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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.
Kate, UK


It is a very worrying trend that we expect such incredible high standards for every profession apart from ourselves

Anthony, England
In recent years the population in the UK seems to have come to the belief that we can all live for ever and every illness can be cured. If someone dies then someone is to blame. And someone must be sued. We saw it first with the railway accidents and everyone clamouring for someone to be tried and found guilty of corporate manslaughter, and now we are doing it on the NHS and doctors. I want doctors to concentrate on trying to help people, not to worrying about the legal consequences should something go wrong. It is a very worrying trend that we expect such incredible high standards for every profession apart from ourselves.
Anthony, England

Instead of wasting money on producing lies, damn lies and NHS statistics, why not spend some money on staff and equipment?
Martin, England

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!
Phil, Nottingham

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.
Chris Eedes, United States of America


The government should be concentrating on improving the funding and bed space of these heart units instead

Richard, UK
This is nothing more than a PR exercise that will do more harm than good. Any surgeon aiming to improve their rating is likely to avoid the sickest patients. The principle of medicine is to do everything you can to help your patient, not to do everything you can to improve your rating. The government should be concentrating on improving the funding and bed space of these heart units instead.
Richard, UK

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?
John Haynes, UK

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.
Ronald Young, Canada

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.
Shaun, Teignmouth, UK

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?
Steve Hodgson, UK


Why don't we score death rates attributable to the failure of the Health Secretary to make proper healthcare provision?

Paul B, Oxfordshire, UK
What exactly is to be published, the death rates directly attributable to the surgeons' activities, or the standard of aftercare provided, or the over-hasty discharge of patients in order to release the bed, or the death rate attributable simply to an overburdened system? Who decides which is which and in what combination? After all the 30 day death rate can incorporate a multitude of occurrences.

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?
Paul B, Oxfordshire, UK


We need to retain focus on innovation, without which there will be no progress

Bernard Stedman, UK
My son has undergone several major cardiac operations as an infant over the past three years. The so-called "standard" procedure appears well defined but my son's specific condition required a different approach to normal, which was at a much higher risk. Should it have failed, I would not have wished my son's surgeon to be penalised for attempting a repair in such circumstances. A key aspect is that we followed the surgeon's diligence and he demonstrated the lengths to which he sought advice from his peers. I support the Bristol parents' views, but we need to retain focus on innovation, without which there will be no progress on treating difficult conditions.
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.
Bill, UK

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.
Daniel Allman, Ireland

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%.
John, France

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.
Chris Gower, London, England


Increased transparency in public practice is a sound idea

Jon Harley, London, UK
Increased transparency in public decision-making and practice is a sound idea when applied to the whole of government. It is important to remember the differing numbers and difficulty levels of operations performed by particular surgeons and hospitals. Certain operations invariably hold more risk than others, and this should be accounted for in the figures to avoid confusion. Though such statistics are a good idea in principle, their effectiveness is questionable beyond causing public outcry. If it highlights the state of our NHS, so be it. It is only through fully appreciating the woeful state that it's currently in that we can improve it.
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.
NN, UK

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.
Delia, UK

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.
Pat, UK


Government response

Key stories

Key figures

Parents' stories

Background briefing

Analysis

Bristol year by year


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