Publish and be damned: death rates could improve outcomes

While trusts are still getting used to the idea of having to publish a quality account from 2010, let alone how they are going to collate all the data they need to fill it with, the Department of Health is keeping up the momentum by taking a bold step to publish a set of mortality rates for all NHS and foundation trusts.

Is this a brave move or a foolhardy one? The DH is determined to fire the starting gun in the race to improve outcomes, signalling, as interim director general of informatics and NHS medical director Sir Bruce Keogh put it, that "the days of discussing whether or not we should publish outcomes are over".

You can say that again. The DH hopes that national newspapers will not seize on the data to compile their own league tables of performance but it is prepared to take the risk - and which journalist doesn't like a league table?

Clinicians and managers may get a rude awakening today if they read that their hospital's death rates are twice or even three times as bad as their neighbour's.

And that is entirely possible. The measurements chosen include two - elective hip and knee replacements - where mortality rates are very low. A single death at a hospital could see that trust plummet down the league.

Sir Bruce is sanguine. He knows mortality rates are a blunt tool, but he wants to start a debate about what more meaningful outcome measures would look like, inviting people to improve the methodology behind them. What better way to kick-start clinical engagement than publishing comparative death rates?

Hopefully he will have plenty of takers - now is the time to shape the debate.