Doctors face best-and-worst listings: Bottomley publishes star-rating tables for NHS hospitals

THE GOVERNMENT yesterday published its first health care league tables giving hospitals star ratings, and immediately raised the prospect of listing the country's best and worst doctors.

Virginia Bottomley, Secretary of State for Health, said the 'NHS information revolution' was unstoppable and she was not ruling out US-style lists which name doctors and rate their performance. Some of this information could be published within two years. More work was needed but that was 'the direction of travel', she told a Westminster press gallery lunch after she had published the hospital league tables.

Her intentions will further anger doctors' leaders and health service unions, who say they welcome the release of information, if it is not misleading. Together with David Blunkett, Labour's health spokesman, they have strongly criticised the star-rating system as a crude measure only of how quickly patients are seen, not how well they are treated.

Dr Sandy Macara, chairman of the British Medical Association council, said: 'I am bound to say I think the Department of Health has shot itself in the foot.'

Mr Blunkett attacked the tables as incomplete and 'flawed'. 'Even the Department of Health admits that one is six is wrong. They ignore the amount of time a patient must wait to see a consultant and don't measure the quality and success of care.'

All the star-rated hopsitals have had their data collection systems approved by the Audit Commission. The Department agrees that 15 per cent of the systems were not up to scratch.

Professor Norman Browse, chairman of the Joint Consultants Committee, which represents the royal medical colleges and the BMA, said: 'Patients must not assume that a hospital with a five- star grade gives good clinical care or one with a single star is a bad hospital.'

St George's Hospital, south London, and Huddersfield NHS Trust have the highest numbers of five-star ratings in the country. Kidderminster Healthcare NHS Trust in the West Midlands had the highest number of one-star ratings. While that was quickly disputed by the trust, which said the figures were inaccurate, a Department of Health spokesman said the tables had been signed as correct in Kidderminster before they had been submitted. It had asked the trust to conduct a 'detailed' audit.

Mrs Bottomley said that the tables were designed to keep the pressure on hospitals and trusts to raise their standards and she intended to make sure it continued. Pressure to improve would come from GPs, the public and the health authorities which buy services on behalf of patients in the locality.

Asked whether the Government would sack chief executives or chairmen of hospitals which did badly, Alan Langlands, chief executive of the NHS, said that it would depend on the circumstances of the individual case. He added: 'The point about these tables is not to victimise individual poor performers but to point it out and encourage improvements.'

Mrs Bottomley said poor performers would be asked by their regions to explain themselves. Earlier, on BBC radio, she had not ruled out sacking managers who failed to improve their hospitals over a period of time .

Philip Hunt, director of the National Association of Health Authorities and Trusts, representing the hospital managers, advised those that had done badly to reassure the public and explain the reasons to local people; to get doctors and nurses to see how improvements could be made and ultimately to talk to the purchasers of the service about money.

'Poor showing will not necessarily tell the whole story. There are big gaps but I think the tables are useful indicators, as far as they go. My gut feeling is that the best performers will also be found to be providing good clinical care,' he said.

The tables have cost nearly pounds 500,000 to produce. They will be updated and published annually.

Separate tables were published yesterday for Wales and Northern Ireland but John Redwood, the Secretary of State for Wales, decided not to give star-ratings to the Welsh hospitals.

The Patient's Charter Hospital and Ambulance Services comparative performance guide 1993-1994. Free copy 0800 555 777.