CEEU : Acute Myocardial Infarction :

How the NHS Manages Heart Attacks

April 2003-March 2004

Printable version of full report in PDF format (391k) *

Summary in Welsh

This report covers the performance of hospitals in England and Wales caring for people having heart attacks from April 2003- March 2004.

The Myocardial Infarction National Audit Project (MINAP) is thought to be the largest independent audit of heart attack care. Since MINAP started in 2000 the percentage of heart attack patients in England receiving clot busting drugs (thrombolysis) within 30 minutes of arrival at hospital has doubled (40 – 81%). This reflects changes within hospitals in the way they treat heart attack patients and the hard work of the staff.

The report contains

1. Introduction
2. What happens when you have a heart attack
3. Drugs to reduce the risk of another heart attack
4. Department of Health standard and goals for heart attack patients
5. Achievement against Department of Health standard and goals for heart attack patients by hospitals in England and Wales
6. Comment
7. Key messages
8. How hospitals have used their MINAP data to improve patient care
9. Glossary
10. Contacts for more information on this report
11. Contacts for information on heart conditions
12. Acknowledgements
13. Hospital location

1. Introduction

The National Service Framework (NSF) for coronary heart disease is a 10-year programme published by the Department of Health in March 2000, which set standards of care for patients with coronary heart disease in England

(www.dh.gov.uk/assetRoot/04/04/90/70/04049070.pdf). The NSF helps the NHS to plan and deliver the service changes needed to raise standards of care, to improve clinical outcomes and to monitor progress. In addition it promotes equal care for all people with coronary heart disease. To make this happen, the NSF has set 12 standards covering areas from prevention to rehabilitation. For more information on what these standards mean for you, see the British Heart Foundation publication: ‘Good Service? The National Service Framework for coronary heart disease. A guide for members of heart support groups, consumer groups and individuals interested in how services for coronary heart disease in England are developed.’

In October 2002 the Department of Health commissioned a review of thrombolysis services. The report, ‘Review of Early Thrombolysis’, was published in June 2003 and identified best practice and made recommendations for the delivery of faster thrombolysis. There have also been two Department of Health reports on progress towards achievement of the NSF standards, which included treatment of heart attack patients, ‘Delivering better heart services’ http://www.dh.gov.uk/assetRoot/04/07/52/80/04075280.pdf in March 2003 and ‘Winning the War on Heart Disease’ http://www.dh.gov.uk/assetRoot/04/07/71/58/04077158.pdf in March 2004.

MINAP was developed to show how hospitals in England are performing against the NSF standard and goals for patients with heart attacks (myocardial infarction). This report from MINAP concentrates on the time taken to give clot busting drugs (thrombolytic therapy) to suitable patients and the use of drugs to reduce the risk of another heart attack (secondary prevention). There is good evidence that both these treatments are highly effective in saving lives.

This is the first year that the results for Wales are published in the MINAP Public Report. Hospitals in Wales joined the project later than the English hospitals and this should be considered when looking at this years report. Hospitals in Wales are assessed on the English NSF standard and goals, however Wales has its own NSF for coronary heart disease. www.wales.nhs.uk/publications/coronary-heart-disease-e.pdf

2. What happens when you have a heart attack

What is a heart attack?

A heart attack occurs when a clot (thrombus) suddenly develops within a heart artery. The heart muscle supplied by the blocked artery suffers permanent damage if the blood supply is not restored quickly.

Thrombolytic treatment

Thrombolytic treatment is the use of clot dissolving drugs. Thrombolytic treatment is effective up to about 12 hours after symptoms begin but is most effective when given very early after symptoms start. Hospitals and ambulance services are increasingly well organised and are collaborating to recognise heart attacks and provide treatment rapidly.

This report covers patients who were eligible for thrombolytic treatment because they had

• definite signs of a heart attack
• no reason why a thrombolytic drug might be harmful to them and
• no good reason to delay giving the treatment

Thrombolytic drugs are not given until a heart attack is confirmed by an electrocardiogram (ECG). Thrombolytic drugs are designed to dissolve clots, so they may be unsuitable for some patients who are at risk of internal bleeding. Patients at significant risk of bleeding may not be given this treatment where the risk of bleeding is greater than any potential benefit.

