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Cancer results cannot be measured in the same way as goals in football

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As the English Premier League gets properly underway we can only hope that this year, at last, standards begin to improve. For too long now we have endured the lamentable spectacle of clubs languishing at the bottom of the table, resulting in the shocking process of relegation. It is unacceptable that fans are being let down in this way and improvements must be made if we are to avoid the situation repeating itself come the end of the season.

Or so Macmillan Cancer Support might argue.

This otherwise excellent charity has chosen league tables as its favoured method for measuring patient experience of cancer treatment, and recently berated London hospital trusts for filling the majority of the places in the bottom 10 for the third year in a row. According to The Guardian, Carol Fenton, Macmillan’s general manager in London said: ‘It is unacceptable that some cancer patients in London are being let down by hospitals failing to provide crucial support, alongside medical treatment. There can be no excuses.’ Of course, this is true - but a league table does not tell me whether or not patients are being let down.

When it comes to league tables there is a message that we need to get across; something to shout from the roof tops, post on every website, and declare to every politician, charity and pressure group:

SOMEBODY HAS TO BE AT THE BOTTOM!!

How can a charity feign shock and surprise, or declare it to be unacceptable that when they publish a league table of the performance of NHS Trusts there is a Trust at the bottom of their table? Of course we want to raise standards and improve patient care, but it could be that ALL the Trusts in the table are providing excellent care, just some are a bit better at it than others. Conversely, it might be that even the Trusts sitting smugly at the top of the pile are providing a poor standard of care and need to get their act together - we cannot tell the difference from a league table!

The vast majority of the data in the full report from the Macmillan site relates only to relative performance compared to other Trusts, and movement in the league table from previous years. Poor performance is defined not by some clinically meaningful measure, but by a Trust being in the bottom 20%. No doubt there are more useful numbers behind the ranking system, but it is very regrettable that such a prominent cancer charity has chosen to highlight only relative performance - and just as depressing that lazy journalism has allowed them to get away with it unquestioned.

The end result of this is not to improve performance, but to sap morale as, year-on-year - and no matter how much care might improve overall - Trusts will always find themselves at the bottom in this annual event, and be accused of failing patients as a result. I don’t know why London keeps representing the lower end of this particular table, but let’s say the situation changes and London Trusts make great strides up the Macmillan ranking nest year - the headlines will inevitably read something like this: ‘Crisis in the North as Cancer Care Slumps!’ or ‘Cancer Charity Calls for South West to Improve Care.’

At the end of the day, however, there may be only one way to really combat this sort of behaviour from charities. After all, if you can’t beat them…perhaps we need to undertake a study on the misuse of statistics by the charitable sector - and we could publish the results in an annual league table!

 

Readers' comments (1)

  • The way in which the results are presented is not always helpful and statistical significance needs to be added, but I don't think it is as bad as you make out.

    The same questionnaire is sent to all patients. It is possible that patients in London are more likely to give the same level of service a lower score but I doubt this is the entire reason.

    Those at the bottom generally are Trusts that you might expect to be there and providing a service that is not as good as others. The poor scores correlate with other measures e.g. those with poor patient experience results also have poor staff survey results.

    In previous years Trusts have taken action to improve patient experience as a direct result of patient survey rankings. Ranking may not be perfect but it does make CEOs sit up and take notice.

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