Wes Streeting’s plan to introduce league tables of the ‘best’ and worst performing NHS providers knocked me for six.
Listening to the news on the radio during the school run yesterday morning, I couldn’t help but to compare the proposal to Ofsted’s school league tables – in particular the significant human impacts such ranking systems have.
Ruth Perry, a headteacher from Reading took her own life last year after Ofsted inspectors dropped the grading of her school from ‘outstanding’ to ‘inadequate’. This was a hard-working professional, who dedicated 32 years to teaching, destroyed by a meaningless rating.
Now I’m fearful this will be the reality for NHS staff too.
Starting from next year, Wes Streeting plans to assess NHS providers against a set of criteria and publish the results. Those doing well will be rewarded financially. If performance dips – financial controls will be imposed, and failing managers will be removed.
But this could have a disastrous impact. Especially because we know the mental health of NHS staff is already fragile.
Since 2011, 2,500 healthcare workers have died by suicide – that’s four people every week. We really don’t need to make their workplace more toxic.
Streeting’s ‘no more rewards for failure’ sounds like a sure fire way to demoralise already hard-working staff even further. No one goes to work in the NHS or in the education sector to intentionally do a bad job.
Is there any evidence that league tables in health or education ever improve care? It’s not a novel idea within the NHS, and they’ve been used before – but focusing on measurable targets often leads to unintended consequences.
Take the four-hour waiting time target in emergency departments, which measures the total time patients should spend in A&E. This has been used as a barometer of hospital performance.
However, staff have been known to hyperfocus on achieving these goals and game the system by – for example – moving patients to corridors at three hours and 55 mins to avoid breaching targets. If this is at the expense of patient care, then do we really want to be part of this game?
Streeting’s package of reforms do nothing to address the actual reasons some Trusts are struggling, and threatens to pull funding and resources from the areas that need it the most rather than providing much needed support.
The reasons for ‘failure’ are usually plain to see, and if it was as easy as sending in a ‘tunaround team’ to sort it out, then does Wes not think this would’ve been done already?
A Cumbrian newspaper recently published an article ranking ‘best and worst GP surgeries’ in the area. I’ve worked at both the ‘best’ and ‘worst’ and can say without a doubt the reasons for the differences.
The staff at both were hard-working, caring and doing their best.
A ranking system massively oversimplified and ignored huge differences in geography (one was in an area of deprivation and unemployment), demographics (disproportionate numbers of complex elderly patients), and the fact that one was caring for a list size less than 800 patients compared to over 25,000 at the other.
You can probably make a reasonable guess which was the ‘worst’.
Streeting’s reforms come after he commissioned an investigation into the NHS by Lord Darzi, which found that hospital productivity has nosedived in the past five years. During that time, resources have increased by 20%, but the number of patients treated has only increased by 3%.
Lord Darzi also had a lot to say about increasing investment into general practice, which feels like today’s elephant in the room. Our Health Secretary continues to focus on hospital performance, while seemingly ignoring the benefits the entire system could reap from proper investment into GPs. He said himself that the average taxpayer welcomes investment into the NHS, but worries it ‘won’t be spent wisely’.
While the number of staff in hospitals has increased since 2015, the general practice workforce has almost 2,000 fewer fully qualified GPs than we had in that same timeframe. Despite this, an average of 1.4million GP appointments are delivered every working day in England. Talk about productivity!
The recent Budget was an opportunity for our new government to invest in general practice and improve productivity further, but they announced that GP practices will be made to pay higher National Insurance contributions – which could realistically see many struggling practices close.
In place of real investment, we get Wes Streeting’s Ofsted-style NHS league tables.
Let’s move away from targets and tick boxes and listen to the staff because the greatest resource the NHS has is its workforce. We need to avoid reducing the work they do every day to a scoresheet.
Ruth Perry’s family spoke of the decline in her mental health as she waited for her Ofsted report. Since her death, they have campaigned relentlessly for a reform of this punitive inspection system, calling for the welfare of teachers and children to be the priority.
We need to do the same in the NHS.
Instead of NHS league tables, listen to its staff. Listen to Lord Darzi and the report commissioned, then invest into the staff already working hard to prop up the system.
They are doing it on a shoestring, and will only do better if properly resourced and funded – especially the areas that are ‘failing’.
We cannot afford to see NHS staff die.
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