Will hospital trust league tables help improve the NHS?

0:02Hi, I'm Charlie Duffield and welcome back to The Standard Podcast.

0:30friends. He's just missing England. And I just think LA is beginning to pull. But first, today new football-style league tables rating the performances of NHS trusts in England have been published for the first time, with specialist hospitals taking the top slots. The rankings score NHS trusts on seven different areas, including waiting times for operations, cancer treatment, time spent in A &E and ambulance response times. Moorfield Specialist Eye Hospital in London tops the table, with the Queen Elizabeth Hospital in Kingslyn, Norfolk at the bottom. Countess of Chester Hospital NHS Foundation Trust, where convicted killer Lucy Letby worked as a nurse, was ranked second to last.

1:18The Health Secretary, Wes Streeting, said the move would help banish the postcode lottery in the speed and quality of treatment, and the Department of Health and Social Care said it marked the start of a new era of transparency and accountability in the NHS. Chief executives will be held accountable for their league table rankings by being sacked or having pay docked by up to£15 ,000 if they fail to improve performance. But critics have cast doubt over how useful league tables are, and trusts have questioned whether they use the right metrics. Joining us now is Sebastian Rees, Head of Health at the Institute for Public Policy Research Think Tank.

2:00Seb, what's your reaction to this news today? A little bit of background on this. So what has been published this morning is the kind of first set of comprehensive league tables on NHS performance for the last little while. Although the NHS had kind of experiments with this before, So there was a rating system in the early 2000s, which ranked hospitals in a similar way. But basically what this does is every NHS trust in England is given an overall performance score based on a number of different metrics. So those are things like wait times, the financial situation of the trust, patient and staff feedback.

2:34And then they're given a total score, which will range between one and four. And those kind of also reflect the segments that different trusts have been placed in. So if you're a top performer, you'll get a score of one or one point, whatever. If you're in the worst performance category, you'll get a score of four or four point whatever. So what that means essentially is those top performing trusts, those are going to be the ones that in the next few years will be given additional freedoms on how they spend their money, the kind of performance targets that they have to meet. And those in the kind of four category will be much more tightly managed.

3:04I think in terms of reflections on this, there's a bit of a good story here. And I think that there are some questions about implementation of this. So I think the first thing to say is this is clearly a really strong signal of intent from the government. They're clearly taking the attitude that sunshine is the best disinfectant in the NHS and that we should really clearly shine a spotlight on good performance in the NHS and also take a hardline approach on poor performance. It's particularly striking that a lot of the emphasis here is on financial management. Waste reading has been very clear that he'll take a zero tolerance approach to financial mismanagement in the NHS and financial management in NHS trust is really strongly featured here.

3:41So you can't do better than three on these ratings if you're in deficit as a provider. So there's some good things here in terms of making clear what the priorities of government are and in terms of kind of shining a spotlight on good and poor performance. But of course, there are risks in this. And I think there are particular worries about a few things. Okay. Tell me more about that. The first is about what the effect this has on staff. We know that across the board, although there is kind of a lot of variation in the NHS performance, staff feel very burnt out, often are very exhausted, and there are big issues with morale.

4:11I think there's a real risk with this kind of league table approach that you threaten worsening morale, particularly in trusts that are already struggling. And then you get a bit of a reinforcing cycle. Trusts that already find it hard to recruit good staff, good leaders, find it even more hard when they've been named and shamed in league tables. And there are also questions about whether the way in which this presents information is particularly useful for those leading NHS organizations, but more importantly for patients. I think often this is maybe at a level of too much abstraction. So it doesn't really make a difference to me as a patient if one local trust is a 2.3 and another local trust is a 2.7.

4:46What really matters to me is much more kind of granular data. So being able to say, I need an appointment for a respiratory condition. How long will I have to wait at trust X versus trust Y? How long will it take me to travel to trust X versus trust Y? I think presenting information in the way to patients that is a little bit more granular, compares like for like might be a better way of doing this. For individual patients, what seems to matter most is being able to compare the performance of different organizations on quite specific grounds. So if you need a hip replacement, it doesn't really matter that your trust has a score of 3 or 3.2 or 1.7.

