Introduction

After the General Medical Council hearings and the subsequent Bristol Royal Infirmary Inquiry into paediatric cardiac deaths, cardiac surgeons expected a stinging attack on British cardiac surgical practice. What emerged instead, in 2001, was a comprehensive report highlighting many of the difficulties facing frontline clinicians and managers in the NHS.1

The story of the paediatric cardiac surgical service in Bristol is not an account of bad people. Nor is it an account of people who did not care, nor of people who wilfully harmed patients. It is an account of people who cared greatly about human suffering, and were dedicated and well-motivated. Sadly, some lacked insight and their behaviour was flawed. Many failed to communicate with each other, and to work together effectively for the interests of their patients. There was a lack of leadership, and of teamwork. It is an account of healthcare professionals who were victims of a combination of circumstances which owed as much to general failings in the NHS at the time than to any individual failing.1

The report included 198 recommendations, of which two stated that patients must be able to obtain information on the relative performance of the trust and of consultant units within the trust. This led to an increasing belief that the interests of the public and patients would be served by publication of individuals' surgical performance in the form of postoperative mortality. A precedent for this existed in the United States, where in 1990, the New York Department of Health published mortality statistics for coronary surgery for all hospitals in the state, and has published comparable data …