FoI reveals mortality rates of cardiothoracic surgeons

Using Freedom of Information legislation, the Guardian has persuaded surgeons to disclose information about their death rates.

When the Freedom of Information Act came into force in 2005, the newspaper applied for the mortality scores of cardiothoracic surgeons who performed heart bypass operations at 36 NHS trusts across Britain.

Heart surgery had been the focus of much debate after a scandal at the Bristol Royal Infirmary where 29 babies died because nobody was aware that its consultants had mortality rates well above the average.

An inquiry under Sir Ian Kennedy, now chairman of the Healthcare Commission, recommended regular publication of the data so nothing similar could happen again. In 2002, Alan Milburn, then health secretary, secured a commitment from the Society of Cardiothoracic Surgeons to make available the risk-adjusted mortality scores of all its members.

The risk adjustment was designed to ensure that surgeons did not turn down difficult cases for fear of spoiling their averages. The society promised to publish the data by 2004, but failed to meet its deadline. So the Guardian encouraged them into action by using the FOI Act to expose their raw mortality rates.

The Guardian's application caused apoplexy among surgeons, who phoned the newspaper to accuse them of wanting to kill people. They said consultants would become more risk averse, leaving patients to die who could have been saved by surgery.

The Guardian published the information, using risk-adjusted figures for NHS trusts that had them available and raw scored for those that did not.

The newspaper reports that "the sky did not fall in on the heart surgeons". Two years ago, the data went up on the Healthcare Commission's website, including mortality rates for all trusts and more than three-quarters of the individual surgeons.

There was an important postscript to the Guardian's freedom of information application in 2005. When the replies came in from the trusts, we found glaring errors in the return from St Mary's teaching hospital in Paddington.

It attributed a clutch of deaths to a consultant who was absent at the time on a lengthy sabbatical and could not have been held responsible. We made the evidence available to the Healthcare Commission.

As a result, the hospital called in Sir Bruce Keogh, then president of the Society of Cardiothoracic Surgeons, to investigate. His confidential report, obtained by the Guardian, found facilities for heart patients at St Mary's were "almost certainly the worst in the country."

His report concluded: "There is a clear failure of teamwork within the cardiothoracic unit, which, when coupled with the poor facilities, staffing practices and inadequate medical cover of the fast-track [recovery] unit, poses a serious clinical risk."

In this case at least, freedom of information did not cost lives. By exposing problems, it may have saved them.

NHS death rates: freedom of information may have saved lives (The Guardian, 29 May 2008)