this week

The government has published the first tables showing how trusts are performing against six clinical indicators, sweeping away the widely derided hospital league tables.

High-level performance indicators were also issued yesterday, underpinning the NHS performance assessment framework launched earlier this year.

Introducing the indicators, which give mortality, readmission and discharge data by trust for the first time, health secretary Frank Dobson said they were 'not league tables' and 'to use them as league tables would be quite misleading'.

But the Sunday Times led coverage with a story headlined 'Hospitals shamed in league tables'.

It named Avon was the 'worst' area of the country for readmissions, a claim denied by the health authority and Bristol and District community health council.

The CHC issued a statement saying the published figures were 'inaccurate or misleading' and called on Mr Dobson to investigate how they were obtained four days before the official launch.

The six clinical indicators published are all that remain of 15 put out to consultation two years ago.

Two further indicators - on complications after surgery - 'may be published in due course after further development work'. Indicators on deaths following specific types of surgery are promised next spring.

James Johnson, chair of the Joint Consultants' Committee, said discussions on producing 'meaningful' indicators had been held 'for several years', but the six were still 'a first attempt to produce such lists'.

'While this provides much interesting information, it demonstrates that we still have a long way to go in the NHS in persuading trusts to provide adequate data,' he said.

The 40 high-level indicators are designed to provide proxy measures for issues such as health improvement and fair access at HA level.

These indicators have also changed since initial consultation, with widely criticised indicators - such as district nurse contacts as a measure of fair access - removed, and indicators to reflect Health of the Nation targets added.

The Institute of Health Services Management's acting director, Suzanne Tyler, welcomed the indicators as 'more sophisticated than we have had before'.

But she said managers would want to see 'contextual information' included in reports, rather than 'crude messages about killer hospitals'.

Nigel Edwards, policy director of the NHS Confederation, said one of the real benefits of the new tables was that those with apparently very strong or very poor performance would look closely at the data. But he argued that there needed to be 'investment in data capture' to refine the tables.

Trusts have been given a 'quality mark' for their data, with 'poor' data provided by 40 trusts, or 17 per cent of the total, excluded.

Dr Kieran Walshe, senior research fellow at Birmingham University's health services management centre, said the focus on data quality issues was 'really welcome' and officials had been 'quite honest' about quality problems.

'The question is still how people will react,' he said.

See comment, page 17.

Quality and Performance in the NHS: high-level performance indicators and clinical indicators.

Deaths in hospital following surgery.

Deaths in hospital following a fractured hip.

Deaths in hospital following a heart attack.

Readmission to hospital following discharge.

Returning home following treatment for a stroke.

Returning home following treatment for a fractured hip.