League tables rating the performance of NHS trusts in England have been published for the first time, to raise standards, though some question what they will achieve.
The NHS has, for the first time, published league tables which rank every trust in England. The Department of Health and Social Care (DHSC) has said each trust will be ranked every three months against clear standards – from urgent and emergency care to elective operations and mental health services.
The government has said that top-performing trusts will be rewarded with greater autonomy, such as the ability to reinvest surplus budgets into frontline improvements like new diagnostic equipment and hospital upgrades. Those facing the greatest challenges will receive enhanced support to drive improvement, with senior leaders held accountable through performance-linked pay.
In an attempt to end the postcode lottery in care, the best NHS leaders will be offered higher pay to take on the toughest jobs, and they will be sent into challenged services to turn them around.
“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,” said health and social care secretary Wes Streeting.
Trusts have been scored into four performance segments, with the first segment representing the best performing areas and the fourth segment showing the most challenged. The government has said that trusts in the middle segments of the tables will be encouraged to learn from top performers to help them improve on their rankings, so they too will be able to benefit financially from their budget surpluses in the future.
“Letting patients and the public access more data will help to drive improvement even faster by supporting them to identify where they should demand even better from their NHS and by putting more power in their hands to make informed decisions on their choice of provider,” said Sir Jim Mackey, chief executive of NHS England.
“The data also supports local NHS trust boards and leadership teams to more easily identify the highest performing services in the NHS and adapt how they deliver care to drive improvement even faster going forward,” he continued.
Three league tables
The data released earlier this week has been split into three league tables for acute, non-acute and ambulance trusts.
Each trust has been scored against metrics in the National Oversight Framework (NOF), which reflect the delivery of NHS priorities, including performance against targets like reducing waiting times for electives and A&E, and improving ambulance response times.
The highest rated acute trust was Moorfields Eye Hospital NHS Foundation Trust. “We are delighted to be recognised in this first table. Many of these are areas we have focused on, and will continue to do so,” said interim chief executive Peter Ridley. Also highly rated was Imperial College Healthcare NHS Trust. “I am very proud of how our staff are increasingly working as one team, with shared values and aspirations, and to see that now translating into improvements in all aspects of our work,” said chief executive Tim Orchard.
At the other end of the table is The Queen Elizabeth Hospital, King’s Lynn, NHS Foundation Trust. In a statement, the Trust admitted that it had “fallen short”. It continued: “Immediate steps are being taken to address the issues. We are working closely within our newly formed Norfolk and Waveney University Hospitals Group, as well as with NHS England and regulators to deliver urgent improvements”.
For non-acute hospital trusts, North Staffordshire Combined Healthcare NHS Trust was rated the highest. “Our ambition is to be Outstanding in everything we do and how we do it. We remain fully committed to improving the well-being of the people and families of our local communities – those we are privileged to serve,” said chief executive Buki Adeyemo. Birmingham Community Healthcare NHS Foundation Trust, which was rated the lowest.
For ambulance trusts, North West Ambulance Service NHS Trust was rated the highest, while the bottom place was taken by East of England Ambulance Service NHS Trust.
Patient safety
The publication of the data is significant and, as the government says, an effort “to raise standards and ensure better value for patients and taxpayers”.
“People want clarity on how their local NHS is doing, and so many will welcome the aspiration to make this easier to understand,” said Chris McCann, deputy chief executive of Healthwatch England.
But there are questions about how useful the data will be in changing behaviour.
“If a service is struggling, transparency must come with accountability. Patients need to know what’s being done to fix the problem, and when it will improve,” McCann continued.
Hugh Alderwick, director of policy at the Health Foundation, has taken a similar line.
“The new ratings need to be used as a way to support struggling organisations to improve, rather than another tool for top-down control and performance management,” he said, also warning that it could harm morale.
“Negative ratings can impact organisational culture, staff morale, and recruitment, which could – perversely – worsen performance further and impact patient care,” he said.
As for the patients, Nuffield Trust chief executive Thea Stein worries that it may harm rather than help patient safety. Speaking specifically of small or remotely situated trusts whose ranking may be down to things outside their control, like the quality of their buildings or difficulty in attracting and retaining staff, she warned: “The scheme also risks discouraging people from getting treatment from poorly performing trusts, or staff from working for them”.
