Health secretary Alan Milburn has published a league table of hospital performance and pledged to reward performance with additional resources.

Nearly 50 hospitals are awarded three stars today - with 77 securing two stars and 35 awarded one star.

Forum Response: Royal College of Nursing

Dr Beverly Malone, general secretary of the Royal College of Nursing, told ePolitix.com: "The RCN believes that performance assessment of NHS Trusts is important to ensure high standards in healthcare. But the star rating system, based on the speed of delivery of key services, does not assess nursing care, which is an essential part of healthcare.

"Star ratings can do more damage than good. This year's ratings may damage morale amongst nurses, many of whom are doing a good job under excessive pressure. Trusts must support and reward their staff for good work and be clear that the performance standards are a measure of organisational performance, not nursing care.

"Our experience shows that performance ratings affect patients too. Many patients coming into hospitals, with a low or zero rating, become very anxious that they will receive poor treatment and nurses are having to give extra time to alleviate their concerns."

"The RCN would like to see more openness and explanation about how the different factors are weighed in the overall star rating assessment. We would like to understand the relationship between the different bodies, Department of Health and Commission of Health Improvement and the Patient Safety Organisation, who are concerned with measuring NHS performance."

Forum Response: Unison

Karen Jennings, national secretary for health at Unison, told ePolitix.com: "The Department of Health have got stars in their eyes when it comes to setting targets and performance indicators, yet they seem blind to the chaos and confusion they leave in their wake. Instead of rolling out this flawed system to other parts of the NHS, they need to look at the counter-productive affect it has on staff morale and patient confidence.

"We are creating a two tier hospital system where the best get better by sucking dry the hospitals around them. Staff will drift away from the "failing" hospitals to join the 'A' team with all the perks and kudos that three stars bring.

"As for patient confidence - I would feel very worried if my local hospital was at the bottom of the list.

"Instead of naming and shaming, the government needs positive measures to raise standards across the whole of the NHS. Don't set Trust against Trust, encourage Trusts to share good practice and deliver on the investment to improve on patient care."