The government has announced that it has set up a working group to develop a single hospital standardised mortality ratio for the NHS in response to the latest report on the scandal at Mid Staffordshire NHS Foundation Trust.
The report, by Robert Francis QC, raised concerns about the quality of coding in the NHS and the different interpretations that are put on NHS data by the different organisations producing comparative statistics about trust performance.
It suggested that an “impeccably independent and transparent source” should be responsible for producing such statistics and that it should probably be a public body.
The government’s response, which says it accepts all of the recommendations in the 450 page report, says that NHS medical director Sir Bruce Keogh will lead a group to develop the new HSMR and that the NHS Confederation will develop a practical guide to its use and interpretation in the NHS.
Nine working group members, including the heads of the NHS Information Centre and Dr Foster Intelligence, the NHS’ major regulators and the National Patient Safety Agency, have issued a supporting statement on the Department of Health website.
This says “[HSMRs] can usefully help us to understand comparative information about in-hospital deaths” but they “should not be used as a sole indicators of patient quality.” It also says “we will be working together to address and explain these limitations.”
While the work is done, the joint statement says “we have agreed to continue using the existing methodology for HSMRs as published on NHS Choices to avoid any further confusion in the service and the wider public.”
Coding and statistics played an important role at Mid Staffordshire, where the trust initially blamed coding problems when the Dr Foster unit at Imperial College in London raised concerns about its apparently high death rates in November 2007.
The alerts were followed up by the unit and the Healthcare Commission, which launched an investigation in summer 2008. The Commission concluded unnecessary deaths had occurred at the trust, particularly among patients admitted through A&E.
It also uncovered terrible care on a number of wards, with patients left unattended, unwashed, unfed and without access to medication. The Francis report endorsed the Commission’s findings.
Following the publication of the report yesterday, NHS chief executive Sir David Nicholson wrote to all NHS chairs, chief executives, medical and nursing directors asking them to read the report and to act on its findings.
In addition to outlining the plan for a new HSMR, the letter says the National Leadership Council has proposed a new system of personal accreditation for senior managers and issued “healthy board” guidance to “help bridge the gap between the board and the ward.”
Monitor will be asked to consider stripping the trust of its foundation status, and Francis has been asked to chair a further inquiry into the role of regulatory agencies.
The Francis report says the contribution made by Dr Foster Intelligence has been “substantial” a “consensus view” is needed on the methodologies used to produce comparative statistics.
It also expresses reservations about the Dr Foster Hospital Guide, noting that hospitals can move rapidly up and down the guide’s ‘league tables’, so that good performance may be misleading.
Although it stresses that “no adverse inferences with respect to Dr Foster should be made” as a result, it argues that “there may be a case for considering whether a public service should be tasked with the production of this type of statistic.”
In response, Dr Foster Intelligence issued a statement saying its work “has played and will continue to play an important part in identifying and remedying failures in standards of care” but there is “more to do” and it “fully supports the recommendation for a single measure to be used across the NHS.”