James Reilly (Dublin North, Fine Gael)
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Question 67: To ask the Minister for Health and Children if her Department, the Health Service Executive or the Health Information Quality Authority has plans to monitor, collate and report on a regular basis on the death rates of patients undergoing major surgery at hospitals here to identify variations if they exist, to address such variations with corrective action and to improve standards in hospitals by publishing such data; and if she will make a statement on the matter. [34521/08]

Mary Harney (Dublin Mid West, Progressive Democrats)
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The objective of performance evaluation is to examine the evidence of quality, safety, efficiency and effectiveness in the health system. There is a wide range of hospital data on patient outcomes which enables this measurement. In addition to outcome measures such as mortality, indicators of process of care are also important. For example, in relation to cancer procedures, it is known that the volume of cases is positively correlated with better patient outcomes.

It must be understood that publishing data, in the form described in the Deputy's question, can be both misleading and open to misinterpretation. A considerable amount of international work has been carried out on the advisability of reporting on this data. Expert opinion is divided on its benefit and as a result practices vary widely between countries. A valid and robust system of statistical adjustment must be in place in order to quantify the prior risk and severity of cases presenting for major surgery so as to allow for meaningful comparisons to be made. At present, hospital discharge data as reported through the Hospital Inpatient Enquiry (HIPE) system, do not adequately adjust for risk. This could lead to specialist centres which usually cater for more complex cases erroneously appearing to have higher mortality rates. Furthermore, in the HIPE system, patients who die outside hospital or who are emergency transfers to another hospital and subsequently die may not be adequately counted. This would limit the reliability of reported mortality rates even where standardisation procedures are applied.

The performance indicators in use in support of the National Service Plan include many measures relating to patient outcomes, access, effectiveness and efficiency of health services. They, and other potential systems of monitoring, are subject to on-going development and refinement by my Department in collaboration with both the Health Service Executive (HSE) and the Health Information and Quality Authority (HIQA). Such developments may include, if deemed appropriate, measures of post-operative mortality rates. This work is also aligned with the work of international organisations such as the Organisation for Economic Cooperation and Development (OECD) and the World Health Organisation (WHO) to ensure that we are able to benchmark ourselves against best international standards.

Other than through these mechanisms, my Department has no plans to publish data on hospital mortality rates for major surgical procedures. The Deputy will be aware that there are a range of strategic initiatives in place to improve the quality of clinical services. They address the need to improve standards of care and will minimise variations in the outcomes patients may experience. These include: Cancer Control: A National Strategy; a Vision for Change; the Strategy for Antimicrobial Resistance in Ireland; Tackling Chronic Disease: A Policy Framework for the Management of Chronic Diseases; etc.