There is much that is crude and deficient about the star-ratings system for NHS trusts (Foundation hospitals plan left in chaos, July 21). However, it is a concern that at least three of the four new foundation trusts that lost a star were marked down because of "poor financial forecasting". Alongside more local participation in health issues, greater financial independence and the freedom to borrow were sold as "benefits" for NHS trusts attaining foundation trust status. Wouldn't financial forecasting be one of the key skills required to borrow and invest in the interests of patients? This debacle suggests that the whole foundation trust issue needs to be revisited.
Dr Fiona Campbell
Democratic Health Network

Of course acute trusts are a vital part of the service. But acute services only deal with a fraction of health and social care needs. The public make 10 times more use of primary care, community and social services, mental health and disability support. Yet the performance of these services is reduced to a footnote.

Adult mental health services are being transformed with a fraction of the new investment that has gone into acute services. Older adult mental health services have had virtually no new investment, yet are still slowly improving - dementia services are propped up by an army of loving (though rarely recognised) carers. And we are fully integrating health and social care and we are doing this in genuine partnership with service users and carers who now sit on boards and management teams throughout the service. (We were, by the way, one of the 15 mental-health trusts to get three stars this year.)
Kevan Taylor
Chief executive, Sheffield Care Trust