It is true that the NHS Confederation has not been blazing a trail in the media about the star-rating system (news focus, page 13, 18 October). However, we have been very active in three ways.

First, we achieved a softening of the traffic-lights approach through our work on the performance task group.

Second, we sought views from members about the star system and raised their concerns about the process, handling and scoring with politicians, advisers and civil servants (see www. nhsconfed. net/priorities/ policies/).

Third, we have launched a major programme of leadingedge work on rethinking performance improvement (news, page 7, 25 October).

To date, NHS management has not been good at articulating a different approach to performance management.

The creation of strategic health authorities provides a unique opportunity for us to rethink how we can create performance management systems that support quality improvement, encourage creativity and empower local management.

Our experience is that providing government with well thought-out alternatives is the route to influence, not blazing a trail in the media.

Stephen Thornton Chief executive NHS Confederation