Efficiency 'league tables' for hospitals

PATIENTS will get their first chance to judge which hospitals are most efficient when 'league tables' are published next year.

The NHS management executive and the Audit Commission have identified measures for inclusion in the tables, while district auditors will monitor how hospitals gather and provide information to try to guarantee accuracy.

Sir Duncan Nichol, the NHS chief executive, agreed yesterday that 'hospital activity' - the number of patient treatments carried out and the yardstick most often quoted by ministers - was not an adequate benchmark for judging the success of health service changes.

'Activity is an important way of assessing value for money. But it is a crude and one-dimensional way of measuring the performance of the NHS,' he said.

The league table is one of the next phases of the Government's Citizen's Charter initiative. Hospitals will have to provide statistics on five indicators for inclusion in the first year's tables. They are: average waiting times for in-patient treatment; the proportions of surgery carried out on a day case basis, of accident and emergency patients who are assessed for treatment within five minutes of arrival, of out-patients seen within 30 minutes of appointment times; and the percentage of

cancelled operations.

Information on ambulance services will be published separately. Each service will be assessed according to the proportion of calls attended within 14 minutes. Ambulance crews should be on the scene of an emergency within that time in 95 per cent of all cases,

under existing Department of Health guidelines.

The first tables are due out by the end of next year. Ministers intend to add more performance indicators by 1995. One important addition will be the average time from a GP's referral to the first out-patient appointment.

Regional health authorities must set local targets on first out- patient appointments by this April. Other indicators will include hospital infection and re-

admission rates. Officials have concluded that it would be highly misleading to force hospitals to publish death rates.

Sir Duncan told a conference of NHS managers in London yesterday that the Patient's Charter had served as a 'crucial stimulus' to improvements in the new NHS internal market. But it was time to build on the charter's foundations.

'We need accessible comparative information - league tables by another name - with the ultimate objective of raising the public's ability to judge, influence and choose health services.'

The Government will be anxious to avert a repetition of the political furore that accompanied publication of the school league tables last year, and Sir Duncan ackowledged that there might be 'lessons to learn' from that episode. He added: 'But let's get the information out. It's better to get some information out, than not at all.'

David Blunkett, Labour's health spokesman, gave a cautious welcome to the initiative. 'We support patient choice and improved performance but these must be built on local co-operation rather than competition.'

Future of NHS regions, page 7