Patient-facing data is essential in the digital era

I t would be easy to read the article from Westaby and colleagues and come to the conclusion that UK medical policymakers had completely lost the plot. If you take what the authors say at face value, the programme to publish named surgeons’ outcomes has proved to be a terrible mistake in the US and is now creating carnage in the UK. What you might also conclude is that the RCS has been ‘duped’ into giving support to a fatally flawed initiative. Why is there such a difference in perspective? The public accountability agenda in surgery is unpopular with some surgeons. It is part of a wider initiative of transparency driven by the government. But it was not, as Westaby suggests, the government that was originally responsible for the recommendation to report surgeons’ outcomes as a ‘punitive post-Bristol political directive’. It came from Sir Ian Kennedy, a lawyer, in the Bristol Public Inquiry report back in 2001. Those recommendations were fulfilled for adult cardiac surgery in 2005, but other specialties lagged behind. When Robert Francis heard the evidence associated with the events at Mid Staffs, he came up with a similar view. The current consultant outcomes publication programme across 13 specialties is the response. So is this all directly antagonistic to the evidence from the US? The argument is, of course, much more subtle. Public reporting was introduced in the US in New York State in 1990 and has been in place in some other states also. The pertinent questions posed by Hannan et al in a recent review of the NY experiences are: Does it improve quality? Are there unintended negative consequences? Does it act to maintain trust in hospitals and the medical profession? There are quite a lot of data on all of this, but they are generally of fairly low level and not all of them are cited by Westaby and colleagues. For example, some major database studies have shown