The public needs all the facts to enable them to fully engage in the debate on healthcare safety

Hospital managers should not have to live in fear, so the fact that one chief executive recently received advice from the police about his safety is shocking. It happened in the wake of the publication of the Dr Foster Hospital Guide last November, which highlighted issues around patient safety. In some areas, it led to vitriolic coverage in local media and angry patients who believe that they or someone they know has been the victim of inadequate care.

The relatively slow way in which safety in medicine is addressed reflects, in part, the lack of understanding of the issue among the public

Public awareness of patient safety is growing. In February, Radio 4 broadcast the results of an investigation into the extent to which hospitals were failing to implement National Patient Safety Agency alerts. Shortly afterwards, the Francis inquiry reported on the failings that occurred at Mid Staffordshire Foundation Trust. Panorama is preparing its own programme on a similar theme.

Public awareness comes at a price. It can unfairly damage confidence in the NHS - even though this problem affects all health systems. It can extract a heavy emotional toll on relatives of patients who may be mistakenly persuaded that loved ones died because of poor care.

It is understandable, then, if some people decide it is better for information about hospital mortality rates to be circulated only among professionals and managers, and not broadcast to the general public. Such a view was aired by Stephen Thornton chief executive of the Health Foundation. He proposed using a more technical presentation of information aimed at expert audiences. Making data inaccessible and relatively incomprehensible can be an effective way of publishing information while excluding the general public from the debate.

He argued that providing this information to the public is of little value since it is not used by patients to inform their choices. This is true. But choice is only one way that the public engages with healthcare information.

Following the debate in the media, writing to newspapers and joining patient action groups are all ways in which people respond to information about safety. But, as importantly, involving the public in the debate about safety changes the tone of the conversation in a way that can spur action - even if the patients themselves do little.

There will be patients who overreact to information about hospital mortality rates, but they are the exception. Most people are remarkably quiescent in the face of continued lack of safety in healthcare, despite decades of evidence of the problem. The public debate on the issue is strangely low key when compared with, say, the outcry and the billions of dollars expended to address the problems at Toyota - problems that are estimated to have led to perhaps 19 deaths.

The relatively slow way in which safety in medicine is addressed reflects, in part, the lack of understanding of the issue among the public. Trying to keep it that way is not an option. That is why it would be a step backward to leave patients and the public out of the debate.

In this context, it is welcome that the Department of Health has taken steps to help shape the debate around mortality rates. It is 10 years since Dr Foster first started publishing hospital mortality rates and we are still working out how to talk about the issues the data raises. By we, I mean all involved - publishers, public and NHS alike.

In response, the DH has launched two initiatives. The first is to define the method for measuring hospital standardised mortality ratios. This is helpful because arguments about methodology - which have a negligible impact in terms of identifying hospitals with high or low mortality rates - have distracted from the more important issues of patient safety. The Francis Inquiry report by independent US experts supports the use of hospital standardised mortality ratios as a tool - one among many - that can be used to identify potential failings in patient safety.

The second initiative is to guide the NHS on how to use and interpret such indicators. This should help to generate a better informed and more consistent debate between the NHS, the media and the public.

No one measure can say whether a hospital is safe. Different data must be examined together, in context. Greater clarity about how these judgements are made and how they ought to be made will allow a better informed debate about hospital safety that can include everyone involved - including patients and the public.