty on doctors to record the cause of death accurately
on the death certificate. The Chief Medical Officer wrote to all
doctors to remind them of the importance of giving full and accurate
information on the death certificate.
Internationally accepted guidance from WHO on the completion
of death certificates requires only those conditions that contribute
directly to death to be recorded. If an infection was part of
the sequence of events that led directly to the death, this should
be recorded in part (i) of the certificate. If the infection contributed,
but was not part of this direct sequence, it should be written
in part (ii).
2. Is it known whether the 20 trusts, recently reported
to have the worst C. difficile infection rates, had bad PEAT scores?
I made clear in my evidence to the Health Select Committee
that any correlation between PEAT scores and infection rates would
not necessarily indicate a causal relationship. It may be that
both figures are influenced by the culture of the organisation.
Variations in infection rates may also be due to a number of factors
including number, age and types of patients/case mix (eg the very
old or the very ill). We expect the measures we are taking to
tackle infection to affect rates of C. difficile across the NHS,
including these hospitals.
It is difficult to directly compare PEAT scores with infection
figures. PEAT scores are recorded by calendar year and the information
on the 20 Trusts with highest numbers of C. difficile was recorded
for Quarter 1 this year.
Looking across the 20 Trusts, all of the hospitals within
these Trusts scored acceptable, good or excellent for their 2007
PEAT environment score. PEAT scores are recorded at hospital level
rather than at Trust level and have been recorded against a five
point scale (excellent, acceptable, good, poor and unacceptable)
in the years 2004-07 and against the a three point scale (green,
amber, red) for the years 2001-03. Over the 30 hospitals within
these 20 Trusts, only six scores of poor or red have been recorded
in all of the years between 2001 and 2007 and no hospitals have
had a score of unacceptable.
You should note that PEAT inspections cover food and aspects
of privacy and dignity, as well as cleanliness and the environment.
Hospitals are given an overall score for environment and an overall
score for food.
3. Healthcare for London: A Framework for Action
In my evidence to the Health Select Committee I noted that
62 or 63% of A&E attendances in London could have been dealt
with in primary care. This figure should be approximately 40%.
I also referred to the tariff for this, in a hospital setting,
being £158. This should have been £81, which compares
to a projected cost of £66 in a polyclinic.
Ara Darzi
4 December 2007
|
