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banner Tuesday, 25 September, 2001, 11:02 GMT 12:02 UK
Will hospital ratings work?
Questions have been raised over how patients will deal with the ratings
Questions have been raised over how patients will deal with the ratings
The government has published its first ever "star-ratings" for hospitals in England. BBC News Online asks what this will mean for staff and patients

Patients can now see how their hospital fares in the ratings table.

The information - on everything from waiting times to ward cleanliness - will influence how the hospital is allowed to spend money.

But some health experts are worried that the information will not help patients, who may be told their hospital is worth no stars, but who will not be able to choose to go elsewhere.

Managers and staff may also be demoralised if they think their hospital is unfairly ranked low.

I don't know if there's anything patients can do. I don't know how they are going to use them

Angeline Burke, Association of Community Health Councils

Angeline Burke, senior policy advisor for the Association of Community Health Councils (ACHCEW), told BBC News Online: "I don't know if there's anything patients can do. I don't know how they are going to use them."

She said patients who hear their hospital is bad and are about to go in for treatment will have no option.

"The situation will be particularly bad if they are in a rural area, and they don't have a number of large hospitals around them."

Some patients may be worried, she said, but others will think the ratings do not match their experience.

Ms Burke said: "I think we need more detail. People know what they are getting from a two or three star hotel, but they don't know what they're getting from a two or three star hospital."

She said patient views and patient representatives like ACHCEW should take part in future assessments, because what patients want can be different from what is measured.

"Cleanliness is important to patients, as is getting assistance to eat if they need it."

Accuracy concerns

The British Medical Association (BMA) said patients had a right to know how hospitals are doing, and hospitals needed to learn from better performing colleagues in other trusts.

But Dr Peter Hawker, chairman of the BMA's consultant's committee, said: "If I have a reservation, it centres on the accuracy of the data upon which the star ratings are constructed.

"I worry that strident reporting of a hospital's weaknesses can dent the confidence of the community in its local hospital, adversely affect recruitment and further damage the morale of clinical staff."

He said it should be remembered that in many places, the service was "over stretched."

John Appleby, director of health systems for independent think-tank the King's Fund said any performance indicators could be important if they held services to account on behalf of the public, and help health professionals and NHS managers to improve their organisations┐ performance over time.

How will it help?

He said: "It is not clear how the new 'star' system will achieve these goals.

"It does have the advantage of giving clear comparisons from one trust to another, and may in time help to show where improvements have happened."

But he added: "It remains uncertain if the government's proposals to give 'earned autonomy' to NHS trusts that score well, while controlling more heavily those with poor ratings, will really help them to improve performance."

And he said more freedom for doctors and nurses to tailor local services may be better for hospitals.

Angeline Burke said hospital managers may be encouraged to act by a bad rating - if they agree with it.

But she said they could be demoralised if they feel their hospital is performing badly for reasons beyond their control.

Being given three stars could be a double edged sword for hospitals, said Ms Burke.

They are set to be inspected less frequently than more poorly rated hospitals, which she said, means they could "rest on their laurels"

Getting one or no stars could also have implications for recruitment, she said.

"Would they really want to go to a poorly performing trust, rather than one down the road which got three stars and where they might have a chance of getting a bonus?

See also:

09 Mar 00 | Health
Hospital league tables lambasted
16 Jun 99 | Performance 99
How performance tables started
28 Oct 99 | Health
CHI: The basics
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