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[Miles Quaritch]

Numerous reports and inquiries have revealed serious failings in the National Health Service. From the Bristol heart babies to Mid Staffordshire, fundamental problems with care have been exposed.

But what Channel 4 News can now reveal is previously unpublished data which shows just how badly our hospital mortality rates compare with other countries. And never more so than for the elderly.

The figures prompted Sir Bruce Keogh, medical director of the NHS, to say he will hold top-level discussions in a bid to tackle the problems.

"I want our NHS to be based on evidence. I don't want to disregard stuff that might be inconvenient or embarrassing...I want to use this kind of data to help inform how we can improve our NHS," he told Channel 4 News.

"I will be the first to bring this data to the attention of clinical leaders in this country to see how we can tackle this problem."

The data is the work of Professor Sir Brian Jarman, who pioneered the use of hospital standardised mortality ratios (HSMRs), as a way of measuring whether death rates are higher or lower than expected and which are adjusted for factors such as age and the severity of the illness.

It was by using HSMRs that Professor Jarman was able to identify the higher than expected mortality rates at the Mid Staffs trusts.

For more than a decade, Professor Jarman has also been collecting hospital data from six other advanced economy countries, adjusting them where possible to take into account the different health systems.

What he found so shocked him, he did not release the results. Instead, he searched - in vain - for a flaw in his methodology and he asked other academics to see if they could find where he might have gone wrong. They, too, could not find fault.

So now he is releasing the findings. And they are shocking. The 2004 figures show that NHS had the worst figures of all seven countries. Once the death rate was adjusted, England was 22 per cent higher than the average of all seven countries and it was 58 per cent higher than the best country.

That meant NHS patients were almost 60 per cent more likely to die in hospital compared with patients in the best country.

"I expected us to do well and was very surprised when we didn't," Professor Jarman told Channel 4 News. "But there is no means of denying the results. They are absolutely clear."

Of course, that was nearly 10 years ago and the NHS has been through several reforms and had record amounts of money poured into it until recently.

When Professor Jarman projected the figures forward to 2012, the hospital death rates in all seven countries had improved - England's faster than some.

However, it is still among the worst and has death rates 45 per cent higher than the leading country, which is America.

NHS medical director Sir Bruce Keogh told Channel 4 News: "The fact is we have a health service that is admired around the world, founded on the cradle to grave principle.

"But the other fact is, we still have too many patients dying in our hospitals when their relatives were expecting them to come home."

Why is America doing better?

Because of confidentiality issues we are not allowed to name the other countries. But America stands out in the data for its lower mortality rates. So we went to find out why.

At the Mayo Clinic Hospital in Phoenix, Arizona, they are in the best two per cent in the country. It is an impressive hospital, with piano music playing in the lobby and sunshine streaming into the rooms.

And around the hospital are signs extolling their ethos: the patient comes first. To this end they have introduced a number of safety systems, including a check and recheck system between the pathology labs and the operating theatres.

For years they have had multi-disciplinary team rounds in which everyone from the consultant to the physio, from the nutritionist to the social worker is involved in the care of that patient.

It means better communication. Everyone is treated as an important part of the team, rather than deferring, in the traditional way, to the consultant.

Professor Richard Zimmerman, a neurosurgeon at the Mayo Clinic Hospital, acknowledges that this can be labour intensive with a dozen or more people involved in each round for each patient, but he said it is cost efficient in the end.

"It is less expensive than having a lot of deaths and having admissions that last longer because you don't do it right the first time," he said.

Nevertheless, critics will say that it is difficult to compare the American hospitals with the NHS and it is true that in the US more money is spent on equipment, drugs, staffing levels. And it has an expensive, much-criticised insurance-based healthcare system.

And yet, American hospitals results are better. They have more per staff per patient, for instance. But what stood out at the Mayo was the attitude to mistakes or near misses. Staff are actively encouraged to report these. Whistleblowers are welcomed. Because they do not want these mistakes repeated.

"If you go to the States doctors can talk about problems, nurses can raise problems and listen to patient complaints," Professor Jarman said.