5:23The kind of things that you'll be interested in are, if I'm getting a hip replacement, how long will it take me to have my first consultation with a specialist? And then how long will it take me to get that operation? Or things like, will I be reimbursed if I travel to this hospital? if it's slightly further away? Or what are the outcomes at this hospital versus another hospital where I could go for my treatment? So I think for patients, these kind of composite scores, these rankings are not necessarily as useful as more specific information about particular pathways, particular departments. So I think a kind of real focus on that data that makes a difference to patients is really important, as well as being able to have a top line point of comparison.

6:01How have hospitals in London performed? Yeah, so I think what we know from the history of these kind of initiatives is when you put a really big spotlight on something like waiting times for elective care, so specialist appointments, that it can make a difference in terms of improving performance against those metrics. Or if you say, we're going to have a zero tolerance approach to the finances, if a trust is in deficit, they will go into the kind of bottom rankings. That can clearly in some areas drive improved performance. So if you know that you're going to be targeted on that, you're going to make every effort to make sure that next year you're not in deficit.

6:35We know that in some areas this can help performance, but the things that get missed out with these kind of rankings, areas that are not measured by the lead tables or kind of more specific submetrics that aren't reflected in that kind of composite score, that often there might be disincentives to prioritize improvement in those areas. All those things kind of, yeah, just get left behind. So I think that we have to say there can be real benefits in this in terms of performance in some areas, but other areas of services that might matter more to patients might be missed out. So I think it's a little bit of a trade off there in terms of kind of what targets we set and what metrics for improvement there are.

7:12I think there is a kind of a risk here that trusts will hit the targets, but miss the point. Do you think these league tables can help fix some of the longstanding problems in the NHS? Yes. So we know that hospitals in London in general are likely to perform better than hospitals in other parts of the country. And there are a number of reasons for that. The first is that London in general has found it easier historically to attract high quality staff and leadership. There's a lot of prestige and working in a lot of the big teaching hospitals in London in particular. So they kind of perform better on that basis.

7:45The other thing which is true of a lot of London trusts is that a lot of them are specialist national trusts. So they might be organizations that excel in providing care in a particular area or for a particular condition. So we know that in these league tables, the top ranked trust is a London trust, Moorfields Eye Hospital. And those kind of hospitals, because they're real super centers, they're trusts that draw in patients from across the country that often they find a little bit easier to make their numbers add up financially and often their kind of performance in their specific area is better than the average hospital.

8:19Finally, is there anything else you want to add? I suppose my overall point is that it's really useful in systems like the NHS that we have a high level of transparency over performance. The NHS is our most expensive and arguably most valued public service. And in that context, it's vital that we kind of can give a warts and all account of how the system is going. I think the real question here is, is league tabling the right approach to improve the performance of NHS organisations? And does it provide information that's valuable to patients? And I think while we can say that the answer to that is partially yes, partially we're going to get more information on performance of trust and that will be more visible to patients.

8:58There are other ways of presenting this information which might be better at driving organisational improvement and also driving better choices and better information for patients. So we should bear that in mind as well. It's not either we have league tables or we don't have league tables. It is how do we present information in a way that really stimulates improvement and also speaks directly to the wants and needs of patients. Let's go to a break. Coming up in part two, the question hanging over the Duke of Sussex's UK visit, will he reconcile with King Charles? We'll see you back here in just a moment.

9:39Welcome back. Prince Harry is back in the UK and has been attending the Well Child Charity Awards in London, as well as other public engagements. There has been speculation about whether this trip will see a reconciliation with his father, King Charles, and brother, Prince William. It was thought that he might meet his father during his UK visit, with the two not having met face-to-face since February 2024, soon after King Charles had been diagnosed with cancer. He joked about his challenging sibling relationship during his visit to the UK in a nod to his fractured dynamic with his brother, Prince William.

10:18Meanwhile, Prince Harry's wife Meghan and their children have remained at their home in Montecito, California. Joining us now is freelance journalist Alice Cockerell. Alice, can you remind us why Harry has become so distant from the rest of the royal family. The source of problems between the king and Harry, or the royal family more generally and Harry, really started in 2020 in kind of the public mind, but there were problems long before that behind the scenes, which we all naively hadn't really understood until the dramatic storm out when Harry and Meghan first went to Canada and then to L.A., and then with a kind of amazing lack of any respect for the established protocol.

