In the light of the Bristol tragedy, the government announced that English hospitals will have to publish mortality figures. This move was widely welcomed by MPs, but was regarded with suspicion by sections of the medical community. Some hospitals may attract large numbers of difficult cases due to their reputation. But such arguments have long been used to keep the public in the dark. If there are mitigating factors for poor results, then doctors will no doubt be quick to publicise them.
Clinical experts are essential for judging many aspects of clinical performance.
In the US they form a vital part of the independent review panels of the Joint Commission on the Accreditation of Healthcare Organisations, which assess and give their approval to hospitals every three years. The difference between mean survival rates for cancer patients in the two countries is stark. Those in the US are twice as likely to be alive after five years as those in Britain. The British government has announced a public inquiry into the Bristol scandal, and in forthcoming legislation it proposes to make trust boards containing lay people responsible for ensuring high clinical, legal and financial standards. Whether doctors like it or not, medical self-regulation is rightly in decline.