NHS League Tables: Hospital death rates show wide variations

HUGE VARIATIONS in death rates in hospitals across England were revealed in tables published for the first time yesterday. They show that patients' chances of dying after surgery or admission to hospital for a heart attack or hip fracture range from less than 1 per cent to more than 6 per cent, a difference of at least six-fold.

However, the tables came with a warning that hospitals with high death rates were not necessarily unsafe. In many cases there were good reasons for the differences related to the area served, the kinds of patient treated and the severity of their illnesses.

Warnings were also sounded about the quality of the data, which has rendered the entries for several hospitals meaningless. Some hospitals complained that the way in which the information was collected meant that like was not being compared with like.

Frank Dobson, the Secretary of State for Health, speaking at the publication of the death rates yesterday, said that the aim was to gather basic facts about the performance of the National Health Service as a means to improve standards of care.

"It is not possible to raise standards unless we have the right information to start with. In the past, there was too much meaningless bean-counting combined with a narrow focus on efficiency. Now, with the co-operation of doctors and others we have made a start in assessing the outcome of treatment and the effectiveness of services," Mr Dobson said.

The death rates, which have been published for several years in Scotland and are planned for Wales and Northern Ireland, are part of a new set of "clinical indicators" that include readmission and discharge rates. They are the first attempt to measure the quality of care and have been collected for every hospital in the country. However, one in six (17 per cent) have been excluded from the tables because their data was unavailable or too poor to use.

A separate set of 41 "high-level performance indicators", including survival rates from breast and cervical cancer, the amount of heart and hip surgery performed and avoidable complications of treatment, are also published. These are presented by health authority and also cover costs of care, waiting lists and access to screening and treatment.

Taken together, the tables provide a snapshot of the nation's health and the NHS's role in protecting it at the end of the century. Mr Dobson announced his decision to publish them after the Bristol heart babies disaster last year as part of the Government's drive to hold doctors and hospitals to account.

The tables show the highest hospital death rates after surgery are in the industrial and mining areas of the North, where poverty and unemployment mean patients tend to be more severely ill on admission to hospital than in the prosperous country and coastal areas of the South. Health authorities in the coalfields and the ports also have higher re-admission rates than those in the most prosperous areas.

Mr Dobson said the eventual aim was to take account of differences in the severity of illness so that hospitals could be fairly compared. However, he ruled out publishing death rates for individual surgeons or clinical teams.

"The objective should be to make sure that anyone in any area can be assured the treatment they are seeking in their local hospital is top- quality. We are not seeking to promote a system in which people shop around for treatment."

The death-rate tables have the backing of the British Medical Association and the Royal Medical Colleges, which for years opposed the idea on the basis that hospitals treating the patients who were most gravely ill would be unfairly pilloried. James Johnson, chairman of the Joint Consultants Committee, said previous league tables had been "crude, highly misleading and largely irrelevant". The new clinical indicators required careful interpretation but had the "greatest scientific validity robust enough to be used".

Mr Johnson warned of the risk that hospitals might be tempted to select low-risk patients to improve their death rating. "We don't want doctors refusing to treat high-risk patients," he said.

The warning was echoed by Stephen Thornton, chief executive of the NHS Confederation, who said the tables should not trigger a "naming and shaming exercise". He added: "We don't want the gaming that has gone on in other countries", referring to attempts by hospitals in New York and elsewhere to manipulate death-rate data.

In response, Mr Dobson said: "There is obviously a danger of that and we will do our damnedest to make sure it doesn't happen. Acknowledging the problem exists is the first stage in making sure it doesn't happen." ( Table not included ) Leading article, Review, page 3