Intended for healthcare professionals


Doctors urge caution in interpretation of league tables

BMJ 2001; 323 doi: (Published 24 November 2001) Cite this as: BMJ 2001;323:1205
  1. Alex Vass
  1. BMJ

    Doctors' organisations have urged caution in interpreting the tables published every day this week by the Times newspaper, comparing the performance of hospitals in treating patients with certain life threatening conditions.

    Both the BMA and the Society of Cardiothoracic Surgeons expressed support for the principle of publishing accurate information but urged caution in its interpretation.

    The Hospital Consultants Guide provided an analysis of the hospital death rates for patients who had had heart bypass surgery or who had been treated for stroke or broken hips. It also listed hospital consultants who worked in five key specialties—heart surgery, heart disease, neurology, orthopaedics, and general surgery—giving their qualifications, waiting times, and private work addresses.

    The data were compiled by Dr Foster, an independent healthcare information company that works with Brian Jarman, emeritus professor of primary health care, at Imperial College, London. Writing in the Times, Professor Jarman said: “We hope the data will increase public awareness and understanding.”

    In the table related to cardiothoracic surgery, published on Monday, top place went to United Bristol Healthcare, well known for its failings in paediatric heart surgery in the early 1990s. Dr Nicholas Bishop, medical director at the trust, said: “We're delighted to be able to be recognised as being good for heart surgery.”

    Bottom of the league was Walsgrave Hospital, run by the University of Coventry and Warwickshire NHS Trust. In the past six years 120 more people died after bypasses at Walsgrave than expected, compared with 50 fewer deaths than expected at Bristol.

    A spokesman for the BMA said: “The BMA supports the publication of accurate information about hospitals and doctors that will be helpful to patients and their general practitioners.

    “Comparing results between different hospitals provides an opportunity to learn from the most successful specialist units and spread good practice. Data is improving all the time, but it is still fairly rudimentary, and league tables therefore still need to be treated with some caution. Some hospitals serve older and sicker populations than others, and pioneering consultants often attract the most difficult cases.

    “We need to move away from a blame culture that assumes that if a patient cannot be treated successfully, the doctor or hospital must have been at fault.

    “Over time, the BMA hopes to see more and better information being made available to the public.

    “Currently, league tables focus on surgery and surgeons. The contribution of other medical and nursing professionals and the patient's underlying state of health also have a crucial influence of the patient's chances of recovery.”

    Bruce Keogh, a consultant thoracic surgeon at Queen Elizabeth Hospital and Birmingham University Hospital NHS Trust, writing on behalf of the Society of Cardiothoracic Surgeons in the Times, said that the information was good news and “independently confirms our evidence that the results of heart surgery are steadily improving.”

    He added that league tables should be used to “analyse, understand and improve the quality of service” but were “not the answer.” In particular, he challenged the tables' ability to detect the many patient factors that affect outcome of surgery. An over-emphasis on league tables could see patients at high risk being turned away from surgery, as this was “an easy way to improve your position on the league table.”

    Tom Treasure, professor of cardiothoracic surgery at Guy's and Thomas's Hospital, said that it was “good to see the numbers out as they can be discussed” and that he felt “quite proud of the figures.”

    He criticised the media coverage that talked of “health ghettos,” “survival lottery,” and “needless deaths” as “inflammatory and guilty of scaremongering.”

    A spokesman for the Department of Health said: “One thing these tables make clear is that across the NHS, surgical performance is improving, and we think that increasing openness about data is involved in that.”

    Dr Liam Fox, Conservative health spokesman, said: “It is bad enough that we have such a big divergence in clinical outcomes, but the worst thing is that patients can be condemned to a substandard health ghetto from which they have no escape.”

    Ranking of 29 hospitals in England that do most heart bypass operations. Ranking is based on both sets of results*

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