3. Drugs to reduce the risk of another heart attack

Several drugs are available which have been shown in large clinical trials to reduce the risk of another heart attack. These are called secondary prevention drugs and include

• aspirin , which helps to prevent the blood from clotting
• beta blockers , which slow the heart rate and lower blood pressure
• statins , which reduce cholesterol levels in the blood

Someone who has had a heart attack is normally given these drugs unless they are unable to take them because of side effects.

4. Department of Health standard and goals for heart attack patients

NSF Standard Six states that thrombolysis should be given within 60 minutes of calling for professional help (Call to Needle time). The Call to Needle time includes the time taken from the patient’s first call for professional help until they reach hospital and the time from the patient’s arrival at hospital until they receive thrombolytic treatment, Door to Needle (DTN). The call for professional help may be to a GP, NHS Direct or the ambulance service. This standard reflects the combined performance of the ambulance service, GPs and hospitals and is the most relevant overall indicator of patient care. However the call time is not always easily available.

Professional help may include a GP, NHS Direct or the ambulance service.

‘Improvement, Expansion and Reform: the next 3 years, Priorities and Planning Framework (PPF) 2003-2006’ http://www.dh.gov.uk/assetRoot/04/07/02/02/04070202.pdf is a framework which builds on the NSF and covers both ambulance and hospital trusts. It emphasises the Call to Needle standard and encourages the NHS to plan to deliver a 10 percentage point increase per year in the proportion of patients who receive thrombolytic treatment within 60 minutes of calling for professional help. It was felt that this would encourage collaborative working between ambulance trusts and hospitals to reduce delays to thrombolysis.

In December 2002, 38% of patients received thrombolysis within 60 minutes of calling for professional help. The Department of Health used 38% as the baseline from which they wish to see a ten percentage point improvement each year, thus achieving 48% nationally by the end of 2003/4. This report shows the hospitals’ position in relation to the Call to Needle national average at the end of 2003/4.

We report here on the achievement of the 60 minute Call to Needle time standard by hospitals, but we recognise that delivery of heart attack care within this timeframe is a responsibility that hospitals share with ambulance services.

Reducing the time taken to get heart attack patients to hospital is a key challenge in further improving overall NHS performance against the 60 minute Call to Needle standard. Increasingly, and particularly where geography or traffic conditions prolong journey times, paramedics are being trained to administer thrombolysis before patients reach hospital.

We also report on the existing NSF goals for Door to Needle and use of secondary prevention medication.

The NSF goal for Door to Needle:

• By April 2002 75% of eligible patients should receive thrombolytic drugs within 30 minutes of arriving at hospital (Door to Needle time).

The NSF goal for secondary prevention:

• By April 2002 80-90% of patients discharged from hospital following a heart attack should be given secondary prevention drugs (aspirin, beta blockers and statins).

We have continued to report the 30 minute Door to Needle goal to allow local cardiac networks to improve their Call to Needle times. We have not reported the 20 minute Door to Needle results this year as the emphasis in both the PPF and the Department of Health’s review of 2003 is on improving the overall patient journey, the 60 minute Call to Needle time.

5. Achievement against Department of Health standard and goals for heart attack patients by hospitals in England and Wales

There are two tables (one for hospitals in England and one for hospitals in Wales) in the link below which show how your hospital is performing against the standard and goals. The tables have six columns. They cannot be printed.

Hospital

Hospitals that admit patients with heart attacks are listed in alphabetical order. A table in Section 13 shows hospital location.

Door to Needle time (DTN)

This is the time from arrival at hospital when the ambulance stops outside the hospital (Door) to the start of the thrombolytic treatment (Needle). The goal was 75% within 30 minutes by April 2002.

Call to Needle time (CTN)

This is the time from the initial call by the patient or their relative for professional help to the GP, NHS Direct or the ambulance service (Call) to the start of thrombolytic treatment (Needle). The national target for the end of 2003/4 is that 48 % of patients should receive thrombolysis within 60 minutes of calling for professional help.

Aspirin, Beta Blocker, Statins

The last three columns show performance against the 80% goal for the use of three drugs which reduce the risk of another heart attack.

National average

The national averageis the overall achievement against the five goals for all hospitals in England or in Wales that treat heart attack patients.

