Everyone Counts - Improving Outcomes for Patients
Publishing of consultant-level outcomes data
NHS England has begun the staged publication of mortality rates for individual hospital consultants in ten medical and surgical specialties. The information relates to clinical outcomes from planned procedures (not emergencies) and is part of the 'Everyone Counts' programme that is aimed at enabling members of the public to access information about outcomes after surgery and other procedures.
The data will initially be refreshed annually and publishing of data in this way will be mandatory from next year. You can find out more about the data, when it will be available for other specialties, where it comes from and what happens where a hospital or consultant is identified as having higher mortality rates from our FAQs below..
NGH carries out procedures in seven of the areas: interventional cardiology, vascular surgery, colorectal surgery, orthopaedic surgery, urological surgery, head and neck surgery, thyroid and endocrine surgery.
You can access the published data via NHS Choices here.
Welcoming the move to greater transparency and openness, Northampton General Hospital's medical director Dr Sonia Swart said: “We fully endorse this initiative by NHS England to ensure that patients are able to access accurate data regarding outcomes following surgery.
“We are very pleased to note that our data tells of a high standard of surgical and cardiological practice, with very low numbers of deaths from routine major surgical procedures. None of our surgeons or cardiologists has a higher than expected death rate.”
All the surgeons and cardiologists involved at NGH have agreed that their data can be published, although we know that some of the data is still being reviewed for accuracy and may not yet be ready for immediate publication.
We are aware that some of our information may presently be incomplete, but we are making every effort to ensure that future information collection will be as comprehensive and reliable as possible.
How can I use the data?
The information published so far includes how many times each participating consultant has performed certain procedures and what their mortality rate is for those procedures. You can see whether or not the data for each consultant is within or outside the expected range. Consultants who fall outside the expected range are sometimes referred to as ‘outliers’.
You can use this data to decide which consultant to choose for your care. However, there are some important issues to bear in mind when looking at the data.
For instance, the vast majority of the data has been through a process known as ‘risk adjustment’. This is a way of accounting for the different mix of patients operated on by a particular consultant’s team. Using risk adjustment, outcomes are calculated as if all consultants operated on the ‘average’ patient. This means that consultants who take on particularly poorly, high-risk patients or carry out the most complicated procedures don’t appear to have an unfairly high mortality rate.
However, not all the data can be ‘averaged out’ in this way. Specific reasons for this are outlined in the introductory text for each set of results. Where risk-adjusted data is not available, actual (also called ‘crude’) clinical outcomes are shown. If the data is not risk-adjusted, a consultant may have a higher mortality rate simply because he or she takes on more difficult cases.
If you have questions or concerns having viewed specific results, please discuss these with your GP or consultant.
What will the NHS do where consultants have high mortality rates?
Any hospital or consultant identified as an outlier will be investigated and action taken to improve data quality and/or patient care.
When will data be available for other procedures and specialties?
The results published to date were selected because relevant data was already being collected for these procedures and specialties. It is likely the programme will be extended from 2014 when data for other conditions can be collected and analysed in a similar way.
Where does the data come from?
The data comes from national clinical audits which continuously review medical practice to check that it is safe and seek ways to improve it. These audits are managed by ‘audit providers’ (usually academic institutions such as a university or royal college) which work with the specialist association. A specialist association is an independent, membership organisation, which represents a particular medical specialty.