Published: 08/01/2004, Volume II4, No. 5886 Page 4 5

An ambulance trust personally praised by prime minister Tony Blair was promoted to three stars in the 2002 star-ratings after former health secretary Alan Milburn queried its ranking.

Two of the UK's best-known specialist acute trusts and a leading London teaching hospital also saw their ratings increase from one to two stars after Mr Milburn's intervention.

On 15 July 2002, Samantha Sinclair, an aide to Mr Milburn, sent an e-mail to Giles Wilmore, head of the DoH performance development unit.

The e-mail began: 'The Secretary of State has gone through the submission you sent up on Friday night in detail. He has commented as follows...' Following a number of queries about the ratings of acute trusts, Ms Sinclair wrote: 'Staffordshire Ambulance Service trust. Why didn't it get three stars?' and 'Great Ormond [Street Hospital for Children trust] and Royal Brompton & Harefield [trust].

Why did they get one star?'

When the star-ratings were published nine days later, Staffordshire had received three stars and Great Ormond Street and Royal Brompton both had two stars.

The Department of Health would not comment on why the ratings of individual trusts had been changed. But in the submission to which Ms Sinclair refers, Mr Wilmore had cautioned that the results for specialist and ambulance trusts were being 'reality' checked with directorates of health and social care, and 'there may therefore be the need to recommend minor changes to these results early next week'.

Before the 2002 star-ratings, Staffordshire had been singled out for praise by the government.

In April 2000, then health minister Gisela Stuart issued a press release which read: 'Staffordshire Ambulance Trust... are an example to the rest of the service and their innovative ideas are increasingly being taken on board by many other ambulance services.'

In May the following year, the prime minister visited the trust's headquarters during the 2001 election campaign. Three months later, he wrote to Staffordshire chief executive Roger Thayne. In the letter, he said: 'I congratulate you on the many best practices you have developed.'

He praised staff for their readiness to grasp new techniques, adapt to new technology and their desire to improve.

Like ambulance trusts, the 19 specialist acute trusts were rated for the first time in 2002. Six received a three-star rating, 11 a two-star rating and only two were eventually awarded one.

The two-star ratings given to Great Ormond Street Hospital for Children trust and Royal Brompton and Harefield trust - while not carrying the rewards associated with three-star status - did offer significant advantages.

By securing two-star status, the trusts were able to:

take forward capital projects worth up to£8m without first getting approval for the project's business case;

retain up£8m of the proceeds from the sale of any asset;

operate with the same freedom as three-star trusts when developing 'spin out' companies based on technical advances achieved by trust staff.

On 17 July, Ms Sinclair sent another e-mail and, referring to a discussion between Mr Milburn and DoH director of operations Alan Doran, wrote: 'On Barts, Secretary of State agreed they had acted in good faith and should be three stars.' The contemporary draft of the star-ratings shows Barts and the London trust receiving one star. When the ratings were published, Barts was given a two-star rating.

A spokesperson for Barts said the trust had a number of dental outpatients who breached the 26week waiting-list target, but it had been acting on guidance that referrals from general dental practitioners were not subject to the 26-week guarantee.

The full picture: which ratings did Alan Milburn query?

Altogether, 12 trusts were mentioned in correspondence between then health secretary Alan Milburn's aide Samantha Sinclair and Department of Health performance development unit head Giles Wilmore.

Of these trusts, seven saw an increase in their ratings, while five did not change.

Mr Milburn queried the ratings of eight trusts via the e-mail sent by Ms Sinclair on 15 July.As well as asking for clarification on the ratings given to Great Ormond Street, Northumbria Healthcare, Royal Brompton and Harefield, South Durham Healthcare and Staffordshire Ambulance Service trusts, the email also inquired why Northampton General Hospital, Princess Alexandra Hospital and West Suffolk Hospitals trusts had all fallen from three to one star.

The e-mail does not explain why Mr Milburn wanted to check the ratings of these last three trusts.They were, however, the only trusts to fall from three to one star.

Of these eight trusts, four (Great Ormond Street, Royal Brompton, South Durham and Staffordshire) saw their star-ratings increase.

At this time, Mr Milburn had also received information on Basildon and Thurrock General Hospitals trust, which was promoted to three stars, and Norfolk and Norwich University Hospital trust.

In an e-mail sent two days later on 17 July, Ms Sinclair mentions two more trusts, Barts and the London (see adjacent story) and University College London Hospitals trust.

Ms Sinclair wrote: 'On UCL, it was agreed that they could continue to look at their readmission data, but that it was up to them to come back with the right data.We couldn't let them off the hook on the basis of some verbal or written reassurance that their data would turn out to be wrong.'

The contemporary draft of the star- ratings shows UCL receiving two stars.When the ratings were published, it was given three.

UCL said the original data provided to the DoH was correct.

Mr Milburn chose not to comment on why he had queried any ranking.

But just before Christmas, leader of the Commons Peter Hain told parliament that Mr Milburn had also 'asked a question'about the rating of Maidstone and Tunbridge Wells trust.

The trust was not one of the 12 included in the e-mail correspondence - and serves the constituency of Tory MP Anne Widdecombe.

'I am happy to report that the star-rating increased there, too, ' said Mr Hain.

All change: which acute trusts moved - and how?

The 15 July e-mail from then health secretary Alan Milburn's office refers to the 12 July draft of the star-ratings and the number of acute trusts in each of the four star-rating categories (zero to three).His aide Samantha Sinclair writes: 'Secretary of State thinks this needs looking at again.'

When the final star-ratings were published nine days later, the number of three-star and two-star trusts had both increased by three, and the number of one-star trusts decreased.

Altogether, 25 trusts saw their ratings change between 12-24 July.

Nine were promoted from two to three stars; a further four were promoted from two to three stars on 16 July, but then demoted back to two stars before final publication of the ratings.Six were demoted from three to two stars.A full list of these trusts was published in HSJ's 18 December edition.

Six trusts were promoted from one to two stars.They were: Barts and The London, Brighton Health Care, Kettering General Hospital, Kingston Hospital, Maidstone and Tunbridge Wells, and North Staffordshire Hospital trusts.