Achievement against the NSF goals for Door to Needle time and secondary prevention is shown using three symbols but the goals are different.

reached the goal
within 25% of the goal
more than 25% from the goal
  ! hospitals with fewer than 20 cases

The Call to Needle target has increased by 10 percentage points from 38% last year to 48% at the end of 2003/4. Hospitals that are on or over the national average of 48% are shown by a . Those that are under it are shown by a .

Hospitals with ‘No Data’

Hospitals that have not returned any data are shown as ‘No Data’ in the table.

Hospitals with fewer than 20 cases

Hospitals with fewer than 20 cases that meet the analysis criteria are shown as ! in the table. There are three main reasons for this

• in small hospitals fewer patients may be admitted with heart attack. Analysis on small numbers may not be representative.
• in larger hospitals primary angioplasty may be used as an alternativetreatment to thrombolysis for the treatment of heart attack. These hospitals are indicated using a ^ symbol.
• in others, failure to report performance may be the cause.

Coverage

This report is based on data from the 12 months, 1 April 2003- 31 March 2004. This report will be updated in April 2005 for the period April 2004 - March 2005 and will continue to be released annually.

• PDF table of hospitals' achievement against NSF targets in England (68k) nb this version is not printable
• PDF table of hospitals' achievement against NSF targets in Wales (51k) nb this version is not printable

6. Comment

• This report is based on the average performance of hospitals over 12 months and may underestimate recent performance.
• All hospitals in England and 17/18 hospitals in Wales are now submitting data to MINAP.
• The number of hospitals achieving the DTN goal has increased from 96 to 156 since the last report in June 2003. Achievement against this goal has increased steadily throughout 2004.
• The use of medication to reduce the risk of further heart attack has continued to increase. The number of hospitals in England achieving the NSF goal for aspirin has increased from 202 - 208, for beta blockers from 174 - 187 and for statins from 175 - 205.
• These results are the best in Europe.
• Achievement of the Door to Needle goal reflects the hospital performance.
• Achievement of the 60 minute Call to Needle standard reflects the combined performance of hospitals, the ambulance service and GPs. There are various reasons, discussed below, why not every hospital is expected to achieve this standard.
• Call to Needle time is dependent on geographical location and it may be impossible to achieve the 60 minute standard where an ambulance service covers a large rural area and journey times may often exceed 30 minutes.
• Delays in transporting a patient to hospital may also occur in heavy traffic or when a patient first calls their GP who visits them before calling an ambulance.
• In most ambulance trusts paramedics can perform ECGs to identify heart attack patients and pre-alert the receiving hospital, and in some cases transmit ECG results. This ensures that the hospital is ready for the patient when the ambulance arrives and delays are reduced.
• Increasing numbers of paramedics are being trained to treat heart attack patients with thrombolytic drugs in the ambulance, especially when journey times are long. This is known as ‘pre hospital thrombolysis’ and holds the key to further progress by taking treatment to the patient.
• The increasing use of primary angioplasty may reduce the number of patients that receive thrombolysis and may account for small numbers in hospitals using this strategy. We have identified hospitals that perform primary angioplasty in the report.
• There has been an increase in the number of patients that make their own way to hospital without involving either the ambulance service or their GP. These patients are excluded from the Call to Needle analyses and may account for low numbers in some hospitals.
• Ambulance crews are trained to recognize the symptoms of a heart attack and thus patients who call 999 can be treated more quickly than those who self present. Patients with symptoms of heart attack should always call 999.
• MINAP ensures the quality of the data by monitoring the completeness and accuracy of the data.

7. Key messages

• The NSF, a ten year programme, was published in 2000 in order to improve the care of patients with heart attack and to reduce the number of deaths from heart attack.
  
• This is the third report to be published on the treatment of heart attack and shows continuing improvement in the care of heart attack patients.

• Hospital treatment of patients with acute heart attacks are now compared nationally using the same definitions. It allows hospitals to monitor improvement in care for people who have suffered a heart attack and compare themselves against all other hospitals.

• Measuring performance against the NSF standard and goals helps hospitals identify areas where care for people with heart attacks can be improved. See Section 8 for comments from hospitals about the use of their MINAP data.

• Everyone should familiarise themselves with symptoms of a heart attack (for a description of symptoms see page 9 of the British Heart Foundation publication: “'Good Service?' The National Service Framework for coronary heart disease. A guide for members of heart support groups, consumer groups and individuals interested in how services for coronary heart disease in England are developed”). NHS Direct Online http://www.nhsdirect.nhs.uk/ also provides useful information on heart attack symptoms and action.
  
