National clinical audits will be stripped of their funding if they refuse to publish provider level information including mortality rates, HSJ has learned.
Only a handful of the several dozen national audits have so far named provider trusts or networks and only one – the National Cardiac Database – publishes survival rates by named consultant.
But HSJ has learned the Department of Health will now tell those who run the audits – generally royal colleges and clinical associations – to publish local level data as a condition of their funding.
Each audit is likely to be asked to identify specific quality measures it will provide, senior sources said. Where appropriate, this will include death rates.
Health secretary Andrew Lansley has committed to publish “detailed data” about providers’ performance online. In a speech last week he complained few specialities had followed the cardiac surgeons’ example.
Some clinicians have resisted publication arguing it could deter units and doctors from taking on difficult cases and from taking part in audits. There are also concerns about the quality of audit data.
The move comes amid growing public interest in the variation between hospital performance. Earlier this week the Guardian published raw death rates for a vascular procedure, requested from trusts under the freedom of information act. A January King’s Fund’s report on quality measurement said results should be published to “support the wider agenda of measuring and reporting on quality”.
The DH is currently reviewing the use and limitations of hospital standardised mortality ratio data. The review is expected to promote the use of other quality measures.
Nick Black, London School of Hygiene and Tropical Medicine professor of health services research, chairs the DH national clinical audit advisory group. He told HSJ the group supported the move to require publication and he would be “disappointed if they weren’t more or less all publishing within two years”.
Professor Black attributed reluctance so far to “a misplaced fear the world will come to an end” if patients can see performance, which had been disproved in the case of cardiac surgery.
Professor Black said: “Those who are saying ‘no’ to publication are increasingly on the margins and having little influence.”
Robin Burgess, chief executive of the Healthcare Quality Improvement Partnership, which oversees audit for the DH, said: “We strongly support this and will work really hard with the [audit] providers we commission to get them to that point.”
*Meanwhile, NHS North West is due to publish trust-by-trust results from the first year of its high profile quality improvement programme, “advancing quality”, on Friday.