Clinical result studies to start

THE BEST AND WORST

NICHOLAS TIMMINS

Public Policy Editor

Pilot studies of clinical outcome indicators - showing how well hospitals treat patients, not just how quickly - may well begin next year, Alan Langlands, chief executive of the National Health Service, said yesterday.

His disclosure came as Virginia Bottomley, in her last press conference as Secretary of State for Health, defended yesterday's second league tables of hospital performance from criticism from doctors and nurses.

The tables include measures of waiting times for treatment and out-patient appointments, how quickly patients are seen in outpatient clinics and assessed on arrival at casualty, and what proportion of certain operations are performed as day cases. They addressed, she said, the NHS's "weakest area". In terms of cost and quality, the NHS excelled, she said. But "the timeliness of response" was the biggest area of complaint.

Critics argued that patients have no real choice over going to Bury or Burton NHS Trust - the best peformers on the limited measures used - rather than Addenbrooke's or St James's, two of the worst, and that comparing the performance of a huge teaching hospital like Addenbrooke's to the much more limited care provided by the tiny Dorset Health Care Trust was meaningless.

Mrs Bottomley argued that hospitals and their managers would compare like with like. In key areas - assessment within five minutes in casualty and patients seen within 30 minutes of appointment - there were measurable improvements from last year.

"We have seen in virtually every trust improvements in waiting times and standards."

She conceded, however, that clinical outcomes - meaures of how well patients are treated - were at least as important.

Scotland has already published death rates, showing, for example that a coronary admitted to the West General hospital in Glasgow has only half the chance of dying within 30 days than if admitted to the Fife Healthcare NHS Trust.

But Mr Langlands said England was less interested in publishing death rates - partly because England lacks the record-linkage system which makes that an easier task in Scotland. Instead Sir Kenneth Calman, the Chief Medical Officer, is discussing other clinical outcome indicators with the medical Royal Colleges, and unpublished pilot studies will be launched, possibly next year.

Items being examined included recurrence of hernias after operations, readmission rates and wound infection rates.

THE BEST

Burton Hospitals NHS Trust

Bury Health Crae NHS Trust

Dorset Health Care NHS Trust

East Gloucestershire NHS Trust

Epsom Healthcare NHS Trust

HaltonGeneral Hospitals NHS Trust Runcorn Cheshire

Mid-Cheshire Hospitals NHS Trust

Northallerton Health Services NHS Trust

North Tees Health NHS Trust

North Tyneside Health Care NHS Trust

Royal Liverpool Children's NHS Trust

THE WORST

Addenbrooke NHS Trust

Alexandra Healthcare NHS Trust Redditch

Northampton General Hospitals NHS Trust

Royal Hull Hospitals NHS Trust

Royal London Hospitals NHS Trust

Royal Orthopaedic Hospital

Royal Shrewsbury Hospitals NHS Trust

St James's University Hospitals NHS Trust Leeds

Walsgrave Hospitals NHS Trust Coventry

Wellhouse NHS Trust

West Suffolk Hospitals NHS Trust