Yesterday I received a promotional email from a publishing company telling me that next week is “Healthcare Quality Week” (but perhaps only in the USA). Who’da thought it? Apparently a great way to celebrate this would be to subscribe to one of their journals. Well, I managed to say no to a danish with my coffee at East Croydon station this morning, so I think I can resist this lesser temptation too.
But the quality of care in the UK is definitely getting a lot of attention. It sort of was trendy for a while in the noughties, discredited through Star Ratings and Sunday newspaper league tables, went away and is now coming back into vogue. It’s worth doing, but it’s jolly hard to look across indicators, specialisms, care settings and disease topics and find an underlying pattern identifying the “bad apples”. (When I say jolly hard, I actually mean impossible. It’s British understatement.)
Yet finding the wrong uns is what people generally expect will happen. People like our Secretary of State for Health, Jeremy Hunt, who said:
As an MP I know how well each school in my constituency is doing thanks to independent and thorough Ofsted inspections. But because the Care Quality Commission only measures whether minimum standards have been reached, I do not know the same about hospitals and care homes. I am not advocating a return to the old ‘star ratings’ but the principle that there should be an easy-to-understand, independent and expert assessment of how well somewhere is doing relative to its peers must be right.
“Right” as in good, I suppose, not “right” as in correct. Well, as the song goes, we are where we are, let’s all get on with it.
The Nuffield Trust and Health Foundation are prominent in this, launching this week something called QualityWatch, joining the field as another publisher of league tables and interactive graphics using existing official data. There is no government endorsement, although that may come. Nuffield Trust ran Mr Hunt’s consultation on rating healthcare providers earlier this year, giving it the thumbs-up, so you can imagine they are in favour.
There is a long history of statisticians versus league tables, which is why I am now writing a retrospective with this title, perhaps for Significance magazine if they like it, perhaps for a medical / health services research audience. I’m going to focus on health because it’s my field but you should look up Harvey Goldstein’s equally critical tone in education, particularly given that “I know how well each school is doing” comment.
I am a member of NHS England’s National Advisory Group on Clinical Audit and Confidential Enquiries. This is entirely my own opinion and not that of NAGCAE, NHS England or HM Government.