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CQC should use Ofsted-style performance ratings

The Nuffield Trust has suggested that the Government introduces a new rating for hospitals, general practices, care homes and other social care providers.

Its new review highlights a gap in available information, with no independent system attempting assessment across the whole NHS. The Nuffield Trusts proposes that the CQC could provide information on the quality of care of providers to inform the public and improve accountability of care.

Attempts to rate hospital performance should focus on individual departments and clinical services, not indicators of management performance such as finances, and ratings must be combined with other approaches, such as surveillance, inspection and special investigations.

The Government should consider how any extra burden a rating might impose that could detract from patient care can be managed, and the organisation implementing the rating must be given the resources and time to develop a new strategic direction.

The rating system should also be sector-led with public representatives and users of care “meaningfully involved”, and an evaluation of costs and benefits from the beginning of the system.

Nuffield Trust chief executive Dr Jennifer Dixon, who led the review, said: “There is a major gap in the information available to the public on the quality of care of their local hospitals, GP practices, care homes and other providers, people are left in the dark.

“The information that does exist is spread across a number of sources, which may reduce its impact and use by the public. One aggregate, comprehensive rating of providers may provide more clarity and simplicity for the public, especially if it came from one 'official' trusted source.

“However, this is not a simple task and it’s clear from the responses we received to our consultation that there is more appetite for introducing ratings in social care and possibly general practice, than in hospitals which tend to be more complex in the range of services they provide.

“Constructing a summary rating for hospitals is possible but would be a difficult and complex task. Ultimately, the goal should be to introduce ratings that drill down to the level of individual departments and clinical services so that patients can have a much truer understanding of the quality of care provided in those departments.”

Dr Peter Carter, chief executive & general secretary of the RCN agreed that there is a gap in the provision of information to patients and said: “Accurate and comprehensive information can help patients and clinicians, and should be geared towards their needs rather than the needs of managers to balance the books. Any ratings system must support staff without adding an extra tier of bureaucracy.”

National Voices’ chief executive, Jeremy Taylor, who contributed to the review, said: “We need a clearer set of measures that capture the safety, quality and experience of care and we call on the Government to follow the Nuffield Trust’s recommendations. These set out a way forward to a better system, involving patients and the public at the design stage so we capture the things that really matter to people.

“We also endorse the Nuffield Trust’s view that a single performance score wouldn’t work in hospitals: there we need a system that highlights variations in performances across different wards and departments.”

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