Hospital League Tables: Five-star praise for London hospital: The Best? Simon Midgley visits St George's Hospital, Tooting, south London

The pace was hotting up yesterday afternoon in the accident and emergency department of St George's Hospital, in Tooting, south-west London, as the number of patients waiting to be seen mounted and the average waiting time for non- urgent injuries, walking and stretchered, rose to two hours.

Gurpinder Bansal, a 21-year-old unemployed panel beater from Tooting, spent one-and-a-half hours waiting for treatment to his left hand, which he had gouged on a nail. He was eventually given six stitches. Mr Bansal was uncritical, however; as a non-urgent case he knew he would have to wait his turn.

'This is my local hospital,' he explained. 'I always come here. It's excellent.'

Mr Bansal said he was aware that St George's, which has just been recognised as possibly the most efficient hospital in England, Wales and Northern Ireland, now operates a triage system in its accident and emergency department.

Under this system, nurses identify which cases are very urgent, urgent, or non-urgent. The very serious cases are seen first, the fairly acute as soon as possible, and the less pressing as soon as possible after the more critical cases have been dealt with.

Mr Bansal said he was happy to wait until the more pressing injuries had been treated.

The NHS league tables gauging the level of efficiency of local hospitals has judged St George's to be the best performing district general hospital and regional specialist treatment centre.

The teaching hospital has been given 13 five-star awards, five four-star awards and three three- star awards for the speed with which it assesses patient injuries in the accident and emergency department, the number of operations it performs in day-care surgeries and the shortness of its waiting lists.

Every patient attending St George's accident and emergency department is assessed for the seriousness of their condition within five minutes of entering the hospital, compared to 30 per cent a year ago.

St George's also scored top marks for the number of knee operations and female sterilisations it conducted involving hospital stays of less than a day, and the percentage of patients waiting for urological, general surgical, ENT and oral surgical operations it admitted within three months of getting on the waiting list. Nearly all patients waiting for those operations were admitted within 12 months.

Andrew Dillon, the chief executive of the St George's Health Care Trust, said yesterday: 'I am very pleased we have done so well.'

He said the improvement in the number of patients assessed within five minutes in the accident and emergency department, and in the waiting times in the other specialist surgery and treatment areas, was down to the sheer hard work and commitment of the hospital staff.

While the triage system will not reduce waiting times for the less urgent cases - yesterday there was an average two-hour waiting time for non-urgent cases - it does at least prioritise the urgency of the cases waiting for attention, Mr Dillon said.

Although the hospital only scored a two-star rating for the time its out-patients spend waiting to be seen, ie only 80 per cent were seen within 30 minutes, the hospital, Mr Dillon said, was working hard to improve this figure to 100 per cent. At the moment some 20 per cent of patients wait for up to two hours.

To tackle this problem a lot of work was being done to encourage doctors to organise their clinics more efficiently and to persuade consultants who are persistently late to be more punctual, and others who occasionally miss a clinic to be more reliable.

As far as waiting lists were concerned, Mr Dillon said the hospital had introduced a system where business managers would help junior doctors to manage their lists in such a way that the needs of urgent patients were balanced with those of patients who had been waiting a long time for admission.

Roger Leicester, a general surgeon specialising in colorectal problems, or 'bottoms', said the improvements in service were partly due to the hospital working closely with GPs and health authorities, talking about how best to meet local needs.

As far as general surgery was concerned there had been an increase in the number of day case surgical operations, the introduction of a convalescent or 'hotel' unit in which recovering patients can convalesce before going home, and the introduction of a weekly rapid access clinic for colorectal cases.

Mr Leicester said that the hospital management worked closely with doctors to improve hospital efficiency and the quality of patient care. While it was important to reduce patient waiting times this was not, he said, in itself a measure of the quality of treatment in hospitals. In future, measurements of the quality of treatment received would become an increasingly important way of assessing the standards of care offered. Sandra Legg, chief nurse in charge of 1,600 nurses at the hospital, said the improvements were due to 'good consultations, good clinical management and good administrative management'.

It was due to putting patients first, caring for your staff and offering top quality service in a competitive environment, she added.

Departments conducted regular audits to make sure they were delivering care efficiently, staff were monitored on their performance every year and multidisciplinary teams were deployed wherever possible, she said. Doctors were also being brought into making management decisions.

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