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Death rate indicator under review

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The Department of Health is struggling to reform a controversial quality indicator that has played a role in identifying hospitals with poor nursing standards.

The hospital standardised mortality ratio - essentially a death rate - is used by the data firm Dr Foster in its annual Good Hospital Guide, which is due to be published this year in November.

Mid Staffordshire Foundation Trust, Basildon and Thurrock University Hospitals Foundation Trust and Tameside Hospital Foundation Trust have all fallen foul of the firm’s mortality ratio and received critical media coverage about high death rates and poor care.

Investigations of those trusts by regulator the Care Quality Commission also uncovered nursing problems.

However, the methodology underlying the Dr Foster death rate is subject to debate and is now being reviewed by the Department of Health. Some have argued that the methodology is weak and that no single measure could accurately reflect hospital quality.

Last week the DH confirmed to Nursing Times’ sister magazine Health Service Journal that the review would not be complete before this year’s Dr Foster guide was published. This means more trusts could find themselves accused of poor performance before there is national agreement on whether the death rate indicator is legitimate.

The DH said the review had proposed a way to calculate “a new HSMR indicator for the NHS, labelled the summary hospital-level mortality indicator”.

However, it has to be tested and will not be finished until next year. Dr Foster said it would use its existing methodology for this year’s hospital guide.

A Nursing Times investigation last year suggested hospitals with higher nurse to bed ratios had lower death rates.

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