COMMENT - NEW RATINGS SYSTEM

Published: 17/02/2005, Volume II5, No. 5943 Page 3

The Healthcare Commission's proposed system for assessing NHS organisations is getting a reasonably warm reaction from senior managers. Seventy one per cent of chief executives surveyed by HSJ believe it 'will produce a broader, fairer and more accurate assessment of performance' than star-ratings (news, pages 5-8).

However, it is also clear that the main reason the proposals are being welcomed is because they mark a break from the previous method of determining success and failure.

When it comes to the claimed advantages of the new system, it is hard to detect much confidence.

The commission's proposals are, for example, meant to reduce the burden of inspection, assist patient choice, boost public health and give greater importance to local targets. 'We'll believe it when we see it, ' say chief executives.

There are also doubts over various aspects of implementation - including the role of non-executive directors, local authority scrutiny committees and patient forums, as well as concerns that the commission's 'helpful' 472 prompts will turn into de facto targets.

As highlighted by HSJ when the consultation was launched (news, page 3, 2 December 2004), the approach taken by the commission in producing aggregate scores for each organisation still creates the possibility of trusts being unfairly 'named and shamed'.

Of course any assessment must be straightforward enough for public understanding and robust enough to censure poor performance. But most chief executives do not believe the new measures are sufficiently sensitive to stop unfounded criticism.

Finally, chief executives seem divided on indicators of future performance.

The 50/50 split in preference for producing the indicators as separate ratings or including them in aggregate scores suggests that more debate is needed. Forward-looking indicators should be more useful to both patients and staff than records of past performance.

The commission is off to a good start, but its honeymoon period is likely to end once the nitty-gritty of introducing the new system begins.