Open surgery: Allowing patients to see death rates will improve the NHS

In the latest step towards a more transparent health service, NHS patients are now able to compare death rates of 5,000 surgeons in 10 major specialities. The NHS medical director, Sir Bruce Keogh, a former cardiac surgeon who pioneered the publication of heart surgeons’ death rates a decade ago, should feel justly proud of his latest achievement – the first time such detailed data has been published anywhere in the world.

It was his crusade for greater openness that led to heart surgeons releasing their individual records in 2004 and it has taken years of tough negotiation since to get those in other specialities to follow suit.

What the surgeons most feared was that those taking on difficult cases with higher risks would have poorer survival rates, which would damage their careers. Today, John MacFie, the president of the Federation of Surgical Specialty Associations, stoked alarm by claiming the death data was crude, potentially misleading and would “encourage risk-averse behaviour which is not in the interests of patients”.

Exactly the same complaints were heard from heart surgeons 10 years ago so it is instructive to look at what has happened to their speciality since.

It was feared that heart surgeons would begin cherry-picking the healthiest patients while those who were elderly, frail and had multiple problems would be pushed to the back of the queue. In fact, the reverse has happened. There has been no sign of cherry-picking and, as the population ages, the patients referred for heart surgery are growing steadily frailer and sicker – yet overall, death rates have fallen.

Heart surgery today in the UK is safer than it has ever been and it is widely accepted that publication of individual surgeons’ death rates is one factor in the improved performance. Data that is incomplete, inaccurate or misleading is soon improved once it is in the public domain.

Publication of the latest death-rate data is a victory for transparency and accountability. It should be celebrated by doctors, patients and the public alike.