A new measure published for the first time by the NHS Information Centre today highlights the extent to which mortality rates vary from trust to trust.

The summary hospital-level mortality indicator has been developed by the NHS IC and compares the actual number of patients who die following treatment at a trust with the number who would be expected to die, given the characteristics of the patients treated there.

It differs from other mortality indicators because it considers all deaths that take place in a trust as well as those taking place within 30 days of discharge. As a result, it offers a new and more comprehensive picture of deaths following hospital care.

The NHS IC was commissioned by the Department of Health to produce the measure and it has been developed in consultation with a wide range of experts. It is currently classed as ‘experimental' which means its methodology may be refined in the light of feedback from trusts and other users.

Summary Hospital-level Mortality Indicator (SHMI), England 1 April 2010 to 31 March 2011 (Experimental statistics) shows mortality rates – or SHMI values – for every acute non-specialist trust in England.

It categorises them as: ‘as expected', ‘higher than expected' and ‘lower than expected' using two differing methods of classification.

The SHMI values of 14 trusts were ‘higher than expected' under both methods, while those of 14 trusts were ‘lower than expected' under both methods.

NHS Information Centre chief executive Tim Straughan said: “The SHMI is best treated as a ‘smoke alarm' that should be used locally by individual hospital trusts to assess and investigate their mortality-related outcomes.

“Though a powerful measure, it should not be taken in isolation as a headline figure of trust performance. It requires careful interpretation and for that reason it is not specifically tailored for use by patients or the public, though we understand there will be clear interest in it.

“Hospital mortality rates have been used across the NHS for a number of years and have been useful in helping trusts identify trends that need further investigation.

“The SHMI marks a major step forward for the NHS, as it will be the single summary hospital-level mortality indicator that will be used consistently across the NHS. We have ensured that everyone can see how it is calculated by publishing details of its methodology on our website. We've done this both in the spirit of transparency and also to help encourage debate about the measure and how it is used.”

The report, which will be published quarterly, is at www.ic.nhs.uk/pubs/shmi1011

ENDS

Notes to editors

1. The NHS Information Centre is England's authoritative, independent source of health and social care information. It works with a wide range of health and social care providers nationwide to provide the facts and figures that help the NHS and social services run effectively. Its role is to collect data, analyse it and convert it into useful information which helps providers improve their services and supports academics, researchers, regulators and policymakers in their work. The NHS Information Centre also produces a wide range of statistical publications each year across a number of areas including: primary care, health and lifestyles, screening, hospital care, population and geography, social care and workforce and pay statistics.
2. There are currently a number of generic mortality indicators used in the NHS. They have been designed by different organisations using different statistical methods to help identify trends that require further investigation. Following the Review of the Hospital Standardised Mortality Ratio (HSMR) in 2010 (http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_121328.pdf), the Department of Health committed to adopting the SHMI as the single summary-level indicator for hospital mortality. It commissioned the NHS Information Centre to develop, deliver and publish the SHMI as it does all national indicators.
3. This indicator has been developed in collaboration with a range of national stakeholders following a review commissioned in 2010 by medical director for the NHS in England Sir Bruce Keogh and chaired by Ian Dalton, then chief executive of the North East Strategic Health Authority. It involved a wide range of stakeholders, including the Department of Health, representatives from strategic health authorities and trusts, the NHS IC, the Care Quality Commission, Monitor, the Kings Fund, the Academy of Royal Colleges, the NHS Confederation, Dr Foster Intelligence, CHKS, University Hospitals Birmingham, the National Patient Safety Agency and Professor Sir Brian Jarman and colleagues from Imperial College. During 2011, several members have continued to support and contribute to the technical work associated with the development and construction of the SHMI (from the Department of Health, the Care Quality Commission, Dr Foster Intelligence, Dr Foster Imperial , CHKS and University Hospitals Birmingham).
4. The report includes two funnel plots, each presenting a different method for classifying trusts according to which ones have SHMI values that are ‘as expected', ‘higher than expected' and ‘lower than expected'. The NHS IC agreed to present both methods of classification at the request of the technical advisory group convened to support development of the measure. This was to reflect differing views within the expert technical group on the best method of classification. The methods presented achieve a different balance between the risks of falsely identifying a trust as not ‘as expected' when it is and falsely identifying a trust as ‘as expected' when it is not.
5. For media enquires please call 0845 257 6990 or contact mediaenquiries@ic.nhs.uk