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BMJ. 2007 September 1; 335(7617): 416.
PMCID: PMC1962865

Surgery outcomes are to be made public—but a five year wait is likely

The Royal College of Surgeons of England plans to make information on the performance of individual hospital units in all types of surgery publicly available in the next five years.

However, press reports have said that proposals to make data on surgical outcomes public would be included in the NHS operating framework for 2008-9 (Guardian, 28 Aug, p 1).

The move is seen as the best way to provide reliable information on which to base NHS commissioning decisions and the recertification of surgeons, as well as to help patients decide where they would like to be treated. It follows the introduction of new standards for judging survival after heart surgery at individual hospitals, the results of which were published by the Healthcare Commission last month (BMJ 2007;335:321, 18 Aug doi: 10.1136/bmj.39307.393750.DB).

The performance of individual surgeons will not be made public, as it has been done for heart surgeons, said Bernard Ribeiro, president of the Royal College of Surgeons.

He explained: “In cardiac surgery you have a very definable end point: death. That's very easy to measure. But in general surgery the risk of death is small. You therefore need to be very careful what end point you are measuring.”

The contribution of other medical staff, such as anaesthetists and nurses, all affected outcome of surgery and how patients felt about their treatment, he said. “We must look at how a unit performs rather than an individual.”

He dismissed fears that this approach might conceal poorly performing surgeons. “If there are outliers, trust chief executives will know who they are,” he said. “This is not a witch hunt.”

The college had been agitating for publicly available data on surgical outcomes since 2005 and had reiterated their importance to the health secretary, Alan Johnson, in a meeting three weeks ago, he said.

A Department of Health spokesman refused to confirm or deny the Guardian's report that proposals to provide publicly available data would be included in the next NHS operating framework. He added that quality indicators for a range of procedures and treatments at individual trusts had already been published on the NHS Choices website for patients in June (www.nhs.uk/Pages/homepage.aspx).

The group responsible for drawing up these indicators “are now working with us to develop further quality indicators, which we plan to publish later this year,” the spokesman said.

“The college is very involved with all of this,” said Mr Ribeiro. “But we are still some way away from the sort of indicators the Department of Health are looking for.”

The heart surgeons took years and spent a great deal of money to arrive at their risk adjusted data, Mr Ribeiro said, adding that measurable data should be available within the next three years and data on differences among techniques by 2010-11.


Articles from The BMJ are provided here courtesy of BMJ Publishing Group