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Medics' NHS league table mortality figures mired in confusion Medics' NHS league table mortality figures mired in confusion
(3 months later)
The launch of the first performance league tables for medics were thrown into confusion on Friday when it emerged that several surgeons had been erroneously listed as having the highest crude mortality rates in the country.The launch of the first performance league tables for medics were thrown into confusion on Friday when it emerged that several surgeons had been erroneously listed as having the highest crude mortality rates in the country.
The tables, the centrepiece of the government's new transparent NHS, are supposed to build public confidence by showing patients how well consultants across England perform against each other.The tables, the centrepiece of the government's new transparent NHS, are supposed to build public confidence by showing patients how well consultants across England perform against each other.
Vascular surgeons, who repair major blood vessels and prevent strokes, were the first of a new group of nine specialities to publish the information, including crude death rates. The figures are based on five years of data from patients who had their operation from 2008.Vascular surgeons, who repair major blood vessels and prevent strokes, were the first of a new group of nine specialities to publish the information, including crude death rates. The figures are based on five years of data from patients who had their operation from 2008.
However, when the data for two key operations conducted by vascular surgeons was published, newspapers alighted on unadjusted measures to claim that surgeon Simon Payne, who is based at Portsmouth Hospitals, had a "death rate of 31% – 10 times the national average and 30 times higher than some of his colleagues".However, when the data for two key operations conducted by vascular surgeons was published, newspapers alighted on unadjusted measures to claim that surgeon Simon Payne, who is based at Portsmouth Hospitals, had a "death rate of 31% – 10 times the national average and 30 times higher than some of his colleagues".
When contacted by the Guardian, the hospital trust in Portsmouth said: "Simon Payne has not carried out that procedure since 2011 after he had a shoulder injury." Once this had been considered, Payne's crude mortality rate was just 2%.When contacted by the Guardian, the hospital trust in Portsmouth said: "Simon Payne has not carried out that procedure since 2011 after he had a shoulder injury." Once this had been considered, Payne's crude mortality rate was just 2%.
The professional body charged with drawing up the data from 472 vascular consultants had to reissue the tables, lowering the crude mortality figures substantially in many cases. In NHS Grampian, vascular surgeon Euan Munro reduced his crude mortality rate from one in eight patients to one in 30 in the reissued tables. In another case, a surgeon was listed as operating at a trust when she was not working there.The professional body charged with drawing up the data from 472 vascular consultants had to reissue the tables, lowering the crude mortality figures substantially in many cases. In NHS Grampian, vascular surgeon Euan Munro reduced his crude mortality rate from one in eight patients to one in 30 in the reissued tables. In another case, a surgeon was listed as operating at a trust when she was not working there.
The NHS warned against ranking surgeons' unadjusted figures, which do not take in factors such as the age of the patient. The vascular surgical procedures which came under scrutiny – elective abdominal aortic aneurysm and carotid endarterectomy – are conducted mainly on men aged 70 to 80. Despite this, both procedures are considered relatively safe, with a mortality rate of about 2.5% nationally.The NHS warned against ranking surgeons' unadjusted figures, which do not take in factors such as the age of the patient. The vascular surgical procedures which came under scrutiny – elective abdominal aortic aneurysm and carotid endarterectomy – are conducted mainly on men aged 70 to 80. Despite this, both procedures are considered relatively safe, with a mortality rate of about 2.5% nationally.
Prof Ben Bridgewater, a director at the Healthcare Quality Improvement Partnership, which runs the consultant-level outcomes for NHS England, said the crude estimates were "virtually worthless" because they failed to take into account the number of emergency cases, the age of the patients or the complexity of each operation. "You have to adjust for the caseload. Some newspapers have just taken the crude data for mortality rates and named people. We have to be careful here," said Bridgewater.Prof Ben Bridgewater, a director at the Healthcare Quality Improvement Partnership, which runs the consultant-level outcomes for NHS England, said the crude estimates were "virtually worthless" because they failed to take into account the number of emergency cases, the age of the patients or the complexity of each operation. "You have to adjust for the caseload. Some newspapers have just taken the crude data for mortality rates and named people. We have to be careful here," said Bridgewater.
