Patient death rates to be made public

The patient death rate of every heart surgeon in the country is to be made public within two years, the government announced yesterday in its final response to the Kennedy report on the NHS failings that allowed babies to die unnecessarily in heart operations at the Bristol royal infirmary.

The health secretary, Alan Milburn, said it was a first step to giving the public hard information about the performance of every doctor - and the right to go elsewhere if they chose. He called it "a milestone in the development of a more open, responsive and patient-centred NHS".

Surgeons, who have been privately collecting data on death rates for more than 20 years, are less than happy. "They are not comfortable but recognise it as an inevitability," said Bruce Keogh, secretary of the Society of Cardiothoracic Surgeons. They fear that they will be condemned on the basis of data that is wrong and that publishing results will lead to surgeons avoiding difficult, high-risk cases where the only hope is an operation, but the patient is likely to die.

"There is little doubt, when we look at the history of cardiothoracic (heart and lung) surgery, that the very best have been surgeons whose operative mortality was the highest," said Mr Keogh.

Roger Boyle, the government's national heart director, paid tribute to the cardiothoracic surgeons' courage in agreeing to have the individual data made public. "Their cooperation has been impressive. It is agreed it is the patients and their families who should come first," he said. Children's heart surgeons' death rates will not be published so soon, because the data has not yet been collected in a useable form.

The government has taken six months to compile its 200-page response. Professor Sir Ian Kennedy's team found that around 35 babies had died during or after complex heart surgery at the Bristol royal infirmary not only because the surgeons were not good enough at certain new techniques, but also because many others in the medical establishment did not act to stop them operating.

Most of the report's 198 recommendations were accepted yesterday. Mr Milburn accepts the urgent need to drive up standards in the NHS, improve the quality of care, put patients at the centre of NHS thinking, and be more open and honest about mistakes.

Negligence


One of the most crucial elements of Prof Kennedy's vision, however, has been left on hold. He says the concept of clinical negligence must be abolished and litigation, which cost the NHS over £400m in 1999/2000, must end. He wants a no-fault compensation scheme, with a sliding scale of payments for victims of medical accidents. It is the only way, he says, to end the blame culture and persuade doctors to admit their mistakes.

The government has asked a working group convened by the chief medical officer, Sir Liam Donaldson, to report and promises a white paper within months, but it is expected to propose a dual system, with no-fault compensation for those who choose it but recourse to the courts still a possibility.

Prof Kennedy said he hoped for a "sufficiently radical" white paper, "prepared to ask the fundamental questions instead of tinkering with the existing systems. What I'm about is a declaration of war on cover-up, fear and lack of openness."

While the government has set up a national patient safety agency, which encourages doctors and nurses to report mistakes so everyone can learn from them, there are signs of resistance to total openness in the document published yesterday, which was produced after consultation with professional bodies. A recommendation that patients be able to tape crucial consultations with their doctors, which has been advocated in cancer care, was rejected on the basis that it could "undermine the relationship of trust" between patients and their doctors, who fear it could be used against them.

Two safety issues which the Kennedy team felt were important have also been rejected. Doctors who become managers should not be allowed to treat a few patients on the side "to keep their hand in", it said. Unless doctors saw patients all the time, their skills would deteriorate and patients could be at risk. The government disagreed.

It also disagreed that the national institute for clinical excellence alone should set standards and produce guidelines for doctors on treatment to avoid dangerous confusion. The government says the royal colleges, medicines control agency and others are also experts.

"I think it's most unfortunate that they haven't accepted the need for clear lines of responsibility and accountability with somebody being ultimately in charge and without duplication, which we recommend as regards standard-setting," said Prof Kennedy. "A central feature of Bristol was this game of pass the parcel. Adopting this approach we run the risk that this situation might continue."

But he was generally pleased with the wholesale adoption of most of his report. "I'm impressed by the seriousness and care of the response," he said.