• Patients should ring 999 for help immediately if the symptoms of a heart attack last more than 15 minutes and are not relieved by resting or using nitrate tablets or spray, if prescribed.
  
• The largest delay is not usually the arrival of the ambulance or giving thrombolysis, but the delay in calling for professional help.

• Most hospitals will have a Patient Advice and Liaison Service (PALS) which should be able to give advice on your hospital’s performance.

8. How hospitals have used their MINAP data to improve patient care; some examples.

Has participation in MINAP enabled you to employ extra staff / resources?

"training programmes for nurses and doctors admitting patients with MI" Gill Clarke, Stoke Mandeville Hospital

"upgrade of cardiac unit" R Ellison, Bridlington and District Hospital

Do you think patient care has improved as a result of participation in MINAP?

"reduced delay in thrombolysis leading to improved outcomes for patients and improved quality and priority of care to all acute coronary syndrome patients" Rose Hurst, Princess Royal Hospital (Haywards Heath)

"Patients are receiving treatment quicker and more efficiently which improves long term outcome" Kathryn Lathan, Leicester General Hospital

"faster response times, better patient care" R Ellison, Bridlington and District Hospital

" all (patients) now referred to cardiologist" Nicky Settle, Friarage Hospital

"better secondary prevention" Adam Timmis, Royal London Hospital

How else has MINAP changed or helped in the day-to-day running of your hospital?

"the improvement of Call to Needle times, observed through local MINAP analysis, justifies pre hospital thrombolysis in our area" Kathryn Lathan, Torbay Hospital

9. Glossary

Acute Coronary Syndrome – When someone goes into hospital with chest pain, it can be difficult for the doctors to tell whether they are having an attack of unstable angina (angina that comes on at rest and with increasing frequency) or a heart attack. Acute Coronary Syndrome is the term used to describe patients that fall into this category.

Angina – Symptoms of chest pain that occur when narrowing of the coronary arteries prevent enough oxygen containing blood reaching the heart muscle when its demands are high- such as during exercise.

Anti-platelet drugs – Drugs including aspirin that prevent blood clotting. Anti-platelet drugs act by reducing the ‘stickiness’ of the small blood cells that can clump together to form a clot.

Aspirin – An anti–platelet drug used to help prevent blood clots forming.

Beta Blockers – Beta-blockers are drugs that block the actions of the hormone adrenaline that makes the heart beat faster and more vigorously. They are used to help prevent attacks of angina, to lower blood pressure, to help control abnormal heart rhythms and to reduce the risk of further heart attack in people who have already had one. They may also be used in small doses in heart failure.

Cholesterol – A fatty substance mainly made by the liver. It plays a vital role in the functioning of every cell wall throughout the body. The body also uses cholesterol to make other vital chemicals. However, too much cholesterol in the blood increases the risk of coronary heart disease and heart attacks.

Clot-busters – Drugs used to dissolve blood clots after a heart attack, see thrombolytic’.

Electrocardiogram – Also known as ‘ECG’. A test to record the rhythm and electrical activity of the heart. The ECG will show if a person has had a heart attack, either recently or some time ago.

Heart Attack – A heart attack occurs when a clot (thrombus) suddenly develops within a heart artery. The heart muscle supplied by the blocked artery suffers permanent damage if the blood supply is not restored quickly. The damage to heart muscle carries a risk of sudden death, and heart failure in people who survive.

Heart failure – Heart failure occurs when a damaged heart becomes less efficient at pumping blood round the body. This may result from damage to the heart muscle caused by a heart attack.

Myocardial Infarction (MI) – A heart attack.

Pre hospital thrombolysis – Thrombolytic treatment is given to the patient in the ambulance by paramedics when they have diagnosed a heart attack. This treatment may be used in rural areas where it takes a long time to get to hospital.

Primary angioplasty - An emergency treatment to reopen a blocked artery using a fine catheter with a small inflatable balloon at its tip. This is a relatively new treatment for heart attack which is not yet widely available.

Secondary Prevention – Drugs that reduce the risk of another heart attack.

Statins – Drugs used to reduce cholesterol levels in the blood.

