Pressure shows up on league tables

Hospitals across London and the South-East failed to shine in today's performance figures, showing pressures on the NHS in important areas such as waiting lists, cancelled operations and emergency re-admissions.

The publication of the performance league tables, where hospital trusts are awarded a rating of zero, one, two or three stars according to how many Government targets they hit, was met with a chorus of disapproval by doctors' leaders.

The figures, published annually, show that out of 166 NHS acute trusts, 46 gained three stars, 77 two stars, 35 one star and eight no stars at all, with more top-rated hospitals than last year.

Some of the winners are Guy's and St Thomas' Trust, which showed high standards in reducing waiting times as well as discharging patients quickly, plus Lewisham Hospital, St Mary's Hospital in Paddington and University College London Hospitals Trust.

All these organisations now have the chance to apply to become Foundation Hospitals, earning some freedom from Whitehall control, and the opportunity to bid for extra cash from the Government.

Health Secretary Alan Milburn said today: "Local services that are doing the best can look forward to greater freedom and more rewards. A modern approach is needed, where there are clear incentives to improve performance across the health service."

Many London hospitals gained only one star, despite their reputation as centres of excellence and being good for research and training. They have been labelled "poor performers".

But doctors, nurses, and managers said the figures, calculated through a fiendishly complex formula involving 38 different criteria, would not tell patients much, if anything, about the quality of their care, and said that the figures were actually misleading in some instances.

Dr Peter Hawker, of the British Medical Association's consultants committee, warned that constantly changing targets impacted on managers and health professionals. "There is precious little scope for manoeuvre and a pressure-cooker atmosphere in our hospitals," he said

Among the losers identified in today's figures are:

? The West Middlesex, which went down from two to one star. It had too many delayed discharges, where elderly patients are being kept in for too long before being allowed to go home or to residential care. The hospital also came out badly from its survey of how patients found the service.

But it did receive an average rating for emergency re-admissions following a fractured hip or a stroke - a sign that the care the patients receive is good.

? Luton and Dunstable Hospitals, which went from three to two stars. This appears to be mostly because patients do not give the hospital a high rating when it comes to areas such as meeting their "physical and emotional needs" although what these are remain unclear.

? Barnet and Chase Farm Hospital in north London, which for the second year running has a zero-star rating. It now faces the prospect of being taken over by new managers unless it starts to show improvements within the next few months. A spokeswoman for the trust said it had achieved seven of the nine key targets, which was an improvement on last year, and showed there had been a "great deal of hard work and commitment by the trust's staff ". But the zero rating reflected a critical report by the Commission for Health Improvement in March.

? Bromley Hospitals Trust, with just one star, which did badly because of high rates of emergency readmissions.

For the first time, specialist hospitals and ambulance trusts have been rated for their performance, and mental health trusts have also been given "indicative" ratings.

London's specialist centres have all done well, apart from the Royal National Orthopaedic Hospital at Stanmore, Middlesex, which had too many cancelled operations, and too many patients having to wait more than three months for an appointment with a consultant.

The ambulance service in London also won a two-star rating, despite the fact it was significantly below average in meeting urgent calls from GPs within the 15-minute target. But the ambulance figures came in for a hammering from Health Which? magazine.

Its managing editor, Sue Freeman, said: "The star ratings ignore whether ambulance services are helping to save lives - that is the most important issue. We are calling on the Department of Health to focus on clinical outcomes and not on response times which can be deeply flawed, as our research has shown."