The financial pressures on the NHS mean that it is no longer enough to simply look at the quality of care provided by our hospitals. We also need to look at how well they are making use of resources. Fantastic outcomes achieved at an unsustainable price will not last.

Indeed, there is a real risk that if services are not efficiently managed the pressure to cut costs will result in serious damage to standards of care. That is why, for the first time, the Dr Foster Hospital Guide is looking at a number of measures of clinical efficiency alongside measures of quality of care.

Although there was no strong relationship between mortality and clinical efficiency, our findings show that it is entirely possible to achieve quality outcomes whilst keeping costs at a minimum. The trusts that managed both should be commended and their clinical practices investigated and replicated.

Having said this, no trust was rated as highly efficient in every indicator. It seems that there is room for improvement across every acute NHS trust and I hope that this data challenges all hospitals to find innovative ways of reducing costs without affecting patient care.

The Doctor Foster analysis of efficiency combines familiar metrics such as readmission rates with new indicators such as weekend screening or patients with no diagnosis. Others will of course have their own suggestions for factors that should be taken into consideration and we hope to use these in next year’s Hospital Guide to start a wider debate around how we rate and improve the way that trusts operate.

Meeting the Nicholson challenge requires a whole re-imagining of the way that care is provided, so we have also looked at avoidable admissions and the strain this is placing on acute trusts. In today’s healthcare environment, only one thing seems to be certain - quality alone is no longer enough.

Roger Taylor is director of research and public affairs at Dr Foster

District general hospitals top efficiency league