comment: The recalculation of the 2002 star-ratings remains a mystery

Published: 08/01/2004, Volume II4, No. 5886 Page 17

Today two members of the Commons health select committee are due to press for an inquiry into the 2002 star-ratings, a move inspired by HSJ's revelations that former health secretary Alan Milburn intervened in the proposed rating of the prime minister's local trust, South Durham Healthcare (news, pages 3-5, 18 December 2003).

HSJ reveals this week that, in all, 25 acute trusts, as well as an unknown number of specialist and ambulance trusts, saw a change in their ratings days before their final publication.

The Department of Health says that ratings were 'subject to regular change throughout the last few weeks leading up to publication'. This statement leaves a number of questions unanswered:

nWhy were these changes made at the last minute despite the fact that acute trust ratings had - by then - been 'reality checked' by the directorates of health and social care and the methodology agreed with the Commission for Health Improvement?

nWhy did ministers choose to reject the strong advice of Giles Wilmore, the civil servant in charge of the star-ratings, not to tamper at this late stage?

nWhy did last-minute recalculation produce a noticeable improvement in the overall profile of the star-ratings, with the number of three and two-star acute trusts each increasing by three and the number of one stars falling by six?

nWhy, with 15 per cent of acute trusts moving up or down the ratings, did the number of zero stars remained unchanged throughout?

nGiven all the above, what criteria changed in the two final recalculations of the ratings to produce the final result?

A statement from the Prime Minister's Office points out that not all the trusts which had their ratings queried by Mr Milburn saw their ratings rise. This is true - but half of them did and none saw their ratings fall. Did Mr Milburn only query those ratings he thought too harsh? If not, what criteria did he use? If so, how did this impact on those trusts which were demoted?

Finally, who 'requested' the changes to South Durham's ratings? Mr Milburn claims he was only 'asking questions', something he was perfectly justified in doing as the DoH had responsibility for the ratings. If so, who made the 'request', or did Mr Wilmore draw the wrong implication from Mr Milburn's enquiry?

The award of two, as well as three, stars in the 2002 ratings brought significant financial and other advantages for trusts which affect the care being delivered today, and will continue to do so for many years to come. The health select committee has an important decision to make. l