PATIENTS are more likely to die in hospital in Scotland than England, according to the first study of its kind which raises the "worrying possibility" of a gulf in NHS care.

The chance of dying after a planned procedure in Scotland was three times higher than in England in 2013/14. In that same year, the mortality rate among for patients admitted as an emergency is also 27 per cent lower in England than Scotland.

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The findings emerged in a study by academics at York University who compared hospital mortality between the two countries from April 1997 until March 2014.

It covered 190 million inpatient admissions, both planned and emergency. 

Hospital mortality decreased in both nations during the period, but "has done so more quickly in England than in Scotland in both emergency and elective care".

By 2013/14, the difference between the two was wider than ever, despite spending per head on health in Scotland being higher than England.

The authors made their comparison after adjusting for variables such as the age of patients, levels of disease, treatment carried out, and deprivation levels, as well as the case mix of patients treated.

The study was published in the BMJ Open journal a day after Health Secretary Shona Robison said that Scotland's respected Patient Safety Programme had cut hospital mortality by more than 10 per cent between 2014 and 2018.

However, Martin Chalkley, an expert in health economics at York University and co-author of the study, said their data "would make it very hard to support the claim [Scottish] hospitals are leading the world in terms of hospital mortality".

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The authors said the difference might partly be explained if more terminally people in England were choosing to die at home or in hospices.

But they added: "The second, more worrying possibility, is that there remains some element of the difference in trend that relates to the efficacy of hospital treatments in the two coutries."

Derek Bell, chairman of the Academy of Medical Royal Colleges and Faculties in Scotland, said: "This paper draws interesting comparisons between different countries.

"It is very important that we look at some of this data through a research lens, recognising that we might not always be using the same definition, although the authors have attempted to address that."

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Jason Leitch, NHS Scotland's national clinical director, said: "Thanks to a decade of hard work by the Scottish Patient Safety Programme we've reached our aim to cut hospital mortality by 10 per cent more than a year earlier than planned.

"We continue to lead the way on patient safety, with other countries looking to learn from our approach, including NHS England.

"We acknowledge the findings of this study but note it only considers deaths in hospital as opposed to 30 days post-admission. Given our policy direction towards more community delivered care, this study may be showing evidence that we are treating sicker patients in Scottish hospitals as a result of this work."