Wes Streeting plans to publish a football-style league table of the best- and worst-performing hospitals in England, prompting fury from NHS bosses and staff at the prospect of struggling trusts being “named and shamed”.
The health secretary will announce the controversial move on Wednesday to an audience of health service leaders and defend it as a “tough” but necessary way of raising care standards.
“There will be no more turning a blind eye to failure. We will drive the health service to improve, so patients get more out of it for what taxpayers put in,” he will say at the annual conference of NHS Providers, which represents England’s 220 NHS trusts.
The league table will be based on metrics such as how long patients have to wait for A&E treatment, surgery and other care, the state of the trust’s finances and also how good its leadership is judged to be.
Streeting hopes to have it ready to be published by the start of next April. He will also set out plans on Wednesday to sack “persistently failing managers” and send “turnaround teams” of improvement experts into poorly performing trusts, including those with big deficits. Trusts with good performance, or which raise themselves up the league table, will be rewarded with extra money to buy equipment and repair or construct facilities.
Healthwatch England, the service’s patient champion, said the league table 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 either an outstanding or poorly performing NHS trust feels like a postcode lottery,” said Louise Ansari, Healthwatch’s chief executive, adding that the service was not good enough at measuring patients’ outcomes and experiences of care.
“Establishing a better system that encourages NHS managers to focus on delivering the best care as efficiently as possible, and leads to quicker changes at struggling trusts, would be good news for everyone,” she said.
But the plan prompted anger from trust leaders, doctors and nurses, who voiced scepticism that publishing a league table would necessarily expand the provision of high-quality care.
“The prospect of more ‘league tables’ will concern health leaders, as these can strip out important underlying information,” said Matthew Taylor, the chief executive of the hospitals group the NHS Confederation. “NHS staff are doing their very best for patients under very challenging circumstances and we do not want them feeling like they are being named and shamed.”
He also challenged the basis of Streeting’s plan, adding: “League tables in themselves do not lead to improvement.” Trusts which are struggling are often doing so because they have too few staff or are facing intense demand for care because their local population is so unhealthy, he added.
Dr Nick Murch, the president of the Society for Acute Medicine, which represents hospital doctors, warned that a league table could make patients shun their local NHS trust, and hit staff morale.
“Penalising and shaming struggling hospitals … is simply likely to create division, damage patient confidence and further demoralise staff who are striving to provide good care in an already poor environment,” he said.
Patricia Marquis, the Royal College of Nursing’s executive director for England, said that while the NHS should not tolerate poor management, the league table risked “scapegoating trust leaders for underinvestment and systemic failures [and] is not the solution. NHS staff must not be pitted against one another. Tables and rankings without addressing root causes could undermine public confidence.”
NHS England will undertake “a no-holds-barred sweeping review of NHS performance across the entire country, with providers to be placed into a league table”, the Department of Health and Social Care (DHSC) said.
“This will be made public and regularly updated to ensure leaders, policymakers and patients know which improvements need to be prioritised,” it explained.
One 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 lead nonexecutive director, as first disclosed in the Guardian last month.
But one trust boss said that it 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’s chief executive, Amanda Pritchard, announced that from next month, women in England will be encouraged to attend cervical and breast cancer screening by receiving messages on their mobile phone.
The new “ping and book” service is intended to tackle the fact that last year, 35.4% of women who were invited to a breast screening appointment did not attend. The reminders could “save thousands more lives”, Pritchard told the NHS Providers gathering in Liverpool.
