NEWS FOCUS: The star-ratings system claimed its first scalp last weekwhen a no-star trust chief executive quit - hounded out of office, claim her supporters. Is she a scapegoat or did she deserve to go? Laura Donnelly reports

The campaign launched in January by the local paper covering Dartford and Gravesham trust had one clear target: 'She must go.' Last week, chief executive Anne-Marie Dean resigned.

During the past year, the trust has made two complaints to the Press Complaints Commission over the paper's crusade to force her resignation. It claimed that The News Shopper had acted unprofessionally and that its coverage had put Ms Dean's safety at risk. The complaints were not upheld. Nonetheless, the newspaper reported that Ms Dean was so frightened that she called for police protection, a claim which was not confirmed by the trust or police.

In February the newspaper held a phone poll - in which 73 per cent of callers backed calls for the resignation. 'What does she do all day?' the newspaper asked. It has printed dozens of readers' letters, as well as an anonymous account of 'bullying', which accused her of regularly screaming at staff.

The newspaper also published a few letters in support of Ms Dean - including a statement from the joint trade unions staff side accusing the paper of 'biased and unfair' reporting.

Seven weeks ago health secretary Alan Milburn launched performance-ratings; Dartford and Gravesham was one of the so called 'dirty dozen' no-star trusts.

Ms Dean was among six chief executives put on three months' 'probation'.

For The News Shopper, the news looked like vindication. For managers used to negative media coverage, Ms Dean's resignation added weight to their worst fears - that the political presentation of the stars had armed the critics with fatal ammunition.

Why did the trust fare so badly on the ratings, and to what extent was Ms Dean personally culpable?

The trust failed core criteria on finance and outpatient waiting lists. It also missed targets on deaths in hospital, outpatient waiting times, consultant vacancies and sickness rates.

Commentators are quick to defend her. Ms Dean, who began working in Dartford health services as a medical secretary 24 years ago, oversaw the first private finance initiative scheme, which was the subject of a National Audit Office report over a£12m miscalculation in savings. The result was Darent Valley hospital, which opened last year.

In a statement, Ms Dean said that having established the hospital, now was 'a natural time to think about moving on to the next challenge'. She has taken early retirement. But sources believe central government used Ms Dean as a guinea pig to pioneer the PFI process, and has now discarded her.

Birmingham University's health services management centre senior research fellow Dr Kieran Walshe is one: 'These chief executives are delivering what they were told to deliver at the time. Now it seems that the goalposts have been moved.'

One source told HSJ: 'It is becoming increasingly clear that involvement in large-scale PFI schemes - and in particular in the first-wave ones - impacts badly on the running of the rest of the service and quality issues. It is a question of taking the eye off the ball, and it does seem unfair that managers who followed government policy of the time are now likely to suffer the consequences.'

Another senior source agrees the early days of PFI in particular were 'extremely labour-intensive', but says Dartford and Gravesham got over£2m in a rescue package from West Kent health authority, and received funding above its weighted capitation.

Dr Walshe criticises the way starratings have been handled and believes many trusts are disillusioned, particularly about 'this way of using them to hammer management and mete out punishment'.

NHS Confederation policy director Nigel Edwards believes the difficulties facing chief executives on probation, and the sudden panic for those with only five weeks to prove themselves, reflects a performance process that is 'a bit ofa mess, and doesn't hang together intellectually'.

Since the hospital has opened, it has come under fire for a number of scandals - including the death of a pregnant woman sent home after being told she didn't need treatment, and the death of an 83year-old who contracted salmonella from one of the wards.

The News Shopper Dartford and Gravesham edition health reporter Emma Coutts-Wood takes the no-star rating at face value: 'When Alan Milburn said it was the worst of the worst. . . well that proved it.'

She compares Dartford's rating with that of nearby Queen Elizabeth Hospital trust, which opened a new PFI site in March and also has a history of financial struggles yet managed three stars.

Ms Coutts-Wood says the paper feels vindicated by Ms Dean's departure. She insists its campaign was sparked by the sheer volume of complaints the paper received about the new hospital and Ms Dean's management style.

Interestingly, the reporter recalls that at the board meeting following publication of the star-ratings, the HA made clear it had far more faith in neighbouring Medway trust, which also received no stars, than in Dartford and Gravesham's chances of turning its performance around.

Dartford, Gravesham and Swanley community health council chair Ernest Brook thinks Ms Dean was 'unfairly lambasted by the media'. He describes her as a 'very capable lady' who did a 'fabulous' job in managing the replacement of three hospitals with 534 beds with one 400-bed site at a time of budgetary cuts, when replacement community services were not up and running.

South East regional director Ruth Carnall offers Ms Dean 'good wishes for the future' and salutes the way she 'led a vital new project in exemplary fashion'.

'They worked through a lot of difficulties that other people have sailed through because of that work.' But Ms Carnall does not suggest Ms Dean has been unfairly treated. 'The trust has got some significant problems - some of those are long-standing.' l