The debate over how hospital mortality should be measured and whether those measures reveal anything useful has rumbled on for the last decade.

The Department of Health has sensibly attempted to bring it to a conclusion by gathering a consensus around a new measure - the summary hospital-level mortality indicator.

The message is: this is important in principle, but you’ll have wriggle room if things get sticky

Unfortunately, in an attempt to calm all the concerns about how the indicator will be consumed by the public and the press - let us call it the Dr Foster Hospital Guide factor - the policy guidance runs the risk of undermining it from the off.

The guidance appears clear: “A poor SHMI would be a prima facie case for an investigation by the hospital… Taking no investigative action… would be a signal of poor board governance”. There is similar advice for commissioners.

However, much of the rest of the document concerns the limitation of the new indicator as a measure of quality. It also contains a lengthy list of caveats which must be used when presenting and interpreting the data.

The message seems to be: this is important in principle, but you’ll have plenty of wriggle room if things get sticky.

The SHMI will be “owned” by the national quality indicator development group created by the national quality board. It is clear the steering group which developed the indicator (also set up by the board) does not always agree on how it should be used, for example in guiding patient choice. Such varying views lie behind the hedged advice.

The new indicator is a definite step forward. The national quality board should ensure it is championed more robustly.

The new mortality indicator suffers from mixed messages