"We have a system whereby for written hospital complaints only one in 375 is actually formally investigated. That is appalling, absolutely appalling."

'Appalling' figures for elderly deaths

What is equally, if not more appalling, though are Professor Jarman's HSMRs for the elderly (in this case classified as over 65).

For conditions which kill a large number of patients in hospitals and most often affect the elderly like pneumonia and septicaemia, patients are significantly more likely to survive in an American hospital.

Indeed, it was this data that Professor Jarman said encouraged him to speak more openly about his concerns about the NHS.

"It is not to say that we do not have some very good quality hospitals but we also have some very poor hospitals," he said.

In Professor Don Berwick's recent report on patient safety, he described HSMRs as a smoke signal - a warning that something may be wrong. Yet they do also raise questions that go to the heart of our cradle to grave care.

Are elderly people overlooked, treated with derision, even, that they die so much more easily in our NHS than elsewhere? And have we settled for mediocre when we could and perhaps should have the best?

http://www.channel4.com/news/nhs-hospital-death-rates-among-worst-new-study-finds

I know it's a long read, but I recommend reading it all.

Pretty surprised by the findings myself, I've always had a very positive experience when dealing with the NHS and the Doctors/Nurses who were around when my parents died were some of the best I've ever encountered, but then it's a lottery in that some hospitals are good and some aren't.

 

[Simon Belmont]

How did they control for people being more likely to seek out free health care?

 

[shadyspace]

You get what you pay for

 

[Stet]

I wouldn't want to go to a US hospital if I felt like I was dying either.

 

[Aegus]

Be interesting to see the stats before and after the Tory government,

 

[Indrid Cold1]

Dat socialised healthcare

 

[CyclopsRock]

http://www.channel4.com/news/nhs-hospital-death-rates-among-worst-new-study-finds

I know it's a long read, but I recommend reading it all.

Pretty surprised by the findings myself, I've always had a very positive experience when dealing with the NHS and the Doctors/Nurses who were around when my parents died were some of the best I've ever encountered, but then it's a lottery in that some hospitals are good and some aren't.

The article here seems to suggest that the averages are tugged down by some absolute hell-holes. After what happened at Mid Staffs, I can see that being the case. Unfortunately it seems that it wasn't some mass incompetence or shortage of funding, but rather a management structure that made it easy - and beneficial - to obfuscate and hide bad information and data to save their own skins rather than because of some mass conspiracy. I don't know if this makes it easier or harder to flush out.

 

[timetokill]

You get what you pay for

Was expecting this to be first post, close enough

 

[Rubenov]

Where is your Socialist God now, UK!

 

[Final Boss]

I wouldn't want to go to a US hospital if I felt like I was dying either.

People with money come from around the world to the US for their medical care, US is BY FAR AND AWAY the best place in the world for care


Now whether or not an individual can afford it is another topic entirely

 

[BruiserBear]

There is a reason so many foreign officials come to the U.S for serious medical care.

I remember hearing a few years ago about a high ranking Canadian minster coming to the U.S for a heart surgery. They've got free health care up there, but the guy wanted to leave the country to get this surgery done. Very telling.

 

[Miles Quaritch]

How did they control for people being more likely to seek out free health care?

I'm not sure. I missed the full interview on C4 news, but they'll hopefully upload it soon so will post it when it becomes available.

 

[Hot Coldman]

I'd be interested to see the percentage of deaths that occur in hospitals as opposed to elsewhere for both countries, too.

 

[Nicktendo86]

I've had bad experiences and good with the NHS, it is a great thing we should be proud of but people hold it as too untouchable, it needs serious reforms in places but if the government do anything everyone will cry that the Tories are destroying it.

 

[Simon Belmont]

I'm not sure. I missed the full interview on C4 news, but they'll hopefully upload it soon so will post it when it becomes available.

I can't help but point out that elderly dying people are way more likely to be in a Hospital in the UK than in the US.

It just seems like a really weird metric to judge performance on.

