Wes Streeting’s NHS League Tables: A Step or Stumble?

The recent proposal by Wes Streeting to introduce a football-style league table for NHS hospitals has sparked considerable debate. While the plan aims to enhance transparency and accountability, it underscores a significant gap in the NHS’s approach to measuring performance: the lack of emphasis on patient-reported outcome measures (PROMs). As the UK falls behind global standards in this area, exploring how these missed opportunities can be addressed to improve the quality of care within the NHS is essential.

The Current Proposal: A Step Forward, but Not Sufficient

Streeting’s plan involves ranking NHS hospitals based on performance metrics, such as waiting times, financial health, and leadership quality. While this approach has potential benefits, including increased transparency and accountability, it also risks oversimplifying complex issues and neglecting the nuances of patient care. By focusing primarily on performance metrics, the plan may inadvertently reward hospitals that excel in bureaucratic efficiency and massaging performance metrics rather than genuinely improving patient outcomes.

The Global Standard: Prioritising Patient Outcomes

Globally, healthcare systems are increasingly prioritising patient-reported outcome measures (PROMs) to evaluate the quality of care. PROMs provide valuable insights into how patients perceive their health status and the impact of medical interventions on their quality of life. By incorporating these measures, healthcare providers can gain a more comprehensive understanding of the effectiveness of treatments and make informed decisions that prioritise patient well-being.

Addressing the Missed Opportunities

To bring the NHS in line with global standards, several key actions can be taken:

1. Integrate PROMs into Performance Metrics: The NHS should expand its performance evaluation criteria to include PROMs. This shift would ensure that hospitals are judged on efficiency and the quality of care they provide. The NHS can better align its objectives with patient-centred care by capturing patient feedback on outcomes.
2. Develop a Comprehensive Framework: A robust framework for collecting and analysing PROMs is essential. This framework should account for variations in patient demographics and the complexity of cases treated across different hospitals. By doing so, the NHS can ensure fair comparisons and avoid penalising hospitals that serve more challenging patient populations.
3. Promote a Culture of Continuous Improvement: Instead of “naming and shaming” underperforming hospitals, the focus should be on fostering a culture of continuous improvement. Providing support and resources for hospitals to learn from best practices and address areas of weakness can lead to sustainable enhancements in care quality.
4. Encourage Collaboration and Knowledge Sharing: The NHS should facilitate collaboration among trusts to share successful strategies for improving patient outcomes. Hospitals can learn from each other’s experiences by creating platforms for knowledge exchange and collectively drive progress.
5. Invest in Training and Development: Healthcare staff must have the necessary skills and knowledge to implement PROMs effectively. Investing in training programs that emphasise the importance of patient-centred care and the use of PROMs can empower healthcare professionals to deliver better outcomes.

Conclusion

Wes Streeting’s plan to introduce league tables for NHS hospitals is a step toward addressing some of the system’s longstanding challenges. However, the NHS must embrace patient-reported outcome measures to elevate the quality of care and align with global standards. By doing so, the NHS can ensure that its focus remains on what truly matters: the health and well-being of its patients. The NHS can bridge the gap and set a new standard for healthcare excellence by committing to continuous improvement, collaboration, and patient-centred care.

References

1. Wes Streeting’s Proposal and League Tables
2. Streeting, W. (2023). NHS Reform Proposal: Introducing League Tables for Hospitals. The Guardian.
3. The Importance of Patient-Reported Outcome Measures (PROMs)
4. Black, N. (2013). Patient reported outcome measures could help transform healthcare. BMJ, 346, f167. DOI: 10.1136/bmj.f167
5. Snyder, C. F., & Aaronson, N. K. (2009). Use of patient-reported outcomes in clinical practice. The Lancet, 374(9687), 369–370. DOI: 10.1016/S0140–6736(09)61400–3
6. Global Trends in Healthcare Performance Measurement
7. Porter, M. E. (2010). What is the value of health care? New England Journal of Medicine, 363(26), 2477–2481. DOI: 10.1056/NEJMp1011024
8. Challenges in Implementing PROMs in the NHS
9. Devlin, N. J., & Appleby, J. (2010). Getting the most out of PROMs: Putting health outcomes at the heart of NHS decision-making. The King’s Fund. Link
10. Strategies for Continuous Improvement in Healthcare
11. Berwick, D. M. (1989). Continuous improvement as an ideal in health care. New England Journal of Medicine, 320(1), 53–56. DOI: 10.1056/NEJM198901053200110
12. Collaboration and Knowledge Sharing in Healthcare
13. Dixon-Woods, M., McNicol, S., & Martin, G. (2012). Ten challenges in improving quality in healthcare: Lessons from the Health Foundation’s programme evaluations and relevant literature. BMJ Quality & Safety, 21(10), 876–884. DOI: 10.1136/bmjqs-2011–000760