Over three years ago, when Congress was debating the Affordable Care Act, many hoped that the final legislation would include a public health option—in other words, government run healthcare, which is present in many European countries. Fortunately, Congress was smart and did not include a government run insurance option in the legislation that passed in March 2010. Why were we so fortunate?
A recent report from Channel 4 News in the U.K. revealed figures showing that National Health Service (NHS) hospitals (the government run health program) have death rates “among the worst” compared to other countries. In fact, Channel 4 found that NHS patients are 45% more likely to die in a hospital than the United States. Due to privacy, the article was not able to reveal the other five countries.
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.
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 But what Channel 4 News revealed “is previously unpublished data which shows just how badly our hospital mortality rates compare with other countries.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 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,” the article noted.
“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.”
“The 2004 figures show that NHS had the worst figures of all seven countries. Once the death rate was adjusted, England was 22% higher than the average of all seven countries and it was 58% 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.”
While the data is from nearly 10 years ago, and the NHS has been through several reforms and given additional government funding, it was “still among the worst and has death rates 45% higher than the leading country, which is America.”
NHS medical director Sir Bruce Keogh told Channel 4 News that there are still “too many patients dying in our hospitals when their relatives were expecting them to come home.”
Channel 4 then explained why America ranked much better than NHS. Accordingly, Channel 4 looked at the Mayo Clinic Hospital in Phoenix, Arizona, which is “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.”
The article explains that one reason for the hospital’s success is the introduction of a “number of safety systems, including a check and recheck system between the pathology labs and the operating theatres.” In addition, they Mayo Hospital has “had multi-disciplinary team rounds in which everyone from the consultant to the physician, from the nutritionist to the social worker is involved in the care of that patient.” This means “better communication” and 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. However, he noted that “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.”
While some criticize American hospitals because the U.S. spends more on equipment, drugs, and staffing levels, and the health insurance system is not perfect, Channel 4 notes that the data still show—”American hospitals 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. Conversely, the U.K. has “a system whereby for written hospital complaints only one in 375 is actually formally investigated. That is appalling, absolutely appalling,” Jarman said.
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.” Consequently, it “was this data that Professor Jarman said encouraged him to speak more openly about his concerns about the NHS.”
Thomas Sullivan, Editor