From the outset, research by the Dr Foster Unit has made a considerable impact on national policy and the research agenda. In short, we have shown the value of hospital administrative data for measuring and monitoring the quality and safety of healthcare here in the UK and abroad.

Research

The value of our methodological contribution to the public inquiries into children’s heart surgery at the Bristol Royal Infirmary and into the crimes of GP Harold Shipman was recognised by the inquiries’ chairmen:

“[Their work] is innovative and, as I had hoped, it has made a real contribution to the debate about the feasibility and the value of setting up a system for the routine monitoring of mortality rates among the patients of GPs” (Dame Janet Smith in her final report for the Shipman Inquiry).

“The Hospital Episode Statistics database should be supported as a major national resource which can be used reliably, with care, to undertake the monitoring of a range of healthcare outcomes” (Ian Kennedy in her final report for the Bristol Royal Infirmary Inquiry).

After we had shown in these two inquiries and related work [ref the inquiries and our BMJ casemix paper] the potential for statistical monitoring of hospital outcomes using routine data, we developed a system to do this using England’s national database, HES. This system is used by managers and clinicians in over two-thirds of NHS hospital trusts to monitor quality of care and was pivotal in alerting the then Healthcare Commission (HCC) to problems at the Mid Staffordshire NHS Foundation Trust. This led to Department of Health reviews of mortality data and monitoring. The national regulator also still uses HES data in its work.

Our research has increased the use of administrative data in the management and monitoring of healthcare in the UK and internationally [link to international page]. We continue to develop and assess the value of new measures of quality and safety such as unplanned reoperations and patient safety incidents.

Policy

Our analyses of mortality rates by day of the week admissions and around the junior doctor changeover have led to real policy changes. Our work on both emergency and elective patients in hospital during the weekend [refs] has stimulated recent NHS moves to provide 24/7 high quality care in the NHS. Our findings of an increase in hospital death rates during the junior doctor changeover have resulted in recommendations put forward by the Academy of Medical Royal Colleges for improved consultant cover⁷ and for a program of shadowing for F1 doctors before they commence work.⁸

One of our most cited papers, “Mortality associated with delay in operation after hip fracture”, underpins the NICE Clinical Guideline on hip fracture which recommends that hospitals “Perform surgery on the day of, or the day after, admission”.

Media coverage