A plea for reason

Many of the arguments in the article by Lilford and Pronovost and the editorial by Black add nothing new to the debate on monitoring the quality of care.1 2 3 We recommend section G and appendix 9 from the Francis inquiry report on Mid Staffordshire for an independent review of these issues.4

The Healthcare Commission’s investigation into Mid Staffordshire5 preceded the Department of Health’s inquiry,4 as did reports by George Alberti and David Colin-Thomé. These were not public inquiries that “take on a life of [their] own”1 but serious investigations of what were found to be very poor standards of hospital care. Sometimes inspections by the Care Quality Commission, the Healthcare Commission’s successor, find problems and at other times they do not: finding problems is not a “self fulfilling prophecy.”1

Without the Healthcare Commission’s investigation,5 prompted by mortality alerts, it is likely that the unacceptable situation in Mid Staffordshire would have continued unchecked and unrecognised by the commission’s self assessment system based mainly on process measures.6 Under this system, two thirds of the standards of compliance were subsequently discovered to be wrong for hospitals considered to be at risk by the Healthcare Commission.7 We believe that an intelligent approach to monitoring quality of care is called for, making use of both outcome (including mortality indicators) and process information to ensure such tragedies do not occur again.