The NHS has published a further wave of performance data for consultant surgeons in England. Members of the public can now access, via the My NHS search tool, performance data for almost 5,000 individual consultants, together with quality data for hospitals, social care and public health services in England. Whilst some of this data has previously been available via NHS Choices, the My NHS dedicated service makes it more easily accessible to the public, with the stated aim that: “Making our data transparent will help to drive up quality and create even better services”.
The published consultant performance data currently covers only ten surgical areas and a limited number of procedures, which have been selected using factors such as whether the procedure is currently covered by audit, how frequently the procedure is undertaken and whether it is considered to be a good indicator of skill. The data shows how many times a particular consultant has performed a procedure and, where available, indicators of quality such as length of hospital stay, number of revisions and mortality rates.
Whilst concerns have been raised about the usefulness and quality of the data, the national medical director of NHS England, Sir Bruce Keogh, has commented that the primary aim is transparency. And, to share risk between the patient and the surgeon, to focus the surgeon’s mind on the appropriateness of surgery for each patient and to ensure that the most appropriate surgeon undertakes each operation.
Others have warned that this transfer of risk may impact adversely on surgeons, potentially leading to some consultants refusing difficult cases. Undoubtedly, any data indicating underperformance would be referred to in any complaints involving an individual for whom data has been published. The Royal College of Surgeons has commented that there is anecdotal evidence that last year’s publication of data has encouraged risk-averse behaviour, which is not in the best interests of patients.
Notwithstanding the potential adverse impact of publication on surgeons, Health Secretary Jeremy Hunt has warned that surgeons who refuse to take part will be publicly named. Indeed the names of 6 vascular surgeons, and their reasons for opting out, have been published. Those reasons highlight the concerns that the data may be flawed or result in pressure on surgeons not to attempt difficult surgery.
It remains to be seen whether such a culture of risk-adversity will hinder the development of highly skilled surgeons in England and the quality of care available over the long term. However, it is clear that the move by NHS England towards a culture of transparency is a positive development. It is hoped that a culture of openness about treatment outcomes will extend to NHS Trusts and clinicians confronting mistakes at an early stage and accepting responsibility where appropriate. Appropriate handling of complaints may, in turn, lead to increased public trust in healthcare providers and clinicians and an overall reduction in the number of medical negligence claims.