Fewer deaths could mean more pay for consultants

Sir Bruce Keogh told HSJ the Department of Health was discussing ways of using outcome measurements to incentivise consultants, including a link to pay.

It follows a decision to publish the death rates of patients undergoing four surgical procedures at every English NHS trust.

Sir Bruce said: “We’ve got to unleash [doctors’] engagement and come up with new measures of performance. They will do a better job given the incentives to do so.”

He said once outcome measures are sufficiently robust the figures, including survival rates, could feed into appraisals, revalidation, service line reporting and clinical excellence awards - which boost consultants’ pay by up to£75,000.

“People in hospitals are really proud of their own units. Anything that would bring money into their own unit would be welcomed.”

The mortality data, to be placed on NHS Choices by September, will cover hip and knee replacements, abdominal aortic aneurysms and oesophagus removals. There are currently no plans to publish the success rates of individual consultants.

The move is part of a wider drive to improve NHS outcome measures. From next April, all acute trusts should collect patient reported outcome measures for hip or knee replacements, groin hernia surgery and varicose vein procedures.

Sir Bruce plans to approach strategic health authorities to establish regional pilots of new measurements by the start of next year.

NHS Employers pay, pensions and employer relations director Gill Bellord was against linking death rates to performance-related pay but did not rule out using other outcome measures.

She said: “All consultants are paid under the same contract and out of 32,000 of them, only 20 per cent are surgeons and fewer still will have the [death rate] data applied to them, so there’s a fairness issue. If appropriate measures could be developed, relevant to all consultants, then we’d be interested in exploring a link with pay.”

Royal College of Surgeons clinical effectiveness unit director Jan van der Meulen said outcomes data could be used for quality improvement but not performance management. He said: “Bad outcomes could be caused by bad data, a bad run or case mix. All these things should be looked at before you make a link with the quality of patient care.”

A report by the National Confidential Enquiry into Patient Outcome and Death published this week found deaths from coronary bypass grafts could be improved by better systems, not just surgical ability.

Quality of care was adversely affected for two thirds of patients, due to poor organisation, communication and teamwork, researchers discovered.

See Andrew Jones on health outcomes

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