NHS chief: surgeons have ‘moral responsibility’ to publish death rates
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Version 0 of 1. Surgeons have a moral responsibility to make public their death rates in operations according to the medical director of the NHS. Sir Bruce Keogh, whose crusade for transparency has resulted in the launch of a website containing data on outcomes for 5,000 NHS surgeons, told the Guardian in an exclusive interview: “Anyone who does an intervention to somebody else has a professional and moral responsibility to be able to describe what they do and defend how well they do it. “That is the essence of professionalism. They should be happy to share that with their patients. In a sense what this endeavour does is demonstrate a new level of professionalism.” Led by Keogh, a former heart surgeon, the NHS published some outcomes data last year but in a far less accessible form. The new site, My NHS, which is part of NHS Choices, will allow patients to search for the results of their potential surgeon, as well as the hospital. But there is evidence of a backlash from some quarters. John MacFie, president of the Federation of Surgical Specialty Associations, called the publication of the data crude and potentially misleading, adding that some important data such as length of hospital stay and further surgery were omitted. Publication of the data was causing some surgeons to avoid more difficult cases where the chances of the patient dying are higher, he said. “There is now good anecdotal evidence that shows publishing this data has encouraged risk-averse behaviour, which is not in the interest of patients. I believe that the data should only be published after any concerns in a surgeon’s performance have been investigated.” But Keogh said that the data was collected by the surgical associations themselves. If information was missing from some specialisms, they could put that right. Publication encouraged surgeons to try to improve, he said. “These are the same arguments that we heard after Bristol in 2001 [the inquiry into the deaths of babies during heart surgery at the Bristol Royal Infirmary which first recommended the publication of mortality data],” he said. “Your readers would be forgiven for thinking this shows a lack of ambition and could be interpreted as protectionist.” The data covers 10 of the 13 surgical specialities – the rest will be added in the coming weeks. The performance of the vast majority of surgeons is within an acceptable range, but a very few are not. “In all of this we have found three surgeons who were outliers [poorer outcomes than the norm], but if this really works, we pick up people with whom there are concerns well before we get to the publication stage,” said Keogh. He declined to elaborate on the three outliers. “They know, their hospitals know and their specialist associations know,” he said. “The combination of those three means appropriate action can be taken.” My NHS includes searchable data on food quality, staffing, patient safety, mental health and other areas of care. From early December it will include the Care Quality Commission’s individual risk rating for GP practices. Keogh in 2006 pioneered the publication of heart surgeons’ individual mortality data by the Society for Cardiothoracic Surgeons, of which he is a former president. They had been encouraged, he said, by the Guardian which had collected and published data from hospital trusts through 36 freedom of information requests the previous year. “There was a bit of menace there from the FoIs, but the fact that it was so responsibly reported gave us the courage to realise that it was not as bad as we feared,” he said. The health secretary, Jeremy Hunt, said that Keogh and heart surgery colleagues had shown the NHS 10 years ago that there was an alternative way to drive up standards than with targets. “They achieved dramatic improvements in performance, not through new targets, but by publishing results for individual cardiac surgeons for the first time,” he said in a speech at the Foundation Trust Network Conference. “Transparency is about patient outcomes not process targets “It uses the power of a learning culture and of peer review, not blame. “Healthcare globally has been slow to develop the kind of safety culture based on openness and transparency that has become normal in the airline, oil and nuclear industries. The NHS is now blazing a trail across the world as the first major health economy to adopt this kind of culture.” The Royal College of Surgeons said it supported NHS England’s commitment to provide more information to patients. “Patients and surgeons should have honest and open conversations about the likely outcome of their surgery and best treatment options available,” said its president, Clare Marx. “Publishing consultant outcomes is just one step for ensuring that dialogue and trust is present.” |