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Monthly Archives: August 2013

Hospital Ratings UK

Guide rates best and worst hospitals in 2011

How good is your hospital? Dr Foster rates hospital performance

As well as listing the hospital trusts in England that score above and below average on a range of different mortality measures, this year’s guide also found that:

  • The rate of patient deaths in England is 20% lower than it was 10 years ago, in part because of improved hospital care.
  • For certain conditions, patients admitted to hospital at the weekend are less likely to get treated quickly and have a higher chance of dying.
  • Hospitals that perform certain operations infrequently pose a significantly greater risk to patients than those which carry out high numbers of the operation.
  • Patient comments and ratings, such as those gathered by NHS Choices, provide a valuable insight into standards of hospital care.
  • Rationalisation and networking of hospital services, to create 24/7 centres of expertise in areas such treatment for stroke, saves lives.

The report also showed that the best-performing hospitals were generally in the south of England, while those found to be the poorest performers were mostly in the north. However, the report did not examine why this was the case.


Who is Dr Foster?

Dr Foster Intelligence is a joint venture between the Department of Health and Dr Foster Holdings LLP and their research partners at Imperial College London. It aims to improve the quality and efficiency of health and social care through better use of information. It provides comparative information on health and social care services to health professionals and organisations to help improve the standard of healthcare.

The 2011 report is the tenth Dr Foster Hospital Guide to be published.


Which hospitals have the highest mortality rates?

Despite overall improvements in mortality, some hospitals have consistently higher mortality rates than others.

For the first time, the Hospital Guide used four measures of mortality:

  • Hospital Standardised Mortality Ratio (HSMR): a measure of in-hospital deaths based on 56 conditions which account for 80% of deaths (a higher ratio indicates problems)
  • Summary Hospital-level Mortality Indicator (SHMI): any deaths occurring in the 30 days following discharge from hospital treatment
  • Deaths after Surgery: surgical patients who have died from a possible complication – this may raise questions over the safety of surgical procedures, or whether operations should have taken place at all
  • Deaths in Low-Risk Conditions: deaths from conditions where patients would normally survive

Four indicators give a more balanced view than a single indicator. Using these indicators, the report found that no trust is higher than expected on all four mortality measures, but two trusts – Hull and East Yorkshire Hospitals and University Hospital of North Staffordshire – are higher than expected on three out of four.

The following 19 hospital trusts have higher than expected mortality rates based on two measures – HSMR and SHMI:

  • Blackpool Teaching Hospitals NHS Foundation Trust
  • Buckinghamshire Healthcare NHS Trust
  • Burton Hospitals NHS Foundation Trust
  • Dartford and Gravesham NHS Trust
  • George Eliot Hospital NHS Trust
  • Hull and East Yorkshire Hospitals NHS Trust
  • Isle of Wight NHS Primary Care Trust
  • Medway NHS Foundation Trust
  • Mid Cheshire Hospitals NHS Foundation Trust
  • North Cumbria University Hospitals NHS Trust
  • Northampton General Hospital NHS Trust
  • Northern Lincolnshire and Goole Hospitals NHS Foundation Trust
  • Shrewsbury and Telford Hospital NHS Trust
  • The Dudley Group of Hospitals NHS Foundation Trust
  • The Royal Wolverhampton Hospitals NHS Trust
  • United Lincolnshire Hospitals NHS Trust
  • University Hospitals of Morecambe Bay NHS Foundation Trust
  • Worcestershire Acute Hospitals NHS Trust
  • York Teaching Hospital NHS Foundation Trust

Overall, 24% of trusts have higher than expected SHMI, 15% have higher than expected HSMR, 3% higher deaths in low-risk conditions, and 1% higher deaths after surgery.


Which hospitals have the lowest mortality rates?

One hospital, Chelsea and Westminster Hospital, achieved low mortality rates across all four mortality indicators.

The following hospitals were low (i.e. performed well) on three measures – HSMR, SHMI and deaths in low-risk conditions:

  • Imperial College Healthcare NHS Trust
  • King’s College Hospital NHS Foundation Trust
  • Kingston Hospital NHS Trust
  • Newham University Hospital NHS Trust
  • South London Healthcare NHS Trust
  • The Whittington Hospital NHS Trust
  • University College London Hospitals NHS Foundation Trust

Royal Devon and Exeter NHS Foundation Trust was low for three different measures – HSMR, SHMI and deaths after surgery.

