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Thursday, 9 March, 2000, 11:24 GMT
Hospital league tables lambasted
Surgery
BMA says league tables are insensitive
Hospital league tables are of little use in their current form, according to a British Medical Association (BMA) report.

The BMA says the information is too complicated to inform patients and not complex enough to help doctors.

It also says that some health authorities are handing over "frail quality" information.

The BMA's Board of Education and Science says a legal obligation should be imposed on trusts to provide high-quality data.


If the audience is the patient, then they are overly complex and will not satisfy the public's desire for simple, easy-to-understand, relative information

British Medical Association
The Clinical Indicators were first published by the government last June.

They measure the performance of every hospital in England in six areas:
  • The number deaths in hospital after surgery
  • Deaths following a fractured hip
  • Deaths after a heart attack
  • Readmission to hospital following discharge
  • How soon patients return home following admission for a stroke
  • How soon patients return home after admission for a fractured hip
The six indicators were chosen after consultation between doctors' leaders and ministers because they are aspects of clinical care which impact on quality of treatment.

More areas will be included over time until eventually nearly every aspect of care will be covered.

But the BMA document claims that the statistics do not include adjustments for the fact cases can vary widely in type and complexity, or for the area hospitals are in.

Neither does the system use risk adjustment, which allows for factors affecting success rates, such as a pre-existing illness in a patient.

Adjustments for both risk and case mix should be included to improve the accuracy of the figures, the document says.

It says: "It is apparent from this overview that the clinical indicators presently available and those proposed do not fulfil all the criteria we have variously established, largely because their audience is ambiguous."

"If the audience is the patient, then they are overly complex and will not satisfy the public's desire for simple, easy-to-understand, relative information.

"If their audience is the individual clinician then they are insufficiently specified for local circumstances, including case mix and relative mix."

The BMA conceeds that tables are of some help to health authorities in assessing performance, but argues that basically the figures are too "insensitive".

It recommends that the Government conducts more research into factors that can affect outcomes in care to ensure the figures are accurate.

A Department of Health spokesman said ministers had accepted when the tables were first published last year that they were far from perfect.

He said: "We expect to publish a further set in the summer and that set will be much more refined than those that we were able to produce last year.

"We always said that we would be continually refining the tables so that they will provide the public with a valuable resource, and health professionals and the NHS with a level of benchmarking they can use to assess their own performance."

Nigel Edwards, director of policy at the NHS Confederation, which represents health authorities and trusts, said: "The main concern about collecting this kind of data is not just a technical question of how it is gathered and whether it is consistent or not.

"But we need to ask what changes in practice and behaviour do the findings bring about? We would encourage the BMA to take this review a step further and look into how to affect change throughout the service."

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See also:

04 Nov 99 |  Performance 99
NHS Performance 1999
17 Jun 99 |  Performance 99
Hospital death rates published
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