SP 10.11 Does The 'Q' Word Make for the Best Hospitals?

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2026
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Abstract
Abstract Aims The new NHS England hospital league tables highlight the “top” acute trusts; notably, the highest ranked hospitals are without Emergency Departments and therefore minimal unplanned admissions. In a healthcare landscape shaped by volatility, uncertainty, complexity, and ambiguity (VUCA), the unpredictable burden of emergency surgery could influence ranking. While numerous metrics underpin the rankings, inpatient workload is absent, but the National Emergency Laparotomy Audit (NELA) numbers offer a surrogate marker. This study explores whether NELA case volumes correlate with hospital league ranking. Methods League ranking, trust size (inpatient beds), and NELA year 8 and 9 data were analysed. Scatter plots were generated and associations tested using Spearman’s rho. Ranked data was examined both in absolute terms and normalised per 100 inpatient beds. Results Correlation between NELA volume and league position was weak across both years. For Year 8, Spearman’s rho was ρ=0.29 (standard) and ρ=0.23 (per 100 beds). For Year 9, correlation was similarly weak (ρ=0.32 and ρ=0.25, respectively). Independent t-tests confirmed no statistically significant relationship between emergency surgical activity and trust rank. Conclusions NELA case volume does not strongly influence hospital league position. However, it suggests that ‘quieter’ specialist centres can solely focus on elective care are advantaged in ranking, reflecting a VUCA tension between strategic service configuration, staff resilience, and productivity. The findings support proposals for ring-fenced elective surgical hubs to protect planned care. However, this is a novel lens through which to view rankings and further analysis is needed to correlate emergency work and top performance definitively.
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Authors Ken Adigwe, Rory Clarke, Ravi Vissapragada, Greta Mclachlan
Journal the british journal of surgery
Year 2026
DOI
10.1093/bjs/znag087.139
URL
https://doi.org/10.1093/bjs/znag087.139
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