Leading Article: Secrecy is not healthy

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THE National Health Service does not like patients to know too much about how it works. It certainly likes to keep quiet about its failings. This is a benign, paternalistic institution that still betrays its origins in the post-war period when food was rationed and patients were supposedly content with what they were given. But people have changed. They are less deferential. Publication yesterday of hospital league tables recognises their right to be informed.

This initiative is a milestone, just as Virginia Bottomley claimed, but it is also incomplete and flawed as David Blunkett rightly pointed out. Where hospital waiting lists are long, it is impossible to distinguish instances of popular oversubscription from plain inefficiency. Yet details revealed on quick treatment in casualty, speed of ambulances and the prevalence of day- case surgery are all good indicators of clinical and even life-saving importance. In other words, Mrs Bottomley's AA guide to hospitals is useful, but remains crude and should not be given undue weight. If it makes hospitals sharpen their performances, the exercise will have been worthwhile.

The larger issue for the future is whether the public should be privy to far more sensitive information about doctors and hospitals that the NHS presently keeps secret. The Royal Colleges know which surgeons are best and worst at their jobs. They have figures on which ones suffer the most patient deaths. But the research is strictly confidential, details being divulged only to the individuals concerned.

Such peer review began decades ago in maternity services and was extended to surgical disciplines in recent years. It is judged to have saved countless lives by discreetly improving patient care. Practitioners argue that confidentiality is vital if fear and antagonism are to be avoided within the NHS. Additionally, much of the information is complex and hard to analyse. The finest and bravest surgeons may take on the most difficult cases and so have the highest death rates. It would be unfair to expose their records to examination by an indiscriminate public that might unfairly stigmatise them. In any case, argue doctors, there are well-developed regulatory methods for dealing with incompetence.

Yet, amid such secrecy, there must be suspicion that medical professionals protect themselves by keeping the public ignorant. Hospitals in the United States were similarly cloaked in secrecy until recently. Then the State Supreme Court in New York ruled that comparative information on deaths after coronary bypass operations should be made public, against the state's wishes.

This is dangerous territory. The right for consumers to know must be balanced against the need for professionals to improve their practices in an environment free of rancour. If Britain is to continue to accept secrecy that the US is fast rejecting, it is up to practitioners to prove that they are tough enough on one another and that patients need not worry about their doctors.