Hospital doctors to come under scrutiny

Frank Dobson announced 10-year programme on quality care

Statistics on the quality of hospital operations are to be published from October, Health Secretary Frank Dobson has announced.

The figures will initially only cover certain specialisms and hospitals in England, but will eventually spread across the country.

Figures on individual doctors' performance will also be monitored, although they will not be published.

The plans were leaked earlier this week, but Mr Dobson's speech showed that the government's proposals are more wide-reaching than was originally thought.

Hip replacements

For example, clinical performance measures will not be limited to death rates. The figures will also measure other areas, such as how long a hip replacement lasts after surgery. Statistics on coronary heart disease are already being collected.

Dr Janardhan Dhasmana - one of the Bristol surgeons

The performance indicators will be "risk adjusted" to take into account factors such as the age of the population served by a hospital.

Referring to the Bristol baby heart scandal, where 29 babies died at the hands of surgeons, Mr Dobson said: "Patients and their GPs want to feel sure that their local hospital is up to scratch. We don't want a system where patients feel they have to travel far afield to get the best treatment."

Open review

He added that the only way to do this was through "an open and external review" of standards.

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Mr Dobson said the new strategy would act as an early warning system for health officials and would push them to tackle problems before they got out of hand.

The standards will be monitored by the new Commission for Health Improvement, announced in the December NHS White Paper. It will visit hospitals every three to four years and have statutory powers to investigate concerns about clinical quality, Patients will be represented on the commission.

Ten-year programme

The publication of hospital performance figures will launch a 10-year rolling programme of reforms aimed at raising public confidence in the NHS. It will include:

• the scrapping of the Conservatives' efficiency index and its replacement by a National Performance Framework which will measure how surgery impacts on health. Under the framework, reference groups will be required to identify how clinical performance should be measured.
• A new information technology strategy will ensure patients are given full information on clinical care. This will be launched later this year.
• The government is to require all hospital doctors to take part in external audits. Currently, clinical audits are voluntary. From next year, doctors will have to take part in a national audit programme so that they can compare their performance on a national basis. Doctors who have an excessive mortality rate may be retrained or told to stop operating, Mr Dobson said.
• Individual doctors will have to share performance figures with the medical director of their trust and the trust's lead consultant. Members of the Commission for Health Improvement will also have access to the figures.

Mr Dobson said the public had a right to know about clinical standards in order to exercise their "common law right to give informed consent" to operations.

Ash Pawade, the leading consultant for the United Bristol Healthcare Trust, which includes the hospital responsible for the deaths of the 29 children, welcomed the government's new strategy.

But he said he feared it could lead to hospitals which came out top of the league being swamped by demand. He added that standards at the trust had improved greatly since 1995.

Meanwhile, the Welsh branch of the British Medical Association has expressed scepticism about the publication of figures on operations.

Dr Bryn John, chairman of BMA Welsh Council, said: "Crude mortality figures are grossly misleading as they are dependent on many factors. When these are taken into account, the results become so complicated as to be almost incomprehensible, even to experts in that field."