Letters

Publication of trusts' star ratings was much as expected. Sadly, so were the accompanying threats made to the managers whose trusts achieved no stars.

For a short while, the cynical were silent. We seemed to have entered a genuine period of development and sharing good practice, being open about mistakes and offering opportunities to learn and improve. The headlines accompanying the launch have shattered any illusions that this spirit ever really existed.

The Institute of Healthcare Management has said consistently that comparisons against which to judge performance are useful, and we have been happy to support the wider availability of such data to the public.

However, using the information as blunt instruments to beat up managers is destructive and unhelpful. It affects not only the individual managers on the receiving end of this public mauling, but the whole organisation they manage.

The notion that there is someone out there better, if only the present person were out of the way, seems a totally untested assertion. The reasons for the results are often complex and the solutions likely to be just as complicated.

There are articles to be written about how complex organisations should be best evaluated, but it would be rare in my experience for the whole of a hospital to be failing.

Most are a mixture of good and less good services, and the choice of indicator can affect the overall judgement.

What of the agencies meant to have been monitoring these trusts? Were they happy with the so-called failing hospitals. And if they were not, what did they do about them? If the hospital fails, is this not an indication that the monitors of that hospital have failed too?

This sort of evaluation poses many questions which need to be answered in an atmosphere of constructive and open development - not one of threats and fear.

Stuart Marples Chief executive Institute of Healthcare Management