The performance of individual cardiothoracic surgeons is to be published, in a drive to create a more open, honest, and patient centred NHS.
The plan is one of several initiatives announced by the government last week in response to the report of the Kennedy inquiry into heart surgery in children at the Bristol Royal Infirmary (BMJ 2001;323:181-2).
An independent office for information on healthcare performance is to be set up—as an arm of the Commission for Health Improvement—which will, by April 2004, release data on mortality within 30 days of surgery. Data collection methods have been developed by the Society of Cardiothoracic Surgeons, which has agreed to cooperate with the initiative.
From 2005, results will be published annually for each heart surgery centre and every three years for each cardiac surgeon.
The 200 page report has taken over six months to produce. It responds to each of the 198 recommendations from the £14m ($20m; €23m) public inquiry. The government has agreed in full or in part to 187 of them.
Bruce Keogh, the secretary of the society, said that surgeons were “not comfortable” with publishing individual performance results but accepted it as inevitable. “We have been collecting data on death rates for four years already, and acting upon it, but are concerned that publishing data could lead to the practice of defensive surgery, where high risk cases are avoided.
“Surgeons have already begun to avoid high risk cases. So how information is presented is going to be critical. We don't know all the answers, and we really want people to help by suggesting ways in which the data can be published without causing damage,” he added.
Coronary bypass operations will be used as the initial marker of performance, said Roger Boyle, the government's national director for heart disease. As this operation is now seen as routine, poor performance in it would best show up potential problems. 
Published information on consultants and units from other specialties is likely to follow. Mr Boyle called the cooperation of the cardiothoracic surgeons “trailblazing in this country and internationally,” while other specialties were still in “infancy.” Mr Keogh, a consultant thoracic surgeon at the University Hospital Birmingham NHS Trust, said: “Public disclosure is right and proper and is likely to roll out throughout the NHS.”
The initiatives are intended to give patients more ability to choose surgeons with the best records. New patient care advisers from the British Heart Foundation will be available to help patients understand the concept of risk. Mr Boyle said that this service would start by July this year for those patients who have been waiting for more than six months for their operation, under the new “choice initiative.”
Health Secretary Alan Milburn, speaking in the House of Commons, said: “The days have gone when parts of the NHS could behave as if they were part of a secret society. Our task is not to pretend that we can eradicate error. Our job is to ensure that there are systems in place to detect errors, to minimise them, and, perhaps most important of all, to learn from them.”
Other initiatives outlined in the report, but announced by the government last year, include the founding of a new body, the Council for Regulation of Healthcare Professionals. This will be responsible for strengthening and coordinating the system of professional self regulation across the professions.
Also, a new Council for Quality of Healthcare will be established that will be “at arm's length from government.” This follows criticism that although much data on the poor performance at Bristol was available, no single body existed to coordinate a response. The council will bring together all agencies currently working to improve standards—the National Institute for Clinical Excellence (NICE), the Commission for Health Improvement, the National Clinical Assessment Authority, and the National Patient Safety Agency—and will oversee all monitoring and inspection within the NHS.
The government's report was “broadly supported” by the BMA, and the King's Fund, the Consumers' Association, and NICE also welcomed the government's initiatives.
Learning from Bristol is available at www.doh.gov.uk/bristolinquiryresponse
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KIRSTY WIGGLESWORTH/PA
Bruce Keogh (right) says surgeons are “uncomfortable” with the publication of individual results, but see it as inevitable