Patients are able to search by hospital and see the performance measures of more than 5000 surgeons in 12 different specialties across the UK. The decision to make the data available to the public has been heavily criticised with claims it has resulted in some surgeons being fired or quitting. Data available since 2005 has resulted in between 20 to 30 cardiothoracic surgeons being deregistered.
Critics argue that experienced surgeons who take on difficult cases are disadvantaged. There is criticism that the public available data is not detailed enough and doesn’t cover information such as duration of stay or number of theatre returns, and that there is no evidence public reporting improves surgical outcomes. A decade long study of the death rates among 110,000 cardiac patients at 10 UK hospital found that surgeons accounted for 4 percent of the risk, the patient’s health 96 percent. Some people have raised concerns that UK surgeons will refuse to operate on high-risk patients. One survey undertaken by the Society for Cardiothoracic Surgery found that 25 percent of heart surgeons were now less likely to take higher risk cases.
There are also concerns that the data could cause patient stress and anxiety as NHS patients do not have choice of doctor. However some members of the public have suggested that league table data be expanded to other specialists including GPs and believe that when performance is measured, performance improves. A recent study of colorectal surgery looked at 90-day mortality after elective surgery. The authors of the study say that 90-day mortality allows for fair comparison between surgeons. The findings of the study ‘Effect of public reporting of surgeons’ outcomes on patient selection, “gaming,” and mortality in colorectal cancer surgery in England’ were that the number of deaths reduced from 2.8 percent to 2.1 percent after 2013 when public outcomes were introduced.
Australian surgeons reluctant to have performance data released publicly
In 2015 New South Wales became the first place in the world outside North America to introduce an independent audit of surgical quality. The National Surgical Quality Improvement Program (NSQIP) was created by the American College of Surgeons and was initially implemented in five hospitals across NSW. Data is collected by a qualified individual and is then fed back to the surgical team.
Representatives of surgeons in Australia and New Zealand agree measuring performance is important but do not support the possibility of making such data publicly available. Surgeons in Australia and New Zealand feel that internal audits are sufficient for determining poor performance. They argue that mortality rates are an inadequate measure of performance and that the reputation of individual surgeons could be harmed if data was to be released publicly. There is also concern that making data publicly available would introduce a level of interference which would impact on the efforts to improve services.