Britain's best hospitals: A patients' guide

A healthcare revolution is giving NHS patients the right to choose treatment at any hospital in Britain. So which is right for you? Jeremy Laurance offers his diagnosis

Thursday 20 March 2008 01:00 GMT

Every doctor knows that the best way to find a good surgeon in a good hospital is to ask an anaesthetist. They are the shadowy figures, always present during operations, with a grandstand view of the action, able to assess the steadiness of the surgeon's hand, the skill of his team – and whether the patient leaves theatre alive.

Most of us do not have access to this vital inside information – and therein lies the problem with what politicians call "patient choice". If you don't have the information, how can you choose?

From 1 April, NHS patients will have more choice than ever: the right to travel to any hospital in England, NHS or private (as long as the private hospital can provide care at the NHS tariff), to secure better treatment.

Doctors don't like it. They accuse the Government of a policy of divide and rule, setting hospital against hospital, encouraging competition that could endanger the losers and overwhelm the winners, destabilising the NHS and depressing morale.

Managers, however, think this doom-laden scenario is overdone, and that in practice few patients will travel long distances, preferring the convenience of local hospitals. Those with rare conditions, comprising perhaps 5 per cent of all hospital patients, may consider going further in order to get specialist care.

It is on that basis that The Independent has drawn up a list of the 10 best specialist hospitals in England. They are at the cutting edge of research and offer the highest standards of care for patients who require treatment in their specialist areas, and intend to take advantage of the new right to choose their hospital.

Each is the leader in its field, providing training to doctors who carry their expertise across the NHS. They are the benchmark institutions for high-quality care, and to which specialists in the field aspire. All 10 are in or near London – an accident of history that reflects the capital's ability to attract wealth and the professions to service it. Similar specialist institutions in other parts of the country are listed as well.

The list is intended as an aid to patients who may be in need of specialist care and wonder where to go. In practice, for most routine procedures – hip replacements, hernia repairs – the local district general hospital will provide a perfectly good service. These operations are common enough for local surgeons to build up expertise and deliver outcomes to compare with the best.

For rare or complex conditions, however, it is important to seek out centres with the experience to provide safe, expert care. A surgeon who does 200 operations a year, of whatever kind, will on balance be safer than one who does 20.

Whatever treatment you require, our list should be the beginning of the search. Patients making a choice should scan the web for information, starting with patient organisations such as Cancerbacup, who offer advice and support. The British Liver Trust next month publishes a guide to the country's 31 specialist liver units, including names of leading clinicians, to help patients choose. Where it leads, others are likely to follow.

Armed with this information, the next step is to approach your GP for advice. Some will be helpful and informative. It is for those who are less so that the information you have been able to glean for yourself will come in useful. Once you've selected a hospital, check its Healthcare Commission performance rating.

The process of choosing a hospital is necessarily crude. It is based on inadequate information that may be both out of date and too general. But experience shows that the best way to refine information is to publish it and to use it. This, therefore, is not the end of a healthcare revolution – it is just the start.

Bones and joints

Royal National Orthopaedic Hospital

The 220-bed hospital in Stanmore, north-west London, provides the most comprehensive range of care for joint and muscular problems in the country.

Its services range from surgery for the most devastating spinal injuries to specialist rehabilitation for sufferers of chronic back-pain. As a centre of excellence it treats patients from across the country, many referred by other consultants from elsewhere for a second opinion.

One fifth of all orthopaedic surgeons in the UK are trained at the hospital, which has eight operating theatres fitted with the latest equipment to perform complex neuromusculoskeletal procedures. The hospital treats almost 10,000 patients a year.

Although most patients would not consider travelling too far for a routine hip replacement, which can probably be done as well in their local district general hospital, the specialist clinics at the Royal National Orthopaedic may provide a reason to make the journey.

Specialist clinics deal with bone tumours, scoliosis (curvature of the spine), rheumatology, spinal injuries, specialist hand and shoulder conditions and sports injuries.

One word of warning – the RNOH's trust did not do well in the Healthcare Commission annual health check.

Alternative specialist orthopaedic hospitals include the Royal Orthopaedic Hospital, Birmingham (rated "good" by the Healthcare Commission) and the Nuffield, Oxford.

Healthcare Commission quality of services rating: Fair


National Hospital for Neurology and Neurosurgery

If you have a head injury, stroke or condition affecting the brain, such as Alzheimer's, epilepsy or multiple sclerosis, this is the place to go. Along with the nearby Institute of Neurology, it is major international centre for treatment, research and training. The National Hospital for Neurology and Neurosurgery has 200 beds at its central London site near Euston station, and treated more than 4,500 in-patients and 54,000 outpatients last year. Part of the University College London Hospitals Trust, it is also planning a new clinical neurosciences building at Queen's Square, which already boasts a state of the art neuro-rehabilitation unit.

