Given how important it is to be able to measure quality of care it’s surprising, to me at least, how badly we currently do it. One measure widely used in many countries, including the UK, is the hospital standardised mortality ratio (HSMR). Various methods have evolved for calculating it, each one hotly defended by its proponents. But voices in this week’s BMJ say the HSMR has had its day and should be scrapped.

Discrepancies between how Dr Foster and the Care Quality Commission rated hospitals in Mid Staffordshire set Nigel Hawkes on the HSMR’s trail, as well as the improbably large 7% reduction …