Last week I met Mr. Graham Smith, the Acting Chief Executive of the Worcestershire Acute Hospitals Trust.

He is new to the area and experienced in short term appointments to troubled trusts. I was relieved that he accepts the critical District Audit Letter and the Commission for Health Improvement (CHI) report that point to problems with financial management, with waiting list and medical records management.

The problems within management being recognised means that we can look forward to changes that will produce benefits to us all in the medium and long term. I expect Mr. Smith will work much more closely with local Primary Care Trusts and indeed staff of his own Trust than has been the pattern so far.

Although it was surprising it was good to see in the Sunday Times Dr Foster Good Hospital Guide that the efforts of staff at our hospitals to keep the service going despite all the difficulties have been recognised. In the quality awards the efforts of staff are commended: -

• In the A & E Department at least 80% of patients are treated within four hours.
• In the treatment of heart attacks, clot busting drugs are given within thirty minutes of a patient's arrival and rehabilitation classes after heart attacks are available.
• Everyone with a suspected stroke receives a CT scan within twenty four hours of admission.

These are definite measures of quality which our service is reported to be achieving.

The other criteria for the Service and Quality Awards are not clearly measures of actual quality or achievement. They only record that requirements of best medical practice are met, that is that multi-disciplinary treatment teams are available for cancers of the breast, lung, stomach and bowel. There is no assessment of the quality of care that these multi-disciplinary treatment teams are able to give.

As with most other attempts at assessments of quality of NHS care, measures of patient satisfaction with the service they receive and measures of staff satisfaction with the service they are able to give are lacking or rudimentary. This explains to me why the Acute Hospitals Trust rates highly in the Good Hospital Guide while I am continuing to receive critical comments about the quality of hospital care from patients, relatives and staff members. I plan to press for much more patient involvement in surveys of quality of care in the future whether they are carried out by CHI or Dr Foster's organisation.

I hope that our new acting Chief Executive will have time while he is here to work closely with PCTs and staff to improve quality of care and the lives of overstretched staff. I believe he will find economies that can be made without cutting any hospital services.

R.T.