Published: 30/01/2003, Volume II3, No. 5840 Page 8 9

Nurses in trusts which have been awarded zero or one-star rating have to spend a 'significant amount of time' reassuring patients that they are being treated in safe surroundings, the Commons public administration committee has heard.

Giving evidence to the committee inquiry into public service targets and league tables last week, Royal College of Nursing executive director Alison Kitson said star-ratings made a serious impact on public confidence and staff morale.

Ms Kitson said that following the announcement of star ratings, the RCN heard a number of concerns from members of staff working in 300 and one star-rated trusts.

In written evidence, she said:

'Nursing staff have had to spend time reassuring both inpatients and those whose admission was imminent that they would receive safe and high-quality care and treatment. Furthermore, staff who had been working to improve care in difficult circumstances, often the result of forces outside their direct control, are upset and angered by what they feel is public 'naming and shaming'.'

She added that the pressure to achieve high star-ratings to access the£500m performance fund and, in the case of three-star trusts, to apply for foundation status, could harm patient care.

'The need to achieve high starratings has enormous potential to distort organisational systems and directly influence staff behaviour in ways which might not be conducive to patient care. There are many anecdotes of this; for instance, accident and emergency corridors and treatment rooms being re-designated as pre-admission units in order to artificially reduce trolley waits.'

The RCN has also called for 'a greater focus on quality targets rather than league tables that measure a relative position' in a process which was more supportive and developmental.

Her evidence was backed up by Sir Graham Morgan, director of nursing at North West London Hospitals trust, speaking in his capacity as chair of the RCN's nurses in executive roles forum.

He told HSJ he wanted to see the government scrap most targets and the 'huge bureaucracy' involved in collating that information.

'I think they could scrap the majority of the 400-odd targets.

Governments have to have some form of measure of performance.

Instead there should be a dialogue between the Department of Health and those with the job of delivering the service as to what the top-level targets should be and in what time frame they can be achieved.'

Sir Graham said that the trusts being put under too much pressure to meet weekly as well as yearly targets was 'leading to a culture that was inquisitorial rather than enabling'.