League tables to show surgeon death rates

The first league tables of heart surgeons' death rates were today promised by the government in its latest attempt to create a more patient-centred NHS and make doctors more accountable, in the wake of last year's highly critical Bristol Royal infirmary inquiry report.

Launching the government's formal response to the inquiry report by professor Ian Kennedy QC, the health secretary, Alan Milburn, said that information on death rates within 30 days of surgery would be published for every cardiac surgeon in England from April 2004, with the support of the Society of Cardiothoracic Surgeons.

The initiative, which was explicitly recommended by the Kennedy report, paves the way for the controversial introduction in the next few years of performance league tables measuring the mortality rates of individual consultants in a wide range of medical specialities.

Mr Milburn told MPs that the NHS had changed profoundly since the early 1990s when the Bristol scandal was unfolding. "There's a real recognition that the old order has quite fundamentally changed."

The government also accepted other Kennedy recommendations including the creation of a new Council for the Quality of Health Care to co-ordinate the health service's myriad quality and inspection bodies.

The National Institute for Clinical Excellence, which measures the cost effectiveness of new drugs and treatments and has the power to restrict their use on the NHS, will be given a more independent role.

In Wales, a national director for children's services is to be appointed in response to the Bristol heart surgery inquiry. A national director for England, Professor Al Aynsley-Green, was appointed in July 2001.

Many of the recommendations of the Kennedy report have already been accepted including: proposals to strengthen the Commission for Health Improvement, the NHS inspectorate; the setting up of the National Patients Safety Agency; and measures to give patients more say in their treatment and care.

Mr Milburn hailed the cardiac league tables as a "milestone in the development of a more open, responsive and patient-centred NHS" and said the NHS needed to publish more information for the benefit of patients.

Negotiations are continuing with the British Paediatrics Association to publish similar information on children's heart surgery, Mr Milburn added.

By April 2004 the Department of Health will have published mortality rates, for the previous two years, for every cardiac surgeon in England. From April 2005 the rates will be published on a rolling three-year basis for each cardiac centre and each cardiac surgeon.

The 180-page government response, Learning From Bristol, follows a multi-million pound inquiry into abnormally high death rates at the children's heart surgery unit the hospital in the late 1980s and early 1990s.

The far-reaching inquiry report addressed fundamental issues of safety, professional culture, and clinical accountability in the NHS and prompted Professor Kennedy to make wide-reaching recommendations for a more open and responsive health service.

Twenty-nine children died and four were left brain damaged while undergoing operations at the Bristol Royal infirmary (BRI) between 1998 and 1995.

The inquiry was ordered by the then Health Secretary Frank Dobson in 1998 after the General Medical Council found two surgeons and the chief executive of the BRI guilty