London's healthcare lottery

London's healthcare lottery was laid bare today with the revelation that patients are four times as likely to die after emergency surgery in the capital's worst hospitals as in the best.

The huge disparities in the quality of NHS treatment emerged in a new analysis of the service, which also shows that deaths after operations at some flagship hospitals have risen dramatically over the past three years.

The performance indicators, published by the Department of Health today, detail achievements and failures in key areas, such as death rates, waiting times and staff shortages.

Mike Stone, director of the Patients' Association, said: "There should be high standards right across the capital, but it is clear that there are not. People living in the areas where hospitals are performing badly on things like death after surgery are bound to feel uneasy about these figures."

At Mayday Hospital in Croydon there are fewer than 1,000 deaths per 100,000 patients undergoing emergency surgery.

But a few miles away at hospitals in Epsom and St Helier in the Surrey commuter belt, and at Havering and Redbridge in east London, nearly 4,000 patients per 100,0000 die after the same operations.

The figures also reveal that Epsom and St Helier - branded the worst trust in the country after a damning inspectors' report last year - and King George Hospital, in Redbridge, have seen their patient survival rates worsen by five per cent over the past three years.

Geoff Martin, London convenor for health workers' union Unison and director of pressure group London Health Emergency, said: "This shows that the access and quality of healthcare in London is a complete lottery depending on which hospital you live near.

"Some of these statistics are terrifying for people about to go for surgery in particular hospitals. The Government needs to tackle this by creating one strategic body responsible for healthcare in London to iron out these inequalities."

The performance indicators are the most detailed assessment of the health service ever published and include information on authorities and trusts measured against 80 indicators.

Massive disparities in deaths after emergency surgery are also found in London's teaching hospitals. St Mary's in Paddington has some of the best survival rates in the country but performance at St George's in Tooting, King's College Camberwell and University College London Hospitals has deteriorated over the past three years.

Death rates within a month of emergency surgery at Bromley

Hospital and Queen Mary's Sidcup are 20 per cent higher than three years ago. The statistics on death rates within a month of routine surgery reveal that no London hospitals fall within the "significantly better than average" category.

A variety of factors are likely to contribute to poor survival rates. Some large teaching hospitals in London take difficult cases from across the South-East, which will have an impact on overall survival rates. However, other issues such as the amount of infections acquired in hospitals can have an impact. London hospitals have the highest levels of the antibiotic resistant superbug MRSA (methicillin-resistant staphylococcus aureus) which causes around 5,000 deaths a year nationally. Pressure on beds can also lead to patients being discharged too early, leading to fatal complications. Mr Stone said: "There is no doubt that there is a correlation between things like bed-blocking, pressures on beds and survival rates."

High-profile hospitals, including Barts, The Royal London, King's College, St George's, UCH and Guy's and St Thomas's, have some of the worst figures for emergency re- admissions. Bart's and the London Trust has the worst record of all acute hospitals, with nearly nine per cent of patients being brought back as emergency cases within a month of being discharged.

John Bacon, director of the London regional office of the NHS Executive, said: "Overall in London deaths after surgery have fallen - by 5.4 per cent for emergency cases and by nine per cent for elective cases.

"For those where specific problems have been identified we would expect them to have drawn up local action plans and the London region will be working with them to bring them up to the level of the best."

Details of how each London authority and trust performed can be found on www.doh.gov.uk/nhsperforman ceindicactors/2002. The BBC is devoting a large section of today's programmes to the state of the NHS.

MMR

The statistics confirm London parents are the least likely to agree to the measles, mumps and rubella vaccine. The health authorities with the lowest take-up of the vaccine are Merton, Sutton and Wandsworth; Bexley, Greenwich and Bromley; and Lambeth Southwark and Lewisham. Only Redbridge and Waltham Forest has a take-up higher than the England average. More than 50 children could be hit by a measles outbreak in southwest London, where take-up of MMR, which has been linked to autism and bowel disease, is among the UK's lowest.

Trolley waits

In the majority of London hospitals, more than 20 per cent of patients wait on a trolley for more than four hours after doctors decide that they need a ward bed.

The worst-performing hospitals nationally, says today's figures, are Bromley; West Middlesex; St Mary's Paddington; Northwick Park and Central Middlesex. From April, the Government will collect data on how long patients wait in A&R from the time they arrive rather than the time of a decision to admit them.

Cancer screening

London has the worst record in the country for the percentage of women being screened for breast and cervical cancer. Ten of the worst 12 health authority areas for cervical screening are in the capital and all but one area of London are in the bottom 20 for breast cancer screening.

Kate Law, head of clinical trials at Cancer Research UK, said: "There are particular issues in London which probably contribute to this such as areas of poverty, high proportions of immigrants, asylum seekers and people without English as their first language."

Staffing

While some hospitals such as Kingston; North Middlesex; Mayday Croydon and Newham have made significant improvements in recruitment and retention of nurses, many others are still struggling to fill vacancies. The highest proportion of nursing posts empty for more than three months are at Homerton, Queen Mary's Sidcup, Havering and St George's hospitals. The number of GPs per 100,000 population has fallen in more than a third of London health authority areas.