UK 'performing well' on heart ops

24 November 2010 Last updated at 19:35 ET

The UK is outperforming most of Europe when it comes to survival rates from heart bypass operations, according to an international audit.

Across Europe, 2.4% of patients on average die following a bypass.

This compared with 2.2% in Scotland, 1.8% in England and just 1.1% in Wales, the study found.

The European Association for Cardiothoracic Surgery looked at data from more than a million operations in 23 countries.

A leading heart surgeon said the decision to collect data on hospital performance had helped cut mortality by 50% in five years.

This is the first ever comparative study of heart operations across the continent, and the NHS was one of the most enthusiastic participants, contributing a large slice of the total data used.

However, a number of countries including France, Denmark, The Netherlands, Austria and the Czech Republic did not participate.

Older and sicker

Nonetheless, the result is a major fillip to the reputation of NHS cardiac surgery - with England and Wales together outperforming the European average by 25%.

This is despite evidence that the task of keeping heart patients alive is tougher here than in many countries.

Patients here were on average older and sicker than in most of the other countries taking part in the audit.

The above-average performances are also set against general improvements in mortality throughout Europe in recent years.

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This excellent data is the culmination of years of hard work carried out by NHS cardiac units"

End Quote John Black Royal College of Surgeons

David Taggart, president of the Society for Cardiothoracic Surgery in Great Britain and Ireland, said: "The results confirm that cardiac surgery in the UK is amongst the very best in Europe and that mortality rates have fallen by half over the past five years as a direct result of the collection, analysis and publication of outcome data.

"Our European partners should be encouraged that this approach is likely to lead to a similar improvement in results."

The Royal College of Surgeons said that the results were "significantly better than expected", and its president, John Black, also expressed his pleasure.

"This excellent data is the culmination of years of hard work carried out by NHS cardiac units.

"As a result of the profession's dedication we are now leaders in Europe in the measurement of quality and outcomes of cardiac surgery."

Other good news, revealed the audit, was that hospital stays tended to be shorter in the UK - less than nine days compared with an average of 10.

This saves the NHS considerable amounts of money - �6.4m each year just from heart bypass operations alone.

Dr Mike Knapton, from the British Heart Foundation, said: "What wonderful news for heart patients in the UK to hear that our cardiac surgeons are leading the way in clinical excellence.

"The decision to audit and publicly disclose the outcomes of cardiac surgery is a powerful driver for improved quality.

"This transparency and openness can only help to ensure excellent care in the operating theatre and during post op rehabilitation.

"We are facing uncertain financial times but it's vitally important we continue to support and publish surgical outcomes so all our good work isn't undone in the future."

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Amputation variation 'shocking'

24 November 2010 Last updated at 20:33 ET By Branwen Jeffreys Health correspondent, BBC News

Variations in the amputation rates in diabetes patients in England have been described as shocking by a charity.

Department of Health data reveals the rate of major amputations in the South West, at three in 1,000, is almost twice the rate in the South East.

The Diabetes UK charity says the majority could be prevented.

The government says it is publishing the information, which also covers other conditions and has been dubbed an "atlas of care", to help improve care.

The amputation difference is one of the most striking revealed in a series of 34 "maps" of healthcare produced.

Treatment of last resort

It also looks at key treatments for some of the most serious conditions including stroke, heart disease and asthma.

There are more than 70 major amputations a week carried out on type 2 diabetes patients in England. It is thought 80% of amputations are potentially preventable.

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Most people in the health service are so focused on what they're doing, working so hard, they've got no idea if they are doing better or worse than someone else"

End Quote Sir Muir Gray

Diabetes can lead to a loss of sensation in the feet so minor injuries can become badly infected without the patient noticing.

If the infection becomes too severe, amputation of a foot or the leg below the knee becomes the treatment of last resort.

Barbara Young, the chief executive of Diabetes UK, said "The existing situation around foot care and amputations is shocking, given the that the majority of amputations can be prevented."

The atlas also reveals a big variation in the percentage of people with diabetes who are receiving all the essential checks to monitor their condition.

This includes the simple foot checks which can help prevent amputation.

While some geographical differences would be expected, researchers say unwarranted variation is a cause for concern. They adjusted their data to take account of different populations in different areas.

Sir Muir Gray, the public health academic who led the research within the Department of Health, said: "Most people in the health service are so focused on what they're doing, working so hard, they've got no idea if they are doing better or worse than someone else.

"The atlas is now going, for the first time, to give them a clear idea of where they are. "

Unwarranted variation

This is particularly true in areas of care where the evidence is clear. Patients with a suspected mini-stroke are at higher risk of a major stroke. The national guidelines recommend they should have specialist tests within 24 hours.

The atlas shows a greater than 10-fold difference in the percentage of patients who are getting that gold standard treatment.

A handful of areas are managing for all the patients at risk but in many parts of England that falls to fewer than half.

Some experts believe reducing the variations to give priority to treatments backed by evidence could help find the savings it needs.

Professor Chris Ham, chief executive of the King's Fund, said "If performance across the NHS can be brought up to the level achieved by the best, then much of the pressure on local NHS budgets can be relieved without having to cut services for patients."

The data in the atlas predates the coalition government but ministers have supported its publication.

Health minister Lord Howe said: "Making this information available will help to identify and address unwarranted variation to better meet the needs of their local populations."

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