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Last Updated: Friday, 29 July 2005, 08:02 GMT 09:02 UK
Are hospital standards falling?
Paramedics take a patient to A&E
This year fewer hospitals in England have received three stars - the top rating - in the Health Commission's annual survey.

It's the first time standards have fallen in four years. Problems with finances and government targets are being blamed.

But primary care, mental health and the ambulance trust have improved, according to the NHS watchdog.

NHS star ratings are to be scrapped - from next year, trusts will be asked to produce annual self-assessments and there will random spot checks on trusts with problems.

What is your experience of NHS hospitals? Is the star rating system fair? What can be done to improve hospitals?

This debate is now closed. Read a selection of your comments below.

The following comments reflect the balance of opinion received so far:

This topic was suggested by Alison, UK
Hospitals are allegedly failing to reach certain targets and have, therefore, lost "stars". Should the Government stop setting targets and allow the hospitals to have more autonomy to improve patient care?

I think the NHS needs to stop appointing nurses and medical staff to managerial positions. Nursing staff are very good at nursing but they are not trained to manage a business. Properly trained managerial staff would be able to manage the business of running a hospital and control the finances. There are far too many managers in the NHS and by employing a few less managers, and more front line staff then they will be able to do the jobs that actually help hospitals to run every day
Lucy, UK

If people were cans of beans and we all were in supermarkets then I could understand the star rating system because everyone would be the same. However we are not. The star rating system is a simplistic and meaningless way of assessing services, just like school league tables. They are there for the consumption of 'middle England' and the sound bite politics and journalism we are fed through the media. Here in Stoke we have a fantastic hospital with dedicated and hardworking professionals who are doing more with fewer resources and as their rating has fallen they will be in line for yet another rubbishing by the media. All I want to say is well done you are all stars... 10 stars that is.
Robert Fair, Staffs

Having just received treatment for a mild heart attack in Fairfield general hospital, Bury. I have nothing but praise for the team in Coronary care unit. I am not surprised that some hospitals are suffering because these days there are too many chiefs in the NHS. Maybe if the cut back on all the unnecessary departments and got back to basics the NHS would be in a better state. I work within the NHS for a supplier and I know the hassle the staff have to go through to sometimes get basic equipment.
W Shepherd, Bolton

I think that the NHS needs to pay more attention to their management. Managers within the NHS appear to be promoted through their ranks and lack basic management skills. This results in a waste of resources, money and mismanagement of staff, particularly at the lower grades.
Doug Powell, London

The rating scheme is not an indicator of good scientific or clinical care of patients
Anon, UK
The Rating scheme is not an indicator of good scientific or clinical care of patients. I would always prefer to wait and see a doctor who actually is an expert than see an inferior/failed doctor instantly I walk into a hospital. I work in a zero rated university teaching hospital but my department has an international reputation for excellence. Everyone who works in the NHS knows that these rating schemes never measure the things that really matter but are management games.
Anon, UK

I have been in and out of hospital quite a few times over the last three years and I have had nothing but wonderful service from paramedics, doctors, nurses, and staff less recognised like cleaners. They have all given me a high standard of care, been incredibly compassionate and kind, and made me feel a whole less frightened by the whole experience. There is too much talk of low 'star' service, so I want to take this time to thank all those in the NHS service for everything they have done for me and my loved ones. You do a great job, guys!
Nicole, London

I think the NHS is appalling. I went in to have a lymph node removed and tested last year and came out with a terrible hip infection after I had been operated on. The lymph node came back clear but I left hospital sicker than when i went in.
Sharon, London

The National Health Service is outdated and obsolete. The limited government resources need to be focused on the poorest in our society, everyone else should be expected to pay for their own healthcare.
S. Gordon, Edinburgh

