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Transparency is the New Challenge for the UK's National Health Service

Posted on Jul 31, 2013 by Sergio Ulloa ()  | Tags: Healthcare, National Health Service, NHS, transparency, uk healthcare

Its is often said that in these fairly secular times, the nearest thing the British have to a national religion is, in fact, its National Health Service. The fact that the creation of the NHS played a central role in the celebrated pageant that formed the opening ceremony of the London 2012 Olympics was testament to this. However, recent months have seen what might be described as a crisis of faith in the institution and not for the first time, actions have been proposed to put it back on track with greater transparency being the most suggested method of doing so.

The NHS was established by a Labour Government in the years immediately after the second world war and celebrated its 65th birthday this year.  It was at the centre of a massive programme of social reform aimed at providing support to families and individuals from 'the cradle to the grave'. The fact that its creation was resisted by the medical profession of the time (and the then Conservative Party) has meant that the assessment of its success and failure has always had a political component.

That being said the Conservative Party, which leads the current Coalition Government in the UK, campaigned that the ' NHS was safe in its hands' and Prime Minister Cameron has regularly paid tribute to the support his own family drew from the service, especially referring to the treatment of his late son Ivan who was  born with cerebral palsy.

The latest travails of the NHS have a number of components. These include; an ageing population with its health concerns, more sophisticated treatment creating demand for  higher cost technology and a population made up of active and informed consumers of health care rather than its patient recipients. Overarching all of this is the challenge of planning and managing an activity that absorbs some £110 billion per annum ($167.5 billion) and employs 1.7 million people - which makes it the largest employer in Europe and allegedly  the  fourth largest ( after the Chinese Army, Indian Railways and Walmart) in the world. Spending on the NHC has risen by 1200% in real terms since it first came into operation.

Following on from a major reform in the structure of the service, which came into operation in April, issues concerning transparency in performance are increasingly generating concern.

Just a few weeks ago the first phase of a commitment to expose the performance of specialist surgeons went live. This phase aims to provide data on the outcomes of procedures for consultants in the specialisms of cardiac and vascular surgery. Ultimately, the commitment is to provide data of mortality levels relating to more than 3,000 surgeons across over twenty separate procedures.

The statistics are derived from the national clinical audit and track performance in respect of benchmarks that cover survival rates, length of stay in hospital after an operation and repeat operation rates, as well as the number of operations performed.

The UK Data Protection Act means that consultants were not obliged to have  these results made public. Nonetheless some 98% of surgeons have signed up and those who did not consent  will be identifiable.

These statistics, which focus on 'mortality rates', have been criticised as being partial and possibly misleading.  It is said that the time frames currently used mean that many surgeons may not perform enough operations for the data to be significant. It has also been argued that mortality rates alone are a crude indicator of performance - the 'failure' of a hip replacement operation is more likely to be evidenced by need for repeat surgery than by a death for example.

However, the enthusiasm for greater transparency in medical performance has already moved on to a commitment in making the UK the first country with a national measure of avoidable deaths.

This commitment is one outcome of a report carried out by the NHS Medical Director for England, Sir Bruce Keogh which looked into some 14 medical trusts across England that were performing poorly in regard to mortality rates. The need to distinguish between 'avoidable' deaths at any institution and less sophisticated measures of mortality rates became very apparent and further research was needed in regard to the measurement of avoidable deaths. It was this statistic which Keogh argued could provide a real trigger for service improvement.

Some leaking of Keoghs report produced a storm of concern when the data was reported in the press and suggested that some 13,000 'unnecessary' deaths had occurred at 14 hospital trusts.. Keogh repudiates these conclusions as being clinically meaningless. However, the unavoidable political overtones of these initial reports - and the equally unavoidable role of the NHS as probably Britain's most kickable political football - meant that the issue generated point scoring between parties on a massive scale.

The facts are that there is probably not a household in the UK which cannot recount tales of both heroism and horror from some close encounter with the NHS. The progress of an institution so central to the emotional and physical well- being of the nation will remain very firmly at the centre of public attention.

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