Streeting’s hospital rankings plan angers NHS doctors and bosses

Wes Streeting plans to publish a football-style ranking of the best and worst performing hospitals in England, sparking anger among NHS bosses and staff at the prospect of struggling trusts being “named and shamed”.

The health minister will announce the controversial move to an audience of healthcare leaders on Wednesday, defending it as a “tough” but necessary way to raise standards of care.

“You no longer have to turn a blind eye to failures. We will improve healthcare so that patients can get more out of it for what the taxpayer puts in,” he will say at the annual conference of NHS Providers, which represents England’s 220 NHS trusts.

The rankings will be based on metrics such as how long patients have to wait for emergency treatment, surgery and other care, the state of the trust’s finances and also how good its leadership is perceived to be.

Streeting hopes to have it ready for publication in early April. He will also set out plans on Wednesday to fire “persistently failing managers” and send “turnaround teams” of improvement experts to underperforming trusts, including those with large deficits. Trusts that perform well, or move up the rankings, will be rewarded with extra money to buy equipment and repair or build facilities.

Healthwatch England, the service’s patient champion, said the rankings would help tackle the wide variation in the quality of care patients receive from different trusts and individual services depending on where they live.

“Currently living in an area with an excellent or poor performing NHS trust feels like a postcode lottery,” said Louise Ansari, CEO of Healthwatch, adding that the service was not good enough at measuring patients’ outcomes and experiences with the care.

“Creating a better system that encourages NHS managers to focus on delivering the best care as efficiently as possible, and that leads to faster change at struggling trusts, would be good news for everyone,” she said.

But the plan angered trust leaders, doctors and nurses, who expressed skepticism that publishing a ranking would necessarily increase the supply of high-quality care.

“The prospect of more ‘league tables’ will worry health leaders as they could take away important underlying information,” said Matthew Taylor, the chief executive of hospitals group the NHS Confederation. “NHS staff are doing their utmost for patients in very challenging circumstances and we don’t want them to feel singled out and shamed.”

He also disputed the basis of Streeting’s plan, adding: “League tables in themselves do not lead to improvement.” Trusts that are struggling often do so because they are short-staffed or face high demand for care because the local population is so unhealthy, he added.

Dr. Nick Murch, chairman of the Society for Acute Medicine, which represents hospital doctors, warned that a ranking could cause patients to shun their local NHS trust and damage staff morale.

“Punishing and shaming struggling hospitals … is likely to create division, erode patient trust and further demoralize staff who strive to provide good care in an already poor environment,” he said.

Patricia Marquis, executive director of the Royal College of Nursing for England, said that while the NHS should not tolerate poor management, the ranking risks “scapegoating trust leaders for underinvestment and system failure (and) is not the solution. NHS staff should not be pitted against each other. Tables and rankings without addressing the root causes can undermine public confidence.”

NHS England will conduct “an unrestricted, in-depth review of the performance of the NHS across the country, which will include ranking providers,” the Department of Health and Social Care (DHSC) said.

“This will be made public and updated regularly to ensure leaders, policymakers and patients know which improvements should be prioritised,” the report said.

A senior NHS leader said the league table plan was “crude. It’s very Alan Milburn,” a reference to the former Health Secretary who has just been confirmed as the DHSC’s key non-executive director, as first revealed in the Guardian last month.

But one trust boss said he could tap into the competition that already exists between NHS trusts and encourage them to outdo their rivals through better performance.

On Tuesday, NHS England chief executive Amanda Pritchard announced that from next month, women in England will be encouraged to take part in cervical and breast cancer screening by receiving messages on their mobile phones.

The new ‘ping and book’ service aims to address the fact that 35.4% of women invited to a breast screening appointment last year did not attend. The reminders could “save thousands more lives”, Pritchard told the NHS Providers meeting in Liverpool.