 

[JordanKZ]

Aaannd what about all the US citizens that die at home because they can't afford to go to hospital? I should suspect that'll bring the figures down...

 

[entremet]

There is a reason so many foreign officials come to the U.S for serious medical care.

Well foreign officials also have no issues with money

 

[Stet]

I can't help but point out that elderly dying people are way more likely to be in a Hospital in the UK than in the US.

Yes, this is a good point. People not being able to afford hospital stays will probably die elsewhere.

 

[aly]

I wouldn't want to go to a US hospital if I felt like I was dying either.

Man, I had some good health insurance and it was a great experience. So I'm not sure what you mean.

 

[CyclopsRock]

People with money come from around the world to the US for their medical care, US is BY FAR AND AWAY the best place in the world for care


Now whether or not an individual can afford it is another topic entirely

I get the impression that US healthcare is much like US Universities - the breadth and speciality in each is unsurpassed as a whole and it's often the best in the world - if you can afford it. With both hospitals and schools, there will be individual ones outside of the US that are equally exceptional, but in the US there are so, so many of both. But it'll cost ya.

 

[Azih]

That's an odd metric. Couldn't it be caused by US hospitals kicking old sick people out of their hospital beds (they still die anyway, just at home) and not due to better care?

Edit: Beaten by others on this, but it's just such an odd stat.

 

[Scalemail Ted]

Does this take into account hospice care?

 

[daviyoung]

Article is disgusting actually. Skirts around the most obvious reasons, and builds off soft targets like team-play and advertising instead. Another nail in the coffin for the NHS before the inevitable privatization. Another grass-is-greener article to oil the wheels of the next public service the government want to sell off. I guess focusing on the basics isn't good enough, or is it too much work? We fucked it, whoops sorry. Now we'll give it to the big boys, they can take care of you plebs. Better in their hands, away from us.

 

[IISANDERII]

People with money come from around the world to the US for their medical care, US is BY FAR AND AWAY the best place in the world for care


Now whether or not an individual can afford it is another topic entirely

No it isn't.

 

[Final Boss]

I get the impression that US healthcare is much like US Universities - the breadth and speciality in each is unsurpassed as a whole and it's often the best in the world - if you can afford it. With both hospitals and schools, there will be individual ones outside of the US that are equally exceptional, but in the US there are so, so many of both. But it'll cost ya.

That sums it up, the best is in America... At a price. Best healthcare, education, opportunities.... but it's just not accessible to everyone living her. You have $$$$$? Then the doors are open

 

[CyclopsRock]

Article is disgusting actually. Skirts around the most obvious reasons, and builds off soft targets like team-play and advertising instead. Another nail in the coffin for the NHS before the inevitable privatization. Another grass-is-greener article to oil the wheels of the next public service the government want to sell off. I guess focusing on the basics isn't good enough, or is it too much work? We fucked it, whoops sorry. Now we'll give it to the big boys, they can take care of you plebs. Better in their hands, away from us.

It's hardly made up entirely of soft targets. It quotes the NHS's own medical director saying " the other fact is, we still have too many patients dying in our hospitals when their relatives were expecting them to come home," and the fact that "We have a system whereby for written hospital complaints only one in 375 is actually formally investigated." These aren't part of some naughty privatisation gambit, they're the result of years and years of a lack of accountability to anyone, least of whom the patients.

 

[peanutbutterlatte]

Patients 100% more likely to die if they can't pay for life-saving treatments.

 

[GaimeGuy]

Does this take into account hospice care?

According to sources cited in wikipedia, 4% of all deaths in England and Wales occur in hospice. in the US, it's roughly 33% (the vast majority of which is provided at home..


The number of deaths that occur in a hospital setting seems like such an odd metric to use and devoid of any meaning other than as a talking point about the dangers of socialized medicine.

 

[AOC83]

US Hospitals: "You can´t afford dying here, get out!"

 

[PJV3]

My experience of working in the NHS is the shortage of staff, the obsession with achieving foundation status and the endless tinkering by government is destroying it.

