Clinical Outcomes

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  • Revealed: the hospitals with the worst death rates in Britain.  Michelle Paduano Guardian Unlimited Sunday November 18, 2001
  • The average patient should treat with caution the heart surgery consultants' guide published by the data firm Dr Foster today, but should not ignore it; the publication of such information may one day - in an indirect way - save your life.  The guide attempts to provide an assessment of hospital mortality information robust enough to enable patients to make an "informed decision" about the "most suitable consultant" in their area.  Guardian Society Monday November 19, 2001
  • Guide reveals maternity service lottery.  Guardian Thursday January 3, 2002
  • League tables to show surgeon death rates.  Guardian Society Thursday January 17, 2002
  • Heart surgeons are to have their death rates published as part of plans to put patients' needs "centre stage", after the death of 29 children at the Bristol Royal Infirmary, the health secretary, Alan Milburn, told MPs. Guardian Unlimited Friday January 18, 2002
  • Patient death rates to be made public.  'Milestone' as performance of every surgeon to be revealed   Guardian Friday January 18, 2002
  • Revolution in maternity wards. Gaby Hinsliff and Kamal Ahmed Guardian Unlimited Sunday January 20, 2002
  • Cancer survival rates disputed.  James Meikle, health correspondent Guardian Monday June 3, 2002
  • NHS quality and performance: the issue explained.  Patrick Butler Society Thursday June 6, 2002
  • Plan to monitor patient death rates to stop a second Shipman.  James Meikle, health correspondent Friday January 31, 2003 The Guardian
  • What the survey said: death rates for heart operations. Monday November 3, 2003
  • The NHS trust that took over a specialist heart hospital from the private sector has a death rate for heart bypass operations that is 2.75 times the national average, according to a survey published today. Tash Shifrin and agencies Monday November 3, 2003
  • Unacceptable variations in hospital care exist across the country with the quality of treatment patients receive dependent on where they live, the health service watchdog said in a report published today. The Commission for Health Improvement (Chi) said overall hospital care across England and Wales had significantly improved in the four years it had been reviewing services.  Thursday March 18, 2004
  • Patients and relatives will be given access to records about individual doctors' performances in a move by the freedom of information tsar that puts him on a collision course with sections of the medical profession. Martin Bright and Jo Revill Sunday January 2, 2005 The Observer
  • Twenty-five surgeons from north-west England publish their individual mortality rates for heart operations today, setting a precedent for other doctors who are under pressure from the public to reveal their results. The surgeons say they hope their move will promote openness and transparency within the NHS. Sarah Boseley, health editor Friday March 4, 2005 The Guardian
  • Guardian investigation under freedom of information extracts first data on heart surgeons and reveals successes and failures of system. Guide: NHS heart surgery data . Sarah Boseley, John Carvel and Rob Evans Wednesday March 16, 2005 The Guardian
  • For the first time in the history of British medicine the mortality rates of individual doctors in one medical speciality are being published in our pages today. Leader Wednesday March 16, 2005 The Guardian
  • The publication today of data on patient deaths during and after heart operations is a landmark step on the road towards a more open health system. John Carvel, Sarah Boseley and Rob Evans Wednesday March 16, 2005 The Guardian
  • Website for heart data. Letter from John Reid Thursday March 17, 2005 The Guardian
  • Many of the trusts added an explanatory note to the data they provided to the Guardian under the Freedom of Information Act. It was drawn up for them by Roger Boyle, heart tsar at the Department of Health. This is the full text of his advice. Thursday March 17, 2005
  • Adrian Marchbank, a consultant cardiothoracic surgeon at Derriford hospital in Plymouth, explains how the Guardian's application under the Freedom of Information Act has 'stirred up a hornet's nest' at his NHS trust. Money allocated for information systems to collect clinical data has been spent elsewhere. Friday March 18, 2005
  • Improving the quality of healthcare is impossible without the honest collection and assessment of data, says Helene Mulholland. Wednesday June 15, 2005 The Guardian
  • Hospital mortality rates in some parts of England are 50% lower than in others, according to a new health index showing huge variations in patient satisfaction, quality of care and equality of access to treatment. James Meikle, health correspondent Wednesday June 15, 2005
  • Interpreting the information here will require context. Some PCTs, for example, will have implemented health campaigns. External factors should be taken into account, says James Meikle. Wednesday June 15, 2005 The Guardian
  • Health mapping 2005: methodology and notes. Paul Aylin, Alex Bottle, Steve Middleton, Susan Williams Wednesday June 15, 2005
