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Published: 15/01/2004, Volume II4, No. 5888 Page 12 13

MPs responded to HSJ's exposé of ministerial involvement in the star-ratings process with a three-hour Commons debate. Helen Mooney was there

There could scarcely be a more high-profile recognition of the significance of HSJ's reve lation of ministerial involvement in the starratings system than the highly charged debate in the Commons last week. But predictably, the event generated more heat than light.

The Conservatives used one of their 20 Opposition Day debates to take on the government following our exclusive story showing that the rating of South Durham Healthcare trust - in prime minister Tony Blair's constituency - was upgraded from two to three stars in July 2002 'following the involvement of the private office of the then Secretary of State for Health and with the knowledge of 10 Downing Street', in the words of the Tory motion.

Health secretary John Reid was forced to go head to head with his counterpart, shadow public services, health and education secretary Tim Yeo over the transparency of the star-rating system.

Mr Yeo told politicians that 'we are dealing with some very murky waters indeed', and added 'the extent of the prime minister's direct personal involvement remains unclear at present'.

The Conservatives and Liberal Democrats ganged up to demand that e-mails and other correspondence about changes to the 2002 indicators should be placed in the public domain, but Mr Reid said he was not prepared to reveal information 'that is confidential to ministers and their advisers'.He added that he was confident the process had been transparent.

Mr Yeo challenged Mr Reid for an explanation on how the ratings criteria had been changed, leading up to the final publication of the 2002 star-ratings. He called for 'greater transparency in the calculation and publication of performance indicators throughout the NHS'.

The Tory motion also expressed concern 'that excessive reliance on such indicators inhibits the independence of professionals and managers, and leads to distortions in the allocation of resources'.

Perhaps unsurprisingly, Mr Reid revealed himself to be a master in the art of political street-fighting, claiming the set-to was 'much more about the Tory party's failure to come to terms with one simple fact: the National Health Service has improved and will continue to improve'.

Health minister John Hutton also made a sterling effort to back Mr Reid. He cited a letter sent by NHS chief executive Sir Nigel Crisp to Dr Liam Fox, Tory cochair and former shadow health secretary. Mr Hutton claimed Sir Nigel was satisfied that 'no improper influences were brought to bear'. Touché! And so the debate rolled on. The government did give in on one area, giving their reasons for the changes in star-ratings immediately prior to the 2002 deadline.

'Put simply, the process of verifying data and refining the indicators to be used ran right up to the point of publication, ' said Mr Reid.

He said that for the 2002 starratings, the Department of Health had been 'concerned to be able to justify publicly the nature of the criteria and the verifiable accuracy of the data'. Therefore, he argued, trusts were given the opportunity to comment on and ratify the 'indicator constructions' to confirm they were correct. As a result, concerns were expressed with two proposed indicators covering catering facilities and information management and technology. Consequently these were dropped, to the benefit of some trusts, including South Durham.Mr Hutton said this was the 'sole reason' for South Durham achieving three stars.

Liberal Democrat MP Paul Burstow, a member of the Commons health select committee, suggested there was 'a fine line between what one might call finetuning, data checking and reality checking of performance indicators and star-ratings, and the fiddling of figures'.

'On the basis of the evidence that was published in the Health Service Journal... one could conclude that that line has been crossed.'

Shadow health secretary Andrew Lansley argued that the Tory motion was not a criticism of civil servants, but he suggested there were those in the NHS who were already sceptical of the credibility of the star-rating system and 'that system will be further undermined by the fact they can now see an instance which appeared open to ministerial influence'.

Mr Hutton wound up the debate with a robust defence of the government's position and a point-blank denial that anyone had done anything wrong. He told the House there was 'no substance to any of the allegations of wrongdoing...'.

No evidence of impropriety has been disclosed; no credible or convincing case has been made out that would lend any measure of support to any part of the interpretation of events... On that basis, I ask my honourable friends to reject the puerile and fatuous motion'.

Despite three hours of frontbench debate, the afternoon succeeded in posing as many questions as it answered. Among the political knockabout, it was easy to forget that the Conservative motion called for an inquiry into how the 2002 starratings were decided.

MPs rejected the motion on a vote of 338 to 204.