The vascular surgery report makes it clear that once adjustments have been made that the surgeons considered all fell within what were considered safe margins of error. Claims that Philip Chan, of Sheffield Teaching Hospitals, had a mortality rate of 18% were therefore misleading. David Throssell, the medical director of Sheffield Teaching Hospitals NHS foundation trust said: "The report clearly states that the mortality rates of all our surgeons fall within the expected range when risk factors such as complexity of patient's health and age have been taken into account."The vascular surgery report makes it clear that once adjustments have been made that the surgeons considered all fell within what were considered safe margins of error. Claims that Philip Chan, of Sheffield Teaching Hospitals, had a mortality rate of 18% were therefore misleading. David Throssell, the medical director of Sheffield Teaching Hospitals NHS foundation trust said: "The report clearly states that the mortality rates of all our surgeons fall within the expected range when risk factors such as complexity of patient's health and age have been taken into account."
In the coming months, data will be made available on 3,500 medics from 10 specialities but it is understood thatIn the coming months, data will be made available on 3,500 medics from 10 specialities but it is understood that
the information will be rolled out to incorporate all surgical consultants.the information will be rolled out to incorporate all surgical consultants.
Just six of the vascular consultants opted out of allowing the publication of their results, a right enshrined in the Data Protection Act which says that surgeons must give their permission. They were named on the NHS Choices website as Richard Bird, who works for Barnet and Chase Farm Hospitals NHS trust, Rob Lonsdale from Sheffield Teaching Hospitals, Hull Royal Infirmary's Peter McCollum, Leszek Wolowczyk from Tameside Hospital, North Manchester general hospital consultant Manmohan Madan and Patrick Kent, who is understood to work at private company Spire Health in Leeds. All six performed within the "expected range", officials said.Just six of the vascular consultants opted out of allowing the publication of their results, a right enshrined in the Data Protection Act which says that surgeons must give their permission. They were named on the NHS Choices website as Richard Bird, who works for Barnet and Chase Farm Hospitals NHS trust, Rob Lonsdale from Sheffield Teaching Hospitals, Hull Royal Infirmary's Peter McCollum, Leszek Wolowczyk from Tameside Hospital, North Manchester general hospital consultant Manmohan Madan and Patrick Kent, who is understood to work at private company Spire Health in Leeds. All six performed within the "expected range", officials said.
Hull Royal Infirmary said: "Prof McCollum's outcomes are among the best in our trust, we have absolutely no concerns at all about his work."Hull Royal Infirmary said: "Prof McCollum's outcomes are among the best in our trust, we have absolutely no concerns at all about his work."
The surgeons' reasons for abstention included objections to the data quality and the way the figures are "risk adjusted" and opposition to having their data put in the pubic domain.The surgeons' reasons for abstention included objections to the data quality and the way the figures are "risk adjusted" and opposition to having their data put in the pubic domain.
Sir Bruce Keogh, the medical director of NHS England, warned in an article for the Guardian: "I think the patient enters the agreement for surgery with the surgeon and someone has to be accountable for the team's outcomes."Sir Bruce Keogh, the medical director of NHS England, warned in an article for the Guardian: "I think the patient enters the agreement for surgery with the surgeon and someone has to be accountable for the team's outcomes."
He said there had been some strange challenges. "For some, it is simply fear of the unknown. For others, there is a genuine objection to the principle of attributing surgical results to an individual when those results are dependent on effective teamwork between surgeon, anaesthetist, theatre and ward nurses and physiotherapists. We concluded that the legal duty for NHS England to promote quality and its commitment to transparency as a driver for quality was in the greater public interest."He said there had been some strange challenges. "For some, it is simply fear of the unknown. For others, there is a genuine objection to the principle of attributing surgical results to an individual when those results are dependent on effective teamwork between surgeon, anaesthetist, theatre and ward nurses and physiotherapists. We concluded that the legal duty for NHS England to promote quality and its commitment to transparency as a driver for quality was in the greater public interest."
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