The quality of care provided at a large busy hospital with many departments cannot be encapsulated in one bald statistic.
Nevertheless, monitoring death rates in hospitals and comparing them to the national average is an important means of flagging up potential problems.
It is not yet clear why mortality rates in two Lanarkshire hospitals - Monklands in Airdrie and Wishaw General - are higher than elsewhere, but it is essential to find out. It is to NHS Lanarkshire's credit that it is already working to investigate the issue and develop an action plan, but an internal review will not be enough to maintain public confidence. That is why the involvement of an external agency is so critical. That agency is Healthcare Improvement Scotland (HiS). Its association with health boards has been the subjecy of debate in recent months. An HiS report on Ninewells Hospital in Dundee referring to patients waiting hours for beds was delayed after a meeting with the chief executive of NHS Tayside and a new version was published later. In addition, comments about beds being too close together at the Royal Alexandra were not included in an official HiS report.
HiS is due to release its findings on NHS Lanarkshire in due course. It can answer its critics by publishing a report that is frank and direct, and fully reflects its findings. Patients in Lanarkshire have a right to expect nothing less.
Transparency matters so much within the NHS, and indeed across all public services, because, without it, poor standards might persist.
The Mid Staffordshire NHS Trust scandal in England is a chilling case in point. Sub-standard care had been allowed to continue at Stafford Hospital for far too long and it took a campaign by a group of angry relatives to highlight the problem. There is no suggestion at all that any such scandal is imminent in Scotland, but just because Mid Staffs did not happen in this country does not mean we should be complacent.
The NHS in Scotland makes use of effective early warning systems, such as hospital standardised mortality rate (HSMR) data, and shows willingness to escalate inspections rapidly within hospitals; good. To complete the picture, it is essential that the public trust HiS to act as its eyes and ears in hospitals.
Having a robust and reliable inspection regime has never been more important, given the unprecedented pressures the NHS is facing.
Other statistics published yesterday highlight the problem: A&E attendance figures show that there were fewer emergency attendances in the winter months (when stories emerged of patients waiting many hours on trollies for a ward bed to become available) than there have been in this summer. This suggests that the underlying cause of last winter's beds crisis was not too many A&E admissions, but bed blocking by existing in-patients (many with complex medical needs linked to age). As the Scottish population ages, such pressures will only increase.
The outstanding dedication of hospital staff ensures that most Scottish patients continue to receive excellent and timely care, but it is in the interests of both staff and patients that any emerging problems are dealt with promptly and openly.
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