Given that just more than 1,000 surgeons carried out tens of thousands of operations, many on patients who had life-threatening or emergency conditions or were in poor general health, this strikes me as remarkably reassuring. These are not so much death rates as life rates. If I were about to go under the knife, I would certainly take comfort from the data. The surgeons should be cheerier than a Liberal Democrat in Dunfermline.
Instead they are showing all the bonhomie of Gordon Brown on a wet weekend in Blackpool. The National Health Service has been resisting the publication of these figures since February last year and has only revealed them now because Kevin Dunion, the information commissioner, overruled it. There have been dark claims that Scottish surgeons may abandon high-risk operations altogether if their results come under such scrutiny. Concerns have also been voiced that pioneering surgery could be halted.
Such threats are outrageous and should be treated with disdain. They represent a form of blackmail from a group of people who have, of necessity, a monopoly. Their attitude goes against the whole concept of a more transparent, accountable National Health Service. Freedom of speech may be being championed in the courts, but Freedom of Information is being resisted by some of our most highly paid public servants.
If ever there were an example of why such transparency and accountability are vital, it is the deeply distressing case of Lisa Norris, which also made the headlines last week. The 15-year-old from Girvan was given 17 huge overdoses of radiation while being treated for a brain tumour at the Beatson Oncology Centre in Glasgow.
It is a desperate situation for Lisa and her family, who now live with the grim consequences of the error. It is also a disaster for the Beatson, whose reputation, following a previous crisis, is being rebuilt under the able leadership of Professor Alan Rodger. The hospital says human error is to blame and, for the staff concerned, it must be devastating. But the lessons learnt from the inquiry into this tragedy may have international implications.
Advertisement
The urge to resist public scrutiny is understandable, but in doing so, surgeons open themselves up to charges of hypocrisy and condescension. The claim that the mortality figures are meaningless because they are too crude and that the general public cannot be trusted to interpret them is deeply patronising and offensive.
We understand that such data represents only a part of the picture. We know that mitigating factors need to be taken into account. But there is no denying the fact that they focus attention on the issue that is of utmost importance to surgical patients — the competence of their surgeon.
There is a great deal of talk these days about the need to avoid a two-tier NHS in Britain. But a two-tier NHS already exists. Doctors and their families — and I write this as the wife of a doctor — are far more likely to use inside information to get what they perceive as the best treatment.
As part of a series on cancer care in Scotland, I asked a number of cancer specialists what they would do if they had cancer. Some said they would use inside information to find the best specialist in the field. Others said they would ask for a second opinion or consult with colleagues to get the most up-to-date advice. Not one said they would follow their GP’s advice and trust to luck. The figures published last week will not give patients that degree of inside information, but they are a step towards levelling the playing field.
Doctors have, historically, not been good at weeding out the bad apples in their ranks, as the inquiry into the deaths of 35 babies following surgery at Bristol Royal Infirmary demonstrated. In Scotland, less than a decade ago, the surgeon Gerald Davies was able to operate on patients at St John’s hospital, Livingston, while more than two times over the legal drink-driving limit. At a fatal accident inquiry into the deaths of two of his patients, the sheriff remarked that it was “ quite astonishing” that serious concerns expressed three years earlier by another surgeon had not provoked an immediate inquiry. Had Davies’s mortality rates been publicly available, he might have been stopped sooner.
Advertisement
Surgeons have nothing to lose from transparency and little to gain from secrecy. They are a robust, highly trained — occasionally arrogant — bunch who should not be threatening to down scalpels in a hissy fit. Most patients who have surgery are eternally grateful to their surgeons and hold them in high esteem. The publication of the mortality rates will do nothing to change that. We literally trust medical professionals with our lives. It’s time they reciprocated.