  • A new set of measurements by which members of the public can assess their local health services is available on the Society Guardian website today. Unlike previous performance targets which have concentrated on administration - numbers of patients treated, GP waiting times, hospital inpatient and outpatient waiting lists - the new indicators examine how well patients are treated, how satisfied they are with their treatment, and how fair the access to health services has been. Leader Wednesday June 15, 2005 The Guardian
  • A London hospital last night claimed it might be the first in the world to publish death rates for all its clinical specialities. In a move that could open the floodgates on the provision of information to patients, it has detailed statistics on how its various departments performed. St George's in Tooting, south-west London, is already one of only a few hospitals in Britain to publish the results for individual heart surgeons, a controversial move opposed by many elsewhere, as was seen when the Guardian used Freedom of Information legislation earlier this year to force other hospitals to reveal their figures. James Meikle, health correspondent Thursday August 25, 2005 The Guardian
  • The health inspectorate plans to publish information about the death rates of individual heart surgeons in April, a year after a Guardian inquiry cast doubt on the reliability of some data collected by hospitals. Sir Ian Kennedy, chairman of the Healthcare Commission, intends to make the results available on an official website in four months. They will allow patients to choose a surgeon on the basis of his or her success rate for similar operations. Sarah Boseley and John Carvel Monday January 2, 2006 The Guardian
  • Three leading NHS hospitals risk being downgraded for failing to give information on the death rates of their heart surgery patients, the Guardian has learned. The trusts are the only ones in the UK not to have provided key data for the Healthcare Commission, which has been gathering information on mortality rates linked to individual surgeons. The information will be published today on a groundbreaking website designed to enable heart patients and their families the chance to make informed choices about where to have surgery. Last night one of Britain's top heart surgeons warned that the commission might penalise the three trusts - St Mary's in Paddington, west London, Glenfields in Leicester, and Morriston in Swansea - by downgrading them in their annual performance ratings. "I think it is utterly unacceptable in a modern health service that units no longer have the discipline or facility to collect good outcome data," said Sir Bruce Keogh, president of the Society of Cardiothoracic Surgeons. After a Guardian investigation last year, the commission asked all hospitals performing heart surgery to provide data on operations such as bypass grafts and aortic valve replacements. The aim was to help patients assess a surgeon's track record before having an operation. In a historic move the commission will publish data on death rates at almost all the 33 hospitals performing this complex work in England and Wales. It will disclose risk-adjusted mortality rates for individual surgeons at 17 cardiac units, and the aggregated results for 13 units. John Carvel and Sarah Boseley Wednesday April 26, 2006 The Guardian
  • League tables showing the length of time patients at hospitals around the country survive cancer may be published by the government so they can make informed decisions about where to go for their care. Health secretary Patricia Hewitt yesterday announced a cancer reform strategy at the Britain Against Cancer conference in London. Mike Richards, the cancer tsar, who will develop the strategy, believes that league tables could be a key tool. But the British Medical Association said yesterday that doctors who treat the sickest patients - often in the most deprived areas - could wrongly appear worse than others. The data hospitals held on patient outcomes was not accurate and did not take into account risks such as the patient's age and the nature of their disease. Sarah Boseley, health editor Friday December 1, 2006 The Guardian
  • Leading hospital did not reveal damning report into heart surgery. A Guardian investigation has led to calls for greater transparency in the NHS after it emerged that heart surgery patients at an elite teaching hospital were exposed to "serious clinical risk", according to a report that was not made public. The hitherto confidential report by Sir Bruce Keogh, one of the most eminent cardiothoracic surgeons in Britain, said facilities for heart patients at St Mary's hospital trust in Paddington in west London, were "almost certainly the worst in the country".John Carvel, social affairs editor Monday January 8, 2007 The Guardian
