HEALTH experts have criticised the body that sparked a controversial investigation into death rates at the Royal Bolton Hospital.
The Dr Foster Ethics Committee — which investigates complaints about Dr Foster Intelligence — ruled the audit of mortality rates at the Royal Bolton in 2013 “fell below high standards expected of the organisation”.
Bolton NHS Foundation Trust bosses submitted a complaint because of the “unnecessary damage” caused by the audit.
Dr Foster Intelligence — a joint venture with the Department of Health to monitor NHS performance — claimed in February, 2013 there were significant discrepancies in data.
The hospital was later cleared of any wrongdoing but the report did raise questions about the way sepsis — which loosely means an infection — is understood by clinicians, coders and analysts.
The ethics committee “substantially upheld” the Bolton trust’s complaint and said the audit did expose a “rift” between patient diagnosis based on a regimented coding practice and that based on clinical opinion.
The committee report stated: “One process depends upon national rules whilst the alternatives uses individual judgement. The DFI audit report should have either solely addressed the audit outcome or enabled a detailed discussion of the cause of breaches in process.” The committee added the audit was “unhelpful to the Bolton health community”.
Trust chairman David Wakefield, who lodged the complaint, said he was disappointed Dr Foster did not apologise to Dr Jackie Bene — who was forced to “step aside” at the time of the investigation.
Mr Wakefield said: “I hope Dr Foster learn from this. They failed to follow the processes expected in an audit such as this and their conclusions on our clinical review process were flawed.
“Their failure to recognise the bigger patient safety issue — early identification and treatment of sepsis — temporarily and unnecessarily damaged the reputation of the trust.
“We believe they owe a duty of care to all trusts and clinicians in areas where it impacts on the confidence of patients.
“We are proud of the work Dr Jackie Bene and her team have undertaken in the treatment of sepsis over several years and we were saddened by the negative publicity surrounding this audit at the time.
“We are disappointed that Dr Foster have not apologised to the trust and in particular to Dr Bene.”
Dr Foster’s co-founder and director of research Roger Taylor said: “The audit we carried out at Bolton was an extremely important piece of work in correctly identifying problems with the reliability of coding.
“It is not normal practice to work to the standard national guidelines in local audits of this sort. We thank the Ethics Committee for its work and are considering its findings with a view to enhancing our procedural processes for this particular type of work as a result.
“We are offering our full support to the Department of Health, the NHS and others to help ensure that coding clarification and management is improved in future.”
Lead consultant demands an apology
THE findings of the complaint about Dr Foster Intelligence have been welcomed by health chiefs in Bolton.
Dr Kevin Jones, a lead consultant for acute medicine at the Royal Bolton Hospital, strongly criticised the investigation into sepsis coding in February, 2013.
He said: “I am delighted that after all their pompous prevaricating and numerous attempts to muddy the waters, Dr Foster have come clean and admitted that their audit was flawed and that it did damage the reputation of our Trust.
“I would like them to go the whole hog and also say they are truly sorry.”
Dr Foster’s ethics committee recommended that in future audits of coding, analysis, opinion and judgement should be clearly separated from the assessment of “adherence to standards.”
Dr Wirin Bhatiani, chairman of NHS Bolton Clinical Commissioning Group (CCG), said: “NHS Bolton CCG welcomes the recommendation as this is a national issue.
"They reflect the findings of the independent clinical review last year.
“It also found clinical care of Bolton patients had not been compromised.
“We are pleased with Dr Bene’s and her team’s continual good work.”