The best performing hospitals in England are to be awarded up to £1m ($1.6m; €1.6m) each in the wake of government league tables published last week.
The performance tables give 46 acute trusts a three star rating (highest rating), 77 two stars (“performing well”), and 35 a single star (“cause for concern”). Eight trusts are judged to be so poor that they are given no stars. Health secretary Alan Milburn said the tables showed that hospitals were improving, but health professionals have questioned a grading system whereby hospitals' performance can vary so much from year to year.
David Wilson, chief executive of Northampton General Hospital NHS Trust, one of three trusts to fall from a three star rating last year to one star this year, said that his trust was marked down because it had one patient waiting more than 18 months for an operation and it had overspent its budget by 0.2%
“One of the problems is that the targets don't measure the quality of clinical care. They are absolutes: either you achieve them or you don't,” he said.
Peter Hawker, chairman of the BMA's consultants committee, said: “Despite claims that outstanding trusts are to be given more freedom and that decision making will devolve to local level, centrally imposed and constantly changing targets dominate NHS managers' lives, with a knock-on effect on all the health professionals working in the service.”
Three star hospitals could be rewarded with up to £1m each and given the opportunity to opt out of “excessive” government control and apply for “foundation hospital” status. They will be able to pay staff as they wish and use the money from land sales for patient care.
Successful hospitals will be established as “shadow” foundation trusts from next July and will be running from April 2004.
Mr Milburn has insisted: “NHSfoundationhospitals will be part of the NHS family and will deliver care forNHS patients on the basis of NHS principles—treatment that is free, based on need and not ability to pay.” (See p 230.) 
Footnotes
Full details of the ratings are available at www.doh.gov.uk/performanceratings/2002