Pregnant women unmoved by maternity hospital ratings, study suggests

Media reports naming the best and worst NHS trusts for maternity care did not lead to more women going to the top hospitals, a study has found.

The NHS Constitution states that providing information to support patient choice is a major priority for driving improvement in services.

The new study casts doubt on this principle, finding that widely publicised patient survey results listing the 10 best and worst performing NHS trusts in England in 2008 did not lead to more women attending the high-ranked hospitals or fewer attending low-ranked hospitals.

The study also found that satisfaction levels did not improve more quickly at hospitals named as the 10 worst compared with others with similar satisfaction levels at the start, suggesting that high-profile public reporting may not have stimulated improvements in care.

The research is published in the Journal of Health Services Research & Policy.

Dr Anthony Laverty from the School of Public Health at Imperial College London, who led the study, said: “The NHS and other health systems are increasingly trying to provide more information about hospitals’ performance on the basis that letting patients make informed choices about where they go for their care will improve standards. The evidence for this is patchy, and mainly comes from cardiac surgery in the US. We wanted to test this idea by looking at maternity care in England, since pregnant women might be more proactive in seeking information and choosing in advance where they want to give birth.”

The results of a survey of 26,000 women assessing their maternity care were released by the Healthcare Commission in January 2008, attracting widespread media coverage both in the national press and in local media where hospitals were rated as doing particularly well or badly.

The Imperial researchers compared the NHS trusts named as best and worst with the remaining trusts, excluding those with only a small number of maternity admissions. They looked at the number of maternity admissions for each trust and survey satisfaction levels in 2007 and 2010.

The data showed no significant difference in admissions in the three years after the media reports at the best or worst trusts.

“Our results suggest that releasing information on the quality of hospitals didn’t mean that women ended up with better care. Added to other studies, the evidence suggests that public reporting is unlikely to improve the quality of health services through patient choice,” said Dr Laverty.

The study was funded by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) North West London, the NIHR Imperial Biomedical Research Centre, and the NIHR Imperial Patient Safety Translational Research Centre.

Reference

A.A. Laverty et al. ‘Impact of ‘high-profile’ public reporting on utilization and quality of maternity care in England: a difference-in-difference analysis.’ Journal of Health Services Research & Policy. DOI: 10.1177/1355819615571444

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