As a Nurse of 28yrs in the NHS I am increasingly fearful of our service and ability to deliver to forever increasing government targets. Whilst trying to achieve these we are losing sight of the needs of the patient. We don't have the time to spend with them we can't sit and hear what they are saying, we can't deliver the care we know they need...why? No staff, no resources, constant constraint, persistent relentless government initiatives, etc. We are in serious danger of no longer knowing what it is we are trying to do and losing sight of what's important...patient care. As far as I am concerned the star rating system should be scrapped it sends the wrong message to the public, takes too much time away from more pressing matters and demoralises the staff of the NHS.
EA, West Yorks

I currently work in NHS management and I would like to take issue with the comment that managers don't understand what the NHS stands for. I joined this organisation so that I could put my skills to use for the good of patient care, rather than for the good of profits. The NHS is in general staffed by people in all departments, not just clinical but management alike, who have a genuine desire to improve the patient experience. The NHS has its faults like all organisations, but in general strives to provide the best service it can within its budgetary constraints, something that all the negative media surrounding it doesn't help to remind people of.
Olive, Sheffield

Not where I live in north Bristol, they are going up. All my experiences with the NHS here have been excellent. The only thing the local hospital failed on was the 4-hour time limit at A&E. Seems to me the important thing about A&E is that people who need to be seen quickly are seen, while those who are able to wait wait.
Tom, Britsol

The star system is a pointless exercise. It does not accurately reflect how good or bad any hospital is. Hospitals currently only focus on the target, and not on the individual patients. Decisions are often made in a way that compromises patient care, in some cases prioritising a long-waiting routine list case over an emergency admission. The only progress they produce is in the ability of management to manipulate the data.
Robert Crowder, Todmorden, UK

Living in Thurrock I have to travel 20 miles to my nearest A & E department. With all these people proposing to build all these houses in Thurrock would it not be better to build another hospital first, It is not fair to expect Basildon to cope with all the people it will bring in.
Denise, South Ockendon, Essex

I wish people would stop complaining about the NHS , the service is 100 times better than the useless health service and doctors in Holland (and you have to pay a lot more over here)it is so bad , I don't even bother to go to doctors here anymore as they do nothing at all. The NHS do the best they can and is probably the best health service in the world, we should be proud of it instead of always complaining.
Ian Purnell, Maastricht Holland

It needs to be stated that these targets are government set and the role of the trust and health authority managers (of which I am one) is to ensure they are successfully achieved. The causal effect of their implementation however is a resource (financial and human) commitment by the trust to achieving them which by implication draws resource away from other clinical areas. This central direction is not well liked by trusts as it usurps local trust direction but is in direct response to public concern over high profile issues. However, these results should be treated as indicative rather than definitive.
Bob Barr, London, UK

My ward had a squad of cleaners on duty for the days leading up to the inspection, the next day reverting back to its one part-time domestic
P, Leicester
As a nurse I have to echo the comments of the A&E doctor, the star system is corrupt. The trust I work for got its 3 stars, to no ones surprise at all. We had advance warning of the inspection, even their precise route through the hospital. Needless to say that route was spotless when the PEAT team arrived, having been attended to by more cleaners than on any normal day. My ward had a squad of cleaners on duty for the days leading up to the inspection, the next day reverting back to its one part-time domestic.
P, Leicester

So, under the Tories we had low taxes and poor hospitals. Under New Labour we have high taxes and..... poor hospitals. Of those two I think I prefer the former.
Matt F, Bristol, UK

Bean counters count beans, not quality. Just because something is measurable does not necessarily mean it is important. The star ratings are essentially meaningless and therefore any change from year to year is also meaningless. I am a doctor proud to work as part of the NHS, and am happy to work hard to improve the quality of care given to my patients, hospital star ratings do not help.
Andrew Brooks, Derby, UK

I feel very saddened by the '1 star' grading of my local hospital, West Suffolk. It's been struggling financially for a long while, but during the two operations I've had in the last couple of years I've received nothing but the highest standards of care. It seems to me that sometimes financial and patient-care related targets are mutually exclusive.
David Edwards, Bury St Edmunds, Suffolk