Thrombolytic Drugs / Treatment / Thrombolysis – Treatment which dissolves a clot blocking an artery and restore blood flow to the heart muscle.

Thrombus – A blood clot.

10. Contacts for more information on this report

Myocardial Infarction National Audit Project

Clinical Effectiveness and Evaluation Unit
Royal College of Physicians
London NW1 4LE
Tel:0207 935 1174 ext.334
Email minap@rcplondon.ac.uk
www.rcplondon.ac.uk/college/ceeu/ceeu_ami_home.htm

Royal College of Physicians

PR Manager Linda Cuthbertson on 020 7935 1174 ext.254
Email: Linda.Cuthbertson@rcplondon.ac.uk

Department of Health

Enquiries to the Department should be directed to the Public Enquiry Office
Tel: 0207 210 4850 (line open from 9.00am to 5.00pm Monday to Friday).
Minicom: 0207 210 5025.
Email at dhmail@doh.gsi.gov.uk

In writing to the Minister for Public Health at

The Department of Health
Richmond House
79 Whitehall
London SW1A 2NS

If you require further information on your local hospital’s performance please contact the hospital’s Patient Advice and Liaison Service.

11. Contacts for information on heart conditions

Ambulance Service Association http://www.asa.org.uk

American Heart Association http://www.americanheart.org/

Blood Pressure Associationhttp://www.bpassoc.org.uk/

British Cardiac Patients Associationhttp://www.bcpa.co.uk/

British Cardiac Society http://www.bcs.com/

British Heart Foundationhttp://www.bhf.org.uk/

NB: The British Heart Foundation runs a medical information line that provides information about heart conditions and their management. It cannot respond to questions about services in individual hospitals. Tel: 08450 70 80 70

The document ‘Good Service’ can be obtained by telephoning 01604 640016 and asking for leaflet code M69.

Diabetes UK http://www.diabetes.org.uk/

DOH website http://www.dh.gov.uk/Home/fs/en

HEART UK http://www.familyheart.org/

National Electronic Library

for Health http://www.nelh.nhs.uk/cardiovascular

NHS Direct http://www.nhsdirect.nhs.uk/ Tel: 0845 4647

Resuscitation Council http://www.resus.org.uk

12. Acknowledgements

This report was completed in close collaboration with the Central Cardiac Audit Database (CCAD) http://www.ccad.org.uk/ who performed data management and analysis.

The Myocardial Infarction National Audit Project acknowledges the contribution of its Patient/Carer Group and British Heart Foundation Patient Focus Groups in the development of this report.

The Healthcare Commission exists to promote improvement in the quality of NHS and independent healthcare across England and Wales. It is a new organisation, which started work on 1 April 2004 and was created under the Health and Social Care (Community Health and Standards) Act 2003. In addition to a range of new functions, the Commission takes over some responsibilities from other organisations. It:

• replaces the work of the Commission for Health Improvement (CHI)
• takes over the private and voluntary healthcare functions of the National Care Standards Commission
• picks up the elements of the Audit Commission’s work which relate to efficiency, effectiveness and economy of healthcare

The Healthcare Commission is now responsible for directing the national clinical audit programme for England and Wales and funds MINAP.

