Britain shamed by NHS death rates

Patients who have major surgery in Britain are four times more likely to die than those in America, according to a major new study.

The comparison of care, which reveals a sevenfold difference in mortality rates in one set of patients, concludes that hospital waiting lists, a shortage of specialists and competition for intensive care beds are to blame.

Fresh evidence of a stark contrast between the fate of patients on either side of the Atlantic will re-open the debate over whether NHS reforms are having any impact on survival rates.

Mounting evidence suggests that patients who are most at risk of complications after an operation are not being seen by specialists, and are not reaching intensive care units in time to save them.

This week health Ministers will present the latest figures showing another yearly rise in the number of intensive care beds for those who are critically ill. But Britain lags far behind America and most European countries in its critical care facilities. An authoritative study to be published later this year will demonstrate that the chances of survival after undergoing a major operation are far greater in an American hospital.

The authors conclude that NHS waiting lists, the lack of specialist-led care and the fact that many patients do not go routinely to intensive care contribute largely to the difference.

A team from University College London (UCL) and a team from Columbia University in New York jointly studied the medical fortunes of more than 1,000 patients at the Mount Sinai Hospital in Manhattan and compared them with nearly 1,100 patients who had undergone the same sort of major surgery at the Queen Alexandra Hospital in Portsmouth.

The results, which surprised even the researchers, showed that 2.5 per cent of the American patients died in hospital after major surgery, compared with just under 10 per cent of British patients. They found that there was a sevenfold difference in mortality rates when a subgroup of patients - the most seriously ill - were compared.

Professor Monty Mythen, head of anaesthesia at UCL who oversees the critical care facilities at Great Ormond Street Hospital, led the British side of the research, which will be published in a peer-reviewed medical journal later this year.

'The main difference seems to be in the quality of post-operative care, and who is likely to care for patients in the US, compared with the UK,' Mythen said.

'In America, in the Manhattan hospital, the care [after surgery] is delivered largely by a consultant surgeon and an anaesthetist. We know from other research that more than one third of those who die after a major operation in Britain are not seen by a similar consultant.'

He also believes that the queue for treatment in the NHS would inevitably mean that British patients were more at risk. 'We would be suspicious that the diseases would be more advanced in the UK, simply because the waiting lists are longer.'

The New York patients had paid through private insurance to go to hospital and were therefore likely to be of a higher social class and healthier, whereas the NHS patients were from all social classes. The researchers attempted to level out social differences by rating each patient according to clinical status.

Each patient was then placed in a mortality-risk category. Those at greatest risk were calculated to have a 36 per cent of dying after surgery, whereas the lowest risk patients had between zero and five per cent chance of dying.

Mythen added: 'We looked at a number of hypotheses, but it does seem to show a difference in the systems of care, rather than a reflection of some other factor. The provision of intensive-care beds is obviously one of the differences. In America, everyone would go into a critical care bed - they go into a highly monitored environment. That doesn't happen routinely in the UK.'

Each year, more than three million operations are carried out on the NHS. Around 350,000 of these are emergencies, which carry a higher risk of complications, but there is no routine triage system in Britain for picking out patients before surgery, to determine who is most at risk.

Previous reports looking at deaths that occur within 28 days of surgery have shown that 36 per cent occurred in patients who went directly into ICU after surgery. But a higher mortality rate - 42 per cent - is seen among patients who had first been sent to a ward, got into difficulties and then had to be transferred to intensive care.

Professor David Bennett, head of intensive care at St George's, after looking at survival rates, said: 'There are substantial number of patients each year who die, who might otherwise have survived had they got the appropriate kind of care after surgery.

'There's a crucial six- to eight-hour period when some people need their cardiac output [the amount of blood the heart pumps out each minute] boosted. Even 80-year-olds undergoing heart surgery are far more likely to survive when they receive that care, so why are we not, as a matter of routine, picking out the people most at risk?'