Milburn unveils reforms to end surgeons' secrecy

Moves to publicise doctors' clinical performance and put patients' needs "centre stage" in the NHS were promised by the Government as part of a package of reforms in response to the Bristol heart surgery scandal.

The first death-rate league tables for surgeons, a whistleblowers' helpline and a new national reporting system for suspicious deaths were among the proposals aimed at preventing similar tragedies in future. Surgeons' groups and the parents of children who died at Bristol Royal Infirmary welcomed the plans, but some expressed concern that some elements would not come into force until 2004.

Publishing his long-awaited response to the public inquiry into the hospital, Alan Milburn, the Secretary of State for Health, pledged to end the "secret society" culture among some surgeons.

A three-year, multimillion- pound inquiry led by Professor Ian Kennedy found that up to 35 children died at the Bristol Royal Infirmary as heart surgeons experimented with a new type of operation. Professor Kennedy's damning report, published last summer, made 198 recommendations, including making health watchdogs independent from Government and tightening regulation of managers.

Some of the suggestions have already been taken up, but Mr Milburn went much further than the inquiry yesterday when he revealed that detailed death rates would be published for every cardiac surgeon.

Information on mortality rates within 30 days of surgery will be printed in England from April 2004 by an independent Office for Information on Healthcare Performance. The Society of Cardiothoracic Surgeons of Great Britain and Northern Ireland, which covers adult operations, has agreed to help collate the results. Similar co-operation from paediatric heart surgeons is expected.

From 2005, results will be published annually for each heart surgery centre and for each cardiac surgeon every three years.

The Government's response to the Kennedy Report, Learning from Bristol, agrees in full or in part with 187 of its 198 recommendations.

In the Commons, Mr Milburn said the Bristol scandal proved the need to make the NHS safer, more open and accountable and predicted it would mark a "very real turning point" in British medical practice. "No one can guarantee, even with the best standards system, that mistakes will not occur. Medicine is not a perfect science, it is a human science," he said.

"Even the best doctors can make the worst mistakes. Our task, therefore, is not to pretend that somehow we can eradicate every error. Our job is to ensure there are systems in place to detect errors, to minimise them and, perhaps most important of all, to learn from them."

Mr Milburn said publicising mortality rates for individual surgeons was a "courageous" measure, but promised the data would be "robust, rigorous and risk-adjusted" to ensure pioneering research would not be affected.

"It means that for the first time patients themselves will be able to see the clinical outcomes that heart surgeons are achieving," he said. "The days have gone when parts of the NHS could behave as if they were part of a secret society."

The Health Secretary stressed that he wanted a "new culture of trust not blame" in the NHS with clear lines of accountability and a willingness to learn from mistakes.

He said the Bristol inquiry had been "awash" with data, but there was no single body to co-ordinate the results or be responsible for any warning signals. To tackle the problem, an umbrella group, the Council for the Quality of Health Care, will be created to oversee all monitoring and inspection within the NHS.

The body, which will be independent of ministers, will bring together for the first time all the agencies working to improve standards, the National Institute for Clinical Excellence, the Commission for Health Improvement, the National Clinical Assessment Agency and the National Patient Safety Agency.

Crucially, Mr Milburn also promised that the new body would work in tandem with a smaller, more accountable, General Medical Council to monitor standards in health care provision.

Steve Parker, chairman of the Bristol Heart Children Action Group whose partner's 10-month-old daughter died at the hospital, welcomed plans for tables to monitor the performance of surgeons.

"Every parent should have the right to have their child operated on by a competent doctor. League tables are never going to be perfect but we should be concerning ourselves with making sure that clinical standards meet the minimum requirement," he said.

The NHS Confederation, the Consumers' Association and the BMA all welcomed the Government's response.

But Donald Booth, a former committee member of the Surgeons' Support Group, said league tables would make surgeons scapegoats when hospital managers were often to blame.