Health Check: Jeremy Laurance

What makes a decent hospital?

There are two things people going into hospital for an operation want to know. Will I come out alive and will I be better than I was when I went in?

You can search in vain for an answer to either question in the hospital league tables published on Tuesday. True they include a column labelled "death rates within 30 days of surgery". It shows, worryingly, that 31 trusts "significantly underachieved" their targets.

But what type of surgery would this be? The tables do not tell us. I suspect that a surgeon who specialises in rearranging coronary arteries will lose a few more patients than one who slices bunions from toes.

It is on grounds like this that critics have sniped at the league tables ever since they first appeared in 1994. Roy Lilley, the exuberant former NHS manager, was at it again this week complaining that they told patients nothing worth knowing, patients didn't have the power to act on the information and the data were inaccurate anyway.

Ministers have a standard response to this charge and they trotted it out again. The data need refinement, but it is only by publishing them, and getting feedback, that we can develop measures that are more relevant and more helpful to patients, they said.

That sounded convincing seven years ago when the first league tables appeared. But the argument is wearing thin now. The measures have been honed, and shaped and in some cases recast entirely and still the call is for refinement and more refinement.

Remember the row, ministers point out, which accompanied publication of the first school league tables. Now they are an essential feature of the academic year, as established as summer exams and winter nativity plays

Hospitals, however, are more complex organisations than schools and have less clear measures of success. Helping a patient achieve a good death may be just as important as saving a life. Can a paper exercise involving the collection of statistical data capture this complexity?

Probably not. Personally, I doubt that league tables will ever provide more than a crude measure of NHS performance. But that does not mean the exercise is a waste of time. This is where Mr Lilley is profoundly wrong. Mr Milburn made the point on Tuesday.

"You have known," he said indicating the assembled press, "and we have known where the bad hospitals are. We have always known. But that information has been privileged access. I believe profoundly the patient has a right to know."

Turning political and media gossip into hard fact is what the hospital league tables are about. They help us see how successfully individual NHS hospitals are run. This information has been available within the NHS for at least 20 years. It was distributed annually round the service on computer disks. But nobody outside a small coterie of managers and systems people saw it. Certainly not patients.

I got hold of one of these disks some years ago when I worked for The Times. I published a table of death rates and got calls from managers across the country enquiring how they could obtain the raw data. They had never looked at the computer disks they had been sent.

Now the information on hospital performance is in the public domain, every manger knows where the data are, what they show and what the implications are. It increases pressure on them to act. They can no longer ignore their long trolley waits, high sickness absence or slow complaints procedure. They must respond.

That is the virtue of making the league tables public – it concentrates managers' minds and helps them kick ass. Of course they are there to inform the public – but their real purpose is as a lever for change.