Burying the NHS mortality row will clear the way for quality push
The Department of Health is trying to get a grip on the toxic issue of hospital standardised mortality ratios.
The public and political furore over the discrepancies between the mortality scores trusts achieved in the Dr Foster Hospital Guide and the Care Quality Commission ratings damaged the regulator’s credibility, pitched the CQC against both the National Patient Safety Agency and the Department of Health, harmed the standing of Monitor and undermined public confidence in the NHS.
This was precisely the sort of fracas the National Quality Board was supposed to prevent
This was precisely the sort of fracas the National Quality Board was supposed to prevent. The board was one of the recommendations in Lord Darzi’s 2008 next stage review. The aim was to align quality goals among key players, including the regulators, the NPSA and Dr Foster.
The national quality initiative is now, finally, beginning to get traction. NHS medical director Sir Bruce Keogh has asked NHS North East chief executive Ian Dalton to seek an agreed method for calculating hospital standardised mortality ratios.
Dr Foster attracted considerable flak over its hospital guide, with some trusts complaining the methods used to rate their performance lacked transparency.
Others complained their score worsened even though they had improved, because the general trend was for even faster improvement. This is a particularly peevish complaint. Just keep up.
While the wisdom of the way Dr Foster presented both the mortality ratios and its patient safety ranking for media consumption can be debated, there is no doubt it succeeded in its core aim of putting performance data and analysis at the centre of the debate about health service quality. Exposing weaker performers to public scrutiny is a remarkably effective way of challenging clinicians and managers who are complacent over safety.
Sir Bruce himself has courted controversy by famously securing the publication of mortality rates for his own discipline of cardiac surgery. He believes data publication is such a powerful tool for driving performance that it justifies the inevitable rough justice it entails.
If the mortality rate initiative succeeds, the next time the data is published there will be little opportunity for weaker performers to wriggle on definitions, while the many stunning trusts across the country will be able to trumpet their success without distraction. The way will also be cleared for agreement on more sophisticated definitions of safety and quality which reflect the experiences of the vast mass of hospital patients who don’t die.
Have your say
You must sign in to make a comment.
Related images
Also in: Burying the NHS mortality row will clear the way for quality push
Share
Readers' comments (4)
Kenneth Lownds | 18-Feb-2010 4:18 pm
Your last sentence makes the same appalling moral judgement as the Government and so many in the NHS - ah well never mind the small percentage who die, on the whole it's good. Utterly repugnant. Ken Lownds, Cure the NHS. Stafford
Unsuitable or offensive?
Anonymous | 22-Feb-2010 10:56 pm
Ken - I hate to ever take the middle ground but perhaps Mr Vize may have been a little quick to end his article. My view he is trying to play a very difficult game of challenging the NHS policy makers whilst trying to keep a sense of balance as far as possible to keep this journal going, which I might add is the only genuine voice of managers in the NHS who do care.
More than 'death rates' or 'indicators' or 'league tables' all the people of this country want to know is that we are safe when we enter a hospital or the care of a professional. Even with all the billions spent on quangos we still go into the NHS 'hoping' everything will be ok. In my opinion 90+% of staff do care and exhaust themselves trying every day. I wish it were 100% but it isn't everyone. Some just don't care which is an awful thing to say but true never-the-less.
When Staffordshire was identified in a league table of poor mortality rates it was way down the list. So mortality is either a poor indicator and their needs to be a serious look at it OR there are 16 or so other Trusts that need inspecting. I'll leave you to guess.
Readers should look at this article too:
http://www.hsj.co.uk/news/acute-care/dh-takes-hold-of-death-ratio-debate/5011590.article
SunTzu
Unsuitable or offensive?
Hugh Rogers | 23-Feb-2010 6:08 pm
Richard Vize is right to say 'Keep Up'. Mortality is improving at about 2% per annum, but the HSMR process is always measured against the previous year as 100. Thus the average HSMR in any year is likely to be 98%.
We (NHS Institute) have studied the factors most likely to improve mortality and published them at www.institute.nhs.uk/ram Implementing these lessions in poorly performing acute trusts has moved their HSMR by as much as 20% in the first year.
I also agree that we need to go on developing 'more sophisticated measures of safety and quality'.
Unsuitable or offensive?
Martin Heaven | 18-Aug-2010 5:25 pm
SMRs are not comparable year on year. The overall rate for the total population becomes 100 and each sub population (Trust) is either above or below 100 each year. That is how the calculation works. 100 in 2008 is not the same as 100 in 2009, and the range of values is scaled differently in each calculation. Comparison year on year and assuming a 20% improvement is wrong.
Unsuitable or offensive?