Stark contradictions between the new star-ratings measure of a trust's performance and the Commission for Health Improvement's evaluation were highlighted last week with the report of a favourable clinical governance review of no-star Ashford and St Peter's Hospital trust.
As the report was published, health secretary Alan Milburn confirmed that he wants to see the work of CHI and the star-ratings system quickly integrated into a single performance measure. He told the Commons health select committee: 'I want to get to a position where - and I hope we will get this next year - what we do and what CHI does gives one set of reporting in the NHS.We need to rationalise it so we are producing one set of information.'
CHI's overwhelming concerns at Ashford and St Peter's centred on problems with delayed discharge and lack of staff - both persistent and severe throughout west Surrey and reinforced in the commission's report on adjacent Royal Surrey County Hospital trust a week earlier.
The trust, which was given three months to turn things round when awarded no stars last month, was commended by CHI for its 'excellent' risk-management procedures, 'its friendly and caring' staff and its 'effective and well-respected leadership'.
Discrepancies between the two systems were most significant on clinical effectiveness indicators.
On the star rating's balanced scorecard the trust 'significantly underachieved' on the two clinical focus measures, which managers attributed to incomplete data.
CHI concluded that on clinical outcomes, 'the trust performs well in comparison to England and comparable trusts'.
Like Royal Surrey trust, patients are spending up to four days in the accident and emergency department, with 40 patients staying overnight in A&E during the CHI visit. The report adds: 'The A&E department is frenetically busy. There are often two patients to a cubicle, making it impossible to maintain the patient's privacy and dignity.'
CHI highlighted the trust's serious staffing problems, contributing to bed closures and costing the trust£6m a year on agency fees.
The trust's poor financial position was a further reason for its zerostar rating.
Despite cohesive and effective leadership, CHI also found a shortage of middle managers, so managers at directorate level found themselves 'firefighting' and 'overly embroiled in operational issues'.
And it concluded: 'The executive team recognise the significant pressures facing the trust.
However, there is also a perception that these issues were out of their control, with the responsibility for solving these issues lying with the regional office.'
Director of nursing and deputy chief executive Joyce WinsonSmith said staff had felt 'very bitter about being branded as failing'.
'There was a very real danger that the recruitment problem could be further compromised by the star ratings, ' she said, 'But the CHI report is absolutely marvellous and staff are certainly feeling vindicated that their efforts are better recognised.'
But she said the star rating could still have a positive effect because there is now an increasing awareness about the scale of the problems the trust is facing.
And she added: 'There has been a fair amount of anger about the star ratings which is healthy - we can build on that and harness people's resolve.'
The trust has produced a draft action plan which highlights work already underway, including the appointment of several new members of the management team and development of a human resources strategy.