Published: 08/01/2004, Volume II4, No. 5886 Page 6 7

An acute trust chief executive has attacked last-minute changes to this summer's star-ratings indicators which he says have left the system discredited.

Portsmouth Hospitals trust chief executive Alan Bedford said the removal of a key indicator from the ratings, nine months into the year 2003-04 'discredits the ratings, and any sense that they somehow reflect the highest priorities for the NHS'.

The indicator on the percentage of cancelled operations re-provided within 28 days will be replaced by an indicator measuring progress on booked admissions in the next set of ratings, due out this summer.

In a letter to HSJ, Mr Bedford said he would now have to tell his staff that their current efforts were not tackling 'one of the highest priority targets'. And he called for greater consistency and earlier announcement of exactly how trusts will be judged, particularly on key indicators.

The chief executive said details of the indicators released by the Commission for Health Improvement just before Christmas were 'no better' than the information previously issued by the Department of Health, in that they did not explain the thresholds by which star measures would be judged, or the measurement period covering them.

Mr Bedford said he was 'long enough in the tooth' to know that 'there had to be a certain number of high-performing trusts, lowperforming trusts, and a number in the middle'.

'I know from reading HSJ that measurements are tweaked and that does make life more difficult for us, ' he said.

But he said it was particularly important that trusts should know exactly how they would be judged when the ability to apply for foundation status, or the risk of receiving no stars, was at stake.

A CHI spokesperson said the change had been made because levels of pre-booking had been raised as a priority during consultations with trusts. And he said a key element of the ratings system was to improve patient experience and any work that was carried out to that end as a result of star ratings should be applauded.

Meanwhile, managers working in primary care attacked the failure to alter indicators for primary care trusts in the face of widespread criticism last year.

Last summer the NHS Alliance and several priimary care trusts complained that performance indicators reflected deprivation levels, performance by local acute trusts and historical health economy performance more than the management performance of PCTs.

Indicators measuring rates at which patients quit smoking and reduction in teenage pregnancies, were singled out for reflecting levels of deprivation rather than management ability.

The indicators for 2003-04 show little sign of change. There is just one new key indicator, on increasing access to treatment for drug abusers. And one of last year's nine key indicators, on providing access to out-of-hours care through NHS Direct, has been relegated to become part of the balanced scorecard.

NHS Alliance chair Dr Michael Dixon said: 'It is already widely acknowledged that this year's [2002-03] star-ratings, based on a similar set of performance indicators, reflected levels of deprivation and the performance of local hospitals far more closely than they measured what PCTs are doing.Now we are getting more of the same for next year.'

No PCTs were franchised as a result of a zero-star rating last year, when CHI said the ratings should be treated as 'a learning experience'.

But Dr Dixon said he feared for good managers whose jobs could be put 'on the line' this year due to factors beyond their control.

National Association of Primary Care chair Dr Peter Smith said last year's ratings were 'a start but not a very good one'. He said he expected improvements in 2005.

And Dr Smith called for a clearer statement this year on whether the PCT star-ratings were intended to be used for performance management or public accountability.

A CHI spokesperson said it was for other bodies to decide what action to take on the data that it provided.

At South Manchester PCT, which received no stars last year, chief executive Dr Adrian Mercer said that although the new indicators were 'not perfect', consistency was also important because PCTs' performance improvement plans were focused on those areas that will be judged again this year.