The hospital's close rival is the Walton Centre for Neurology and Neurosurgery at Fazakerley, Liverpool, the only specialist neurological NHS trust, which occupies a purpose-built facility serving 3.5 million people in the North-west. A research team from the centre won a large US grant to investigate the neurodevelopmental effects of anti-epileptic drugs.

Healthcare Commission quality of services rating: Good


Royal Brompton & Harefield NHS Trust

The largest specialist heart and lung centre in the UK, the Royal Brompton and Harefield acquired its reputation through the work of Sir Magdi Yacoub, the internationally renowned surgeon who pioneered heart transplants in the UK the 1980s.

Yacoub was a friend and confidant of Diana, Princess of Wales and achieved global fame after it emerged that he'd been smuggling her into the hospital to watch him at work. Pictures of her heavily mascara'd face peering over a surgical mask became one of the iconic images of the princess.

The trust attracts staff and patients from across the country and around the globe, and is a centre for research with between 500 and 600 papers published in scientific journals each year. Its 10 research programmes each received the highest rating in 2006.

Each year, surgeons perform 2,400 coronary angioplasties (where a balloon is threaded through an incision in the groin to the heart and expanded to widen a blocked artery), 1,200 coronary bypasses and 2,000 treatments for respiratory failure – so they do not lack for experience.

Other specialist heart units with strong reputations are Papworth Hospital, Huntingdon, where Britain's first successful heart transplant was carried out in 1979; and the Cardiothoracic Centre, Liverpool, formed in 1991.

Healthcare Commission quality of services rating: Good


The Royal Marsden NHS Trust

The first dedicated cancer hospital in the world, founded in 1851, is still the best. With the Institute of Cancer Research, the Royal Marsden is the largest comprehensive cancer centre in Europe, seeing more than 40,000 patients from the UK and abroad each year. It has the highest income from private patients of any hospital in Britain, testifying to its international reputation.

The hospital's Fulham Road branch in London was seriously damaged by a fire in January, which destroyed the top floor, and the wards and theatres affected will not reopen until next year. It had 169 beds before the fire. There are a further 184 at the Royal Marsden's branch in Sutton, Surrey.

The hospital was founded by Dr William Marsden, who was deeply affected by the death of his wife Elizabeth from cancer.

England has two other specialist cancer centres – the Christie Hospital in Manchester, and the Clatterbridge Centre for Oncology, near Liverpool.

Although cancer is one of the specialties excluded from the expanded patient-choice agenda, it is still possible to arrange a referral with the agreement of your GP and primary care trust. If you have a rare cancer, that could be worthwhile.

Healthcare Commission quality of services rating: Excellent

Ear, nose and throat

Royal National Throat, Nose and Ear Hospital

The country's largest ear, nose and throat hospital is also Europe's centre for audiological research, with an international reputation for its expertise and range of specialties, all on one site on London's Gray's Inn Road.

Its services range from minor procedures such as inserting grommets (tiny valves placed in the eardrum of a child to drain fluid from the middle ear) to major head and neck surgery. A quarter of its 60,000 patients were referred from other parts of the UK and abroad last year. The hospital has a cochlear implant programme, a snoring and sleep disorder clinic, and a voice clinic, the oldest and largest in the UK. One in 25 people develops voice problems such as hoarseness, but it rises to one in five among, for example, teachers, actors and barristers.

A measure of the Royal National's success is the fact that one third of patients referred from other clinics or hospitals with voice problems has their diagnosis changed on investigation there. Although there are many other centres where throat, nose and ear problems can be treated, none are pre-eminent enough to be included in this guide.

Healthcare Commission quality of services rating: Good


St Marks Hospital, Harrow

Britain's leading national and international referral centre for diseases of the bowel is the only hospital in the UK and one of only 14 worldwide to be recognised as a centre of excellence by the World Organisation of Digestive Endoscopy.

Founded by Frederick Salmon in 1835, St Marks was one of the first specialist hospitals and has played a major part in raising the profile of bowel disease, gastroenterology and nutrition in teaching and research.

It is a chosen site for the NHS bowel-cancer screening programme being rolled out across the country, which seeks to detect and treat changes in the bowel before cancer develops. Bowel cancer is the second most common cause of cancer in the UK but often goes undetected because sufferers can fail to report important symptoms, such as blood in the faeces, often out of embarrassment.

