Government Response to Kennedy Throws Spotlight on Information

A new Office of Information on Health Care Performance is to be set up as part of the government response to the Kennedy Report’s recommendations.

The new office will be positioned within the Commission for Health Improvement and will publish “star” ratings to compare the performance of NHS organisations against national targets.

Other key measures promised to improve the quality and availability of information include a pledge to publish data on the clinical performance of consultants and their teams/units for use by both clinicians and patients, and a promise to publish, by April 2004, 30 day mortality rates for the previous two years for every cardiac surgeon in England.

Health secretary, Alan Milburn, said, “This is a milestone in the development of a more open, responsive and patient-centred NHS."

The Kennedy Report, which dealt with the host of issues raised at the public inquiry into the excessive death rate among child cardiac surgery patients at Bristol Royal Infirmary in the early 1990s, pointed out many problems caused by the lack of reliable information.

The report, named after Professor Sir Ian Kennedy, chair of the inquiry, said that information about performance was the “basic building block” of any system of quality and standards, but that there had been great difficulties in this area.

The report made a list of recommendations which are addressed by the government in its response published this week and a whole chapter is devoted to information for decision making and the monitoring of performance. It concludes, “Information is at the heart of everything we do in the NHS.”

The response places great emphasis on the electronic patient record (EPR) as the key to generating better quality information.

”By 2005, these [EPRs] will provide the basis for a single approach to collecting data for clinical and administrative purposes and for performance assessment. But of equal value is the cultural change their introduction will foster: for the first time patients will have routine access to their records in a way that will support the development of a more open and honest relationship with the clinicians treating them.

”Patient records will also be readily available, subject to the patient’s consent, to all the relevant clinicians involved in their care which will substantially improve the co-ordination of the care provided.”

The response acknowledges, however, that EPRs will not be in place for several years and promises that, in the meantime, a range of initiatives will be developed to make better use of routinely collected data.

The wait for EPRs could indeed be lengthy. The government’s response coincided with a report from the NHS Modernisation Agency which said that most health communities had serious doubts about their ability to meet the EPR targets.

IT budgets raided to fund other parts of the service, difficulties with staff recruitment and the NHS’s patchy IT infrastructure are cited as reasons for the expected delay.

Other information measures set out in the government response include: making better use of hospital episode statistics by linking to Office for National Statistics mortality data; undertaking national audits in each clinical priority area named in the NHS Plan; setting up a directory of clinical audit databases from 2002 and strengthening and supporting the clinical coding function.

The total response stretches to 189 pages and covers many other issues raised by the Bristol disaster including the regulation of healthcare professionals and managers, fostering respect for and honesty with patients, the special needs of children and setting standards for healthcare.

Mr Milburn said: "Bristol was a tragedy for the families involved. The Kennedy Report provides a searing analysis of the failings in organisation and culture that were prevalent not only in Bristol, but throughout the NHS in those years.

"Failure to put patients at the centre of care, failure of communication, lack of leadership, paternalism and a ‘club culture’ in which people ‘got on’ in their careers by not rocking the boat. Today, a new relationship is needed between patients and services and between the health service and government."