Leading Article: NHS league tables will help to improve the nation's health

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The Independent Culture
ALL LEAGUE tables are misleading, except perhaps in sport. The health tables published yesterday are no exception. The complex sets of figures showing death rates in different areas, outpatient waiting times, and survival rates for patients with different diseases can all be interpreted in different ways. Poor performance on one measure can have more to do with geography, the population and poverty than with professional competence.

But the tables are important, in that they make it possible to examine objectively how and where the health service most urgently needs to be improved. For too long, the virtue of the National Health Service was accepted as an unchallengeable given. It was as though the fact that Britain had a free health service freed it from the need for any kind of scrutiny. To say that this led to a form of institutional atrophy would be to understate the case.

The asking of questions was not considered acceptable behaviour. Patients were expected to bow down before the medical gods, who answered questions only if absolutely necessary, and sometimes not even then.

The first publication of these "health indicators" - officially, we must not call them league tables - will focus attention on the whys and wherefores of the strengths and weaknesses of different areas. They will also tilt the balance in health care slightly more in favour of the patients than of the professionals. Previous attempts to avoid detailed analysis of the differences in different areas have only helped to keep the problems unsolved. Until recent years most Britons felt too timid to ask questions, let alone to think that we could enjoy anything so quaint as "patients' rights". We were (rightly) grateful that we did not have to pay for the privilege of visiting the doctor. In addition we learnt from experience that we must honour and obey the men in white coats.

In most European countries, this unequal relationship has long since been jettisoned. There, a doctor gains respect for trying to help and cure patients - but he or she knows that the respect is conditional. Admittedly patients are not "customers" in the conventional sense, but nor can their wishes and fears simply be ignored.

Our medical profession has gradually been groping towards the openness that has been so badly needed for so long. The medical welcome for the new tables should therefore itself be welcomed as confirmation of a change of tack. Let us hope it is not just lip-service.

Analysing the respective performances of different hospitals is likely - initially at least - to create confusion and misunderstandings. But it is at least a start. Above all, yesterday's publication means that there is greater information in the public domain. That can only be a good thing - for patients and doctors alike.