Cardiac surgeons call for greater transparency

"The publication of useful information goes to the heart of our modernisation plans. Cardio-thoracic surgeons have led the way in demonstrating that a transparent NHS is a better and safer NHS. By opening up data and highlighting variation in standards, outcomes for patients needing cardio-thoracic surgery have improved substantially.

We would like to see many more areas using data to improve outcomes. That's why over the next year, we'll make another £1.2 million available for more clinical audits, to provide more data to help us drive up clinical standards."

Andrew Lansley
Health Secretary

“The NHS is littered with repeated failures of clinical governance and the medical profession must respond. Cardiac surgeons were forced to act after the Bristol inquiry and have subsequently proven that public accountability drives up standards of patient care while reducing costs as areas of substandard practice are resolved.  Giving access to appropriate information will reassure the public and allow patients to make informed decisions about their care, but currently the NHS and the medical profession are failing to deliver.”

Ben Bridgwater
UHSM Consultant Cardiac Surgeon & Report Author

Patients are being denied access to real choice in treatment because the medical profession and NHS are dragging their feet on providing reliable, independent and accessible information, says a new report from the Society for Cardiothoracic Surgery (SCTS). The study summarises a decade of comprehensive public audit in the UK, and makes suggestions for future developments in patient information to improve quality of care.

The report, written by UHSM Consultant Cardiac Surgeon Ben Bridgwater, was launched at the SCTS annual meeting. with a response from the Secretary of State for Health, Andrew Lansley. The key points are:

Clinical outcome measurement is good value for money: SCTS estimate the costs of data collection for cardiac surgery in England to be £1.5m per annum – just 0.6 per cent of total spend on cardiac surgery. However, they estimate that quality improvements brought in as a result have achieved a £5m saving in bed days for coronary artery bypass operations alone. The Department of Health should consider dramatically increasing the budget currently allocated to supporting clinical audits to enable more associations to follow suit.

Data collection improves patient care:  Access to reliable information protects and informs patients by explaining variance and preventing poor practice. Public reporting at hospital and individual surgeon level has resulted in a 50% improvement in risk adjusted mortality rates for cardiac surgery and has demonstrated that over 99% of cardiac surgeons are performing at a satisfactory level. The report urges those yet to engage in audit to consider customising the SCTS template with publication of data for use within their own specialty.”

The internet is rapidly changing public perceptions of access to information: The report argues that medicine risks being left behind and losing trust if it doesn’t rise to meet this challenge. SCTS argue that medicine needs to learn from broader consumer behaviour and take a more active role in the “information revolution”.

Suggests public demonstration of effective Continuing Professional Development (CPD): Consultants are expected to keep up to date with the latest developments in their fields and are awarded points for attending accredited course, conferences and reading literature to prove this. SCTS suggest this remains “vaguely defined and loosely organised.” and feel that demonstrating effective CPD is important to continue to maintain the trust of patients. They say that surgeons should undergo an online education and assessment programme to ensure that CPD is up to date and relevant to current practise.

Individual mortality reporting is now possible for lung cancer (thoracic) surgery: following the example set by cardiac surgeons; the thoracic surgeons are looking to implement a risk-adjustment model needed for full clinical outcome reporting.

The report also provides a detailed analysis of the back up systems and processes SCTS have developed over the past decade for successful clinical data gathering for others to use. It also describes how a proactive “traffic light system“ for live interpretation of surgeon performance data can detect problems early and prompt swift action – seeing off emerging patient safety issues or areas of sub-standard practice before they become serious. They say that together the unique set of initiatives set out in the report will ensure optimal patient care for all cardiothoracic surgical patients.