'The frail quality' of information in hospital league tables makes them of little use to patients, doctors or managers, the British Medical Association this week warned.

In a discussion paper flagging up the difficulties surrounding clinical indicators, the BMA's board of science and education called for further research on the impact of variations in casemix and risk factors on outcomes. It recommended that future league tables should take account of this.

But the NHS Confederation attacked the paper, describing it as 'backward looking'. Policy director Nigel Edwards said: 'Unless you start using data you can't start improving it.'

Indicators should be used as 'a spur to action', he said. 'The question is, how are you going to make sure people are going to change their performance?'

While acknowledging that there were problems with the way the information was collected, he said: 'If five independent indicators showed you were near the bottom of a league table, you would worry. The important question is how do you change year on year?'

The paper examines the six clinical indicators published last June to compare individual trusts and health authorities. It concludes that they are unlikely to meet the needs of either patients or doctors, and are statistically flawed for the purposes of comparing trusts.

The paper blames these failures on the fact that tables are geared at an 'ambiguous audience'.

Current indicators compared figures on deaths in hospital following surgery, hip fractures and heart attacks; emergency readmissions following discharge; and discharge times following treatment for strokes and hip fractures.

The paper says current data is 'too complicated' for the public and insufficiently specific to be much use to individual clinicians.

It quest ions whether information could ever be made available to the public that will allow useful comparisons of doctors or hospitals, describing the view of performance measures as consumer information as 'misguided'.

But Mr Edwards highlighted developments elsewhere: 'In New York you can look at the death rate of cardiac surgeons on the web.'

Dr Vivienne Nathanson, head of the BMA's professional resources and research group, said the usefulness of such data was in dispute. She said the report was not designed to provide indications of the way forward, but to point out problems with existing data.

'We are not saying that patients shouldn't have information. What we are saying is, there are problems with presenting it as a true league table.'

Clinical Indicators www.bma.org.uk