The following trusts were low (i.e. performed well) on two measures – the HSMR and SHMI:

  • Barnet and Chase Farm Hospitals NHS Trust
  • Barts and the London NHS Trust
  • Cambridge University Hospitals NHS Foundation Trust
  • Epsom and St Helier University Hospitals NHS Trust
  • Frimley Park Hospital NHS Foundation Trust
  • Guy’s and St Thomas’ NHS Foundation Trust
  • North West London Hospitals NHS Trust
  • Royal Free Hampstead NHS Trust
  • Sheffield Teaching Hospitals NHS Foundation Trust
  • St George’s Healthcare NHS Trust
  • University Hospitals Bristol NHS Foundation Trust
  • West Suffolk Hospitals NHS Trust

Overall, 22% of trusts have lower than expected SHMI, 19% have lower than expected HSMR, 8% lower deaths in low-risk conditions, and 1% have lower rates of deaths after surgery.

Some trusts appeared to have both good and bad mortality results, which could be due to the way hospitals record deaths. For example, the Aintree University Hospitals NHS Foundation Trust has both a lower than expected HSMR and higher than expected SHMI.

Dr Foster’s guide draws attention to this inconsistency, explaining that this may be due to palliative care deaths being included within the HSMR. Different hospitals tend to code palliative care deaths in different ways, and higher rates of palliative care recording can lower a hospital’s mortality rate. If the relevant hospital has recorded their palliative care deaths, the HSMR adjusts for these deaths, which the report says makes it fairer on hospitals that care for terminally ill patients and who would otherwise be shown to have higher than normal in-hospital mortality rates.

Besides Aintree, nine other trusts coded a quarter of their HSMR as being palliative care cases. The SHMI measure, on the other hand, does not adjust for palliative care deaths. Dr Foster says it supports calls for palliative care coding guidelines to be made clearer.


Why are people at higher risk going into hospital at nights and weekends?

In general, hospitals with the fewest senior doctors available at weekends have the highest mortality rates. A 2010 study by the Dr Foster Unit observed that people admitted to hospital over the weekend with common cardiovascular emergencies or with cancer were 7% more likely to die than those admitted from Monday to Friday.

Key factors that can contribute to higher mortality rates outside of normal working hours are:

  • lower availability of specialist community and general practice services, resulting in more terminally ill patients being admitted and dying in hospital
  • reduced specialist in-hospital services being available at weekends, particularly diagnostic investigations such as MRI scans
  • different out-of-hours staffing levels (for example, out-of-hours consultants are normally on call rather than on site and immediately available in the hospital)

The last point on staffing was considered to be a particular contributing factor that the report focused on. Dr Foster mapped senior staffing availability to the number of hospital beds against mortality rates for 130 trusts. They observed that more senior staff per bed at weekends is associated with a lower weekend mortality rate for emergency conditions, while more senior doctors (as a percentage of all doctors) is associated with lower rates.

The report noted nine trusts whose HSMR was within the expected range for people admitted Monday–Friday, but higher than expected for those admitted at the weekend:

  • Doncaster and Bassetlaw Hospitals NHS Foundation Trust
  • George Eliot Hospital NHS Trust
  • Mid Cheshire Hospitals NHS Foundation Trust
  • Northampton General Hospital NHS Trust
  • Nottingham University Hospitals NHS Trust
  • Scarborough and North East Yorkshire Health Care NHS Trust
  • Sherwood Forest Hospitals NHS Foundation Trust
  • The Royal Wolverhampton Hospitals NHS Trust
  • Wrightington, Wigan and Leigh NHS Foundation Trust

The range of senior consultant availability at night was also wide. While almost a third of hospitals with an A&E unit had no consultants on site during the night, others had five or more consultants available in the hospital.

Of particular note is the risk associated with hip fracture at these times. Overall, patients who break their hip have a one in ten chance of dying, but the chance of surviving is much greater if they receive surgery within two days. For people admitted on Friday or Saturday, there is a lower chance of prompt treatment. In-hospital mortality in 2010/11 was observed to vary from 3.2% to 16.3% between providers. Numerous studies have shown that organisational factors in the patient’s treatment play a major part in determining patient survival.

