comment: The standard we should expect from government - and the star-ratings

Published: 15/01/2004, Volume II4, No. 5888 Page 15

NHS chief executive Sir Nigel Crisp has declared himself satisfied that there was no attempt to 'manipulate' the 2002 star-ratings and that 'political considerations' did not influence decisions (news, pages 4-5).

Sir Nigel has carefully examined the evidence available to him and HSJ does not doubt his belief in the robustness of the ratings. Health secretary John Reid has also explained how NHS concerns were factored into the rating equations until the last minute in an attempt to produce the most realistic picture of performance.

However, despite these reassurances, there remain a number of unanswered questions, which - for the sake of transparency and confidence in the government's management of the NHS - should be addressed.

One of the inconsistencies in the government's line is the approach taken to the mental health ratings. Sir Nigel has made much of how these were published in an indicative form, but it is clear that the government was in fact advised by some in the Department of Health and in the NHS not to publish any at all.

The government acted out of a desire to get the 'measurement' of an important part of the NHS underway. But there must be questions about whether this - in principle, a sensible and desirable policy - led it to act in haste and produce ratings which, ironically, gave little real indication of which trusts were providing the best, and worst, services for users.

By giving responsibility for star-ratings to the Commission for Healthcare Audit and Inspection, the government has shown it wants the measurement of performance in the NHS to be both transparent and beyond reasonable criticism. It should want its own actions to meet these high standards. l