Burying the NHS mortality row will clear the way for quality push

The public and political furore over the discrepancies between the mortality scores trusts achieved in the Dr Foster Hospital Guide and the Care Quality Commission ratings damaged the regulator’s credibility, pitched the CQC against both the National Patient Safety Agency and the Department of Health, harmed the standing of Monitor and undermined public confidence in the NHS.

This was precisely the sort of fracas the National Quality Board was supposed to prevent

This was precisely the sort of fracas the National Quality Board was supposed to prevent. The board was one of the recommendations in Lord Darzi’s 2008 next stage review. The aim was to align quality goals among key players, including the regulators, the NPSA and Dr Foster.

The national quality initiative is now, finally, beginning to get traction. NHS medical director Sir Bruce Keogh has asked NHS North East chief executive Ian Dalton to seek an agreed method for calculating hospital standardised mortality ratios.

Dr Foster attracted considerable flak over its hospital guide, with some trusts complaining the methods used to rate their performance lacked transparency.

Others complained their score worsened even though they had improved, because the general trend was for even faster improvement. This is a particularly peevish complaint. Just keep up.

While the wisdom of the way Dr Foster presented both the mortality ratios and its patient safety ranking for media consumption can be debated, there is no doubt it succeeded in its core aim of putting performance data and analysis at the centre of the debate about health service quality. Exposing weaker performers to public scrutiny is a remarkably effective way of challenging clinicians and managers who are complacent over safety.

Sir Bruce himself has courted controversy by famously securing the publication of mortality rates for his own discipline of cardiac surgery. He believes data publication is such a powerful tool for driving performance that it justifies the inevitable rough justice it entails.

If the mortality rate initiative succeeds, the next time the data is published there will be little opportunity for weaker performers to wriggle on definitions, while the many stunning trusts across the country will be able to trumpet their success without distraction. The way will also be cleared for agreement on more sophisticated definitions of safety and quality which reflect the experiences of the vast mass of hospital patients who don’t die.