2010 statistics on hip fracture showed:

  • Across hospitals, 30% of patients with a hip fracture had to wait two or more days for surgical treatment.
  • Across the country, the number of patients waiting more than two days for an operation was significantly higher (an increase of 4.8%) in patients admitted on a Friday or Saturday compared with patients admitted from Sunday to Thursday.
  • 11% of trusts were shown to have lower operating rates at weekends.

In the following five trusts, 50% of all hip fracture patients waited more than two days for an operation:

  • Doncaster and Bassetlaw Hospitals NHS Foundation Trust
  • Leeds Teaching Hospitals NHS Trust
  • Pennine Acute Hospitals NHS Trust
  • Royal Free Hampstead NHS Trust
  • South Tyneside NHS Foundation Trust


How might weekend services be improved?

Dr Foster says the answer may lie not necessarily in increasing the number of out-of-hours staff and services, but in reorganising the resources available to target where they are most needed. An example is networking with other hospitals in an area.

London has reorganised its stroke care in this way. Instead of all A&E departments treating strokes, a small number of hospitals now manage all stroke patients at a very high standard, seven days a week, 24 hours a day. Before the reorganisation (in 2009/10) 10% of stroke patients died within seven days of admission if they were admitted at the weekend compared to 8% who were admitted on weekdays. For weekend admissions in 2010/11, mortality has dropped to 7.3% compared to 6.4% for weekday admissions.

The report provides examples of other trusts that have reconfigured their services to provide more consistent out-of-hours care.


Why are people at higher risk going into a hospital that performs fewer operations?

In general, patients treated in hospitals that perform operations rarely are more likely to die than in hospitals that perform a higher number of operations. This is particularly the case for major cardiovascular conditions such as an abdominal aortic aneurysm (a weakened section of the major artery that runs through the body, which has a very high mortality risk if it ruptures).

The risk of dying from major surgery used to treat this condition is 70% higher in hospitals that perform a lower number of these operations. Hospitals that perform fewer than 35 of these operations a year have a 13% patient mortality rate compared with 8% among hospitals that perform more than 35. (The report defines low-volume hospitals as those doing more than ten but 35 or fewer operations a year.)

Various factors may contribute to the difference in mortality across hospitals, including:

  • the experience and workload of individual surgeons
  • the organisational structure of the hospital and having surgeons in a dedicated speciality
  • the fact that more experienced medical centres are more likely to use more advanced, less invasive techniques with lower rates of complications and mortality

The report lists the large number of trusts which performed 35 or fewer procedures for abdominal aortic aneurysm in 2010/11.

Surgery for abdominal aortic aneurysm is the only area covered by this report. In other words, it cannot be inferred that you are at higher risk if you go into a hospital that performs fewer operations of any other type than another hospital.


What steps can improve patient safety and mortality?

The report also discusses factors that can help improve patient safety and outcomes.

It discusses the difference the rapidly increasing use of percutaneous coronary angiography (PCI, a technique to open up heart vessels blocked during a heart attack) has made to mortality from heart attacks: mortality has decreased by 2.5% since 2006. According to the report, it normally takes an estimated 15 years from the discovery of a new treatment to its widespread use by doctors, but the faster this happens, the greater the benefit seen.

Another factor in improving patient safety and mortality is following best practice and cost-effective patient care (care that is the safe and effective for patients and at the same time makes the best use of the NHS budget). The report discusses hip and knee replacements, which have increased over the past five years due to the increasing age of the population. Trusts that perform the best for these procedures had fewer patients with a long length of stay in hospital, fewer emergency readmissions within 28 hours, and lower rates of re-operation (a repeat operation done within one year of the initial procedure). Good care can also cost less in the long term.

The Hospital Guide Questionnaire looked at how certain trusts were improving patient recovery and reducing length of patient stay after these orthopaedic procedures. This is known as the Rapid Recovery Pathway. Factors that can improve patient recovery are:

  • pre-surgery education for patients to help relieve anxiety and increase understanding
  • admission on day of surgery, reducing length of stay
  • having a standardised anaesthetic protocol that helps with pain management and recovery
  • multi-disciplinary recording of patient records, helping share information and reduce risk of complications
  • orthopaedic physiotherapy services being available seven days a week, which improves recovery and length of stay
  • using criteria-based discharge: a checklist that helps reduce error in the discharge process, reducing risk to the patient
  • phoning patients in the 48 hours after their discharge to help reduce the risk to the patient and readmissions to hospital


What do patients’ comments tell us?

