As part of the "Everyone Counts" guidance, to drive up quality and help patients make informed decisions NHS England now publishes mortality rates for individual hospital consultants in ten specialties. This practice will also be part of the NHS Standard Contract from 2014/15.
The data – covering around 3,500 consultants can be seen on the NHS Choices website available via this link:
Data will be published in the following ten specialties:
- interventional cardiology;
- cardiac surgery;
- vascular surgery;
- upper gastro-intestinal surgery;
- colorectal surgery;
- orthopaedic surgery;
- bariatric surgery;
- urological surgery;
- head and neck surgery; and
- thyroid and endocrine surgery.
The data will initially be refreshed annually and publishing of data in this way will be mandatory from next year.
How can I use the data?
The information published so far includes how many times each participating consultant has performed certain procedures and what their mortality rate is for those procedures. You can see whether or not the data for each consultant is within or outside the expected range. Consultants who fall outside the expected range are sometimes referred to as ‘outliers’.
You can use this data to decide which consultant to choose for your care. However, there are some important issues to bear in mind when looking at the data.
For instance, the vast majority of the data has been through a process known as ‘risk adjustment’. This is a way of accounting for the different mix of patients operated on by a particular consultant’s team. Using risk adjustment, outcomes are calculated as if all consultants operated on the ‘average’ patient. This means that consultants who take on particularly poorly, high-risk patients or carry out the most complicated procedures don’t appear to have an unfairly high mortality rate.
However, not all the data can be ‘averaged out’ in this way. Specific reasons for this are outlined in the introductory text for each set of results. Where risk-adjusted data is not available, actual (also called ‘crude’) clinical outcomes are shown. If the data is not risk-adjusted, a consultant may have a higher mortality rate simply because he or she takes on more difficult cases.
If you have questions or concerns having viewed specific results, please discuss these with your GP or consultant.
What will the NHS do where consultants have high mortality rates?
Any hospital or consultant identified as an outlier will be investigated and action taken to improve data quality and/or patient care.
When will data be available for other procedures and specialties?
The results published to date were selected because relevant data was already being collected for these procedures and specialties. It is likely the programme will be extended from 2014 when data for other conditions can be collected and analysed in a similar way.
Where does the data come from?
The data comes from national clinical audits which continuously review medical practice to check that it is safe and seek ways to improve it. These audits are managed by ‘audit providers’ (usually academic institutions such as a university or royal college) which work with the specialist association. A specialist association is an independent, membership organisation, which represents a particular medical specialty.