25 June 2013

Since my last message things have moved rapidly and unexpectedly.  As you are aware, the variability of the quality of the data between different Trusts and the effect this has on different surgeons’ outcomes has been a major concern.   It was for this reason that it was agreed with HQIP that surgeons who felt that their outcome was inaccurate should be given the opportunity to re-submit data.  What we had not anticipated was the number of surgeons who would take this option.  At last count this was nearly 100 and from conversations I have had with colleagues around the country, there are surgeons who are aware of inaccuracies in their data, but who have decided not to re-submit.  HQIP has been made aware of the concerns we have about the process and the number of surgeons involved.  There are other issues that have worried me as well, particularly how we handle the outcome figures for surgeons who are not members of ACPGBI.  I was contacted late on Wednesday by Professor Ben Bridgewater (Medical Lead for Outcome Reporting) to discuss this matter.  I have been advised by Professor Bridgewater that whilst such concerns about the colorectal surgery data exists, it would be best if release of all the colorectal data was delayed until there was confidence in its accuracy.  Publication of data for some surgeons and not others would lead to confusion amongst the Public and the Press.  He indicated that HQIP agreed that we should be given more time to get this right.  I take this decision to be Government acknowledgment of the complexity of using the NBOCA data for this purpose. Another recent development has been a hardening of HQIP’s desire to reveal the identities of those surgeons who have asked for their data not to be published at the end of the month.   I thought this unfair whilst there are concerns about accuracy of some individual outcomes.  I have discussed this decision with the Executive and considered the options open to us.  I remain committed to the principle of open reporting of outcomes, but only of accurate data.  For this reason I think a “time out” is the right approach and we should take this opportunity to try to get the data as accurate as possible, accepting the limitations of NBOCA for this purpose. I appreciate this will displease some members who are happy that their data is accurate and were content to have their data published at the end of the month.  To those of you who think “he’s making it up as he goes along”, you are right, I am, but only in trying to come up with the best solution for all colorectal surgeons in a rapidly shifting environment.  I would much rather that it is me who has to explain why all the data is being withheld, rather than have individual surgeons face the dilemma of whether they withhold data and face scrutiny for this or allow publication of data they feel is erroneous and face scrutiny for apparent poor performance.

What Next?

I am in discussion with NBOCA and the Clinical Effectiveness Unit as to the implications of this decision.  To those who are in the process of re-submitting data, please continue this work.  It is possible that the deadline will be extended, but a number of people have already indicated to me that they have completed review of their data and are nearly ready to re-submit.  To those of you who are satisfied with the accuracy of their data then nothing further need be done; please be patient whilst we work on data for other surgeons.  I am sure there are a number of surgeons who were happy to have their outcomes published but who would like to take this opportunity to resubmit data, particularly where they feel that the number of cases included in the initial analysis was too low, even though their mortality figures were about right.  We will work out the process and time scale for data re-submission shortly and I will communicate this early next week.  At the end of this process I hope we will have more accurate data, in which everyone will have confidence.  It is clear to me that in the current climate, where openness within the NHS is under close examination, surgeons withholding consent to publish data will be under as much, or more scrutiny than those surgeons with high mortality figures. I am grateful to you for your support with this very difficult issue and I am heartened by your engagement in the process.   I am confident that we will eventually have it sorted out. Graham Williams President ACPGBI

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