“Good” and “bad” hospitals: it’s easy to get the judgement wrong

By David Beeson

Last weekend was fun, with all the denunciations of the worst-performing hospitals in the NHS. With high readmission rates and high mortality, these are terrible, dangerous places, not institutions of healing.

Except that I’ve spent quarter of a century working with healthcare information. I am deeply sceptical of the kind of indicators this study used. Take mortality figures for instance: they’re pretty dubious, especially when they’re based – as these were – on deaths in hospital only. Unless you take into account people who die soon after leaving hospital, the institutions which discharge or transfer their patients early will always look better on a mortality measure. Unfortunately, linking up deaths after leaving hospital with the hospital records is not something we can do easily, and certainly not something we can do for all hospitals.

In any case, the idea that a hospital is ‘good’ or ‘bad’ as a whole, in some simplistic black or white way, is deeply misleading. A hospital with an excellent ophthalmology specialty may leave a lot to be desired in cardiology. Even individual specialties may cover a wide range of performance quality: one endocrinologist may be outstanding while it may be best to avoid his colleague down the corridor. In fact, even when it comes to evaluating consultants you may need to take account of the condition that needs treating: the surgeon who does an excellent job on shoulder joints may be way below par on hips.

So it didn’t surprise me at all that several of the dirty dozen of apparently underperforming hospitals had been rated good or excellent by the Care Quality Commission. The Commission tries to assess hospitals on a wide range of indicators. They still try to boil them down to a single, overall rating, but at least they’re not trying to judge hospitals on just fifteen measures as this study did – not even one indicator per specialty.

The weekend’s scandal, then, was a lot of noise about depressingly little real information. So why did it generate so much hot air?

It must be because while we all love the NHS, we love to knock it too. The press can work up a real lather of indignation about what they regard as poor healthcare delivery.

Of course, this also has the benefit of providing another stick with which to beat the government. What a mess they’re making of healthcare, we’re told. Even though waiting lists have come down to levels that were inconceivable a decade ago, hospital-acquired infections are dropping like a stone, and in most areas huge strides have been made in treating diseases. Even in the much-maligned cancer services, the improvement over the nineties is remarkable.

How has that been achieved? By at last making the kind of investment in the NHS that the service really needed. That’s the kind of news that ought to be trumpeted from the rooftops. If only to make sure, as we approach the election, that it doesn’t get drowned by the racket of poorly-informed noise coming out of the news media.

Or the Tory Party.