You report that the Royal Sussex County Hospital in Brighton has been awarded no stars (The Argus, July 27).

This must lower the morale of the staff further after the shocking revelations of the BBC Panorama programme.

John Hutton, junior health minister in 2002, explained the meaning of star allocation to a Labour Peer to whom I had written:

"Your constituent is concerned that the recent published 'NHS performance ratings' provide an unfair reflection of the performance of the Royal Sussex County Hospital which got no stars.

"The ratings are not designed primarily as a commentary on clinical performance. They do not mean that poorly performing hospitals are unsafe, or do not contain good clinical services and hard working staff."

In every sphere of life there is a rogue elephant and perhaps the nurses who appeared so uncaring in Peel and Stewart wards should have further training.

When I visited the developing country of The Gambia, West Africa, I was shown around the Royal Victoria Hospital, Banjul.

There were many people in the country without limbs and with cerebral malaria. Large extended families lived in compounds and the elderly were respected. They were poor, the hospital had limited facilities but everyone was respected.

During my life I have had a great deal of experience of the medical profession as a patient. I have been admitted to the Royal Sussex County Hospital several times and last September, recovering from major surgery, I was very impressed by the skills and dexterity of the nurses. My consultant surgeon, Mr Donald Manifold, had a lovely manner and came and sat on the bed.

Having said this, I am not yet very elderly and realise how distressed the relatives of those poor patients featured in the Panorama programme were.

I am writing this letter having just attended an educative morning at the RSCH for people newly diagnosed with diabetes. Janice (diabetic nurse), Louise (dietician) and Martin (podiatrist) were excellent communicators, caring and ready to answer our questions.

When I think about all those people in The Gambia who may have lost limbs through diabetes, I am very grateful for our NHS and the Royal Sussex.

-Carole Irvine, Saltdean