British doctors criticise surgery bonuses

Doctors' leaders have warned that plans to pay bonuses to surgeons based on the outcomes of operations could discourage doctors from treating high-risk patients. The country's largest hospital trust, Imperial College Healthcare Trust in London, is discussing a pilot scheme in which doctors would be rewarded financially for operations that are particularly successful.

But the British Medical Association, the professional association which represents doctors, warned that this could deter doctors from carrying out complex surgery or operations on frail and elderly patients. It added its voice to other critics of proposals to extend NHS cash reward schemes to reflect performance against a number of quality indicators such as mobility after surgery. Dr Jonathan Fielden, chairman of the BMA's consultants committee, said: "The outcome of an operation is based on multiple factors ... Other members of the medical team would also have fundamental roles in the care a patient receives and the outcome achieved."

A spokesman for the Imperial College trust would not say which operation the scheme would apply to, but he added: "It's about rewarding excellence." Katherine Murphy, from the charity the Patients Association, said: "Patients will be horrified."

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Australia: Public hospital bungle covered up

A whistleblower was bullied and information was covered up when a crucial cancer treatment went wrong, critics say. On Friday, SA Health revealed a radiation machine at the Royal Adelaide Hospital, used to treat 720 people between July, 2004, and July, 2006, was delivering the wrong dose.

Yesterday, the hospital was accused of bullying and harassing an employee who tried to expose the error, and of covering up the mistake, which only came to light last week. While working as the Employee Ombudsman, Gary Collis said he dealt with a hospital employee who was bullied after taking his concerns to management. The whistleblower also said up to three machines were not working properly. Mr Collis said whistleblowers in this situation had "very little protection". "Until there is genuine protection the individuals are going to think more about their own survival careerwise rather than just keep on banging their heads against the wall," he said.

SA Health chief executive Dr Tony Sherbon said RAH management discovered the error in 2006 through a quality assurance check but chose not to inform the department, prompting accusations of a coverup from the State Opposition. Dr Sherbon was only made aware of the problem on July 16 this year after someone filed a formal complaint.

"In 2007, the Central Northern Adelaide Health Service completed an investigation of an allegation of bullying and harassment," he said. "It found there was no bullying. This person suffered no retribution." He added that as far as he knew only one machine was affected.

The calibration error meant people received a dose up to 5 per cent lower than prescribed by their doctor. It is not clear what effect, if any, this would have on their survival. SA Health has launched a review into the error and has contacted all patients affected.

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