Ministers get star quiz script

A ministerial 'script' to handle the fallout from last month's star-ratings has revealed Department of Health tactics on how it planned to tackle media inquiries about controversial aspects of government policy.

HSJ has seen a 52-page briefing document given to ministers which lists the key areas the media was likely to attack and suggests possible 'lines to take'.

In particular, civil servants warn ministers that they are likely to face allegations that the foundations policy was 'in disarray' and that 'inconsistency' in star-ratings 'confuses and demoralises the NHS'. The document also acknowledges that the government has performed a 'policy Uturn' by abandoning the franchising of failing trusts.

In a section titled 'hot issues', civil servants outline a number of allegations ministers are likely to face. One states:

'The NHS foundation trust policy is in disarray. Four of the authorised NHS foundation trusts received a 2 star rating as did 11 of the wave 1A hopefuls.'

Ministers are advised that the best response to this point is:

'Not at all.

'There are now 20 NHS Foundations in existence. This marks an important step on the road to decentralisation and freeing up the NHS from day to day Whitehall control... this is good for the democracy [sic] and good for the NHS.'

On franchising, the policy to replace chief executives of 'failing twists' with managers from an agreed register, invented two years ago and recently quietly abandoned' the document says explicitly: '[The DoH] will no longer require trusts to undergo the management franchising processes.'

Civil servants warn ministers they could be left answering the question: 'How can you justify this policy U-turn?'

The suggested response is: 'This is entirely in line with StBoP [Shifting the Balance of Power, the policy of devolution].

[Strategic health authorities] have demonstrated the capability... to rectify problems within their NHS organisations locally and effectively, and it is therefore no longer necessary to impose NHS franchising on NHS trusts.'

The document does say that it will 'remain an option for the NHS locally, led by the SHA to initiate' franchising should they want to. Of the NHS and private sector organisations that were placed on the 'register' of bodies qualified to take up franchises, the brief says they 'can still be involved in performance improvement of NHS organisations'.

The document also warns that ministers may be asked whether 'inconsistency in targets from year to year confuses and demoralises the NHS', a concern raised by many of those unhappy with lower than expected ratings (see the Big Story, pages 10-11).

It advises ministers to say: 'The star ratings system provides a robust measure of trusts [sic] overall performance. The key targets reflect the priorities identified to the NHS in the priorities and planning framework 2003-2006.

The wider range of performance indicators are chosen to reflect the wider range deliverable specified in the NHS Plan, PPF and NSFs [national service frameworks].'

The 'core script' of the document outlines the kinds of messages the DoH wants to outline in response to coverage of the annual star-ratings. These include the fact that performance across the NHS has improved dramatically over the last four years and the move towards reduced numbers of targets. It also identifies a number of trusts which ministers could highlight as 'heroic improvers'.

But the document also spells out the 'accusations' and 'hot issues' which could come under the spotlight, as well as setting out 'defensive lines'ministers could take.

The briefing document lists the 'negative' messages from this year's ratings. It highlights that, 'the performance of mental health trusts remains a cause for concern, ' and adds: 'The quality of information available in mental health trusts... also needs improvement.'

But its core script concludes:

'The Healthcare Commission's view of this at their press conference was that there was nothing significantly wrong with mental health trusts' performance.'

Asked whether this reflected their views fairly, a spokesman for the commission said: 'The view expressed at the star-ratings conference was that mental health was still lagging behind the rest of the service.'

Hot issues - what the document says Q Franchising: how can you justify this policy Uturn?

A This is entirely in line with Shifting the Balance of Power. SHAs have demonstrated their capability to rectify problems within their NHS organizations locally... it is no longer necessary to impose franchising.

QThe foundation trust policy is in disarray.

Four of the authorised foundation trusts received a 2 star rating as did 11 of the wave 1A hopefuls.

ANot at all. There are now 20 foundation trusts in existence. This marks an important step on the road to decentralisation.