The case for and against

? It will enable managers to spot when problems are beginning to arise. Bristol highlighted a situation in which a surgeon's mistakes or incompetence were often spotted too late.

? A national overview of success rates for different operations will emerge, allowing hospitals to compare themselves with each other, and enabling patients to see exactly what standard of service they are getting from their local hospital.

Against:

? Data collection has been very scrappy in the past. The BMA is working with the Department of Health to improve the process, but that may mean consultants having to do a lot more paperwork to ensure the statistics mean something.

? Crude death rates don't take into account important variations, such as the fact that some surgeons and hospitals operate on much higher-risk cases than others.

? It could destroy team morale. Surgeons do not act alone but are supported by highlyskilled teams of anaesthetists, nurses and technicians who all need to work closely together.