Decline in standards found at flagship NHS hospitals

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The Government's flagship foundation hospital scheme suffered a serious setback yesterday when some of the country's most famous hospitals were downgraded by inspectors.

The Government's flagship foundation hospital scheme suffered a serious setback yesterday when some of the country's most famous hospitals were downgraded by inspectors.

Ministers want all NHS hospitals to achieve foundation status within four years, giving them financial flexibility and freedom from Whitehall control.

But yesterday the latest star ratings showed standards were slipping in both hospitals that have already achieved foundation status and among those in line for promotion.

Of the first 20 hospitals to be granted foundation status earlier this year, four slipped from the maximum three stars to two, indicating failure to meet at least one performance target. They were Addenbrooke's hospital and Papworth heart hospital in Cambridge, Moorfields Eye hospital in London and Peterborough hospital.

In addition, 11 of the 32 hospitals that have applied to become foundation trusts in October failed to achieve a three-star performance. On current rules, this means they will automatically be dropped.

The Healthcare Commission, the independent NHS inspectorate that published star ratings for NHS trusts in England yesterday, said the question of which hospitals should be eligible for foundation status was a matter for ministers.

Anna Walker, chief executive, said: "If we find [their performance] doesn't qualify for three stars we have to say so."

Foundation hospitals are one of the Government's innovations for driving forward NHS modernisation. Ministers fought a bruising battle to get the legislation through Parliament last February, against a Labour backbench rebellion which claimed they would leave other hospitals at a disadvantage, introducing a two-tier service.

Tony Blair pledged that all hospitals would have the opportunity to become foundation trusts by 2008, putting them on an equal footing. But yesterday's results show that fluctuations in trust performance could make that unachievable.

The Health Department said there was "no specific requirement" that a foundation trust must maintain three-star status, although three stars are necessary to achieve it. A spokesman added that they would continue to work with those that had applied for foundation status but lost their three-star rating "with a view to them obtaining approval to go forward at the next earliest opportunity".

Overall, the performance ratings show the NHS improving against tougher targets in most areas, the Healthcare Commission said. This year, 43 per cent of hospital trusts were awarded the maximum three stars, against 36 per cent last year.

But the commission singled out the poor performance of mental health trusts and of primary care trusts (PCT) in London as cause for concern.

The GP service in the capital is the weakest in the country and the ratings show no PCT achieved three stars in London. Among mental health trusts, one in three was awarded one or zero stars, indicating significant under-performance.

Sir Ian Kennedy, chairman of the Healthcare Commission, announced that the performance ratings, which have been heavily criticised for being too complex for patients to use but too simple to provide fair comparisons, will be replaced with a new system based on new measures from 2005-06.

The NHS Confederation, representing NHS trusts, said the volatility in the performance ratings showed they were a "crude measure" and there was no need to be "overly concerned" that some foundation trusts had lost stars.

Andrew Lansley, the shadow Health Secretary, said the star ratings were "extremely misleading" for patients.