Methodology will be challenged, but changes are clear for all to see

Published: 25/07/2002, Volume II2, No. 5815 Page 17

Congratulations are due. The management of English acute hospital trusts appears to have improved over the last year. Acute trusts have performed well in the face of more demanding inpatient and outpatient waiting-list targets. The number of trusts breaching targets for 12-hour trolley waits and cancelled operations has fallen significantly. Every single acute trust has met the targets for hospital cleanliness.

Last year's target of patients with suspected breast cancer waiting less than two weeks from urgent GP referral to an outpatient appointment has been broadened to cover all cancer, and in this light the performance of the acute trusts is creditable. The one indicator giving cause for concern is financial performance - here 15 acute trusts, including three three-star trusts, underachieved, and 20 significantly underachieved.

Overall, against a higher benchmark, the proportion of three-star acute trusts has risen from 20 per cent to 28 per cent. And the figure for no-star trusts has fallen from 7 per cent to 5 per cent. However, the fact that the number of two-star trusts has fallen from 60 per cent to 46 per cent and the total of one-star trusts has risen from 13 per cent fo 21 per cent suggests either a greater willingness to separate those organisations in mid-table or the first sign of real disparity in the performance of acute trusts.

Particular congratulations are due to the surprising number of acute trusts that have jumped from no-star status to two stars, or from one star to to three stars. They have shown what is possible in 12 months.

HSJ went to press the day before the official launch of the ratings, but it seems the Department of Health is also due some praise for greater sensitivity in its handling of this year's ratings. Information was released to the trusts first and then to the media, making it much easier for the trusts to manage the resulting repercussions. The press will be full of questions about the credibility of the methodology - and there remain many questions to be asked. However, the government appears to have resisted the temptation to present the figures in a way that shows a huge leap forward in performance. Perhaps ministers concluded that nobody would believe such a claim, but that has not stopped this government - or others - in the past.

Are the star-ratings a complete guide to the management of acute trusts - and now, of course, specialist, ambulance and mental health trusts? The answer must still be no. But as indicators of how trusts performed during the year, their authority is improving.