Do you believe that the public humiliation your commission has inflicted on this hospital will improve the quality of care that patients receive? How can you, when the very basis for your judgment is so evidently weak? For I question your commission's work and your defence of it on grounds of science.

Where, for example, is the transparency surrounding your precise methods of measurement? Where is the attempt to review systematically the work of all those employed by the hospital or primary care trust you are evaluating? Where is the estimation of your own measurement error? Where is the effort to investigate success outside of your narrowly drawn targets to give a properly balanced picture of an institution's work? Where is the qualitative information to add to the reductive numerical approach that you currently endorse? Your report answers none of these questions.

Why is there this utter failure of scientific rigour? For an answer, one has to look no further than the make up of your commission. Only two of your 14 commissioners have daily front-line responsibilities for patient care. It is hard to respect your commission's judgments when you have a board with such limited ongoing clinical service experience.

Indeed, your commission's dubious methods are creating a culture of waste, deception, and fear among NHS staff. Those within hospitals and primary-care trusts who are responsible for submitting data to your commission spend enormous amounts of time on these bureaucratic exercises, time that would be better spent improving the quality of services. The perverse incentives your commission has introduced encourage manipulation of figures to meet targets that may bear little relation to local priorities. And the power that you wield has inculcate
'"/>

Contact: Joe Santangelo
j.santangelo@elsevier.com
1-212-633-3810
Lancet
29-Jul-2004