There must be no knee-jerk reaction to those trusts that perform badly

Published: 04/07/2002, Volume II2, No. 5812 Page 17

Hardly a British Medical Association conference goes by without politicians quite rightly coming under attack for using the NHS for party-political point-scoring.

The Department of Health itself can go some way to protect the service from being what BMA chair Dr Ian Bogle calls the 'Punch and Judy show of British politics' when it publishes its star performance ratings this month.

The DoH was careful not to label the stars an annual league table and to some extent that may have limited last September's media feeding frenzy. That is to be commended.

But chief executives at trusts given a zero-rating were flabbergasted to hear that health secretary Alan Milburn was putting them 'on probation' and giving them three months to turn things around. At the other end of the scale, chief executives sitting in three-star heaven are now being offered the world - foundation trust status, more freedom, and even the opportunity to franchise their zero-star cousins.

Cue an avalanche of media praise and/or scorn. Punch and Judy indeed. That is not the way to do it. Especially when concerns are being raised about the validity of the data being used to award these ratings and the fact that the ratings system is retrospective and cannot work well for trusts which are improving or deteriorating rapidly. It is also unfair on trusts that are stuck in ancient, crumbling premises awaiting rebuilding.

This year, star ratings for acute trusts will be similar to those of last year, but the influence of the clinical governance reviews carried out by the Commission for Health Improvement will have a wider impact. In theory, this will mean that the rating should be more eloquent, and quality based.

However, for the first time, this month primary care trusts which were in existence before March this year and ambulance trusts are also being rated. That presents even greater problems. PCTs are worried about being judged on factors that are beyond their control - such as inpatient and outpatient waiting times. The situation is worse still with ambulance trusts - according to a survey (news, pages 6-7, 27 June) there is no universal set of definitions when recording response times to 999 calls.

There must be a level playing field before stars are awarded and no instant retribution for those who fare badly. That really is the way to do it.