Scores of hospitals are having to readmit large numbers of patients as emergencies within a month of discharging them, a worrying trend amid generally positive signs of improvement in NHS performance.
The record of some trusts deteriorated by well over 10% in a year, according to league tables for England published today.
Health officials were last night concerned by variations between hospitals, some of which have also shown significant progress in this area, since the percentage of readmissions is a key indicator both of quality of care in hospital and the level of support patients receive on returning home.
The figure was as low as 4% of patients in some hospitals, around 9% in others. The overall national performance in this area slipped by 1.7% between 1999-2000 and 2000-01.
The government's political opponents put the blame on the pressure which hospitals were under to end hold-ups in casualty departments and deliver shorter waiting lists.
Figures for health authorities showed another key problem, with 6.3% of patients in English hospitals in 2000-01 facing delays in being discharged because of problems with care homes and with social services.
But again there was a huge disparity between authorities, with few patients stuck in hospital in areas such as Croydon, south London, Wigan, Bolton or south Derbyshire, while more than 14% waited for discharge in north and mid-Hampshire, south Staffordshire and south Essex.
Bed blocking meant other patients were being discharged early to make room for emergency cases.
The government has already given health authorities an extra £100m to ease bed-blocking problems and promised another £200m this year. But consultants and health managers last night appealed for understanding about the extra pressures until improved NHS funding and staffing arrived.
There were significant improvements elsewhere, of 5% in deaths following emergency surgery, of 5.2% in deaths from heart disease and stroke and just over 2% in deaths from cancer.
Some comparisons between authorities and trusts were adjusted for age of local populations but did not reflect the economic and social mix.
The Department of Health argued that comparisons could be made on individual year on year performance to determine real signs of deterioration or progress. For instance, infant mortality rates in east Surrey, just over three deaths per 100,000 live births in 1997-99, the best in England, far exceeded what they were in Walsall, the worst, where there are nearly nine deaths per 100,000 live births.
But the challenge facing Walsall health authority will be to explain how the picture was about 14% worse than local infant mortality rates for 1996-98, whereas east Surrey improved by a similar margin. Infant mortality in the London areas of Camden and Islington worsened by 30% over the same period.
Access to GPs also varied widely. In the Wirral, Cheshire, all practices this year have an appointment system that can offer patients the chance to see a GP within two working days, compared with fewer than half in Southampton and south-west Hampshire. Take-up rates for the measles, mumps and rubella vaccine as well as diptheria up to the end of March last year varied between well over 95% in north Cumbria to well under 80% in parts of south London.
Nigel Crisp, chief executive of the NHS, said officials were considering how to adjust figures for the severity of cases seen by different hospitals. Each trust and health authority would get its own report on how it had performed and must take appropriate action.
"At a time when the NHS is bombarded by criticism, it is good to see surgical mortality rates are falling. But there is still much work to do."
Peter Hawker, chairman of the consultants' committee of the British Medical Association, said there were "enormous pressures" on doctors and "every so often a judgment call may be wrong".
He added: "The government realise they have closed too many beds and resources and facilities are not there."
Evan Harris, the Liberal Democrat health spokesman, said the readmission figures were "a damning indictment of the way government targets have forced trusts to discharge patients too early in order to get trolley waiters in."
Liam Fox, for the Conservatives, said Labour's "chronic mismanagement" of the care home sector had given rise to "a truly bleak state of affairs."
· An international survey for the Organisation for Economic Co-operation and Development suggested Britain was bottom of a league table of developed countries for heart bypass surgery, with 35 operations per 100,000 people , and second only to Greece for artery widening operations, with 37 per 100,000.
