Never again?


Sir Bruce Keogh’s much-trailed review published yesterday sets out his prescription following external reviews of the 14 hospitals identified as being outliers on standardised hospital mortality ratios for a number of years.  The outcome of the reviews shows that, while there is excellent care delivered every day in the NHS, it is clear that the practices in some hospitals need to change.  Furthermore, it is likely that this does not just apply to the 14 that have been reviewed.

A key question should be how these problems can be identified earlier.  Standardised mortality rates, by their nature, are a retrospective view– they can only tell us what has already happened.  And while they should be a red flag for questions to be raised about the services hospitals deliver, there must be other, quicker ways for us to identify those services which need to make improvements.

Earlier this year, MHP Health Mandate published our prototype Quality Index, combining publicly available data on hospitals’ performance with information on the public’s preferences.  We set out to explore whether the aggregate ratings Jeremy Hunt favoured were possible – and they were.  But there was no correlation between the standardised hospital mortality index and our Quality Index – indeed two of the Keogh 14 hospitals appeared in the top quartile of index for quality. 

Standardised mortality rates are clearly an important part of the puzzle when regulators and others are assessing the quality of care within a hospital.  But as our Quality Index found, quality is much more nuanced than simple mortality rates.  For example, people were actually more concerned about waiting times than they were about the risk of being harmed.  And we found that quality means different things to different people.

So, while the interventions called for by the Keogh review will make a difference in these hospitals, we also need to have measures that can set out clearly – and importantly earlier – where hospitals may be delivering poor quality care.  The Government has made commitments around the use of data and now is the time for action.  We need to learn the lessons from the Francis inquiries and Sir Bruce Keogh’s reviews.  The NHS and regulators, charities and companies, patients and the public must make use of broader quality indicators – infection rates, patient and carer complaints, waiting times and feedback from staff surveys – to identify problems when they start to emerge.  And services must listen and respond to this and to what patients and their families and carers are saying so that we do not get to the point again where we are looking at the evidence in mortality figures.