Publication of consultant treatment outcomes

NHS England has begun the staged publication of mortality rates for individual hospital consultants in ten specialties, a major breakthrough in NHS transparency.

This leads a push to give patients more information about their treatment, helping the NHS drive up and maintain the quality of care.

The data – covering around 3,500 consultants can be seen on the NHS Choices website.

The data will initially be refreshed annually and publishing of data in this way will be mandatory from next year.


RJAH Consultant treatment outcomes

RJAH Orthopaedic Hospital has a good record for low mortality risk. RJAH has access to a national benchmarking system and the results of this are reported to the Trust Board in June. The report demonstrates that RJAH is the second lowest in the peer group of specialist orthopaedic hospitals in the UK.

Due to the low mortality numbers, every death is fully investigated by the Clinical Governance Team.

Thus far the information for individual consultant’s mortality has been provided only for the 17 RJAH consultants carrying out hip and knee replacements.  In the interest of transparency none of our consultants have withheld their consent for the information to be made available to the public. 

In 2013, the British Medical Association (BMA) questioned the safety of elective operating at weekends because of some published reports of a higher death rate (Aylin et al.).  We have compared mortality rates at RJAH according to the day of the week and can find no evidence of a higher mortality when operating at weekends.


Other information

How can I use the data?

The information published so far includes how many times each participating consultant has performed certain procedures and what their mortality rate is for those procedures. You can see whether or not the data for each consultant is within or outside the expected range. Consultants who fall outside the expected range are sometimes referred to as ‘outliers’.

You can use this data to decide which consultant to choose for your care. However, there are some important issues to bear in mind when looking at the data.

For instance, the vast majority of the data has been through a process known as ‘risk adjustment’. This is a way of accounting for the different mix of patients operated on by a particular consultant’s team. Using risk adjustment, outcomes are calculated as if all consultants operated on the ‘average’ patient. This means that consultants who take on particularly poorly, high-risk patients or carry out the most complicated procedures don’t appear to have an unfairly high mortality rate.

However, not all the data can be ‘averaged out’ in this way. Specific reasons for this are outlined in the introductory text for each set of results. Where risk-adjusted data is not available, actual (also called ‘crude’) clinical outcomes are shown. If the data is not risk-adjusted, a consultant may have a higher mortality rate simply because he or she takes on more difficult cases.

If you have questions or concerns having viewed specific results, please discuss these with your GP or consultant.

What will the NHS do where consultants have high mortality rates?

Any hospital or consultant identified as an outlier will be investigated and action taken to improve data quality and/or patient care.

When will data be available for other procedures and specialties?

The results published to date were selected because relevant data was already being collected for these procedures and specialties. It is likely the programme will be extended from 2014 when data for other conditions can be collected and analysed in a similar way.

Where does the data come from?

The data comes from national clinical audits which continuously review medical practice to check that it is safe and seek ways to improve it. These audits are managed by ‘audit providers’ (usually academic institutions such as a university or royal college) which work with the specialist association. A specialist association is an independent, membership organisation, which represents a particular medical specialty.

Specialities included in the Consultant Outcomes Publication

Below is a list of the Consultant Outcome Publications for different specialities.  Please see the Healthcare Quality Improvement Partnership (HQIP) website for further information.