13. Hospital location

Hospitals in England

Hospital	Town
Addenbrooke’s Hospital	Cambridge
Airedale General Hospital	Keighley
Arrowe Park Hospital	Wirral
Ashford Hospital	Ashford
Barnet General Hospital	Barnet
Barnsley District Hospital	Barnsley
Basildon Hospital	Basildon
Bassetlaw District General Hospital	Worksop
Battle Hospital	Reading
Bedford Hospital	Bedford
Birmingham Heartlands Hospital	Birmingham
Bishop Auckland General Hospital	Bishop Auckland
Blackburn Royal Infirmary	Blackburn
Bradford Royal Infirmary	Bradford
Bridlington and District Hospital	Bridlington
Bristol Royal Infirmary	Bristol
Broomfield Hospital	Chelmsford
Burnley General Hospital	Burnley
Calderdale Royal Hospital	Halifax
Central Middlesex Hospital	London
Charing Cross Hospital	London
Chase Farm Hospital	Enfield
Chelsea and Westminster Hospital	London
Cheltenham General Hospital	Cheltenham
Chesterfield Royal	Chesterfield
Chorley Hospital	Chorley
City Hospital	Birmingham
Colchester General Hospital	Colchester
Conquest Hospital	St Leonards on Sea
Countess of Chester Hospital	Chester
County Hospital Hereford	Hereford
County Hospital Louth	Louth
Crawley Hospital	Crawley
Cumberland Infirmary	Carlisle
Darent Valley Hospital	Dartford
Darlington Memorial Hospital	Darlington
Derby Royal Infirmary	Derby
Derriford Hospital	Plymouth
Dewsbury District Hospital	Dewsbury
Diana, Princess of Wales Hospital	Grimsby
Doncaster Royal Infirmary	Doncaster
Dorset County Hospital	Dorchester
Ealing Hospital	Southall
East Surrey Hospital	Redhill
Eastbourne District General Hospital	Eastbourne
Epsom Hospital	Epsom
Fairfield Hospital	Bury
Frenchay Hospital	Bristol
Friarage Hospital	Northallerton
Frimley Park Hospital	Frimley
Furness General	Barrow in Furness
George Eliot	Nuneaton
Gloucestershire Royal Hospital	Gloucester
Good Hope General Hospital	Sutton Coldfield
Grantham and District	Grantham
Halton General Hospital	Runcorn
Hammersmith Hospital	London
Harrogate District Hospital	Harrogate
Hartlepool General	Hartlepool
Heatherwood Hospital	Ascot
Hemel Hempstead General	Hemel Hempstead
Hexham General Hospital	Hexham
Hillingdon Hospital	Uxbridge
Hinchingbrooke Hospital	Huntingdon
Homerton Hospital	London
Hope Hospital	Manchester
Horton General Hospital	Banbury
Hospital of St Cross	Rugby
Huddersfield Royal Infirmary	Huddersfield
Hull Royal Infirmary	Hull
James Cook University Hospital	Middlesborough
James Paget Hospital	Great Yarmouth
John Radcliffe Hospital	Oxford
Kent and Canterbury Hospital	Canterbury
Kent and Sussex Hospital	Tunbridge Wells
Kettering General Hospital	Kettering
King’s College Hospital	London
King George Hospital	Goodmayes
Kings Mill Hospital	Sutton in Ashfield
Kingston Hospital	Kingston Upon Thames
Leeds General Infirmary	Leeds
Leicester General Hospital	Leicester
Leicester Royal Infirmary	Leicester
Leighton Hospital	Crewe
Lincoln County Hospital	Lincoln
Lister Hospital	Stevenage
Luton and Dunstable Hospital	Luton
Macclesfield District General	Macclesfield
Maidstone General Hospital	Maidstone
Manchester Royal Infirmary	Manchester
Manor Hospital	Walsall
Mayday University Hospital	Croydon
Medway Maritime Hospital	Gillingham
Milton Keynes General Hospital	Milton Keynes
Montagu Hospital	Mexborough
New Cross Hospital	Wolverhampton
Newark Hospital	Newark
Newham General Hospital	London
Norfolk and Norwich Hospital	Norwich
North Devon District Hospital	Barnstable
North Hampshire Hospital	Basingstoke
North Manchester General Hospital	Manchester
North Middlesex Hospital	London
North Staffordshire Hospital	Stoke on Trent
North Tees General	Cleveland
North Tyneside General Hospital	North Shields
Northampton General Hospital	Northampton
Northern General Hospital	Sheffield
Northwick Park Hospital	Harrow
Nottingham City Hospital	Nottingham
Oldchurch Hospital	Romford
Ormskirk and District General	Ormskirk
Peterborough District Hospital	Peterborough
Pilgrim Hospital	Boston
Pinderfields General Hospital	Wakefield
Pontefract General Hospital	Pontefract
