Jeremy Laurance: A revolutionary move that puts focus on real objective of NHS: better health

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The Independent Online

It used to be said that a doctor buries his mistakes. Not any more. From today that traditional loophole is closed. For four common operations – and, in time, for many more – mistakes that lead to the grave will be all too public.

Today's publication of death rates following surgery – the first by any government anywhere – is a bold move. It is also a revolutionary one. For 60 years, governments have plunged billions into the NHS and struggled to meet rising demands. Yet we have never asked whether what it does is worth doing.

We have counted the operations and the patients treated and measured the lengths of waiting lists. But we have not asked whether, for all the pills we have popped and the treatments we have received, we are any better.

From today, that changes. Instead of counting the number of operations, we can begin to ask, as Florence Nightingale did in the 1860s, if the patients undergoing surgery are dead, relieved or unrelieved.

Publication of death rates will inevitably be met with protests. Patients are bound to be alarmed by crude figures suggesting deaths in their local hospital are three times higher than in the one in the next town. Surgeons will complain like is not being compared with like and managers will bemoan the damage to their reputations.

All the protests can safely be ignored. It is true that deaths are a crude measure of the success of medical care – there is none cruder. But publishing the data is not the end of the story – it is the beginning. It is intended to trigger a debate about the best way of measuring the effects of care. It puts the focus where it belongs – on the outcome, not the process – just as Florence Nightingale recognised 150 years ago.

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