Ministers have condemned 'unacceptable' variations in standards of health care that are revealed in league tables of performance by NHS trusts and health authorities across England.They show nearly five times more patients are waiting for treatment in the worst performing health authorities, than in the best.
In some areas emergency cases are invariably seen within two hours of arrival in an A&E unit. In other areas less than 40% meet this standard.
Death rates within 30 days of surgery are at least three times higher in some hospitals, than in others of the same type.
John Denham, the health minister, said the variations were not necessarily a signal of defective management or poor organisation of clinical services.
They might also be caused by inequalities in the health needs of different parts of the country. Or they might be a signal that some areas have not had enough resources to provide sufficient doctors, nurses or beds.
'Whatever the reason, the extent of these variations is unacceptable. The national plan [due this month] has to tackle these variations effectively,' he said.
It would provide for more doctors, more nurses, more beds and more comprehensive primary care services. Health authorities and trusts would then have the resources to tackle all aspects of under-performance.
The league tables measure 99 health authorities and 275 hospital trusts against 56 yardsticks of performance. Government statisticians claim to have improved the quality of data after widespread criticism last year, but warn that variations may sometimes be explained by special factors that managers or clinicians cannot control.
For example, the apparently high death rates in some teaching hospitals are the result of the most dangerously ill patients being referred there.
Mr Denham said adjustments in the format of the tables made it impossible to measure whether individual authorities or trusts were getting better or worse.
National figures for England showed reductions in deaths from cancer and circulatory diseases, and increased rates of surgery for hips, cataracts and hearts. But there was a deterioration in the figures for operations being cancelled at the last minute.
The league tables show stark variations in mortality rates. People in Manchester are more than twice as likely as people in Surrey to die between the ages of 15 and 64. Manchester comes bottom of a series of national mortality tables, with the highest rate of deaths from cancer, circulatory diseases, suicide and accidents.
The number of patients who die in hospital within 30 days of emergency surgery varied from under 3% in Portsmouth and south-east Hampshire to 5.5% in Wigan and Bolton. The Portsmouth hospitals trust came top of the table for 'very large' acute hospitals with a death rate of 2.2%, compared to 6.4% at St Helier in Carshalton, Surrey.
The tables point to big variations in trolley waits. In Sunderland and Walsall every emergency case in A&E was seen within two hours, but in Barnet and Kingston & Richmond health authorities, this target was met for less than 40% of patients.
In north Derbyshire, 89% of people were seen as outpatients within 13 weeks of GP referral, but in Portsmouth and SE Hampshire the rate was only 61%.
The number of operations cancelled for non-medical reasons on the day of, or after, admission varied from zero in the London borough of Barnet to just over 5% in nearby Camden and Islington.
Five-year survival rates for women aged 15 to 99 diagnosed with breast cancer varied from 83.7% in east Surrey to 64.5% in north Staffordshire. The five-year survival rate for people diagnosed with lung cancer ranged from 8.5% in east and north Hertfordshire to 2.1% in Rotherham. For colon cancer, the survival rate ranged from 52.4% in Herefordshire to 24.9% in the Tees health authority.
For the first time the tables include a patient satisfaction index. The proportion of patients complaining ó or saying they felt like complaining ó about GP surgery staff in the last 12 months varied between 8% in Gloucestershire to 19% in Liverpool.
The Department of Health said the tables were helping health authorities to improve performance. Managers in Sheffield saw from last yearís tables that they had high cancer mortality rates. Their rapid diagnostic outpatient services were now top of the table for delivering appointments within two weeks of referral. The authority was now in the top 10 for take-up on screening.
Lincolnshire health authority achieved an unprecedented growth in prescribing cheaper generic drugs. And Barnsley health authority took steps to reduce the amount of tranquillisers prescribed by GPs, after last yearís indicators showed doctors prescribed twice the national average.
Mr Denham said: 'We have made it clear the NHS needs more doctors and more nurses. We are investing in additional critical care beds and the development of more comprehensive primary care services.
'At the same time, these performance indicators enable the local health service to identify where their performance falls below that of the best and we expect measures to be taken to improve poorly performing services.'