The trouble with performance indicators is that the government are continually changing the goalposts and changing priorities. Another major hurdle all Trusts have had to jump was changing was in pay modernisation. An inordinately large proportion of time has been given by all staff groups to the detriment of patient care. The vast majority of staff within the NHS works well in excess of their contracted hours just to keep pace with government demands. The government should back off and give all trusts time and adequate resources to meet what's expected of them.
J, Middlesbrough UK

Before they give star ratings they should put funding where it is needed
Amanda Jenkinson, West Midlands
I think rating hospitals is like rating hotels. MMSR has a large impact, and the government are simply not funding enough for housekeeping staff to clean the hospitals as they should be. Being a support service assistant myself, I can see where the problems are. Doctors and nurses are stretched. So before they give star ratings they should put funding where it is needed.
Amanda Jenkinson, West Midlands

Having previously worked for the NHS it does not surprise me that hospitals are losing stars. Money is spent on non-essential items instead of medical equipment. Staff would complain at meetings if biscuits were not provided with the tea and coffee and expensive venues were often used to hold the meetings. Many non-medical departments are now based in plush office blocks rather than in the hospitals themselves. One department, which has only been created for one year for a particular project, has a newly refurbished office and furniture which could not be described as basic. It is shocking that the NHS can spend money on luxury offices and biscuits for stuffy men in suits when they are already overspending and under performing.
Anon, London

The health watchdog has said targets are harder this year and 'The overall improvement in performance this year should not be underestimated.' The disgrace is the headlines saying 'fewer 3 star hospitals'. Why must the media always try and find failure in success?
Will Rossetti, Bristol, UK

Nothing like a good old league table to deplete the morale of thousands of doctors, nurses and NHS staff who work so hard everyday. Has anyone been in an NHS hospital recently? The improvement in recent years is staggering. The standards the government have set are sometimes unreasonable high; this doesn't mean a hospital is 'bad.'
Alex, Cambridge

The star ratings are a farce - my local NHS trust was recently the subject of a Panorama special on hospital cleanliness yet it still achieves a pass rating - how can this be?
Stuart Hadley, Birmingham, UK

I am pleased both of my local hospitals have a 3 star status. However the system will only get better everywhere else when hospitals invest in more support staff instead of wasting millions on a huge senior management structure.
Simon Young, Essex

The government requires trust to achieve targets to convince the public that the NHS service is improving. I am sure that we can see without the targets. Get rid of the targets and audit measurements and use the money IN the NHS. This is a free service, we don't even pay to visit the doctor! The public's expectations of our NHS is far too high. We have more people using the service than 10 years ago. What do people expect? There is not enough tax paid to fund the large increase in its use. The NHS will require higher funding from Joe Public's purse. If you want a better health service then you will have to pay at one end or the other. Myself I prefer higher taxes.
Jeanette, Northampton

I'm still struggling to lower my anger than I had to endure a 3 day traumatic labour before finally needing a C-section under general anaesthetic.... because I am lead to believe that my NHS authorities stats for C-sections was already over quota. I don't care whether it's down to finances or hospital management but things like this should not be allowed to happen and both sides should stop blaming each other and instead concentrate together to achieve a better outcome than is clear from the results that have come through today.
Sharlie, Oxfordshire

The problems within the NHS are going to take time and effort to correct
Tony, Grays, UK
Working within an NHS Trust, I can tell you that everyone is working as hard as possible to ensure the highest level of care possible is achieved. It's easy for people to criticise the poor standards, but in recent years the NHS has started to turn around after almost two decades of severe under-funding by prior governments. The problems within the NHS are going to take time and effort to correct, which I can say with confidence, is what everyone working here wants.
Tony, Grays, UK

I am a qualified nurse, I can honestly say that I have given 100% on every shift I have worked since qualifying in 1998. I genuinely care for all my patients, even the ones that swear, bite and scratch. I care for my patients as if they were my own family. My passion for nursing is ebbing though when I come to work to be faced with more unrealistic targets stipulated by the government and to be told that we are now a zero rated trust because we were 2% off one target out of eight. Where is the incentive to give quality nursing care when it is easier to cut corners to meet targets?
P, Leeds, UK

