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Performance 99 Wednesday, 16 June, 1999, 10:03 GMT 11:03 UK
Analysis: Why publish death rates?
doctors
Indicators aim to assess quality of services
By BBC Health Correspondent Richard Hannaford

The argument against the publishing of "death rates" has always been that they are too simplistic and misleading.

NHS Performance 99
Local doctors have always known the reputation of various surgeons and hospitals and, when asked privately, would admit they'd never allow Dr X or Mr Y to operate on any member of their family.

But how can, say the opponents, you compare a heart surgeon who deals with only a few very sick cases, with one who does hundreds of operations a year - but whose patients are in the main healthy?

Or indeed a hospital in a leafy surburb with one in an area of deprivation and poverty?

Public's right to know

But supporters of this type of information say the public have a right to know what the rest of the medical profession only talks about behind closed doors.

And they say if such information is collected and published it will allow hospitals to compare their performance with other trusts. It could also provide an early warning system if things are going wrong.

The idea of giving patients more information is not new. The Conservative government introduced the idea of performance tables - giving hospitals a star rating for seeing patients quickly in casualty for example.

They were an attempt to measure the quality of the service and to show people how well the NHS was performing.

However, they fell into disrepute because of the extra administrative work they created for staff, and the fact that they measured the process of care, not the quality of it.

Today's clinical indicators are meant to address that.

Concern over relevance

However, despite earlier protestations about giving the public clearer and more relevant information about their local health services, these tables will be largely incomprehensible to the public.

They have been designed so as to make it virtually impossible to create a meaningful league table where the best and worst hospital in England can be ranked.

That's because the politicians recognise that the doctors might not co-operate if they feel they're being blamed for bad performance - fairly or otherwise.

There is also the fear that patients might decide to shop around.

If a local hospital is branded as being the worse in the country - or even the worse in the district - many people might reasonably decide that they'd prefer to have their treatment else where.

Vicious circle

That, of course, would place an enormous strain on those other hospitals that would find their waiting lists rocketing.

Meanwhile the hospital being boycotted could find itself in a vicious circle.

Fewer patients and a poor reputation would make it hard to recruit staff, which in turn could lead to the royal medical colleges expressing concern about standards.

If nothing was done to turn the situation around the hospital could eventually be forced to merge with another unit or even close and services would be lost.

See also:

16 Jun 99 | Performance 99
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16 Jun 99 | Performance 99
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