comment

Arguments over this year's health authority and trust 'league tables' - or more properly the NHS performance indicators - began to rage days in advance of publication when a well-briefed Sunday Times took it upon itself to name and shame Avon health authority as the 'worst' in the country for emergency hospital re-admissions (see news, pages 2-3).

Chalk that one up to the Department of Health or whoever briefed Mr Murdoch's flagship newspaper on lobby terms. It even provoked the local community health council into condemning the report as 'an ill-founded scare story', and into demanding from health secretary Frank Dobson an explanation of the story's genesis.

And so, from genesis to apocrypha. Mr Dobson is supposedly rather keen on the indicators: they show him getting tough on poor performance, and meet all sorts of pledges to tell people more about their health service.

Civil servants are less keen - at least in terms of courting the kind of publicity the DoH was actively seeking this week. The technical specialists get edgy at the very idea that the indicators can be used to compare HAs or hospitals - let alone draw up league tables. They are not even intended to provide answers for the public, they warn: it is highly complex stuff intended merely as a starting point from which clinical directors can begin to ask questions.

And so the practical difficulties mount. Add a breakdown in standards of data collection which led to the exclusion of 62 trusts from the charts - a problem which civil servants concede may be the fault of the DoH's new data-gathering system - and the whole exercise begins to look a little shaky.

Throw in a few indicators whose relevance to the performance objective to which they are tied is obscure in the extreme - teenage pregnancies as an outcome of NHS care - and it becomes apparent that little progress has been made in shoring up the whole jerry-built edifice of NHS performance assessment since the system was put out to consultation in January last year.

The two fundamental questions, however, remain now as they were then: do league tables - for that is what they will be taken to be - add anything to NHS openness and accountability? And does the inevitable public scourging of organisations at the foot of the table add one jot to the quality of health service care? If evidence cannot be found to support either argument, there really is little point proceeding along this path.

Topics