COMMENT: Success of new ratings will hinge on how improvement is achieved

At last we have those long-awaited rankings - traffic lights metamorphosed for some unclear reason into stars - to tell us what we probably already know. It doesn't really matter how the system is dressed up. Most people working in the NHS already have a fairly good idea of where their own organisation is at when it comes to being good, mediocre - or not good at all.

Managers could pretty much work it out for themselves - and indeed have done - from existing data. The same arguments pertain now as for all those previous league tables that pretended not to be - arguments about weighting and demographics and internal changes.

And asking managers to worry about whether there will be an extra star next year if their food is good enough and the decor is right is surely just a little tacky.

But to get back to the point of it all, the ratings are above all about improving services for patients. What people really want to know if they need to be admitted to hospital is, 'Can I get seen quickly and are they going to make me better?' The problem is that even after trying to thrash out a meaningful ratings system for well over a year, it is still not entirely clear how this one is going to improve patient care. The introduction of the new system certainly presents an opportunity to get rid of managers who are seen to be underperforming, but it remains to be seen whether that is the same thing.

The test of the worth and efficacy of the new system will come over the coming year when we are able to see what the Modernisation Agency is made of, and whether all the rhetoric about improving performance has been turned into reality.

If, by then, there are more hospitals with three stars and few or none with no stars, presumably ministers can pat themselves on the back and say they have delivered.

But in the meantime, there are a dozen hospitals - condemned by receiving the lowest of the new ratings - at which morale has plummeted further still and where confidence among local communities about the standard of healthcare they can receive has taken a huge blow.

The Modernisation Agency will have a difficult time rebuilding the confidence of staff and the public in 'failing' trusts' and supporting the improvements that must be made.

When stars are awarded next year, it is not just the hospitals which will be judged but the agency and the government as well.