I don't know how the nurses and doctors stay in the service.

 

[Azih]

It's hardly made up entirely of soft targets. It quotes the NHS's own medical director saying " the other fact is, we still have too many patients dying in our hospitals when their relatives were expecting them to come home,"

That isn't an oversight. It seems like UK hospitals have a policy on treating someone until the end.

Whether that should be changed is another debate. But there are very obvious reasons for you to go one way rather than the other and does not reflect badly on the NHS at all.

 

[daviyoung]

It's hardly made up entirely of soft targets. It quotes the NHS's own medical director saying " the other fact is, we still have too many patients dying in our hospitals when their relatives were expecting them to come home," and the fact that "We have a system whereby for written hospital complaints only one in 375 is actually formally investigated." These aren't part of some naughty privatisation gambit, they're the result of years and years of a lack of accountability to anyone, least of whom the patients.

And I wonder what the solution could be...

 

[kirblar]

Reducing spread of infectious disease in hospitals through better practices is something that's getting a lot more attention nowadays. One example that came up in my health economics class - there was a relatively new hospital where the designers had put a wall fountain/waterfall in the entrance. As pretty as it was, though, it turned out that it quickly turned into a cesspool of disease because it was essentially a stagnant pond in the middle of a bunch of sick people.

 

[Scalemail Ted]

According to sources cited in wikipedia, 4% of all deaths in England and Wales occur in hospice. in the US, it's roughly 33% (the vast majority of which is provided at home..


The number of deaths that occur in a hospital setting seems like such an odd metric to use and devoid of any meaning other than as a talking point about the dangers of socialized medicine.

Yeah, This is exactly what I had anticipated.

 

[Giygas AF]

That sums it up, the best is in America... At a price. Best healthcare, education, opportunities.... but it's just not accessible to everyone living her. You have $$$$$? Then the doors are open

I agree with this, but if you lowered the cost it would probably do what NHs is like. So you can have expensive care that is great or affordable care that is okay (both of which you can get in the states as well.) Comparing the NHS to the Mayo Clinic is hilarious as well, because MC is miles better than 90% of US hospitals as well.

 

[CyclopsRock]

That isn't an oversight. It seems like UK hospitals have a policy on treating someone until the end.

Whether that should be changed is another debate. But there are very obvious reasons for you to go one way rather than the other and does not reflect badly on the NHS at all.

So why's he saying that too many are dying when people expect them to go home? I don't think his point was that people have unrealistic expectations or that it's because they keep them in house rather than sending them to hospices.

And I wonder what the solution could be...

It sounds like literally any criticism, then, would be seen by you as a proxy for justifying privatisation. Complaints are being ignored? Oh, well then you must be trying to privatise it, you beast!

 

[jim-jam bongs]

This doesn't sound like it's necessarily an endorsement of US healthcare so much as a condemnation of the appalling state of the NHS. If they could release the statistics for the other countries as well it might make that spin a lot less plausible.

 

[GaimeGuy]

Reducing spread of infectious disease in hospitals through better practices is something that's getting a lot more attention nowadays. One example that came up in my health economics class - there was a relatively new hospital where the designers had put a wall fountain/waterfall in the entrance. As pretty as it was, though, it turned out that it quickly turned into a cesspool of disease because it was essentially a stagnant pond in the middle of a bunch of sick people.

Once I got to "waterfall" in this post I cringed because I knew what was coming in the rest of the story.

How can you think about putting an apparatus of standing water like a pond or a waterfall in a hospital setting? :X

 

[AbortedWalrusFetus]

It doesn't matter if more people visit the hospital in the UK or not. These ratios are probably based on the percentages of survival of given illnesses and ages. Meaning it doesn't matter if 100 or 1000 people check in. If 10% survive in either case the volume doesn't necessarily matter (unless it's not statistically significant).

 

[Tenks]

The elderly figure is interesting. Obviously the elderly are a huge drain on socialized medicine. I wonder if the hospitals in the UK see them as a walking liability and don't give them outstanding care where in the USA they are seen as a walking payday and are given every opportunity to extend life. I know when my grandmother was extremely ill she was getting phenomena on a seemingly bi-weekly basis and in the hospital all the time.

