Improving and assuring accuracy
There is a need for a review by the Department of Health, the Information Centre and the UK Statistics Authority of the patient outcome statistics, including hospital mortality and other outcome indicators. In particular, there could be benefit from consideration of the extent to which these statistics can be published in a form more readily useable by the public.
- The Office for Statistics Regulation (OSR) assessed SHMI in Assessment Report 308 (published 30 July 2015) and confirmed it as National Statistics (now termed "Accredited Official Statistics"), the highest designation for official statistics in the UK. The assessment was conducted following a request from the Secretary of State for Health (OSR, Assessment Report 308, July 2015).
- SHMI has been published monthly since January 2019 (previously quarterly), providing more frequent and accessible mortality data for providers and the public. It is published by NHS England Digital with full methodology documentation (NHS England Digital, SHMI).
- The NHS Outcomes Framework publishes patient outcome statistics across five domains, with indicators reviewed through periodic consultations. The framework has been published annually since March 2022 (previously quarterly).
- NHS England Digital publishes indicator data on the Indicator Portal, providing access to a wide range of outcome, quality, and safety indicators in formats enabling public use and comparison. The review of patient outcome statistics that Francis recommended has been substantially implemented through these mechanisms.
How was this evidence gathered?
Response
Accepted
Response
AcceptedThe government published "Hard Truths: the Journey to Putting Patients First" (Cm 8777) on 19 November 2013, responding to all 290 recommendations of the Francis Report. This followed an initial response "Patients First and Foremost" in March 2013. Key reforms included a new Chief Inspector of Hospitals, strengthened Care Quality Commission inspection regime, a statutory duty of candour, and the fit and proper person test for NHS directors. Volume 2 (Cm 8754) contains the government's detailed responses to each of the 290 recommendations. See: https://assets.publishing.service.gov.uk/media/5a7cd486ed915d63cc65d167/34658_Cm_8777_Vol_1_accessible.pdf
Published Evidence
Published assessments of progress from inspectorates, select committees, official progress reports, and other sources. Source type badge indicates whether each assessment is independent or government self-reported.
Summary Hospital-level Mortality Indicator (SHMI) published monthly as Accredited Official Statistics by NHS England. Provides standardised transparent methodology for comparing hospital mortality rates. Ratio of actual deaths within 30 days of discharge to expected deaths.
Research published 2023 marking ten years since the Francis Report found mixed results. Structural and legislative changes largely delivered (duty of candour, FPPR, CQC overhaul, revalidation, Freedom to Speak Up Guardians). However, cultural change not fully embedded; understaffing, fear of speaking up, and poor complaint handling persist in parts of the NHS.
Government published "Culture Change in the NHS" (Cm 9009) reporting progress on all 290 recommendations. Key achievements: 19 hospitals placed in special measures; those trusts recruited 109 additional doctors and 1,805 additional nurses; 129 board-level changes made; excess avoidable deaths fell by 450 in less than a year.
Government published "Hard Truths: The Journey to Putting Patients First" (Cm 8777) in two volumes. Vol 1 set out new actions; Vol 2 provided detailed response to each of the 290 recommendations. Approximately 204 of 290 recommendations were fully accepted.