The resurrection of hospital mortality statistics in England.
Mortality statistics for English hospitals were published by the Labour government in 1998, partly in response to the tragedy at the Bristol Royal Infirmary involving the deaths or serious injury of babies and children who had had unsuccessful heart operations. Despite being presented as an important innovation, this publication policy had a number of precedents, most notably the data produced as a result of Florence Nightingale's efforts in the 1860s and the clinical indicators developed by the Scottish Office in the early 1990s. In addition, league tables of death rates for English hospitals were available from 1992 to 1996, although there was widespread ignorance of their existence. This paper examines each of these precedents before discussing events that weakened public trust in the medical profession's ability to regulate itself and led to the Labour government's decision to resurrect the publication of hospital mortality data. It is suggested that these performance indicators may be largely symbolic of the government's broader commitment to performance assessment, but it is also recognised that, if coupled with appropriate incentives, public disclosure of mortality data may foster genuine performance improvements.
Street
Andrew
A
Centre for Health Economics, University of York, York, UK.
D022126:Access to Information; D002983:Clinical Competence / Q000706:statistics & numerical data; D003625:Data Collection / Q000266:history / Q000379:methods; D030881:Disclosure; D004739:England / Q000453:epidemiology; D049672:History, 19th Century; D049673:History, 20th Century; D049674:History, 21st Century; D017052:Hospital Mortality; D006779:Hospitals, Public / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D007255:Information Services / Q000266:history; D008505:Medical Staff, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D015279:Organizational Culture; D011643:Publishing / Q000266:history; D019984:Quality Indicators, Health Care; D012606:Scotland / Q000453:epidemiology; D013222:State Medicine / Q000592:standards