Patient survival rates for individual surgeons will be published from 2013

Surgeons in 10 specialties in the NHS in England will be ranked in new league tables covering survival rates of patients and quality of care from next year, the NHS Commissioning Board has announced.

In its planning guidance for 2013-14, published this week, the board set out plans for healthcare providers to publish consultant level data for specialties including adult cardiac, vascular, and orthopaedic surgery by summer 2013.1

Results for individual cardiothoracic surgeons have been published since 2005, because the specialty was prompted to collect the data by the publication of the Kennedy report into children’s heart surgery at Bristol Royal Infirmary.

Publication of data from surgeons in a wider group of specialties will become a contractual obligation from 2014-15 to allow comparison across hospitals. Information on interventional cardiology, upper gastrointestinal, colorectal, bariatric, urological, head and neck, and thyroid and endocrine surgery will also be published.

The move—recently trailed by the NHS Commissioning Board’s medical director, Bruce Keogh2—is a key strand of the board’s policy to stimulate patient choice in the NHS by publishing more data about the quality of care. The board’s guidance, Everyone Counts: Planning for Patients 2013/14, sets out a raft of incentives and levers designed to improve services and tackle health inequalities. The board said that the publication of league tables would help clinical commissioning groups meet targets set in the new NHS outcomes framework and help doctors deliver more responsive health services and better outcomes among patients.

The board will also regularly collect “core clinical data” from general practices to help analyse outcomes across care pathways and encourage service integration, with the first set of data published alongside the new guidance. It said that this would sit alongside a “comprehensive set of data” on hospital care that it would develop for 2014-15.

Commissioners will be expected to put in place mechanisms to gather “real time patient and carer feedback and comment” for all services by 2015, beginning with the “friends and family test,” a simple question asking whether patients would recommend a service to their friends or family. This will be used among all acute hospital inpatients and emergency department patients from April 2013.

Also included are details of how the quality premium—a new financial incentive to be paid to clinical commissioning groups—will be paid from 2014-15. Payment will depend on their improvement or achievement on four national measures and four locally agreed measures of quality, set together with local health and wellbeing boards. The national measures will include potential years of life lost from causes considered amenable to healthcare, avoidable emergency admissions, the friends and family test, and incidence of healthcare associated infections. Groups will not qualify for payments if they overspend on approved limits in 2013-14.

The board said that the introduction of the quality premium, subject to regulations, will be part of a “fundamental review of incentives, rewards, and sanctions” that the board will carry out in time to plan for 2014-15.

David Nicholson, the board’s chief executive, said, “We want to put power in the hands of clinicians who know their patients best. We want to give them the money, information, and tools to do the job. And we want the public to have the information they need to make choices and participate fully in the development of their health services.”

Norman Williams, president of the Royal College of Surgeons, said that the college “wholeheartedly” supported the move to greater transparency, citing how the “successful publication of outcomes data for heart and vascular surgery has already shown how outcomes can drive standards in the NHS.”

But he added: “However, designing ways to measure the outcomes from across surgery that would give credible and meaningful data is extremely complicated, and no one size fits all.

“It is vital that any analysis of surgeons who take on the higher risk patients (such as those with complex health needs like diabetes and respiratory problems) is fair and reflects the complexity of these conditions so as not to deter surgeons from treating difficult cases for fear of being penalised.”