THE boss of the North-East's biggest hospital trust has warned that it could lose its remaining two stars if there is no reform of star rating rules.

Len Fenwick, chief executive of the 1900-bed Newcastle Hospitals NHS Trust, said either star rating assessment rules had to change or substantial extra resources had to be found.

If nothing changed Mr Fenwick warned of "a huge shock" with the highly rated Newcastle trust in line for a possible zero star rating.

Mr Fenwick spoke out after a 6.9 per cent rise in the number of referrals between April and September this year compared with the same period last year.

This included a 68 per cent increase in medical oncology patients, a 41 per cent rise in children's dentistry and a 34 per cent rise in orthodontics.

In effect the Newcastle trust was punished for being successful, losing a star and the extra million pounds a year which goes with it. The trust is still smarting over its demotion from a three to a two star trust in the last round of star ratings carried out by the Commission for Health Improvement.

The trust was punished for having 127 out of 180,000 patients in one particular department waiting over 26 weeks. At the time the Newcastle trust argued that larger teaching hospitals with specialist facilities should not be assessed in the same way as smaller hospitals.

The main concern is that the Tyneside trust has no control over the number of referrals it takes from other hospitals and North-East GPs "There is a standard being set in waiting times and access to services but the case load has grown by 7pc in recent months and that is not being matched by the necessary funding and resources," said Mr Fenwick.

"If our trust does not meet those targets we will be severely penalised in the performance ratings which could then have an adverse affect on the star ratings assessment," he added.

Mr Fenwick said he had "some sense of optimism" whether CHI might change its assessment criteria but accepted that the way of measuring trusts for the coming year would probably not change.

He said the issue of extra resources would be raised with PCTs as part of the "constant dialogue" between commissioners and providers in the NHS.