17.11.14
Surgeons to be penalised if they fail to publish mortality rates
Surgeons will face penalties if they refuse to publish mortality rates of their patients, the medical director of NHS England has announced.
As part of the health service’s ongoing transparency efforts, performance data for about 5,000 surgeons is to be released on Wednesday so patients can compare death rates of hospital doctors. Patients are able to refuse to be operated on if they are worried about a surgeon’s poor figures.
However around 2,500 consultants have not published their figures, but the Royal College of Surgeons have said that all doctors can and do discuss outcomes with patients and “to suggest that we would need to be forced to be open is utterly misleading”.
Nevertheless, NHS England is looking into ways of forcing surgeons into revealing their figures. Sir Bruce Keogh said: “We are looking now at a series of inducements, penalties to force that [publishing death rates].”
He added that the move was necessary to help improve and maintain the quality of care.
Sir Bruce suggested that some of the measures that could be imposed on those surgeons who do not publish their mortality figures include failing their five-yearly revalidation and withholding financial bonuses.
He told the Sunday Times: “We will lose some surgeons. We will, and we have as a consequence of this endeavour.
“The other thing that is more likely, and will help with quality, is that those surgeons who are doing just a small number of operations will think ‘I’m not doing that any more’, and they will pass on those operations to their colleagues.”
The publication of death rates is controversial, with some experts saying they are not universally useful. Critics say that surgeons who take on some of the most complex cases might have a higher death rate than those cherry-picking the easier patients. Others worry that recording results in this way could mean trainee surgeons are given fewer chances to gain experience.
Sir Bruce, a heart surgeon, acknowledged that the move was unpopular with some, but was unrepentant and said: “This is not going to go away.”
Miss Clare Marx, president of the Royal College of Surgeons said: “Around 2,500 surgeons do not contribute to these current audits as their work does not include this sort of surgery or patient care – it is not that they have anything to hide. The NHS has decided to use only the current 13 audits for this year. Surgery depends on the entire team and the structure in which surgeons work. The RCS and Specialist Surgical Societies would therefore like to see further publication of data at a unit or team level.
“Surgeons do not need to be forced to hand over results. Surgeons participate in audit as part of their professional practice. Audit is part of the five year revalidation by the General Medical Council, the process by which all doctors are required to demonstrate they are up to date and fit to practise. It is conducted locally within the hospitals in which the surgeon work as well as nationally.
“All patients can, and do, discuss with their surgeons the likely outcome from their surgery, including their chances of dying. It is part of the professional nature of our work that we willingly discuss our outcomes with patients. To suggest that we would need to be forced to be open is utterly misleading.”
This week will see the data for surgeons operating in 12 areas, including kidney and heart surgery, published. Of the 5,000 consultants whose data has been published, the NHS has said that only four are considered outside the acceptable range.
(Image: c. John Chew)
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