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Monday, 21 January, 2002, 13:07 GMT
Bristol babies: Will the reforms make a difference?
The death rates of individual cardiac surgeons are to be made public as part of a drive to create a more open, patient-centred NHS, Health Secretary Alan Milburn has announced.
The measure is part of the government's response to the report into the deaths of children undergoing heart surgery at Bristol Royal Infirmary.
Ministers have already responded to the Bristol tragedy by introducing a number of measures, which include the establishment of two new bodies to minimise the risk of similar events in future.
Do the reforms go far enough? Will they make a difference?
This Talking Point has now closed. Read a selection of your comments below.
Both my elderly parents died this summer, my mother from cancer, my father from a heart problem. Even though my mother was misdiagnosed by the hospital for some months, I have nothing but praise for the doctors, surgeons, nurses and carers. With both my parents, despite their age, every effort was made on their behalf and the doctors took great pains to explain to me everything that was happening. Doctors and surgeons are not God; they do their best, and they don't want to lose patients. This will just put more and unjustifiable pressure on them in what is already a very difficult job.
Instead of wasting money on producing lies, damn lies and NHS statistics, why not spend some money on staff and equipment?
The introduction of league tables can only be a good thing. It will hopefully lead to increased scrutiny of the medical profession. As humans we are all fallible. It is time that surgeons realised this. As a health care professional, I have witnessed the increased accountability for NHS workers. Medicine appears to have been overlooked. My colleagues and myself feel it is time this changed!
You have to bear in mind that heart surgery is very often high-risk surgery and the death rate is going to be higher than for conventional surgery.
It seems a pity, therefore, that cardiac surgeons are singled out - a bit of a witch-hunt really.
While I have every sympathy for the parents of the children that died at Bristol, I also have another memory. My Mother who was then 65, had serious bypass surgery performed by the very same team at Bristol. She was told then by them that given her age and state of health, she was marginal but nevertheless, they did the work. Now many years later, she is still with us and will celebrate her diamond wedding anniversary this year. My worry about these league tables is simple, would my mother have been operated on if they had existed then?
As an expat with contact with other cultures, I see surgeons as humans who are justified in making decisions based on ethics more than public cries. If he is quite certain that he would only be keeping a patient alive for a short time, should he work to that end? I say yes.
The reforms may not go far enough, but they are bound to make a difference and that can only be a good thing. If even one life is saved then they will have been justified but let's hope the improvement is more marked than that. We all appreciate the complexity and difficulties faced by surgeons but we are all accountable in one way or another.
The league tables themselves will not make a blind bit of difference - they haven't in education or transport. Why is the public so obsessed with these meaningless statistics?
This latest initiative will result in surgeons refusing to deal with marginal cases. Worse still, it could result in the very best surgeons who have greater ability to deal with marginal cases receiving the worst "scores", merely as a consequence of the relative difficulty of their work. The only way the government seems able to approach these matters is by marking people out of 10. The worst candidate for this is Alan Milburn who seems willing point to fingers at anybody so that he looks good. Why don't we score death rates attributable to the failure of the Health Secretary to make proper healthcare provision in this country?
Bernard Stedman, UK
No, the reforms do not go far enough. We should have equal visibility and transparency on ministers' decisions and actions not only in the health service but other areas as well. Their decisions impact lives. They are professionals as well and part of the system, its problems and solutions.
It's time for proof and action not "talking" which is all any government seem to do; talk, but rarely ever carry out these promises. I think we should wait and see whether this is just another promise used to get the public of their backs, or an actual pledge, which will be carried out to the bitter end. Let's hope for our children's and our children's children's sake, that it is the second of those! Boys we know you can talk the talk, now its time to show you can walk the walk.
Paul B in Oxfordshire is absolutely right: 'Surgeons will not accept marginal cases'. My father in law died after having his heart by-pass. The surgeon told him he had at best a 20% chance of survival. My father in law took the chance because without it he had about a month to live. After he died the surgeon who is acknowledged as one of the best at one of UK's most renowned teaching hospitals, told us he only saw patients who everyone else had given up on. Hopefully he will not be put off taking on such people to get a higher rating. 20% survival is better than 0%.
No. When the figures are published it will cause a massive stir amongst the public and make even more of a mockery of our NHS system.
Jon Harley, London, UK
There is an ethical dilemma in informing patients re: death rates of surgeons in a collective system, where the patient does not fully have the power to "shop around". If you find your neighbour is seeing a surgeon with a lower death rate than the one you are seeing, will you be able to swap surgeons half way through your treatment? Merely informing patients without giving them the right to change is unethical.
However, how can a collective system like the NHS operate if patients have absolute choice? Who would want to be treated by a Junior Doctor who has never performed the procedure before, and what implications does this have for future training of Doctors? I have no answers but patients should try to understand the full implications of what is being recommended by the Kennedy Report.
On the contrary Pat, doctors are more likely to take on the more challenging cases knowing that they're finally going to get the recognition they deserve. Plus: we should be able to choose doctors who we think are up to the job.
Surely this is likely to lead to many doctors refusing to even attempt to treat the more difficult cases, concentrating instead on the easiest to treat in order to protect their precious statistics.
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