You Won't Feel a Thing

I saw something on TV today about plans for the NHS to publish surgeons’ death rates to improve transparency and enable people to use this information to guide their decisions as to whether to go with a particular surgeon or not.  I found this quite interesting so thought I’d post my thoughts on it, which I hope makes a refreshing change from the types of issues I normally write about!

I’m all for the NHS being as open, honest and transparent as possible, and I’m all for patients being given comprehensive information, choice and control in their care.  Unfortunately, I don’t think publishing surgeon success rates will achieve this.  Numbers of deaths occurring under a person’s care, although at face value may seem important, is actually a pretty arbitrary and fairly useless piece of data.  There are so many other variables to be considered, such as type and difficulty level of the procedure, pre-existing health factors or underlying conditions in the patient, and unforeseen complications during surgery.  Providing death rates alone could result in a very capable surgeon who is able to deal with complex cases being considered less competent by patients than they really are, meaning said patients may request a different surgeon (and perhaps end up with a poorer outcome!).  This is a problem, and I believe that if the NHS is to share this data with patients it should be provided in context and supplemented by other data to help the patient make sense of it.

Further, it seems possible that this will be detrimental to staff morale and performance: surgeons may become less likely to opt to take on complex or challenging cases, and the publication of figures may create scapegoating when things go wrong in surgery.  It is important to remember that a whole team of people is involved in surgery, not just the surgeon.  There may be a danger that by publishing this data, fingers are wrongly pointed at surgeons regarding their performance (when it is quite possible that deaths may have been due, for instance, to an error by the anaesthetist).   The culture of box-ticking, blame and covering one’s back is in my opinion already too prominent in the NHS, and there is a danger that this move will only serve to make things worse on that front.

Patient reassurance: death rates probably not the answer!

Finally, whilst in potentially life-threatening operations this data may be salient, in most cases the person would surely more likely want to know their anaesthetic will be successful, recovery will be quick, they will have minimal pain and be unlikely to have to undergo further surgery (“it’s ok, you won’t feel a thing”, that sort of thing!).  The value of publishing death rates would be much enhanced by providing information on these sorts of things too.  This is the type of information that would really empower patients to make truly informed choices about their care.

Finally, surely it is reasonable to expect that generally you are in safe hands when undergoing surgery?  If a surgeon’s death rates raised cause for concern, I would certainly hope that the NHS would be investigating this and taking necessary action where competency proves to be below the required standard.  If standards are robustly monitored in this way then one would expect there to be no cause for concern, which would in fact make the publication of this data completely redundant!

Does this move really promote patient choice?

To conclude, whilst I am in favour of NHS transparency and patient choice, I really don’t believe the publication of surgeons’ death rates will make any real progress towards achieving this.  Sadly I believe this is a tokenistic gesture to give the illusion of openness and patient control whilst not actually delivering this, but continue to look forward to the day when our healthcare services genuinely give us these outcomes!