'Tough and rigorous' ratings aim to drive up standards and give patients and families better insight into quality of treatment

Hospitals will be told to make urgent improvements if any department is providing poor care, under new Ofsted-style ratings prompted by the Mid Staffordshire NHS scandal.

The "tough and rigorous" ratings will go further than Ofsted's single overall ranking for schools in England by giving an official assessment, from "inadequate to "outstanding", based on inspections of every department of every hospital.

The Care Quality Commission (CQC), which regulates NHS care, hopes the ratings will drive up standards and give patients and families a better insight into the quality of treatment they can expect from particular hospital services.

Under CQC plans being unveiled on Monday, inspectors will rate every department, as well as each hospital and hospital trust, as inadequate, requires improvement, good or outstanding. The changes will begin in October, with the first ratings published in December.

The switch from the CQC's widely discredited hospital monitoring system was ordered by the health secretary, Jeremy Hunt, in the wake of Robert Francis QC's report in February into events at Stafford hospital, where between 400 and 1,200 patients died unnecessarily as a result of poor care and neglect from 2005-2008.

Inspectors will examine if the care is safe, effective, caring and compassionate, well-led and responsive to patients' needs, and decide on a rating for each. They will examine if staff have breached any of 10 new "fundamental standards" of care, as suggested by Francis.

Failings such as dementia patients being isolated in their rooms all day and not receiving support and stimulation, would be classed as a breach of the fundamental standards. Lapses such as a patient going thirsty because his or her water jug has not been filled, or hungry because staff have not helped with eating, would not necessarily on their own count as a breach, unless they were found to happen regularly or across a number of departments.

"It's going to be tougher and much more rigorous, and will be much more clear about when services are failing or inadequate," said David Behan, the watchdog's chief executive. Revelations about abusive treatment of patients at the Winterbourne View hospital for people with learning disabilities had also influenced the ratings, he said.

If an inspection reveals problems, the newly appointed chief inspector of hospitals, Professor Sir Mike Richards, will issue a warning notice, giving the hospital a fixed period in which to improve things, possibly just a few days.

Hunt welcomed the plans, as did the Academy of Medical Royal Colleges, which represents the UK's 220,000 doctors. Major changes needed in the NHS included "setting clear standards of care and publishing ratings so that patients have a single version of the truth about how their hospitals are performing on finance, leadership and, most importantly, the quality of care", said Hunt.

But NHS bosses voiced discontent. Mike Farrar, chief executive of the NHS Confederation, said: "We welcome steps to improve transparency within the NHS, but in doing so, we must avoid creating perverse incentives whereby a single focus develops on those areas being measured alone, at the expense of other areas [of care] that are equally as important."

The CQC had not yet persuaded NHS managers to accept the ratings, which risked "skewing resources to only those areas being measured", added Farrar. In a recent poll, 73% of NHS chief executives and chairs disagreed with Ofsted-style ratings.

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NHS England concedes that consultants can legally refuse to hand over performance data

The value of the NHS league table for surgeons has been cast into doubt after it emerged that consultants can opt out of the system that rates their individual performance.

NHS England conceded on Wednesday evening that consultants could legally refuse to hand over performance data, including how many people die in their operating theatres, under the Data Protection Act.

About 4% of consultants across the country have opted out of providing performance data to the league tables due to be published by all NHS trusts this summer.

The new ratings system was heralded last year as a "revolution" for patients by the NHS commissioning board, the new independent quango in charge of the health service.

The league tables are supposed to cover consultant-level data for survival rates and quality of care in 10 specialities including cardiac, vascular and orthopaedic surgery, measured against national standards, and what their patients say about them.

A spokeswoman for NHS England said: "Around 96% of consultants across 10 specialities who have responded have opted in to the publication of data about their performance, which patients should have the right to see.

"We urge all consultants to think very carefully about the effect on their patients and their colleagues if they choose to opt out on the basis of legislation designed to protect personal data."

The spokeswoman added that the new performance rankings heralded "a new level of openness". But she added: "There is some way to go before the NHS is as transparent as it should be."

The reform is also seen by ministers as key to driving patient choice in the NHS, although doctors have been resistant to such changes in the past. Only after the outcry from the Bristol children's heart surgery scandal and years of campaigning did surgeons make public their survival rates for heart bypass operations and aortic valve replacement surgery.

The NHS England spokeswoman said she was optimistic that those surgeons who had opted out of the new league tables would change their minds. "The experience with the publication of cardiac data strongly suggests that consultant surgeons who do feel uncomfortable quickly come on board when they see the enormous benefits publication brings to their patients and to themselves," she said.

A Department of Health spokesman said: "If there are legal grounds for individual doctors opting out, any patient and their family would be entitled to ask why and may prefer their operation to be carried out by someone who was prepared to be fully transparent."

The first of the new ratings of consultants will be published today by the University Hospital of South Manchester. It will begin by publishing data on its cardiologists and cardiothoracic surgeons before extending the rankings.

UHSM cardiac surgeon Ben Bridgewater said: "Most doctors have always welcomed transparency. The problem in the past has been about credibly and fairly producing the metrics and reporting them in real time so doctors, and now patients, can review performance.

"In cardiac and thoracic surgery, we surgeons have been pushing for weaknesses to be improved so that we can give our patients the best possible service and outcome. After all, at the end of the day it's our names above the bed."

Dr Paul Flynn, chair of the British Medical Association's consultants committee, said: ""Publishing data for individual consultants is complex. Some consultants may take on higher-risk cases that would lead to raised mortality rates. Some patients will have multiple health problems which can increase the likelihood of complications.

"It is critical that any information provided is accurate and in context. If not, it will be misleading and cause unnecessary anxiety to patients."

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