Mortality data and transparency in the NHS (and elsewhere)

In Health industry, How to work better, Uncategorized on October 29, 2008 by Alan Lovell Tagged: , , , , , , , , ,

I read an article in the HSJ the other day about mortality rates during NHS operations being made available to the general public. It is, apparently, possible to find mortality rates for certain procedures on the NHS Choices website, but it certainly ain’t easy. I’ve just been pottering around for a while and, finally, for example looking at coronary bypass surgery at some London trusts, I got to this page (I hope the link works for you – if not, start on the homepage and click ‘compare hospitals’ and then ‘compare hospitals for treatments’ and, well, carry on from there). Some data is given to compare hospitals, though not explicit mortality rates – rather, they all have the same statement that with regards to mortality it is “As expected compared to the UK average”, which is not particularly helpful, especially given that the HSJ article implied that such a statement would be found for all NHS Trusts. I suppose that’s a good thing, i.e. that there’s no great disparity in care between Trusts, though it would be nice to see a few above average Trusts breaking from the pack (though of course that would then doom some to be below average…).

Other questions for which there is data for some of the Trusts are “does the surgical department have a lot of experience in this operation?”, “how long am I likely to spend in hospital?”, “how long will I wait from referral to treatment?”, and “how well does this organisation control MRSA blood infections for elective patients” (although for these last two questions the site does warn that different NHS trusts collect data in different ways, and hence the data are not comparable between trusts. Ho hum). The statistics are rather crude, and collected at the Trust level, so in real terms for the patient having to decide where to go for his/her coronary bypass operation they are pretty much useless. However, there are two things to say. One is that I expect (hope) that the data being collected will become more helpful, comparable and granular as time goes on. Secondly, even given their crude, unhelpful state at the moment, I’m delighted the data are out there.

I like being open and publishing outcome data because the act of transparency helps ensure that everyone “ups their game” as Paul Levy, a big fan of transparency (whatever the costs) might put it. It makes us all uncomfortable, as we all make mistakes and probably the natural reaction is to try and hush them up and save face, but really the improvement of a system requires that mistakes and errors are recognised and logged. Some will be human error of course, and that’s all fine and good and to be expected, but some of them are likely to be the result of systemic error – i.e. error that occurs because of a fault of the system. And while you cannot do much about human error, you can do a great deal about systemic error.

Now, while the NHS for the most part probably hates having their data out there, the reality is that it is unlikely to be used by patients during their decision making process. It probably will be used from time to time by jounalists, but journalists will just make up stats if they don’t have them to hand, so it doesn’t really make much of a difference. However, just the knowledge and discomfort of having the outcome data out there means that transparency and the acknowledgement of error is hopefully going to become more common in the NHS and, as a result, systems will be improved, to the ultimate benefit of the patient. Maybe I’m just being hopelessly optimistic, but I’m delighted to see NHS data being released to the prying eyes of all, and I hope that it’s a trend that continues even if, from time to time, it’s used against them.


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