Intended for healthcare professionals

Rapid response to:

Information In Practice

Performance league tables: the NHS deserves better

BMJ 2002; 324 doi: (Published 12 January 2002) Cite this as: BMJ 2002;324:95

Rapid Response:

The unreasonable simplicity of league tables

I submitted a previous email with the above title in response to Alex
Vass' article on The Times' last set of league tables (Nov. 19 to Nov 23,

The point I made then is probably reinforced by Adab et al's
paper(2). If we try to summarise complex information in a single league
table then it is highly likely that the ranking will not reflect the
differing realities of different places and will not be easily understood
by either lay people or interested professionals. In the case of Dr
Foster's tables I also argued that including SMRs was a misuse of that
statistic and misleading in its own right.

At least the use of control charts might pick out those few outliers
where action needs to be taken or the more serious issues unpicked and
understood. At the moment that seems to go farther than we've gone before
and is probably a reasonable increment in developing our understanding and
ability to support those where there are real concerns.

(1) Vass A. Doctors urge caution in interpretation of league tables.
BMJ 2001; 323:1205 .

(2) Adab P, Pouse AM, Mohammed MA, Marshall T. Performance league tables:
the NHS deserves better. BMJ 2002; 324:95-8 .

Jonathan Howell

Competing interests: No competing interests

30 January 2002
Jonathan V Howell
Consultant in Public Health Medicine
South Staffordshire Health Authority, Mellor House, Corporation Street, Stafford. ST16 3Sr