hospital imageThe NHS achieved record satisfaction and approval rates by the general public in 2012 but what a difference a year makes.  Scandals such as the North Staffordshire Hospital Trust scandal have eroded confidence and many people have an altogether different idea of the NHS.

In the latest damming headline some papers reported that NHS patients are 45% more likely to die than patients in the US. These headline were based on a study by Professor Jarman [from Imperial who compared  HSMRs [hospital standardised mortality ratios].  HSMRs look at whether actual death rates in hospital are higher or lower than would be expected, taking into account patients’ age and severity of illness. He notes in his report that England has

  • poorer cancer survival
  • longer waiting lists
  • lower patient input, with only a small proportion of hospital complaints formally investigated
  • lower GP out-of-hours on-call service
  • lower rates of services, including lower use of diagnostic procedures such as MRI, heart surgery, and lower immunisation rates
  • a lower number of doctors per bed and per 1,000 population
  • a lower number of acute beds per 1,000 population

However he also states that the amount of money spent does not mean the best outcomes are achieved. The US spends more than twice as much per person on healthcare as the UK and still has lower life expectancy and higher infant mortality rates. Around a third of the US population – often the poorest – have no or inadequate healthcare insurance, and so are probably less likely to be covered or go to hospital. It is possible that the poorer groups in society could fare equally well in the NHS, or even better, than they would do in the US.

Differences in the way healthcare systems are paid for in the US can potentially have an influence on the way episodes of healthcare are recorded. Hospitals tend to get paid more, since care is privately funded, if a diagnosis is more severe – there s a financial incentive in what is called ‘up coding’.

All NHS hospitals submitted statistics while only the best US and European hospitals had statistics. In England many terminally ill patients die in hospital unlike Europe.  Professor Jarman says that it should also be noted that high HSMRs should not automatically be taken as an indicator that all hospital care is poor particularly.

No methodology has been provided for any of the countries in the study so Professor Jarman points out that we cannot be sure we are comparing like with like statistics. At present Professor Jarman’s analysis does not appear to have been peer-reviewed and he says that it should be interpreted with caution however that is certainly not what the press have done.

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