It is more than 10 years since figures were published showing hospital death rates for heart surgery, with specific departments and – a year later – individual surgeons identified for all to see.
Publication of the comparative data was a recommendation that followed the Bristol children’s heart surgery scandal in the 1990s; it was mandated by the Health Secretary at the time, Alan Milburn, and it was almost universally regarded as a good thing. So it is little short of scandalous that no other medical specialty had followed the heart surgeons’ lead – until this week, when the Royal College of Obstetricians and Gynaecologists published a report on maternity care in NHS hospitals in England.
It goes without saying that having such a report is better than not having one, and that maternity departments – where many otherwise healthy women have their first, and sometimes only, encounter with an NHS hospital – are a suitable place to start. It is beyond time that all women were given the chance to make an informed choice about where to have their babies. The drawback is that this report still does not give them that opportunity because it does not identify the departments, even as it highlights worryingly wide variations in practice.
The RCOG says the hospitals concerned now have time to improve their performance before a new report, naming names, is published next year. That may be justifiable – if the promise is honoured. As with cardiac surgery, some of the variation may have less to do with competence than with particular demographic factors or with expertise that attracts harder cases. A way has to be found to take this into account.
Still, the time it has taken to persuade another medical specialty to produce even anonymous data suggests that, yet again, the cards are stacked in favour of the specialist providers of a public service and against the users. Next year’s RCOG report must provide the information people want and need, and the Government must increase the pressure on other parts of the medical profession to do the same.