In addition to hospital mortality rates, another important indicator of hospital performance is what patients say about their treatment. Online patient feedback can provide information that is not always clear from statistics, and websites such as NHS Choices and Patient Opinion now feature thousands of detailed comments on how patients view their treatment. The Dr Foster report says that comparing reports on these systems with national patient surveys has shown a reasonable degree of agreement:

  • NHS trusts that score well on these surveys also tend to score well on data collected by Patient Opinion and NHS Choices.
  • Overall, over half of patients say they would recommend the place in which they were treated, a quarter said they would not recommend it, and 16% had no opinion.

The hospitals most often recommended percentage of people recommending the hospital) were:

  • The Cheshire and Merseyside NHS Treatment Centre Private (97%)
  • North Downs Hospital Private (96%)
  • Queen Victoria Hospital (East Grinstead) NHS (96%)
  • Euxton Hall Hospital Private (95%)
  • Fulwood Hall Hospital Private (93%)
  • The Royal London Hospital For Integrated Medicine NHS (92%)
  • Boston NHS Treatment Centre Private (91%)
  • Emersons Green NHS Treatment Centre Private (86%)
  • The Heart Hospital NHS (84%)
  • Airedale General Hospital NHS (82%)
  • Frimley Park Hospital NHS (82%)
  • St Richard’s Hospital NHS (81%)
  • Warwick Hospital NHS (80%)
  • Princess Anne Hospital, Southampton NHS (79%)
  • Royal Hampshire County Hospital NHS (77%)

Hospitals least often recommended were:

  • Medway Maritime Hospital (35%)
  • The Royal London Hospital (35%)
  • Whipps Cross University Hospital (35%)
  • Hull Royal Infirmary (32%)
  • Royal Bolton Hospital (29%)
  • Pinderfields General Hospital (27%)
  • Croydon University Hospital (26%)
  • Queen’s Hospital, Romford (26%)
  • Newham General Hospital (21%)
  • Queen’s Medical Centre, Nottingham (20%)

Where there was dissatisfaction, the five factors most likely to contribute to this were:

  • not being involved in care decisions
  • not being treated with dignity and respect
  • hospital staff not seeming to work well together
  • poor hospital cleanliness
  • being treated in mixed sex accommodation

Private hospitals seemed to score well. It is difficult to tell the reasons for this. As these comments were registered on NHS Choices, they may reflect NHS patients being treated by private units. Also, the comparison between NHS and private may not be equal as private hospitals may be smaller and also manage less complex cases.

The report concludes with its Trusts of the Year, which had the best four mortality indicators and best scores in response to three questions on the national patient survey, which asked:

  • Overall, how would you rate the care you received?
  • Were you involved as much as you would like in decisions about your care and treatment?
  • Did you feel you were treated with respect and dignity while you were in the hospital?

The four highest-performing hospitals according to these results were:

  • Royal Devon and Exeter NHS Foundation Trust South
  • University College London Hospitals NHS Foundation Trust London
  • Cambridge University Hospitals NHS Foundation Trust Midlands
  • Sheffield Teaching Hospitals NHS Foundation Trust

Only the Chelsea and Westminster Hospital NHS Foundation Trust scored low on all four mortality measures.


How can I choose and rate hospitals near me?

NHS Choices allows you to score the treatment you have received and leave specific explanations of what made your treatment good or bad. These opinions are publicly viewable, meaning you can read what other people have experienced before choosing where you want to be treated.

The service can be used to rate not only hospitals, but also a range of services, including GP surgeries and dentists. See our services finder to choose and rate your NHS services.


Hospital Guide 2013

What’s in the Hospital Guide 2013?

We expect this year’s Dr Foster Hospital Guide to be published in November 2013 (exact timing to be confirmed); it will be the 12th edition in the series.

