Operation Success Rates Help Patients Choose Treatment, UK

Main Category: Public Health
Article Date: 11 Jul 2008 - 3:00 PDT

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The NHS has taken a significant step towards greater patient choice with the publication of national operation survival rates.

The data for four common operations for each trust in England comes from the Healthcare Commission's published cardiac survival data.

The figures, which are published in a user-friendly format and as raw data, reveal that all hospitals are performing within acceptable guidelines and five hospitals are above average.

The figures are published alongside the Health Informatics Review - a review of how information can be better used across the Department and NHS.

The Health Informatics Review sets out a vision, supported by a number of key proposals, that describe how coverage and quality of information can be enhanced to meet these needs and help transform health and social care and will be followed by a more detailed, technically based Health Informatics Review Implementation Report in the autumn 2008.

Publication of the survival rates immediately puts into action one of the report's key recommendations - to give patients a greater say in the care they receive by extending choice on treatment options. It also builds on the Department's commitment, to enhance quality and choice, which was outlined in the NHS Next Stage Review, published on 30June.

The data, which indicates the success of an operation, is published on the NHS's website, NHS Choices, as part of the 'hospital scorecard', which allow patients to compare hospital treatment options from a range of clinical and non-clinical data such as length of stay and MRSA rates.

The NHS Choices website can be found at: http://www.nhs.uk

NHS Medical Director and interim Director General for Informatics Sir Bruce Keogh said:

"Whilst we are rightly proud of our NHS which offers good, evidence based and innovative clinical services there is a view that we have lagged behind other industries in providing sophisticated IT infrastructure to support NHS staff to deliver a 21st century service which enables to patients engage more fully in their care.

There is a strong appetite in the NHS to develop a coherent informatics infrastructure to address the issues of data transfer and security between multiple organisations using a myriad of different systems in Europe's largest organisation, but this is not going to be easy. To get it right will take time but good information is fundamental to modern healthcare."

The first data to be published is for Abdominal Aortic Aneurysms (elective and emergency), elective hip replacements and knee replacements and will be followed in the coming months by a series of clinical outcome data being made available for a wider range of elective and emergency surgery.

Alongside the new data, NHS Choices will publish Health Guides to help manage depression, dementia, diabetes and asthma. Each contains useful information on prevention, diagnosis, treatment and living with long-term conditions.

The Health Informatics Review takes forward the commitments outlined in the NHS Next Stage Review to extend choice and realise the potential of our technology capabilities to enhance healthcare.

The Health Informatics Review Implementation report will set out how the measures identified in the review will be put into practice. These include:

- Developing better systems of securely sharing information across organisational boundaries;

- Developing a 'Myspace' type interface that allows staff to access information about education and training, clinical information and research, and career progression through a single site;

- Piloting systems such as clinical dashboards that allow clinicians to monitor the performance of a service and quality of care by combining many sources of clinical information from the hospital and local health community in single display. It allows health professionals to get a clear picture at a glance of a several indicators of a patient's condition; and

- A renewed focus on reducing the time taken and the resources needed to collect data while ensuring it is used to maximum benefit.

NHS Connecting for Health, which now incorporates NHS Choices, is delivering these key elements of the Review, including the development of clinical dashboards, which will improve the quality of patient care.

Commenting on the outcome of the Health Informatics Review, chief executive of The NHS Information Centre Tim Straughan said:

"We welcome the outcome of the Informatics Review which firmly establishes The NHS Information Centre as the central, authoritative source of health and social care information in England. High-quality, relevant information is crucial to enable the NHS to deliver world class services and to enable patients to make decisions about their health and care. We are delighted the review so clearly establishes our role in both providing and encouraging the availability of such information across the service."

Notes

1. The Health Informatics Review was commissioned by the NHS Chief Executive and Department of Health Permanent Secretary to:

- assess the supply of, and demand for, information across the NHS and social care, so that the data collected can be used to provide valuable and relevant information;

- make sure that, five years after the commissioning of the National Programme for IT, the framework for the NHS Care Records Service and the Secondary Uses Service (SUS) is in line with recent, current and potential future policy;

- make sure that the governance of informatics within the NHS and the Department of Health (DH) is clear and appropriate, and supported by the right management.

A copy can be accessed at: http://www.ournhs.nhs.uk

2. In the NHS Choices survival data hospitals which performed better than the expected range were as follows:

- For AAA (elective): Newcastle Upon Tyne Hospitals NHS Foundation Trust, University Hospitals of Leicester NHS Trust, Worcestershire Acute Hospitals NHS Trust

- For AAA (emergency): Norfolk and Norwich University Hospital NHS Trust

- For hip replacement (elective, planned): No hospitals in this category

- For knee replacement (elective, planned): East Kent Hospitals NHS Trust

3. NHS Choices clinical indicators and guides to long-term conditions can be found at: http://www.nhs.uk

The clinical indicators figures are published as bandings that indicate whether they are within acceptable limits and standardised mortality ratios (SMR) for each trust and procedure.

The standardised mortality ratios within a given band may vary widely between trusts. This difference does not represent a statistically significant variation in performance.

The difference in SMR numbers arise because of:

- the relatively small numbers of deaths associated with the four procedures.
- small numbers of operations being performed by a trust
- the relative complexity of the cases.

Standardised mortality ratios are not an average. They are a measure against expectations. The survival rate nationally, for hip and knee operations is that 98% of patients will survive. Therefore, it should not be surprising that for this procedure all trusts fall within the expected range.

The measured performance of trusts within the same band is effectively equivalent. It would therefore be inappropriate to draw conclusions about the risks to survival at individual trusts from a comparison of standardised mortality ratios.

Department of Health, UK