'Star rating' style system back on the agenda for NHS

The regulator wants to move away from simply assessing whether organisations are complying with its standards to making and publishing an overall judgement about them.

The news comes as the Nuffield Trust’s review into whether Ofsted style ratings could be introduced in health and social care, published this morning, said developing overall measures for hospitals would be “difficult and complex”. Nuffield chief executive Jennifer Dixon, who led the review for the government, also said it would take between five and ten years to develop ratings for individual departments and clinical services.

However, in an exclusive interview with HSJ, before the publication of the Nuffield review, CQC chair David Prior said the regulator wanted to introduce hospital level ratings quickly.

He said they would be similar to the system of “star ratings” used for hospitals last decade. Mr Prior the information would initially be presented with a detailed narrative sitting alongside it. Ratings will be updated in “real time” rather than just once a year as with previous rating systems, he said.

“Whether it’s a star rating or a whether it’s ‘excellent’ and ‘good’, it has to be something the patient can understand. It’s not going to be a perfect system to start with,” he added.

While the CQC and the Nuffield trust both found an appetite for a ratings system in social care, Mr Prior accepted reintroducing such a system in the NHS was unlikely to be universally popular in the service.

The previous star rating system run by the Healthcare Commission and the Annual Healthcheck which followed it were disliked by many in the NHS as it was felt they could not capture variation in performance within a trust. The Annual Healthcheck was fatally undermined when serious problems were uncovered at Basildon University Hospitals Foundation Trust, despite the trust having a good rating.

Mr Prior said the new chief inspector of hospitals, to be appointed later this year, would ensure judgements were fair.

Asked whether the CQC had concluded that star rating system was the right kind of approach, Mr Prior said: “If we’d kept it, it would have been a lot better system now than it was then.”

Launching the outcome of her ratings review yesterday, Ms Dixon agreed the Annual Healthcheck had been abandoned prematurely.

She said: “As constructed the annual health check did not do the best but it’s construction was not a bottom up sector led one, it was [based on a view that] these are the national standards.

“Although the annual health check did not spot Mid Staffs by itself it may be that a better system could do.

“I think it would have been useful to continue it and have a better examination of its benefits and costs.”

The Nuffield review recommends the CQC is made responsible for producing the ratings, and is given the time and resources necessary to do so. It suggests more progress could be made with less complex services such as GPs and social care and warns the government to be mindful of increasing the regulatory burden on providers and evaluate the costs and benefits.

It suggests a range of data that could be used in ratings including peer review reports, NHS Litigation Authority judgements, waiting times, staffing levels and quality and outcomes framework indicators.