Dr Foster is committed to the publication of the guide as an independent assessment of NHS hospitals highlighting variations in care and also celebrating success within the NHS. Although our focus has traditionally been on the performance of NHS hospitals, this year we are also featuring some measures at CCG level. Following the recent NHS reforms and the emphasis on CCGs to ensure their services provide high quality and efficient care, we believe that now is a good time to extend our portfolio of metrics to cover CCGs.

Dr Foster are committed to making the process of producing the Hospital Guide as transparent as possible and so we have produced a document which outlines our plans. There are versions of What’s in the Hospital Guide 2013 for both acute trusts and commissioners, highlighting those metrics of most relevance for each group and setting out a timeline for this work.

Key themes under consideration for inclusion in this year’s Hospital Guide include, as well as the usual measures of mortality, a focus on constituent components of the HSMR, including the palliative care coding rate, a range of indicators at hospital site (as well as NHS Trust) level and an update on some of our previous work looking at the impact of stroke networks. Among those indicators we are exploring at CCG level are avoidable admissions, PCI for AMI and selected elective procedures.

Dr Foster are developing these metrics in partnership with the Dr Foster Unit at Imperial College London and in consultation with clinicians. Inevitably some will change and may be discarded as this research phase continues and we will keep you informed about this process.

The final metrics, data and methodologies will be shared in the autumn but if you have a question you would like to raise in the meantime, please contact them at hospitalguide@drfoster.co.uk


Clinical Commissioning Groups (CCG) and how they perform

Clinical Commissioning Groups (CCG) and how they perform

Clinical Commissioning Groups (CCGs) commission most of the hospital and community NHS services in the local areas for which they are responsible. Commissioning involves deciding what services are needed, and ensuring that they are provided. CCGs are overseen by NHS England, which retains responsibility for commissioning primary care services such as GP and dental services, as well as some specialised hospital services. All GP practices now belong to a CCG, but groups also include other health professionals, such as nurses.

Services CCGs commission include:

  • most planned hospital care
  • rehabilitative care
  • urgent and emergency care (including out-of-hours)
  • most community health services
  • mental health and learning disability services

CCG performance

CCGs play a major role in achieving good health outcomes for the local population that they serve. NHS England has designed a set of performance indicators that will help measure how well an individual CCG is tackling theses health issues.

You can use these indicators to see how well your local CCG is doing and compare it both on national and local terms.

Not all the indicators are available yet, but you can already compare CCGs on how well they are:

  • preventing people from dying prematurely
  • enhancing the quality of life for people with long-term conditions
  • helping people to recover from episodes of ill health or following injury
  • ensuring that people have a positive experience of care

Simply use the clickable map above to select a CCG and view the data.

The Longer Lives project

The CCG indicators begin to show the effectiveness of local commissioning. In addition, Public Health England’s Longer Lives project aims to help communities to improve their collective health by highlighting the health challenges faced in each local authority area. It shows data on premature deaths for the five most common causes of mortality in England, which are:

It also shows inequalities in premature mortality across the country and provides examples of effective local interventions.

The project is currently in its early stages. However, new data sets will be introduced continuously, including data for county districts. Visit the Longer Lives website for more detailed information.


The NHS complaints procedure

The NHS complaints procedure

Most medical care and treatment goes well, but things occasionally go wrong, and you may want to complain. So where do you start? Every NHS organisation has a complaints procedure. To find out about it, ask a member of staff, look on the hospital or trust’s website, or contact the complaints department for more information.


You may want to make positive comments on the care and services that you’ve received. These comments are just as important because they tell NHS organisations which factors are contributing to a good experience for patients.

What are my rights?

If you’re not happy with the care or treatment you’ve received or you’ve been refused treatment for a condition, you have the right to complain, have your complaint investigated, and be given a full and prompt reply.

The NHS Constitution explains your rights when it comes to making a complaint. You have the right to:

  • have your complaint dealt with efficiently, and properly investigated,
  • know the outcome of any investigation into your complaint,
  • take your complaint to the independent Parliamentary and Health Service Ombudsman if you’re not satisfied with the way the NHS has dealt with your complaint,
  • make a claim for judicial review if you think you’ve been directly affected by an unlawful act or decision of an NHS body, and
  • receive compensation if you’ve been harmed.

Who should I complain to?

If you’re not happy with an NHS service you can make a complaint. You should complain to your service provider such as GP, dentist, hospital or pharmacist first.

