13 June 2013
Professor Norman Williams, President of the Royal College of Surgeons, said:
The Royal College of Surgeons is not there to defend ‘bad’ doctors, or those who are not performing as well as they should. Patients have a right to know of doctors who are not meeting the standards expected of them.
That’s why we need as many surgeons as possible to give their consent to the publication of their individual outcomes results this summer because it’s important to be open and transparent, and because the process of collecting the data will improve over time and drive up standards.
We always expected this information would be mandated but it was the government’s own legal advice, taken earlier this year, that made it clear that in preparation for the publication of data from nine national surgical clinical audits,they would have to ask for doctors to consent to the use of their data, under the Data Protection Act of 1998.
We would urge the Government to work with us on this, for the sake of better patient care and more transparency.
The issues surrounding consent are:
1. Not everyone is included in an audit. Around 4,000 surgeons in over 20 procedures will be involved which is over half of the consultant surgeons in England. The remaining consultants do not do the particular procedures. If the Department of Health decides to name hundreds of doctors who are missing from audit data, they may be wrongly identifying people as withholding consent when in fact they never entered data in the first place.This will harm patient confidence in surgeons, and wrongly stigmatise individuals.
2. We have been contacting surgeons to gather their consent and are in the midst of this process. Whether individuals consent or not, there are robust systems in place that have been running in many areas of surgery for a number of years to look at individuals where their outcomes are not what would be expected. Where concerns are valid their employer and the regulators are informed and action can be taken.
3. The data is complex and has to be checked.
The analysis of data is complex with many pitfalls. Some surgeons have delayed giving consent until they know the data is robust. This process has been carried out at high speed and we are still sorting out many data issues. For example patients’ outcomes do not depend on the performance of the surgeon alone – they depend on the entire team and the structure in which they work. They are also dependent on the complexity of the patient’s conditions.
We need to work through that and ensure that the data is reliable – not least because patients won’t want unreliable measurements. They will want the measurement of surgical results to be as accurate as possible. These audits are put together on a voluntary basis and surgeons need to be confident that they are done in the right way.
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