Dicing with death

Do I feel a frisson of Schadenfreude on hearing that the madness of performance data is being extended to surgeons? No, I merely despair.

The government has proposed that surgeons' success rates should be published - in fact, some data has already been released, including mortality rates for individual specialists. Does the government dislike surgeons? I don't know. But I do know that if I were to be opened up by one, I'd rather their hands did not shake - and this doesn't seem a good way of reducing the nerves of the person with the carving knife.

I'm surprised NHS boss Sir Bruce Keogh was so positive about this wheeze when he was interviewed at the end of last year. He claimed that surgeons themselves would determine what data was collected. Well, that would be a first: governments rarely trust professionals to make their own rules. Politicians regard professions with suspicion - they talk darkly of secret gardens and do everything they can to flatten their walls and plough up the flower beds.

That this is a disaster waiting to happen is amply demonstrated by what league tables have done to education. Of course all schools should publish their exam results to parents, but as soon as the figures are out in the open they're turned into league tables. Attempts to make the data sensitive to context are doomed to fail: politicians and journalists alike want something simple - and entirely misleading.

Then policymakers insist on using the data to set benchmarks, so a school's aspiration to high achievement is replaced by the need to meet an arbitrary government floor target. Under intolerable pressure from the government and its Rottweiler-like inspectorate, schools have no choice but to play the game.

If it's all about the C-D boundary, that's what schools will focus on. If the sheer number of GCSEs counts, they'll invent courses that allow children to notch up the equivalent of five GCSEs in one area of study. These are perverse incentives, but they're not the fault of schools. They are the fault of the structure in which they operate.

But how will this play out in the world of surgery? We've already seen a huge rise in the number of Caesarean sections in the US, which is widely attributed to gynaecologists playing things ultra-safe. So I guess surgeons will stick to operations on bunions and moles, or other procedures that need only a local anaesthetic, because a general one comes with a greater risk. As for cardiac or cancer interventions, forget it: they'll just stick a drip in you. They'd be daft to risk their careers by taking the knife to patients.

I know, I know. People will say I'm exaggerating: the government hasn't even threatened league tables for surgeons. But if the data exists, tables will surely follow. Then we'll get more idiotic comments such as the one uttered by that most lamentable of education secretaries, John Patten, who served in the early 1990s: he apparently declared himself furious that so many children were below average.

Don't say I didn't warn you.

Bernard Trafford is headmaster of the Royal Grammar School in Newcastle

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