  • Private providers stung by vaccine data failures. Private providers of single measles, mumps and rubella vaccines have come in for stinging criticism from NHS GPs and the Health Protection Agency (HPA) over their inability to produce accurate data. The HPA has attempted to estimate the contribution of single vaccines to protection in the overall population. Researchers identified 27 providers in England and Wales via internet searches and the Medicines and Healthcare Products Regulation Agency. But only nine of the clinics provided any data, and none were able to produce all the data requested. It was impossible to find out how many children had received all doses of each vaccine, said Dr Natasha Crowcroft, consultant epidemiologist at the HPA. 'Despite concerted effort and long delays, data were only received from one-third of the providers,' she said. 'I'd say we weren't surprised but were disappointed, and recommend the Healthcare Commission sets the same standard of data collection and reporting by private clinics as is required of the NHS.' Dr George Kassianos, a Berkshire GP and RCGP vaccination spokesman, said: 'What this study demonstrates is that, due to the high costs [of single vaccines], parents choose what to have for their children so most only receive one vaccine - measles - and many will not have the second dose. These children's NHS notes are incomplete, their immunity to these diseases is incomplete or non-existent, and the only thing certain is the profit the providers are making.' Summary by Keep our NHS Public of Doctor 17 April 2007
  • Hospital 'mortality rate lottery'. A study by Dr Foster Research has revealed that patients are twice as likely to die in some hospitals as in others. Despite falling overall mortality rates, there were vast disparities between the 152 hospital trusts analysed. Researchers said that 7,400 lives could have been saved if the worst performing trusts achieved the expected rate. The Royal Free Hospital NHS Trust in North London was the best-performing, with a mortality rate 26 per cent lower than the expected rate. The highest mortality level was found at George Eliot Hospital Trust in Nuneaton, Warwickshire, 43 per cent above the expected level. Factors affecting rates were infections, medical error and failure of "quality of care". Summary by Keep our NHS Public of Times 24 April 2007
  • NHS to rate GPs for new patient guide. GPs are set to be rated on a series of practice indicators to allow patients to choose where they want to be registered. The NHS has joined with private firm Dr Foster to draw up plans for assessing GPs using prescribing and referral data. Dr Foster Intelligence, a 50:50 public-private venture, plans a scorecard on similar lines to its high-profile Hospital Guide, the latest edition of which is published this week. A spokesperson insisted the scheme would be voluntary, but it has intensified pressure for a nationwide, practice-led accreditation scheme. The RCGP warned that if GPs did not engage with its own controversial system for accrediting practices, private firms would be bound to take over. The National Audit Office criticised the Department of Health in February for setting up Dr Foster Intelligence without going out to tender. Summary by Keep our NHS Public of Pulse 27 April 2007
  • Stroke patients die needlessly in care lottery, study reveals. Hundreds of deaths of stroke sufferers could be avoided if disparities in treatment were remedied, new figures suggest today. More than a third do not receive treatment on a stroke unit where their prospects are considerably better, a national audit found. Research, funded by the Healthcare Commission, found large disparities in the quality of care offered across England, Wales and Northern Ireland. Patients in Wales are more likely to die, or if they survive suffer higher levels of disability, than elsewhere. Fewer than three in 10 (28%) patients there are treated in a stroke unit, compared with an average across the three countries of 62%. Meanwhile, two out of three (64%) patients in England and seven out of 10 (73%) patients in Northern Ireland can expect to visit a specialist unit. Press Association Wednesday May 9, 2007 SocietyGuardian.co.uk
  • Cancer survival rates have doubled, say experts.  Patients have 46% chance of living for 10 years.  Specialists reject call for expensive new drugs. Sarah Boseley, health editor Wednesday May 16, 2007 The Guardian
  • Surgery records online. An independent NHS special health authority, the Information Centre, has published online the survival rates for specialist heart hospitals treating children. The move follows the inquiry into child heart surgery at Bristol Royal Infirmary in 2001, which found that patients should have greater access to information. The Congenital Heart Disease Website is a world first and lists consultants, contact details and hospital website links. Summary by Keep our NHS Public of Times 1 June 2007
  • Speedier treatment boosts heart attack survival rates. More patients are receiving emergency treatment within 60 minutes of suffering a heart attack, but there is still variation between hospitals, a report out today reveals. In England, 64% of patients were given "clot-busting" drugs within an hour of calling for help in 2006-07 - up on the 58% in 2005-06. Some hospitals met that target just 26% of the time, but the report pointed out this could be down to rural locations making some trips slower or some units offering patients angioplasty without the need for drugs first. Press Association Thursday July 12, 2007 SocietyGuardian.co.uk
  • Ignorance isn’t bliss – Policy Exchange. New research: Standards would be driven up if NHS patients received more of the right kind of information. Download report: Measure for measure.  Care & Health 20 July 2007
