Rating providers for quality: a policy worth pursuing?

This report was commissioned by the Secretary of State for Health to review whether ratings of provider performance should be used in health and social care.


Published: 22/03/2013

ISBN: 978-1-905030-62-0

Download the summary [PDF 232.1KB] Download the full report [PDF 1.4MB]

Dr Jennifer Dixon CBE, Chief Executive, Nuffield Trust, discusses the advantages and disadvantages of an 'Ofsted-style' ratings system.

Should there be 'Ofsted-style' ratings for health and social care providers such as hospitals, GP practices and care homes?

In November 2012, the Rt. Hon Jeremy Hunt MP, Secretary of State for Health, commissioned Dr Jennifer Dixon CBE and the Nuffield Trust to consider this question as part of a review of whether aggregate ratings of provider performance should be used in health and social care in England.

This report is the final output of the review process. It was presented to the Secretary of State for Health on 22 March 2013.

Provider ratings were earlier published by various bodies from 2008 to 2010 in social care, and from 2001 to 2009 in the NHS. Early forms of the health rating (“star ratings”) were particularly visible to the public and professionals before being scrapped.

Our analysis suggests that a clear gap has arisen in terms of the provision of comprehensive and trusted information on the quality of care of providers to inform the public and improve accountability.

The report concludes that the costs and benefits in implementing a ratings system may be favourable for providers of social care and for general practices (given the potential for choice and the nature of care provided in those settings).

The benefits are less certain for hospitals, given the way that ratings were designed and used in the past. The report lists a number of conditions that would have to be fulfilled for any potential benefits of hospital ratings to be fully realised.

Constructing a summary rating for hospitals is possible but would be a difficult and complex task Dr Jennifer Dixon CBE, Chief Executive, Nuffield Trust

Two main methods were employed to inform the review: engagement with policy-makers, professionals, the public and other key stakeholders; and reviews of relevant literature.

The engagement process involved: a set of meetings with key groups of stakeholders; an eight-week online consultation process; a series of three focus groups with the public, conducted by Ipsos MORI; and bilateral meetings with key individuals.

More than 200 organisations and individuals contributed to the online consultation. These contributions have informed the conclusions and recommendations of the final report.

Ipsos MORI’s focus groups with the public explored how a system of ratings could interact with the needs and priorities of patients and local communities.

Suggested citation

Nuffield Trust (2015) Rating providers for quality: a policy worth pursuing? Research report.