Major geographical variations in outcomes and performance within the health service are revealed in a new Department of Health report.
The findings of the report are subject to numerous caveats but they still give us an indication as to what areas of the service are working and where there may be room for improvement.
For the first time, a single report brings together information on key indicators of quality in the one document, in a manner that can better inform the way we use the health service and show where more work is needed.
From a patient’s point of view the standout information in the first report of the National Healthcare Quality Reporting System is the variation in results across hospitals. Information on the death rates from heart attacks and stroke for patients in hospitals, which are being named for the first time, will be parsed and analysed across the country.
The performance of some hospitals will have to be examined closely in the light of these figures. Those hospitals with a big throughput of patients and specific expertise seem to perform best.
For instance, the Mater Hospital in Dublin, where the first heart transplant in Ireland was carried out, cared for almost 2,000 patients who suffered a heart attack in 2011-2013. Some 4 per cent died within a month of admission. By contrast, in the Midland Regional Hospital in Tullamore, 265 patients were seen and 12 per cent of them died.
In relation to death rates after a haemorrhagic stroke, Beaumont Hospital, home to the State's main neurological centre, performed best. Its death rate was less than one-third of that of Naas General Hospital, which dealt with one-tenth of the number of patients.
Biggest hospitals
This doesn’t necessarily mean the biggest hospitals perform better. Variance may be due to many factors – the way data is collected, the profile of the local population, or whether a hospital is a specialist centre taking the sickest patients.
"The indicators in this report signal that certain services require further analysis and examination in order to identify if a problem exists," says Dr Tony Holohan, the department's chief medical officer. "One can draw on the analogy of a smoke alarm going off. Further investigation may reveal a faulty smoke alarm or an actual fire."
The report responds to the “what” and the “where” about some health services, but the “why” remains largely unanswered. Why can St Vincent’s hospital provide hip fracture surgery for almost all its patients within two days whereas one in three patients will have to wait longer in Cork University Hospital?
Why are Caesarean section rates so much higher in a Co Kilkenny hospital than in Sligo? Why are there such large variations between the rate of hospitalisation in different counties for respiratory illness, asthma and diabetes?
Questions
Some of these questions have been around for quite some time and should have been answered by now. There will be more questions as more indicators are covered in future years. These will cover performance in a wider range of medical conditions and will drill down to a hospital-specific level.
As Minister for Health Leo Varadkar points out in a foreword to the report, this process won't be universally popular among staff. Some will be uneasy about the focus on measurement and fear sensationalisation of the results. Against this, the health service will struggle to get out of its current slough without precisely measuring what it does and learning from the results.
