By Nick Triggle Health correspondent, BBC News
Only heart
surgeons have published individual performance data so far
The first wave of new performance data for individual
surgeons in England is being published in what is being hailed as a historic
moment for the NHS.
Vascular surgeons have become the first of a new group of
nine specialities to publish the information, including death rates.
It appears on the NHS
Choices website. The other groups will follow in the coming weeks.
But the move has been overshadowed by some surgeons refusing
to take part.
They were able to do this because of data protection laws,
although earlier this month Health Secretary Jeremy Hunt warned that those
refusing to take part would be publicly named.
Just six out of nearly 500 vascular surgeons, who specialise
in procedures on the arteries and veins, including stents, have opted out.
But NHS Choices states none of the six had results outside
the normally expected range.
This is an historic moment for surgery, and I'm
enormously proud of what surgeons up and down the country have achieved”
Prof Norman WilliamsRoyal College of Surgeons
They have been named as Richard Bird, Patrick Kent, Robert
Lonsdale, Manmohan Madan, Peter McCollum and Leszek Wolowczyk.
They, and their reasons for opting out - including not
agreeing with publication of the data - are detailed on the
website.
Vascular surgeon Peter McCollum told BBC Radio 4 that he
opted out because the data was "inherently flawed".
"Bad surgeons will not be picked up by this process -
and it puts pressure on younger surgeons not to do any difficult surgery at
all."
He said he would prefer data to be analysed on a unit level,
rather than for individual surgeons, because this would give a better picture
of outcomes.
Nonetheless, the move to publish this data is being viewed
as a significant milestone.
To date, individual performance data has only been published
for heart surgeons.
But for years there has been debate about whether other
areas of medicine should follow.
The publication of surgery-specific data was first called
for in 2001 by Prof Sir Ian Kennedy, who chaired the inquiry into the excessive
number of deaths of babies undergoing heart surgery in Bristol.
'Clam up'
Understanding the data
It is important not to view the surgeons' performance data
as a league table.
Surgeons all carry out a different range of procedures, even
within the same specialty. They also deal with a different number of cases each
year, on both high and low-risk patients.
Some surgeons will have many complex patients. Also, some
procedures are inherently riskier than others.
What the tables do show are the number of times a procedure
has been performed by a surgeon over a year, the mortality rate and - after
adjusting for risk - if the outcomes fall within an acceptable range.
It's acknowledged that surgeons need to perform a certain
number of operations to keep their skills at a high level.
But some doctors have been resistant to widening publication
of data for eight surgical specialties and cardiology, as there is a fear that
it may give a misleading impression.
Those doctors who take on the most difficult and complex
cases may appear to be performing badly, when in fact they could be the leading
specialists in their field.
The specialities taking part account for about 4,000
surgeons, more than half the workforce.
Alongside mortality rates, the data includes information on
other aspects such as length of stay in hospital after a procedure.
NHS medical director Sir Bruce Keogh told the BBC:
"This has been done nowhere else in the world, and I think it represents a
very significant step.
"A number of great British institutions have lost some
element of public trust recently because they're seen to clam up when things go
wrong.
"It's my ambition that we in the NHS do exactly the
opposite and we share the way we perform and what we offer our patients with
the public, who I think really deserve to see how well we're performing,
because everybody owns the NHS."
'Celebration'
Sir Bruce Keogh says the public deserves to see the data
Prof Norman Williams, president of the Royal College of
Surgeons, said: "This is an historic moment for surgery, and I'm
enormously proud of what surgeons up and down the country have achieved.
"It has been a difficult and complex undertaking
carried out in a short timescale but we see this as the beginning of a new era
for openness in medicine.
"It is early days, but it will change for the better
the nature of the bond between patient and surgeon, which is based on both
openness and trust."
The college said that overall it looked as if more than 99%
of doctors had agreed to the release of the data this summer with fewer than 30
expected to resist.
On BBC Radio 4's Today programme, Ian Martin, a surgeon and
president of the Federation of Surgical Specialty Associations, said:
"What we're seeing today is almost a celebration that British surgery has
the confidence to allow the public and patients, quite rightly, to have an
insight into the workings behind what they do.
"But I think there are some qualifications here, and
it's important to understand that this data has limitations.
"We've got to be incredibly careful when we tell the
public that what we tell them is qualified and they understand what that
means."
Vascular surgeon David Mitchell says the data will reassure
some patients that have concerns
Cardiac surgeon Prof Ben Bridgewater added: "We've been
collecting data on cardiac surgery since 1996 and we've been publishing it at
individual surgeon level since 2005, and what we've seen associated with that
is big improvements in quality: the mortality rates in cardiac surgery today
are about a third of what they were ten years ago.
"We liken it to the British Olympic cycling team,
whereby you just tighten up on every little thing that you do, and every member
of the team tightens up on every little thing that they do, and that leads to
big improvements in quality."
'Transparency'
In a discussion on the programme, Sir Bruce said the data
would force surgeons to think twice before risky operations.
"With difficult cases, these results force people to
think more carefully and encourages surgeons to send those more difficult cases
on to other more specialised surgeons."
But he denied that publishing the data would make surgeons
more risk averse.
He said: "Secrecy is not the way forward - transparency
really is."
Roger Taylor, who analysed the data for the Today programme,
said he applauded the doctors who had the courage to publish their data.
But he said it was important to put the information in
context.
"It would be interesting knowing the volume of
operations done by each doctor because those who did fewer operations tend to
have poorer outcomes."
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