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‘Saving’ hospitals costs lives

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05 December 2006

Campaigns to save services currently provided in district general hospitals could lead to more than 1,000 unnecessary deaths each year, according to new analysis from the Institute for Public Policy Research (ippr), published later this month.

New techniques to treat heart attacks are significantly safer, according to research published in The Lancet. ippr’s analysis calculates that if heart attack care was reconfigured to enable universal access to these new treatments, around 500 extra lives could be saved every year. There could also be around 1,000 fewer repeat heart attacks and 250 fewer strokes.

At the moment, most of the 61,000 emergency heart attack patients treated each year by the NHS are taken to their local hospital. But last year, only 1,600 received the latest treatment in a specialist hospital unit. Research shows that patients will often be safer if they travel further for specialist treatment, rather than being treated at their local hospital.

The analysis also looks at people who have suffered severe injury and concludes that they are more likely to survive if they are treated in specialist centres rather than local hospitals. International evidence from countries with regionalised trauma systems shows that treating people in specialist centres is safer, and that taking people with severe injuries past their local hospital direct to a specialist centre means they are more likely to survive. The Royal College of Surgeons and British Orthopaedic Association estimate that universal access to specialist trauma centres could save around 770 extra lives every year.

But the research shows that these life saving treatments are more complex and can only be provided at a smaller number of specialist hospitals, with the right equipment and expert staff. Specialist units also need to see enough patients to maintain staff skills. So even if cash resources were unlimited, there would be patient safety reasons for centralising these services.

Richard Brooks, ippr Associate Director, said:

“Hospital change should be good news for patients. If clinicians, politicians and the public work together to change hospital services, many more lives can be saved every year. On the strength of the evidence, people should be out on the streets campaigning for changes to NHS services to protect the health of their families, not to keep services the way they are.

“Many people are understandably worried about local services moving away from their local district general hospitals. In particular, residents are concerned about access to care if they or a family member has a heart attack or a serious accident.

“But if heart attack and serious injury victims were taken past their local hospitals to a specialist centre, they would be significantly more likely to survive. Other traditionally hospital-based services like tests, routine surgery and minor treatments are better provided in local community hospitals and clinics.”

Notes to Editors

The Future Hospital: the progressive case for change by Joe Farrington-Douglas with Richard Brooks will be published later in December.

Heart attacks killed 39,000 people in England and Wales in 2004 (7 per cent of all deaths), and 61,000 emergency heart attacks were seen by the NHS in England.

Research published in The Lancet (Keeley, E., Boura, J. and Grines, C. (2003) “Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials” The Lancet Vol. 361, No. 9351) shows that the latest treatments for heart attacks, where tiny balloons are inserted into the blood stream to un-clot patients’ blocked arteries (angioplasty), have a higher success rate than the current clot-busting drugs (thrombolysis). The research shows that one in four heart attack victims who currently die after treatment with drugs would survive. Half as many would have repeat heart attacks and half as many would have strokes following primary angioplasty compared to thrombolysis.

It is recommended that angioplasty is performed within three hours of the initial 999 call, a significantly longer period than the ‘golden hour’ target for the alternative clot-busting drug treatment at a local hospital. Modern ambulances are equipped with defibrillators and ECG machines allowing patients to be resuscitated at home or on the way to hospital. In some cases, including in very remote areas or if the 999 call was made late, it may still be safer to treat patients locally with thrombolysis.

The British Cardiovascular Intervention Society guidelines state that, in order to maintain their skills and provide safe care, each angioplasty consultant would need to perform 75 operations per year and each specialist centre would need to see at least 200 patients.

The Department of Health and British Cardiac Society are currently piloting primary angioplasty services in West Yorkshire, West London, Greater Manchester, Barts and the London, South Tees, Royal Devon and Exeter and South East London.

Severe injury is a major cause of death and disability, particularly among people under 35 years of age (11 per cent of deaths under 35). There are about 10,000 patients suffering multiple injuries in the UK each year. However, this represents only one per 1,000 emergency cases admitted by hospitals. Severe trauma outcomes data from: Royal College of Surgeons of England and the British Orthopaedic Association (2000) Better Care for the Severely Injured.

Contacts:

Matt Jackson, ippr senior media officer, 020 7339 0007 / 07753 719 289 / m.jackson@ippr.org

Richard Darlington, ippr media manager, 020 7470 6177 / 07738 320 645 / r.darlington@ippr.org