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NHS Performance 2000 Thursday, 13 July, 2000, 22:39 GMT 23:39 UK
Health figures - dubious distinctions
operation
Hospitals taking the hardest cases come off worst
There are so many outside factors which could affect the performance of a hospital or health authority that some argue they are of little real value to the public.

What the man on the street wants from these figures is an instant guide to the best hospitals - and those which simply aren't up to scratch.


They don't distinguish between very difficult liver cases and operations to correct ingrowing toenails

King's College Hospital spokesman
Of course, life is rarely that simple, and even if a set of statistics is far enough from the norm to raise eyebrows, it may take months of further investigation before it is revealed whether doctors, managers, or simply the hand of fate is to blame.

Virtually every hospital finding itself rock bottom of a particular indicator can come with a perfectly understandable reason why they are there.

And conversely, the crudeness of the figures may well mean that hospitals with genuine problems may still sit comfortably "mid table".

The Department of Health statisticians have not been able to adjust the figures for "casemix". This takes account of the type of operations carried out there.

A district general hospital doing standard heart angioplasty procedures is likely to have much lower death rates than a top notch heart operations doing last-ditch cutting edge operations on desperately-ill patients.

Yet this is not reflected in the figures.

King's College Hospital in south London is the perfect example of this in practice.

Tough cases

It deals with the toughest cases - patient with liver failure on the very edge of death in many cases. Only one other hospital in the UK is equipped to help them, and one in four will die.

A spokesman for the hospital said: "The figures simply aren't sensitive enough.

"They don't distinguish between very difficult liver cases and operations to correct ingrowing toenails."

Neither is deprivation. Patients from deprived areas with cancer are likely to go to the doctor later with their symptoms, therefore in general having more advanced cancer, which is more likely to kill them.

Their general health is likely to be worse, also making is harder to fight the disease.

So when East Surrey tops the breast cancer survival rate league table, and North Staffordshire rests on the bottom, it is not necessarily a reflection of a gulf in the quality of cancer services between the two.

Simply gathering the numbers together can add to the problem.

If you are measuring something that does not happen very often - for example the death of an elderly person within a month of hip replacement, the slightest change in the figures can produce a huge statistical effect.

cancer drug
Does poor cancer survival really mean poor care?
If the average number of deaths a year is two for the average hospital, should four die at one particular hospital, suddenly that hospital has a death rate double the average, and the public is concerned, probably without reason.

The British Medical Association says these figures should carry a "massive health warning", while conceding they can be a useful pointer to managers and doctors, if not to the untrained eye.

However, the very act of forcing hospitals to record the numbers can be beneficial, as even the act of gathering the figures - in the knowledge they are to be published - focuses attention on areas which might not have been top priority a decade ago.

And managers are able to compare more easily what they are doing with the best of the rest.

Dr Peter Hawker, chairman of the BMA's consultants' committee, said: "Doctors want to improve the quality of patient care they offer to patients.

"They want to learn from the best performing hospitals and change their working methods."

See also:

13 Jul 00 | NHS Performance 2000
13 Jul 00 | NHS Performance 2000
04 Nov 99 | Performance 99
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