We understand from the chairman of the Healthcare Commission that its system for identifying and following up ‘alerts’ about apparently high mortality rates has been in operation for less than two years. Details of the methodology used and number of alerts followed up in the first year of operation (August 2007 to July 2008), but not of the trusts concerned, are set out in the commission’s report “Following up mortality outliers”, which is published on the commission’s website at:
85 ‘alerts’ were considered in the first year. After statistical analysis, 43 were not pursued with the trusts concerned. The commission pursued the remaining 42 with the trusts until it confirmed it was satisfied with the explanation for the apparently high rates and with actions being taken. When pursuing alerts with trusts the commission looks for:
evidence that the trust has given serious consideration to the commission’s questions and has addressed all of the matters raised;
robust evidence in support of the trust’s arguments;
an indication of whether the trust was already aware of the issue and was already taking some form of action;
evidence that the trust is making reasonable clinical judgments; and
assurance that the trust is monitoring its own rates of mortality and is undertaking reviews where necessary.
The chairman of the Healthcare Commission has commented that each ‘alert’ relates to mortality rates for a specific diagnosis or condition rather than to an overall trust-wide or hospital-wide mortality rate.