Britain: Nurses' low pay 'fatal in rich areas'

Lives are being lost because of the central negotiation of pay rates for nurses, a study has found. Hospitals in prosperous areas such as London and the South East find it harder to recruit and retain nurses than those in areas where local wage rates are lower. This is because regional differences in nurses' pay are not as big as regional differences in the wider labour market. As a result, hospitals in prosperous areas treat fewer patients and have worse results than those in poorer areas, says a team from Bristol and London in a report for the Centre for Economic Performance and the Centre for Market and Public Organisation.

A gap of 10 per cent between nurses' pay and that of women working locally in the private sector was said to raise the death rate among people admitted to hospital after a heart attack by 5 per cent. The NHS and the Royal College of Nursing (RCN) are wedded to the idea that nurses everywhere in the UK should be paid the same. There are some regional variations, say Professor John Van Reenan, of the London School of Economics, and colleagues, but they do not fully reflect differentials in the labour market. In inner London, for example, white-collar wages for women are 60 per cent greater than those of women in the North East. Allowances are paid to nurses who work in inner London, but they amount to only about 11 per cent more than the wages of their colleagues in the North East.

The new research by Emma Hall, Carol Propper and John Van Reenen tracked changes in wage rates and changes in performance in more than 100 English hospital trusts between 1995 and 2002. Hospitals in areas where the outside labour market is strong treat fewer patients per staff member. They have higher death rates among patients who are admitted after heart attacks.None of these effects is found in private sector nursing homes. Nor do they seem to arise from financial problems faced by hospitals in high-cost areas.

There is a 15 per cent increase in death rates between hospitals where outside wage rates are in the top 10 per cent and those in the bottom 10 per cent. Productivity varies by 18 per cent between the top 10 per cent and the bottom 10 per cent. The results have important implications for regulated labour markets, and the NHS, the report concludes. "Rather than focusing on across-the-board increases in national pay, which we found not to be cost effective, relaxing the regulatory system to allow local wages to reflect local market realities would improve productivity and save lives," it says.

Peter Carter, the general secretary of the RCN, said: "In the RCN's experience, poor hospital performance tends to be related to an absence of clinical leadership, inadequate resources and staffing levels or ineffective financial management. "The modelling in this study can lead to simplistic conclusions on very complex issues."

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Australia: Call for inquiry into public hospital death at hands of a Saudi

Coverup?

The NSW Opposition has called for the parliamentary inquiry into Royal North Shore Hospital to be reopened to hear evidence from a senior anaesthetist who raised concerns about the hospital's practices with a coroner. Opposition health spokeswoman Jillian Skinner said she would push to reopen the inquiry after Deputy State Coroner Carl Milovanovich, who is investigating the death of teenage patient Vanessa Anderson, said it was not his role to canvass broader issues at the hospital.

Vanessa, 16, suffered a seizure and died two days after her skull was fractured by a stray golf ball in November 2005. The inquest has heard she received no anti-convulsant drugs and was prescribed Panadeine Forte and the painkiller Endone, a combination three medical experts described as inappropriate.

Mr Milovanovich was set to deliver his findings last July, but adjourned the inquest after senior anaesthetist Dr Stephen Barratt wrote to him raising concerns about Sanaa Ismail, the anaesthetics registrar who increased Vanessa's dose of Endone. As the inquest resumed yesterday, Michael Williams SC, for the Anderson family, also sought to question Dr Barratt about his wider concerns at the hospital, but Mr Milovanovich limited the doctor's evidence to matters relevant to Vanessa's treatment.

Dr Barratt told Westmead Coroner's Court that Saudi-trained Dr Ismail "unfortunately has an issue of needing to save face" and invented stories. While he backed down from his initial assertion that this was a "cultural issue", he said: "She will not admit to mistakes." Recalled as a witness, Dr Ismail - now a senior registrar at the hospital - repeated her evidence that she misread Vanessa's medication chart, not realising she was on high-strength Panadeine Forte rather than ordinary Panadeine.

Dr Barratt told the court that two incidents earlier in 2005 had triggered his concerns about Dr Ismail's performance when unsupervised. However, when cross-examined by Dr Ismail's barrister Stephen Barnes, Dr Barratt conceded there was "little or nothing" in either incident to raise safety concerns. He agreed that an internal investigation cleared her of mistakes in treating the first patient, who went into cardiac arrest while in labour.

The court heard Dr Barratt had been "impaired" by extreme anxiety when he contacted the coroner and was prescribed medication less than three weeks later. Outside court, Vanessa's father Warren Anderson said the six-month adjournment had been difficult: "We just want the truth about what happened to our daughter." Ms Skinner will move to reopen the parliamentary inquiry so Dr Barratt could testify "about all of the matters he wanted to canvass". Mr Milovanovich will hand down his findings on Thursday.

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