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Consultant treatment outcomes

NHS England is committed to making more information available about how services and professionals are performing. The aim is to drive up the quality of care and to help people choose the treatment that suits them best.

This initiative is a central part of NHS England's ambition to ensure every patient gets high-quality care, and to build improved services for the future.

On this page you’ll find links to information about individual consultants in a number of clinical areas. You can look at their results for a range of operations and treatments to help you make decisions about your care.

Prof Sir Bruce Keogh, National Medical Director of NHS England, said: "This is a major breakthrough in NHS transparency.

"We know from our experience with heart surgery that putting this information into the public domain can help drive up standards. That means more patients surviving operations and there is no greater prize than that."

The reporting of the data was led by Prof Ben Bridgewater from the Healthcare Quality Improvement Partnership (HQIP). Prof Bridgewater is a practising heart surgeon who leads the successful cardiac consultant-level reporting that paved the way for this work.

Prof Bridgewater said: "Ultimately there is one patient and one responsible consultant. This means the public can now know about the care given by each doctor and be reassured an early warning system is in place to identify and deal with any problems. A number of extra new safety checks have been created as natural by-products of putting this work in train, and this will only improve as processes are refined. In terms of geographical coverage and specialties covered, this is truly groundbreaking."

The data show where the clinical outcomes for each consultant sit against the national average. Where results differ significantly from the national average, there may well be good reason, and you can discuss this with your GP and/or surgeon.

The information available for each type of treatment varies, but in all cases you can see how many times each consultant has performed a particular procedure.

You may wish to discuss the data with your GP before choosing where to be treated, or with your consultant before your operation. Find out more about choosing a consultant.  

Where can I find the data?

Data is initially being made available for the following clinical areas (specialties). Click on the links below to see the data:

  • Adult cardiac surgery (heart surgery). Procedures covered: coronary artery bypass graft, valve surgery, aortic surgery, all cardiac surgery.
  • Vascular surgery (surgery on veins and arteries). Procedures covered: abdominal aortic aneurism, carotid endarterectomy.
  • Thyroid and endocrine surgery (surgery on the endocrine glands). Procedures covered: thyroidectomy, lobectomy, isthmusectomy.
  • Bariatric surgery (surgery to treat obesity). Procedures covered: gastric bypass, gastric banding, sleeve gastrectomy.
  • Interventional cardiology (heart disease treatments carried out via a thin tube placed in an artery). Procedures covered: percutaneous coronary intervention.
  • Orthopaedic surgery (surgery for conditions affecting bones and muscles). Procedures covered: hip replacement, knee replacement.
  • Urological surgery (surgery on the kidneys, bladder and urinary tract). Procedures covered: nephrectomy.
  • Colorectal surgery (surgery on the bowel). Procedures covered: bowel tumour removal.
  • Upper gastrointestinal surgery (surgery on the stomach and intestine). Procedures covered: stomach cancer removal, oesophageal cancer removal. 
  • Head and neck cancer surgery (PDF, 323kb). Procedures covered: larynx cancer removal, oral cavity cancer removal, oropharynx cancer removal, hypopharynx cancer removal, salivary gland cancer removal.
  • Lung cancer. Surgery for lung cancer, specifically for operations performed between January and December 2012

    This initiative applies to England only, although some specialties have also chosen to publish data they hold for Scotland and Wales. The NHS plans to make much more information available in future.

    Due to data protection legislation, consultants had to agree to have results from their operations published and around 98% have. Results that are not published are still analysed and acted upon as necessary by the NHS.

    Consultants who have not agreed to have data published are listed on this website. See a list of these consultants (PDF, 226kb).

    How can I use the data?

    The information published so far includes how many times each participating consultant has performed certain procedures and what their mortality rate is for those procedures. You can see whether or not the data for each consultant is within or outside the expected range. Consultants who fall outside the expected range are sometimes referred to as "outliers".

    You can use this data to decide which consultant to choose for your care. However, there are some important issues to bear in mind when looking at the data. For instance, the vast majority of the data has been through a process known as "risk adjustment". This is a way of accounting for the different mix of patients operated on by a particular consultant’s team. Using risk adjustment, outcomes are calculated as if all consultants operated on the "average" patient. This means that consultants who take on particularly poorly, high-risk patients or carry out the most complicated procedures don’t appear to have an unfairly high mortality rate.

