Abstract
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:
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