Alternatively, you can complaint to the commissioner of that service. In the past, this was your local primary care trust (PCT). PCTs ceased to exist on April 1 2013. Now you will have to take your complaint either to NHS England or your local Clinical Commissioning Group (CCG).

In general, NHS England commissions most primary care services like GP and dental services. CCGs oversee the commissioning of secondary care such as hospital care and some community services.

When should I complain?

As soon as possible. Complaints should normally be made within 12 months of the date of the event that you’re complaining about, or as soon as the matter first came to your attention.

The time limit can sometimes be extended (so long as it’s still possible to investigate the complaint). An extension might be possible, such as in situations where it would have been difficult for you to complain earlier, for example, when you were grieving or undergoing trauma.

Where do I start?

Since April 2009, the NHS has run a simple complaints process, which has two stages.

  1. Ask your GP, hospital or trust for a copy of its complaints procedure, which will explain how to proceed. Your first step will normally be to raise the matter (in writing or by speaking to them) with the practitioner, e.g. the nurse or doctor concerned, or with their organisation, which will have a complaints manager. Alternatively, if you prefer, you can raise the matter with the relevant commissioning body such as the NHS England or a local CCG. The process is called local resolution, and most cases are resolved at this stage.
  2. If you’re still unhappy, you can refer the matter to the Parliamentary and Health Service Ombudsman, who is independent of the NHS and government. Call 0345 015 4033

Who can help?

Making a complaint can be daunting, but help is available.

Patient Advice and Liaison Service

Officers from the Patient Advice and Liaison Service (PALS) are available in all hospitals. They offer confidential advice, support and information on health-related matters to patients, their families and their carers. Find your local PALS office.

NHS Complaints Independent Advocacy Service

Since April 1 2013, individual local authorities have a statutory duty to commission independent advocacy services to provide support for people making, or thinking of making, a complaint about their NHS care or treatment. Arrangements will vary between local authority areas. Contact your local PALS or complaints manager, or local authority for information about how this service is provided in your area.

Citizens Advice Bureau

Your local Citizens Advice Bureau can be a great source of advice and support if you want to complain about the NHS, social services or local authorities. You can find your local Citizens Advice Bureau on its website.

NHS Direct

NHS Direct can advise on NHS complaints. Call 0845 4647.

The Public Law Project’s website includes a guide to making a complaint.

NHS Choices complaint process

In the event that a complaint is made about a piece of content that cannot be resolved by the NHS Choices journalist, the matter will be escalated to the Chief Editor.

Note: NHS Choices is only responsible for the content of this website and any operational issues about it. If you wish to make a complaint about our content or any operational issues, please take a look at the NHS Choices complaint process (PDF, 21 kb).


Hospital Family Test: More Than 30 Wards Fail

Critics say the Government’s new patient survey is too blunt an instrument to provide useful data and is open to distortion.

The Government’s flagship test designed to highlight poor patient care has been condemned as “misleading” amid confusion over the results.

The “Friends and Family Test” asks patients whether they would recommend the ward or A&E department where they have been treated.

They must pick between six options, from “extremely likely” to “extremely unlikely”, and their answers are put together to generate an overall score.

However, because “likely” to recommend is classed as a neutral response, critics claim the end picture can be distorted.

Indeed, nine in every 10 patients at the hospital with the “worst” A&E department in England said they would recommend it.

Patient charities also argued the results are meaningless because they are so general and may not directly relate to the quality of care.

The Patients Association said they are “confusing to navigate” and will not address the “fundamental failures” in the health service.

Chief executive Katherine Murphy said: “Asking people to recommend a hospital is not like asking someone to recommend a hotel.

“This could really be seen as a smokescreen to cover some of the more fundamental issues that need to be addressed – like the issue around poor care that so many elderly people experience on a daily basis.

“I think that it could be quite misleading from a patient’s point of view.”

More than 400,000 people completed the survey, which was introduced in April, with results relating to around 4,500 NHS wards and 144 A&E services.

Most appeared happy with their treatment, although 36 wards received a negative score in June – down from 66 in April.

Despite months of criticism, only one A&E department – Chase Farm Hospital in north London – was given a negative score.

