Editor's blog Monday 21 March 2011: Variation, again, and the moral high ground

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Variation in healthcare is a fact of life. And much like the broader facts of life, the scared and the stupid don't like to talk about it.

The great Professor Alan Maynard has often pointed out that health policy is essentially Buddhist, and based on principles of reincarnation. Greater attention to variation in activity and outcomes and treating more patients as day cases are, Alan has noted, the policy mainstays of today - just as they were in Barbara Castle's 1976 Priorities For Health And Social Care.

All who have observed the NHS over decades, from Andrew Wall to Geoffrey Rivett to Charles Webster to Nick Timmins, could pick a similar example. Plus ca change.

Addressing variation is a bit hard, but it's not very hard. There are just massive vested interests in the way.

It is wholly a fair deal for the NHS's cardiovascular surgeons to point out that the rest of the surgical specialties have resolutely failed to follow their lead.

Sarah Boseley's article in today's Guardianhighlights a new report by cardiac surgeons, backed by John Black's Royal College of Surgeons, calling for much greater data transparency.

Ben Bridgewater and colleagues' 2007 study of cardiac surgery showed that the publication of data has been associated with reduced mortality and that surgeons have not, as feared, sought to cherry-pick the lowest-risk cases.

Bridgewater is the lead author of the new RCS-backed study, which comes in the wake of last year's excellent Guardian FOI-based study revealing pretty significant variations in mortality rates for vascular surgery, showing some correlation with the number of operations performed per year.

RCP President John Black told Boseley, "Cardiac surgery has been the trailblazer in this field and what they have learned over the past decade is making it far easier for those following to get audits up and running quickly. We are now hearing that the thoracic surgeons are looking to implement full reporting and there really is no reason why every surgical specialty should not now be following suit. The College would like to see more clinical audits funded and participation in them a mandatory condition for all providers of surgical services in the NHS".

Amen to that. While much of the liberation theology policy preached by Archbishop Andrew Lansley over NHS modernisation is (to borrow Simon Stevens' taxonomy) highly contestable and not highly measurable, Our Saviour And Liberator is spot-on about the need to publish more data.

It just makes you wonder why his archbishopric the Department of Health are hiding the Ipsos MORI public satisfaction with the NHS polling data.

Dartmouth Atlas creator John Wennberg's excellent, concise new article for the BMJ is also worth a read.