Hospital league tables: how does the new ranking system work?

“Football-style” NHS league tables, which rank the best- and worst-performing hospitals and trusts in England, have now arrived despite warnings that they “would not help patients choose where to seek care”, said The Guardian.

The rankings, which list short-term care or acute trusts, non-acute trusts and ambulance trusts separately, are available to the public and will be reassessed every three months.

Health Secretary Wes Streeting said he hopes league tables will increase transparency and end the postcode lottery in medical treatment, taking “the best of the NHS to the rest of the NHS”.

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Health experts, on the other hand, have warned that it is “impossible to capture correctly whether any hospital” is “good or bad”. The new system “could prompt patients to avoid seeking help at lower-rated ones”.

What do the ratings represent?

Last November, the government approved a new framework for assessing the quality of care provided by NHS trusts. Providers are now evaluated on their performance across six domains: access to services, effectiveness and experience of care, patient safety, staff wellbeing, fiscal responsibility, and improving health and reducing inequality.

These measure waiting times for elective care, promptness of cancer diagnoses, ambulance response times and A&E wait times, mental health access rates, and the ease of booking appointments. The facilities’ finances are also taken into account “and it is possible that a hospital rated highly for clinical care will be marked down if they are running up a larger than expected deficit”, said the BBC.

Currently, specialist trusts including Moorfields Eye Hospital, the Royal National Orthopaedic Hospital and The Christie NHS Foundation Trust top the list. The Queen Elizabeth Hospital in King’s Lynn, Norfolk, received the worst rating.

Each trust is assigned a score between one and four, with lower numbers representing higher rankings – Moorfields was rated 1.39 and the Queen Elizabeth Hospital received 3.35, for example. The trusts are “then sorted into four categories called segments, with the best overall performers in segment one and the worst in segment four”, said the BBC. Trusts facing financial challenges will not be able to rank higher than segment three.

While comparing trusts based on their ratings “can be a helpful indicator of potential areas of disparity for further investigation”, it should be done “cautiously”, keeping in mind factors like trust size and merger history, said NHS England.

Why are some experts urging caution?

Since the plan’s announcement, critics have raised several issues with how effective and trustworthy NHS league tables will be. Streeting “accused health think tanks of ‘elitist nonsense’” after claims that the tables would be “difficult to interpret”.

But the tables “don’t tell you in simple terms” how a hospital is performing, Sarah Woolnough, chief executive of the King’s Fund, told the BBC. “It’s not elitist to say these rankings risk confusing people, rather than helping them choose where to get great care.”

There is also a risk that “trusts will focus only on the measures that immediately boost their ranking", even if those measures aren’t necessarily best for their patients, Thea Stein, chief executive of the Nuffield Trust, told The Telegraph. “As finances have a particular sway on the rankings”, the tables are “of limited use” for patients seeking care.

What will happen to low-ranked trusts?

The newly published league tables show that 80% of England’s acute hospital trusts “are considered to be failing because they are ‘off-track’ on performance targets or running financial deficits”.

While NHS executives and leaders at top-ranked trusts may be offered bonuses, more flexibility with budgeting, or temporary pay raises “to go into the lower-ranked organisations and turn them around”, those leading the “worst performers” might see their pay frozen or docked.

Some health experts have expressed “fears that those serving poorer or more isolated areas will be stigmatised”, said The Mirror. Divides between urban and rural areas, and the north and south of England, have already emerged in the tables.

“There’s more work to do” before staff and patients can fully trust the league tables, said Daniel Elkeles, chief executive of NHS Providers, an organisation that represents trust leaders.

The tables need to be accurate and fair – “anything less could lead to unintended consequences, potentially damaging patient confidence in local health services, demoralising hard-working NHS staff and skewing priorities”.