Poole Hospital	Poole
Princess Alexandra Hospital	Harlow
Princess Royal Hospital	Haywards Heath
Princess Royal Hospital	Telford
Princess Royal University Hospital	Bromley
Queen’s Hospital	Burton upon Trent
Queen Alexandra Hospital	Portsmouth
Queen Elizabeth Hospital	Kings Lynn
Queen Elizabeth Hospital	Gateshead
Queen Elizabeth Hospital	Woolwich
Queen Elizabeth II Hospital	Welwyn Garden City
Queen Elizabeth the Queen Mother	Margate
Queen Mary’s Hospital	Sidcup
Rochdale Infirmary	Rochdale
Rotherham General Hospital	Rotherham
Royal Albert Edward Infirmary	Wigan
Royal Bolton Hospital	Bolton
Royal Bournemouth General	Bournemouth
Royal Cornwall Hospital	Truro
Royal Devon and Exeter	Exeter
Royal Free Hospital	London
Royal Hallamshire Hospital	Sheffield
Royal Hampshire County Hospital	Winchester
Royal Lancaster Infirmary	Lancaster
Royal Liverpool University Hospital	Liverpool
Royal London Hospital	London
Royal Oldham Hospital	Oldham
Royal Preston Hospital	Preston
Royal Shrewsbury Hospital	Shrewsbury
Royal Surrey County Hospital	Guildford
Royal Sussex County Hospital	Brighton
Royal United Hospital Bath	Bath
Royal Victoria Infirmary	Newcastle
Russells Hall Hospital	Dudley
Salisbury District Hospital	Salisbury
Sandwell Distict Hospital	West Bromwich
Scarborough General Hospital	Scarborough
Scunthorpe General Hospital	Scunthorpe
Selly Oak Hospital	Birmingham
Skegness District Hospital	Skegness
Solihull General Hospital	Birmingham
South Tyneside District Hospital	South Shields
Southampton General Hospital	Southampton
Southend Hospital	Westcliff on Sea
Southmead Hospital	Bristol
Southport and Formby District Hospital	Southport
St George’s Hospital	London
St Helier Hospital	Carshalton
St James’ University Hospital	Leeds
St Mary’s Hospital	Newport
St Mary’s Hospital	Paddington
St Peter’s Hospital	Chertsey
St Richard’s Hospital	Chichester
St Thomas Hospital	London
Staffordshire General Hospital	Stafford
Stepping Hill Hospital	Stockport
Stoke Mandeville Hospital	Aylesbury
Sunderland Royal Hospital	Sunderland
Tameside General Hospital	Ashton under Lyne
Taunton and Somerset Hospital	Taunton
The Alexandra Hospital	Redditch
The Great Western Hospital	Swindon
The Ipswich Hospital	Ipswich
Torbay Hospital	Torquay
Trafford General Hospital	Manchester
University College Hospital	London
University Hospital Aintree	Liverpool
University Hospital Lewisham	London
University Hospital of North Durham	Durham
University Hospital Queens Medical Centre	Nottingham
Victoria Hospital	Blackpool
Walsgrave Hospital	Coventry
Wansbeck General Hospital	Ashington
Warrington District General Hospital	Warrington
Warwick Hospital	Warwick
Watford General Hospital	Watford
West Cornwall Hospital	Penzance
West Cumberland Hospital	Whitehaven
West Middlesex University Hospital	Isleworth
West Suffolk Hospital	Bury St Edmunds
Westmoreland General Hospital	Kendal
Weston General Hospital	Weston Super Mare
Wexham Park Hospital	Slough
Whipps Cross Hospital	London
Whiston Hospital	Prescot
Whitby Hospital	Whitby
Whittington Hospital	London
William Harvey Hospital	Ashford
Worcester Royal Infirmary	Worcester
Worthing Hospital	Worthing
Wycombe General Hospital	High Wycombe
Wythenshawe Hospital	Manchester
Yeovil District Hospital	Yeovil
York District Hospital	York

Hospitals in Wales

Hospital	Town
Bronglais Hospital	Aberystwyth
Glan Clwyd District General Hospital	Rhyl
Llandough Hospital	Penarth
Llandudno Hospital	Llandudno
Maelor Hospital	Wrexham
Morriston Hospital	Swansea
Neath Port Talbot Hospital	Neath
Nevill Hall Hospital	Abergavenny
Prince Charles Hospital	Merthyr Tydfil
Prince Philip Hospital	Llanelli
Princess of Wales Hospital	Bridgend
Royal Glamorgan Hospital	Llantrisant
Royal Gwent Hospital	Newport
Singleton Hospital	Swansea
University Hospital of Wales	Cardiff
West Wales General Hospital	Carmarthen
Withybush General Hospital	Haverfordwest
Ysbyty Gwynedd	Bangor

 

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This page last updated on June 20, 2006