Sir,

While Aniket Tavare [1] presents evidence for both sides of the argument relating to the quality of performance data, the article does give a positive slant to public disclosure. This, it would seem, is in no small part due to his selection of opinions from those with a vested interest in the success of this venture. For example, he mentions by name the two founders of the Dr Foster company on no less than a dozen occasions. Under the circumstances, what else can we expect but favourable comments?

Both Tavare [1] and Fiona Godlee in the Editor’s Choice [2] include the same quotation by Bruce Keogh. It is worthwhile looking at the full version rather than the abbreviated quote in the BMJ. “Of course there were problems with the published data: some was risk adjusted, some was crude; some units submitted calendar years, some fiscal years, some included redo operations some did not. One unit was left out completely and some surgeons were attributed to the wrong hospitals. Whilst this provided some comfort to detractors of the process the shortcomings are not important in the grand scheme of public disclosure.” [3]

Neither Tavare nor Godlee pass any comment on this extraordinary view that flaws in the data are not important. Does the quality of the data not matter? We have become accustomed to seeing so-called reliable data brought into question. Mortality statistics have been subjected to severe criticism, so much so that Nick Black has recommended abandoning the widely used hospital standardised mortality ratios altogether. [4] And we should remember that death is the hardest of end-points. What fate awaits other data based on softer outcomes? The problem is that statistical data can be so readily misinterpreted and manipulated, distorted and abused. [5]

When the data are suspect, the information provided to patients is of little value. And what about the effect of the process on clinicians who may be held to account for their poor performance based on faulty statistics? Patients and doctors would be well advised to be sceptical of this “grand scheme of public disclosure”.

James Penston
james.penston@nhs.net

References

1. Tavare A. Where are we with transparency over performance of doctors and institutions? BMJ 2012;345;e4464.

2. Godlee F. Editor’s Choice: Publish your team’s performance. BMJ 2012;344;e4590.

3. Keogh BE. Presidential Address: A decade of immunisation. 2008.

4. Black N. Assessing the quality of hospitals. BMJ 2010;340;c2066.

5. Penston J. Stats.con – How we’ve been fooled by statistics-based research in medicine. The London Press. November 2010.

Competing interests: None declared