Hospital League Tables: Low-scoring units 'may not survive': Statistics released yesterday show that the National Health Service is a lottery. Celia Hall and Graham Moorby report
Thursday 30 June 1994
Philip Hunt, director of the association, said that hospitals revealed as high performers will attract more work, earn more and improve, while those shown to do least well could lose out.
'It will happen at the margins. The high performers will only have limited extra capacity but a 5 per cent loss from a small unit that is already struggling could have a big effect. It may be that some hospitals will not survive.'
The hospital and ambulance tables published yesterday show more clearly than any other measure how much the National Health Service is a lottery.
While they are widely criticised for being an exercise in hospital productivity - how quickly hospitals move patients through the system - they reveal huge differences across the country and within the regions. In some hospitals nearly 100 per cent of patients are seen within half an hour of arriving for their outpatient appointment; in others, more than 40 per cent face long waits.
But three measures can be read as indicators of quality: the percentage of people arriving in accident and emergency departments who are assessed within five minutes; the percentage of operations treated as day-case surgery and the time it takes for an ambulance to reach an emergency.
Yesterday saw the publication, for the first time of league tables for England, Wales and Northern Ireland. Controversially, most of those in England were given star ratings from one to five. But 15 per cent are not starred because the Audit Commission, asked to assess all the hospitals' systems for gathering data, decided that these were inadequate. The tables list details of more than 500 hospitals and community units, the 'providers' of health services, by up to 23 different measures of performance.
These are in three groups. The first gives the percentage of patients waiting more than 30 minutes for an outpatient appointment; those waiting more than five minutes for assessment in casualty and those not seen within two months of a second cancelled operation.
The second section gives the percentage of operations treated as day cases for four common procedures - hernia operations, internal examination of the knee joint, cataract surgery and key-hole sterilisation for women.
The third section, for eight common specialties, gives the percentage of patients admitted within three months and the percentage of patients admitted within 12 months.
Analysis of the tables by a crude assessment of high- and low-scoring hospitals reveals a small number doing very well and an equally small number doing very badly. Even the 'best' hospitals had black spots and the 'worst' their good points - and many famous ones produced surprises.
In London, Great Ormond Street Hospital for Sick Children scored badly on admitting sick children within three months; St Bartholomew's revealed its patchy service. It scored six five-stars and six one-stars. It did not do well on day surgery despite having a dedicated unit.
By comparison, King's Healthcare NHS Trust, south London, which also has a new day surgery unit, rated four 5-stars out of five and one 4-star for day cases.
Brighton Health Care NHS Trust did well on day surgery but was not good on its 3- and 12- month waits. Managers in Brighton said that without the tables they would not have been aware that they were falling behind in some specialties.
Surrey appears to be particularly blessed with high numbers of percentages of patients being seen quickly. Analysis of the tables for health ministers which looked for overall performance factors revealed North Thames region as having the highest number of poor performers and Anglia and Oxford as having none that did very badly.
The Trent region demonstrated the confusing picture given by the league tables. One of the worst performers was the Pilgrim and Associated Hospitals Unit which was given nine one-star ratings, but it was also awarded five five-stars.
One of the worst performances in England was in the South and West Region at Bath's Royal United Hospital NHS trust. It received the poorest performance rating of one-star in 13 categories and faced particular criticism over its waiting times. Only 41 per cent of patients were admitted within three months for general surgery and only 24 per cent for trauma and orthopaedics. Bill Collins, who chairs the trust, said overall staff could be proud of their performance and they had earned two five-star ratings.
'We fully accept that waiting times for both in-patients and out- patients had to improve,' he said. 'I am delighted to say that they have done so. When the RUH became a trust we inherited a situation where our waiting times were some of the worst in the country but we have improved rapidly.'
The West Midlands had two hospitals whose number of one- star ratings was in double figures. Kidderminster appeared to do badly but managers say the figures are incorrect. The Walsgrave Hospitals NHS Trust was awarded the one-star rating in 10 categories, particularly for waiting times.
Among the worst performers in the North West was the Furness Hospitals Unit which was given a one-star rating for its waiting lists in eight areas of surgery.
Hospitals in the Northern and Yorkshire Region had impressive records with the worst picking up seven one-star gradings each. These included Grimsby Health NHS Trust, which saw only 55 per cent of out-patients within half an hour of their appointment time. Four hospitals in the region saw all patients within 30 minutes.
In Wales, the Velindre Hospital, South Glamorgan, had one of the worst records for out-patient appointments. Only 40 per cent of out-patients were seen within half an hour of the appointment time.
A spokesman for the hospital said while it was disappointed with its performance, changes had been made and a recent survey showed more than 58 per cent were now seen within half an hour.
'It must be recognised that Velindre is a specialist cancer hospital dealing with very ill and vulnerable patients,' said the spokesman. A recent survey of patients showed only 3 per cent felt they had to wait too long.
Another poor performer, according to the tables, was the Rhymney Valley Health Unit, Mid Glamorgan, which saw only 60 per cent of its out-patients within half an hour of appointment time and only 61 per cent of accident and emergency cases were assessed within five minutes of arrival. A spokesman for the unit said it was concerned about the figures and a review of staffing and administration was under way. 'The public can be assured that we are constantly striving to improve and that a marked improvement will be made.'
Ambulance services in London were the worst in Britain, according to the tables. The figures showed that only 62 per cent of ambulances arrived within the Patient's Charter target of 14 minutes - 25 per cent worse than any other urban area in England. The quickest ambulances were in Greater Manchester where nearly 98 per cent arrived within 14 minutes and 96.6 per cent of Mersey Regional ambulances arrived within the target time.
A spokesman for the London Ambulance service said the figures showed an improvement of 3.2 per cent compared to last year, despite an increased workload. Nearly pounds 15m of new investment would enable the service to respond to 85 per cent of calls within 14 minutes by April next year.
The star ratings, awarded by the Department of Health, are intended to make the tables more accessible to the public than naked percentage figures would be, by reflecting the performance hospitals can reasonably be expected to achieve in each service. For example, the percentage of out patients seen within 30 minutes needs to be in the high 90s to rate five stars; but no such figures for day surgery are achievable or even desirable, and scores in the 60s and 70s have been awarded five stars. The ratings purport to reflect performance criteria on a national basis; a five-star performance in one region is supposed to compare to a five-star performance in another.
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