7 July 2011
A transcript of a speech by Sir Bruce Keogh, NHS Medical Director, during a transparency event on 7 July with Cabinet Minister Francis Maude.
Read the speech
My name is Bruce Keogh. If you search my background, I’m currently the NHS medical director and I’m driven by a simple philosophy and that is, that it is the responsibility - the moral, social, professional responsibility - of all professions and all professionals to be able to describe what they do and to define how well they do it. If they can’t do that, they forfeit their professionalism. This applies to all groups: doctors, teachers, politicians, and others.
So how does this announcement that you’ve just heard from the minister today play into the overall healthcare initiative? I think a focus on transparency isn’t just a philosophical or ideological gimmick; it is a necessary progression. I see it this way. The future of healthcare is going to be driven by three forces: the first is economics; the second is public expectations; and the third is technology. And on the technology front, the most powerful influence in my view is going to be around IT. We live in the world of the iPad, interactive TV, the world of the internet. The internet has opened up a lot of previously privileged knowledge - which was held only by healthcare professionals - to the public and to citizens of the countries of the world. That has changed the behavioural and social dimensions of medical practice in a way that cannot, should not, and will not ever go back. It also offers the opportunity to process and present vast amounts of data in many different ways, and the end result of that is that people have become their own bankers, their own travel agents, even their own check-out cashiers at supermarkets. How long, I ask you, before people expect to be the navigators and controllers of their own healthcare? I think the desire is already there. I think all they need is enough information, and I put it to you that today’s technology allows that. I think we should encourage it and lead it.
Within the context of our country, our citizens are all shareholders in the NHS. Sadly, many of them become reluctant customers at some point in their life, and that is when the problems start. We have international evidence, for example, that we have probably the best primary care in the world in this country. Primary care has some of the best information of any primary care systems in the world, and I am really proud of our primary care, but I find myself asking, ‘How do you find out about your GP’s practice? How do GP practices demonstrate their areas of expertise? How do they show the public how good they are?’ Now, it is not for me to answer that question, but we will be asking GP leaders and particularly the Royal College of General Practitioners to help us answer this question. How do you find out about your hospital? How do you find out about your consultants, and how do you find out where it’s best to go other than by rumour or word of mouth? And I put it to you that rumour and word of mouth are no longer good enough; they are not good enough for clinicians and they are not good enough for patients.
Ten years and exactly one week ago, I sat over in Parliament and listened to Alan Milburn, who was then the Secretary of State, respond to the Kennedy inquiry into unnecessary deaths of some babies in Bristol. There were a number of recommendations in that report, two of which related to greater transparency of data around performance in hospitals. That data is still not widely available. We’ve addressed it in heart surgery, but not everybody liked it. There was fear. There were arguments over the statistical methodology and the way that the data was to be presented, but we got there in the end. What it’s done is it has transformed the nature of the consultation between the patient and the surgeon. It’s transformed the results of heart surgery in this country. It’s estimated that it’s probably saved up to a thousand lives a year, and it’s done that by resulting in much more reflective practice among the heart surgeons in this country. So that transparency and focus on quality has saved lives. Our heart surgery is now measureable, demonstrably, and statistically better than anywhere else in Europe; indeed, the mortality rates are half that of Germany and one-fifth that of Portugal.
This combination, in my view, of professional and public scrutiny is unassailable. I’ve seen the advantages first-hand. I am now Medical Director of the NHS and I want to bring this transparency to other areas of the NHS. We have to keep up with other industries and give people the information that they want. Now, not all people want the same information; different people want different information. There’s no ‘one size fits all’. The curiosity of different individuals will be driven by their personal circumstances and the seriousness, or the rarity, of their clinical problem. Now, in this country we have made a lot of progress, particularly through NHS choices, where over the last three years we have published over 600 measures of comparative performance. So, we have more information, more published information than any other healthcare system in the world. But, is it the right information? Is it in the right areas? Is it accurate enough? I’m afraid the answer’s no.
So, we have quite a bit of work to do. But today, today is about the next leap that we have to take. It is about putting more data and raw data out into the public domain for others to process and present. The solution to these issues doesn’t lie with a few people in Whitehall; it lies with the professionals and the population of the country at large. Some are going to find this difficult; they are going to find it very difficult, actually, but I make no apologies. I am quite clear that this is the right thing to do. Some, who offer poor services, will fall victim to this transparency, and so they should. Most people, on the other hand, will use this data to improve their services, and some will actually find out that they’re excellent when they didn’t know they were excellent and others can learn from them. So, transparency of the right data will undoubtedly prompt some very difficult conversations, but it will drive quality and will reduce the risk of organisational and professional failures such as those that we’ve seen amid Staffordshire.
I also here a lot of talk about bringing our NHS up to the European average and I say, ‘Why?’ We’re already better than the European average in many cases. The clinical leaders of this country don’t aspire to European mediocrity; let me be absolutely clear about that. We have an ambition to be the best, and greater transparency of data will help us get there, where we aren’t. It will expose variation, open difficult conversations in some places. But most importantly, in my view, it will build confidence in our NHS where we are among the best; heart surgery, treatment of heart attacks would be two examples.
I’d just like to finish off by saying, as Medical Director, my vision for the future of healthcare is underpinned by greater availability and the processing of data. I see a future where those who wish can take responsibility for their own healthcare. I see a future where the NHS is a service industry that will help people to achieve that aim. I see a future where patients have access to good information on the pros and cons of different treatments, and the relative outcomes of those treatments in different places. I see a future where they have greater knowledge which helps their doctors and nurses understand what they want. This will make consultations so much more meaningful and focused. I’ve had a glimpse of this after publishing results in heart surgery. By the time I stopped practising about 50% of patients would come into the clinic, they’d looked you up on the internet, so they knew about you, they’d looked up their condition on the internet, and they had some idea of the available treatments. This meant that you could have a focused and sensible and very meaningful conversation with your patients that really helped them in my view. It also helped me, as a surgeon, understand their fears and anxieties.
I see a future where patients own their own records. A future where patients can book their appointments online. I see a future of digital consultations which will bring clinicians into the home via broadband. It’ll speed diagnostic times. I see that, in time, it will break down frustrating geographic and institutional boundaries. It will bring seven-day-a-week access to help from people who are fearful of their medical conditions. And, in time, access to personalised international consultations will be available 24 hours a day, seven days a week, around the world. Appreciation of the impact of these new technologies is limited only by our imagination. And you say, ‘Yeah right, he can say that’, but think of Christopher Columbus; it is the 15th century, he is on the Eastern Seaboard of the United State, one of his guys has had too much to drink, he says, ‘One day, you’re going to be able to get across here in just a few hours in a big ship with 300 people that can fly.’ You know. They were limited by their imagination. I think this is going to happen much quicker than we expect, and I think today’s initiative is going to catalyse that and accelerate the speed of change. We in the NHS, in my view, have to be ready for that. And I believe that those of us working in the NHS have a professional and societal responsibility to drive this in the interests of improving quality for our patients. Thank you very much.