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Last Updated: Tuesday, 20 July, 2004, 23:22 GMT 00:22 UK
Q&A: NHS star ratings
How many stars did we get?
This year's NHS star ratings have been published.

But what do they mean and do they tell us anything about the state of the health service.

What are NHS star ratings?

The NHS star ratings were first published in 2001. Hospitals, ambulances and primary care services in England are given hotel-style stars, which aim to show how well they are doing.

They are awarded zero, one, two or three stars. The best receive three. The worst get none.

In previous years, the ratings were published by the Department of Health. They are now done by the NHS watchdog, the Healthcare Commission.

How are health trusts rated?

The commission assesses each trust against a range of criteria, including key government targets.

Trusts lose stars if they fail to achieve these targets.

For instance, a hospitals may lose a star if it fails to balance their books, keep their wards clean or treat patients quickly enough.

Ambulances may be downgraded if they fail to answer 999 calls quickly enough or take steps to improve the working lives of staff.

Primary care trusts may be marked down if patients are unable to see a GP within 48 hours or if they don't have good services for drug addicts or for helping smokers to quit.

Mental health trusts may lose a star if they don't have good outreach teams in place or proper plans for caring for patients.

The commission also assesses the "clinical focus" of each trust - how they monitor the care they give to patients and how they try to reduce clinical negligence claims.

It also examines their "patient focus" - how they deal with patients.

For instance, trusts may lose marks if they fail to deal with complaints properly or if they don't allow outpatients to make appointments for days that suit them.

Are the ratings meaningful?

The Healthcare Commission insists that the ratings are meaningful. It says they give an accurate picture of how every trust in England is performing.

Health Secretary John Reid says they can be used to track progress in the NHS and to see if it is improving.

However, others disagree. One of the problems is that the NHS is given advance notice of what targets will be used to compile the ratings.

Critics also complain that the ratings give no indication of the quality of care patients will receive in their local trust.

For instance, they do not take mortality rates or the number of people who contract potentially fatal superbugs into account.

How important are they?

Like it or not, the ratings are used by the government and others to assess the performance of various parts of the NHS.

For instance, only three star hospitals are allowed to apply to become foundation trusts, which have much greater freedom from government control.

The ratings have also prompted ministers to sack NHS managers and send in trouble-shooters to zero-rated trusts.

Managers say the ratings also have an impact on staff morale.

Are they here to stay?

The ratings are now in their fourth year. However, the way they are calculated has changed each year.

The Healthcare Commission has already announced plans to change the way it compiles the ratings next year.

It is by no means guaranteed that it will continue to award hotel-style stars to NHS trusts.

The commission says it will launch a consultation later in the year to ask for views on how it should rate trusts and how their performance should be assessed.

However, the Conservatives have pledged to scrap star ratings if they come to power.

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