Where are we with transparency over performance of doctors and institutions?

The Bristol paediatric cardiac surgery scandal shook the foundations of British medicine and the repercussions are still being felt today. In the early 1990s, the death rate for children aged under 1 year having heart surgery at the Bristol Royal Infirmary was exposed as being twice that of other centres and led to a public inquiry. One reason why Bristol happened was, “No standards were laid down against which performance in the NHS and quality of care could be measured,1” according to Alan Milburn, the health secretary at the time. Ian Kennedy’s damning inquiry report produced a broad set of recommendations for the NHS, including that “patients and the public must be able to obtain information as to the relative performance of the trust and the services and consultant units within the trust.”2

Fast forward a decade, and the health secretary, Andrew Lansley, stated: “[Patients] need to know who is providing quality, safe, effective, accessible services.”3 Laudable sentiments, but isn’t everyone providing good care? Unfortunately not, according to the NHS’ Atlas of Variation, which describes the substantial “unwarranted variation” in performance that still exists across England, even after patient and social factors have been controlled for.4

Although the UK has started to publish data from its public services only relatively recently, Tim Kelsey, director of transparency and open data at the Cabinet Office, says “we publish far more data than anyone else in the world in healthcare.” So how far are we towards Kennedy’s vision for a transparent health service?

After Bristol, the Society of Cardiothoracic Surgeons (SCTS) emerged as a paragon of healthcare transparency, …