Dobson reveals surgery death rates

Fifty years of secrecy surrounding the clinical performance of NHS hospitals was finally breached yesterday with publication of the first comparative figures for deaths among patients in England who have undergone surgery. People will now be able to check their local hospital's performance against the average and against figures for similar units. Hospitals with poor relative performance, and no good excuse, will be required to make speedy improvement.

Accuracy


However, the impact of the first set of figures was blunted by problems over the accuracy of some of the data and government warnings that it would be premature to draw firm conclusions. Frank Dobson, health secretary, said: "Some of [the figures] may not be as accurate as we would like, but we felt that after putting in the best part of two years' effort, we needed to make them public."

Similar clinical indicators have already been published in Scotland and Wales. The English series gives six categories including deaths in hospital within 30 days of surgery, both emergency and routine; deaths in hospital of people over age 65 admitted with broken hips; and emergency readmission to hospital within 28 days of previous discharge. Additionally, the department of health has published 41 performance indicators, revising and expanding those introduced by the last government and enabling comparison between NHS trusts and health authorities on issues such as length of wait for treatment, incidence of disease, cancer survival rates and tooth decay among children.

Doubts about validity of some of the data notwithstanding, health service leaders acclaimed their publication a watershed.

Stephen Thornton, chief executive of the NHS Confederation, representing health authorities and trusts, said: "I think it is the beginning of an unstoppable process of greater openness in the NHS. Patients need as much information as is reasonable to give them."

Doctors' groups were more cautious, but welcomed the figures as a step forward. James Johnson, who chairs the joint consultants' committee representing senior hospital doctors, said: "It is completely unacceptable that as we approach the 21st century, we still have so little meaningful data by which doctors and hospitals in the NHS can compare their performance."

Ranking


Most attention will focus on the clinical indicators, particularly the death rates, but the health department is cautioning against regarding them as league tables. As a crude ranking shows, hospitals with some of the worst records for deaths after routine surgery in 1997-98 were specialist cancer or heart units such as the Christie in Manchester, Papworth in Cambridge and Harefield, Middlesex. Cancer units also have high readmission rates for further therapy.

The Northern Devon Healthcare trust says its poor showing is erroneous, claiming its true performance is better than average. The NHS Executive has admitted to "major technical difficulties" with the trust's figures.

At the other extreme, however, the excellent showing of the Leicester Royal Infirmary will be seen at least partly as the product of pioneering "re-engineering" work undertaken by the trust in recent years, whereby staff went back to the drawing board to find better ways of doing things.

Mr Dobson said he did not want patients and their GPs to use the figures to shop around for the best care. Rather, the aim was to bring under-performing hospitals up to the average for units of their type, allowing for general health and social differences across the country. Stressing that it would take a long time to perfect the data before unambiguous lessons could be drawn, the minister said he was "not setting deadlines" for hospitals to show improvements.

Mr Johnson warned that care would be needed to avoid doctors being deterred from treating high-risk patients, fearing a rise in the death rate. And Mr Thornton cautioned against the temptation to "name and shame" poor-performing hospitals. "We don't want them to engage in some of the gaming with the data that has gone on in other countries," Mr Thornton said.

Deaths after non-emergency surgery


Lowest

Leicester Royal Infirmary

Robert Jones & Agnes Hunt Hospital, Oswestry

Northallerton Health Services

Wrightington Hospital, Wigan

Westmorland Hospitals

Highest

Northern Devon Healthcare

Christie Hospital, Manchester

Papworth Hospital, Cambridge

Harefield Hospital, Middlesex

Stockport Healthcare