Patients will be asked to rate the success — or failure — of common operations as part of a drive to improve the quality of NHS care, The Times has learnt.

In a national programme - the first of its kind in the world, 250,000 patients in England will be asked to fill out questionnaires giving their views on how successful planned surgery and subsequent recovery has been.

The feedback, known as “patient-reported outcome measures” (PROMs), will be gathered from April and result in hospitals and private clinics that provide surgery on the NHS receiving a published score.

In an interview with The Times, Lord Darzi of Denham, the health minister, said that the scores would appear online, enabling people to choose where they would like to be treated, while doctors compete with each other to provide the best service.

PROMs data will initially be collected for four common operations — hip replacements, knee replacements, hernia repair and varicose vein removal — but it could soon be expanded for other procedures and conditions such as heart disease and diabetes, he said.

It is thought that the routine collection of the data will enable clinical teams to compare their performance with each other, while local health authorities could use it to commission only the best services based on patient experiences.

The reforms follow Lord Darzi’s year-long review of the NHS in England, published last June, which concluded that local health trusts and regulators should increasingly take patients’ views into account in order to improve standards of care.

“This is a very powerful tool that measures the success of operations as reported by patients themselves,” he said. “The information collected will empower patients to choose a hospital that achieves the best results for the operation they need.”

He added that PROMs would help eliminate situations where “a surgeon may judge a hip replacement successful because the procedure has been performed perfectly on the day, the patient will rightly disagree if they are still in pain and continue to have a poor quality of life six months down the line".

In the questionnaires, patients will be asked the same set of questions on the state of their health before and after their surgery, including whether they still experience pain or other problems that affect their quality of life.

Six months after knee surgery, for example, patients will be asked whether they can walk for more than a few minutes without pain, or perform everyday activities without problems.

The Department of Health expects to publish comparable PROMs scores, “adjusted for case mix”, within a year for the two orthopaedic procedures and nine months for general surgery cases. A pilot study of 2,400 patients by the London School of Hygiene and Tropical Medicine found that 80 per cent of patients were willing to fill out either the “before” or “after” form, with 65 per cent of patients filling out both.

A similar response rate could produce reliable national data, the Department said.

Lord Darzi said: “The challenge I have put to the Department is where do we take this next. We are looking at whether we can develop these for long-term conditions, for patients with heart disease and diabetes”, he added.

Mortality rates for the four selected operations were first published last year, but critics complained that the measures offered only an illusion of choice as any differences between hospitals are claimed not to be significant.

Quantifying patient’s views will produce wider variations in quality, Lord Darzi said: “You have to do 3,000 hip replacements to see one death. But if you look at patient experience, you know — ‘was I received well when I arrived at the hospital? Was the care something that I would recommend to friends?’. For a lot of patients this information is very relevant.”

PROMs have previously been recorded by BUPA, the private health group, but only within its own hospitals, now owned by Spire.

Andrew Vallance-Owen, a former surgeon and now medical director at BUPA, said: “As a national programme this is undoubtedly the first - I don’t think anywhere else is routinely reporting patient outcomes in this way. While consumers may find this interesting, the biggest impact can be on the surgeons themselves, they are very competitive.”

Procedures including cataract surgery, hysterectomy, tonsillectomy and gall bladder removal, but “you’ve got to have high volume procedures, and high response rates in order to get reliable data”, he said.

Clare Marx, president of the British Orthopaedic Association, and a surgeon at Ipswich Hospital NHS trust, said that the long-term success of operations would not be exclusively measured by forms, however.

“Of course it’s important to know what patients think, but PROM scores will be very dependent on the patient’s immediate recovery and their perspective on a whole range of issues, including the environment in which they were treated and how long they waited.

“But the impact of a poorly performed hip or knee replacement may not be noticeable until some years later, when the joint could fail. Most units will be doing well for patient recovery six months later but the real test is how people are doing five, ten or 15 years down the line.”

Nigel Edwards, policy director for the NHS Confederation, which represents health service managers, added: “If PROMs are done properly and you can get good response rates, this is a better measure of patient care than crude mortality rates. The trick will be to ensure that it’s not horrendously bureaucratic for the NHS to collect this data.”

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