Cardiothoracic surgeons, who as a specialty have promoted greater performance transparency, are having second thoughts over publishing patient death rates.
A letter from the Society for Cardiothoracic Surgery to NHS England CEO Simon Stevens says there is now considerable debate among its members over the value of surgeon-specific patient mortality data.
The letter says: “This debate is primarily driven by concern that publishing at consultant level results in risk-averse behaviour, with some surgeons less willing to operate on patients with a perceived high risk of mortality, despite potential overall patient benefit, because of a fear for the potential adverse consequences for themselves if the patient dies”.
The publication of performance data has been a key aim of NHS England medical director, Sir Bruce Keogh, a former heart surgeon, and Jeremy Hunt, the health secretary, who believe it will help drive up standards.
Cardiothoracic surgeons initially blazed a trail on publishing outcomes data on the Healthcare Commission website. However, after the creation of the Care Quality Commission, the data was left to drift and became out of date.
It was finally refreshed and added to on MyNHS – part of the NHS Choices website – and patients can research the type of operation they are going to have, establish how many similar operations are carried out each year and understand the potential risks associated with their operation.
However, a key measure for surgeons is the numbers of patients who die during or following an operation. The Society for Cardiothoracic Surgery collects this data and adjusts it to take account of the difficulty of the cases each surgeon takes on before being published on NHS Choices.
Now the Society says some surgeons are being vilified. Publication “is having a damaging effect on individual surgeons, with destruction of confidence, disruption of functional teams and inappropriate suspensions, with unfair media attention,” says the letter.
One surgeon was featured in the tabloid press after the release online in November of the latest data which showed he was one of three – along with a vascular and a colorectal surgeon – with higher-than-acceptable mortality rates.
Simon Kendall, secretary of SCTS, said the data was 18 months old and pointed out that surgery was about self-confidence and the confidence of others in the surgeon’s abilities. “If that confidence gets damaged, it becomes a much more difficult job,” he said.
Kendall acknowledged there was no hard evidence that surgeons were avoiding operating on sicker people with a higher risk of dying on the operating table, but he said a survey had found that 25% of heart surgeons were now less likely to take such cases and 75% had seen risk-averse behaviour in a colleague.
SCTS says it does not want to scrap all individual data but feels the public should see the results for the whole department first. There would then be explanations of the team-working and shared responsibility for what happens in the operating theatre and afterwards before people reached a breakdown of the individual surgeon’s results.
“We don’t want to stop individualised outcomes data,” he said. “We don’t want to change anything in the short term,” Kendall said. Ten years of data publishing had improved quality, he said. “There have been major improvements in outcomes despite the fact that we are operating on older and sicker patients.”
Ian Wilson, a well-respected heart surgeon at University Hospitals Birmingham NHS Trust, was dismissed last year for allegedly entering false data which made his own performance look better than it was.
Large numbers of patients now scrutinise surgeons’ published results. MyNHS gets an average of 17,700 visitors per week, of which about 14,000 are surgeon searches, according to the Healthcare Quality Improvement Partnership (HQIP), which collects and analyses all the data – now from 13 specialities – before putting it online.
Of those, 13% of searches are for adult cardiac surgery data – more than 1,800 searches per week.
Speaking to The Guardian, NHS England Medical Director Sir Bruce said there would be no going back on the principle of giving the public accurate and meaningful information on doctors’ performance.