A matter of life and death

- Friday, 25th August 2000

 

I am sorry to return yet again to the subject of hospitals. But they are a matter of life and death.

The recent published information about health outcomes shows a very disturbing picture.

The results show that Hemel Hempstead had nearly the worst level of fatalities for emergency hip operations for elderly people of any hospital in the country. One in six of those treated have died within 30 days of the operation. That is over twice as high as the national average.

The level of fatalities following emergency operations of all kinds is also among the worst of any hospital. Moreover it has been deteriorating every year since 1997.

I have analysed the figures for all the local hospitals surrounding this constituency: Watford, Luton and Dunstable, the Lister and the QEII as well as Hemel Hempstead and St Albans. With the honourable exception of the QEII, mortality rates following emergency operations have also got worse in all of them since 1997.

Of course, in many aspects of health care our local hospitals provide healthcare equal or better than the national norm. We should pay tribute to local health care employees for their dedication and care.

Issues related to the NHS have had a high profile in this area throughout my time as a Member of Parliament. The decision to merge St Albans and Hemel Hempstead accident and emergency units created an uproar that, quite rightly, lasted for years. At other times the newspapers have been dominated by stories of threatened ward closures, alleged staff shortages and demands for increased resources.

It was quite right that these issues should provoke concern. But the current questions about the standard of local healthcare dwarf them all. What is surprising is how relatively low key the reaction has been.

Some political activists, who were keen to score political points about resources, reorganisation and imaginary threats to the NHS under the last government, have been notably quiet about this matter of life and death.

What really worries me is who knew, and who did not know, that there was cause for concern about health outcomes in some units at Hemel Hempstead?

The Chairman of the West Herts Health Authority - one of many political appointments made since the election - was apparently unaware how worrying the figures were until they were published.

Surely she should have known and should have set up an inquiry before they became the public rather than waiting until Charles Elphicke and I called for one.

By contrast some doctors have indicated to me that they were aware that all was not well - particularly in orthopaedics.

Apparently even some patients were becoming aware of this and were choosing to go to the QEII instead. I am not sure how they were able to do so other than by going privately.

The doctors say that they could not do much to redirect patients to other hospitals for fear of "destabilising the local health economy ". I find that an ominous phrase. Doctors? primary concern should be the health of their patients not the bureaucratic convenience of the health service.

As I have explained before in this column and elsewhere, individual doctors and their patients can no longer choose which hospital they wish to be referred to. This Government‘s reforms require each primary care group to contract to send all its patients to a given hospital for each type of operation. For most operations people living in Harpenden and St Albans are contracted to go to Hemel Hempstead.

In the short term we are stuck with this system. All we can hope is that the proposed new Primary Care Trust covering both Harpenden and St Albans will use its enhanced clout to bring about a rapid improvement in the clinical standards in the hospitals to which they have contracted to send local people.

One good lesson of this whole experience is the value of publishing information about hospital performance. Of course it is important to interpret information properly. Specialised hospitals may treat people with very severe conditions and therefore have apparently high mortality rates even though they are in fact providing the best possible care. But I believe that people are intelligent enough to take such factors into account.

What is clear in this case is that if the last government had not decided to start publishing this sort of information (against strong opposition) nothing would have been done to discover what lies behind the worrying figures locally and to bring about any necessary improvement.

Publishing information and restoring the right of GPs and patients to make informed choices between hospitals within the NHS is just as important in improving standards as increasing resources.

 

 

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