SURGEONS' LEAGUE TABLES OF DEATH

THE death rates of all surgeons will be published to try to avoid another Bristol heart babies scandal, the Government announced today.

Hospitals will also be given "star ratings" which will enable patients to compare the performance of doctors and services in their area, Health Secretary Alan Milburn said.

The plans were announced as part of the Government's response to the damning report into the Bristol scandal. The three-year, multimillion pound inquiry was the biggest in the history of the NHS and exposed the way in which the performance of individual surgeons and entire hospitals had gone unmonitored.

It found that up to a third of child heart patients treated at the Bristol Royal Infirmary between 1988 and 1995 received "less than adequate care" and that the death rate at the paediatric cardiac unit was double that of elsewhere.

Twenty nine children died as surgeons claimed they were on a "learning curve" with the introduction of a new type of operation.

However, the parents of children who died during those years told the inquiry how they were misled about the risks involved and not informed of the true death rates.

The inquiry has led to an overhaul of the way the medical profession is regulated and how consent is gained for operations.

The General Medical Council is now putting the final touches to its " revalidation" process, which will require doctors to prove their continuing fitness to practise at regular intervals, possibly every five years.

Professor Ian Kennedy's damning report, published in July, made 198 recommendations, including proposals to regulate NHS managers and to make bodies such as the Commission for Health Improvement and the National Institute for Clinical Excellence independent of the Department of Health.

The Government has already implemented some of the recommendations, creating a national director of children's healthcare services and issuing guidelines for patients on the questions they should ask before consenting to treatment.

By April 2004 the Department of Health will have published mortality rates for the previous two years for every cardiac surgeon in England. From April 2005 the rates will be published on a rolling three-year basis for each cardiac centre and each cardiac surgeon.

Problems started at the Bristol Royal Infirmary in 1988 when a new type of hole-inthe-heart surgery for babies was introduced. By the early Nineties, the death rate was so notorious that doctors from other hospitals called it "the killing fields".

Anaesthetist Stephen Bolsin became so concerned that he conducted his own audit of operations being carried out by surgeons James Wisheart and Janardan Dhasmana which showed their death rates were higher than average, The surgeons disputed his findings and senior managers, including hospital chief executive Dr John Roylance, ignored Mr Bolsin's concerns. The anaesthetist was eventually forced out of his post.

In 1998 the General Medical Council began one of its biggest-ever professional misconduct cases into the behaviour of Wisheart, Dhasmana and Roylance. Wisheart and Roylance were struck off the medical register while Mr Dhasmana was banned from operating on children for three years.

The inquiry also uncovered how thousands of children and adults who died in hospitals around the country were stripped of their hearts, lungs and other organs without the knowledge of relatives.

Dr Harvey Markovitch, spokesman for the Royal College of Paediatrics, said today: "Broadly speaking, we are in favour of this, as we feel that referring doctors and parents do have a right to know this information. Our anxieties are to do with the anxieties of surgeons, that the figures will only mean something if they are making a fair comparison."

CASE FOR AND AGAINST

FOR

Death tables will help restore public confidence in the NHS. Parents in Bristol did not know they were consenting to operations by surgeons who had death rates double the national average.

It will enable managers to spot when problems are beginning to arise.

Bristol highlighted a situation in which a surgeon's mistakes or incompetence were often spotted too late.

A national overview of success rates for different operations will emerge, allowing hospitals to compare themselves with each other, and enabling patients to see exactly what standard of service they are getting from their local hospital.

AGAINST

Data collection has been very scrappy in the past. The BMA is working with the Department of Health to improve the process, but that may mean consultants having to do a lot more paperwork to ensure the statistics mean something.

Crude death rates d o n' t t a ke i n t o account important variations, such as the fact that some surgeons and hospitals operate on much higher-risk cases than others.

It could destroy team morale.

Surgeons do not act alone but are supported by highlyskilled teams of anaesthetists, nurses and technicians who all need to work closely together.

Copyright 2002
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