Hospital fatality leagues warning

HOSPITAL DEATH-rate league tables announced by the Government could lead to top-performing hospitals being swamped with patients. That was the stark warning yesterday given by the specialist who has taken over children's heart surgery in Bristol following the deaths of 29 children.

Frank Dobson, the Secretary of State for Health, said in a speech last night that the "appalling tragedy" at Bristol could not be allowed to happen again. He announced a new duty on trusts to investigate concerns about clinical quality and a new requirement on all doctors to take part in a national audit programme which would involve checks on their individual performance.

Mr Ash Pawade, paediatric heart surgeon at the United Bristol Hospital Trust, said the trust's record had improved dramatically since the two surgeons, James Wisheart and Janardan Dhasmana, who are currently the subject of a General Medical Council inquiry, stopped operating on children in 1995.

Latest figures showed a mortality rate of 3.5 per cent for congenital children's heart surgery at Bristol between April 1996 and March 1997, compared to a national average of 6.1 per cent.

"I think it is right that the public should be able to see these type of figures. But it is difficult to see how the NHS will cope with the movement that the league tables will bring about. Certain units that do well will obviously be in greater demand and people will want to be treated at them instead of at other centres," he said.

Mr Dobson yesterday launched a 10-year programme of measures to improve clinical information which he said was necessary to safeguard patients and restore confidence.

From October, when the tables, are introduced, there will be an annual chart of the number deaths and complications after an operation, death rates after heart attacks and death rates after hip fractures.

Other measures of clinical quality will be developed for each speciality and all doctors will be required to take part in monitoring their performance and comparing it with national averages.

"Bristol shows that it is not enough merely for individual clinicians to know their comparative figures," Mr Dobson added. "To ensure that results from audit feed into action, individual doctors will be required to share their results confidentially with the medical director of the trust ...

"The net result will be that patients will be assured that services at their local hospital are being monitored and are of a consistently high standard."

Britain's biggest union, Unison, welcomed the publication of hospital league tables but warned that extra funding would be needed.

Bob Abberley, head of health for the union, said: "We welcome the Government's move to disclose statistics previously shrouded in secrecy. The public expects unsatisfactory hospitals to be identified and to be told what steps are being taken to improve their services.

"The Government should also play its part in ensuring that the necessary help and resources are made available. League tables can make a major contribution to raising standards in the NHS."