FAQ

Everyone counts: Publication of Consultant clinical outcomes

Frequently Asked Questions

Contents

General 1
What, where and when? 1
Why were these ten specialties chosen? 2
Why ‘consultant level’? 2
Consent 2
Outliers 3
The data 3
Risk 3

 

General

This is the start of a journey to drive forward with the transparency agenda, particularly in light of the findings of the Francis report. This will act as a catalyst for improvements in audit quality, participation and analysis that will enable fuller transparency in the future.

What, where and when?

From Friday 28 June 2013, a portal will be available on the NHS Choices website (www.nhs.uk/consultantdata) so that data across specialties is easily accessible from one place.
There will be a staged publication of the data as follows:

Specialty

Launch date

Cardiac surgery By 10am, Friday 28 June 2013
Vascular By 6pm, Friday 28 June 2013
Bariatric By 6pm, Sunday 30 June 2013
Interventional cardiology By 10am, Monday 1 July 2013
Orthopaedics By 10am, Monday 1 July 2013
Endocrine and Thyroid By 6pm, Monday 1 July 2013
Urology By 6pm, Friday 5 July 2013
Head and neck Autumn 2013
Bowel cancer Autumn 2013
Upper GI Autumn 2013

 

  • 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. For example, Urology have decided to specifically published details on length of stay in hospital and Thyroid and Endocrine have decided to publish ‘readmission to hospital’ as an outcome indicator. In future, it is expected that specialties should publish more data as the process evolves.
  • Data will be refreshed annually.
  • This initiative relates to England only. Some audits that collect UK-wide data will be publishing data for consultants practicing in Scotland, Wales and/or Northern Ireland where those consultants have given permission for their data to be included.
 

 

Why were these ten specialties chosen?

Specialties were chosen on the basis that they are covered by an audit that was felt fit for purpose, or in a position that they could be developed so they are fit for purpose. The initiative will be expanded over time to include other specialties.


Why ‘consultant level’?

Consultants are senior physicians who take ultimate responsibility for the care of patients that are referred to them. It is therefore appropriate that they are responsible for the outcomes of their patients, acting as a representative of their multi-disciplinary team (MDT).

Consent

  • The direction of travel is towards complete transparency at consultant level. There is however, a need to comply with the Data Protection Act (1998) and current legal advice taken by both NHS England and HQIP has indicated that best practice is to gain consent to publication
  • Data are published for all consultants in England unless they explicitly do not consent
  • To date, around 99 percent of consultants have agreed or not objected to information regarding their practice being published. Consultants and their reasons for opting out of publication will be listed on the NHS Choices website.
  • For consultants who have not explicitly consented, their data is still included when calculating national averages
  • The small number of consultants whose clinical outcomes data lies outside of the expected range (outliers) have consented to publication of their data.
  • This is a major cultural change in the way the NHS works and we expect this to take time to bed in. As is the experience with the publication of cardiac data previously, we expect this to change over time with more consultants agreeing to their data being published.

Outliers

  • An outlier is a consultant whose clinical outcomes data lies outside of the expected range, which is based on the national average. This may be due to data quality/completeness, unusual or complex patient casemix that cannot be adjusted for risk or performance issues.
  • There will inevitably be a small number of outliers, which is where the consultant’s data is outside an expected range. It is really important that people understand that somebody could be an outlier because they take on difficult cases. It doesn’t necessarily mean there is a performance issue. Where someone is an outlier, it is important that expert colleagues review the data so that the issued are properly understood by all.
  • Outlier policies are defined and professionally led by the specialist societies/audit suppliers
  • The publication of consultant outcomes data has stimulated specialist societies to take ownership of the setting and monitoring of clinical standards, including drawing up and implementing outlier policies and improving clinical governance. These developments will protect patients and improve quality.

The data

  • It is expected that the results of this data will reassure patients that the quality of clinical care is high
  • Variation within the expected range is relatively small and could be due to a number of factors. It would therefore not be reliable to ‘rank’ consultant performance using the data
  • The publication of this data will help assist patients in having an informed conversation with their consultant or GP about the procedure or operation they are due to have.
  • All individual analyses are supported by thorough narratives explaining how to understand results
  • This ‘pilot approach’ to presenting data will generate a variety of examples from which best practice can be determined going forward in consultation with patients and thorough robust research
  • NHS Choices, a site with extensive experience in presenting information in a way that patients and the public can understand, is acting as the central hub of information
  • Specialist societies and audits are being encouraged to be innovative in the way that data are presented in this first instance, so presentation of results among specialties differs slightly. However, most patients will be interested in viewing the specialty relevant to them, so adverse effects of their being different from one another should be minimal

Risk

  • Where possible, data are adjusted to take into consideration the risk of a procedure on patients with different risk factors. Improvements in risk adjustment methodologies will be stimulated by putting data into the public domain
  • In adult cardiac surgery, where results have been published at consultant level since 2005, there is no evidence that publication encourages risk averse behaviour. In fact, year on year, more high risk patients have been receiving cardiac surgery in the UK. Despite these high risk patients being given the option of surgery, mortality rates have actually gone down significantly
  • Publishing outcomes puts pressure on the profession to implement the treatment options that are proven to be most effective for high risk patients, enabling an increased number of high risk patients to successfully undergo surgery (as evidenced by cardiac surgery).

 

 
 
 
 
 
 
 
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