Analysis: How cancelled operation highlights critical care bed bottleneck

The furore over Margaret Dixon's cancelled operations has triggered a bitter political row but it has also highlighted key issues surrounding patients' treatment on the NHS.

The surgery planned for Mrs Dixon at Warrington General Hospital may have been routine but cases such as hers present one of the most difficult challenges for the NHS. The operation to reconstruct her shoulder would have been straightforward in a healthy patient, but Mrs Dixon has other medical problems which make it risky in her case.

Before surgery could go ahead, hospital managers had to guarantee a high dependency bed would be available so that she could get the specialist nursing care necessary for a patient in her condition. But emergency patients have to take priority. Her operation was repeatedly cancelled to give priority to emergency patients, putting immense strain on her and her family. Mrs Dixon's case exposes the shortage of critical care beds (high dependency and intensive care beds combined). The Department of Health claims the number has grown by 34 per cent to 3,160 since July 2000. But Britain lags behind other European countries such as Germany, Switzerland and the Netherlands, which have more than twice the provision of critical care beds.

Future patients may fare better than Mrs Dixon. Cheshire and Merseyside Strategic Health Authority said yesterday it was to spend up to £3m to build a new critical care unit at Warrington hospital.

Staff shortages have also been blamed for the cancellation of 17,402 operations in the three months to December last year, an increase on the previous quarter, in line with seasonal trends, but - say the Department of Health, part of an overall downwards trend.

The Tories claim that cancelled operations are running 67,000 higher than six years ago.

On most indicators the NHS is improving under Labour, although problems remain. Waiting times, delayed discharges, cancer and heart disease deaths, ambulance response times and speed of referrals have all improved. What is less clear is whether these improvements show value for money for the billions invested.

So how has Labour fared on the key NHS issues?

WAITING TIMES

Hospital waiting lists have fallen by more than a third in the past six years and are at their lowest level for more than a decade. The number of people waiting more than six months for admission has halved, 96 per cent of patients are seen within four hours in accident and emergency departments and 99 per cent are offered an appointment with a GP within two days.

The NHS is on course to meet its most challenging target - that no patient should wait longer than six months for hospital treatment by this December, which was once dismissed by critics as a pipe dream. The main bottleneck is delays in diagnostic tests.

STAFFING

The NHS workforce has grown by 3.7 per cent a year over the past five years to 1.3 million. This includes 56,700 more nurses than in 1999, 5,400 more consultants and 1,900 more GPs. However this has not been enough to meet the government targets for cutting waiting lists, and extra doctors and nurses have been recruited from overseas to lift surgery rates.

MRSA

One of the key failings NHS has been the escalating hospital-acquired MRSA infectionrate, which was given as the cause of death for 955 patients in 2003, a threefold rise on 1997. This is almost certainly an underestimate, as doctors are not req- uired to record MRSA on death certificates. Deaths due to the bacterial infection have risen 15-fold since 1992. Britain has one of the highest rates in Europe.

FUNDING

Spending on the NHS has risen from £43bn in England in 2000/1 to almost £70bn in 2004/5, the largest and longest sustained rise in its history. Growth is set to continue at a similar rate until 2008 but economic forecasts suggest it will then begin to slow. The only certainty in health is that demand will accelerate.

POLITICAL TREATMENTS

Jennifer Bennett

"The War of Jennifer's Ear" became an infamous political own goal. Labour seized the case of five-year-old Jennifer Bennett ahead of the 1992 election, highlighting her 11-month wait for an operation to alleviate a painful "glue ear". The party never intended her identity to be known but the Bennetts were sucked into a political storm when her medical notes were leaked, with the complicity of the Tories. A nervous Neil Kinnock appeared on the family doorstep. The pressure caused her parents to divorce. They refuse to discuss the case.

Rose Addis

Another opposition leader to emerge bloodied was Iain Duncan Smith, then Tory leader, in January 2002. He jumped on a newspaper story about Rose Addis, 94, who had fallen and cut her head, telling MPs she had been left for three days at Whittington Hospital in north London, "caked in blood" after staff refused to wash her. But hospital authorities suggested she refused treatment from staff on the ground of their race. The hospital's medical director, a Labour Party campaigner, accused Mr Duncan Smith of not checking the facts.

Mavis Skeet

The 74-year-old was due to have surgery in December 1999 to determine whether her cancer of the oesophagus had spread, but the operation was cancelled four times in five weeks because of staff illness and a lack of beds in a flu crisis. In January 2000 doctors said that the cancer was inoperable; she died five months later. Her daughter, Jane Skeet, said she would have had a greater chance of surviving with an early operation, and wrote to Tony Blair: "How can you justify the loss of a life because of the lack of a suitable bed?"

Sharon Storer

Tony Blair's visit to Birmingham's Queen Elizabeth Hospital in May 2001 was supposed to have been a carefully orchestrated PR stunt ahead of the general election, but it turned into a disaster when he was accosted by Sharon Storer, who said her partner, Keith Sedgwick, was kept in an unsuitable ward for 24 hours before being seen by a specialist. Mr Sedgwick, 51, continues to have treatment for his non-Hodgkin's lymphoma and is cared for full-time by Ms Storer at their home near Stratford-upon-Avon.