Hospital Standardised Mortality Ratios
July 2024 to June 2025

About this release

This release by Public Health Scotland (PHS) provides information on Hospital Standardised Mortality Ratios (HSMRs) which are updated on a quarterly basis and reflect the HSMR for the latest 12-month reporting period July 2024 to June 2025. The associated crude mortality data is also presented by quarter and month to show trends from July 2020 to June 2025.

HSMR is a measure that compares the actual number of patient deaths in a hospital to the number predicted, after adjusting for the case-mix of patients. This adjustment accounts for factors (i.e. age, underlying conditions, illness severity) known to influence an individual’s risk of death, allowing hospitals to be compared against the Scottish average.

This publication has been produced using the updated HSMR methodology based on the 2025 HSMR Model Review which was published last quarter.

Main points

For the period July 2024 to June 2025:

• No hospitals had a significantly higher standardised mortality ratio than the national average.
• No hospitals had a significantly lower standardised mortality ratio than the national average. The standardised mortality ratio for Western General Hospital, NHS Lothian (0.84) is below the lower warning limit.

Funnel plot showing Hospital Standardised Mortality Ratios (HSMRs) for deaths within 30 days of admission, July 2024 to June 2025. Each point represents a hospital, plotted by number of expected deaths (x-axis) against HSMR (y-axis). No hospitals had a significantly higher standardised mortality ratio than the national average. One hospital had an SMR below the lower warning limit: Western General Hospital, NHS Lothian (0.84).

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HSMR for deaths within 30-days of admission, July 2024 to June 2025 ^p*

*Provisional

Background

HSMR is a risk-adjusted hospital mortality measure which has an important role to play in facilitating a critical examination of the quality of care and patient safety in Scottish Hospitals.

In Scotland, the national HSMR is set at 1.00. A hospital with an HSMR less than one has fewer deaths observed than predicted within 30 days of admission, whereas an HSMR greater than one indicates more observed deaths than predicted in the same period. However, a higher-than-predicted number of observed deaths does not necessarily imply that those deaths were avoidable, unexpected, or due to shortcomings in the quality of care.

HSMRs are calculated using data from all acute inpatient and day-case admissions across all specialties in hospital, excluding obstetrics and psychiatry as most of this activity is captured in separate datamarts. The metric includes deaths occurring within 30 days of admission, whether they happen in hospital or in the community.

The HSMR methodology has been updated as part of the 2025 Model Review to ensure it remains robust and continues to support fair comparisons against the national average over time. These updates are relatively minor and reflect best practice in statistical modelling and clinical relevance. Therefore, no changes are expected to crude mortality rates or the volume of hospital activity used in HSMR calculations. For more information, please refer to the 2025 HSMR Model Review and 2025 Technical Document.

Further information

A technical document is available on how HSMR is calculated. A frequently asked questions document is also available. For more information see the HSMR section of our website.

HSMRs published from August 2019 onwards cannot be compared to prior releases using a different methodology. For more information see Research and Development.

The next release of this publication will be 10 February 2026.