The CQC has ordered the Queen Elizabeth Hospital in Birmingham ("QEH") to report its heart surgery results every week after data suggested its mortality rates were significantly higher than expected. Data on surgical outcomes has been collected since the Kennedy report 15 years ago, but the Birmingham situation shows how various organisations can collaborate and the increasing role of big data in healthcare regulation.
The 2001 Kennedy report into children's heart surgery at Bristol Royal Infirmary demonstrated the importance of collecting accurate information on the outcomes of surgery in order to highlight unexpected results and best practice. While it acknowledged that such data was not, in isolation, a measure of good or safe practice (where, for example, particularly complex or dangerous surgery is only performed at certain hospitals or by certain surgeons), it was a strong indicator of outliers and where further review may be required.
As a result of the report considerably more data is now collected. In particular, heart surgeons' mortality rates are now collected by the Society for Cardiothoracic Surgeons (SCTS), the representative body for cardiothoracic surgery. In turn, the SCTS data is analysed by the National Institute for Cardiovascular Outcomes Research (NICOR) and passed on to the Healthcare Quality Improvement Partnership (HQIP), a collaboration of the Academy of Medical Royal Colleges, the Royal College of Nursing and National Voices.
According to news reports, last year NICOR and HQIP discussed the apparently poor results shown in the data with QEH, which partly attributed the results to the actions of a former QEH surgeon currently facing GMC fitness to practise procedures over allegedly altering data on his surgery outcomes, and the lack of inclusion of heart surgery taking place in a local private hospital. Subsequently, HQIP reported the information to the CQC, which conducted an inspection last year. Reports suggest that the CQC considered closing the cardiothoracic surgery unit, but instead agreed that QEH will report its surgery outcomes every week for continued monitoring. The final CQC report of the inspection has not yet been released, but is due imminently.
This case demonstrates how learning points from the Kennedy report have been implemented, albeit perhaps not with the results hoped. Without the Kennedy recommendations this information may not have been collected and these concerns may not have been raised. However, the fact that various organisations appear to have had concerns for some time which are only now being acted on suggests that review processes may need to be considered more closely in future. There is an increasing focus (both in the healthcare sector and more broadly) on the use of 'big data', but this case demonstrates that acting on the information collected may be far more difficult than the initial collection and analysis.