The Department of Health is taking action to ensure the NHS agrees a way of measuring and reporting hospitals’ death rates, in response to the furore prompted by last year’s Dr Foster Hospital Guide.
The move has been welcomed as a “step in the right direction” by some of the trusts that were labelled unsafe - they claim unfairly - in the wake of the figures published in November.
Sir Bruce said that following the Dr Foster publication he “was getting a lot of contact from people asking, ‘What the hell is going on?’”
They have been disputed by several of those labelled poor, and some in the NHS have strongly criticised the publication for undermining confidence in the service and the quality reporting framework.
The DH and regulators were engulfed in the row because many of the Dr Foster Intelligence ratings contradicted trusts’ performance according to the Care Quality Commission and foundation trust regulator Monitor, calling those systems into question.
NHS medical director Sir Bruce Keogh has asked NHS North East chief executive Ian Dalton to lead a group which will agree a method for calculating hospital standardised mortality ratios.
It is hoped it will reach a consensus during the summer then look at agreeing a range of other patient safety measures.
Sir Bruce acknowledged that following the Dr Foster publication he “was getting a lot of contact from people asking, ‘What the hell is going on?’”.
“I think it is good that Dr Foster has published this but it would be even better if that could be used to have a real debate,” he said.
Sir Bruce said the group would involve NHS managers, clinicians, academics, the companies with an interest and the Information Centre. It will report to the National Quality Board, which Sir Bruce and Dr Foster both sit on.
He said: “We can give people the choice to be involved in the debate so, when they appear as an outlier, they feel less aggrieved.”
Some have warned an all hospital mortality ratio or another single number indicator, which can easily be interpreted by the public, will never accurately reflect a hospital’s patient safety and quality.
Sir Bruce said: “The only way we’ll find out is if we try to develop one - we have to enter that territory. Statistically it is difficult, but at the end of the day patients want [a] measure that says, ‘Is this place safe?’”
Blackpool, Fylde and Wyre Hospitals Foundation Trust, whose services are rated “good” by the CQC, was one of 12 in Dr Foster’s lowest safety rating band.
Chief executive Aidan Kehoe said the DH move was a “step in the right direction”.
But he said: “What it won’t resolve is the whole issue of measuring mortality as an indicator of patient safety as we don’t think it gives a fair picture of the quality of care patients can expect.”
St Helens and Knowsley Hospital Trust, which the CQC rated “excellent”, was another of the 12. Medical director Mike Lynch said the negative publicity had a big impact.
He said: “Our staff have worked exceptionally hard over a number of years to deliver high quality care. It is very upsetting indeed to be besmirched in this way.”
Dr Lynch said: “If there is some standardisation of the methodology, these gaping gaps between where an organisation believes it is, based on a raft of information, versus where Dr Foster places it, might close.”
King’s Fund senior policy fellow and epidemiologist Veena Raleigh, who last month published a report on quality measurement, said the focus should be on several indicators.
She said: “There is a risk of the information losing credibility with the clinicians who have the task of delivering quality, and know how complex it is to measure that.”
Dr Foster said it was “committed to the DH’s consultative process”.
Research director Roger Taylor said in a statement: “This is good news for Dr Foster and the industry. Debate [has] from time to time detracted from the important task of understanding and investigating high mortality rates.”
Mortality rates: a history
- 1993 Sir Brian Jarman, at Imperial College, begins developing the ratios
- 2001 Bristol Royal Infirmary inquiry recommends openness
- 2001 Sir Brian starts publishing ratios with Dr Foster
- 2006 Society for Cardiothoracic Surgery president Sir Bruce Keogh publishes survival rates for cardiac surgery units
- 2007 Sir Bruce appointed NHS medical director. He moves to publish outcomes on NHS Choices
- August 2008 Research for NHS West Midlands adds to criticism of value of HSMRs
- March 2009 HSMRs credited with alerting to scandal at Mid Staffordshire FT
- March 2009 First meeting of the DH’s quality board
- November 2009 Hospital Guide again receives huge coverage. Its worst rated trust is Basildon and Thurrock University Hospitals FT
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