The Summary Hospital-level Mortality Indicator (SHMI) is a score that reports on mortality rates at trust-level across the NHS in England, using a standard and transparent methodology. It is produced and published quarterly as an official statistic by the Health and Social Care Information Centre (HSCIC) and was published first in October 2011.
Following the recommendations from the national review of the Hospital Standardised Mortality Ratio (HSMR), the Department of Health commissioned the HSCIC to produce and publish SHMI. As part of the review, the Department of Health also commissioned independent statistical modelling work, which was carried out by the School of Health and Related Research (ScHARR) at the University of Sheffield.
The SHMI is the ratio between the actual number of patients who die following hospitalisation at the trust and the number that would be expected to die on the basis of average England figures, given the characteristics of the patients treated there. In essence, therefore, SHMI is trying to do the same things as HSMR – it’s just that different variable factors are taken in to account in calculating the scores. The principle one of these is that SHMI includes deaths following a patient’s discharge (within 30 days).
Below are two charts showing the Trust’s latest rolling 12-month ratings, which are published every quarter and are always six months in arrears. The first chart, which is based on data published nationally by the HSCIC, shows a broadly improving performance in the Trust’s SHMI score since 2012, although more improvement is needed.
One area for which SHMI does not an adjustment is palliative care. The Trust is one of a handful of hospital groups in the NHS that has a hospice (most are run by charities); it also is unusual in having a seven-day a week palliative care service. Whilst both of these are important services for patients, they have an effect between them of more patients being coded as dying within our care – which many would argue skews the Trust’s SHMI rating. Dr Foster Intelligence uses the data produced by the HSCIC and adjusts it for palliative care, the results of which are set out in the second table below. The latter shows SHMI scores that better reflect the Trust’s performance and matches more closely other mortality indicators – such as HSMR and crude mortality.
Data source – Dr Foster Toolkit – July 2015 refresh