Every NHS trust in England has been given a star rating by the country's independent health watchdog, the Commission for Health Improvement. For primary care trusts, it is the first time the exercise has been done.
Figure 1.
Matt Tee, project director for the star ratings initiative, and Dame Deirdre Hine, chairman of CHI, who admitted that capturing patients' experience was one of CHI's biggest challenges
Credit: MARK THOMAS
Although acute and specialist trusts show a general shift towards a higher ranking, there has been a slide in ratings among ambulance and mental health trusts, suggesting little improvement or a fall in standards in these services.
The commission has rated each of the 579 English NHS trusts according to its performance across a range of indicators including whether it achieved government targets; clinical factors such as surgery outcomes and infection rates; patient satisfaction; and managerial quality. Altogether, 599 star ratings were awarded because some trusts provide more than one service.
Overall, more services (87) have been awarded three stars this year than last year (68), excluding primary care trusts. But there are also more services awarded no stars this year—22, compared with 12 last year. Ambulance services in particular have shown a drop in standards, with 14 with fewer stars than last year. The “dip” may be partly explained by the fact that ambulance services have been more rigorous than before in the way they record and collate data, said Matt Tee, project director for the star ratings initiative.
Star ratings at a glance
Among acute and specialist trusts, 50 had a higher rating than last year, 81 stayed the same, and 35 had a lower rating
Among ambulance trusts, 2 had a higher rating than last year, 15 stayed the same, and 14 had a lower rating
Among mental health trusts, 13 had a higher rating than last year, 19 stayed the same, and 21 had a lower rating
Primary care trusts were rated for the first time: 45 received three stars, 139 two stars, 98 one star, and 22 no stars
No primary care trusts in London were awarded three stars
Four trusts (Aintree, Essex Rivers, Walsall, and Newcastle) on the short list to become foundation hospitals dropped from three star to two star status
Royal Alder Hey Liverpool Children's NHS Trust received three stars, up from two stars last year
The secretary of state for health, John Reid, has welcomed the latest ratings as a sign that standards across the NHS are improving. “I am encouraged that the Commission for Health Improvement has found that hospitals are improving, although obviously I am disappointed that there are four more zero rated [acute] hospital trusts,” he said. “Many of the targets are tougher this year—as we reduce the maximum time patients have to wait for treatment—yet still most hospitals are meeting them. There are 10 more three star hospital trusts, and almost 80% of hospital trusts have maintained or improved their rating from last year.”
However, the BMA's chairman, Mr James Johnson, has questioned the value of the star ratings for patients and the demoralising effect that a low ranking has on staff: “Nobody should judge how well a hospital is doing by looking at star ratings. They measure little more than hospitals' ability to meet political targets, and they take inadequate account of clinical care or factors such as social deprivation. It is grossly unfair on staff working in low rated trusts that public confidence in them is being undermined.”
Dame Deirdre Hine, chairwoman of the commission, admitted that capturing patients' experience to reflect accurately the quality of services was one of the biggest challenges facing the commission. “We all recognise that the star rating business is far from perfect, and we have been discussing with the Department of Health to look at ways in which we can make the rating more reflective of performance and relevant to the public,” she said.
She rejected, however, the claim that low ratings could demoralise staff in poor performing hospitals, leading to further falling standards. “An awful lot depends on whether they [the trusts] see it as a challenge or take it lying down. It's about leadership and energy to move themselves out, and it begs the question of what needs to be changed,” she said.
To access the star rating see www.chi.nhs.uk/ratings