| There’s no question that England’s publicly run National Health Service is in trouble. Even the government acknowledges that it’s broken. Fixing it is proving to be one of Prime Minister Keir Starmer’s biggest challenges.
Among the government’s latest strategies is a league table ranking the system’s NHS trusts — organizational units that group together services by geography or function — and allowing patients and experts to pore over the results. Cue headlines in the British media highlighting the worst hospitals in the country. The proposed playbook also includes offering the best chief executives higher pay to take on challenged trusts and rewarding top-performing units. It’s all a bit reminiscent of the private sector, where CEOs can expect to see their own relative performance reflected publicly in the company’s stock price — and their own remuneration.
But can naming and shaming really fix what can seem like impossible problems in the health service? Experts are not convinced.
These league tables aren’t entirely new. The approach is pretty similar to a model rolled out in the 2000s, according to Phoebe Dunn, senior policy fellow at the Health Foundation think tank. Then, a star system was put in place but eventually scrapped as it was felt to be “too crude a measure of overall performance,” she says.
“The evidence suggests that these kind of overall organizational ratings can improve performance in the areas that are measured, but they can also have negative effects,” Dunn says. With the star ratings system, “we saw things like gaming, or distortion of local priorities given it’s a very nationally driven, kind of top-down approach.” The takeaway from the 2000s? Rankings aren’t a quick fix.
If you, like me, always check Google Maps’ reviews of restaurants before you visit, you might be asking: Shouldn’t we be able to do something similar for hospitals, considering how much higher the stakes are?
“Transparency is a good thing,” says Ruth Robertson, senior policy fellow at the King’s Fund, another think tank. But she questions the value of publishing data in a league table form.
“A ranking based on giving a single rating to a huge hospital trust is quite simplistic,” she says, adding that it’s difficult to pinpoint “the link between that and an improvement happening.” In addition, she says these rankings don’t include other key information that informs patients’ choices, like how far away a hospital is.
Many countries track performance of their health system, but it’s rare to have an outright best-to-worst ranking. In the US, the government uses a star rating for hospitals and offers a tool to help people choose better-performing ones.
There’s a certain logic to treating trusts like listed companies. But it equates the autonomy experienced by the CEO of, say, Pfizer or AstraZeneca with that of leaders in a very different kind of institution. The chief executive of an NHS trust can’t turn around the organization on their own, says Robertson. “Giving one leader an X percent pay rise is not going to be able to solve a really intractable issue like the A&E wait at a hospital,” she says. An issue like that “is an indicator of problems within the hospital and across the whole health system.”
Instead of hospitals, maybe we should be ranking health system improvement proposals… — Ashleigh Furlong |