The latest results have been published at a time when the public perception of hospital care is at an all-time low. My hospital, King's College in South London has lost its 3rd star simply as a result of finance. The star ratings do not show to the general public the huge improvements made by dedicated and talented NHS staff. The A&E department at King's has been commended and shown as one of the best in the UK, and yet a star is still lost! Thank goodness the system is about to change!
DR, London UK

The Star Ratings are a very crude and inaccurate tool indeed, and the amount of cheating/fudging possible to ensure hitting them is immense. I think what we are seeing here is a combination of less cheating as loopholes are filled, plus chronic under funding becoming impossible to hide any more, and not actually any real degradation of our hospitals.
Mark Williams, Grays, Essex

I just felt that I had to stick up for the NHS, as it does work well. I think it needs modernising but I think the problem is too many managers that don't really understand what the NHS actually stands for. I would love to see more managers actually having more nursing experience as then they would have a better understanding of what it is like to work in the environment itself....the staff shortages, the shortages of basic equipment i.e hoists, handling belts, to simple things like soap and other toiletries.

However the nurses and other nursing staff do their best, and we experienced this when my father-in-law was operated on and back onto the ward within 3 hours of him going to A+E. The care he received was great. These 'Stars' aren't a good thing in my opinion - who has the right to be judgemental like that? In my opinion it should be the service users themselves i.e the patients and their relatives - if there is a problem, let the staff know.
Danni, Ipswich, UK

The star ratings are a complete waste of time and effort
S, Newcastle
As an A&E doctor, I can tell you that the star ratings are a complete waste of time and effort. Nobody on the coal face pays any attention to them. The A&E waiting time is a complete joke. The times are falsified in order to meet the targets, and patients are moved from A&E, against the advice of clinicians, by the managers. The managers are not accountable to anyone but themselves and make decisions that could adversely affect patient outcomes. The star rating system has been corrupt since its inception as the chief execs and middle managers focus on the targets that will get them points, at the expense of genuine clinical need. As we know, points make prizes (or in this case stars).
S, Newcastle

The majority of health services are delivering really tough targets. I think that taking services down to a local or regional level does create differences in how health services perform, but perhaps that is an issue about local accountability- and perhaps the public bothering to hold local health chiefs accountable. It's important to understand that the NHS was close to collapse a decade ago. In under 10 years it's got miles better - not perfect, but then nobody has a magic wand. I'm diabetic and the improved service just so far will add years to my life.
Chris, London

I am delighted to hear that Mansfield District Primary Care Trust has retained its 3 star status of excellence. I have been overwhelmingly pleased by the level of care provided by them over the past three years of my illness. All the staff based at Ransom Hall also deserve a round of applause for their commitment to improving services. Well done Mansfield District
Michael Jones, Mansfield, UK

These results show that it is pointless for the Government to pour increasing amounts of taxpayers' money into the National Health Service before a radical change in management and structure is introduced. As evidenced in Brighton recently in the Panorama TV programme filmed in the old people's ward, top management is unaccountable, anarchy seems to prevail, wards are still filthy, patients aren't cared for - the list is endless. All this proves that targets are pointless as they only gloss over the rotten foundations.
Tony Ellis, Northwood, England

I think it's absolutely disgusting, the government has nagged on about this being a high priority yet things get worse. My partner is pregnant and the three hospitals near us in South London have all received poor results, this coupled with the terrible results regarding MRSA on these hospitals has made us decide on a home birth. I am losing complete faith in our local hospitals to provide a satisfactory service. The last thing you want to worry about is someone coming out worse than when they went in.
Andrew Daw, London

Does the last comment by Andrew Daw not prove that the star ratings are considered and used by the public. By choosing a home birth then this couple have opted not to use an Acute Hospital with a low star rating and instead opted for the home birth with a community mid-wife who will be part of the NHS and attached to (possibly) a better performing Trust or PCT.
IC, Southend, Essex


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