The benefits and problems with hospital ratings

When it comes to matters of health, people typically like to know they are receiving the best possible care. But with the National Health Service (NHS) under pressure in the UK, public ratings of the health services offered have lowered significantly.

A 2022 analysis by The Health Foundation, Public perceptions of the NHS and social care: performance, policy and expectations, found that the public is pessimistic about the state of the NHS and social care.

• 57% think the general standard of care provided by the NHS has become worse in the past 12 months.
• 69% think the standard of social care services has deteriorated.

With all of this in mind, people are increasingly turning to official hospital rankings and star ratings to help them determine where to go for healthcare services. The NHS in England even offers a free, online search tool to help people compare hospitals based on factors such as:

• overall quality of service according to the Care Quality Commission’s (CQC) inspection rating
• waiting times
• patient reviews.

But what exactly are hospital ratings, and what are the benefits and problems associated with them?

Hospital rating systems

Hospital ratings typically consider overall service, as well as individual areas of care and specialties. They may look at everything from readmission rates to patient satisfaction, and use different types of methodology systems and metrics.

And it’s not just hospitals that are reviewed. Other services that can be inspected and rated for quality measures include:

• primary care services
• GP surgeries
• mental health services
• public health centres
• teaching hospitals
• emergency departments, known as Accident and Emergency (A&E) departments in the United Kingdom.

Hospital ratings in England

England’s Care Quality Commission (CQC) rates hospitals on a scale of outstanding, good, requires improvement, and inadequate. This is an overall rating, but the CQC also provides a rating for five other areas.

1. Patient safety. Are people protected from abuse and avoidable harm?
2. Effectiveness. Does the care, treatment, and support achieve good patient outcomes, helping people maintain quality of life? Is it based on the best available evidence? 
3. Care. Do staff involve and treat patients with compassion, kindness, dignity, and respect?
4. Responsiveness. Are services responsive to people’s needs? Are they organised to meet patient requirements?
5. Leadership. Is the team well-led? Does the leadership, management, and governance of the organisation ensure it's providing high-quality care that's based around individual needs? Do they encourage learning and innovation? Do they promote an open and fair culture? 

Hospital ratings around the world

Hospital rating systems vary in different countries. In the United States, for example, there are several organisations that can provide ratings for hospitals and healthcare services. The federal government’s Centers for Medicare and Medicaid Services, for instance, created Hospital Compare to share hospital quality performance information with the public. There’s also a rating offered by the U.S. News & World Report, which in 2022 ranked the Mayo Clinic as the number one hospital in the country for the seventh consecutive year.

There are also more broad perspectives on hospitals. For example, the Organisation for Economic Co-operation and Development (OECD) annually publishes an online database of health statistics. This database offers statistics on health and health systems across OECD countries.

The benefits of hospital ratings

Hospital ratings provide patients with an objective view of the quality of care they can expect to receive. This can help patients make informed decisions about where to receive treatment. 

It’s also worth noting that hospital ratings are typically accompanied by a detailed report outlining how to improve services. This can help hospital staff and health care professionals – such as hospital leaders, clinicians, and so on – make the interventions and changes required to improve:

• health outcomes
• patient wellbeing
• decision-making
• quality of care
• reputational perception.

The problems with hospital ratings

Some of the main concerns with hospital ratings are that they can potentially be subjective, and can’t always provide a complete picture of hospital quality.

This is because ratings are based on a range of factors, including patient experience surveys and inspection reports, which can be influenced by a variety of things. For example, hospitals and other healthcare providers may receive a poor rating due to factors outside of their control, such as staff shortages or funding.

Additionally, hospitals may focus on meeting the requirements of the rating system rather than improving patient care.

Why do hospitals receive low ratings?

There are many reasons why UK hospitals may receive bad ratings. For example, a shortage of staff and resources can impact the quality of care patients receive, which will have a knock-on effect in terms of patients’ perceptions about the service.

A 2019 report by The Health Foundation linked a lack of investment in the NHS in England – including a declining capital budget from the Department of Health and Social Care (DHSC) – to a number of issues that could have an impact on ratings, such as:

• risks to patient care
• declining staff productivity
• ageing, unsuitable infrastructure.

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