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Public denied information

Patients are still being denied the information they need to make an informed choice about heart surgery.

Patients are still being denied the information they need to make an informed choice about heart surgery ten years after the Bristol babies scandal.

The Kennedy inquiry into the deaths of babies at the Bristol Royal Infirmary, following disciplinary action against two surgeons whose success rates were not as good as colleagues at other children's heart units, prompted the government to demand in 2001 that adult heart surgeons make their death rates public.

The information should have been available by last year, but many hospital trusts are still not collecting adequate data.

The Guardian used 36 simultaneous applications under the Freedom of Information Act to extract for the first time national data about the individual mortality rates of all cardiac surgeons practising in the NHS.

The exercise, unprecedented in its scale found: one London teaching hospital where trust managers and the cardiac consultants cannot agree among themselves about which surgeon should be assigned responsibility for particular deaths; hospitals, which diverted money the government allocated to improve record-keeping and risk assessment; and hospitals that are unable to give risk-adjusted data, which would reveal to patients the proportion of high and low risk operations undertaken by surgeons.

The disclosure of individual surgeons' mortality data is the first step towards admitting the public into the secret garden of the medical profession, which would allow patients to exercise informed choice on the basis of knowledge about doctors' clinical record.

Heart surgeons have been in the spotlight because of the Bristol scandal, which led to the striking off of two doctors. The GMC investigated the cases of 53 babies, of whom 29 died.

Choice will be the buzzword of the health debate at the general election, but although patients may be able to choose the hospital with the smarter waiting rooms or larger car park, they are nowhere near getting real information about their consultant's results.

Many doctors object to the publication of death rates, for fear that some will be stigmatised as worse than others, when the truth may be that they take the harder cases, where deaths are more likely.

They cite New York, where the publication of heart surgeons' mortality figures caused some to shy away from the riskier cases.

But publication has been inevitable since Alan Milburn, who was then health secretary, told the Society of Cardiothoracic Surgeons in 2001 that he wanted the data in the public domain by last year. The society has worked hard to collect and validate risk-adjusted data that allows for the likelihood of some deaths, but has been frustrated by the low priority given to the exercise by some trusts.

2nd September 2008

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