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Consultant treatment outcomes

NHS England has begun the staged publication of mortality rates for individual hospital consultants in ten specialties, a major breakthrough in NHS transparency. This leads a push to give patients more information about their treatment, helping the NHS drive up and maintain the quality of care. 

The data - covering around 3,500 consultants can be seen on the NHS Choices website (www.nhs.uk/consultantdata).  The data will initially be refreshed annually and publishing of data in this way will be mandatory from next year.

How can patients 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.

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 or data registries which 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) which work with the specialist association. A specialist association is an independent, membership organisation, which represents a particular medical specialty. Those specialities, along with the associated societies and the audit/registry from which the data will primarily derive from, can be seen in the table below.  Clicking on the links below will take you directly to the relevant society website where you can view the outcomes. 

 Specialty

 Clinical audit/registry title

 Specialist Society

 Adult cardiac surgery

 National Adult Cardiac Surgery Audit

 SCTS

 Vascular surgery

 UK Audit of Vascular Surgical Services & Carotid Endarterectomy

 VSGBI

 Thyroid and endocrine surgery

 BAETS national audit

 BAETS

 Interventional cardiology

 Adult Coronary Interventions

 BCIS

 Orthopaedic surgery

 National Joint Registry

 BOA

 Bariatric surgery

 National Bariatric Surgery Register

 BOMSS

 Urological surgery

 BAUS cancer registry

 BAUS

 Colorectal surgery

 National Bowel Cancer Audit Programme

 ACPGBI

  Head and neck surgery

 National Head and Neck Cancer Audit (DAHNO)

 BAHNO

 Upper gastro-intestinal surgery

 National Oesophago-Gastric Cancer Audit

 AUGIS

 Lung cancer

 National Lung Cancer Audit

 BTS/SCTS

 Neurosurgery

 National Neurosurgery Audit Programme

 SBNS

 Urogynaecology

 BSUG Audit Database

 BSUG