11:01I mean, it must have been drummed into Harry from such an early age that the last thing you ever do is air your dirty laundry in public. Anyway, so he kind of went on this self-destructive, I would say, course of action. So first, most notably, he spoke to Oprah and said that there was a racist in the royal family, someone who'd speculated about what the colour of his son Archie would be. And then he went on in his book Spare, which is a slightly kind of mournful tome where he accuses kind of everyone. Most notably, he accuses the royal family of colluding with the press, specifically Charles and Camilla.

11:32So he thinks the press turned on him and especially Meghan. And he thinks that was a calculated smear campaign. They saved the reputation to initially rehabilitate Camilla, but then kind of keep their relationship. And so they were thrown under the bus. The most recent kind of source of beef between Harry and the King, Harry came back six months ago to fight a case in the high court because his protection was withdrawn or the funding of it from the government. And he said in an interview to the BBC, he essentially accused his father of not intervening with the king, who's kind of quite a goody-goody about convention.

12:06He just never would have done that in a million years, but Harry seems to think that he should have. And so he said, I can't talk to my dad at the moment. He has done a lot to estrange many members of his family who think that discretion is the best part of valour. I mean, the kind of sources of grief between them are deep and wounding. And why do you think he now wishes to reconcile with them? I think that him and Meghan aren't thriving as well as the kind of excitement they were pushed along the adrenaline of the first few years. He's kind of mesmerizing deals they struck with Netflix, book deals, and suddenly Netflix now they've either changed.

12:40I mean, it was rumored that they got$100 million or something idiotic for their first contract. Now they just have a first look kind of an option deal, which won't bring in that much money. So on a kind of purely fiscal analysis, their star is waning slightly. There's non-working royals, you know, there's no real reason why they'd be more interesting to people wanting to throw cash at them. So on that kind of mercenary level, it's in both of their vested interests to be close to the royal family again. But I think much more importantly, he misses his dad a lot. And I think Charles is much sicker than anyone really knows.

13:15Someone who works in the palace said that it might just be two years he has to live, which is heartbreaking for any son to know about their father, especially if you're estranged. I also think Harry's just profoundly homesick. Some of his friends told me that at the beginning, he went through a phase of kind of slightly alienating them in the early days of Meghan, because I don't think she really approved of them. But anyway, he seems bent on reconciliation with them. Maybe LA life is starting to pull. All he really wants to do is go to the pub with his old, like very loyal, you have to say, school friends and stuff, and not hang out with Meghan's slightly less amusing LA friends.

13:52The core crux of it. in my mind, is he is just yearning for his homeland, especially in the summer. He used to love Balmoral. He used to love just England generally. So I think he could not be homesick. He seems bent on not just reconciling with his father, but also his friends. I think William's a trickier prospect altogether. And you can actually tell, I think, since he flew back to London yesterday, he seems to be doing everything right. He was very diligent about telling the palace what his movements would be, where he was going. He's very much following all royal protocol, which I think in a kind of more defiant, belligerent phase of his life, he wouldn't have necessarily done.

14:30He's towing the line with a view to being embraced back to the royal bosom. So do we know how King Charles feels about all of this? I think Harry was always really Charles's favourite son. What I hadn't really realised until I started researching this, was that him and William have always had a pretty strange relationship. They bicker a lot. Someone who works in the royal household told me that William, he can't call his dad just off the bat. They schedule calls with one another through the king's private secretary or private office. I mean, Harry would say that this is all part of this kind of machine within the palace and conspiracy within the media that we've all been kind of made to think that the king and William get on brilliantly.

15:13Harry would say, as part of his real theory, that everything is corrupted, that the palace have kind of fed the media this false narrative, which we all absorb, but there's some kind of payoff at the end, whereas Harry was thrown under the bus. He writes about in his book Spare that William and the king never really got on. I bet Charles, despite all of Harry's attacks and the way he's behaved in the last few years. Just misses him. He calls him my darling boy and he has just always adored Harry. Camilla probably is much more wary of Harry but I would think that the king's first instinct would be to forgive and forget.

15:51And that's The Standard. For all the latest news head to standard.co.uk. If you'd like to get in touch please do drop us a line at podcasts at standard.co.uk. we'll be back here tomorrow at 5pm we'll see you then