Published: 01/07/2004, Volume II3, No. 5912 Page 4

Primary care trusts are furious that they could lose out in this year's star-ratings if an investigation finds waiting-list irregularities took place at one of the country's flagship specialist trusts.

Royal National Orthopaedic Hospital trust director of commissioning Stuart Coalwood was suspended last month after concerns were raised about possible irregularities in the management of waiting lists. So far an investigation by the north London trust has established that about 300 patients have been taken off the waiting list, although the trust claims that these were 'mainly for valid reasons'.

But last week a letter from North Central London strategic health authority chief executive Christine Outram to all trust and PCT chief executives on her patch warned of 'several hundred'breaches.Now the SHA and the trust are investigating and the SHA has warned PCT chief executives that any irregularities uncovered 'may have a negative impact on ratings' for PCTs when they are published later this month.

Because the RNOH is a specialist centre, in total about 75 PCTs nationwide commission from it.

It is believed that up to eight PCTs in North Central London, North West London and Bedfordshire and Hertfordshire SHAs fear they will lose a star.And other PCTs are worried that they might not gain a star that they would otherwise expect to.

Ensuring that patients do not breach waiting-time targets is one of nine key indicators in this year's PCT star-ratings.

North Central London SHA alerted PCTs last month that action was being taken to ensure that no patients would be breaching waiting-list targets by 31 July.

Ealing PCT chief executive Robert Creighton said that unless the thresholds for measuring stars were altered, the impact of newly revealed breaches would 'reverberate around the system'.He said there was anger among PCTs and called it 'an idiotic state of affairs'.

Another PCT chief executive, who did not want to be named, said it was 'incredibly difficult' in a large organisation to keep track of what happens at a distant specialist referral centre.

Watford and Three Rivers PCT chief executive Felicity Cox, whose trust is one of the biggest commissioners from RNOH outside London, said she would be 'very disappointed if the issues at the RNOH have an adverse impact on our star ratings'.

And Enfield PCT chief executive Sally Johnson said that although her PCT would not lose a star, there was a danger it might not improve to two stars, as it had hoped.

A North Central London SHA spokeswoman said: 'We are going through a validation process and we will not get a clear picture of the situation until that is finished. We have a tight timescale and we will notify the Department of Health, the Healthcare Commission and other SHAs when we are finished.'

The star-ratings are due out on July 25.A Healthcare Commission spokesman said no decision could be taken on how the investigation would affect the ratings until it received the results of the SHA's investigations.

Worth the wait: who should be held account for list breaches Whether primary care trusts should be held to account for breaches of waiting times by the acute trusts from which they commission services is the main point of debate.

One acute trust source said PCTs should hold their own waiting-list figures in order to detect waiting-list breaches.He said: 'It is their raison d'etre to know where patients are and whether they have been treated.This says something about the quality of observation in primary care.'

But PCT chief executives involved in the Royal National Orthopaedic Hospital trust incidents argued that it would be difficult for PCTs to monitor the situation effectively.

Enfield PCT chief executive Sally Johnson said PCTs that commission services from up to 40 trusts must rely on acute trust figures.But she insisted PCTs would 'rise to the challenge' if they were given the resources to take over responsibility for waiting lists.

A Healthcare Commission spokesman said the star-ratings indicator on waiting-list breaches was designed to measure PCTs' commissioning ability.

Ealing PCT chief executive Robert Creighton said the switch to giving PCTs greater ownership of lists could not happen 'overnight', and better monitoring systems were needed first.