Bypass survival 'depends on hospital'

The chances of surviving heart bypass surgery vary greatly depending on which hospital the patient attends, a report has revealed.

Walsgrave Hospital in Coventry - run by the University Hospitals of Coventry and Warwickshire NHS Trust - is named as having the highest death rate for coronary artery heart by-pass surgery.

United Bristol Healthcare meanwhile comes out on top in the The Times Hospital Consultants' Guide, with a standardised mortality ratio of 48 compared with 182 for Walsgrave. The national average is 100.

The guide has been compiled by the independent medical consultancy Dr Foster, with the help of the Department of Health.

A Department of Health spokeswoman said: "One thing these tables make very clear is that across the NHS, surgical performance is improving, and we think increasing openness about data is involved in that.

"But of course there are some hospitals whose progress has not matched up to that overall improvement.

"We expect trusts to look at their data, think carefully about why it may be different to the national improvement and - where the differences can't be accounted for in terms of case-mix or other issues - take action to improve their record as a matter of urgency."

Shadow health secretary Liam Fox said: "These statistics again highlight the crisis in the NHS under Labour.

"They are bad enough in themselves, but there are some parts of the country where medical outcomes are unacceptably poor.

"What makes matters much worse is that, because Labour have removed the freedom of patients to move to other parts of the country for treatment, we now have areas of Britain where patients and their doctors are stranded in third rate health ghettos."

Nicholas Bishop, medical director at United Bristol Healthcare Trust, said: "We're delighted to be able to be recognised as being good for heart surgery. It reflects credit on the surgeons and the whole team."

The guide is good news for United Bristol Healthcare, which was heavily criticised by the Kennedy Report into the deaths of babies at Bristol Royal Infirmary.

Plymouth Hospitals, Leeds Teaching Hospitals and Southampton University Hospitals trusts followed closely behind United Bristol Healthcare with low mortality rates.

Hammersmith Hospitals and University College London Hospital, both in the capital, and South Manchester University Hospitals, were among the highest.

There are two procedures used for coronary heart disease - which is the UK's biggest killer, claiming 135,000 lives every year.

One takes a vein from the leg and uses it to bridge the blockage, while the other re-routes the mammary artery in the chest to achieve the same result.

The death rates for by-pass operations show the greater the proportion of arterial grafts, the lower the mortality.

Nearly 90% of patients in the UK now get at least one mammary graft, but the proportions vary between different hospitals.

In some units, only 55% of patients get an arterial graft, while in others it is as high as 95%.

At Walsgrave Hospital, the proportion of bypass operations with at least one arterial graft was low - less than 60%, which the authors believe could be one explanation behind the high mortality rate.

The guide of 29 hospitals is the first which mortality rates for NHS trusts have compared particular diagnosis and operation.

It was based on analysis of data supplied by the Department of Health.

Sir Brian Jarman, emeritus professor at Imperial College, who analysed the figures separately, said: "This guide is a valuable tool for patients and GPs alike as it helps to identify variation in quality of hospital services.

"It also shows that the success rate of heart surgery is getting better all the time."

The Department of Health spokeswoman added: "On one hand detailed, accurate information drives up performance in the service by highlighting the best and worst performers.

"On the other, it breaks down barriers between the NHS and the patients to create a more transparent relationship where poor performance cannot be swept under the carpet.

"But if this information is to serve its purpose and drive up standards in the NHS and keep the public properly informed, it must be accurate and present a fair and balanced picture of the NHS.

"For example, there are serious issues around case-mix and the severity of patients with whom particular hospitals deal.

"We are committed to the idea of publishing sub-trust level performance - as are the Royal College of Surgeons and the BMA - and this is one of the recommendations of the Kennedy Report."