monitor

Monitor hates to brag about his influence in the corridors of power.

But in the wake of the star-ratings, as the cruelly zeroed recover and the celestial three-star types celebrate, how nice to find that a top tip from Monitor has paid off. Yes, two of the NHS's quietest and meekest chief executives have triumphed, just as Monitor was sure they would.

Regular readers will recall that shy and retiring University College London Hospitals trust supremo Robert Naylor and his low-profile University Hospitals Birmingham trust colleague, Mark Britnell, were spotted deep in conversation at May's NHS Confederation conference in Harrogate. The two had raced to the conference from a disruptively timed foundation-fest organised by the Department of Health in London, to pump up enthusiasm for foundation status and all its lovely freedoms. The pair were presumed to be consoling each other as - rather awkwardly - our freedom fighters had just four of the requisite stars between them. Monitor prefers a light-touch, supportive and developmental way of improving performance, whether by ministers or anyone else, so he merely expressed a gentle hope that Big Al might find Mark and Robert an extra little twinkle each at star-rating time.

And lo! Among the three-star glitterati, what should Monitor spot but the very lovely UCLH and UHB, shining away. How satisfying it was - and even more so when one of Monitor's colleagues reported that Mr Britnell himself had been on the phone, expressing his and Mr Naylor's gratitude for all Monitor's help. Sparkly Mark was 'sure Monitor's pressure on the health secretary' had done the trick. Monitor rather suspects that the hard work of staff at the two trusts may have counted for nearly as much as his own influence on Big Al, certainly in areas where Monitor gets a bit squeamish - like dealing with unpleasantly ill patients. But It is always nice to have one's efforts appreciated.

Sadly, though, Tony Blair's favourite trust boss, Northumbria Healthcare chief exec Sue Page, is no longer likely to be on the very crest of the foundation first wave, despite her pioneering spirit. Ms Page it was who made that 'extraordinary leap' into politics, endorsing Labour at a general election press conference - way ahead of her health management peers. But though her trust was named in May as one of four plucky trusts thrusting themselves forward for the first wave, it has subsequently dropped a star. Oh dear.

Perhaps Ms Page should call for a vote from Monitor next time round. The link between Monitor's endorsement and a three-star triumph may not be entirely transparent, but what matters is what works.

Which brings us to NHS walk-in centres which, according to an independent study, are a great success. Monitor knows this because he has diligently read a DoH press release, revealingly entitled 'Independent report hails NHS walk-in centres a success'. It informs us that they are a 'safe, wellused addition to NHS healthcare services, achieving high levels of patient satisfaction'. Apparently, the report, commissioned from Bristol University academics, 'found people were 'very satisfied' with the quality of care they received and benefited from speed of access, convenient locations and extended opening hours'. Oddly, though, news of another evaluation by Bristol University examining centres of a distinctly walk-in kind also caught Monitor's eye, splashed as it was across the front page of GP magazine.

'DoH study condemns walk-ins, ' it screamed. 'Walk-in centres are expensive and do not reduce demand, according to a DoH-funded evaluation, ' GP continues. The scheme has 'failed in its two key aims' - increasing access for disadvantaged groups and reducing workload for GPs, out-of-hours services and A&E. Monitor was having a little trouble reconciling the two evaluations. But health minister John Hutton must have evaluated the situation quicker than anyone - he opened another walk-in centre the very day the report was announced.

And now a word or two in praise of plain English. Monitor is very keen on this - but so, too, is Ann Smart, investment director at North East London strategic health authority. Reporting on waiting lists at Whipps Cross University Hospital trust, she goes the extra mile to avoid those confusing medical terms. 'The trust experienced an outbreak of the small, roundstructured virus at the beginning of May, which closed the trust to elective admissions...' As opposed to the scary, big, square one, Monitor assumes.