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Why is Ian Kennedy's healthcare commission damaging NHS care?

(below is the full text of an open letter from THE LANCET to Ian Kennedy, Chair of the newly established UK healthcare commission).

On July 21, 2004, the UK's Healthcare Commission--a new independent inspectorate chaired by the lawyer and ethicist, Ian Kennedy--published its annual performance ratings of National Health Service (NHS) Trusts in England. Although the commission concluded that "the NHS is improving", the newsworthy message was that there had been notable slippages in the star ratings of several hospitals, among them Addenbrooke's Hospital in Cambridge. The headline in The Times, for example, ran: "Elite hospitals shamed by loss of 3-star status". Kennedy defended his star system. In The Guardian that day, he wrote, "star ratings have been useful. They are a wake-up call to the health service". Here, The Lancet publishes an open letter to Kennedy.

Dear Ian,

The star ratings that you published and defended last week are having a damaging effect on the health service you and I care about. Worse still, they are likely to undermine public confidence in a health system that enjoys an unparalleled commitment from its doctors, nurses, and allied health workers. I wonder if you fully appreciate the harm that your commission is causing.

Let me quote from a letter sent to reassure demoralised staff at one hospital that not only lost a star but also had its clinical care rated as "poor". They are horrified at the damage your report has caused to their community's confidence in the hospital. Did your evaluation reflect accurately the hospital's achievements? Here is what the chief executive wrote:

"[We] met seven of the nine key targets, including shorter inpatient and outpatient waiting times, two week maximum wait for all cancers, commitment to improving the working lives of staff, and hospital cleanliness...star ratings are based on last year's information. During that year, we have made significant improvements but thi
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Contact: Joe Santangelo
j.santangelo@elsevier.com
1-212-633-3810
Lancet
29-Jul-2004


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