Star rating system fails to reduce variation

BMJ 2003; 327 doi: (Published 24 July 2003) Cite this as: BMJ 2003;327:184

Doctors, managers, and opposition MPs attacked the NHS star rating system last week. Would it be improved if it measured health outcomes and allowed for more local input? Zosia Kmietowicz reports

The publication of star ratings for all NHS trusts in England last week (19 July, p 119) has raised many questions about the value and purpose of this latest government backed appraisals system.

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Health Secretary John Reid (left) claims the system has improved standards. But it was dubbed “pathetic” by Liberal Democrat Evan Harris (centre), and “a gimmick” by Conservative leader Iain Duncan Smith (right)


It is two years since the health service league table was first published, and although the system has been overhauled and transferred to independent assessors during that time there is little evidence of what has been achieved. What do the ratings really show, and are they in any way meaningful to the patient who is waiting for hip replacement surgery or a cardiac bypass or who wants to have a home birth?

The government's purpose in introducing star ratings was to lessen variation in performance between trusts, raise standards, and make services more accountable to the public.

On the first count—the attempt to reduce variation—this year's results indicate that the policy has failed in two health-care sectors. In acute trusts and ambulance trusts the gap …

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