Hospital Standardised Mortality Ratios
October 2024 to September 2025

About this release

This quarterly release by Public Health Scotland (PHS) provides information on Hospital Standardised Mortality Ratios (HSMRs) for the latest 12-month reporting period October 2024 to September 2025 which are based on patients admitted during this period and include all deaths within 30 days of admission, whether in hospital or the community

Assessing patient safety and the quality of care delivered in hospitals is essential. The Hospital Standardised Mortality Ratio (HSMR) is a key indicator that measures hospital mortality. It compares the observed number of patient deaths associated with a hospital to the number predicted after adjusting for the case mix of patients. This adjustment accounts for factors such as age, underlying health conditions, and severity of illness, enabling hospitals to be compared fairly against the Scottish average.

Main points

For the period October 2024 to September 2025:

• No hospitals had a significantly higher standardised mortality ratio (above three standard deviations) than the national average. However, the standardised mortality ratio for Royal Infirmary of Edinburgh at Little France (1.12) is above the upper warning limit (above two standard deviations), which indicates a higher than predicted number of deaths. See background for further details.
• No hospitals had a significantly lower standardised mortality ratio than the national average, which indicates that none reported fewer number of deaths than predicted.

Funnel plot showing Hospital Standardised Mortality Ratios (HSMRs) for deaths within 30 days of admission, October 2024 to September 2025. Each point represents a hospital, plotted by number of expected deaths (x-axis) against HSMR (y-axis).

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HSMR for deaths within 30-days of admission, October 2024 to September 2025 (provisional)

Background

HSMR acts as a signal, highlighting hospitals where mortality is higher or lower than predicted. This prompts hospitals to review their care processes, check for possible issues and identify areas for improvement.

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 (considered less suitable for inclusion due to low mortality and differing pathways).

The HSMR methodology is reviewed periodically to ensure it remains robust and continues to support fair comparisons against the national average over time. For more information on the most recent update, 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 12 May 2026.