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19th September 2007

Surgery success rates are to be made public by the NHS

Three fundamental changes in the NHS are driving a strategy to provide increased transparency to the performance of NHS hospitals, specialist units, and in some specialities, even those of individual surgeons.

The changes being discussed are the result of the medical royal colleges wanting to measure individual consultant’s performance as a reliable means of deciding whether they should be allowed to retain their licence to practice. This is being proposed as part of a plan for regular reviews of professional standards.

Hospital departments which under-perform in the future, will be put under pressure by NHS commissioners who want to know the quality of each department to allow the purchase of care units from the best performing ones.

The third change is planned to allow patients to make informed choices about where they go for their treatment. Patients are often asked to make their decisions based on material provided by the trusts, which emphasize the quality of meals or their car park facilities. Patients will be able to compare the quality of the clinical care provided for their particular medical condition.

An “operating framework” is expected to be published for 2008 / 9 that will include proposals to make the success rates available to the public. When the government moves away from setting central targets, successful medical outcomes should be the key driver of local improvement in the health service.

This builds on the recently published survival rates of patients undergoing coronary artery bypass grafts and aortic valve replacements, a pioneering initiative by heart surgeons. The fear was that publishing figures for patients who had died would result in misleading patients by suggesting higher fatality scores for some surgeons. It was also thought that there would be reluctance by some surgeons to take on cases that are more difficult.

These fears proved unfounded, following the introduction of risk-adjusted data. The publication of the data has brought huge benefits to the surgeons who are now able to explain the figures and introduce patients to the concept of risk.

It is hoped that other specialities will embrace these moves and identify relevant outcomes to form the basis of measurement of their speciality.

From a patient's perspective, such moves can be seen as positive initiatives to improve the quality of the service they can expect, by a more proactive approach to risk management. The availability of such data in the past would have highlighted hospital departments or particular surgeons that were in difficulty, so potentially preventing historic tragedies such as that of children’s heart surgery in Bristol.

Surgical Success Rate Useful Websites

For more details of this initiative go to the Guardian website at http://society.guardian.co.uk/health/story/0,,2157370,00.html

You can also find more information at the British Medical Association (BMA) at
http://www.bma.org.uk/ap.nsf/Content/infospecialists

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