League tables for the NHS

Measures of performance need to be meaningful The secretary of state for health and social care, Wes Streeting, has announced NHS league tables to guarantee “no more rewards for failure” in UK healthcare.1 Under the plan, the worst performing hospitals would have turnaround teams installed and managers sacked, while the best would have more freedom to invest capital.2 This package of measures mirrors the policy approach of the early 2000s. A wealth of evidence from that period suggests this is no easy fix.3 Designing a ranking that is fair and accurate for organisations as huge and complicated as NHS trusts is difficult. Star ratings in the 2000s saw repeated cycles of a crisis of confidence before major revisions and improvements were made.4 Goodhart’s law states that once a measure becomes a target, it stops being a good measure, as managers find ways to hit the target without making anything better.5 Ambulance trusts under star ratings would delay starting the clock for waits and recategorise calls so that standards were …