Professor Frank Keane:

We can do so but we do not do so. The Deputy asks why we do not do so. One must realise that every hospital in the country is different. Let us take a big volume thing. A hospital might provide ophthalmic surgeons and surgery and do a considerable amount of cataract surgery. We know that 95% of cataract surgery is done as a day case, so that will skew that hospital which will find it much easier to reach that target of 75%, 80% or whatever it is. If a hospital only carries out laparoscopic cholecystectomies and tonsillectomies, about which we have been talking, it will find it very hard to reach that 75%. Different hospitals have very different specialty mixes and using that 75% figure to compare hospitals in terms of their performance is not terribly effective. What is much more effective is looking at individual procedures. This is what we are doing now with the nursing instrument for quality assurance, NIQA, system described by Dr. O'Connell where we are feeding back to clinicians data that are now as close as three months old. One must remember that this has only just come about because, before that, we were showing them data that were a year to a year and a half old, which is not meaningful for a practising clinician in terms of changing their practice. We have this system that looks at individual procedures. Not only does it tell individuals or individual specialty units what their performance is, it sets them a target for each of those procedures and compares them with national targets, national activities relating to what is going on and the best in class, so to speak. That is designed to stimulate and cajole change and make sure that people understand their performance.