The NHS Trust which runs St George’s Hospital in South London has become the first in the UK, and possibly the world to publish all its death rates by individual clinical specialty.

The death rates are published in the form of graphs on the Trust website.

The graphs, for a full range of specialties from birth to geriatrics, are risk-adjusted according to a formula developed by the Trust’s Mortality Monitoring Team. The formula works out objectively which risk factors affect the death rate for any given specialty and then apply weightings to those factors. The formula and those that developed it were star performers in last year’s Health Service Journal Awards for patient safety.

Senior doctors at St George’s are very clear that it is not possible to use their figures to compare with other hospitals. While other hospitals may choose in time to publish similar information, as yet there is no common risk-adjustment process.

But St George’s publication will allow patients, relatives and the public to see what exactly the chances of death in any particular clinical specialty are at the hospital. More broadly, the graphs show that, despite some concern that hospitals are increasingly ‘unsafe’ places, in fact the opposite is true. The overall death rate for patients is falling consistently.

There are several reasons why the Trust has decided to publish its death rates in this way:

  • A desire to have a well-informed dialogue with patients and the public about clinical safety in hospitals
  • The fact that NHS hospitals are accountable to the public for their clinical, as well as management performance
  • The move to patient choice in the NHS means patients will want increasingly detailed information about the clinical safety and reputation of hospitals
  • Improving risk-adjustment methodology means achieving a balance between accuracy and simplicity is easier

Trust Chief Executive Peter Homa has been a keen advocate of openness and improving patient safety at St George’s:

“Our patients are increasingly well-informed, and will very shortly be in a position to make choices about where they go for their treatment. Many factors will play a part in those choices, and issues like car parking and cleanliness will be important.

“However, we also know that the more serious and complex the operation, the more the clinical safety, record and reputation of the hospital will be a factor for the patient, in consultation with their GP. By using carefully developed risk adjustment systems, in a format that is easy to understand, we can show our patients not only that we have high standards in patient safety, but also that they are steadily improving in the long term.

“There may be some who say we are oversimplifying, that this is too complex for the public to understand, or that they do not agree with our risk-adjustment system. We appreciate those sorts of concerns, but we feel that we have really begun to get a good balance between risk-adjustment on one hand, and ease of understanding on the other.

Mr Mike Bailey is the Medical Director who leads on patient safety issues at St George’s, and is himself an expert urology surgeon:

“We have had extensive discussions with consultant colleagues at St George’s about taking this step. The consultant body has been enthusiastic and supportive of our publication of mortality rates, building as it does on our publication earlier this year of cardiac surgery mortality rates.

“We have received helpful comments both from consultants and from our patient representative groups about how to present the data to make it easily understandable.

“We think that by being the first NHS hospital to publish this information, we can inform our dialogue with patients, GPs and the public about clinical safety and outcomes. We are aware of the level of interest in this type of information and hope that by providing it in this way, we will demonstrate that we are very focused on the quality of care we deliver.”

Notes to editors

  1. Mortality rates for all specialties managed by the George’s Healthcare NHS Trust are published on the Trust website: