Published: 08/01/2004, Volume II4, No. 5886 Page 24

Throughout this year the advice we have been given by the Department of Health via our strategic health authority is that the star-ratings criteria would remain unchanged, although the thresholds for measuring each item would of course be adjusted.

The publication by the Commission for Health Improvement in December of the the performance indicators for 2003-04 unfortunately proves that expectation wrong.

Without any warning, the key star-rating on the re-provision of cancelled operations within 28 days has been removed to be replaced by success in the booking of inpatients and outpatients.

All year, clinical, managerial and clerical staff here have been highly focused on keeping the promise to patients contained in that 28-day rule.

Although keeping that promise is a 'good thing' in itself, I now have to tell these hard-working staff that their efforts were not, after all, fulfilling one of the highest-priority star-ratings targets. This discredits the ratings, and any sense that they somehow reflect the highest priorities for the NHS.

This sort of belated change will make it very hard for us to convince staff that the key starratings are top priorities, reflecting the performance and reputation of their trust, if they think that key targets can be moved three-quarters of the way through the year.

Finally, CHI's announcement is no better than similar ones from the DoH. They contain no reference to the thresholds under which each star measure will be assessed, so at month nine we still have no idea what the specific targets are, or even the measurement period for many of the items.

This is not the way either to engage staff or give guidance on priority effort.

Alan Bedford Chief executive Portsmouth Hospitals trust