NHS League Tables: Lottery over breast cancer survival

By Cherry Norton and Jeremy Laurance

SURVIVAL RATES for women diagnosed with breast and cervical cancer are almost twice as high in some parts of England as in others.

The rates, included in the health authority performance indicators published yesterday for the first time, show that in Solihull 82 per cent of women with breast cancer live at least five years, compared with 54 per cent in Wakefield and Tees.

For cervical cancer the range is from 44 per cent in Hillingdon, north- west London, to 84 per cent in the East Riding of Yorkshire and 86 per cent on the Isle of Wight.

Survival from breast and cervical cancer is affected by the quality of screening programmes, how soon women consult their doctor with symptoms and the quality of treatment.

Health authorities have been ranked to provide a guide to the effectiveness of NHS treatment for the two diseases in each area, using a composite measure.

Death rates for hospitals following surgery, ranked in groups by type of hospital, show the best performers are the specialist children's hospitals. Children, being young and mostly fit, do very well after surgery.

Cancer hospitals, and those such as Harefield performing heart transplants, operate on patients who are already close to death and therefore have worse survival rates.

Weston Park, a cancer hospital in Sheffield with the highest death rate, does not do surgery.

However, because surgery is defined as any invasive procedure, cancer patients who had catheters or intravenous lines inserted fell into the category, pushing up its score and illustrating the difficulty of making sense of the tables.

Several hospitals with the highest death rates, including North Manchester and Oldham, made similar claims. Northern Devon Healthcare, based on a district general hospital in Barnstaple, was rated worst on several tables. It said it had been the victim of a computer glitch that had distorted its figures.

Overall, most hospitals have post-operative death rates after an emergency admission (listed on the opposite page) of below 3 per cent, but 35 of the 210 hospitals exceed that rate. They will be expected to scrutinise and explain why their rate is high.

Following routine surgery, most hospitals have death rates below 0.5 per cent but 21 of 204 hospitals listed in the tables exceed this rate.

The United Bristol Healthcare NHS Trust, which includes the Bristol Royal Infirmary, scene of the Bristol babies disaster, is one of the best performers on deaths after surgery and after a heart attack or hip fracture, a reflection of the management effort that has gone into returning it to a top-performing institution. However, its readmission rate is one of the highest. The hospital said that was the result of an error in the way the information was submitted.

Information for the tables has been collected over three years and shows a national trend of falling death rates after heart attacks, possibly as a result of improved treatment. It also shows rising rates of emergency readmissions, reflecting the pressure on the health service to discharge patients as hospitals have struggled to cut waiting-lists.

The "surgery rates" indicator shows the inequity in the NHS. People who live in Brent and Harrow, north Hertfordshire and east Norfolk are much more likely to get a coronary bypass or a hip replacement, should they need one, than the residents of Kensington, Chelsea and Westminster, north Yorkshire and north Derbyshire. The indicator on mental health shows that Barnsley is now the tranquilliser capital of the country.

Three times more Valium is swallowed in that part of South Yorkshire than in more rural Herefordshire.

Tranquillisers, unlike anti-depressants, are addictive and medical opinion is that prescribing should be reduced. The message has not yet reached the heart of the Yorkshire coalfield.

A measure of "adverse events/complications" is included to detect low- quality care, which combines readmission rates and the rate at which hernia operations have to be redone.

Hernias are one of the commonest reasons for surgery and if they are not done properly they can break down and require a second operation.

Patients in Nottingham and Kingston and Richmond had the lowest rate of adverse events, while those in Portsmouth and south-east Hampshire had the highest.

However, a spokesman for Nottingham health authority said its data was incomplete and could not be relied on.

Frank Dobson, Secretary of State for Health, insisted yesterday that the indicators, the most comprehensive that have been published, were not "league tables" but intended for use by NHS management to gauge their performance, compare it with others, spread best practice and nip problems in the bud.

He admitted the information was complex but insisted that that was the nature of health care.

"If it were simplified to get a headline it would become misleading and would not command the confidence of the professions," he said.

Lowest Death Rate

Kettering General, Northamptonshire The top-performing general hospital in England last year. The hospital had the lowest death rates following surgery for large acute hospitals, with 353 deaths per 100,000 operations, compared with the average of 2,278 per 100,000. It was founded in 1896, has 600 beds, and offers a range of acute and midwifery services to 280,000 people in North and East Northamptonshire. Douglas Pattisson, acting chief executive, said: "The indicators show that local people can be proud of the services provided by Kettering General Hospital. However there are areas where improvements still need to be made."

Highest Death Rate

Salford Royal Hospital NHS Trust Has the highest recorded death rate following emergency surgery, with the exception of the specialist cancer hospital Weston Park in Sheffield. However, its rating illustrates the danger of jumping to conclusions on the basis of a single measure. The trust, based on the 700-bed Hope hospital in Salford, admitted one child aged under 14 who had a procedure performed in A&E and later died. The hospital does not normally treat children and therefore had a 100 per cent death rate in that age-group, which distorted its overall score. A spokeswoman for the trust said: "The calculation is grossly misleading. Our death rates are decreasing."