 

[Bony Manifesto]

I've had bad experiences and good with the NHS, it is a great thing we should be proud of but people hold it as too untouchable, it needs serious reforms in places but if the government do anything everyone will cry that the Tories are destroying it.

I think the reason people think this government is looking to destroy the NHS from the inside is less about irrational anti-Tory bias and more about the Health and Social Care Act 2012!

 

[Dr.Acula]

My takeaway is that all health care systems can do better, and just because the NHS is being critical and open on its own areas of concern doesn't mean that public care has failed. Other countries should not be quick to point at these stats, collected using the UK's own methods and not directly comparable to other countries, and declare themselves superior and feel this gives them the ammunition to dally on making improvements to health care. It is not a race to the bottom, and there is no good in slamming a stat as condemnation of an entire system of delivering care -which works very well the world over.

 

[Azih]

So why's he saying that too many are dying when people expect them to go home? I don't think his point was that people have unrealistic expectations or that it's because they keep them in house rather than sending them to hospices.

My point is that this metric doesn't reflect badly on the NHS as a service providing health care as the article is painting it.

 

[Walshicus]

The number of deaths that occur in a hospital setting seems like such an odd metric to use and devoid of any meaning other than as a talking point about the dangers of socialized medicine.

Indeed. Overall mortality rates are far better way of judging the success of the system.

 

[Piggus]

I can't help but point out that elderly dying people are way more likely to be in a Hospital in the UK than in the US.

It just seems like a really weird metric to judge performance on.

What do you base that on exactly? Elderly people in the US are covered by Medicare and usually have supplemental insurance to go with it.

 

[GJS]

HSMRs are crap and are influenced by a number of other factors than quality of care and the creators and many other people have talked about the flaws. They have been replaced by SHMIs instead

Jarman himself has said that many of the hospitals identified as having high deaths under HSMRs, have shown to have expected levels of death using the revamped and more complete SHMIs.

 

[equippedwithtowel]

There is a reason so many foreign officials come to the U.S for serious medical care.

I remember hearing a few years ago about a high ranking Canadian minster coming to the U.S for a heart surgery. They've got free health care up there, but the guy wanted to leave the country to get this surgery done. Very telling.

Well no shit.

When you have a six figure budget you can go to the best available in the world.

The rest of us poors have to deal with the socialist hellhole we call Ontario.

 

[daviyoung]

It sounds like literally any criticism, then, would be seen by you as a proxy for justifying privatisation. Complaints are being ignored? Oh, well then you must be trying to privatise it, you beast!

The article compares UK to US, why? Because they can't compare it to say, France or Canada, with similar systems to us? What is the one main reason there's a difference, the one the article only mentions in passing? The tactic of running down a service until the public welcome any change worked for virtually all the other public services that have been sold off, so I remain skeptical. The comparison between the NHS and one clinic in the US raises more questions than it answers, and it handily doesn't offer a solution. The idea that they have it better over there is good enough, the idea that it's shit now is good enough. The path is a well trodden one unfortunately.

 

[GaimeGuy]

What do you base that on exactly? Elderly people in the US are covered by Medicare and usually have supplemental insurance to go with it.

Hospice is the only Medicare benefit that includes pharmaceuticals, medical equipment, twenty-four hour/seven day a week access to care and support for loved ones following a death.

The US system is designed to push the dying out of the hospitals and into hospice

 

[Simon Belmont]

It doesn't matter if more people visit the hospital in the UK or not. These ratios are probably based on the percentages of survival of given illnesses and ages. Meaning it doesn't matter if 100 or 1000 people check in. If 10% survive in either case the volume doesn't necessarily matter (unless it's not statistically significant).

Not so fast. "Whether or not somebody goes to the hospital for their life threatening illness" is a selection bias. Once there is a selection bias the statistics can no longer be extrapolated to the general population.