Monday, November 30, 2009

NHS hospitals performance debates and league tables

A report in yesterdays Observer Eleven more NHS hospitals at centre of safety scandal based on research by the Dr Foster organisation has escalated controversy about how hospitals should be judged, with underlying debates about monitoring techniques and the quality of data supporting the indicators on which these are based.

I have been critical of the relationship between Dr Foster and the NHS information centre, and the culture of secrecy which surrounds it, for many years (see:
* CfH Learning to Manage conference March 2009
* NHS-HE Forum Meeting May 2008
* Dr Foster & the Information Centre July 2007
* NAO report on Dr Foster Feb 2007
* Is NHS data there for any company - or just one? April 2006
* Paying for data your taxes paid for March 2006)
however I think the main current issue is around the selection of indicators and the way in which they are collected an published.

Last week the press picked up on the perceived discrepancies between the Care Quality Commission demand for improvements at Basildon and Thurrock University Hospitals NHS Foundation Trust following unannounced inspections and league tables showing them performing well - based on self reporting mechanisms completed by the trusts.

The patients association, amongst others, have called for a more rigorous inspection regime, rather than allowing organisations to rank themselves against published criteria - and this is probably a good thing, but the Dr Foster 2009 hospital guide highlighted in the Observer used a different set of criteria, focusing specifically on "avoidable deaths" and untoward occurrences" showing wide variations in the hospital standardised mortality ratio but not taking into account wider measures of patient satisfaction etc.

Errors such as swabs being left in body cavities during surgery are important, and a terrible tragedy for the individuals involved, they are rare when you take into account the number of operations performed. Measures which improve the quality of care and reduce avoidable problems are obviously to be welcomed, however the latest Dr Foster report has been described as "alarmist".

I think a wider debate on the appropriate indicators of performance and an openness about the quality of data which supports them is overdue and to be welcomed.

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