More dangerous NHS hospitals

High death rates at a Staffordshire hospital trust are to be investigated by the Healthcare Commission. The watchdog said that data showed the death rates at Mid Staffordshire NHS Foundation Trust were “out of normal range”. The inquiry will focus on what appear to be higher than normal death rates for emergency admissions. The commission will also investigate the quality of care provided across the trust, in particular to older people.

The trust, which serves 300,000 people, said yesterday that it believed its death rates were normal for a trust of its size. Martin Yeates, the chief executive, said that the trust and the Strategic Health Authority had investigated the trust’s higher than average standardised mortality rate and concluded that it was due to “problems in recording and coding information about patients”. He said this had improved in the past year.

Nigel Ellis, of the Healthcare Commission, said that it was important to “bring clarity” to the situation. “If we thought the trust was unsafe we would have already taken action,” he said.

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Australia: 'More clerks than nurses' in NSW health system

The NSW health system employs more clerks than nurses, and continues to obstruct desperately needed reform, the former director-general of the Premier's Department said yesterday. Ken Baxter, who ran the agency under Labor premier Bob Carr, yesterday released an Australian Centre for Health Research report calling for a federal takeover of public hospital funding, saying the scale of state bureaucracies, cost-shifting and woefully inadequate reporting data justified the overhaul. He cited annual report data that showed more than a third of NSW's 90,997 health staff were classified "administrative or other". "In the NSW health system, there are more clerks than there are nurses," Mr Baxter said, estimating nurse numbers at 30,000.

In Tasmania, the system was even more heavily weighted towards office workers, with 45 per cent of the 8992 full-time equivalent staff classified as administrative or other, his figures show. Administrative jobs accounted for a quarter of positions in the Northern Territory and a fifth in Queensland and the ACT, with data from Victoria, South Australia and Western Australia non-existent or incomplete. "A number of the states can't give you accurate figures and certainly none of them (are) comparable," Mr Baxter said.

Many of the jobs in health had gone to IT support, despite the fact that more than $2 billion had been spent on IT systems throughout the Australian health sector "without delivering any real improvements" in performance data or services, he said.

The ACHR report into the future of Australia's federal-state healthcare agreements argues for a slimmed-down system where area health services and local boards run public hospitals, directly funded by the commonwealth based on their success in meeting performance indicators. The states would be left as owners of the hospitals, but would relinquish their current roles as co-funders and sole administrators.

Mr Baxter said more direct lines of responsibility would help reduce cost-shifting estimated at up to $500 million a year. "If we want that same level of service and we want the same standard, then some of these changes have got to be made," he said. "And none of them are going to be comfortable. But if you ask (NSW Health Minister) Reba Meagher, life is not comfortable for Reba at the moment."

Ms Meagher has faced off several scandals over substandard services at hospitals such as the busy Royal North Shore in Sydney while leading resistance to commonwealth calls to sign up to nationally consistent performance data for state hospitals. But she defended herself against Mr Baxter's claims, saying frontline clinical staff, including doctors, dentists, ambulance workers and allied health professionals, as well as nurses, outnumbered administrative staff and made up two-thirds of the system's workforce. "NSW Health has been actively restructuring the health system to shift resources away from administration into frontline health services," she said.

She also defended NSW's record in reporting on hospital performance, citing emergency and surgery data by hospitals published quarterly. But "we won't support benchmarks that are simply reporting for reporting's sake or have the potential to act as a disincentive for medical staff to report adverse events," Ms Meagher said.

Mr Baxter called the arguments against the release of hospital scorecards "nonsense". The NSW Government had surrendered in the face of bureaucratic resistance, he said.

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