NHS surgery league tables – a work in progress

League table for surgeons – track records and success rates to be made public.

That was the headline in the Observer, which claimed that hospital surgeons would be graded in official league tables to be published within a year, giving patients information about doctors’ success rates for the first time.

That was in October 2001.

What has happened since then has been not a lot.

Individual heart surgeons’ death rates were made public in 2005, but only because the Guardian newspaper used freedom of information laws to access the data.

Two years later, a list of 200 heart surgeons and the overall scores of 38 NHS trusts was published by the Healthcare Commission. It was actually good news, showing that 96.5 per cent of the 35,000 patients who had heart surgery the previous year survived – above the average European survival rate.

And subsequently the Society for Cardiothoracic Surgery has praised itself for its members leading the way on this openness and transparency. But the fact is they were brought kicking and screaming to the (league) table.

There were all sorts of dire warnings that surgeons would be discouraged from taking on more difficult cases for fear of affecting their league position and that the information might mislead patients.

In the end they worked out a way of risk-adjusting the data, to take into account surgeons who had, for instance, more complex, sicker patients.

It has so far not been rolled out to other specialties, although patients have been promised it by next month in England.

Yet, even today, we are told that doctors will be able to opt out of the league tables because they have to be asked by law if they will allow their data to be published.

The implication, of course, is that the tables will be rendered meaningless. But according the NHS England’s own figures only four per cent have so far opted out. The Royal College of Surgeons also said that the vast majority of consultants were consenting.

However, a spokeswoman told me, there are numerous reasons why they might opt out. In bowel surgery, for instance, there may be two surgeons performing at the same time or there could be an entire team involved in the operation.

What she did say was that they are not in a position to hide. If a surgeon is what they euphemistically describe as an ‘outlier’ – that is one who has higher than average death rates, they are investigated. The only problem, of course, is that patients do not get to see those results.

It is also a fact that England is the first place in the world to try these league tables, so it is a model that is being worked on along the way.

Mind you, if there was any need of further evidence that change happens slowly in the NHS, I came across an article in the Sunday Times from May 2001 in which it was announced that more than half of Britain’s child heart surgery centres may be forced to close in a drive to improve standards.

This was in the wake of the Bristol heart scandal which left more than 100 children dead or brain-damaged.

Yesterday, the Health Secretary Jeremy Hunt told the Commons that the Safe and Sustainable Review was flawed and that plans to close three children’s heart surgery units in England would need to be postponed.

So 12 years after that announcement and 18 years after we first heard about what was happening at Bristol, the status quo holds.

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