  • NHS surgery success rates to be made public. A radical overhaul of NHS strategy which will give patients a right to know the success rates of every specialist unit in every hospital is being planned by leading surgeons and government officials. For the first time, patients will be allowed to compare the quality of the clinical care provided in each NHS department. People with a particular medical condition will be able to assess the quality of the relevant specialist teams at rival NHS hospitals before choosing where to go for treatment. In some specialties, results for individual surgeons may be available. The strategy of increased transparency is being driven by three fundamental changes in the NHS: The medical royal colleges want to find a reliable method for deciding whether individual consultants are fit to retain a licence to practise under the government's plan for regular reviews of doctors' professional standards. NHS commissioners want to know the quality of every hospital department so they can purchase more care from units with the best outcomes and put pressure on under-performers. Health ministers want to give more data to patients to help them choose the right hospital on medical grounds instead of them relying on local gossip or promotional material from trusts about quality of meals and availability of car parking. John Carvel, social affairs editor Tuesday August 28, 2007 The Guardian
  • NHS rationing rife, say doctors. Rationing of NHS treatments is becoming more widespread, a survey of GPs and hospital doctors suggests. Doctor magazine asked readers about rationing. Of 653 answering questions on consequences, 107 - 16% - said patients had died early as a result. More than half - 349 - said patients had suffered as a result. This compared with one in five in a similar survey conducted nine years ago. The government said decisions had to be made on which treatments to provide. The magazine asked 12,000 of its readers a variety of questions with between 473 and 857 replying to each one. Doctors said more debate was urgently needed over what should and should not be rationed. They reported not being allowed to prescribe drug treatments including smoking cessation drugs and anti-obesity treatment. They also reported that local NHS trusts had been placing restrictions on fertility treatments, obesity surgery and a host of minor operations, including those for varicose veins. The magazine said the findings of the latest poll showed rationing was becoming more widespread. A similar survey nine years ago showed that a much smaller proportion - one in five, compared to half - were aware of patients who had suffered due to rationing. Summary by Keep our NHS Public of BBC 25 September 2007
  • NHS rationing has caused patient deaths, doctors claim. One in six doctors has seen patients die because NHS resources were rationed, according to a survey published today. More than half report seeing patients suffer because treatment was rationed. And two-thirds claim they have been told not to prescribe certain drugs by their NHS trust, even though the results could be fatal. The survey of more than 850 GPs and hospital doctors was carried out jointly by Doctor and Hospital Doctor magazines. It shows the situation has deteriorated since a similar survey by Doctor nine years ago. Then, one in five doctors reported that patients had suffered as a result of treatment rationing and one in 20 knew patients who had died. More than half of those in the new poll said they had been asked not to refer patients or to carry out certain procedures. Of those whose prescribing was rationed, 75% said it was on cost grounds. Examples included some branded statins (used to lower cholesterol), which 21% of respondents said they had been told not to prescribe, and some smoking cessation drugs (9%). Press Association Tuesday September 25, 2007 SocietyGuardian.co.uk
  • Half of trauma patients in A&E receive poor care, say doctors. More than half of all patients arriving in hospital with severe injuries receive poor care, according to an investigation led by senior doctors which also expresses concern about the care of patients before they even reach hospital. Trauma, or serious physical injury, is a leading cause of death of young people, who may end up in hospital after a road accident or fight. But the report, from the charity National Confidential Enquiry into Patient Outcome and Death (NCEPOD), found medical staff often did not appreciate how severely ill patients were and showed little urgency over care. They also made erroneous clinical decisions. Often the problem lay with inexperienced junior staff left to manage trauma patients admitted at night. A third of patients arriving in A&E did not see a consultant there. ... The report, covering care before hospital, says that in some cases patients should have been taken directly to hospitals capable of dealing with brain injuries.  Sarah Boseley, health editor Wednesday November 21, 2007 The Guardian

     

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Sheila Porter-Williams
Campaign for Health Service Democracy
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Dunchurch
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sheilaCHSD@porter-williams.freeserve.co.uk