Bowel cancer can be treated via colonoscopy, to find and remove polyps – growths on the wall of the bowel. The hospital's education programme attracts clinicians from across the UK and overseas with the aim of spreading good practice elsewhere.

The hospital is part of the North West London Hospitals Trust. In the north of England, Hope Hospital, Manchester also has a specialist bowel diseases unit.

Healthcare Commission quality of services rating: Good


King's College hospital NHS Trust

The liver unit at King's is the largest in the world. It is one of 31 specialist liver units in the UK, but none can match it for expertise, facilities or state of the art equipment. It offers investigation and treatment for all types of acute and chronic liver disease, which is increasing in the UK.

The unit performs 200 liver transplants a year, and more than 200 patients with liver failure are admitted to its intensive care unit each year.

King's carried out the first successful transplantation of islet cells – part of the pancreas involved in producing insulin – in a Type 1 diabetic, greatly reducing his need for injected insulin. Last month, the Department of Health announced plans to establish six new islet transplantation centres round the country, based on the research at King's.

Liver problems are common, and not all patients are lucky enough to be treated at King's. Other highly regarded major centres among the 31 specialist units are the Freeman Hospital in Newcastle upon Tyne; St James's University Hospital, Leeds; University Hospitals Leicester NHS Trust; Addenbrooke's Hospital, Cambridge and Derriford Hospital, Plymouth.

The British Liver Trust is to publish a detailed guide to liver units and their specialists next month, to help patients choose where to go.

Healthcare Commission quality of services rating: Excellent


The Maudsley Hospital

One of Britain's oldest hospitals, the Maudsley's contribution to mental-health care stretches back at least 760 years. It was previously known as the Bethlem and Maudsley Trust, from its origins as the Priory of St Mary of Bethlehem from which the name "Bedlam" comes. It was first referred to as a hospital for the insane in 1403 and was founded on its present south London site by psychiatrist Henry Maudsley in 1907.

Today it is a centre of excellence for the delivery mental-health care. Its addictions centre offers new treatments for drug abuse, alcoholism, eating disorders and smoking, it provides innovative care for disturbed children and adolescents and is the largest mental-health training institute in the country.

It has pioneered new approaches to the treatment of heroin addiction and its specialists have raised concerns over the link between cannabis and schizophrenia which have led the Government to review changes to the law.

Psychiatry is excluded from the new extension to patient-choice – but a GP may still be persuaded to seek permission for a referral to the Maudsley from your local primary care trust.

Healthcare Commission quality of services rating: Good


Great Ormond Street Hospital NHS Trust

If you have a child with a rare or complicated disorder, this is the place to come. It is the largest centre for research into childhood illness outside the US, the largest centre for children's cancer in Europe and delivers the widest range of specialist care of any children's hospital in the UK.

Great Ormond Street won't treat just any patient, though: it only accepts specialist referrals from other hospitals and community services – in order to ensure it receives the rare and complex cases and not the routine.

Paediatrics is one of the most rewarding areas of medicine for doctors because it has seen some of the most spectacular advances over the past 30 years, especially in cancer, where survival has improved dramatically.

Many of those cared for at GOSH still have life-threatening conditions but they are promised the best care both because of the expertise of its medical staff and because of the trust's extraordinary success in attracting charitable donations, which have made it among the best-funded medical institutions in the country.

JM Barrie's gift of the royalties from Peter Pan in 1929 has been a vital, and hugely valuable, source of income for the hospital for almost 80 years.

Other commendable children's hospitals include Alder Hey, Liverpool, Manchester and Sheffield.

Healthcare Commission quality of services rating: Excellent.


Moorfields Eye Hospital

The largest specialist eye hospital in the country and one of the largest in the world, Moorfields was founded in 1805. It treats more patients than any other eye hospital or clinic in the UK and more than half the ophthalmologists practising in the UK have received specialist training at Moorfields.

However, in recent years the hospital has relied too heavily on its reputation and grown complacent. Though standards of academic excellence are still high, it has neglected the services it offers to patients, which were rated weak on quality by the Healthcare Commission in its annual health check last year.

The hospital carried out 23,000 ophthalmic operations last year, providing surgeons with extensive experience on which to hone their skills. The reputation of the trust is such that it has started to run clinics in distant hospitals, capitalising on its brand. The hospital employs 1,300 staff who work on 13 sites.

Moorfields was founded to treat an epidemic of trachoma, a form of tropical conjunctivitis which still causes blindness in Africa, and was brought back to England by British troops returning from the Napoleonic wars in Egypt.

Despite its recent problems, Moorfields remains Britain's most highly-regarded eye treatment centre. No alternative hospitals have a comparable reputation.

Healthcare Commission quality of services rating: Weak

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