Shortage of doctors `is costing lives'

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ENGLAND HAS fewer doctors than almost any comparable nation, and the risk of dying in hospital is higher because of that, researchers have found.

A shortage of doctors is one of the main reasons for death rates in some English hospitals being four times higher than in others. England has only six doctors per 1,000 population. That compares with an average of 10 per 1,000 for 28 developed countries who are members of the Organisation for Economic Co-operation and Development, and include America and Germany.

A study of 183 English NHS hospitals who treated 7.5 million patients over the four years from 1991-92 and 1994-95 found death rates varied from one in 30 patients discharged to one in seven. As expected, hospitals with the highest rate of emergency admissions, who are generally the sickest patients, had the highest death rates. Overall 60 per cent of the admissions were emergencies and they accounted for 93 per cent of the deaths. But after taking account of the proportion of emergency cases and the age, sex and severity of the patient's diagnosis, Professor Brian Jarman and colleagues of the Imperial College School of Medicine said the strongest predictor of a high death rate was a low number of hospital doctors per bed and a low number of GPs in the population served.

The findings, published in the British Medical Journal, were seized on by doctors' leaders yesterday. Unrest is growing among Britain's 23,0000 consultants at their growing workload caused by the drive to cut waiting lists. The British Medical Association claims an additional 4,000 doctors are needed just to compensate for the cut in junior doctors' hours.

Speaking at the BMA's annual consultants' conference in London yesterday, Dr Peter Hawker, chairman of the consultants' committee, said: "We need to increase the pool of doctors. Doing so will save lives. Perhaps now the link between mortality figures and doctor number has been made so clearly the Government will feel impelled to act." Consultants are negotiating with the Government over new contracts to recognise the longer hours. They are furous that a review body recommendation that they share a pounds 50m bonus for extra work is being ignored.

Professor Jarman said his study was the first of its kind and urged caution in interpreting the results. But they suggested that every 1 per cent increase in the number of hospital doctors per bed - an extra 333 doctors if the number of beds remained unchanged -would result in 186 fewer deaths per year. If GPs are overworked, they tend to send patients to hospital later who are sicker and more likely to die. Each 1 per cent increase in GPs would save an extra 575 lives a year.

The Department of Health said the number of doctors in England increased by 2,300 between 1996 and 1997 and medical schools were on course to provide an extra 7,000 doctors up to 2001. An extra 1,000 medical students would be recruited to begin training by 2005.

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