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Thursday, 17 January, 2002, 16:42 GMT
'Don't deter doctors from high-risk ops'
The medical profession faces many changes
The medical profession faces many changes
Doctors have accepted the need for radical changes in the wake of the Bristol heart baby deaths.

But they have said the publication of individual cardiac surgeon's death rates had to be done in a fair way, which would not deter consultants from taking on high-risk cases.

The measure is contained in the government's response to the inquiry into events at the Bristol Royal Infirmary, where up to 35 babies died unnecessarily in the mid 1990s.


What we don't want to do is stop innovation and compassion in surgeons who are prepared to take on high risk cases

Bruce Keogh, secretary of the Society of Cardiothoracic Surgeons of Great Britain and Ireland

From April this year, the Department of Health and the Society of Cardiothoracic Surgeons of Great Britain and Ireland are to work together to collate, analyse and publish data.

By April, 2004 when enough data has been collected, surgeon-specific information will be published showing 30-day mortality after heart surgery.

In the next few weeks, data on the performance of paediatric cardiac units is set to be published, based on data collected over the last year.

The Society has also collated its own data on certain heart operations which has been published on its website.

Roger Boyle, National Director for Heart Disease, said the information would help patients who had been waiting for treatment for a long time, who could choose to be treated in another hospital - NHS or private.

Roger Boyle,  National Director for Heart Disease
Roger Boyle, National Director for Heart Disease

"It makes it all the more important to have this sort of data in the public arena," he said.

Routine coronary heart bypass operations, which should have very low mortality rate, will be used as a guide to performance.

Mr Boyle said: "If things are going wrong with these patients, that would be the first sign for concern."

However data for high risk case data will also be published.

Patient care advisers are also going to be appointed, under the umbrella of the British Heart Foundation, to help people understand the information that is published.

But surgeons are concerned that data could be misinterpreted by patients if it is presented in the wrong way.

Consultant's concerns

Bruce Keogh, secretary of the Society of Cardiothoracic Surgeons of Great Britain and Ireland added it was also essential surgeons were not put off operating on high-risk cases.

He said: "There is little doubt when you look at the history of cardiothoracic surgeons that the very best and the most innovative surgeons in the world have been the people whose operative mortality has been the highest.


We must make sure that we put in place protections so that patients who are particularly sick do not get excluded from care

Dr Vivienne Nathanson
"What we don't want to do is stop innovation and compassion in surgeons who are prepared to take on high risk cases.

"If we do that we will have done our patients a great disservice."

The Royal College of Surgeons welcomed the system of reporting "near misses" to the National Patients Safety Agency, which it said would "empower" patients and help surgeons.

Professor Sir Peter Morris, president of the RCS, warned: "Variables such as case mix and operation risk must be allowed for so that one compares like with like.

"Otherwise, there is a real risk that patients will be misled and surgical teams may be unfairly criticised."

Hugh Ross, chief executive of Bristol Children's Hospital, said: "It seemed to me to be a combination of pulling together some very important strands of government policy that have emerged over the last year or two - and also some important new initiatives to ensure we can maintain and restore the confidence of the public in the NHS."

Openess 'key'

Mavis Mclean, from the Oxford Centre for Family Law, and a panel member of the Bristol Inquiry welcomed the publication of data.

She said she hoped the tragedy Bristol could not be repeated: "Could it happen again? I trust not, I hope not, and most of all I pray not.

"The key thing is to set up a system where mistakes can be discussed and dealt with."

The British Medical Association said patients should know as much as possible about their proposed treatment, including the track record of the hospital, and where possible the doctor treating them

It said most consultants were already able to tell their patients what their own success rates were and what complications may be expected.

But it added many consultants would feel uneasy about the publication of data because they knew NHS data was "currently incomplete and riddled with inaccuracies".

Dr Vivienne Nathanson, head of ethics for the BMA, said: "We must make sure that we put in place protections so that patients who are particularly sick do not get excluded from care simply because they would potentially damage the league table position of a unit or a hospital or an individual surgeon."

Managers' view

The NHS Confederation said the government's response to the Bristol report would help the NHS to improve so that a similar tragedy could not happen again.

Mavis Mclean: 'welcomed report'
Mavis Mclean: 'welcomed report'
Nigel Edwards, acting chief executive, said: "The aim of the Kennedy Report was to produce an NHS in which patients are at the centre and where systems are in place to ensure safe care.

"The NHS has been working towards this goal for some time and the Government's plans today will help take us further."

But Donald Booth, a former committee member of the Surgeons' Support Group said league tables would make surgeons "scapegoats" for the heart scandal.

Dr Booth, a 67-year-old from Melksham whose wife was successfully operated on for a triple bypass by surgeon Janardan Dhasmana six years ago, put the blame on the hospital managers.

He said: "The surgeons are not to blame and have been made scapegoats without a shadow of a doubt."


Government response

Key stories

Key figures

Parents' stories

Background briefing

Analysis

Bristol year by year
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