The King's Fund warns overall rankings of NHS trusts in league tables may be too simplified

In a new blog, Danielle Jefferies, Senior Analyst at The King’s Fund, writes:

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

“This means a single ranking cannot give the public a meaningful understanding of how good or bad a hospital is. A single ranking hides the variation in performance across different departments within the same hospital. And a single ranking by trust also hides the variation in performance that can exist across the multiple hospital sites that are often run by a single trust (for example, Manchester University NHS Foundation Trust runs 10 acute and specialist hospitals).

“If done in the right way, league tables can be a helpful tool. But we know there are lots of complexities to consider when designing league tables. The government should open up a conversation with the public on the level of detail that would be most meaningful to them.

“One option is to make rankings more granular so that individual hospitals and departments within hospitals get separate rankings. Another option is to have a ranking system comparing trusts to their individual performance improvement goals that have been set centrally, rather than comparing them with other trusts (for example progress on improving their elective waiting times by 5 percentage points). This might be a fairer way to judge individual trusts in a system where everyone is failing to meet the national performance targets.”

Notes to editors

1. This figure shows that there is no consistent relationship between a trust’s A&E performance and its elective care or cancer diagnosis performance:

   

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