And even then, 295 of 516 patients asked about the hospital said they were “extremely likely” to recommend it and another 167 said they were “likely” to do so.

One ward at Fairfield General Hospital in Bury, Greater Manchester was given a negative grade.

But of the patients quizzed, not a single one said they would be “unlikely” or “extremely unlikely” to recommend being treated there.

The low overall response rate of 13.1%, which fell short of the 15% target, also raised fears would-be patients would be judging hospitals on the views of a tiny minority.

And the Point Of Care Foundation warned that it was impossible to tell whether a negative response was due to poor care or an issue such as car parking.

Director Jocelyn Cornwell said: “Some hospitals were using much better methods of collecting feedback but they have had to abandon what they were doing and replace it with this rather blunt instrument which is not good for patients, or for developing useful information to improve health services.

“We would ask the Government to think again about how more useful information on patient care could be collected and used to improve services.”

NHS England’s national director for patients and information Tim Kelsey insisted the initiative was a “major step forward”.

“Direct patient and citizen feedback is vital to improving the services the NHS provides. Trusts can concentrate their focus on improvement with this information,” he said.

“From this first publication, we can see a significant and real variation in the quality of customer service across the NHS.

“There are home truths here and everyone will expect those Trusts who have large numbers of their patients choosing not to recommend their services to respond as quickly as possible.”

David Cameron, who is on holiday in Portugal, said: “I want the NHS to put patient satisfaction at the heart of what they do and expect action to be taken at hospitals where patients and staff say standards are not good enough.”

Health Secretary Jeremy Hunt called it a “historic moment”.

“By making these ratings public, we’re giving patients the power to choose the best place for their care – and driving other hospitals to raise their game,” he said.

NHS England will now publish monthly updates on patient feedback.

By the end of next year, it hopes to roll the test out to include GP practices, community services and mental health services. All other services will be included by April 2015.


Health News: Obesity killing more people than thought

“Obesity killing more people than thought,” reports Sky News, which is among many media outlets that fail to mention that the headline is based on estimates of US obesity-related deaths.
Researchers wanted to know whether being overweight or obese was associated with increased risk of death among people in the US. They believed previous research had underestimated obesity-related deaths because of a failure to account for the different ways in which obesity can harm health.
They used data from nationally representative surveys over a 20-year period and estimated the percentage of “excess” deaths associated with being overweight or obese. Overall, they estimated that being overweight or obese accounted for about 18% of US deaths for people aged 40 to 85 years between 1986 and 2006.
These estimates don’t directly apply here because they are based on the US and not the UK. But it’s important not to be complacent. In the UK, 24% of men and 26% of women are now obese – only a little behind the US, where the figures are 27.9% of women and 29% of men.
A 2001 National Audit Office report put the figure for UK obesity-related deaths at 6%. However, in the words of a recent Public Health England report on the issue: “It … seems likely that more than 6% of all deaths will be attributable to obesity today”.


The NHS Structure 2013

The NHS structure explained

The NHS is undergoing major changes in its core structure.
Most of the changes took effect on April 1 2013, though some were in place before then. It will be some time before all the changes are fully implemented. All vital NHS services will continue as usual during the transition period and beyond.
View large version of the new NHS structure graphic

These changes will have an effect on who makes decisions about NHS services, how these services are commissioned, and the way money is spent.

Some organisations such as primary care trusts (PCTs) and strategic health authorities (SHAs) will be abolished, and other new organisations such as clinical commissioning groups (CCGs) will take their place.

NHS services will be opened up to competition from providers that meet NHS standards on price, quality and safety, with a new regulator (Monitor) and an expectation that the vast majority of hospitals and other NHS trusts will become foundation trusts by 2014.

In addition, local authorities will take on a bigger role, assuming responsibility for budgets for public health. Health and wellbeing boards will have duties to encourage integrated working between commissioners of services across health, social care, public health and children’s services, involving democratically elected representatives of local people. Local authorities are expected to work more closely with other health and care providers, community groups and agencies, using their knowledge of local communities to tackle challenges such as smoking,alcohol and drug misuse and obesity.

However, none of these changes will affect how you access NHS services in England. The way you book your GP appointment, get a prescription, or are referred to a specialist will not change. Healthcare will remain free at the point of use, funded from taxation, and based on need and not the ability to pay.


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