The Department for Health did not have a good week last week. It started with hospitals being accused of putting patients’ lives at risk, for failing to comply with safety alerts issued by the National Patient Safety Agency. And it has ended with the DH accepting that it must agree a way of measuring and reporting hospital death rates, after Policy Exchange released a series of official documents, obtained under the Freedom of Information Act, which criticised the NHS for a ‘pervasive culture of fear’ and obsession with targets rather than a focus on patient safety
The documents, submitted to the DH by three internationally respected healthcare organisations, detail a litany of failures in oversight mechanism. The first report said there was a ‘pervasive culture of fear in the NHS and certain elements of the Department for Health’ and regulation was ‘light-handed’. It highlighted the flaws in the system of allowing hospitals to declare whether they were compliant with national standards – as two thirds of the assessments made by regulators did not agree with the declarations.
The second report found that the health service did not have a clear idea of what good quality health care meant so resorted to the default position that “quality means meeting the targets”. This report too stated “The NHS has developed a widespread culture more of fear and compliance, than of learning, innovation and enthusiastic participation in improvement”, and that “Most targets and standards appear to be defined in professional, organisational and political terms, not in terms of patients’ experiences of care”. The final document criticised the Department of Health for being more interested in costs than clinical quality and that assessments of health care seemed to be motivated by political rather than health concerns.
As we’ve pointed out, it is astounding that there is no system of performance improvement in the NHS. But suppose there was. If we could, say, spot increased mortality at any hospital on a monthly basis we could prevent temporary problems turning into scandals – and so avoid the tragedies like the ones at Tunbridge Wells, Mid-Staffordshire and Basildon & Thurrock.
And there is already a way to do that. The Hospital Standardised Mortality Ratio (HSMR) was developed here in the UK. It accounts for different risk factors so that hospitals undertaking complex operations, or dealing with critical patients, are not painted in a poor light. It measures the hospital’s actual performance against what is expected – and so can give an early warning to inspectors, regulators, clinicians, and patients. HSMRs have been around for many years and consequently they have large evidence base which shows that they are reliable and robust.
More and more countries around the world are adopting and publishing HSMRs as part of their hospital performance improvement plan. Whilst it is welcome that the DH has finally admitted it must do the same, we can’t afford for the Government to drag its feet any longer – the sooner we have a proper means of seeing hospitals’ performance rates, the better.
Natalie Evans is Deputy Director of Policy Exchange.
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