Dr Giles Croft's lament about the inaccuracy of Hospital Episode Statistics and their inappropriateness as a means of managing the performance of doctors (HSJ, November 2nd) raises the nice issue of why there are some problems with HES accuracy. Surely such inaccuracies are the product of failures by clinicians to take such recording seriously?
An obvious remedy for this is 'demerit' awards! What were merit awards, now called clinical excellence awards, should be reformed so that those clinicians who do not code HES accurately and are clearly demeritorious, should have their salaries reduced.
I suggest that this nice incentive system would lead to behaviour changes beneficial to patients and those interested in performance management.
Professor Alan Maynard, Department of Health Sciences, York University