Researchers at the University of York have found that Scottish hospitals have experienced slower reductions in inpatient deaths than their English counterparts.
In a first-of-its-kind study, the researchers looked at extensive data on hospital admissions and discharges in both countries over a 17-year period. They found that while the number of people dying in hospital has declined in both countries, it is falling substantially faster in England.
Rather than looking at deaths in individual hospitals, which often gives small amounts of data and a lot of variation, the researchers examined broader trends by looking at administrative data from across the two countries.
They distinguished between "elective" hospital admissions, where patients went into hospital for planned care, and "emergency" hospital admissions where care was unplanned. The researchers found that in-hospital mortality was falling faster in England in both cases.
Among elective admissions, while the numbers of deaths were small in both countries, in 2014 0.3% of patients died in Scotland compared with 0.1% in England. In the case of emergency admissions 4% of patients died in English hospitals versus 6% in Scottish hospitals.
The authors of the paper, published today in the British Medical Journal Open, say that further investigation is needed into why trends in hospital mortality are different in the two countries with otherwise similar healthcare systems.
Co-lead author of the paper Professor Martin Chalkley from the Centre for Health Economics at the University of York said: "Because the data we used for the study records information on individual patients and admissions to hospital, we were able to take variations in the reasons why people were admitted to hospital as well as differences in populations such as age, levels of disease and deprivation, into account.
"We expected to see differences in the numbers of hospital deaths between England and Scotland, but the fact that rates of mortality in hospitals are falling faster in English hospitals is unexplained. There may be a benign reason for the difference, but these findings now demand further study - other things being equal, why are people more likely to die in hospital in Scotland than in England?"
Dr María José Aragón also from the Centre for Health Economics at the University of York and co-lead author of the study said: "It is possible that financial reforms to the NHS in England - such as the National Tariff Pricing System, which could increase planned admissions - may have played a role in reducing the proportion of hospital deaths when it comes to elective hospital admissions. But the fact that we also see a slower decrease in hospitals deaths for emergency care in Scotland means this is not a particularly convincing explanation for the fact that there is a slower decline in Scotland for both types of admissions".
Professor Chalkley added: "It is possible that the explanation lies in a difference in cultural views of hospitals between the two countries - perhaps in Scotland hospitals are regarded as a more suitable place for end of life care than in England - but if that is the case then it is not a documented policy that has been discussed and evaluated.
"The results could also be due to do with hospital performance, or the slower adoption of new techniques. Understanding the differences in the rates of hospital deaths in England and Scotland is worthy of further investigation."
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María José Aragón et al, How do time trends in inhospital mortality compare? A retrospective study of England and Scotland over 17 years using administrative data, BMJ Open (2018). DOI: 10.1136/bmjopen-2017-017195