NHS medical director wants surgeon league tables

The medical director of the NHS in England plans to publish individual surgeons' results within two years.

Sir Bruce Keogh believes this will force clinicians to focus on their performance and seek help when surgical practice falls below acceptable standards.

The Health Secretary Jeremy Hunt fully supports the plan to publish individual surgeons' results.

The BMA says league tables may lead some surgeons to avoid complex cases.

The publication of surgeon-specific data was first called for in 2001 by Prof Sir Ian Kennedy, who chaired the inquiry into the excessive number of deaths of babies undergoing heart surgery in Bristol.

The measure was not introduced, but Sir Bruce Keogh has told BBC Radio 4's The Report he believes it is now time to do so.

Sir Bruce, a former heart surgeon, says there is already evidence that publishing outcomes in his own specialist field has improved results. He hopes his plan will supplement yearly appraisals for doctors and will be revalidated every five years.

The investigative documentary also examines how an obstetrician and gynaecologist from The Royal Cornwall Hospitals NHS Trust, known locally as Treliske Hospital, was allowed to continue operating despite several inquiries over a 12-year period into his clinical competence.

Rob Jones, who delivered Prime Minister David Cameron's daughter by Caesarean section in 2010, was suspended in May this year after an external review by the Royal College of Obstetricians and Gynaecologists (RCOG).

The RCOG report, obtained by the BBC, highlighted Mr Jones' failure to stick to guidelines in his obstetrics and gynaecology practice, with at least five reported fistulas - a rare complication when a hole is torn between the vagina and the bladder (or in some cases the vagina and the rectum).

The review said having more than one fistula case in a consultant's career would be unusual and goes on to say: "There is a general opinion amongst theatre staff that Mr Jones' surgery is of poor standard yet no-one has been strong enough to do anything about it."

Other issues identified from the RCOG review into Mr Jones' performance include bizarre decisions; poor documentation and communication; poor consent technique and an impression of increased surgical complications.

More than 1,500 women who saw Mr Jones as gynaecology outpatients are having their care reviewed.

'Emotionally devastating'

One patient, 35-year-old Claire Hill, had an operation carried out by Mr Jones in 2010.

The operation went wrong and she had to go back to him for a hysterectomy which left her with a devastating fistula injury, when a hole was torn in her urinary tract.

"I was severely incontinent for the best part of the next year which was devastating emotionally, physically it impacted on every part of my life," she told the BBC.

"My self-confidence went down; I couldn't walk the kids to school because even though I was strapped to a catheter bag, I was flooding even with the catheter bag in."

She is suing the hospital trust for negligence.

In a statement released by the Medical Defence Union, Mr Jones says that he co-operated fully with the investigation carried out by the trust and agreed his retirement with them.

Mr Jones informed the GMC that his practice had been the subject of a recent investigation when he submitted his application for voluntary erasure from the register.

But Sir Bruce Keogh says the story of Rob Jones shows the current system is not working:

"It worries me that someone has been through a large number of external investigations, and it encourages me to ask what level of governance exists within an organisation that allows it to happen?"

The Royal Cornwall Hospitals NHS Trust says it cannot comment until the publication of an external review it has commissioned into the way it dealt with concerns over the past 20 years.

'Right operation'

Sir Bruce says he wants to roll out publication of individual surgeons' results in England to help drive clinical outcomes.

"It forces you, if you know your results are going to be out in the public domain, to concentrate on your own performance and data [and] to seek help from colleagues.

"It encourages you to really consider whether you are operating on the right patients and doing the right operation at the right time."

In a statement, the doctors' union the British Medical Association says it supports measures intended to improve outcomes and it is important that patients have the information they need about the surgeon operating on them.

But it says it also has concerns that simply publishing crude mortality figures will be misleading as they are dependent on many factors, adding:

"Some surgeons are deterred from taking on very complex, and therefore high risk procedures, because published simplistic league tables count against them."

The Welsh government also has concerns over league tables, saying they may promote adverse behaviour such as non-reporting. However, a spokesman said that the new revalidation process for clinicians, supported by good performance data, would be a key part of tackling issues where they existed.

Scotland has no plans to launch a scheme similar to that proposed by Sir Bruce Keogh. However, the Scottish government expects health boards to routinely monitor individual surgical performance and also publishes hospital standardised mortality ratios on a quarterly basis.

Hear more on this story on The Report on BBC Radio 4 on Thursday, 6 December 2012 at 20:00 GMT. You can listen again via the BBC Radio 4 website or The Report download.