Helpfulness of NHS league tables ‘questionable’, experts say

It is “questionable” as to whether ranking NHS services will be helpful for patients, experts have said.

It comes as failing hospitals in England are set to be named and shamed in new league tables for the first time on Tuesday.

Health Secretary Wes Streeting said the move will pinpoint where urgent support is needed and help end the “postcode lottery” of care for patients.

However, commentators warned hospital performance is “not as simple as good or bad”.

The quarterly tables, which were announced by Mr Streeting in November, will score trusts based on a range of measures.

This includes finances and patient access to care, as well as bringing down waiting times for operations and A&E, and improving ambulance response times.

Trusts will be categorised in four segments, with the first reflecting the best performers and the fourth showing the worst.

Top performers will be given greater freedoms and investment, the Department of Health and Social Care (DHSC) said.

Meanwhile, those in the middle will be encouraged to learn from trusts at the top to help them improve their rankings.

It comes as the British Medical Association (BMA) announced that doctors in their first year of training in England are to be balloted over the prospect of industrial action over a lack of places for doctors in training.

The union has called for an increase in the number of training places.

Expanding the number of training places could also form part of ongoing talks with the Government as ministers and the BMA’s Resident Doctors Committee try to break the stalemate in the ongoing row over pay.

Under the plans by DHSC, higher standards will also be set for leaders, with pay tied to performance.

Senior managers at trusts that are persistently ranked poorly could see their pay docked, while NHS leaders will have extra pay incentives to go into challenged trusts and turn them around.

Mr Streeting said: “We must be honest about the state of the NHS to fix it. Patients and taxpayers have to know how their local NHS services are doing compared to the rest of the country.

“These league tables will identify where urgent support is needed and allow high-performing areas to share best practices with others, taking the best of the NHS to the rest of the NHS.

“Patients know when local services aren’t up to scratch and they want to see an end to the postcode lottery – that’s what this Government is doing.”

Separate tables will be published for acute, non-acute and ambulance trusts.

From next summer, they will also be expanded to cover integrated care boards, which are responsible for planning health services at a local level, and wider areas of NHS performance.

Sir James Mackey, chief executive of NHS England, said giving patients access to more data “will help to drive improvement even faster by supporting them to identify where they should demand even better from their NHS”.

However, Danielle Jefferies, senior analyst at The King’s Fund, warned that “a single ranking cannot give the public a meaningful understanding of how good or bad a hospital is”.

“Whether NHS trust league tables will be helpful to the public is questionable, because hospital performance is not as simple as good or bad,” she said.

“For example, if a hospital has good A&E waiting times, you might assume that that good performance would be reflected elsewhere in the hospital.

“In reality, there is no consistent relationship between how well a hospital trust ranks on its four-hour A&E waiting times and how well it ranks on its 18-week elective waiting times or 28-day faster cancer diagnosis.”

She added that while tables can be a “helpful tool”, a single ranking “hides the variation in performance across different departments within the same hospital” and also “hides the variation in performance that can exist across the multiple hospital sites that are often run by a single trust”.

The new league tables follow the publication of an NHS England online dashboard which aims to give the public more information on how local health services compare.

Trusts are ranked by seven measures of performance including waiting times, cancer treatment, time patients spend in emergency departments and waits for diagnostic tests.