York research reveals problems with NHS star ratings
Posted on 28 January 2005
A study led by researchers at the University of York has found that star ratings, introduced in the NHS in 2001 to grade the performance of acute hospitals, are widely believed to be based on inaccurate or incomplete information.
At one hospital, data was purposely "manipulated and misrepresented" to secure a more favourable rating, while ploys used included scheduling cancellations at a time to avoid unfavourable data and re-classifying trolleys as beds.
The researchers also heard reports that pressure to meet the performance targets has also led, in some cases, to varying degrees of bullying, intimidation and harassment of hospital staff.
The research, led by Dr Russell Mannion of the University's Centre for Health Economics and published by the Royal Society of Medicine Press, found that staff at some hospitals felt that the star ratings were not a fair reflection of their organisation's performance.
This research highlights some important gaps in knowledge and failings in current policy and practice
Dr Russell Mannion
But the study, conducted with researchers at the Universities of Manchester and St Andrews, concluded that some hospitals were positive about the ratings system, as it aligned local management performance with key national targets. It was also seen as improving communication between the Government and acute hospitals as well as identifying 'dysfunctional senior management' which might otherwise have remained undetected.
Some staff were also concerned that the ratings failed to acknowledge unique local conditions, often beyond a hospital's control, which had an adverse impact on its ability to function efficiently. Pressures to meet the performance targets were reported to have led to various degrees of bullying, intimidation and harassment of staff in apparently under-performing Trusts.
The study also found that in 'high' performing Trusts, the desire to retain their stellar status was creating a demanding climate for staff which could sometimes extend to discomforting levels of pressure and coercion.
Dr Mannion said the study revealed a "widespread belief that the data used to calculate the star rating were often incomplete and inaccurate" with staff at one highly-rated hospital admitting to "purposefully manipulating and misrepresenting data in order to improve their rating."
He added: "This research highlights some important gaps in knowledge and failings in current policy and practice. That star ratings may be used for good or ill makes it imperative that the Healthcare Commission monitors the impact of these data, especially in terms of any dysfunctional consequences for patients and staff."