Aggregate hospital ratings 'risk leaving out what matters'

MHP Health Mandate’s report Quality at a glance: Using aggregate measures to assess the quality of NHS hospitals is published today.

It comes as a government commissioned review on the use of Ofsted-style aggregate quality ratings for NHS providers, by the Nuffield Trust, is due to report at the end of this month.

Health Mandate, a policy consultancy, has created a “quality index” rating for hospital trusts based both on their overall performance, and performance in relation to a specific condition - lung cancer.

The report says: “Despite the relative ease of [creating them] aggregate ratings at an organisation-wide level run the risk of leaving out what matters to patients with specific conditions.

“This is because an aggregate rating offers only an overall assessment of a hospital’s quality, even though this may incorporate information on services which a patient is unlikely to use. This report, therefore, also
sets out one approach to compiling quality ratings for individual conditions - in this case lung cancer.

“The report finds that there is no link between the aggregate and the specific quality ratings we have developed, and therefore concludes that - to be relevant to patients - attention must be focused on
quality ratings for individual conditions, even though there is also a place for aggregate quality measures.”

Health Mandate looked at which quality measures were most important to people, and used the information to weight their own “index” score. The most important factors were good patient experience, operation waiting times, and infection rates.

According to the consultancy’s work and overall “quality index”, the highest performing organisation is the West Suffolk Foundation Trust.

The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust came second in the rankings, followed by Harrogate and District NHS Foundation Trust, Kettering General Hospital NHS Foundation Trust and Frimley Park Hospital NHS Foundation Trust.

The worst-performing trust, according to the list, was Barking, Havering and Redbridge University Hospitals NHS Trust, followed by North West London Hospitals NHS Trust.

Many of those towards the bottom of the list and have previously been subject to regulatory intervention.

The index shows a strong relationship between Foundation Trust status and high performance. Only four out of 37 trusts in the top quarter do not have foundation trust status. while 23 out of the 36 trusts in the bottom quarter do not have foundation trust status.

Mike Birtwistle, managing director of MHP Health Mandate, said: “Quality in health is complex and there is a strong case for bringing information together to enable an at a glance assessment of a trust’s performance. Every board of every hospital should be looking at this at every meeting. It picks up the specifics that matter most to the public, providing a barometer of how hospitals are performing.

“We have seen what happens when people wait for patients to be harmed before taking action to improve the quality of care. We need to use much more sensitive and relevant measures of quality. The government needs to provide the resources to encourage this to happen.”