To drive them to excellence or to retirement?
To encourage them to concentrate on their patients or their figures?
To allow for improvisation or to merely go through the motions on familiar ground only?
To say yes to low risk surgery only and leave the high risk cases to …..er.. to nature to take its course, since no surgeon in their right mind would want those patients' blood on their hands or their name on their lists anymore!
To add insult to the uninjured is the decision to name the surgeons who have not agreed to have their performance figures published. That will show them. Footballers and rapists seem to have more right to anonymity for what they do than self-chosen do-gooders in this system.
Apparently, patients will now be able to choose their surgeons more effectively. Apparently, it is now very clear for patients to decide whether they go to the surgeon who has a complications rate of 2 out of 100 or to the one who had 1 out of 60 complications rate. If the surgical outcomes data is anything like the rest of the NHS data, it will be pathetically inaccurate and wholly uninterpretable. Much of the data routinely collected under a consultant's name on the NHS hardly reflects the involvement of the surgeon in many cases. Surgery undertaken by a registrar on call under the auspices of the admitting consultant, or surgery done under one consultant's name by another consultant as the patient was transferred to another ward post admission are some examples of confounding variables that is the bane of NHS data collection. Throw in "episodes" and "spells" and "super spells" and you have data that merely drives good surgeons belligerent and not to excellence.
So what is the solution? Solution to what? Depends on what this whole exercise was supposed to achieve in the first place.
Was this introduced to improve surgical performance? I thought training was supposed to do that.
Was this introduced to provide feedback for surgeons for them to reflect on their efficiency? There is appraisal for that and revalidation to follow through concerns.
Was it introduced to make the public choose the good performers so that those with "lower" performance figures would undergo self extinction because nobody chose them? In effect, using market forces factor to drive surgeon's survival? Ridiculous.
Was this provided to reassure the public? Maybe, but unfortunately, as I see it, it merely introduces paranoia and uncertainties in the doubting minds of the already vulnerable surgeon-shopping patients. The rest of them would merely have one look at the list and decide that it is too complex and dull to read. Is the surgeon employed by an NHS hospital with no overall concerns? Yes? He seemed to explain things well. He seems to understand what the problem is. I think it is ok then. The parking at that hospital is also good with low TV rates. I will have him do my surgery.
What? His surgical mortality rate is at the 90th percentile? I wonder what his anaesthetists' mortality rate is like? and what is the group mortality rates for his nursing team? What percentage of his mortality was attributable to aftercare on somebody else's ward? What percentage of his patients were near death door anyway and he was offering palliative surgery where there was only one outcome either way Is his junior staff any good? No information on those? Just some numbers against some people's names? Ditch the list. I am ready for surgery.