MINISTERS HAVE promised that, by the end of this year, NHS patients will have four or five hospitals to choose from when their GP books them in for treatment. The horror of GPs at the thought of the extra work is matched by the shock of consultants at the mass of extra information patients will have to be given to make “choose and book” meaningful.
Currently, such information is limited. You might be told that one surgeon has a waiting list of ten days for a particular operation, while another has ten weeks. Press further and you can sometimes discover the mortality rates for individual hospital units, data likely to raise more questions than it answers. Why is the wait so short for that doctor? Is it because nobody wants to be treated by him? And why is mortality so high there? Because the doctors are killing their patients, or because, being the best unit in the country, they treat the sickest and most high-risk cases?
The doors to NHS records have been slammed shut to patients for half a century. Now ministers are trying to prise them open. And for the first time, the “success” rates of individual consultants are going to become public: which procedures precisely they carry out, and what the results are for each. For without such detailed information, a patient cannot make an informed choice between doctors.
It doesn’t come easy. The head of Britain’s cardiothoracic surgeons, Sir Bruce Keogh, gave warning yesterday that piecemeal publication of such detailed data by individual hospitals, which is already happening, partly due to the Freedom of Information Act, is “irresponsible” and could be “devastating” for patients and the profession. The Royal Brompton and Harefield Trust, in West London, has produced, for instance, an analysis of the number of operations carried out by each of its seven cardiothoracic surgeons, broken into low, intermediate and high risk, and the patients’ survival rates.
Sir Bruce argues that because there is no standard way of presenting such data, it is meaningless and might misinform the public. His point is a fair one: that unless such charts compare like with like, a patient might misconstrue a surgeon’s performance as poor, when that surgeon, being the best, takes on the high-risk cases which have a higher mortality rate.
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Better imperfect information than none at all, I say. I doubt that any system could give a patient all the information about a consultant’s record that would be needed to make a truly informed choice. It would always require a GP or other health professional to explain some of the data. And to Sir Bruce’s credit, he has been working with the Government, in the face of great hostility from the Royal College of Surgeons, to produce a sophisticated formula which will allow a fair comparison of mortality rates.
Sir Bruce himself is a good example of why the work is essential. Imagine that you have been referred to him for a coronary artery bypass graft (CABG). Imagine that you want to find out a little more about him. You go on to the website for the University College London Hospital (UCLH), where he works, to look up cardiothoracic surgery. It is listed, but there is no information about it. There is also a thoracic clinic, but Sir Bruce doesn’t work there. You search the “consultants quick list”. He’s not on it. So you search the entire UCLH site for his name. “Search is currently unavailable,” it tells you. “Please return at a later stage.”
Fortunately you have the website of the health research group Dr Foster (www.drfoster.co.uk) to turn to. Type in Keogh, and up pops Sir Bruce. He is at the Heart Hospital, part of UCLH. His waiting time is 140 days. It costs £150 for a first consultation privately. He is Professor of Cardiac Surgery at UCLH, a consultant cardiac surgeon, president-elect of the Society of Cardiothoracic Surgeons. But what you really want to know is — what’s his form with coronary artery bypass grafts? How many CABGs has he performed in the past year, and what was his success rate?
Here your luck runs out. You have discovered as much as you are going to about Sir Bruce before you turn up for your consultation. You can, however, find out on Dr Foster, with a bit of tinkering around, that — uh, oh — UCLH has by far the highest mortality rate for CABGs in the country. Now what do you do?
As it happens, I know Bruce Keogh. I spent a revolting and fascinating couple of hours standing at his patient’s head as he performed a triple heart bypass. From a completely amateur viewpoint I can assure anyone about to go under his knife that it looked a tidy enough job. But what would I know? Perhaps his colleague Robert Bonser would have been better, despite lacking Sir Bruce’s string of impressive titles.
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And that’s the point. Without really detailed information, the patient is in the dark. Should you be impressed by Sir Bruce’s credentials but worried about his hospital’s mortality rate? You need to know two things: that the CABG mortality figures used by Dr Foster are a year old and have improved dramatically since all UCLH heart operations were moved to the Heart Hospital; and that the bad figures predate Sir Bruce’s employment there. See what I mean about never knowing enough? A little information can be a dangerous thing.
So we need more of it. The floodgates are open now and the momentum is unstoppable. Tim Kelsey, the chief executive of Dr Foster, says that far from being stupid, as doctors tend to assume, patients are perfectly capable of drawing intelligent conclusions from imperfect data. They will also demand more complicated information, such as whether a hospital offers a particular treatment as a day case rather than an inpatient, whether physiotherapy will be available, or if the hospital can promise that you will see the same doctor throughout your treatment.
All of which your GP will presumably have to go through with you when you choose and book. Which may give him something of a headache, but can only be good for you.
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