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Last Updated: Sunday, 9 January 2005, 00:58 GMT
Uncovering the secrets of the NHS
By Nick Triggle
BBC News

Now the Freedom of Information Act has come into force, will the secret workings of the NHS will be revealed or will patients lose interest in finding out about funding streams and hospital statistics?

The new freedom of information law covers all NHS bodies

Hardly a day goes by without the health service hitting the headlines.

As one of the most exposed and inspected areas of government, you may think there is little left to know about what goes on in NHS bodies across the country.

But campaigners and patients' groups believe a whole new side of the NHS is set to be revealed as sweeping powers which give individuals the right to ask for information come into force.

The Freedom of Information Act, which kicked in on 1 January, requires more than 100,000 public bodies to disclose information they hold.

The legislation covers all NHS bodies, including hospitals, GP surgeries and primary care trusts, as well as the Department of Health.

The biggest difference it could make is forcing doctors, and in particular surgeons, to reveal individual performance details.

Surgeon data

To date the medical profession has resisted such a move, arguing the best surgeons often take on the trickiest cases, thereby distorting the mortality rates.

Heart surgeons have taken the largest step towards publishing performance data by releasing the performance details of individual teams - comprising three or four surgeons - last year.

How the act could make a difference
Doctor performance data - The information commissioner wants to see individual data being published on doctors
Staffing levels - The public will be able to ask about staffing levels at hospitals and what sort of cover there is at night or in A&E
Spending - NHS bodies will be required to reveal what they are spending their money on, meaning hospitals may have to explain what each department gets
Infection rates - MRSA levels are often only collected on a local level but are sometimes hard to get hold of, the act should change that
Medical records - Patients will be able to request to see their own records, which has often proved hard in the past, but not anyone else's
But Information Commissioner Richard Thomas, the tsar charged by Parliament with ensuring the act is enforced, has said he wants doctors to go a step further and publish individual data.

He looks like being on collision course with the medical profession, as the Royal Society of Surgeons said it was still opposed to such a move.

And Dr John Powell, chairman of the British Medical Association's IT committee, backed the opposition.

"It does not make sense to publish simplistic indicators of doctor's performance such as patient deaths," he said.

"These figures do not take into account the case load of a doctor."

He said the BMA supported the principle of "right to know" but warned the time doctors spent away from patients to deal with the paperwork "must be minimised".

Nonetheless, Katherine Gundersen, research officer for the Campaign for Freedom of Information, said the NHS offered "enormous opportunity" to make use of the act.

"Performance data is certainly something that could come under the remit of the act

People will soon get bored
Dr Grant Kelly, British Medical Association
"But it is hard to predict how it is going to go, we shall have to see what people ask for and what approach organisations take."

She said there was a danger public bodies would wrongly use the 1998 Data Protection Act to argue they could not release information.

Some hospital officials have removed patient information boards - containing a patient's name, location and consultant to help identification - from above hospital beds because they felt this came under the act.

But doctors writing in the British Medical Journal recently questioned this practice, arguing it had led to mistakes being made.

'Huge impact'

Ms Gundersen said she felt this was a misrepresentation of the act.

And she added the Freedom of Information Act should allow the public access to details unless they were personal, such as other people's medical files, or if they were commercially confidential or damaging to the national interest.

Theoretically, this should allow the public to access information on infection rates within hospitals, staffing levels, A&E cover, hospital death rates and a multitude of information held by the Department of Health.

Surgeons operating
Individual doctor performance data could be released under the act
And it also strengthens patients access to their own medical records - people are already entitled to ask to see them but in the past incomplete or edited details have been handed over.

Simon Williams, director of policy at the Patients Association, said his organisation was planning to make use of the new laws to help benefit the public.

"MRSA rates are not always easy to get hold of, particularly in Wales, so we will be asking local health bodies for details.

"In the long-term individual performance data would certainly be welcome and I think patients will be able to interpret them - despite doctors' protests."

A spokeswoman for the information commissioner's office also said she believed the act could have a huge impact on the NHS.

She said: "The NHS is very close to our hearts and I think people will be interested in what's going on."

'Waste of resources'

But Dr Grant Kelly, a member of the British Medical Association council and a GP in Chichester, West Sussex, said he expected interest to "die down" after an initial flurry of activity.

"GP surgeries may be asked to explain where they get their funding from but people will soon get bored," he said.

He said hospitals might get more requests to justify what they spent their money on and explain why they couldn't afford to pay for a specific treatment.

"Patients and hospitals can get into quite a few disputes and I can see a situation where some hospitals will have to employ someone to deal with information requests and that is a waste of resources," he said.

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