Major breakthrough in NHS transparency as consultant mortality data goes online for first time

NHS England will today (Friday 28 June) begin the staged publication of mortality rates for individual hospital consultants in ten specialties, a major breakthrough in NHS transparency.

It is leading a drive to give patients more information about their treatment, helping the NHS drive up and maintain the quality of care.

The data – covering around 3,500 consultants – will appear on the website NHS Choices and will cover a range of operations and procedures.

Using national clinical audit data, it will show the number of times a consultant has carried out a procedure, mortality rates and whether clinical outcomes for each consultant are within expected limits. The specialist societies that have produced the data will also include additional indicators where appropriate to their specialty.

Outside of cardiac surgery, it is the first time that the performance of individual surgeons can be viewed openly online. It is also the first time globally that this level of performance information has been published.

Two specialties will go live today (Friday 28 June), with a further five specialties going live over the next seven days. An additional three specialties will go live with their data in Autumn this year.

The overall results are expected to reassure patients, with mortality rates for almost all surgeons being within the expected range.

Professor Sir Bruce Keogh, National Medical Director of NHS England, said: “This is a major breakthrough in NHS transparency.

“We know from our experience with heart surgery that putting this information into the public domain can help drive up standards.  That means more patients surviving operations and there is no greater prize than that.

“Surgeons deserve real credit for taking this voluntary leap. The public interest is clear but there were valid and proper concerns about the dangers of misinterpretation and a great deal of work has been done to address them.

“The NHS is on a journey with transparency.  The more we shine lights into corners of the NHS the more you will see.  That can be hard for NHS staff and policy makers. But it is the right thing to do.

“The data results show mortality levels. But in the majority of cases the issue is, how will an operation or procedure improve the quality of a patient’s life. Over time, the information that will be available will expand to include more indicators which reflect this important quality measure.”

Sir Bruce added: “There will inevitably be a small number of outliers, which is where the consultant’s data is outside an expected range. It is really important that people understand that somebody could be an outlier because they take on difficult cases. It doesn’t necessarily mean there is a performance issue. Where someone is an outlier, it is important that expert colleagues review the data so that the issues are properly understood by all.”

On surgeons who have yet not consented to publication of their data, Sir Bruce said:

“This is a major cultural change in the way the NHS works and we expect this to take time to bed in.  A small number of surgeons have so far not consented to their data being published but, as is our experience with the publication of cardiac data, we expect this to change over time with more consultants agreeing to their data being published.

“Now I expect hospitals and surgeons to use this information to judge the outcomes their patients are getting. This information will empower commissioners to make more informed decisions about the services they buy for their communities.”

The publication of consultant-level outcomes has been managed by the Healthcare Quality Improvement Partnership (HQIP), which runs the National Clinical Audit and Patient Outcomes Programme for NHS England. HQIP worked with the relevant specialist societies and audit project teams to bring the results together.

The reporting of the data was led by HQIP Outcomes Publication Director Professor Ben Bridgewater – a practicing heart surgeon who leads the successful cardiac consultant-level reporting which paved the way for this work.

Professor Bridgewater commented: “Ultimately there is one patient and one responsible consultant. This means the public can now know about the care given by each doctor and be reassured an early warning system is in place to identify and deal with any problems. A number of extra new safety checks have been created as natural by-products of putting this work in train, and this will only improve as processes are refined. In terms of geographical coverage and specialties covered, this is truly groundbreaking.”

The Secretary of State Jeremy Hunt said:

“We need to see a revolution in transparency in the NHS – publishing this data will not only drive better care for patients, it could literally save lives.  Publishing success rates in heart surgery has already led to one of the lowest mortality rates in Europe.

“These organisations have shown a real commitment to transparency in publishing this information.  This will help patients choose their surgeon and surgeons to learn from each other and strive to improve.  Transparency is key to becoming the world’s safest health system – not just by today’s standards but by the standards we all aspire to.”

Jeremy Taylor, Chief Executive of National Voices, the national coalition of health and social care charities, said: “We have known for many years that publishing the outcomes of surgery and other medical interventions is a vital driver for improved safety and quality.  The transparency genie is out of the lamp but some people seem to have been trying to put in back in again.  It is therefore very good to see this further step forward in clinical transparency.”

Initially, data will be available for ten surgical specialties and one medical specialty. This will develop and grow over time with further specialties being added.

There will be a staged publication of the data as follows:

Specialty Publication date
Cardiac surgery By 10am, Friday 28 June 2013
Vascular By 6pm, Friday 28 June 2013
Bariatric By 6pm, Sunday 30 June 2013
Interventional cardiology By 10am, Monday 1 July 2013
Orthopaedics By 10am, Monday 1 July 2013
Endocrine and Thyroid By 6pm, Monday 1 July 2013
Urology By 6pm, Friday 5 July 2013
Head and neck Autumn 2013
Bowel cancer Autumn 2013
Upper GI Autumn 2013

The publication of this data was initially set out in NHS England’s planning guidance ‘Everyone Counts: Planning for Patients 2013/14.’ On behalf of NHS England, the Healthcare Quality Improvement Partnership (HQIP) has worked with specialty associations to develop the data using selected national clinical and medical audits for consultants practising in these areas.

To date, around 99 percent of consultants have agreed or not objected to information regarding their practice being published. Consultants and their reasons for opting out of publication will be listed on the NHS Choices website.

The data will be available via via NHS Choices  and it will initially be refreshed annually and reporting of data in this way will be mandatory from 2014/15.

By summer this year, acute Trusts will be expected to link to the information on NHS Choices from their own websites.