    However, not all the data can be "averaged out" in this way. Specific reasons for this are outlined in the introductory text for each set of results. Where risk-adjusted data is not available, actual (also called "crude") clinical outcomes are shown. If the data is not risk-adjusted, a consultant may have a higher mortality rate simply because he or she takes on more difficult cases.

    If you have questions or concerns having viewed specific results, please discuss these with your GP or consultant.

    What will the NHS do where consultants have high mortality rates?

    Any hospital or consultant identified as an outlier will be investigated and action taken to improve data quality and/or patient care. 

    Why is my consultant not listed?

    At present, data is only available for the specialties listed on this page. The majority of these sets of results were published by July 1 2013, with the remainder made available in September 2013. Not all consultants who work in these specialties are included in the data published so far. A consultant may not appear because:

    Data on the procedures that they carry out may not be collected by the National Clinical Audit for their specialty.

    They may not have carried out enough procedures to be included in the analysis.

    • For clinical outcomes data to be reliable, it must be based on enough procedures. Consultants who have not submitted enough procedures to the audit are not included.
    • A doctor might have carried out low numbers of procedures as a responsible consultant if they only became a consultant towards the end of the analysis period, or if they stopped practising the procedures listed part way through the analysis period.

    They may have retired or stopped carrying out the procedures on which data are published.

    They may practise outside England. This initiative applies only to England, although some data for Scotland and Wales have been made available in some specialties.

    They may have chosen to opt out of having their data published. Consultants may opt out because they believe that the data submitted about their practice is inaccurate or incomplete, they may not agree with outcomes data being published at consultant level, or they might be concerned about the public’s response to their outcomes data.

    Why doesn't the data look the same for all of the specialties?

    This is the first time that data on individual consultants have been published on this scale. A number of approaches are being tested to see which methods work best, so that these can be used more consistently in future.

    Each specialty has been asked to publish data showing, for each consultant, how many times they have performed a procedure and what their mortality rate is for that procedure.

    Each specialty has decided which procedures to include, and what measure of mortality to show, based upon what is most relevant to their patients and what data are collected.

    Some specialties have published additional information. In future all specialties should publish more data as the process evolves.

    When will data be available for other procedures and specialties?

    The results published to date were selected because relevant data was already being collected for these procedures and specialties. It is likely the programme will be extended from 2014 when data for other conditions can be collected and analysed in a similar way. 

     

    Where does the data come from?

    The data comes from national clinical audits that continuously review medical practice to check that it is safe and seek ways to improve it. These audits are managed by "audit providers" (usually academic institutions such as a university or royal college) that work with the specialist association. A specialist association is an independent, membership organisation, that represents a particular medical specialty.

    Comments

    The 5 comments posted are personal views. Any information they give has not been checked and may not be accurate.

    MR um said on 08 July 2013

    This is a good initiative which will enhance the reputation and quality of surgical care in the NHS.The data compiled in this manner does hide inadequacies of practicing surgeons. I can give you two specific examples how this occurs. In bariatric surgery, surgeons who operate on patients with multitudes of co-morbidities and risk factors are prone to high risk of complications. Such patients are operated by dedicated, very experienced and technically good surge who takes on challenging cases. Let us call this surgeon “A”. If this surgeon’s data is compared to a surgeon who ruthlessly weeds out all complicated cases from his waiting list using every trick in the book to postpone, dissuade, frighten complicated patients from not having bariatric surgery, but needs metabolic surgery most will naturally have good morbidity and mortality figures. Let us call this surgeon “B” The mortality and morbidity profile of the surgeon “B” artificially becomes very good! This off course enhances his reputation and patients would be fooled into thinking surgeon “B” is more competent than surgeon “A”In colo-rectal surgery there are surgeons with varying competencies and patients with variable premorbid state & disease complexity. Those with simple pathologies need average skills to obtain good outcomes, patients with complex clinical needs would benefit from best surgical skill set to improve his outcomes. One other aspect of this specific surgery is that risk averse surgeons who are most likely high in seniority and high in management strata are able to easily postpone the surgeries often prolonging non-surgical therapies till a time comes when they can delegate responsibility of the surgery to a surgeon who is not high in the seniority or authority. These will invariably skew the mortality and morbidity data of these unfortunate surgeons. These are two examples how morbidity and mortality data may not give the best assessment of surgeons skill & experience.

