How good is your surgeon?

The Norfolk and Norwich University Hospital.

The Norfolk and Norwich University Hospital. - Credit: PA

Performance data for around 5,000 surgeons revealing how many patients have died in their care over the past year was made public by NHS England on Wednesday.

The league tables were launched for the first time last year but have been extended to cover 13 surgery areas and an extra 1,000 consultant surgeons for 2014.

The data shows the mortality rate of patients who have undergone a specific operation, such as cardiac surgery, under an individual doctor and whether they are within expected limits.

NHS England said the mortality rates for 'almost all surgeons' are 'within the expected range'.

The data is being published on new website MyNHS where patients can compare critical data about hospitals and the professionals who will be treating them.

In a speech on Wednesday, Health Secretary Jeremy Hunt said: 'Transparency is about patient outcomes, not process targets. It uses the power of a learning culture and of peer review, not blame.


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'Healthcare globally has been slow to develop the kind of safety culture based on openness and transparency that has become normal in the airline, oil and nuclear industries. The NHS is now blazing a trail across the world as the first major health economy to adopt this kind of culture.'

But despite Norfolk surgeons being given a clean bill of health, not all are happy with the publication of the data.

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Liam Hughes, an interventional cardiologist who has worked at the Norfolk and Norwich University Hospital (N&N) for 20 years, said: 'I, along with all the cardiologists at the N&N are comfortably within the accepted range of performance.

'However as Mark Twain famously said, 'there are lies, damn lies and statistics'.

'As presented, the crude data is potentially very misleading to the public and may have a detrimental rather than the anticipated 'transparency is always good' consequence.

'Everybody is competent but some surgeons will appear below average and if you're recording performance and ranking people what happens to the poor patients who think 'I'm going to look up Mr So and So. Oh my goodness, he is in the relegation zone'.'

He added the statistics did not take account of how risky individual procedures were. 'It will make some surgeons risk averse, for fear that your results will be used against you. Having an operation is intrinsically risky,' he added.

NHS England's medical director Professor Sir Bruce Keogh who has championed better transparency in the NHS, said the website will help to drive up standards.

'This represents another major step forward on the transparency journey,' he said.

'It will help drive up standards, and we are committed to expanding publication into other areas.

'The results demonstrate that surgery in this country is as good as anywhere in the western world and, in some specialities, it is better.

'The surgical community in this country deserves a great deal of credit for being a world leader in this area.'

At the weekend Sir Bruce said penalties will be enforced against hospital consultants who refuse to publish patient death rates, with around 2,500 believed to not be taking part in the initiative.

He told the Sunday Times: 'We are looking now at a series of inducements, penalties to force that (publishing death rates).'

He added: 'We will lose some surgeons. We will, and have as a consequence of this endeavour.'

But critics said the move to publish surgeon's performance data is 'crude and misleading'.

John MacFie, president of the Federation of Surgical Speciality Associations, which represents surgeons, said: 'There is now good anecdotal evidence that shows publishing this data has encouraged risk-averse behaviour, which is not in the interest of patients.

'I believe that the data should only be published after any concerns in a surgeon's performance have been investigated.

'In reality very few deaths can be attributed to surgical error alone, and this data only attracts attention away from institutional failings. Put simply, hospitals should not be allowing surgeons to practice unless they can demonstrate their practice is safe.'

Work to compile the data has again been led by the Healthcare Quality Improvement Partnership (HQIP), which manages the National Clinical Audit programme on behalf of NHS England.

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