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    GMC1960 said on 04 July 2013

    The report aims to `drive up the quality of care and to help people choose the treatment that suits them best`. I am not sure ...
    Are my questions answered, ie,: Does the report tell me about the particular skills and knowledge of a consultant surgeon and the members of his/her team? Does it tell me how many high risk ground breaking or new procedures have been performed, by the consultant and his/her team, on patients in an attempt to save lives? Does it tell me about the quality of the consultant`s pre and post-operative care – or that provided by his/her team and other professionals? Have such factors been taken into account when making `risk adjustments`? I see no evidence. What the report does emphatically say is that I must not rank the surgeons according to the mortality figures as this `would be misleading and it could make people draw the wrong conclusions about an individual surgeon’s performance`. But, on the evidence given what else can I draw conclusions about? Surely this data is flawed and incomplete?
    As I see it, patients and their families are presented with data which is tenuous, open to interpretation and has the potential to cause unnecessary distress and distrust.
    Consultants, who have spent years training and practising, who pass on their skills and knowledge to others, who are committed to CPD, may also feel distress and distrust. I would be very surprised that if, in such a `front line` organisation as the NHS, regular monitoring, evaluation and review of practice and procedures did not take place and, where practice and procedures are found to be inadequate, there are no improvement measures in place!
    In my view the report fails, where it should succeed, to inform wholly and truthfully with reliable evidence and put the `human` first. Perhaps those who prepared it should consider (as perhaps should we all): `I will remember that I remain a member of society, with special obligations to all my fellow human beings..`

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    runwellian said on 29 June 2013

    Whilst I think some doctors need to be highlighted for a poor standard of work, the majority fight to save lives.

    Some folk will die no matter how hard doctors try, and feel this kind of thing will block patient 'at risk' from having surgery.

    A hip replacement may be routine for a healthy adult, but someone obese, that comes with many added risks, they will now find themselves moved off the lists until they lose weight!

    Having an operation will now be a very selective process, folk will be turned away for routine surgery if hey have any cardiac issues, over weight, a smoker etc.

    I would be more interested to know if the doctor speaks english that i can understand, where he did his training and how many successful operations he has done, to do that just ask other patients!

    Is this not yet another 'tick box' exercise, and a waste of time?
    It is important that doctors are monitored as they go, perhaps based on a number of deaths in a short period of time and / or on a percentage of operations carried out?

    Each operation is unique, sometimes things go wrong, sometimes things are found after the patient has been 'opened up', I find it hard to believe any bad surgeon is allowed to practice and would hope with all my heart that his / her colleagues would shout from the rooftops if that was the case?

    Perhaps the biggest problem with the NHS is that they care more about 'ticking boxes' than patients? Ticking boxes doesn't mean a job is done well, or that a surgeon is good or bad, life itself can throw in many spanners!

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    harry73 said on 29 June 2013

    I will be surprised if any information comes out on NHS Treatment centres or private hospitals. This is just a trap to divert patients out of mainstream NHS to these alternate options !

    Even if information comes out on treatment centers what is the point ? They operate on low risk patients and NHS trusts operate on higher risk patients. Obvious who will be the winners here !

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    GPJG said on 28 June 2013

    I have a widget on my computer which links to health and science stories in the media, together with the NHS choices comments often pointing out how badly-reported these stories are. Yet surgeons can only trust the media to report these statistics appropriately, despite all the evidence that the media is not capable of this.
    We are told on the radio this morning that this is not about league tables, yet one tabloid has already published photos of the three surgeons with the highest mortality rates.
    I am a GP, and I certainly can tell little or nothing useful from these figures about the standard of care each surgeon offers.
    I was particularly worried to hear a representative from Dr Foster, the NHS statistics unit (whose use of Standardised Mortality Ratios has been challenged by other statisticians), on the radio this morning. He implied that the wider variation in outcome data for surgeons performing fewer operations was evidence of poorer care. Certainly, he made no mention of the fact that such wider variation is an inevitable statistical consequence of smaller sample sizes, and does not automatically mean anything about the quality of care provided.
    I recommend that anyone tempted to trust these figures should read the article "Can chance make you a killer" by Michael Blastland on the BBC News website. It gives graphic examples of how pure chance can make a surgeon or hospital appear to be dangerous.
    Two things will happen: firstly, perfectly good surgeons will have their careers blighted. It will in particular offer more ammunition for managers and politicians who want to silence whistleblowers.
    Secondly, grieving relatives will be led to believe that their loved ones died as a result of an incompetent surgeon, when in fact it was purely bad luck. How does this help anyone?
    These statistics should come with a Government Health Warning

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    Page last reviewed: 28/06/2013

    Next review due: 28/06/2015

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